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Curio J, Nienaber S, Kuhn EW, Eghbalzadeh K, Ahmad W, Mehdiani A, Schröder J, Körber MI, Wienemann H, Baldus S, Adam M. Transcaval Transcatheter Aortic Valve Replacement for Pure Aortic Regurgitation Using a Dedicated Self-Expanding Device. JACC Case Rep 2024; 29:102320. [PMID: 38601848 PMCID: PMC11002802 DOI: 10.1016/j.jaccas.2024.102320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 04/12/2024]
Abstract
Novel dedicated devices allow transcatheter treatment of pure aortic regurgitation (AR). The JenaValve Trilogy Heart Valve System was introduced as the first dedicated and on-label AR transcatheter aortic valve replacement system, implementing a locator-based and calcium-independent anchoring mechanism. Here, we present the first-in-human transcatheter aortic valve replacement for pure AR via a transcaval access in a patient with prohibitive alternative arterial accesses.
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Affiliation(s)
- Jonathan Curio
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Stephan Nienaber
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Elmar W. Kuhn
- Department of Heart Surgery, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Heart Surgery, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Wael Ahmad
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Arash Mehdiani
- Department of Cardiac Surgery, Medical Faculty and Rheinisch-Westfälische Technische Hochschule (RWTH) University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jörg Schröder
- Department of Cardiology, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Maria Isabel Körber
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Hendrik Wienemann
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
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Eghbalzadeh K, Kuhn EW, Gerfer S, Djordjevic I, Rahmanian P, Mader N, Wahlers TCW. Ten-Year Long-Term Analysis of Mechanical and Biological Aortic Valve Replacement. Thorac Cardiovasc Surg 2024; 72:167-172. [PMID: 35667381 DOI: 10.1055/s-0042-1744477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND For patients undergoing aortic valve replacement (AVR), structural valve deterioration (SVD) of a bioprosthesis (BP) is substantially accelerated in younger patients and valve-in-valve implantation is not always a considerable option. The risk-benefit assessment between SVD versus the risk of bleeding and thromboembolic events in patients with a mechanical prosthesis (MP) resulted in an age limit shift irrespective of inconsistent results reported in literature. METHOD This retrospective single-center study compared 10-year long-term outcomes in patients undergoing isolated AVR with MP or BP. The risk-adjusted comparison of patients undergoing isolated AVR (n = 121) was performed after 1:1 propensity score matching (PSM) for age, sex, endocarditis, and chronic renal impairment (caliper of 0.2) leading to 29 pairs. Short- and long-term outcomes with respect to reoperation, major bleeding, stroke, all-cause and cardiovascular mortality, and overall survival at 10 years were analyzed. RESULTS After PSM, groups were comparable with respect to preoperative characteristics, including patients with a mean age of 65 ± 3 years (MP) and 66 ± 4 years (BP) and an incidence rate of 6.9% for infective endocarditis in both cohorts. Short-term outcomes (transient neurologic disorder = 0.0 vs. 6.9%; stroke = 0.0%; in-hospital mortality = 3.4%) and in-hospital stays were comparable between MP and BP. CONCLUSION After isolated AVR with MP and BP, 10-year long-term outcomes were comparable in the reported single-center cohort. MP can still be implanted safely without a disadvantage as regards long-term survival.
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Affiliation(s)
- Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Stephen Gerfer
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Thorsten C W Wahlers
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
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Gaisendrees C, Eghbalzadeh K, Adam M, Djordjevic I, Mehler O, Wahlers T, Kuhn EW. Improving the effectiveness of CPR during interventional procedures. Perfusion 2024:2676591241232279. [PMID: 38302468 DOI: 10.1177/02676591241232279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
INTRODUCTION The number of interventional procedures, such as transcatheter aortic valve replacements or thoracic endovascular aortic repairs, is on the rise. Intraprocedural cardiac arrest is a rare occurrence during high-risk procedures. Modern hybrid-operating tables may adversely affect chest compression quality due to their flexibility. To investigate this relationship, we analyzed the blood pressure generated during chest compressions at different degrees of table extension and assessed the effect of an additional stabilization bar to secure the table. METHODS A CPR manikin was connected to online blood pressure monitoring on a hybrid operating table. Chest compressions were administered using a mechanical device (at 100 bpm and 80 bpm). Hemodynamic effects were evaluated at various degrees of table extension (0%, 50%, 100% table extension) and with the addition of a stabilization bar. RESULTS A greater degree of table extension was associated with lower diastolic blood pressure. The addition of a stabilization bar alleviated this drop in diastolic blood pressure and enabled the generation of higher mean arterial pressures at 50% and 100% table extension during chest compressions. CONCLUSION The flexibility of a hybrid operating table adversely impacts the hemodynamic effect of chest compressions. This effect may be mitigated by using a stabilization bar. These results may be relevant for providing further recommendations for CPR guidelines in hybrid OR settings.
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Affiliation(s)
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Matti Adam
- Department of Cardiology, University Hospital of Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Oliver Mehler
- Department of Anesthesiology, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
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Curio J, Kuhn EW, Körber MI, Baldus S, Khan JM, Adam M. Electrosurgical laceration and stabilisation of three clip devices (ELASTA-Clip) to enable transcatheter mitral valve implantation. EUROINTERVENTION 2023; 19:744-745. [PMID: 37982165 PMCID: PMC10658197 DOI: 10.4244/eij-d-23-00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Jonathan Curio
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Elmar W Kuhn
- Department of Heart Surgery, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Maria Isabel Körber
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, D.C., USA
- Department of Interventional Cardiology, St. Francis Hospital and Heart Center, Roslyn, NY, USA
| | - Matti Adam
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Liakopoulos OJ, Kuhn EW, Hellmich M, Schlömicher M, Strauch J, Reents W, Diegeler A, Thielmann M, Wendt D, Börgermann J, Gummert JF, Stoppe C, Goetzenich A, Martens S, Reichenspurner H, Wippermann J, Reuter H, Choi YH, Wahlers T. Statin loading before coronary artery bypass grafting: a randomized trial. Eur Heart J 2023:7136604. [PMID: 37086268 DOI: 10.1093/eurheartj/ehad238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/01/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023] Open
Abstract
AIMS Evidence suggests that a high-dose statin loading before a percutaneous coronary revascularization improves outcomes in patients receiving long-term statins. This study aimed to analyse the effects of such an additional statin therapy before surgical revascularization. METHODS AND RESULTS This investigator-initiated, randomized, double-blind, and placebo-controlled trial was conducted from November 2012 to April 2019 at 14 centres in Germany. Adult patients (n = 2635) with a long-term statin treatment (≥30 days) who were scheduled for isolated coronary artery bypass grafting (CABG) were randomly assigned to receive a statin-loading therapy or placebo at 12 and 2 h prior to surgery using a web-based system. The primary outcome of major adverse cardiac and cerebrovascular events (MACCE) was a composite consisting of all-cause mortality, myocardial infarction (MI), and a cerebrovascular event occuring within 30 days after surgery. Key secondary endpoints included a composite of cardiac death and MI, myocardial injury, and death within 12 months. Non-statistically relevant differences were found in the modified intention-to-treat analysis (2406 patients; 1203 per group) between the statin (13.9%) and placebo groups (14.9%) for the primary outcome [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.74-1.18; P = 0.562] or any of its individual components. Secondary endpoints including cardiac death and MI (12.1% vs. 13.5%; OR 0.88, 95% CI 0.69-1.12; P = 0.300), the area under the troponin T-release curve (median 0.398 vs. 0.394 ng/ml, P = 0.333), and death at 12 months (3.1% vs. 2.9%; P = 0.825) were comparable between treatment arms. CONCLUSION Additional statin loading before CABG failed to reduce the rate of MACCE occuring within 30 days of surgery.
