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Jussli-Melchers J, Friedrich C, Mandler K, Alosh MH, Salem MA, Schoettler J, Cremer J, Haneya A. Risk Factor Analysis for 30-day Mortality After Surgery for Infective Endocarditis. Thorac Cardiovasc Surg 2024. [PMID: 38373718 DOI: 10.1055/s-0044-1779709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Infective endocarditis (IE) remains a challenging disease associated with high mortality. Several scores have been suggested to assess surgical risk. None was sufficiently adequate. We therefore analyzed risk factors for 30-day mortality. METHODS A total of 438 consecutive patients had surgery for IE in our department between 2002 and 2020. Patients were divided into two groups, one consisting of 30-day survivors (362 patients; 82.6%) and one of nonsurvivors (76 patients; 17.4%). Logistic regression analysis on pre- and intraoperative risk factors was performed and the groups were compared by univariable analyses. RESULTS Patients in mortality group were older (69 [58, 77] vs. 63 [50, 72] years; p < 0.001), EuroSCORE II was higher (24.5 [12.1, 49.0] vs. 8.95 [3.7, 21.2]; p < 0.001) and there were more females. More frequently left ventricular function (below 30%), preoperative acute renal insufficiency, chronic dialysis, insulin-dependent diabetes mellitus, NYHA-class IV (New York Heart Association heart failure class IV), and cardiogenic shock occurred. Patients in the mortality group were often intensive care unit patients (40.8 vs. 22.4%; p < 0.001) or had a preoperative stroke (26.3 vs. 16.0%; p = 0.033). In the nonsurvivor group Staphylococcus aureus was prevalent. Streptococcus viridans was common in the survivor group as was isolated aortic valve endocarditis (32.9 vs. 17.1%; p = 0.006). Prosthetic valve endocarditis (PVE) and abscesses occurred more often in nonsurvivors. In the logistic regression analysis, female gender, chronic dialysis, cardiogenic shock, and NYHA IV and from intraoperative variables PVE, cardiopulmonary bypass time, and mitral valve surgery were the strongest predictors for 30-day mortality. CONCLUSION This study indeed clearly indicates that significant risk factors for 30-day mortality cannot be changed. Nevertheless, they should be taken into account for preoperative counselling, and they will alert the surgical team for an even more careful management.
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Affiliation(s)
- Jill Jussli-Melchers
- Department of Cardiac Surgery, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
| | - Christine Friedrich
- Department of Cardiac Surgery, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
| | - Kira Mandler
- Department of Cardiac Surgery, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
| | - Mohamad Hosam Alosh
- Department of Cardiac Surgery, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
| | - Mohamed Ahmed Salem
- Department for Cardiac Surgery, Justus Liebig Universitat Giessen Fachbereich Medizin, Gießen, Hessen, Germany
| | - Jan Schoettler
- Department of Cardiac Surgery, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiac Surgery, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
| | - Assad Haneya
- Department for Cardiac Surgery, Krankenhaus der Barmherzigen Brüder, Heart Center Trier, Trier, Germany
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Al-Tawil M, Salem M, Friedrich C, Diraz S, Broll A, Rezahie N, Schoettler J, de Silva N, Puehler T, Cremer J, Haneya A. Preoperative Imaging Signs of Cerebral Malperfusion in Acute Type A Aortic Dissection: Influence on Outcomes and Prognostic Implications-A 20-Year Experience. J Clin Med 2023; 12:6659. [PMID: 37892797 PMCID: PMC10607191 DOI: 10.3390/jcm12206659] [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: 08/20/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Acute type A aortic dissection (ATAAD) continues to be a subject of active research due to its high mortality rates and associated complications. Cerebral malperfusion in ATAAD can have a devastating impact on patients' neurological function and overall quality of life. We aimed to explore the risk profile and prognosis in ATAAD patients presenting with preoperative imaging signs of cerebral malperfusion (PSCM). METHODS We obtained patient data from our Aortic Dissection Registry, which included 480 consecutive ATAAD cases who underwent surgical repair between 2001 and 2021. Primary endpoint outcomes included the in-hospital and 30-day mortality, postoperative new neurological deficit, mechanical ventilation hours, and intensive care unit (ICU) length of stay. RESULTS Of the total cohort, 82 patients (17.1%) had PSCM. Both groups had similar distributions in terms of age, sex, and body mass index. The patients in the PSCM group presented with a higher logistic EuroSCORE (47, IQR [31, 64] vs. 24, IQR [15, 39]; p < 0.001) and a higher portion of patients with a previous cardiac surgery (7.3% vs. 2.0%; p = 0.020). Intraoperatively, the bypass, cardioplegia, and aortic cross-clamp times were similar between both groups. However, the patients in the PSCM group received significantly more intraoperative packed red blood cells, fresh frozen plasma, and platelets transfusions (p < 0.05). Following the surgery, the patients who presented with PSCM had markedly longer ventilation hours (108.5 h, IQR [44, 277] vs. 43 h, IQR [16, 158], p < 0.001) and a significantly longer ICU length of stay (7 days, IQR [4, 13] vs. 5 days, IQR [2, 11]; p = 0.013). Additionally, the patients with PSCM had significantly higher rates of postoperative new neurological deficits (35.4% vs. 19.4%; p = 0.002). In the Cox regression analysis, PSCM was associated with significantly poorer long-term survival (hazard ratio (HR) 1.75, 95%CI [1.20-2.53], p = 0.003). Surprisingly, hypertension was shown as a protective factor against long-term mortality (HR: 0.59, 95%CI [0.43-0.82], p = 0.001). CONCLUSION PSCM in ATAAD patients is linked to worse postoperative outcomes and poorer long-term survival, emphasizing the need for early recognition and tailored management.
