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Patrascu A, Binder D, Al Farwan F, Weinmann K, Ott I. Two 'firsts' in a patient with tricuspid valve infective endocarditis following edge-to-edge repair: a case report. Eur Heart J Case Rep 2024; 8:ytae181. [PMID: 38690560 PMCID: PMC11060098 DOI: 10.1093/ehjcr/ytae181] [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: 11/23/2023] [Revised: 03/28/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024]
Abstract
Background Tricuspid regurgitation (TR) is associated with increased morbidity and mortality. As many elderly TR patients are deemed inoperable, transcatheter edge-to-edge repair (T-TEER) is arising as a viable treatment option. Though procedural safety aspects seem excellent, long-term risks cannot be ignored, including the feasibility of cardiac pacing by endovascular lead implantation at a later time, as well as T-TEER device-related infective endocarditis (IE), in the context of systemic infection. Case summary We present the case of an 80-year-old man with recurrent admissions for right heart failure due to massive TR, despite successful percutaneous mitral valve repair. The patient was turned down for surgery and eventually underwent T-TEER, with successful TR reduction to mild-to-moderate and improvement in quality of life. Five months later, the patient was admitted for symptomatic bradycardia and the first reported pacemaker implantation after T-TEER with a specific tricuspid valve device was performed. Lead implantation was guided by transoesophageal echocardiography, and did not worsen residual TR. Two years later, the patient presented with device-related tricuspid valve IE, again a 'first' following T-TEER. Despite antimicrobial therapy, the vegetation embolized through the atrial septal defect caused by prior mitral-TEER and triggered an ischaemic stroke. Furthermore, sepsis led to multiorgan failure and eventually death. Discussion Tricuspid regurgitation is an individual predictor of morbidity and mortality, frequently found in elderly, and should be addressed in symptomatic inoperable patients. With the rise of interventional treatment, new challenges face long-term follow-up and treatment after percutaneous repair. This case report underscores the feasibility of endovascular pacemaker lead implantation after T-TEER, while it points to the risk of device-related tricuspid valve IE.
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Affiliation(s)
- Alexandru Patrascu
- Department of Cardiology, Helios Hospital Pforzheim, Kanzlerstrasse 2-6, Pforzheim 75175, Germany
- Private University in the Principality of Liechtenstein (UFL), Triesen, Principality of Liechtenstein
| | - Donat Binder
- Department of Cardiology, Helios Hospital Pforzheim, Kanzlerstrasse 2-6, Pforzheim 75175, Germany
| | - Feraas Al Farwan
- Department of Cardiology, Helios Hospital Pforzheim, Kanzlerstrasse 2-6, Pforzheim 75175, Germany
| | - Kai Weinmann
- Department of Cardiology, Helios Hospital Pforzheim, Kanzlerstrasse 2-6, Pforzheim 75175, Germany
| | - Ilka Ott
- Department of Cardiology, Helios Hospital Pforzheim, Kanzlerstrasse 2-6, Pforzheim 75175, Germany
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Patrascu A, Weinmann K, Ott I. A parachute-like mitral valve with a unique calcification pattern. Eur Heart J Case Rep 2024; 8:ytae155. [PMID: 38567270 PMCID: PMC10986393 DOI: 10.1093/ehjcr/ytae155] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/23/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Alexandru Patrascu
- Department of Cardiology, Rhythmology, Electrophysiology and Angiology, Helios Hospital Pforzheim, Kanzlerstrasse 2-6, 75175 Pforzheim, Germany
| | - Kai Weinmann
- Department of Cardiology, Rhythmology, Electrophysiology and Angiology, Helios Hospital Pforzheim, Kanzlerstrasse 2-6, 75175 Pforzheim, Germany
| | - Ilka Ott
- Department of Cardiology, Rhythmology, Electrophysiology and Angiology, Helios Hospital Pforzheim, Kanzlerstrasse 2-6, 75175 Pforzheim, Germany
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Stockhausen S, Kilani B, Schubert I, Steinsiek AL, Chandraratne S, Wendler F, Eivers L, von Brühl ML, Massberg S, Ott I, Stark K. Differential Effects of Erythropoietin Administration and Overexpression on Venous Thrombosis in Mice. Thromb Haemost 2023. [PMID: 37846465 DOI: 10.1055/s-0043-1775965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND Deep vein thrombosis (DVT) is a common condition associated with significant mortality due to pulmonary embolism. Despite advanced prevention and anticoagulation therapy, the incidence of venous thromboembolism remains unchanged. Individuals with elevated hematocrit and/or excessively high erythropoietin (EPO) serum levels are particularly susceptible to DVT formation. We investigated the influence of short-term EPO administration compared to chronic EPO overproduction on DVT development. Additionally, we examined the role of the spleen in this context and assessed its impact on thrombus composition. METHODS We induced ligation of the caudal vena cava (VCC) in EPO-overproducing Tg(EPO) mice as well as wildtype mice treated with EPO for two weeks, both with and without splenectomy. The effect on platelet circulation time was evaluated through FACS analysis, and thrombus composition was analyzed using immunohistology. RESULTS We present evidence for an elevated thrombogenic phenotype resulting from chronic EPO overproduction, achieved by combining an EPO-overexpressing mouse model with experimental DVT induction. This increased thrombotic state is largely independent of traditional contributors to DVT, such as neutrophils and platelets. Notably, the pronounced prothrombotic effect of red blood cells (RBCs) only manifests during chronic EPO overproduction and is not influenced by splenic RBC clearance, as demonstrated by splenectomy. In contrast, short-term EPO treatment does not induce thrombogenesis in mice. Consequently, our findings support the existence of a differential thrombogenic effect between chronic enhanced erythropoiesis and exogenous EPO administration. CONCLUSION Chronic EPO overproduction significantly increases the risk of DVT, while short-term EPO treatment does not. These findings underscore the importance of considering EPO-related factors in DVT risk assessment and potential therapeutic strategies.
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Affiliation(s)
- Sven Stockhausen
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Walter-Brendel Center of Experimental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Badr Kilani
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Walter-Brendel Center of Experimental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Irene Schubert
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Walter-Brendel Center of Experimental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | | | - Sue Chandraratne
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Walter-Brendel Center of Experimental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Franziska Wendler
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Walter-Brendel Center of Experimental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Luke Eivers
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Walter-Brendel Center of Experimental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Marie-Luise von Brühl
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Walter-Brendel Center of Experimental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Walter-Brendel Center of Experimental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Ilka Ott
- Department of cardiology, German Heart Center, Munich, Germany
| | - Konstantin Stark
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Walter-Brendel Center of Experimental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
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Müller AM, Bertram J, Bradaric C, Koppara T, Cassese S, Xhepa E, Heilmeier B, Ott I, Kastrati A, Laugwitz KL, Ibrahim T, Dirschinger RJ. Frequency of subclavian artery stenosis in patients with mammarian artery coronary bypass and suspected coronary artery disease progression. Clin Res Cardiol 2023; 112:1204-1211. [PMID: 36239814 PMCID: PMC10449982 DOI: 10.1007/s00392-022-02113-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/04/2022] [Indexed: 12/24/2022]
Abstract
We retrospectively analyzed patient records of all patients with a history of internal mammarian artery (IMA) coronary bypass undergoing coronary angiography at two cardiovascular centers between January 1st 1999 and December 31st 2019. A total of 11,929 coronary angiographies with or without percutaneous coronary intervention were carried out in 3921 patients. Our analysis revealed 82 (2%) patients with documented subclavian artery stenosis. Of these, 8 (10%) patients were classified as having mild, 18 (22%) moderate, and 56 (68%) severe subclavian artery stenosis. In 7 (9%) patients with subclavian artery stenosis, angiography revealed occlusion of the IMA graft. 26 (32%) patients with severe subclavian artery stenosis underwent endovascular or surgical revasculararization of the subclavian artery. In this retrospective multicenter study, subclavian artery stenosis was a relevant finding in patients with an internal mammarian artery coronary bypass graft undergoing coronary angiography. The development of dedicated algorithms for screening and ischemia evaluation in affected individuals may improve treatment of this potentially underdiagnosed and undertreated condition.
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Affiliation(s)
- Arne M Müller
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Justus Bertram
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Bradaric
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tobias Koppara
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Abteilung Für Herz- Und Kreislauferkrankungen, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Abteilung Für Herz- Und Kreislauferkrankungen, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | | | - Ilka Ott
- Helios Klinikum Pforzheim, Abteilung für Kardiologie, Angiologie und Intensivmedizin, Kanzlerstr. 2-6, 75175, Pforzheim, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Abteilung Für Herz- Und Kreislauferkrankungen, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Biedersteiner Str. 29, 80331, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Biedersteiner Str. 29, 80331, Munich, Germany
| | - Tareq Ibrahim
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ralf J Dirschinger
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
- Gefäßpraxis im Tal, Tal 13, 80331, Munich, Germany.
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Trenkwalder T, Lachmann M, Stolz L, Fortmeier V, Covarrubias HAA, Rippen E, Schürmann F, Presch A, von Scheidt M, Ruff C, Hesse A, Gerçek M, Mayr NP, Ott I, Schuster T, Harmsen G, Yuasa S, Kufner S, Hoppmann P, Kupatt C, Schunkert H, Kastrati A, Laugwitz KL, Rudolph V, Joner M, Hausleiter J, Xhepa E. Machine learning identifies pathophysiologically and prognostically informative phenotypes among patients with mitral regurgitation undergoing transcatheter edge-to-edge repair. Eur Heart J Cardiovasc Imaging 2023; 24:574-587. [PMID: 36735333 DOI: 10.1093/ehjci/jead013] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
AIMS Patients with mitral regurgitation (MR) present with considerable heterogeneity in cardiac damage depending on underlying aetiology, disease progression, and comorbidities. This study aims to capture their cardiopulmonary complexity by employing a machine-learning (ML)-based phenotyping approach. METHODS AND RESULTS Data were obtained from 1426 patients undergoing mitral valve transcatheter edge-to-edge repair (MV TEER) for MR. The ML model was developed using 609 patients (derivation cohort) and validated on 817 patients from two external institutions. Phenotyping was based on echocardiographic data, and ML-derived phenotypes were correlated with 5-year outcomes. Unsupervised agglomerative clustering revealed four phenotypes among the derivation cohort: Cluster 1 showed preserved left ventricular ejection fraction (LVEF; 56.5 ± 7.79%) and regular left ventricular end-systolic diameter (LVESD; 35.2 ± 7.52 mm); 5-year survival in Cluster 1, hereinafter serving as a reference, was 60.9%. Cluster 2 presented with preserved LVEF (55.7 ± 7.82%) but showed the largest mitral valve effective regurgitant orifice area (0.623 ± 0.360 cm2) and highest systolic pulmonary artery pressures (68.4 ± 16.2 mmHg); 5-year survival ranged at 43.7% (P-value: 0.032). Cluster 3 was characterized by impaired LVEF (31.0 ± 10.4%) and enlarged LVESD (53.2 ± 10.9 mm); 5-year survival was reduced to 38.3% (P-value: <0.001). The poorest 5-year survival (23.8%; P-value: <0.001) was observed in Cluster 4 with biatrial dilatation (left atrial volume: 312 ± 113 mL; right atrial area: 46.0 ± 8.83 cm2) although LVEF was only slightly reduced (51.5 ± 11.0%). Importantly, the prognostic significance of ML-derived phenotypes was externally confirmed. CONCLUSION ML-enabled phenotyping captures the complexity of extra-mitral valve cardiac damage, which does not necessarily occur in a sequential fashion. This novel phenotyping approach can refine risk stratification in patients undergoing MV TEER in the future.