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Affiliation(s)
- Oliver J Liakopoulos
- Department of Cardiothoracic Surgery, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
- Department of Cardiac Surgery, Kerckhoff-Clinic, Campus Kerckhoff, Justus-Liebig-University of Giessen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, University Hospital Cologne, Cologne, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Wilko Reents
- Department of Cardiac Surgery, Bad Neustadt a. d. Saale, Germany
| | - Anno Diegeler
- Department of Cardiac Surgery, Bad Neustadt a. d. Saale, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Jochen Börgermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christian Stoppe
- Department of Thoracic and Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Andreas Goetzenich
- Department of Thoracic and Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Sven Martens
- Department of Cardiac and Thoracic Surgery, University Hospital Münster, Münster, Germany
| | | | - Jens Wippermann
- Department of Cardiothoracic Surgery, Otto-von Guericke University, Magdeburg, Germany
| | - Hannes Reuter
- Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
- Department of Cardiac Surgery, Kerckhoff-Clinic, Campus Kerckhoff, Justus-Liebig-University of Giessen, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Gerfer S, Kuhn EW, Gablac H, Ivanov B, Djordjevic I, Mauri V, Adam M, Mader N, Baldus S, Eghbalzadeh K, Wahlers TCW. Outcomes and Characteristics of Patients with Intraprocedural Cardiopulmonary Resuscitation during TAVR. Thorac Cardiovasc Surg 2023; 71:101-106. [PMID: 35853463 DOI: 10.1055/s-0042-1750304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement (AVR) for higher risk patients. Periprocedural TAVR complications decreased with a growing expertise of implanters. Yet, TAVR can be accompanied by life-threatening adverse events such as intraprocedural cardiopulmonary resuscitation (CPR). This study retrospectively analyzed predictors and outcomes in a cohort of patients from a high-volume center undergoing periprocedural CPR during TAVR. METHODS A total of 729 patients undergoing TAVR, including 59 with intraprocedural CPR, were analyzed with respect to peri- and postprocedural outcomes. RESULTS Patients undergoing CPR showed a significantly lower left ventricular ejection fraction (LVEF) and lower baseline transvalvular mean and peak pressure gradients. The systolic blood pressure measured directly preoperatively was significantly lower in the CPR cohort. CPR patients were in a higher need for intraprocedural defibrillation, heart-lung circulatory support, and conversion to open heart surgery. Further, they showed a higher incidence of atrioventricular block grade III , valve malpositioning, and pericardial tamponade. The in-hospital mortality was significantly higher after intraprocedural CPR, accompanied by a higher incidence of disabling stroke, new pacemaker implantation, more red blood cell transfusion, and longer stay in intensive care unit. CONCLUSION Impaired preoperative LVEF and instable hemodynamics before valve deployment are independent risk factors for CPR and are associated with compromised outcomes. Heart rhythm disturbances, malpositioning of the prosthesis, and pericardial tamponade are main causes of the high mortality of 17% reported in the CPR group. Nevertheless, mechanical circulatory support and conversion to open heart surgery reduce mortality rates of CPR patients.
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Affiliation(s)
- Stephen Gerfer
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Hannah Gablac
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Borko Ivanov
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Victor Mauri
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Thorsten C W Wahlers
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
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Gerfer S, Grandoch M, Wahlers TCW, Kuhn EW. Factor Xa Inhibitors for Patients after Mechanical Heart Valve Replacement? Thorac Cardiovasc Surg 2021; 71:189-194. [PMID: 34894638 DOI: 10.1055/s-0041-1736242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with a mechanical heart valve need a lifelong anticoagulation due to the increased risk of valve thrombosis and thrombo-embolism. Currently, vitamin K antagonists (VKA) are the only approved class of oral anticoagulants, but relevant interactions and side effects lead to a large number of patients not achieving the optimal therapeutic target international normalized ration (INR). Therefore, steady measurements of the INR are imperative to ensure potent anticoagulation within a distinctive range. Direct oral anticoagulants (DOACs) with newer agents could serve as a possible alternative to VKAs in this patient cohort. DOACs are approved for several indications, e.g., atrial fibrillation (AF). They only have a minor interaction potential, which is why monitoring is not needed. Thereby, DOACs improve the livability of patients in need of chronical anticoagulation compared with VKAs. In contrast to dual platelet inhibition using aspirin in combination with an ADP receptor antagonist and the direct thrombin inhibitor dabigatran, the oral factor Xa inhibitors apixaban and rivaroxaban show promising results according to current evidence. In small-scale studies, factor Xa inhibitors were able to prevent thrombosis and thrombo-embolic events in patients with mechanical heart valves. Finally, DOACs seem to represent a feasible treatment option in patients with mechanical heart valves, but further studies are needed to evaluate clinical safety. In addition to the ongoing PROACT Xa trial with apixaban in patients after aortic On-X valve implantation, studies in an all-comer collective with rivaroxaban could be promising.
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Affiliation(s)
- Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Maria Grandoch
- Institute of Pharmacology and Clinical Pharmacology, Medical Faculty and University Hospital of Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Thorsten C W Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, University of Cologne, Cologne, Germany
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Lake P, Kuhn EW, Mauri V, Macherey S, Kaliba J, Baldus S, Frerker C, Schmidt T. Transcatheter valve-in-valve-in-valve replacement in tricuspid position in a patient with pre-existing permanent dual-chamber pacemaker. Clin Res Cardiol 2021; 110:2010-2014. [PMID: 33909128 PMCID: PMC8639564 DOI: 10.1007/s00392-021-01842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
Graphic abstract
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Affiliation(s)
- Philipp Lake
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Victor Mauri
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Sascha Macherey
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | | | - Stephan Baldus
- Department of Internal Medicine III, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christian Frerker
- Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
| | - Tobias Schmidt
- Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Campus Lübeck, Germany
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Mauri V, Frohn T, Deuschl F, Mohemed K, Kuhr K, Reimann A, Körber MI, Schofer N, Adam M, Friedrichs K, Kuhn EW, Scholtz S, Rudolph V, Wahlers TCW, Baldus S, Mader N, Schäfer U, Rudolph TK. Impact of device landing zone calcification patterns on paravalvular regurgitation after transcatheter aortic valve replacement with different next-generation devices. Open Heart 2020; 7:openhrt-2019-001164. [PMID: 32393655 PMCID: PMC7223472 DOI: 10.1136/openhrt-2019-001164] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Residual paravalvular regurgitation (PVR) has been associated to adverse outcomes after transcatheter aortic valve replacement (TAVR). This study sought to evaluate the impact of device landing zone (DLZ) calcification on residual PVR after TAVR with different next-generation transcatheter heart valves. METHODS 642 patients underwent TAVR with a SAPIEN 3 (S3; n=292), ACURATE neo (NEO; n=166), Evolut R (ER; n=132) or Lotus (n=52). Extent, location and asymmetry of DLZ calcification were assessed from contrast-enhanced CT imaging and correlated to PVR at discharge. RESULTS PVR was ≥moderate in 0.7% of S3 patients, 9.6% of NEO patients, 9.8% of ER patients and 0% of Lotus patients (p<0.001), and these differences remained after matching for total DLZ calcium volume. The amount of DLZ calcium was significantly related to the degree of PVR in patients treated with S3 (p=0.045), NEO (p=0.004) and ER (p<0.001), but not in Lotus patients (p=0.698). The incidence of PVR ≥moderate increased significantly over the tertiles of DLZ calcium volume (p=0.046). On multivariable analysis, calcification of the aortic valve cusps, LVOT calcification and the use of self-expanding transcatheter aortic valve implantation (TAVI) prostheses emerged as predictors of PVR. CONCLUSIONS The susceptibility to PVR depending on the amount of calcium was mainly observed in self-expanding TAVI prostheses. Thus, DLZ calcification is an important factor to be considered in prosthesis selection for each individual patient, keeping in mind the trade-off between PVR reduction, risk of new pacemaker implantation and unfavourable valve ha emodynamics.
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Affiliation(s)
- Victor Mauri
- Heart Center, University of Cologne, Koln, Germany
| | - Thomas Frohn
- Heart Center, University of Cologne, Koln, Germany
| | - Florian Deuschl
- Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
| | - Kawa Mohemed
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Kathrin Kuhr
- Heart Center, University of Cologne, Koln, Germany
| | | | | | - Niklas Schofer
- Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
| | - Matti Adam
- Heart Center, University of Cologne, Koln, Germany
| | - Kai Friedrichs
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Elmar W Kuhn
- Heart Center, University of Cologne, Koln, Germany
| | - Smita Scholtz
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Volker Rudolph
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Thorsten C W Wahlers
- Department of Cardiothoracic Surgery, Klinikum der Universität zu Köln, Klinik und Poliklinik für Herz- und Thoraxchirurgie, Cologne, Germany
| | - Stephan Baldus
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Klinikum der Universität zu Köln, Klinik und Poliklinik für Herz- und Thoraxchirurgie, Cologne, Germany
| | - Ulrich Schäfer
- Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
| | - Tanja K Rudolph
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
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Kuhn EW, Rudolph V, Baldus S, Adam M. Transcatheter aortic valve implantation after transcatheter mitral valve implantation. EUROINTERVENTION 2020; 16:430-431. [PMID: 31746762 DOI: 10.4244/eij-d-19-00690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
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Kuhn EW, Liakopoulos OJ, Choi YH, Rahmanian P, Eghbalzadeh K, Slottosch I, Deppe AC, Wahlers TCW. Preoperative Statin Therapy for Atrial Fibrillation and Renal Failure after Cardiac Surgery. Thorac Cardiovasc Surg 2020; 69:141-147. [PMID: 32506416 DOI: 10.1055/s-0040-1710322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Performing cardiac surgery in patients with cardiovascular risk factors incorporates a steady risk for the development of postoperative complications. Perioperative statin intake was associated with an improvement of perioperative outcomes in these patients. However, the European Association for Cardio-Thoracic Surgery guidelines regarding the perioperative statin treatment were changed recently due to large studies reporting about relevant adverse effects related to statin therapy. METHODS All relevant databases were searched including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and the metaRegister of Controlled Trials. Various registries were screened (National Research Register, the ClinicalTrials.gov, and gray literature) with search on online conference indices of relevant scientific meetings. No language restrictions were applied. RESULTS We identified 10 randomized controlled studies summarizing 3,468 participants undergoing various kinds of cardiac surgical procedures. All included studies presented with marked differences regarding study design. Pooled analysis indicated that statin pretreatment was associated with a formally reduced incidence of postoperative atrial fibrillation (AF) (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.39-1.00; p = 0.05) but with an increased incidence of renal failure (OR 1.20, 95% CI 1.01-1.44; p = 0.04) compared with control. Substantial heterogeneity was observed among studies reporting about AF. CONCLUSION Current but sparse evidence reveals that statin pretreatment is associated with a higher rate of postoperative renal failure compared with control therapy but is ineffective to substantially reduce postoperative AF. Given the relevant heterogeneity among included studies, statin pretreatment cannot be generally recommended.