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Puehler T, Friedrich C, Lutter G, Frank D, Saad M, Seoudy H, Salem M, Schoettler J, Cremer J, Haneya A. Midterm Follow-up of the Transatrial-to-Left Ventricle Cannulation for Acute Type A Dissection. Ann Thorac Surg 2023; 116:467-473. [PMID: 35595088 DOI: 10.1016/j.athoracsur.2022.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/23/2022] [Accepted: 04/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is still controversial as to which cannulation strategy for acute type A aortic dissection (AAD) is optimal. Antegrade perfusion to diminish further organ malperfusion and ischemia is preferable. METHODS We retrospectively analyzed a total of 420 patients who underwent AAD surgery from January 2001 to December 2020. Group A included 229 patients with a transatrial cannulation; group B included 191 patients with all other additionally used cannulation sites. A retrospective analysis was conducted at 30 days and according to clinical outcome and midterm mortality. Risk factors for probability of death were analyzed by multifactorial logistic regression. RESULTS The calculated risk scores and demographic preoperative variables were comparable except for hyperlipoproteinemia (P = .011) and redo operation in group B (P < .001) and more pericardial tamponade in group A (P = .006). In addition, fewer patients with postoperative new onset of renal failure were observed in group A (P = .039), although new onset of dialysis was not different between the groups (P = .878). Patients in group A were discharged from the hospital significantly earlier (P = .004). Nevertheless, although significantly more total arch surgery was performed in group A, shorter operation times (P < .001) and lower transfusion rates were observed in group A. Patients' follow-up after a median time of 3.6 (0.6-7.6) years showed no difference in 30-day, 1-year, and long-term mortality. Multivariate logistic regression revealed aortic valve stenosis (P = .041), coronary artery bypass graft surgical procedures (P = .014), preoperative cardiopulmonary resuscitation (P < .001), and length of surgery (P = .032) as the strongest risk factors for mortality. CONCLUSIONS Transatrial cannulation for AAD operation was safe and successfully performed under emergent conditions. Although no benefit in mortality was achieved, clinical benefits of shorter operation times, less transfusion, better kidney preservation, and earlier discharge of the patient were observed.
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Affiliation(s)
- Thomas Puehler
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany.
| | - Christine Friedrich
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Derk Frank
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany; Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Mohammed Saad
- Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Hatim Seoudy
- Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Mohamed Salem
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan Schoettler
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Pommert NS, Zhang X, Puehler T, Seoudy H, Huenges K, Schoettler J, Haneya A, Friedrich C, Sathananthan J, Sellers SL, Meier D, Mueller OJ, Saad M, Frank D, Lutter G. Transcatheter Aortic Valve Implantation by Intercostal Access: Initial Experience with a No-Touch Technique. J Clin Med 2023; 12:5211. [PMID: 37629253 PMCID: PMC10455155 DOI: 10.3390/jcm12165211] [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: 06/28/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is now a well-established therapeutic option in an elderly high-risk patient cohort with aortic valve disease. Although most commonly performed via a transfemoral route, alternative approaches for TAVI are constantly being improved. Instead of the classical mini-sternotomy, it is possible to achieve a transaortic access via a right anterior mini-thoracotomy in the second intercostal space. We describe our experience with this sternum- and rib-sparing technique in comparison to the classical transaortic approach. METHODS Our retrospective study includes 173 patients who were treated in our institution between January 2017 and April 2020 with transaortic TAVI via either upper mini-sternotomy or intercostal thoracotomy. The primary endpoint was 30-day mortality, and secondary endpoints were defined as major postoperative complications that included admission to the intensive care unit and overall hospital stay, according to the Valve Academic Research Consortium 3. RESULTS Eighty-two patients were treated with TAo-TAVI by upper mini-sternotomy, while 91 patients received the intercostal approach. Both groups were comparable in age (mean age: 82 years) and in the proportion of female patients. The intercostal group had a higher rate of peripheral artery disease (41% vs. 22%, p = 0.008) and coronary artery disease (71% vs. 40%, p < 0.001) with a history of percutaneous coronary intervention or coronary artery bypass grafting, resulting in significantly higher preinterventional risk evaluation (EuroScore II 8% in the intercostal vs. 4% in the TAo group, p = 0.005). Successful device implantation and a reduction of the transvalvular gradient were achieved in all cases with a significantly lower rate of trace to mild paravalvular leakage in the intercostal group (12% vs. 33%, p < 0.001). The intercostal group required significantly fewer blood transfusions (0 vs. 2 units, p = 0.001) and tended to require less reoperation (7% vs. 15%, p = 0.084). Hospital stays (9 vs. 12 d, p = 0.011) were also shorter in the intercostal group. Short- and long-term survival in the follow-up showed comparable results between the two approaches (30-day, 6-month- and 2-year mortality: 7%, 23% and 36% in the intercostal vs. 9%, 26% and 33% in the TAo group) with acute kidney injury (AKI) and reintubation being independent risk factors for mortality. CONCLUSIONS Transaortic TAVI via an intercostal access offers a safe and effective treatment of aortic valve stenosis.