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Affiliation(s)
- Teresa Trenkwalder
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
| | - Mark Lachmann
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Vera Fortmeier
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany
| | | | - Elena Rippen
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Friederike Schürmann
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
| | - Antonia Presch
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
| | - Celine Ruff
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
| | - Amelie Hesse
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Muhammed Gerçek
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany
| | - N Patrick Mayr
- Institute of Anesthesiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
| | - Ilka Ott
- Department of Cardiology, Helios Klinikum Pforzheim, Kanzlerstrasse 2-6, 75175 Pforzheim, Germany
| | - Tibor Schuster
- Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montréal, QC, Canada
| | - Gerhard Harmsen
- Department of Physics, University of Johannesburg, Auckland Park, 5 Kingsway Avenue, Rossmore, 2092 Johannesburg, South Africa
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, 35-Shinanomachi, Shinjuku-ku, 160-8582 Tokyo, Japan
| | - Sebastian Kufner
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
| | - Petra Hoppmann
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Christian Kupatt
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
| | - Karl-Ludwig Laugwitz
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany
| | - Michael Joner
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
| | - Jörg Hausleiter
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Erion Xhepa
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstrasse 8a & 9, 80336 Munich, Germany
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Patrascu AI, Binder D, Alashkar I, Schnabel P, Stähle W, Weinmann K, Schneider J, Conzelmann LO, Mehlhorn U, Ott I. Transcatheter Tricuspid Valve Repair in Prohibitive Risk Patients: Impact on Quality of Life and Major Organ Systems. Can J Cardiol 2022; 38:1921-1931. [PMID: 36096401 DOI: 10.1016/j.cjca.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/01/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Percutaneous repair for severe tricuspid regurgitation (TR) is emerging as a viable option, but patient selection is challenging and predetermined by comorbidities. This study evaluated mid-term outcomes of transcatheter tricuspid valve repair (TTVR) in very sick inoperable patients and explored the concept of risk-based therapeutic futility. METHODS TTVR patients treated in our centre were prospectively assigned to prohibitive-risk (PR) and high-risk (HR) subgroups, based on Society of Thoracic Surgeons (STS) Score, frailty indices, and major organ system compromise. Efficacy and safety outcomes were compared at baseline, 30 days, and 6 months. RESULTS Thirty-three patients (mean age 81.9 ± 5.1 years) completed follow-up from May 2021 to March 2022: 18 PR (mean STS Score 15.5 ± 7%) and 15 HR (mean STS Score 6.4 ± 1.7%). The primary efficacy end point of at least 1 grade of TR reduction by 30 days was recorded in 93.9% of all patients, with no device-related adverse events. Improvement in initial New York Heart Association functional class III/IV occurred in 74% of PR and 93% of HR patients. Six-minute walk test increased by 81 ± 43.6 metres (P < 0.001) and 85.8 ± 47.9 metres (P < 0.001), respectively. Renal function tests improved by 15% (P = 0.048) and 7% (P = 0.050), while liver enzymes decreased by 18% (P = 0.020) and 28% (P = 0.052). Right ventricular systolic function increased in both subgroups by at least 24% (P < 0.001). Six-month mortality was 12.1%, with 6 hospitalisations for acute heart failure. CONCLUSIONS TR reduction significantly affected quality of life, functional capacity, cardiac remodelling, and multiorgan involvement similarly in PR and HR patients. TTVR is feasible in very sick symptomatic patients, regardless of predicted risk.
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Affiliation(s)
- Alexandru I Patrascu
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany; Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.
| | - Donat Binder
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
| | - Ibrahim Alashkar
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
| | - Peter Schnabel
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
| | - Wilfried Stähle
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
| | - Kai Weinmann
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
| | - Jochen Schneider
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
| | | | - Uwe Mehlhorn
- Department of Cardiac Surgery Helios Hospital, Karlsruhe, Germany
| | - Ilka Ott
- Department of Cardiology, Rhythmology, Electrophysiology, and Angiology Helios Hospital, Pforzheim, Germany
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7
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Patrascu I, Binder D, Alashkar I, Weinmann K, Schneider J, Staehle W, Schnabel P, Ott I. Transthoracic echocardiography guidance of transcatheter edge-to-edge percutaneous tricuspid valve repair: the TTE-TTVR pilot study and methodology proposal. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.106] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Transcatheter tricuspid valve repair (TTVR) is an emerging option for treating high-grade tricuspid regurgitation (TR) [1], mostly performed by edge-to-edge repair, and always guided by transesophageal echocardiography (TOE). In patients with excellent acoustic window, transthoracic echocardiography (TTE) can also provide a comprehensive understanding of tricuspid valve (TV) morphology [2]. Also, in TTVR there is no need for transseptal puncture.
Purpose
We sought to determine if TTVR can be successfully conducted by a novel TTE guiding approach, in conjunction with fluoroscopy [3].
Methods
30 consecutive patients, scheduled for TTVR, were assigned to a TTE group (n=10), in the presence of excellent acoustic window, and a TOE group (n=20). On top of fluoroscopy, TTVR was guided exclusively by TTE in the first group, with TOE result confirmation solely upon clip release, due to safety reasons. The second group underwent classical TOE guidance. Understanding the 4 right heart chamber views (Fig. 1) and their respective fluoroscopic angulations was paramount. TR severity, parameters of quality of life and functional capacity were assessed and compared between-groups, at baseline and 30 days.
Results
Except for lower BMI (TTE 22.3±0.8 vs TOE 29.8±4.3, p<0.001), other baseline characteristics were very similar between groups, e.g., age (81.7±3.9 vs 82.8±4.1, p=0.483) or EuroSCORE II (11.9±10.3 vs 10.4±8, p=0.692).Device success was achieved in all patients, with a total of 15 implanted clips in the TTE group (mean no. of clips / patient 1.5±0.7) and 31 clips in the TOE group (1.5±0.6). Device time (75±37.1 vs 65.7±31.3 minutes, p=0.506) and fluoroscopy duration (16.3±10.5 vs 14.4±7.2 minutes, p=0.564) were also close. TR reduction was successful in all but one patient, in each group (90% vs 95%, p=1.000). TR improvement was equal between-groups, with 2 or more grade reduction in 60% of each group, at 30 days. Thus, grade IV/V and V/V TR, present in 60% of all patients at baseline, dropped to 10% (9/10 vs 18/20, p=1.000) by procedure end and follow-up (Fig. 2). No device associated complications occurred. By 30 days, there was one non-cardiac death and one major bleeding.
At follow-up, all but one patient had at least one grade reduction in NYHA class (10/10 vs 19/20, p=1.000). Kansas City Cardiomyopathy Questionnaire score and 6-minute walk distance similarly improved (Δ20.7±14.9 vs 15.5±7.9 points, p=0.227; Δ80.5±60.1 vs 46.6±30.6 meters, p=0.121). A statistical in-group difference was also noticed in renal function improvement by follow-up [glomerular filtration rate (GFR) TTE group 56.8±18.7 vs 64.8±12.5 ml/m2/1.73 m2, p=0.028; TOE group 50.7±19.9 vs 62.2±25.9, p=0.001].
Conclusion
TTE guidance of TTVR is feasible in selected patients with excellent acoustic window and could offer an alternative in case of high anesthetic risk. Similar procedural success and clinical outcomes, as with TOE guidance, can be achieved.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Patrascu
- Helios Pforzheim Clinic , Pforzheim , Germany
| | - D Binder
- Helios Pforzheim Clinic , Pforzheim , Germany
| | - I Alashkar
- Helios Pforzheim Clinic , Pforzheim , Germany
| | - K Weinmann
- Helios Pforzheim Clinic , Pforzheim , Germany
| | - J Schneider
- Helios Pforzheim Clinic , Pforzheim , Germany
| | - W Staehle
- Helios Pforzheim Clinic , Pforzheim , Germany
| | - P Schnabel
- Helios Pforzheim Clinic , Pforzheim , Germany
| | - I Ott
- Helios Pforzheim Clinic , Pforzheim , Germany
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8
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Voll F, Wolf F, Ingwersen M, Kinstner CM, Kufner S, Ibrahim T, Ott I, Krankenberg H, Fusaro M, Cassese S. Diabetes mellitus and femoropopliteal in-stent restenosis. VASA 2022; 51:247-255. [DOI: 10.1024/0301-1526/a001006] [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: 11/19/2022]
Abstract
Summary: Background: The influence of diabetes mellitus (DM) on recurrent in-stent restenosis (ISR) of femoropopliteal arteries remains understudied. We investigated whether DM has an impact on recurrent restenosis after femoropopliteal stenting in patients included in the dRug-coatEd balloon angioPlasty for femoropopliteAl In-stent Restenosis (REPAIR) cooperation. Patients and methods: The REPAIR cooperation pooled the patient-level data from 3 randomized trials in which patients with ISR of femoropopliteal arteries received either drug-coated balloon (DCB) or plain balloon angioplasty. For this analysis, patients were divided in two groups based on whether they had or had not a DM diagnosis at the time of enrollment. The primary outcome was target lesion revascularization (TLR). The main secondary outcome was recurrent ISR. Other outcomes of interest were death, Rutherford class improvement and ankle-brachial index at follow-up. Results: 256 patients (DM, n=99 vs. non-DM, n=157) with 12-month follow-up were included in the analysis. Compared to non-DM patients, DM patients displayed no difference in terms of TLR [adjusted hazard ratio (95% Confidence intervals): 0.96 (0.55, 1.69), p=0.89] and recurrent ISR [1.04 (0.61, 1.77), p=0.88], whilst mortality was higher [9.38 (1.06, 83.11), p=0.044]. There were no differences between groups with respect to other secondary outcomes. The percutaneous treatment with DCB as compared to plain balloon angioplasty significantly reduced the risk of TLR and recurrent ISR without an excess risk of death irrespective of DM (p for interaction ≥0.70). Conclusions: In patients with femoropopliteal ISR, diabetes has a neutral effect on the risk of recurrence, but increases mortality at 12-month follow-up. DCB as compared to plain balloon angioplasty is associated with superior efficacy without trade-off in safety, regardless of diabetes.