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Affiliation(s)
- Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | - Oliver J Liakopoulos
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | - Ingo Slottosch
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | - Antje Christin Deppe
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | - Thorsten C W Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
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12
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Kuhn EW, Liakopoulos OJ. Commentary: Transapical aortic valve replacement versus surgical aortic valve replacement: A fundamental touchstone! J Thorac Cardiovasc Surg 2020; 162:1710-1711. [PMID: 32387158 DOI: 10.1016/j.jtcvs.2020.03.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Oliver J Liakopoulos
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany; Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim, Campus Kerckhoff, University of Giessen, Bad Nauheim, Germany.
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13
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Weber C, Rahmanian PB, Nitsche M, Gassa A, Eghbalzadeh K, Hamacher S, Merkle J, Deppe AC, Sabashnikov A, Kuhn EW, Liakopoulos OJ, Wahlers T. Higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis. BMC Cardiovasc Disord 2020; 20:47. [PMID: 32013875 PMCID: PMC6998844 DOI: 10.1186/s12872-020-01338-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/09/2020] [Indexed: 01/29/2023] Open
Abstract
Background Cardiac surgery for prosthetic valve endocarditis (PVE) is associated with substantial mortality. We aimed to analyze 30-day and 1-year outcome in patients undergoing surgery for PVE and sought to identify preoperative risk factors for mortality with special regard to perivalvular infection. Methods We retrospectively analyzed data of 418 patients undergoing valve surgery for infective endocarditis between January 2009 and July 2018. After 1:1 propensity matching 158 patients (79 PVE/79 NVE) were analyzed with regard to postoperative 30-day and 1-year outcomes. Univariate and multivariable analyses were performed to identify potential risk factors for mortality. Results 315 patients (75.4%) underwent surgery for NVE and 103 (24.6%) for PVE. After propensity matching groups were comparable with regard to preoperative characteristics, clinical presentation and microbiological findings, except a higher incidence of perivalvular infection in patients with PVE (51.9%) compared to NVE (26.6%) (p = 0.001), longer cardiopulmonary bypass (166 [76–130] vs. 97 [71–125] min; p < 0.001) and crossclamp time (95 [71–125] vs. 68 [55–85] min; p < 0.001). Matched patients with PVE showed a 4-fold increased 30-day mortality (20.3%) in comparison with NVE patients (5.1%) (p = 0.004) and 2-fold increased 1-year mortality (PVE 29.1% vs. NVE 13.9%; p = 0.020). Multivariable analysis revealed perivalvular abscess, sepsis, preoperative AKI and PVE as independent risk factors for mortality. Patients with perivalvular abscess had a significantly higher 30-day mortality (17.7%) compared to patients without perivalvular abscess (8.0%) (p = 0.003) and a higher rate of perioperative complications (need for postoperative pacemaker implantation, postoperative cerebrovascular events, postoperative AKI). However, perivalvular abscess did not influence 1-year mortality (20.9% vs. 22.3%; p = 0.806), or long-term complications such as readmission rate or relapse of IE. Conclusions Patients undergoing surgery for PVE had a significantly higher 30-day and 1-year mortality compared to NVE. After propensity-matching 30-day mortality was still 4-fold increased in PVE compared to NVE. Patients with perivalvular abscess showed a significantly higher 30-day mortality and perioperative complications, whereas perivalvular abscess seems to have no relevant impact on 1-year mortality, the rate of readmission or relapse of IE.
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Affiliation(s)
- Carolyn Weber
- Department of Cardiothoracic Surgery, University of Cologne, Kerpener Strasse 62, D-50937, Cologne, Germany.
| | | | - Melanie Nitsche
- Department of Cardiothoracic Surgery, University of Cologne, Kerpener Strasse 62, D-50937, Cologne, Germany
| | - Asmae Gassa
- Department of Cardiothoracic Surgery, University of Cologne, Kerpener Strasse 62, D-50937, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, University of Cologne, Kerpener Strasse 62, D-50937, Cologne, Germany
| | - Stefanie Hamacher
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Julia Merkle
- Department of Cardiothoracic Surgery, University of Cologne, Kerpener Strasse 62, D-50937, Cologne, Germany
| | - Antje-Christin Deppe
- Department of Cardiothoracic Surgery, University of Cologne, Kerpener Strasse 62, D-50937, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, University of Cologne, Kerpener Strasse 62, D-50937, Cologne, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, University of Cologne, Kerpener Strasse 62, D-50937, Cologne, Germany
| | - Oliver J Liakopoulos
- Department of Cardiothoracic Surgery, University of Cologne, Kerpener Strasse 62, D-50937, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University of Cologne, Kerpener Strasse 62, D-50937, Cologne, Germany
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14
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Djordjevic I, Eghbalzadeh K, Sabashnikov A, Deppe AC, Kuhn EW, Seo J, Weber C, Merkle J, Adler C, Rahmanian PB, Liakopoulos OJ, Mader N, Kuhn-Regnier F, Zeriouh M, Wahlers T. Single center experience with patients on veno arterial ECMO due to postcardiotomy right ventricular failure. J Card Surg 2019; 35:83-88. [PMID: 31692108 DOI: 10.1111/jocs.14332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Right ventricular (RV) failure is associated with poor outcome and increased mortality in cardiac surgery. Aim of our study was to analyze the outcome of veno arterial extracorporeal membrane oxygenation (va ECMO) therapy in patients with isolated RV failure in postcardiotomy cardiogenic shock (PCS) and to evaluate risk factors associated with 30-day-mortality. METHODS Between August 2006 until August 2016, 64 consecutive patients with va ECMO therapy due to fulminant RV failure in PCS were identified and included in this retrospective observation. Further, outcome data and a comparison of va ECMO survivors and nonsurvivors was conducted. RESULTS The mean age of the patient cohort was 63 ± 14 years. Patients were treated with va ECMO for 79 ± 61 hours. Twenty-eight patients (44%) were successfully weaned off ECMO support. Overall 30-day-mortality was 88% (56/64). Hemoglobin concentration before ECMO implantation, maximum rise of muscle-brain type creatine kinase during ECMO therapy, as well as lactic acid concentration 24 hours after initiation of va ECMO therapy were predictive for 30-day mortality. CONCLUSION ECMO therapy in RV failure due to PCS is shown to be associated with an excessive mortality. Regarding our data, va ECMO might only be an appropriate short-term mechanical assist device separating patients form cardiopulmonary bypass with an acceptable weaning rate. Particularly, in case of failed hemodynamic recovery of the right heart on va ECMO, direct RV bypass systems might function as a bailout option. Additionally, cardiac enzymes and lactic acid might provide valuable information in meeting therapy-related decisions.
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Affiliation(s)
- Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany.,Heart Centre, ECMO Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany.,Heart Centre, ECMO Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany.,Heart Centre, ECMO Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Antje C Deppe
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany.,Heart Centre, ECMO Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany.,Heart Centre, ECMO Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Joon Seo
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany.,Heart Centre, ECMO Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Julia Merkle
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany
| | - Christoph Adler
- Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Parwis B Rahmanian
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany
| | - Oliver J Liakopoulos
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany
| | - Ferdinand Kuhn-Regnier
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Centre, University Hospital Cologne, Cologne, Germany.,Heart Centre, ECMO Centre Cologne, University Hospital Cologne, Cologne, Germany
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15
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Weber C, Gassa A, Eghbalzadeh K, Merkle J, Djordjevic I, Maier J, Sabashnikov A, Deppe AC, Kuhn EW, Rahmanian PB, Liakopoulos OJ, Wahlers T. Characteristics and outcomes of patients with right-sided endocarditis undergoing cardiac surgery. Ann Cardiothorac Surg 2019; 8:645-653. [PMID: 31832354 DOI: 10.21037/acs.2019.08.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background There has been an increasing incidence of right-sided infective endocarditis (RSIE) due to the global rise of intravenous drug use (IVDU) and an increasing number of implantable cardiac electronic devices and central venous catheters. Our aim was to investigate differences in the clinical presentation, microbiological findings and prognosis of patients undergoing surgery for RSIE compared to left-sided infective endocarditis (LSIE). Methods Relevant clinical data of all 432 consecutive patients undergoing valve surgery for infective endocarditis (IE) at our institution between January 2009 and December 2018 were retrospectively analyzed. Acquired data included patients' demographic and preoperative comorbidities, manifestation of IE according to the recently modified Duke Criteria, perioperative data and relevant clinical outcomes. Results A total of 403 patients (93.3%) underwent surgery for LSIE and twenty-nine patients (6.7%) for RSIE. Eleven patients with RSIE (37.9%) showed a concomitant left-sided infection. Compared to LSIE, RSIE patients were significantly younger [47.5 (40.4-69.3) vs. 65.1 (53.7-74.6); P=0.008] and presented with less comorbidities such as hypertension (41.4% vs. 65.3%; P=0.010) and coronary artery disease (6.9% vs. 29.0%; P=0.010). Rates of IVDU (34.5% vs. 4.5%; P<0.001), human immunodeficiency virus (HIV) (10.3% vs. 1.7%; P=0.023) and hepatitis C virus (HCV) infection (24.1% vs. 5.2%; P=0.001) were greater in RSIE. The proportion of Staphylococcus aureus IE was significantly higher in RSIE compared to LSIE (37.9% vs. 21.1%; P=0.035). 30-day mortality was 6.9% after surgery for RSIE compared to 14.6% after operation for LSIE (P=0.372). Conclusions Patients undergoing surgery for RSIE compared to LSIE presented with a higher rate of pulmonary septic emboli, more Staphylococcus aureus infections and larger vegetations. Larger multicenter prospective trials are needed to provide more reliable data on the clinical profile of these patients, in order to determine optimal surgical management.
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Affiliation(s)
- Carolyn Weber
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Asmae Gassa
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Julia Merkle
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Johanna Maier
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | | | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Parwis B Rahmanian
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | | | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
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16
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Rahmanian PB, Eghbalzadeh K, Giese D, Kuhn EW, Djordjevic I, Kaya S, Weber C, Baldus S, Mader N, Wahlers TC. SAVR versus TAVI: What about the Hemodynamic Performance? An In Vivo and In Vitro Analysis. Thorac Cardiovasc Surg 2019; 68:608-615. [DOI: 10.1055/s-0039-1695779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abstract
Background Surgical aortic valve replacement (SAVR) is nowadays discussed whether it remains the gold standard of treatment. In the last decade, there has been a tremendous increase in transcatheter aortic valve implantation (TAVI) due to the growing expertise and excellent results of the catheter-based approach. We, therefore, retrospectively compared the rapid deployment valve (RDV), the Edwards Intuity valve (IEV), with the Edwards Sapien 3 (S3V) with regard to post-procedural hemodynamics.
Methods A total of 246 patients treated with TAVI or SAVR between February 2009 and November 2015 were included. One-hundred twenty-five patients were analyzed in the SAVR group and compared with 121 patients undergoing TAVI. Transvalvular pressure gradients (PGs) and the incidence and extent of aortic regurgitation (AR) were compared post-procedurally by echocardiography for each valve size. In vitro hemodynamics were analyzed by placing both valves into an aortic silicone phantom connected to a pulsatile flow pump and measured using phase-contrast magnetic resonance imaging (4D flow MRI).
Results Post-procedurally, mean transvalvular PGs for the 23 mm valves were 9 (7;11.5) versus 13 (9;18) (p < 0.001), whereas maximum PGs were 16.5 (14;22) versus 25.5 mm Hg (17.5;34) (p < 0.001) in IEV and S3V patients, respectively. The 21 mm IEV showed significantly lower transvalvular PGs compared with the 23 mm S3V: mean PGs: 11 (8;13) versus 13 (9;18) (p < 0.05); maximum PG: 19.5 (13;24) versus 25.5 (18;34) mm Hg (p < 0.05). Analysis revealed significantly lower post-procedural transvalvular PGs for larger valves sizes. With respect to AR, the incidence of AR was significantly lower in IEV group (p < 0.05). In vitro velocities and turbulent kinetic energy values showed similar results between both valves.
Conclusion Implanted RDVs presented a lower incidence of paravalvular regurgitation and were associated with significantly lower post-procedural transvalvular PGs, especially for small valve sizes. Our data might support the application of rapid deployment aortic valves in patients with small aortic annulus in the TAVI era.
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Affiliation(s)
| | | | - Daniel Giese
- Department of Radiology, Uniklinik Koln, Koln, Germany
| | - Elmar W. Kuhn
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Germany
| | - Süreyya Kaya
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Germany
| | - Stephan Baldus
- Department of Cardiology, University of Cologne, Heart Center, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Germany
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17
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Eghbalzadeh K, Kuhn EW, Sabashnikov A, Weber C, Sahyoun C, Rudolph T, Baldus S, Wahlers TCW, Mader N. "Vascular Outlining": Augmented Imaging for Transfemoral Access-A Preclinical Investigation. Thorac Cardiovasc Surg 2018; 68:158-161. [PMID: 29490387 DOI: 10.1055/s-0038-1629922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Advanced visualization software tools have been used in clinics to improve the safety and accuracy of transcatheter procedure. Imaging techniques have greatly evolved during the era of transcatheter aortic valve implantation (TAVI). In a retrospective analysis, we investigated the feasibility of augmented fluoroscopy for iliofemoral access using a novel "Vascular Outlining" roadmapping technology. METHODS The Vascular Outlining prototype device (Philips Healthcare) application was used with iliofemoral angiography of 10 patients undergoing transfemoral TAVI. The software processes any conventional angiographic sequences, extracting the static outline of vessels and projecting the two-dimensional vessel margins as a roadmap on live fluoroscopy. Post-processed results were clinically assessed to determine whether the technical performance of the tool is sufficient. RESULTS Augmented imaging was possible in all investigated angiography sequences. The analysis of software-generated images showed accurate projection of the two-dimensional outline of the iliofemoral vessels as an overlay on the live fluoroscopy image in most cases. Overlay inaccuracy was only observed in cases with low contrast or patient movement. CONCLUSION In static and contrasted angiography sequences, "Vascular Outlining" showed accurate image overlay. We identified that the quality of the vascular outline is dependent on the opacification of the contrast injection and the stability of the patient on the table. With further development. this application might increase the accuracy of femoral puncture and reduce the incidence of vascular complications. Clinical trials are needed to confirm these hypotheses.
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Affiliation(s)
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center Cologne, Cologne, Germany
| | | | - Carolyn Weber
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | | | - Tanja Rudolph
- Department of Cardiology, Uniklinik Koln, Koln, Germany
| | | | | | - Navid Mader
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Germany
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18
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Sabashnikov A, Djordjevic I, Deppe AC, Kuhn EW, Merkle J, Weber C, Sindhu D, Eghbalzadeh K, Zeriouh M, Liakopoulos OJ, Rahmanian PB, Kuhn-Régnier F, Choi YH, Madershahian N, Wahlers T. Managing Traps and Pitfalls During Initial Steps of an ECMO Retrieval Program Using a Miniaturized Portable System: What Have We Learned From the First Two Years? Artif Organs 2017; 42:484-492. [PMID: 29280162 DOI: 10.1111/aor.13067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/13/2017] [Accepted: 09/21/2017] [Indexed: 11/30/2022]
Abstract
The aim of this study was to provide early and mid-term results of the newly established extracorporeal membrane oxygenation (ECMO) retrieval service in a tertiary cardiothoracic center using the miniaturized portable Cardiohelp System (Maquet, Rastatt, Germany). A particular attention was paid to organizational and logistic specifics as well as challenges and pitfalls associated with initial phase of the program. From January 2015 until January 2017 a heterogenic group of 28 consecutive patients underwent ECMO implantation in distant hospitals for acute cardiac, pulmonary or combined failure as a bridge-to-decision and were subsequently transported to our institution. Each cannulation was performed bedside on intensive care units (ICU) using the Seldinger's technique. Early outcomes and mid-term overall survival with up to two-year follow-up along with the impact of ongoing cardiopulmonary resuscitation (CPR) on outcome were presented. Also, changes in hemodynamics and tissue perfusion factors 24 h after ECMO implantation were evaluated. ECMO implantations were performed in 15 distant departments with the median distance of 23(10;40) (maximum 60) km. A total of 15 patients (54%) were cannulated under CPR with the median duration of 30(20;110) (maximum 180) min. After 24 h of support there were significant improvements in SvO2 (P = 0.021), mean arterial pressure (P = 0.027), FiO2 (P = 0.001), lactate (P = 0.001), and pH (P < 0.001). The mean ECMO support duration was 96 ± 100 (maximum 384) hours, whereas 11 patients (40%) were weaned off support and discharged from hospital. Overall cumulative survival in patients without the need for CPR was 61.5% at one week and 38.5% at 1 month, 6 month, and 1 year, whereas patients requiring CPR survived in 40% at one week, and 33.3% at 1 month, 6 month, and 1 year (Log-Rank (Mantel-Cox) P = 0.374, Breslow (Generalized Wilcoxon) P = 0.162). Our initial experience shows that launching new ECMO retrieval programs in centers with sufficient ICU capacities and local ECMO experience can be feasible and associated with acceptable "real world" results despite the initial learning curve. Rapid logistical organization and team flexibility are the key points to ensure comparable survival of patients requiring prolonged CPR.