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Affiliation(s)
- Felix Voll
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
| | - Florian Wolf
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Maja Ingwersen
- Department of Radiology, Friedrich-Schiller-University, Jena University Hospital, Jena, Germany
| | - Christian M. Kinstner
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Sebastian Kufner
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
| | - Tareq Ibrahim
- I. Medical Department – Cardiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Ilka Ott
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
- Cardiology Clinic, Helios Hospital Pforzheim, Germany
| | | | - Massimiliano Fusaro
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
- Department of Interventional Cardiology, Klinik Vincentinum, Augsburg, Germany
- These authors contributed equally
| | - Salvatore Cassese
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
- These authors contributed equally
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9
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Ott I. Geschlechtsspezifische Unterschiede bei koronarer
Herzerkrankung. Aktuelle Kardiologie 2022. [DOI: 10.1055/a-1692-0929] [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
ZusammenfassungDie koronare Herzerkrankung ist die häufigste Herzerkrankung bei Frauen und Männern.
Geschlechtsspezifische Unterschiede in der Symptomatik, der Prognose und der Behandlung
bei Patienten mit koronarer Herzerkrankung wurden bereits in zahlreichen Studien
untersucht. Frauen sind älter, besitzen mehr Komorbiditäten, beklagen eher atypische
Symptome, suchen später ärztliche Hilfe auf und werden weniger leitliniengerecht
behandelt. In dem Artikel sollen geschlechtsspezifische Unterschiede bei Patienten mit
akutem und chronischem Koronarsyndrom zusammengefasst werden.
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Affiliation(s)
- Ilka Ott
- 1. Med. Klinik, HELIOS Klinikum Pforzheim GmbH, Pforzheim,
Deutschland
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10
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Patrascu A, Binder D, Polleit B, Ott I. Transthoracic guidance of percutaneous tricuspid valve repair: a case report. Eur Heart J Case Rep 2021; 5:ytab449. [PMID: 34909572 PMCID: PMC8664752 DOI: 10.1093/ehjcr/ytab449] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/17/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Percutaneous tricuspid valve (TV) repair for tricuspid regurgitation (TR) is arising as a viable treatment option in high-risk patients and can lead to symptom control an improvement in quality of life (QoL). Newest devices have greatly increased safety and efficacy of interventional TR therapy. However, as with any emerging medical procedure, safety aspects need to be considered and procedural risks gradually reduced.
Case summary
We present the case of an 87-year-old woman with massive TR despite successful percutaneous mitral valve repair. The patient was turned down for surgery and eventually underwent percutaneous TV repair using the TriClip™ (Abbott Medical) device. Significant TR reduction with sustained procedural success at 30-day follow-up were associated with functional and clinical improvement. Transthoracic echocardiographic guidance of the procedure, thanks to excellent parasternal TV visualization, is highlighted, while the complex anatomy of the TV is pointed out.
Discussion
Tricuspid regurgitation is an individual predictor of morbidity but frequently found in elderly patients who are deemed very high risk for surgical treatment. This case underscores the use of modern interventional techniques and devices for addressing TR and improving QoL, whether as a stand-alone procedure or as part of complete interventional therapy of the atrioventricular valves.
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Affiliation(s)
- Alexandru Patrascu
- Department of Cardiology, Helios Hospital Pforzheim, Kanzlerstrasse 2-6, 75175 Pforzheim, Germany
| | - Donat Binder
- Department of Cardiology, Helios Hospital Pforzheim, Kanzlerstrasse 2-6, 75175 Pforzheim, Germany
| | | | - Ilka Ott
- Department of Cardiology, Helios Hospital Pforzheim, Kanzlerstrasse 2-6, 75175 Pforzheim, Germany
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11
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Ott I, Rumpf P, Kasel M, Kastrati A, Kaemmerer H, Schunkert H, Ewert P, Tutarel O. Transcatheter valve repair in congenitally corrected transposition of the great arteries. EUROINTERVENTION 2021; 17:744-746. [PMID: 33528360 PMCID: PMC9724916 DOI: 10.4244/eij-d-20-01093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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)
- Ilka Ott
- Medizinische Klinik I, Helios Klinikum Pforzheim, Pforzheim, Germany
| | - Philipp Rumpf
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Markus Kasel
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Peter Ewert
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany,Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Oktay Tutarel
- German Heart Centre Munich/Technical University of Munich, Lazarettstr. 36, 80636 Munich, Germany
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12
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Sonne C, Persch H, Rosner S, Ott I, Nagy E, Nikendei C. Significant differences in written assessments as a result of a blended learning approach used in a clinical examination course in internal medicine: a randomized controlled pilot study. GMS J Med Educ 2021; 38:Doc42. [PMID: 33763527 PMCID: PMC7958916 DOI: 10.3205/zma001438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/14/2020] [Accepted: 09/30/2020] [Indexed: 05/21/2023]
Abstract
Background: Taking a medical history and performing a physical examination represent basic medical skills. However, numerous national and international studies show that medical students and physicians-to-be demonstrate substantial deficiencies in the proper examination of individual organ systems. Aim: The objective of this study was to conduct a randomized controlled pilot study to see if, in the context of a bedside clinical examination course in internal medicine, an additional app-based blended-learning strategy resulted in (a) higher satisfaction, better self-assessments by students when rating their history-taking skills (b1) and their ability to perform physical examinations (b2), as well as (c) higher multiple-choice test scores at the end of the course, when compared to a traditional teaching strategy. Methods: Within the scope of a bedside course teaching the techniques of clinical examination, 26 students out of a total of 335 students enrolled in the 2012 summer semester and 2012/2013 winter semester were randomly assigned to two groups of the same size. Thirteen students were in an intervention group (IG) with pre- and post-material for studying via an app-based blended-learning tool, and another 13 students were in a control group (CG) with the usual pre- and post-material (handouts). The IG was given an app specifically created for the history-taking and physical exam course, an application program for smartphones enabling them to view course material directly on the smartphone. The CG received the same information in the form of paper-based notes. Prior to course begin, all of the students filled out a questionnaire on sociodemographic data and took a multiple-choice pretest with questions on anamnesis and physical examination. After completing the course, the students again took a multiple-choice test with questions on anamnesis and physical examination. Results: When compared to the CG, the IG showed significantly more improvement on the multiple-choice tests after taking the clinical examination course (p=0.022). This improvement on the MC tests in the IG significantly correlated with the amount of time spent using the app (Spearman's rho=0.741, p=0.004). Conclusion: When compared to conventional teaching, an app-based blended-learning approach leads to improvement in test scores, possibly as a result of more intensive preparation for and review of the clinical examination course material.
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Affiliation(s)
- Carolin Sonne
- Technische Universität München, Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen des Erwachsenen, Munich, Germany
- *To whom correspondence should be addressed: Carolin Sonne, Technische Universität München, Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen des Erwachsenen, Munich, Germany, Phone: +49 (0)178/6139340, E-mail:
| | - Hasema Persch
- Technische Universität München, Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen des Erwachsenen, Munich, Germany
- Universitätsklinikum Ulm, Innere Medizin II, Sektion Sport- und Rehabilitationsmedizin, Ulm, Germany
| | - Stefanie Rosner
- Technische Universität München, Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen des Erwachsenen, Munich, Germany
| | - Ilka Ott
- Technische Universität München, Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen des Erwachsenen, Munich, Germany
| | - Ede Nagy
- Universitätsklinikum Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik, Heidelberg, Germany
| | - Christoph Nikendei
- Universitätsklinikum Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik, Heidelberg, Germany
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13
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Müller AM, Räpple V, Bradaric C, Koppara T, Kehl V, Fusaro M, Cassese S, Ott I, Kastrati A, Laugwitz KL, Ibrahim T. Outcomes of endovascular treatment for infrapopliteal peripheral artery disease based on the updated TASC II classification. Vasc Med 2020; 26:18-25. [PMID: 33256573 DOI: 10.1177/1358863x20967091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We retrospectively analyzed all endovascular procedures of infrapopliteal arterial lesions (n = 383) performed in 270 patients at our institution between December 2008 and January 2018. The overall technical success rate was 97% and yielded 98% for stenoses (n = 214) and 95% for occlusions (n = 169). Trans-Atlantic Inter-Society Consensus (TASC II) classification had no impact on success rates (TASC A + B vs C + D; 96.5% vs 96.9%, p = 0.837). Freedom from clinically driven target lesion revascularization (TLR) after 6 and 12 months was 88.3% and 77.2%. TLR was comparable for TASC A to C lesions and no difference was observed comparing groups of moderately complex TASC A/B lesions and more complex TASC C/D lesions (TASC A + B vs C + D; 78.5% vs 74.2%, p = 0.457). Freedom from TLR was significantly lower in very complex TASC D lesions (TASC A + B + C vs D; 79.7% vs 42.5%, p < 0.001). Multivariate analysis identified TASC D lesions (hazard ratio D/A: 1.5; overall p = 0.002), Fontaine class III and IV (hazard ratio III or IV/IIa or IIb: 2.4; p = 0.041), and occlusive lesions (hazard ratio occlusion/stenosis: 2.4; p = 0.026) as predictors for TLR. In conclusion, endovascular therapy for infrapopliteal artery disease was safe and accompanied with a promising long-term outcome.
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Affiliation(s)
- Arne M Müller
- Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin I., Technische Universität München, Munich, Germany
| | - Veronika Räpple
- Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin I., Technische Universität München, Munich, Germany
| | - Christian Bradaric
- Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin I., Technische Universität München, Munich, Germany
| | - Tobias Koppara
- Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin I., Technische Universität München, Munich, Germany
| | - Victoria Kehl
- Klinikum rechts der Isar, Institut für Medizinische Informatik, Statistik und Epidemiologie, Technische Universität München, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Ilka Ott
- Helios Klinikum Pforzheim, Abteilung für Kardiologie, Angiologie und Intensivmedizin, Pforzheim, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin I., Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Tareq Ibrahim
- Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin I., Technische Universität München, Munich, Germany
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14
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Deutsch MA, Brunner S, Grabmaier U, David R, Ott I, Huber BC. Cardioprotective Potential of Human Endothelial-Colony Forming Cells from Diabetic and Nondiabetic Donors. Cells 2020; 9:cells9030588. [PMID: 32131432 PMCID: PMC7140510 DOI: 10.3390/cells9030588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/20/2022] Open
Abstract
Objective: The potential therapeutic role of endothelial progenitor cells (EPCs) in ischemic heart disease for myocardial repair and regeneration is subject to intense investigation. The aim of the study was to investigate the proregenerative potential of human endothelial colony-forming cells (huECFCs), a very homogenous and highly proliferative endothelial progenitor cell subpopulation, in a myocardial infarction (MI) model of severe combined immunodeficiency (SCID) mice. Methods: CD34+ peripheral blood mononuclear cells were isolated from patient blood samples using immunomagnetic beads. For generating ECFCs, CD34+ cells were plated on fibronectin-coated dishes and were expanded by culture in endothelial-specific cell medium. Either huECFCs (5 × 105) or control medium were injected into the peri-infarct region after surgical MI induction in SCID/beige mice. Hemodynamic function was assessed invasively by conductance micromanometry 30 days post-MI. Hearts of sacrificed animals were analyzed by immunohistochemistry to assess cell fate, infarct size, and neovascularization (huECFCs n = 15 vs. control n = 10). Flow-cytometric analysis of enzymatically digested whole heart tissue was used to analyze different subsets of migrated CD34+/CD45+ peripheral mononuclear cells as well as CD34−/CD45− cardiac-resident stem cells two days post-MI (huECFCs n = 10 vs. control n = 6). Results: Transplantation of human ECFCs after MI improved left ventricular (LV) function at day 30 post-MI (LVEF: 30.43 ± 1.20% vs. 22.61 ± 1.73%, p < 0.001; ΔP/ΔTmax 5202.28 ± 316.68 mmHg/s vs. 3896.24 ± 534.95 mmHg/s, p < 0.05) when compared to controls. In addition, a significantly reduced infarct size (50.3 ± 4.5% vs. 66.1 ± 4.3%, p < 0.05) was seen in huECFC treated animals compared to controls. Immunohistochemistry failed to show integration and survival of transplanted cells. However, anti-CD31 immunohistochemistry demonstrated an increased vascular density within the infarct border zone (8.6 ± 0.4 CD31+ capillaries per HPF vs. 6.2 ± 0.5 CD31+ capillaries per HPF, p < 0.001). Flow cytometry at day two post-MI showed a trend towards increased myocardial homing of CD45+/CD34+ mononuclear cells (1.1 ± 0.3% vs. 0.7 ± 0.1%, p = 0.2). Interestingly, we detected a significant increase in the population of CD34−/CD45−/Sca1+ cardiac resident stem cells (11.7 ± 1.7% vs. 4.7 ± 1.7%, p < 0.01). In a subgroup analysis no significant differences were seen in the cardioprotective effects of huECFCs derived from diabetic or nondiabetic patients. Conclusions: In a murine model of myocardial infarction in SCID mice, transplantation of huECFCs ameliorated myocardial function by attenuation of adverse post-MI remodeling, presumably through paracrine effects. Cardiac repair is enhanced by increasing myocardial neovascularization and the pool of Sca1+ cardiac resident stem cells. The use of huECFCs for treating ischemic heart disease warrants further investigation.
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Affiliation(s)
- Marcus-André Deutsch
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany;
| | - Stefan Brunner
- Department of Internal Medicine I, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr. 15, D-81377 Munich, Germany; (S.B.); (U.G.)
| | - Ulrich Grabmaier
- Department of Internal Medicine I, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr. 15, D-81377 Munich, Germany; (S.B.); (U.G.)
| | - Robert David
- Reference- and Translation Center for Cardiac Stem Cell Therapy (RTC), Rostock University Medical Center, Department of Cardiac Surgery, Department Life, Light & Matter (LL&M), 18057 Rostock, Germany;
| | - Ilka Ott
- Department of Internal Medicine, Division of Cardiology, Helios Klinikum Pforzheim, Kanzlerstraße 2-6, D-75175 Pforzheim, Germany;
| | - Bruno C. Huber
- Department of Internal Medicine I, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistr. 15, D-81377 Munich, Germany; (S.B.); (U.G.)
- Correspondence: ; Tel.: +49-89-44-000
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15
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Bradaric C, Koppara T, Müller A, Haller B, Ott I, Cassese S, Fusaro M, Kastrati A, Laugwitz KL, Ibrahim T. Incidence and predictors of stent thrombosis after endovascular revascularisation of the superficial femoral artery. EUROINTERVENTION 2019; 15:e1107-e1114. [DOI: 10.4244/eij-d-19-00187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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16
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Gewalt SM, Helde SM, Ibrahim T, Mayer K, Schmidt R, Bott-Flügel L, Hoppe K, Ott I, Hieber J, Morath T, Byrne RA, Kufner S, Cassese S, Hoppmann P, Fusaro M, Schunkert H, Laugwitz KL, Kastrati A, Schüpke S. Comparison of Vascular Closure Devices Versus Manual Compression After Femoral Artery Puncture in Women. Circ Cardiovasc Interv 2019; 11:e006074. [PMID: 30354782 DOI: 10.1161/circinterventions.117.006074] [Citation(s) in RCA: 10] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The value of vascular closure devices (VCD) in women undergoing transfemoral catheterization has not been sufficiently investigated. METHODS AND RESULTS This is a sex-specific analysis of 1395 women enrolled in a large-scale, randomized, multicenter trial, in which patients undergoing transfemoral diagnostic coronary angiography were randomly assigned in a 1:1:1 ratio to arteriotomy closure with an intravascular VCD, extravascular VCD, or manual compression (MC). Primary objective was to assess the safety and efficacy of 2 different VCD compared with MC regarding vascular access-site complications at 30 days. A secondary comparison was between 2 different types of contemporary VCD. Overall, women were at higher risk for vascular access-site complications compared with men (9.0% versus 6.4%; P=0.002). Vascular access-site complications were comparable in women assigned to VCD and MC (8.6% versus 9.8%; P=0.451). There was no interaction of treatment effect and sex ( Pinteraction=0.970). Time to hemostasis was significantly shortened with VCD compared with MC (1 [interquartile range, 0.5-2.0] minutes) versus 11 [interquartile range, 10-15] minutes; P<0.001); however, more women with VCD required repeat MC (2.4% versus 0.6%; P=0.018). The use of the intravascular compared with the extravascular VCD was associated with a numerical reduction in vascular access-site complications (6.6% versus 10.7%; P=0.027) and significant reductions in time to hemostasis and VCD failure. CONCLUSIONS In women undergoing diagnostic coronary angiography via the common femoral artery, VCD and MC provided comparable safety, while time to hemostasis was reduced with VCD. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01389375.
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Affiliation(s)
- Senta M Gewalt
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Sandra M Helde
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.).,Klinikum Landkreis Erding, Abteilung Kardiologie und Pneumologie, Germany (S.M.H., L.B.-F.)
| | - Tareq Ibrahim
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany (T.I., P.H., K.-L.L.)
| | - Katharina Mayer
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Roland Schmidt
- Krankenhaus der Barmherzigen Brüder, Innere Medizin II, Munich, Germany (R.S.)
| | - Lorenz Bott-Flügel
- Klinikum Landkreis Erding, Abteilung Kardiologie und Pneumologie, Germany (S.M.H., L.B.-F.)
| | - Katharina Hoppe
- German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
| | - Ilka Ott
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Julia Hieber
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Tanja Morath
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.).,German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Petra Hoppmann
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany (T.I., P.H., K.-L.L.)
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany (T.I., P.H., K.-L.L.).,German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.).,German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
| | - Stefanie Schüpke
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.).,German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
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Kasel AM, Rumpf M, Frangieh AH, Mayr P, Joner M, Xhepa E, Lederman RJ, Greenbaum AB, Khan JM, Ott I, Deutsch O, Michel JM. International LAMPOON: first European experience with laceration of the anterior mitral valve leaflet prior to transseptal transcatheter mitral valve implantation. EUROINTERVENTION 2019; 14:746-749. [PMID: 29969430 DOI: 10.4244/eij-d-18-00201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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)
- A Markus Kasel
- Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
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18
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Braun D, Frerker C, Körber MI, Gaemperli O, Patzelt J, Schaefer U, Hammerstingl C, Boekstegers P, Ott I, Ince H, Thiele H, Hausleiter J. Percutaneous Edge-to-Edge Repair of Recurrent Severe Mitral Regurgitation After Surgical Mitral Valve Repair. J Am Coll Cardiol 2019; 70:504-505. [PMID: 28728696 DOI: 10.1016/j.jacc.2017.05.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
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Cassese S, Wolf F, Ingwersen M, Kinstner CM, Fusaro M, Ndrepepa G, Ibrahim T, Ott I, Lammer J, Krankenberg H, Fusaro M. Drug-Coated Balloon Angioplasty for Femoropopliteal In-Stent Restenosis. Circ Cardiovasc Interv 2018; 11:e007055. [DOI: 10.1161/circinterventions.118.007055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 12/24/2022]
Affiliation(s)
- Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (S.C., G.N., I.O., Massimiliano Fusaro)
| | - Florian Wolf
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria (F.W., C.M.K., J.L.)
| | - Maja Ingwersen
- Klinik für Angiologie, Asklepios Klinikum Harburg, Hamburg, Germany (M.I., H.K.)
| | - Christian M. Kinstner
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria (F.W., C.M.K., J.L.)
| | - Michele Fusaro
- Department of Diagnostic and Interventional Radiology, Santa Maria di Ca’ Foncello Hospital, Treviso, Italy (Michele Fusaro)
| | - Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (S.C., G.N., I.O., Massimiliano Fusaro)
| | - Tareq Ibrahim
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I.)
| | - Ilka Ott
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (S.C., G.N., I.O., Massimiliano Fusaro)
| | - Johannes Lammer
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria (F.W., C.M.K., J.L.)
| | - Hans Krankenberg
- Klinik für Angiologie, Asklepios Klinikum Harburg, Hamburg, Germany (M.I., H.K.)
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (S.C., G.N., I.O., Massimiliano Fusaro)
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20
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Steppich B, Schürmann F, Bruskina O, Hadamitzky M, Kastrati A, Schunkert H, Fusaro M, Ott I. Ultrasound-guided thrombin injection for treatment of femoral artery pseudoaneurysm with concomitant AV-fistula - a retrospective single centre experience. VASA 2018; 47:507-512. [PMID: 30175945 DOI: 10.1024/0301-1526/a000732] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Increasing volume of complex percutaneous endovascular procedures in highly anticoagulated patients generate a not negligible percentage of femoral pseudoaneurysms (PSA) with concomitant arteriovenous fistulas (AVF). While ultrasound-guided thrombin injection (UGTI) is the therapy of choice for PSA, concomitant AVF is regarded as a contraindication for UGTI, as venous thromboembolism is feared. In this retrospective, register-based cohort study, we report on and evaluate the use of UGTI for the treatment of PSA with AFV. PATIENTS AND METHODS All patients (n = 523), who underwent UGTI for femoral PSA at the German Heart Centre Munich from January 2011 until January 2018, were retrospectively reviewed for the presence of a concomitant AVF and outcomes were recorded. RESULTS Forty femoral PSA/AVFs treated by UGTI were identified. The mean enddiastolic arterial-flow-velocity above the AVF, an estimate of the AVF size, was 14.61 ± 1.7 cm/sec. The Majority of patients exhibited flow-velocities < 25 cm/sec (n = 31; 77.5 %) and were on either uninterrupted oral anticoagulation (n = 32; 80 %) or dual antiplatelet therapy (n = 8). Twenty-eight (70 %) PSA/AVFs could be successfully closed by UGTI. In eight multicompartmental PSAs, partial obliteration necessitated combined treatment with manual compression, while one partial occlusion was treated by observation. There were three failures, of which two underwent covered-stent-graft-implantation and one surgical repair. One DVT (2.5 %) occurred two days after UGTI in the by far largest AVF (60 cm/sec) included in the study. Besides two late PSA recurrences treated by surgery, no other complications were observed. AVF persisted in 65 %, all of them asymptomatic. The mean follow-up was 6 ± 15.5 months. CONCLUSIONS UGTI appears to be a treatment option in femoral PSA/AVF, at least under oral anticoagulation in small fistulas with enddiastolic arterial-flow-velocities ≤ 25 cm/sec. However, caution is necessary in larger AVFs, which should remain a contraindication for UGTI.