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Affiliation(s)
- Anton Sabashnikov
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.,ECMO Centre, University Hospital Cologne, Cologne, Germany
| | - Ilja Djordjevic
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.,ECMO Centre, University Hospital Cologne, Cologne, Germany
| | - Antje-Christin Deppe
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.,ECMO Centre, University Hospital Cologne, Cologne, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.,ECMO Centre, University Hospital Cologne, Cologne, Germany
| | - Julia Merkle
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.,ECMO Centre, University Hospital Cologne, Cologne, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.,ECMO Centre, University Hospital Cologne, Cologne, Germany
| | - Dirk Sindhu
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.,ECMO Centre, University Hospital Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.,ECMO Centre, University Hospital Cologne, Cologne, Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Oliver J Liakopoulos
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Parwis B Rahmanian
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Ferdinand Kuhn-Régnier
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.,ECMO Centre, University Hospital Cologne, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Navid Madershahian
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.,ECMO Centre, University Hospital Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.,ECMO Centre, University Hospital Cologne, Cologne, Germany
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19
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Eghbalzadeh K, Kuhn EW, Sabashnikov A, Weber C, Rahmanian PB, Siedek F, Mauri V, Rudolph T, Baldus S, Madershahian N, Wahlers TC. Latest Generation of Balloon-Expandable Valve, the Edwards Sapien 3 Valve: Less Paravalvular Regurgitation but Higher Transvalvular Pressure Gradients. Thorac Cardiovasc Surg 2017; 67:236-242. [PMID: 29172210 DOI: 10.1055/s-0037-1608750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The latest generation of balloon-expandable valve, the Edwards Sapien 3 valve (S3V), was designed to reduce paravalvular regurgitation (PVR). We retrospectively compared S3V with Edwards Sapien XT valve (SXTV) with regard to postprocedural transvalvular pressure gradients (PGs). METHODS Analysis of 152 patients receiving SXTV and 125 patients receiving S3V between February 2009 and April 2015 was performed. Transvalvular PGs and the incidence and extent of aortic regurgitation (AR) were compared postprocedurally by echocardiography for each valve size. RESULTS Postprocedurally, mean PGs for the 23 mm valves were 10.9 ± 5.3 versus 13.9 ± 5.1 (p = 0.017), whereas maximum PGs were 19.9 ± 8.3 versus 26.1 ± 10.4 mm Hg (p = 0.005) in SXTV and S3V patients, respectively. For the 26 mm valves, gradients were also significantly higher in S3V patients (mean PG: 11.6 ± 4.9 vs. 9.2 ± 4.2 [p = 0.004]; maximum PG: 23.0 ± 10.1 vs. 17.2 ± 7.4 mm Hg [p < 0.001]). Analysis revealed no significant differences in postprocedural transvalvular PGs for 29 mm valves (mean PG of 9.3 ± 3.9 and 11.2 ± 4.3 mm Hg [p = ns] and maximum PG of 17.5 ± 7.2 vs. 20.9 ± 6.8 mm Hg [p = ns]) between SXTV and S3V groups, respectively. With respect to PVR, the incidence of AR was significantly lower in S3V group (p = 0.001). CONCLUSION S3V shows lower incidence of PVR; however, it is associated with significantly higher postprocedural transvalvular PGs for 23 and 26 mm valve sizes. These data might contribute to the scientific discussion, especially with respect to prosthesis selection in individual patients with small annular dimension.
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Affiliation(s)
- Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Center, Universitätsklinikum Köln, Cologne, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center, Universitätsklinikum Köln, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, Universitätsklinikum Köln, Cologne, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, Heart Center, Universitätsklinikum Köln, Cologne, Germany
| | | | - Florian Siedek
- Department of Radiology, Universitätsklinikum Köln, Cologne, Germany
| | - Victor Mauri
- Department of Cardiology, Heart Center, Universitätsklinikum Köln, Cologne, Germany
| | - Tanja Rudolph
- Department of Cardiology, Heart Center, Universitätsklinikum Köln, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, Universitätsklinikum Köln, Cologne, Germany
| | - Navid Madershahian
- Department of Cardiothoracic Surgery, Heart Center, Universitätsklinikum Köln, Cologne, Germany
| | - Thorsten C Wahlers
- Department of Cardiothoracic Surgery, Heart Center, Universitätsklinikum Köln, Cologne, Germany
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Merkle J, Djorjevic I, Sabashnikov A, Kuhn EW, Deppe AC, Eghbalzadeh K, Fattulayev J, Hohmann C, Zeriouh M, Kuhn-Régnier F, Choi YH, Mader N, Wahlers T. Mobile ECMO – A divine technology or bridge to nowhere? Expert Rev Med Devices 2017; 14:821-831. [DOI: 10.1080/17434440.2017.1376583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Julia Merkle
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Ilija Djorjevic
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Antje-Christin Deppe
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Javid Fattulayev
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Christopher Hohmann
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Ferdinand Kuhn-Régnier
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
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Deppe AC, Weber C, Liakopoulos OJ, Zeriouh M, Slottosch I, Scherner M, Kuhn EW, Choi YH, Wahlers T. Preoperative intra-aortic balloon pump use in high-risk patients prior to coronary artery bypass graft surgery decreases the risk for morbidity and mortality-A meta-analysis of 9,212 patients. J Card Surg 2017; 32:177-185. [DOI: 10.1111/jocs.13114] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Antje-Christin Deppe
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Oliver J. Liakopoulos
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Ingo Slottosch
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Maximilian Scherner
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Elmar W. Kuhn
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
- Center of Molecular Medicine Cologne; University of Cologne; Cologne Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery; Heart Center of the University of Cologne; Cologne Germany
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Deppe AC, Weber C, Zimmermann J, Kuhn EW, Slottosch I, Liakopoulos OJ, Choi YH, Wahlers T. Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. J Surg Res 2016; 203:424-33. [DOI: 10.1016/j.jss.2016.03.008] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/07/2016] [Accepted: 03/02/2016] [Indexed: 11/27/2022]
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Abstract
This review has been withdrawn as authors are unable to complete the updating process. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Elmar W Kuhn
- Heart Center, University of CologneDepartment of Cardiothoracic SurgeryKerpener Strasse 62CologneGermany50924
| | - Ingo Slottosch
- Heart Center, University of CologneDepartment of Cardiothoracic SurgeryKerpener Strasse 62CologneGermany50924
| | - Thorsten Wahlers
- Heart Center, University of CologneDepartment of Cardiothoracic SurgeryKerpener Strasse 62CologneGermany50924
| | - Oliver J Liakopoulos
- Heart Center, University of CologneDepartment of Cardiothoracic SurgeryKerpener Strasse 62CologneGermany50924
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Kuhn EW, Madershahian N, Rudolph TK, Scherner M, Choi YH, Wahlers T. Catheter Insertion via Extracorporeal Membrane Oxygenation Cannula during Transcatheter Aortic Valve Implantation. Thorac Cardiovasc Surg Rep 2016; 5:41-43. [PMID: 28018822 PMCID: PMC5177439 DOI: 10.1055/s-0036-1572512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/13/2016] [Indexed: 11/18/2022] Open
Abstract
Background Patients referred to transcatheter aortic valve implantation (TAVI) present with multiple risk factors for intraprocedural complications. Case Description We describe a TAVI procedure with sudden hemodynamic collapse and cardiopulmonary resuscitation. Therefore, extracorporeal membrane oxygenation cannulas were immediately implanted via vessels of the groin. A Y-connector was inserted into the arterial line of the extracorporeal membrane oxygenator using an additional sheath facilitating to insert a pigtail catheter to guide the further valve implantation. Conclusion This case report provides an option to insert a pigtail catheter after implantation of extracorporeal membrane oxygenator cannulas without need for additional vascular access.