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Affiliation(s)
- Birgit Steppich
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| | | | - Olga Bruskina
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| | - Martin Hadamitzky
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| | - Adnan Kastrati
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| | - Heribert Schunkert
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| | - Massimiliano Fusaro
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| | - Ilka Ott
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
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Rumpf PM, Tutarel O, Michl J, Frangieh A, Kasel AM, Kaemmerer H, Schunkert H, Kastrati A, Ewert P, Ott I. P1590Percutaneous systemic av-valve repair for the treatment of severe tricuspid regurgitation in patients with congenitally corrected transposition of the great arteries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Affiliation(s)
- P M Rumpf
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - O Tutarel
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - J Michl
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - A Frangieh
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - A M Kasel
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - H Kaemmerer
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - H Schunkert
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - A Kastrati
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - P Ewert
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - I Ott
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
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22
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Shivaraju A, Michel J, Frangieh AH, Ott I, Thilo C, Schunkert H, Kastrati A, Leon MB, Dvir D, Kodali S, Bapat V, Guerrero M, Kasel AM. Transcatheter Aortic and Mitral Valve-in-Valve Implantation Using the Edwards Sapien 3 Heart Valve. J Am Heart Assoc 2018; 7:JAHA.117.007767. [PMID: 29982230 PMCID: PMC6064864 DOI: 10.1161/jaha.117.007767] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Anupama Shivaraju
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Department of Cardiology, Advocate Christ Medical Center, Oak Lawn, IL
| | - Jonathan Michel
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Antonio H Frangieh
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ilka Ott
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Thilo
- Department of Cardiology, Klinikum Augsburg Herzzentrum Augsburg-Schwaben, Augsburg, Germany
| | - Heribert Schunkert
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Martin B Leon
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Danny Dvir
- University of Washington Medical Center, Seattle, WA
| | - Susheel Kodali
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Vinayak Bapat
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Mayra Guerrero
- Evanston Hospital/NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, IL
| | - Albert M Kasel
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Abstract
SummaryMagnesium deficiency and its association with platelet hyperreactivity has been well recognised in a variety of diseases including myocardial infarction, preeclampsia, and diabetes. In order to investigate potential effects of intravenous Mg2+ supplementation, platelet function was studied by measurements of in vitro bleeding time (BT) and of fibrinogen (Fg)-mediated aggregation of washed platelets. In addition, the effect of Mg2+ on platelet adhesion onto immobilised Fg, on Fg binding to activated platelets, and on surface expression of GMP-140 or GP53 was evaluated. Mg2+(4 mM) prolonged in vitro BT by 30% and inhibited Fg-mediated aggregation significantly, independent of the agonist used to initiate platelet aggregation (ADP, collagen, epinephrine, thrombin, phorbol ester). Adhesion of resting platelets to immobilised Fg was reduced by 50% in the presence of 2 mM Mg2+. Moreover, Mg2+ reduced Fg binding to ADP- or collagen-stimulated platelets as well as surface expression of GMP-140 with an IC50 of approximately 3 mM. Intravenous administration of Mg2+ to healthy volunteers inhibited both ADP-induced platelet aggregation (p <0.05) by 40% and binding of Fg or surface expression of GMP-140 by 30% (p <0.05). Thus, pharmacological concentrations of Mg2+ effectively inhibit platelet function in vitro and ex vivo.
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Affiliation(s)
- M Gawaz
- The First Medical Department and Institute of Anatomy, Technical University, Munich, Germany
| | - I Ott
- The First Medical Department and Institute of Anatomy, Technical University, Munich, Germany
| | - A J Reininger
- Institute of Anatomy, Technical University, Munich, Germany
| | - F-J Neumann
- The First Medical Department and Institute of Anatomy, Technical University, Munich, Germany
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Cassese S, Ndrepepa G, Kufner S, Byrne RA, Giacoppo D, Ott I, Laugwitz KL, Schunkert H, Kastrati A, Fusaro M. Drug-coated balloon angioplasty for in-stent restenosis of femoropopliteal arteries: a meta-analysis. EUROINTERVENTION 2018; 13:483-489. [PMID: 28169215 DOI: 10.4244/eij-d-16-00735] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Our aim was to perform a meta-analysis to investigate the outcomes of patients undergoing percutaneous revascularisation with drug-coated balloon (DCB) angioplasty because of femoropopliteal in-stent restenosis (ISR). METHODS AND RESULTS We searched scientific databases for studies of DCB angioplasty for femoropopliteal ISR. The primary outcome was target lesion revascularisation (TLR). The main secondary outcome was recurrent ISR. Other outcomes of interest were Rutherford class (RC) improvement, ankle-brachial index (ABI) and death. A total of 367 patients enrolled in four studies received DCB (n=188) or plain balloon angioplasty (n=179). Median follow-up was 12 months. Patients treated with DCB angioplasty displayed a lower risk for TLR (odds ratio [OR] 0.20, 95% confidence interval [CI]: 0.07-0.55, p=0.002) and recurrent ISR (OR 0.24, 95% CI: 0.09-0.61, p=0.003), and a sustained RC improvement (OR 2.57, 95% CI: 1.40-4.72, p=0.002) with similar ABI and mortality as compared to those patients treated with plain balloon angioplasty. CONCLUSIONS In comparison to plain balloon angioplasty, DCB therapy for femoropopliteal ISR is associated with superior clinical and antirestenotic efficacy. Further randomised trials comparing DCB with therapies alternative to plain balloon, in a larger number of patients, and with extended follow-up are needed to address definitively the role of DCB for femoropopliteal ISR.
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Affiliation(s)
- Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Kufner S, Joner M, Schneider S, Tölg R, Zrenner B, Repp J, Starkmann A, Xhepa E, Ibrahim T, Cassese S, Fusaro M, Ott I, Hengstenberg C, Schunkert H, Abdel-Wahab M, Laugwitz KL, Kastrati A, Byrne RA. Neointimal Modification With Scoring Balloon and Efficacy of Drug-Coated Balloon Therapy in Patients With Restenosis in Drug-Eluting Coronary Stents: A Randomized Controlled Trial. JACC Cardiovasc Interv 2018; 10:1332-1340. [PMID: 28683939 DOI: 10.1016/j.jcin.2017.04.024] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [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: 03/17/2017] [Revised: 04/07/2017] [Accepted: 04/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to compare neointimal modification with scoring balloon pre-dilation before drug-coated balloon (DCB) versus DCB standard therapy in patients presenting with drug-eluting stent (DES) restenosis. BACKGROUND DCB angioplasty for the treatment of coronary drug-eluting stent restenosis has demonstrated encouraging results. The efficacy of DCB treatment relies on rapid initial drug transfer and tissue retention of the antiproliferative drug. Neointimal modification with scoring balloon pre-dilation may enhance the efficacy of DCB therapy. METHODS In this randomized, open-label, active-controlled trial, 252 patients with clinically significant DES restenosis were enrolled at 4 centers in Germany. Patients undergoing DCB angioplasty were randomly assigned to treatment with scoring balloon pre-dilation or standard therapy. The primary endpoint of the study was in-segment percentage diameter stenosis on 6- to 8-month follow-up angiography. The secondary endpoints included binary angiographic restenosis and late lumen loss on follow-up angiography, the combined incidence of death or myocardial infarction, target lesion revascularization, and target lesion thrombosis at 1 year. RESULTS Follow-up angiographic data at 6 to 8 months were available for 203 patients (80.6%). Scoring balloon pre-dilation compared with standard therapy showed significantly lower rates with respect to the primary endpoint (35.0 ± 16.8% vs. 40.4 ± 21.4%; p = 0.047) and binary angiographic restenosis (18.5% vs. 32.0%; p = 0.026). Late lumen loss was numerically lower after scoring balloon pre-dilation compared with standard therapy (0.31 ± 59 mm vs. 0.41 ± 0.74 mm; p = 0.27). There was no difference between the groups in the incidence of death or myocardial infarction (4.0% vs. 3.4%; p = 0.73). Scoring balloon versus standard therapy showed comparable rates of target lesion revascularization (16.2% vs. 21.8%; p = 0.26). No target lesion thrombosis occurred out to 1 year. CONCLUSIONS In patients presenting with drug-eluting stent restenosis, neointimal modification with scoring balloon improves the antirestenotic efficacy of DCB therapy. (Intracoronary Stenting and Angiographic Results: Optimizing Treatment of Drug Eluting Stent In-Stent Restenosis 4 [ISAR-DESIRE 4]; NCT01632371).
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Affiliation(s)
- Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Simon Schneider
- I. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Ralph Tölg
- Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany
| | - Bernhard Zrenner
- Krankenhaus Landshut-Achdorf, Medizinische Klinik I, Landshut, Germany
| | - Janika Repp
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Alissa Starkmann
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tareq Ibrahim
- I. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ilka Ott
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Hengstenberg
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | | | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
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Graf EC, Ott I, Praceus J, Bourier F, Lueth TC. Patient-specific catheter shaping for the minimally invasive closure of the left atrial appendage. Int J Comput Assist Radiol Surg 2018; 13:837-846. [PMID: 29623540 DOI: 10.1007/s11548-018-1752-4] [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] [Received: 01/28/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The minimally invasive closure of the left atrial appendage is a promising alternative to anticoagulation for stroke prevention in patients suffering from atrial fibrillation. One of the challenges of this procedure is the correct positioning and the coaxial alignment of the tip of the catheter sheath to the implant landing zone. METHOD In this paper, a novel preoperative planning system is proposed that allows patient-individual shaping of catheters to facilitate the correct positioning of the catheter sheath by offering a patient-specific catheter shape. Based on preoperative three-dimensional image data, anatomical points and the planned implant position are marked interactively and a patient-specific catheter shape is calculated if the standard catheter is not considered as suitable. An approach to calculate a catheter shape with four bends by maximization of the bending radii is presented. Shaping of the catheter is supported by a bending form that is automatically generated in the planning program and can be directly manufactured by using additive manufacturing methods. RESULTS The feasibility of the planning and shaping of the catheter could be successfully shown using six data sets. The patient-specific catheters were tested in comparison with standard catheters by physicians on heart models. In four of the six tested models, the participating physicians rated the patient-individual catheters better than the standard catheter. CONCLUSION The novel approach for preoperatively planned and shaped patient-specific catheters designed for the minimally invasive closure of the left atrial appendage could be successfully implemented and a feasibility test showed promising results in anatomies that are difficult to access with the standard catheter.
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Affiliation(s)
- Eva C Graf
- Institute of Micro Technology and Medical Device Technology, Boltzmannstr. 15, 85748, Garching, Germany.
| | - Ilka Ott
- German Heart Center Munich, Munich, Germany
| | - Julian Praceus
- Institute of Micro Technology and Medical Device Technology, Boltzmannstr. 15, 85748, Garching, Germany
| | | | - Tim C Lueth
- Institute of Micro Technology and Medical Device Technology, Boltzmannstr. 15, 85748, Garching, Germany
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Albrecht T, Waliszewski M, Roca C, Redlich U, Tautenhahn J, Pech M, Halloul Z, Gögebakan Ö, Meyer DR, Gemeinhardt I, Zeller T, Müller-Hülsbeck S, Ott I, Tepe G. Two-Year Clinical Outcomes of the CONSEQUENT Trial: Can Femoropopliteal Lesions be Treated with Sustainable Clinical Results that are Economically Sound? Cardiovasc Intervent Radiol 2018; 41:1008-1014. [DOI: 10.1007/s00270-018-1940-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
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Shpakovsky DB, Shtil AA, Kharitonashvili EV, Tyurin VY, Antonenko TA, Nazarov AA, Osipova VP, Berberova NT, Foteeva LS, Schmidt C, Ott I, Milaeva ER. The antioxidant 2,6-di-tert-butylphenol moiety attenuates the pro-oxidant properties of the auranofin analogue. Metallomics 2018; 10:406-413. [PMID: 29399682 DOI: 10.1039/c7mt00286f] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Metal-based drugs are gaining momentum as a rapidly developing area of medicinal inorganic chemistry. Among gold pharmaceuticals, auranofin is a well known antirheumatic drug. The efficacy of gold-organic complexes largely depends on their pro-oxidant properties since auranofin targets the redox enzyme thioredoxin reductase (TrxR). However, an uncontrollable oxygen burst may be harmful for healthy cells; therefore, the search for chemical modifications to attenuate oxidation-related general toxicity of gold containing anti-inflammatory drugs is justified. In this study, we demonstrate that the incorporation of a specific antioxidant phenol fragment can counterbalance the pro-oxidative potential of the Au containing complex molecule. The electrochemical studies of AuPPh3SR (1, R= 3,5-di-tert-butyl-4-hydroxyphenyl) and its precursors AuPPh3Cl (2) and RSH (3) showed that complex 1 and phenol 3 efficiently scavenged the radicals (as detected by cyclic voltammetry) whereas 2 had no effect. Compound 1 inhibited TrxR in vitro with IC50 0.57 ± 0.15 μM, a value one order of magnitude bigger than the potency reported for auranofin. Compound 1 (5 mg kg-1 daily gavage for 14 days) caused a decrease in ex vivo spontaneous and ascorbate-induced lipid peroxidation in the homogenates of rat lung, heart muscle, spleen, liver, kidneys, testicles and brain as assessed by the thiobarbituric acid reactive substances. Importantly, in animals fed with 1, no discernible general toxicity was registered suggesting that this compound is well tolerated. Our results provide evidence for an efficient synthetic route to obtain gold containing anti-inflammatory drug candidates with balanced pro/anti-oxidative properties.
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Affiliation(s)
- D B Shpakovsky
- Lomonosov Moscow State University, Department of Medicinal Chemistry & Fine Organic Synthesis, Moscow, Russia.
| | - A A Shtil
- Lomonosov Moscow State University, Department of Medicinal Chemistry & Fine Organic Synthesis, Moscow, Russia. and Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - E V Kharitonashvili
- Lomonosov Moscow State University, Department of Medicinal Chemistry & Fine Organic Synthesis, Moscow, Russia.
| | - V Yu Tyurin
- Lomonosov Moscow State University, Department of Medicinal Chemistry & Fine Organic Synthesis, Moscow, Russia.
| | - T A Antonenko
- Lomonosov Moscow State University, Department of Medicinal Chemistry & Fine Organic Synthesis, Moscow, Russia.
| | - A A Nazarov
- Lomonosov Moscow State University, Department of Medicinal Chemistry & Fine Organic Synthesis, Moscow, Russia.
| | - V P Osipova
- Astrakhan State Technical University, Astrakhan, Russia
| | - N T Berberova
- Astrakhan State Technical University, Astrakhan, Russia
| | - L S Foteeva
- Vernadsky Institute of Geochemistry and Analytical Chemistry, Moscow, Russia
| | - C Schmidt
- Institute of Medicinal and Pharmaceutical Chemistry, Technische Universität Braunschweig, Braunschweig, Germany
| | - I Ott
- Institute of Medicinal and Pharmaceutical Chemistry, Technische Universität Braunschweig, Braunschweig, Germany
| | - E R Milaeva
- Lomonosov Moscow State University, Department of Medicinal Chemistry & Fine Organic Synthesis, Moscow, Russia.
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Stein A, Mohr F, Laux M, Thieme S, Lorenz B, Cetindis M, Hackl J, Groha P, Demetz G, Schulz S, Mehilli J, Schömig A, Kastrati A, Ott I. Erythropoietin-induced progenitor cell mobilisation in patients with acute ST-segment-elevation myocardial infarction and restenosis. Thromb Haemost 2017; 107:769-74. [DOI: 10.1160/th11-08-0552] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 01/05/2012] [Indexed: 01/24/2023]
Abstract
SummaryErythropoietin improves myocardial function and enhances re-endothelialisation. Aim of this study was to analyse progenitor cell mobilisation and restenosis in patients from the Regeneration of Vital Myocardium in ST-Segment Elevation Myocardial Infarction by Erythropoietin (REVIVAL-3) study. Patients with STEMI undergoing percutaneous coronary intervention (PCI) were randomly assigned to Epoetin beta (EPO) (n=68) or placebo (n=70). Drug-eluting stents (DES) were utilised in 93% of patients receiving EPO and in 95% of patients receiving placebo (p=0.83). Serial venous blood samples were drawn; CD133+ progenitor cells were quantified by four-colour flow cytometry and cytokines interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12 and tumour necrosis factor (TNF) alpha were analysed by cytometric bead array. Fortyeight hours after PCI a significant increase in CD133+ progenitor cells was observed in the EPO group. Yet, no differences in plasma cytokines were found. Quantitative coronary angiography after six months revealed an increase in segment diameter stenosis in the EPO group (32 ± 19% vs. 26 ± 14%, p=0.046). However, this increase in neointima generation was not associated with progenitor cell mobilisation. EPO in patients with STEMI treated with PCI is associated with an increase in diameter stenosis that is not associated with circulating progenitor cells.ClinicalTrials.gov Identifier: NCT00390832
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Stein A, Ott I. Erythropoietin, progenitor cells and restenosis. A reply to Minamino et al. Thromb Haemost 2017. [DOI: 10.1160/th12-03-0208] [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: 11/05/2022]
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31
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Busch G, Steppich B, Sibbing D, Braun SL, Stein A, Groha P, Schömig A, Kastrati A, Beckerath NV, Ott I. Bivalirudin reduces platelet and monocyte activation after elective percutaneous coronary intervention. Thromb Haemost 2017. [DOI: 10.1160/th08-09-0582] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Summarylating platelets and CD11b, CD14 and CD15 on circulating leukocytes were evaluated by flow cytometry. Cytokine levels of IL-12p70, tumour necrosis factor (TNF), IL-8, IL-6, IL-1β and IL-10 were determined by cytometric bead array. Platelet surface expression of PAC-1, P-Selectin and GPIbα was significantly reduced after PCI in patients receiving bivalirudin as compared to heparin. Similarly, CD11b expression on CD14+ monocytes was diminished after bivalirudin. However, no differences were observed in cytokine levels between the bivalirudin and the heparin group, before or after PCI. In conclusion, our data suggest that bivalirudin may reduce platelet and monocyte activation in patients undergoing elective PCI. Thereby, bivalirudin might reduce periinterventional thrombotic complications.
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Schäfer S, Behling F, Skardelly M, Koch M, Ott I, Paulsen F, Tabatabai G, Schittenhelm J. Low FoxG1 and high Olig-2 labelling indices define a prognostically favourable subset in isocitrate dehydrogenase (IDH)-mutant gliomas. Neuropathol Appl Neurobiol 2017; 44:207-223. [PMID: 29053887 DOI: 10.1111/nan.12447] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 10/12/2017] [Indexed: 11/30/2022]
Abstract
AIMS Previous data suggest that expression of transcription factors FoxG1 and Olig-2 can separate hotspot histone H3 family member 3A (H3F3A)-mutant tumours in paediatric glioma. We evaluated their prognostic potential and feasibility for identifying H3F3A-mutant tumours among IDH-mutant/wild-type gliomas. METHODS Immunohistochemistry of FoxG1/Olig-2 and α-thalassaemia/mental-retardation-syndrome-X-linked gene (ATRX) in 471 cases of diffuse gliomas and molecular determination of IDH, H3F3A, MGMT and 1p/19 codeletion status. RESULTS Mean percentage of FoxG1-positive tumour cells increased from 17% in WHO grade II to over 21% in grade III to 37% in grade IV tumours, whereas mean Olig-2 indices decreased from 29% to 28% to 17% respectively. FoxG1 indices were similar in astrocytic and oligodendroglial tumours, whereas Olig-2 indices were increased in oligodendrogliomas compared to astrocytic tumours (n = 451, P < 0.0001). FoxG1-positive nuclei were significantly reduced in IDH and H3F3A K27-mutant tumours, whereas Olig-2-positive nuclei were significantly reduced in IDH-wild-type and H3F3A G34-mutant tumours. Among IDH-mutant tumours, mean Olig-2 index was significantly higher in 1p/19q codeleted tumours (mean: 43%) compared to IDH-mutant tumours with ATRX loss (mean: 23%, P < 0.0001). A significantly better outcome was first suggested for FoxG1low tumours (n = 212, log rank P = 0.0132) and Olig-2high tumours (n = 203, log-rank P = 0.0011) based on classification and regression tree determined cutoffs, but this was not confirmed by multivariate analysis including IDH mutation, WHO grade, ATRX status and age. CONCLUSIONS While the combined FoxG1/Olig-2 profile may discriminate H3F3A K27- and G34-mutant tumours and define a prognostically favourable subset in IDH-mutant gliomas, our data show that labelling indices of these transcription factors overlap with adult IDH-mutant and wild-type tumour classes.
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Affiliation(s)
- S Schäfer
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - F Behling
- Department of Neurosurgery, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - M Skardelly
- Department of Neurosurgery, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - M Koch
- Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Interdisciplinary Division of Neurooncology, Departments of Vascular Neurology & Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Center for Personalized Medicine, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,German Consortium for Translational Cancer Research (DKTK), DKFZ partner site Tuebingen, Tuebingen, Germany
| | - I Ott
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - F Paulsen
- Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Department of Radiation Oncology, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - G Tabatabai
- Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Interdisciplinary Division of Neurooncology, Departments of Vascular Neurology & Neurosurgery, Hertie Institute for Clinical Brain Research, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Center for Personalized Medicine, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,German Consortium for Translational Cancer Research (DKTK), DKFZ partner site Tuebingen, Tuebingen, Germany
| | - J Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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Steppich BA, Seitz I, Busch G, Stein A, Ott I. Modulation of tissue factor and tissue factor pathway inhibitor-1 by neutrophil proteases. Thromb Haemost 2017. [DOI: 10.1160/th08-05-0293] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryDuring systemic inflammation, neutrophil activation is accompanied by endothelial cell damage and hypercoagulability. Activated neutrophils release serine proteases that participate in tissue injury.We sought to investigate the effects of neutrophil proteases on proinflammatory and procoagulant changes in endothelial cells.The effects of elastase (HNE), cathepsin G (CG), and proteinase 3 (PR3) on expression of tissue factor (TF) and tissue factor pathway inhibitor-1 (TFPI) were examined in human umbilical vein endothelial cells. Flow cytometry demonstrated that these proteases proteolytically degraded endothelial cell-bound TFPI. TFPI mRNA expression was reduced by HNE and CG. PR3, but not HNE or CG, increased surface expression of TF and TF mRNA.Yet, increased TF expression did not enhance TF activity suggesting induction of encrypted TF. Using antibodies and siRNA to inhibit and silence PAR-1 and PAR-2, we observed that PR3 upregulation of TF is at least in part mediated by PAR-1.Although CG and HNE cleaved PAR-1, antibody reactivity to the PAR-1 hirudin-like sequence demonstrated inactivating cleavage, accounting for the selective ability of PR3 to induce PAR-1-mediated procoagulant effects.This was supported by induction of p42/44 MAPK by PR3. In conclusion, PR3 degradation of TFPI increases the procoagulant activity of endothelial cells. Release of PR3 after neutrophil activation may represent an important step in neutrophil-mediated vascular injury.