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Affiliation(s)
- Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center Cologne, Cologne, Germany
| | - Navid Madershahian
- Department of Cardiothoracic Surgery, Heart Center Cologne, Cologne, Germany
| | - Tanja K Rudolph
- Department of Cardiology, Heart Center Cologne, Cologne, Germany
| | - Maximilian Scherner
- Department of Cardiothoracic Surgery, Heart Center Cologne, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center Cologne, Cologne, Germany
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Kuhn EW, Bennink G, Wahlers T, Wippermann J. Correction of Double-Chambered Right Ventricle 40 Years after Pulmonary Valvuloplasty. Thorac Cardiovasc Surg Rep 2015; 4:31-3. [PMID: 26693124 PMCID: PMC4670311 DOI: 10.1055/s-0035-1556814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/21/2015] [Indexed: 10/24/2022] Open
Abstract
Background Double-chambered right ventricle is a partial separation of the right ventricle by pathological tissue. This anomaly is described in infants and children but can also be diagnosed in young adults. Case Description A 47-year-old patient presented with chest pain and exercise intolerance. Further evaluation revealed a double-chambered right ventricle. During the surgical procedure, fibrotic tissue was transected, and a pulmonary valve replacement including enlargement of the main pulmonary artery was performed. Conclusion Subpulmonary obstruction of the right ventricle can be related to double-chambered right ventricle even in adulthood. Treatment options include surgical resection with pulmonary valve replacement.
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Affiliation(s)
- Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center Cologne, Cologne, Germany
| | - Gerardus Bennink
- Department of Cardiothoracic Surgery, Heart Center Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center Cologne, Cologne, Germany
| | - Jens Wippermann
- Department of Cardiothoracic Surgery, Heart Center Cologne, Cologne, Germany
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Deppe AC, Arbash W, Kuhn EW, Slottosch I, Scherner M, Liakopoulos OJ, Choi YH, Wahlers T. Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of over 16 900 patients investigated in randomized controlled trials. Eur J Cardiothorac Surg 2015; 49:1031-41; discussion 1041. [DOI: 10.1093/ejcts/ezv268] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 07/02/2015] [Indexed: 01/27/2023] Open
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Abstract
BACKGROUND Patients referred to cardiac surgery for cardiovascular disease are at significant risk for the development of major postoperative adverse events despite significant advances in surgical techniques and perioperative care. Statins (5-hydroxy-3-methylglutaryl-co-enzyme A (HMG-CoA) reductase inhibitors) have gained a pivotal role in the primary and secondary prevention of coronary artery disease and are thought to improve perioperative outcomes in patients undergoing cardiac surgery. This review is an updated version of a review that was first published in 2012. OBJECTIVES To determine the effectiveness of preoperative statin therapy in patients undergoing cardiac surgery. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 11), MEDLINE (1950 to November 2013 Week 3), EMBASE (1980 to 3 December 2013 (Week 48)) and the metaRegister of Controlled Trials. Additionally, we searched ongoing trials through the National Research Register, the ClinicalTrials.gov registry and grey literature. We screened online conference indices from relevant scientific meetings (2006 to 2014) to look for eligible trials. We applied no language restrictions. SELECTION CRITERIA All randomised controlled trials comparing any statin treatment before cardiac surgery, for any given duration and dose, versus no preoperative statin therapy (standard of care) or placebo. DATA COLLECTION AND ANALYSIS Two review authors evaluated trial quality and extracted data from titles and abstracts identified by electronic database searches according to predefined criteria. Accordingly, we retrieved full-text articles of potentially relevant studies that met the inclusion criteria to assess definitive eligibility for inclusion. We reported effect measures as odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). MAIN RESULTS We identified 17 randomised controlled studies including a total of 2138 participants undergoing on-pump or off-pump cardiac surgical procedures, and added to this review six studies with 1154 additional participants. Pooled analysis showed that statin treatment before surgery reduced the incidence of postoperative atrial fibrillation (AF) (OR 0.54, 95% CI 0.43 to 0.67; P value < 0.01; 12 studies, 1765 participants) but failed to influence short-term mortality (OR 1.80, 95% CI 0.38 to 8.54; P value = 0.46; two studies, 300 participants) or postoperative stroke (OR 0.70, 95% CI 0.14 to 3.63; P value = 0.67; two studies, 264 participants). In addition, statin therapy was associated with a shorter stay for patients on the intensive care unit (ICU) (WMD -3.19 hours, 95% CI -5.41 to -0.98; nine studies, 721 participants) and in the hospital (WMD -0.48 days, 95% CI -0.78 to -0.19; 11 studies, 1137 participants) when significant heterogeneity was observed. Results showed no reduction in myocardial infarction (OR 0.48, 95% CI 0.21 to 1.13; seven studies, 901 participants) or renal failure (OR 0.57, 95% CI 0.30 to 1.10; five studies, 467 participants) and were not affected by subgroup analysis. Trials investigating this safety endpoint reported no major or minor perioperative side effects of statins. AUTHORS' CONCLUSIONS Preoperative statin therapy reduces the odds of postoperative atrial fibrillation (AF) and shortens the patient's stay on the ICU and in the hospital. Statin pretreatment had no influence on perioperative mortality, stroke, myocardial infarction or renal failure, but only two of all included studies assessed mortality. As analysed studies included mainly individuals undergoing myocardial revascularisation, results cannot be extrapolated to patients undergoing other cardiac procedures such as heart valve or aortic surgery.
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Affiliation(s)
- Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Kerpener Strasse 62, Cologne, Germany, 50924
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Liakopoulos OJ, Kuhn EW, Hellmich M, Kuhr K, Krause P, Reuter H, Thurat M, Choi YH, Wahlers T. Statin Recapture Therapy before Coronary Artery Bypass Grafting Trial: Rationale and study design of a multicenter, randomized, double-blinded controlled clinical trial. Am Heart J 2015; 170:46-54, 54.e1-2. [PMID: 26093863 DOI: 10.1016/j.ahj.2015.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Patients undergoing coronary artery bypass grafting (CABG) are still at significant risk for postoperative major adverse cardiac and cerebrovascular events (MACCEs). Recent clinical evidence shows that cardioprotection in patients receiving a chronic statin treatment can be "recaptured" by a high-dose statin therapy given shortly before an ischemia-reperfusion sequence. Evaluation of this novel therapeutic approach in the setting of CABG seems promising because myocardial ischemia-reperfusion injury plays a pivotal role in poor clinical outcomes that may be improved by a simple preoperative statin recapture treatment. METHODS The investigator-initiated StaRT-CABG trial is a multicenter, randomized, double-blinded, 2-parallel group controlled clinical study in 2,630 patients. The trial aims to evaluate whether a high-dose statin recapture therapy given shortly before CABG reduces the incidence of MACCE at 30 days after surgery (primary composite outcome: all-cause mortality, nonfatal myocardial infarction, and cerebrovascular events). Consenting patients who are on chronic statin therapy before surgery will be randomized to receive either oral statin reloading therapy or matching placebo 12 and 2 hours before CABG. Key secondary end points include enzymatic myocardial injury; new-onset atrial fibrillation; length of stay in the intensive care unit and hospital; need for repeat coronary revascularization at 30 days; and, finally, all-cause mortality at 12 months after surgery. IMPLICATIONS The StaRT-CABG trial is expected to provide highly relevant clinical data on the efficacy of this novel therapeutic approach to optimize the care for patients with coronary artery disease undergoing CABG.
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Deppe AC, Liakopoulos OJ, Kuhn EW, Slottosch I, Scherner M, Choi YH, Rahmanian PB, Wahlers T. Minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for single-vessel disease: a meta-analysis of 2885 patients†. Eur J Cardiothorac Surg 2014; 47:397-406; discussion 406. [DOI: 10.1093/ejcts/ezu285] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kuhn EW, Liakopoulos OJ, Stange S, Deppe AC, Slottosch I, Scherner M, Choi YH, Wahlers T. Meta-analysis of patients taking statins before revascularization and aortic valve surgery. Ann Thorac Surg 2013; 96:1508-1516. [PMID: 23993896 DOI: 10.1016/j.athoracsur.2013.04.096] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/16/2013] [Accepted: 04/22/2013] [Indexed: 11/26/2022]
Abstract
Statin intake before cardiac surgery is associated with favorable outcomes. We sought to analyze the evidence for statin pretreatment before isolated coronary artery bypass graft surgery and aortic valve replacement surgery. In this meta-analysis, we demonstrate beneficial results for the endpoints mortality, stroke, atrial fibrillation, and length of stay in hospital in 36,053 statin-pretreated coronary artery bypass graft surgery patients compared with control subjects retrieved from 32 studies, but fail to detect relevant advantages through preoperative statin therapy for 3,091 patients undergoing aortic valve replacement from four trials. Strict adherence to guidelines recommending statin treatment before CABG surgery is therefore mandatory.