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Pogatsa-Murray G, Wedel JV, Steppich B, Schömig A, Kastrati A, Stein A, Zohlnhöfer D, Ott I. Expression of CXCR4, VLA-1, LFA-3 and transducer of ERB in G-CSF-mobilised progenitor cells in acute myocardial infarction. Thromb Haemost 2017; 103:638-43. [DOI: 10.1160/th09-09-0657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 11/10/2009] [Indexed: 11/05/2022]
Abstract
SummaryG-CSF induced mobilisation of progenitor cells is a multistep processes involving chemokines, growth factors, matrix-degrading enzymes, and cell adhesive interactions mediated by specific receptors on haematopoietic cells. This study’s aim was to investigate progenitor cells mobilised during myocardial infarction after treatment with granulocyte-stimulating factor (G-CSF). In the randomised, double-blind, placebo-controlled REVIVAL-2 study, 114 patients with acute myocardial infarction were included. Five days after successful percutaneous coronary intervention patients received either 10 μg/kg G-CSF (n=56) or placebo (n=58) subcutaneously for five days. Venous blood samples were analysed on day(s) 1, 3, 5 and 7 after therapy, and progenitor cell mobilisation and surface expression of VLA-4, LFA-1 and CXCR-4 was measured on circulating progenitor cells using flow cytometry. G-CSF induced a significant increase in circulating progenitor cells (72 ± 20 cells/μl vs. 4.5 ± 0.8 cells/μl, p<0.05). Surface expression of LFA-1, VLA-4 and CXCR4 on progenitor cells was decreased by 44%, 49% and 60% after G-CSF as compared to placebo (p<0.05). In accordance, mRNA expression of CXCR4 was reduced. Moreover, anti-proliferative transducer of ERB (TOB) mRNA was decreased, suggesting an increased proliferative potential of the mobilised progenitor cells. Decreased expression of adhesion and chemokine receptors on G-CSF mobilised progenitor cells in acute myocardial infarction may alter the homing capacity of circulating cells to the myocardium.
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Ott I. Tissue factor inhibition: Another approach reducing thrombosis after vascular injury. Thromb Haemost 2017; 103:7-8. [DOI: 10.1160/th09-10-0712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 10/20/2009] [Indexed: 11/05/2022]
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Steppich B, Stegmüller F, Rumpf PM, Pache J, Sonne C, Lesevic H, Braun D, Hausleiter J, Kasel AM, Ott I. Vascular complications after percutaneous mitral valve repair and venous access closure using suture or closure device. J Interv Cardiol 2017; 31:223-229. [DOI: 10.1111/joic.12459] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/29/2017] [Accepted: 10/03/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Birgit Steppich
- Deutsches Herzzentrum der Technischen Universität München; München Germany
| | - Felix Stegmüller
- Deutsches Herzzentrum der Technischen Universität München; München Germany
| | | | - Jürgen Pache
- Deutsches Herzzentrum der Technischen Universität München; München Germany
| | - Carolin Sonne
- Deutsches Herzzentrum der Technischen Universität München; München Germany
| | - Hasema Lesevic
- Deutsches Herzzentrum der Technischen Universität München; München Germany
| | - Daniel Braun
- Kardiologie der Ludwigs-Maximilians-University München; München Germany
- Partner Site Munich Heart Alliance; DZHK (German Heart Centre for Cardiovascular Research); Munich Germany
| | - Jörg Hausleiter
- Kardiologie der Ludwigs-Maximilians-University München; München Germany
- Partner Site Munich Heart Alliance; DZHK (German Heart Centre for Cardiovascular Research); Munich Germany
| | | | - Ilka Ott
- Deutsches Herzzentrum der Technischen Universität München; München Germany
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Frangieh AH, Sonne C, Moritz Rumpf P, Kasel AM, Ott I. Clipping through a mirror: First reported successful MitraClip in a patient with dextrocardia. Cardiol J 2017; 24:586-587. [PMID: 29087542 DOI: 10.5603/cj.2017.0120] [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] [Received: 05/07/2017] [Revised: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | | | | | - Ilka Ott
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
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Wittmann T, Cassese S, Groha P, Steppich B, Voll F, Hadamitzky M, Ibrahim T, Kufner S, Dewitz K, Kasel M, Laugwitz KL, Schunkert H, Kastrati A, Fusaro M, Ott I. TCT-560 Paclitaxel-Eluting Balloon versus conventional Balloon Angioplasty for In-Stent Restenosis of Superficial Femoral Artery. The ISAR-PEBIS randomized trial. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.738] [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: 10/18/2022]
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Ott I, Shivaraju A, Schäffer N, Frangieh A, Michel J, Husser O, Hengstenberg C, Mayr P, Colleran R, Pellegrini C, Cassese S, Fusaro M, Schunkert H, Kastrati A, Kasel A. Parallel suture technique with ProGlide: a novel method for management of vascular access during transcatheter aortic valve implantation (TAVI). EUROINTERVENTION 2017; 13:928-934. [DOI: 10.4244/eij-d-16-01036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Demetz G, Oostendorp RA, Boxberg AM, Sitz W, Farrell E, Steppich B, Steinsiek AL, Rudelius M, Ott I. Overexpression of Insulin-Like Growth Factor-2 in Expanded Endothelial Progenitor Cells Improves Left Ventricular Function in Experimental Myocardial Infarction. J Vasc Res 2017; 54:321-328. [DOI: 10.1159/000479872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/28/2017] [Indexed: 11/19/2022] Open
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41
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Rumpf PM, Ott I. Percutaneous edge-to-edge repair in tricuspid and mitral valve regurgitation. Herz 2017; 42:651-652. [PMID: 28939915 DOI: 10.1007/s00059-017-4625-7] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- P M Rumpf
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, München, Germany.
| | - I Ott
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, München, Germany
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Frangieh AH, Ott I, Michel J, Shivaraju A, Joner M, Mayr NP, Hengstenberg C, Husser O, Pellegrini C, Schunkert H, Kastrati A, Kasel AM. Standardized Minimalistic Transfemoral Transcatheter Aortic Valve Replacement (TAVR) Using the SAPIEN 3 Device: Stepwise Description, Feasibility, and Safety from a Large Consecutive Single-Center Single-Operator Cohort. Structural Heart 2017. [DOI: 10.1080/24748706.2017.1358832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Antonio H. Frangieh
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Ilka Ott
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Jonathan Michel
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Anupama Shivaraju
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - N. Patrick Mayr
- Deutsches Herzzentrum Mänchen, Institut für Anästhesiologie, Technische Universität München, Munich, Germany
| | - Christian Hengstenberg
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Oliver Husser
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Costanza Pellegrini
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Albert Markus Kasel
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
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Colleran R, Kufner S, Rosenbeiger C, Joner M, Cassese S, Ott I, Fusaro M, Ibrahim T, Laugwitz KL, Abdel-Wahab M, Neumann F, Richardt G, Kastrati A, Byrne R. 3122Longterm comparative efficacy of drug-eluting stents versus bare metal stents in saphenous vein graft lesions: 5-year clinical follow-up of a randomized trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3122] [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: 11/13/2022] Open
Affiliation(s)
- R. Colleran
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - S. Kufner
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - C. Rosenbeiger
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - M. Joner
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - S. Cassese
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - I. Ott
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - M. Fusaro
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - T. Ibrahim
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - K.-L. Laugwitz
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | | | - F.J. Neumann
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - A. Kastrati
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - R.A. Byrne
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
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Kufner S, Ndrepepa G, Hoyos M, Cassese S, Byrne R, Colleran R, Fusaro M, Ott I, Laugwitz KL, Kastrati A. P4680Comparative prognostic value of postprocedural CK-MB and high-sensitivity troponin T in patients with non-ST-segment elevation myocardial infarction undergoing PCI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4680] [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: 11/12/2022] Open
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Müller AM, Langwieser N, Bradaric C, Haller B, Fusaro M, Ott I, von Beckerath N, Kastrati A, Laugwitz KL, Ibrahim T. Endovascular Treatment for Steno-Occlusive Iliac Artery Disease: Safety and Long-Term Outcome. Angiology 2017; 69:308-315. [DOI: 10.1177/0003319717720052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
We evaluated safety and long-term outcome of endovascular therapy for steno-occlusive iliac artery disease. All endovascular procedures of iliac artery lesions performed at our institution between 2001 and 2014 (n = 676) were retrospectively analyzed. The overall technical success rate was 99% and yielded 100% for stenoses (n = 596) and 95% for chronic total occlusions (n = 80). Lesion complexity defined by the Trans-Atlantic Inter-Society Consensus (TASC) II classification had no impact on success rates (TASC A + B vs C + D; 99.5% vs 98.6%, P = .359). During a median follow-up of 11 months, the overall rate of restenosis was 9.4%. After 1 and 3 years, the primary patency rates were 94% and 86% and the secondary patency rate was 100%, respectively. The TASC II classification had no impact on long-term patency rates (TASC A + B vs C + D; 86% vs 81%). In a multivariable analysis, stent diameter remained the only significant predictor for restenosis (hazard ratio: 0.58; 95% confidence interval: 0.41%-0.81%; P = .002). In this single-center retrospective study, endovascular therapy for steno-occlusive iliac artery disease was associated with high technical and clinical success rates as well as an excellent long-term patency rate irrespective of lesion complexity.