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Affiliation(s)
- Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany.
| | - Oliver J Liakopoulos
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Sebastian Stange
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Antje-Christin Deppe
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Ingo Slottosch
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Maximilian Scherner
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
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Kuhn EW, Liakopoulos OJ, Stange S, Deppe AC, Slottosch I, Choi YH, Wahlers T. Preoperative statin therapy in cardiac surgery: a meta-analysis of 90,000 patients. Eur J Cardiothorac Surg 2013; 45:17-26; discussion 26. [PMID: 23562936 DOI: 10.1093/ejcts/ezt181] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this systematic literature review with meta-analysis was to determine the strength of evidence for a preoperative statin on the reduction of adverse postoperative outcomes in patients undergoing cardiac surgery. Randomized controlled (RCT) and observational trials were searched in online databases that reported about the effects of preoperative statin therapy on major adverse clinical outcomes after cardiac surgery. Analysed outcomes included early all-cause mortality, myocardial infarction, atrial fibrillation (AF), stroke and renal failure using a priori-defined criteria. Effect estimates were calculated and are given as odds ratio (OR) with 95% confidence intervals (95% CI) using fixed- or random-effect models. Literature search of all major databases retrieved 2371 studies. After screening, a total of 54 trials were identified (12 RCT, 42 observational) that reported outcomes of 91 491 cardiac surgery patients with (n = 46 614; 51%) or without (n = 44 877; 49%) preoperative statin therapy. Preoperative statin use resulted in a 0.9% absolute risk (2.6 vs 3.5%) and a 31% odds reduction for early all-cause mortality (OR 0.69; 95% CI 0.59-0.81; P < 0.0001). In addition, statin treatment before surgery was associated with a substantial reduction (P < 0.01) in the postoperative end-points AF (OR 0.71; 95% CI 0.61-0.82), new-onset AF (OR 0.68; 95% CI 0.54-0.85), stroke (OR 0.83; 95% CI 0.74-0.93), stay on intensive care unit (weighted mean difference [WMD] -0.14; 95% CI -0.23 to -0.03; P < 0.01) and in-hospital stay (WMD -0.57; 95% CI -0.76 to -0.38; P < 0.01). No statistical differences were found between groups with regard to myocardial infarction or renal failure. In conclusion, the current systematic review strengthens the evidence that preoperative statin therapy extends substantial clinical benefit to early postoperative outcomes in cardiac surgery patients.
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Affiliation(s)
- Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
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Deppe AC, Liakopoulos OJ, Choi YH, Slottosch I, Kuhn EW, Scherner M, Stange S, Wahlers T. Endoscopic vein harvesting for coronary artery bypass grafting: a systematic review with meta-analysis of 27,789 patients. J Surg Res 2013; 180:114-24. [DOI: 10.1016/j.jss.2012.11.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/15/2012] [Accepted: 11/08/2012] [Indexed: 12/13/2022]
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Kuhn EW, Liakopoulos OJ, Deppe AC, Slottosch I, Neef K, Sterner-Kock A, Madershahian N, Choi YH, Wahlers T. Rosuvastatin Reloading before Cardiac Surgery with Cardiopulmonary Bypass. Eur Surg Res 2013; 50:1-13. [DOI: 10.1159/000345448] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 10/25/2012] [Indexed: 11/19/2022]
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Kuhn EW, Choi YH, Schönherr M, Liakopoulos OJ, Rahmanian PB, Choi CYU, Wittwer T, Wahlers T. Intraoperative stress in cardiac surgery: attendings versus residents. J Surg Res 2012; 182:e43-9. [PMID: 23228324 DOI: 10.1016/j.jss.2012.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 10/09/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Performing cardiac surgery is associated with stress for surgeons. We investigated stress levels of experienced surgeons and trainees during coronary artery bypass graft teaching procedures. METHODS We assessed heart rate (HR) and sympathovagal balance (SVB) of experienced surgeons (attendings; n = 7) and residents enrolled in a training program (residents; n = 3) using a one-lead electrocardiogram during a total of 109 elective isolated coronary artery bypass graft procedures. We measured HR and SVB for baseline values at rest and at prespecified phases during the procedure in the role as primary surgeons (n = 10) and assistants (n = 9). RESULTS All participants were healthy men with a mean age of 41.4 ± 4.3 y. For patients operated on during this study, demographic and intraoperative data were homogeneous. Compared with rest, mean HR and SVB for the whole procedure were higher for surgeons and assistants, with significant differences for HR values (surgeons, 83.7 ± 8.8 beats/min [bpm]; assistants, 85.4 ± 12.7 bpm, P < 0.05 versus 62.3 ± 5.1 bpm). Courses of HR and SVB were comparable for attending and resident groups but values were higher throughout for attendings compared with residents in their role as surgeons during the total procedure, and as assistants during cardiopulmonary bypass. Mean HR and SVB values of attendings assisting the procedure were higher compared with those of residents performing the operation. CONCLUSIONS Surgical experience is not associated with reduced stress levels. Supervising a teaching case in cardiac surgery can be linked with more stress compared with the resident performing the procedure.
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Affiliation(s)
- Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
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Strauch JT, Scherner M, Haldenwang PL, Madershahian N, Pfister R, Kuhn EW, Liakopoulos OJ, Wippermann J, Wahlers T. Transapical minimally invasive aortic valve implantation and conventional aortic valve replacement in octogenarians. Thorac Cardiovasc Surg 2012; 60:335-42. [PMID: 22547302 DOI: 10.1055/s-0032-1304538] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Transcatheter aortic valve implantation (TAVI) has been developed to minimize the operative trauma in high-risk patients. Patient selection for TAVI is still subject to debate and octogenarians are often regarded as high-risk patients. METHODS In this single-center study, data of 169 octogenarians who received conventional AVR (90) or TAVI (79) have been analyzed retrospectively according to the endpoint definitions of the Valve Academic Research Consortium to answer the following questions: (a) Should patients due to their age of 80 years or older be considered as high risk? (b) Is the EuroSCORE a suitable tool for estimating mortality after AVR or TAVI in octogenarians? (c) Is TAVI the procedure of choice for octogenarians? RESULTS TAVI patients showed higher comorbid conditions concerning an existing renal dysfunction (31 vs. 56%, p = 0.001), peripheral vascular disease (6 vs. 30%, p < 0.001), diabetes (19% vs. 49%, p < 0.001), a decreased ejection fraction (LVEF < 30%: 2 vs. 13%, p < 0.05), and pulmonary hypertension (23 vs. 48%; p < 0.005) with an increase of the perioperative risk represented by logistic EuroSCORE (AVR 11% ± 1.27 vs. TAVI 38% ± 1.35; p < 0.0005) and STS Score (7% ± 0.52 vs. 14% ± 0.56; p < 0.0005). All-cause and cardiovascular-cause in-hospital or 30-day mortality was 5.6% (n = 5) and 3.4% (n = 3) in the AVR cohort and 8.8% (n = 7) and 7.6% (n = 6) in TAVI-patients (p = 0.55; p = 0.31), respectively. The overall combined safety endpoint at 30 days was 22.2% (n = 20) in AVR patients and 29.1% (n = 23) with regard to the TAVI group (p = 38). Analysis of cerebrovascular complications, vascular complications, and pacemaker revealed no significant differences. In the AVR group, actuarial survival at 6 months and 1 and 2 years was 89, 78, and 74%, respectively. Data of the TAVI patients are only available for a follow-up of 6 months and revealed a survival of 85%. CONCLUSION AVR and TAVI in octogenarians show comparable results, but the analyzed cohorts differ significantly in their risk profile. The results indicate an overrated perioperative mortality using the EuroSCORE but on the other hand logistic EuroSCORE represents articulately the different risk profile of the two groups. For this reason, we consider the EuroSCORE still to be a useful tool for preoperative risk assessment. Moreover, octogenarians cannot per se be considered as "true high risk" patients. Differentiated clinical judgment is most important for reasonable decision making.
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Abstract
BACKGROUND Patients referred to cardiac surgery for cardiovascular disease are at significant risk for the development of post-operative major adverse events despite significant advances in surgical techniques and perioperative care. Statins (HMG-CoA reductase inhibitors) have gained a pivotal role in the primary and secondary prevention of coronary artery disease, and are thought to improve perioperative outcomes in patients undergoing cardiac surgery. OBJECTIVES To determine the effectiveness of a preoperative statin therapy in patients undergoing cardiac surgery. SEARCH METHODS We searched CENTRAL (Issue 2 of 4, 2010 on The Cochrane Library), MEDLINE (1950 to May, Week 1 2010), EMBASE (1980 to 2010 Week 19), and the metaRegister of Controlled Trials. Additionally, ongoing trials were searched through the National Research Register, the ClinicalTrials.gov registry and grey literature. Conference indices from relevant scientific meetings (2006-2009) were screened online for eligible trials. No language restrictions were applied. SELECTION CRITERIA All randomized controlled trials comparing any statin treatment before cardiac surgery, for any given duration and dose, to no preoperative statin therapy (standard of care) or placebo. DATA COLLECTION AND ANALYSIS Two authors evaluated trial quality and extracted data from titles and abstracts identified from the electronic database searches according to pre-defined criteria. Accordingly, full text articles of potentially relevant studies that met the inclusion criteria were retrieved to assess definite eligibility for inclusion. Effect measures are reported as odds ratios (OR) or weighted mean difference (WMD) with 95% confidence intervals (95%-CI). MAIN RESULTS Eleven randomized controlled studies including a total of 984 participants undergoing on- or off-pump cardiac surgical procedures were identified. Pooled analysis showed that statin pre-treatment before surgery reduced the incidence of post-operative atrial fibrillation (AF) (OR 0.40; 95%-CI: 0.29 to 0.55; p<0.01), but failed to influence short-term mortality (OR 0.98, 95%-CI: 0.14 to 7.10; p=0.98) or post-operative stroke (OR 0.70, 95%-CI: 0.14 to 3.63; p=0.67). In addition, statin therapy was associated with a shorter length of stay of patients on the intensive care unit (ICU) (WMD: -3.39 hours; 95%-CI: -5.77 to -1.01) and in-hospital (WMD: -0.48 days; 95%-CI: -0.85 to -0.11) where significant heterogeneity was observed. There was no reduction in myocardial infarction (OR 0.52; 95%-CI: 0.2. to 1.30) or renal failure (OR 0.41; 95%-CI: 0.15 to 1.12). These results were unaffected after subgroup analysis. No major or minor perioperative statin side-effects were reported from trials investigating this safety endpoint. AUTHORS' CONCLUSIONS Preoperative statin therapy reduces the odds of post-operative AF and shortens the stay on the ICU and in the hospital. Statin pretreatment had no influence on perioperative mortality, stroke, myocardial infarction or renal failure. Since analysed studies included mainly patients undergoing myocardial revascularizations the results cannot be extrapolated to patients undergoing other cardiac procedures such as heart valve or aortic surgery.
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Affiliation(s)
- Oliver J Liakopoulos
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany.
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Kuhn EW, Liakopoulos OJ, Brehmer L, Slottosch I, Deppe AC, Choi YH, Wippermann J, Wahlers T. Myocardial protection with warm versus cold blood cardioplegia in patients with prolonged aortic cross-clamp times during isolated cardiac surgery. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Deppe AC, Liakopoulos OJ, Kuhn EW, Slottosch I, Geissen J, Choi YH, Neef K, Wahlers T. In-vivo and in-vitro effects of short-term statin pretreatment on coronary relaxation and injury. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kuhn EW, Choi YH, Pyun J, Neef K, Liakopoulos OJ, Slottosch I, Wittwer T, Wahlers T. Circulating endothelial cells – a super-sensitive marker of myocardial injury indicating superior myocardial protection for intermittent cold versus warm blood cardioplegia in patients undergoing CABG surgery. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Deppe AC, Liakopoulos OJ, Slottosch I, Kuhn EW, Stange S, Choi YH, Wahlers T. Endoscopic vein harvesting improves leg wound related morbidity and might impair graft patency: A systematic literature review with meta-analysis. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Slottosch I, Liakopoulos OJ, Staupendahl L, Kuhn EW, Deppe AC, Choi YH, Wippermann J, Wahlers T. Comparison of warm versus cold blood cardioplegia for patients undergoing urgent coronary artery bypass grafting for acute coronary syndrome. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Stange S, Liakopoulos OJ, Kuhn EW, Deppe AC, Choi YH, Slottosch I, Wahlers T. Statin use and clinical outcomes after cardiac surgery: a meta-analysis of over 90.000 patients. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kuhn EW, Liakopoulos OJ, Choi YH, Wahlers T. Current evidence for perioperative statins in cardiac surgery. Ann Thorac Surg 2011; 92:372-9. [PMID: 21620371 DOI: 10.1016/j.athoracsur.2011.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 03/31/2011] [Accepted: 04/04/2011] [Indexed: 12/13/2022]
Abstract
Cardiac surgery improves life expectancy and quality of life for the constantly ageing population in developed countries. Mediated by their lipid-dependent and lipid-independent mechanisms, statins are sought to provide benefit with regard to better outcomes after cardiac surgery. Current guidelines recommend statin use in patients undergoing coronary artery bypass grafting, while less evidence is available for patients referred to heart valve surgery. Optimal selection of statin drug and dosage including perioperative timing of statin therapy remains largely unknown, but results of ongoing meta-analyses and future randomized trials will add important evidence to guide perioperative statin treatment of cardiac surgery patients.
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Affiliation(s)
- Elmar W Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
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Liakopoulos OJ, Kuhn EW, Choi YH, Chang W, Wittwer T, Madershahian N, Wassmer G, Wahlers T. Myocardial protection in cardiac surgery patients requiring prolonged aortic cross-clamp times: a single-center evaluation of clinical outcomes comparing two blood cardioplegic strategies. J Cardiovasc Surg (Torino) 2010; 51:895-905. [PMID: 21124287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM The aim of this study was to evaluate the impact of intermittent warm (IWC) versus intermittent cold blood cardioplegia (ICC) in high-risk patients that require prolonged periods of aortic cross-clamping during on-pump cardiac surgery. METHODS From 3527 consecutive patients undergoing on-pump cardiac surgery, 520 patients were retrospectively identified that required prolonged aortic cross-clamp ≥ 75 min. Myocardial protection was performed with ICC (N.=280) or IWC (N.=240). Groups were compared regarding clinical outcomes, myocardial injury (CK-MB, cTnT) and multivariate analysis was performed to assess the impact of applied cardioplegia on 30-day all-cause mortality, cardiac death, perioperative myocardial injury (PM) and major adverse cardiac events (MACE). RESULTS Demographic data, mean logistic Euroscore, aortic-cross-clamping and CPB time were comparable between groups. Patients with ICC needed more intraoperative defibrillations, had more postoperative blood transfusions and a prolonged hospital stay when compared to the IWC-group (P < 0.05). Thirty-day all-cause mortality tended to be higher in IWC (11% vs. 6%; P = 0.083) with significantly higher cardiac mortality (9% vs. 4%; P=0.015) compared to ICC. Myocardial injury was more pronounced in the IWC-group with a higher incidence of PMI (IWC: 17% vs. ICC:6%; P < 0.05) and MACE (IWC:37% vs. ICC:25%; P < 0.05). Groups did not differ regarding other postoperative clinical outcomes. Multivariate analysis revealed IWC to be independently predictive (P < 0.05) for 30-day all-cause mortality (OR:2.42; 95% CI:1.04-5.05), cardiac death (OR:3.57; 95% CI:1.49-8.85), MACE (OR:1.87; 95% CI:1.22-2.87) and PMI (OR:3.46; 95% CI:1.86-6.41). CONCLUSION ICC results in less myocardial damage and reduced postoperative cardiac mortality and morbidity in patients requiring extended periods of aortic-cross-clamping during on-pump cardiac surgery, suggesting superior cardioprotection when compared to IWC.
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Affiliation(s)
- O J Liakopoulos
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
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Kuhn EW, Liakopoulos OJ, Borys MJ, Haldenwang PL, Strauch JT, Madershahian N, Choi YH, Wahlers T. Statins improve surgical ablation outcomes for atrial fibrillation in patients undergoing concomitant cardiac surgery☆. Interact Cardiovasc Thorac Surg 2010; 11:24-8. [DOI: 10.1510/icvts.2009.230060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Liakopoulos OJ, Kuhn EW, Wahlers T. Reply to the Editor. J Thorac Cardiovasc Surg 2010. [DOI: 10.1016/j.jtcvs.2009.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Strauch JT, Scherner MP, Haldenwang PL, Pfister R, Kuhn EW, Madershahian N, Rahmanian P, Wippermann J, Wahlers T. Minimally Invasive Transapical Aortic Valve Implantation and the Risk of Acute Kidney Injury. Ann Thorac Surg 2010; 89:465-70. [DOI: 10.1016/j.athoracsur.2009.09.090] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 09/16/2009] [Accepted: 09/17/2009] [Indexed: 12/26/2022]
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