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Affiliation(s)
- Arne M. Müller
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Nicolas Langwieser
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Christian Bradaric
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institut für Medizinische Statistik und Epidemiologie, Technische Universität München, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Ilka Ott
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Nicolas von Beckerath
- Allgemeines Krankenhaus Viersen, Abteilung Kardiologie und Angiologie, Viersen, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tareq Ibrahim
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
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Ott I, Cassese S, Groha P, Steppich B, Voll F, Hadamitzky M, Ibrahim T, Kufner S, Dewitz K, Wittmann T, Kasel AM, Laugwitz KL, Schunkert H, Kastrati A, Fusaro M. ISAR-PEBIS (Paclitaxel-Eluting Balloon Versus Conventional Balloon Angioplasty for In-Stent Restenosis of Superficial Femoral Artery): A Randomized Trial. J Am Heart Assoc 2017; 6:JAHA.117.006321. [PMID: 28743787 PMCID: PMC5586321 DOI: 10.1161/jaha.117.006321] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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] [Indexed: 11/16/2022]
Abstract
Background Paclitaxel‐eluting balloon (PEB) angioplasty has superior efficacy compared with conventional balloon angioplasty (BA) for de novo lesions of superficial femoral artery (SFA). Studies investigating the angiographic and clinical performance of PEB angioplasty versus BA for in‐stent restenosis of SFA are limited. We performed a randomized trial to investigate angiographic and clinical performance of PEB versus BA for in‐stent restenosis of SFA. Methods and Results Patients with symptomatic in‐stent restenosis of SFA were randomly assigned to either PEB or BA at 2 centers in Munich, Germany. The primary end point was the percentage diameter stenosis at 6‐ to 8‐month follow‐up angiography. Secondary end points were the rate of binary restenosis at follow‐up angiography and target lesion revascularization, target vessel thrombosis, ipsilateral amputation, bypass surgery of the affected limb, and all‐cause mortality at 24‐month follow‐up. Seventy patients were assigned to PEB (n=36) or BA (n=34). Mean lesion length was 139±67 mm, and roughly one third of lesions were completely occluded at the time of the index procedure. At control angiography, the percentage diameter stenosis (44±33% versus 65±33%, P=0.01) and binary restenosis were significantly reduced with PEB versus BA (30% versus 59%, P=0.03). At 24‐month follow‐up, PEB was associated with a significant reduction of target lesion revascularization in comparison to BA (19% versus 50%, P=0.007). There was no difference with respect to other outcomes of interest. Conclusions In patients with in‐stent restenosis of SFA, a percutaneous therapy with PEB compared with BA has superior angiographic performance at 6 to 8 months and improved clinical efficacy up to 24‐month follow‐up. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01083394.
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Affiliation(s)
- Ilka Ott
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Philipp Groha
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Birgit Steppich
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Felix Voll
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Martin Hadamitzky
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tareq Ibrahim
- 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Karl Dewitz
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Theresa Wittmann
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Albert Markus Kasel
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Karl-Ludwig Laugwitz
- 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Brendel LC, Dobler F, Hessling G, Michel J, Braun SL, Steinsiek AL, Groha P, Eckl R, Deisenhofer I, Hyseni A, Roest M, Ott I, Steppich B. The anticoagulant effect of heparin during radiofrequency ablation (RFA) in patients taking apixaban or rivaroxaban. J Interv Card Electrophysiol 2017; 49:237-244. [PMID: 28735423 DOI: 10.1007/s10840-017-0274-2] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 07/10/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Measuring the anticoagulant effect of heparin during radiofrequency ablation (RFA) in patients taking apixaban and rivaroxaban is challenging, since the activated coagulation time (ACT) does not seem to reflect the true anticoagulant activity of these drugs. We therefore evaluated coagulation properties of apixaban and rivaroxaban during RFA by different coagulation assays to better monitor periprocedural hemostasis. METHODS The study included 90 patients (61 ± 12 years) with atrial fibrillation who underwent RFA procedures. Patients received 20 mg rivaroxaban (n = 73) once or 5 mg apixaban (n = 17) twice daily 4 weeks prior to the procedure. During RFA, unfractionated heparin i.v. was given to maintain an ACT of 250-300 s. Blood samples were taken before and 10, 60, and 360 min after heparin administration. RESULTS Heparin displayed a lower anti-Xa activity in rivaroxaban-treated patients compared to apixaban-treated patients. In contrast, D-dimer and prothrombin fragment F1+2 plasma levels indicated a higher activation of the coagulation cascade in apixaban/heparin than in rivaroxaban/heparin patients. This discordant coagulative state measured in vitro had no clinical impact in terms of bleeding or thromboembolic complications. CONCLUSION We found different biochemical responses to rivaroxaban/heparin and apixaban/heparin during RFA. Precaution is necessary when monitoring periprocedural hemostasis in DOAC patients to avoid mismanagement.
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Affiliation(s)
- L C Brendel
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - F Dobler
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - G Hessling
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - J Michel
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - S L Braun
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - A L Steinsiek
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - P Groha
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - R Eckl
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - I Deisenhofer
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - A Hyseni
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Roest
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Ott
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - B Steppich
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany.
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Bradaric C, Eser K, Preuss S, Dommasch M, Wustrow I, Langwieser N, Haller B, Ott I, Fusaro M, Heemann U, Laugwitz KL, Kastrati A, Ibrahim T. Drug-eluting stents versus bare metal stents for the prevention of restenosis in patients with renovascular disease. EUROINTERVENTION 2017; 13:e248-e255. [PMID: 28044987 DOI: 10.4244/eij-d-16-00697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to assess the impact of drug-eluting stents (DES) compared to bare metal stents (BMS) for the endovascular treatment of atherosclerotic renal artery stenosis (ARAS). METHODS AND RESULTS We retrospectively evaluated all of our endovascular BMS and DES implantations performed in de novo ARAS between 2000 and 2014 at our institution. The occurrence of in-stent restenosis (ISR) detected by ultrasound or angiography, kidney function, blood pressure (BP), and the number of antihypertensive drugs were analysed as endpoints. Overall, 338 renal arteries were treated in 298 patients. BMS were implanted in 163 (48%), and DES in 175 lesions (52%). Of the 175 lesions treated with DES, 55 (31%) were treated with a BMS-in-DES hybrid technique. For reasons of comparability, only lesions treated with balloon sizes of 4-6.5 mm were included in the final analysis. After 12 months, the rate of ISR >50% was 18.6% in the BMS group and 7.2% in the DES group (p=0.031). None of the BMS-in-DES-treated (hybrid) lesions developed ISR (hybrid technique vs. BMS only p=0.008, hybrid technique vs. DES only p=0.034). Systolic BP and number of antihypertensive drugs remained unchanged in the BMS group but declined in the DES group (p=0.02). Renal function significantly deteriorated in the BMS group (p=0.03) but did not change significantly in the DES group (p=0.188). CONCLUSIONS DES were superior to BMS in preventing ISR. Overall, the BMS-in-DES-technique (hybrid) achieved the lowest risk for ISR.
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Affiliation(s)
- Christian Bradaric
- Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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Ott I, Cassese S, Groha P, Steppich B, Hadamitzky M, Ibrahim T, Kufner S, Dewitz K, Hiendlmayer R, Laugwitz KL, Schunkert H, Kastrati A, Fusaro M. Randomized Comparison of Paclitaxel-Eluting Balloon and Stenting Versus Plain Balloon Plus Stenting Versus Directional Atherectomy for Femoral Artery Disease (ISAR-STATH). Circulation 2017; 135:2218-2226. [PMID: 28424222 DOI: 10.1161/circulationaha.116.025329] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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] [Received: 09/03/2016] [Accepted: 03/17/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Atherosclerosis in the superficial femoral artery is common in patients suffering from peripheral artery disease. Paclitaxel-eluting balloon (PEB) angioplasty, stenting, and directional atherectomy (DA) have provided new options for the treatment of superficial femoral artery disease; however, the comparative efficacy of these interventional strategies remains uncertain. METHODS One hundred and fifty-five patients with symptomatic peripheral artery disease due to de novo superficial femoral artery stenotic or occlusive lesions were randomized to treatment with plain balloon angioplasty (BA) followed by PEB angioplasty and stenting (n=48), BA and stenting (n=52), or DA with distal protection and bailout stenting (n=55). The primary end point of the study was percentage diameter stenosis after 6 months measured by angiography. Other end points included target lesion revascularization, thrombosis, ipsilateral amputation, binary restenosis, and all-cause mortality at 6 and 24 months. RESULTS Baseline and lesion characteristics were comparable in all groups with a mean lesion length of 65.9±46.8 mm and 56% total occlusions. At 6 months angiography, the percent diameter stenosis was significantly lower in patients treated by PEB angioplasty and stenting (34±31%) as compared with BA angioplasty and stenting (56±29%, P=0.009) or DA (55±29%, P=0.007). Similarly, binary restenosis was significantly lower after treatment with PEB and stenting as compared with BA and stenting or DA. Clinical follow-up at 24 months revealed a lower risk for target lesion revascularization after PEB angioplasty and stenting as compared with BA and stenting or DA. We found no difference in terms of target lesion thrombosis and mortality among groups, and no patient underwent amputation. CONCLUSIONS Treatment of de novo superficial femoral artery lesions with PEB angioplasty and stenting is superior to BA angioplasty and stenting or DA in terms of angiographic diameter stenosis at 6 months and target lesion revascularization at 24 months. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00986752.
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Affiliation(s)
- Ilka Ott
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.).
| | - Salvatore Cassese
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Philipp Groha
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Birgit Steppich
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Martin Hadamitzky
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Tareq Ibrahim
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Sebastian Kufner
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Karl Dewitz
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Regina Hiendlmayer
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Karl-Ludwig Laugwitz
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Heribert Schunkert
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Adnan Kastrati
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
| | - Massimiliano Fusaro
- From Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (I.O., S.C., P.G., B.S., M.H., S.K., K.D., R.H., H.S., A.K., M.F.); 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (T.I., K.-L.L.); and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (K.-L.L., H.S., A.K.)
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Lesevic H, Karl M, Braun D, Barthel P, Orban M, Pache J, Hadamitzky M, Mehilli J, Stecher L, Massberg S, Ott I, Schunkert H, Kastrati A, Sonne C, Hausleiter J. Long-Term Outcomes After MitraClip Implantation According to the Presence or Absence of EVEREST Inclusion Criteria. Am J Cardiol 2017; 119:1255-1261. [PMID: 28237285 DOI: 10.1016/j.amjcard.2016.12.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/14/2016] [Accepted: 12/14/2016] [Indexed: 12/31/2022]
Abstract
Numerous patients are treated with the MitraClip, although they do not fulfill the stringent inclusion criteria of the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) trials. The outcome of those patients is not well known. Therefore, we compared the long-term outcome after MitraClip treatment between patients who matched (group 1) and did not match (group 2) the EVEREST criteria. One hundred thirty-four consecutive patients were treated from September 2009 to July 2012: 59 patients (44%) in group 1 versus 75 patients (56%) in group 2. Investigated end points were acute procedural success (for group 1 vs 2: 97% vs 95%; p = 0.694), all-cause mortality (28% vs 27%; p = 0.656), reintervention (RI) rate (11% vs 37%; p = 0.010), and improvement in mitral regurgitation (MR) (-1.3 ± 1 vs -1.5 ± 1, p = 0.221) and in New York Heart Association functional class (-0.7 ± 1 vs -0.9 ± 0.8, p = 0.253) during the follow-up of 33 months (27.9 to 38.3). The morphologic extent of a flail leaflet was an independent predictor for RI. In conclusion, although the overall outcome was comparable between both groups, recurrent symptomatic MR with need for RI was higher in group 2, mainly because of complex valve pathologies: especially flail width >15 mm and gap ≥10 mm. Improvements in the interventional strategy are warranted for reducing the need for RI in patients with primary MR.
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