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Affiliation(s)
- Nina Sophie Pommert
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
- DZHK—German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany;
| | - Xiling Zhang
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
- DZHK—German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany;
| | - Hatim Seoudy
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (H.S.); (O.J.M.); (M.S.)
| | - Katharina Huenges
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
| | - Jan Schoettler
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
| | - Christine Friedrich
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
| | - Janarthanan Sathananthan
- Cardiovascular Translational Laboratory, Providence Research & UBC Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada; (J.S.); (S.L.S.); (D.M.)
- Centre for Heart Valve Innovation and Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- UBC Centre for Cardiovascular Innovation, Vancouver, BC V6Z 1Y6, Canada
| | - Stephanie L. Sellers
- Cardiovascular Translational Laboratory, Providence Research & UBC Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada; (J.S.); (S.L.S.); (D.M.)
- Centre for Heart Valve Innovation and Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- UBC Centre for Cardiovascular Innovation, Vancouver, BC V6Z 1Y6, Canada
| | - David Meier
- Cardiovascular Translational Laboratory, Providence Research & UBC Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada; (J.S.); (S.L.S.); (D.M.)
- Centre for Heart Valve Innovation and Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- UBC Centre for Cardiovascular Innovation, Vancouver, BC V6Z 1Y6, Canada
| | - Oliver J. Mueller
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (H.S.); (O.J.M.); (M.S.)
| | - Mohammed Saad
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (H.S.); (O.J.M.); (M.S.)
| | - Derk Frank
- DZHK—German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany;
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (H.S.); (O.J.M.); (M.S.)
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (T.P.); (K.H.); (J.S.); (A.H.); (C.F.)
- DZHK—German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany;
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Eide M, Jussli-Melchers J, Friedrich C, Haneya A, Lutter G, Cremer J, Schoettler J. Surgical Myocardial Revascularization with a Composite T-graft from the Left Internal Mammary Artery-Comparison of the Great Saphenous Vein with the Radial Artery. Thorac Cardiovasc Surg 2023. [PMID: 37506730 DOI: 10.1055/s-0043-1771358] [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: 07/30/2023]
Abstract
BACKGROUND Composite T-grafts between left internal mammary artery (LIMA) and radial artery (RA) are a common concept in complete arterial myocardial revascularization. The aim of the present study was to investigate whether the use of the great saphenous vein (SV) instead of RA leads to comparably good results in terms of outcome in this context. METHODS Patients who underwent myocardial revascularization with a T-graft using RA or a segment of SV to the right coronary artery or circumflex artery between the beginning of 2014 and the end of 2019 at the Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel were included. To minimize surgical variation, only patients were observed by a single senior surgeon in the department. Exclusion criteria were previous cardiac surgery, preoperative extracorporeal circulatory support, off-pump surgery, additional aortocoronary bypasses, and cardiac combination procedures. RESULTS A total of 115 patients were studied. In 55 patients, the T-graft was placed between the LIMA and SV, and in 60 patients, the T-graft was placed between the LIMA and RA. Patients in the SV group were older (70.6 ± 7.8 vs. 58.5 ± 10.0 years; p < 0.001), suffered more frequently from non-ST elevation myocardial infarction (12.7 vs. 1.7%; p = 0.027), arterial hypertension (83.6 vs. 61.7%; p = 0.009), and atrial fibrillation (18.2 vs. 1.7%; p = 0.003). They were less likely to be active smokers (16.4 vs. 38.3%; p = 0.009) and less likely to have a history of variceal surgery (0 vs. 15.0%; p = 0.003). Calcification of the ascending aorta was also found more frequently in the saphenous group (18.2 vs. 3.3%, p = 0.009). Operative times and number of distal anastomoses did not differ significantly between the two groups. Postoperative deliriums (16.7 vs. 5.0%; p = 0.043) were observed more frequently in venous patients. Wound healing disorders of the leg (11.1 vs. 0%; p = 0.011) did only occur in SV group and wound infections of the arm only in the RA group. Complete follow-up was achieved in 74.8% of cases. Median follow-up was 60.3 (39.6; 73.2) months. Serious adverse cardiac-cerebral events (19.0 vs. 22.7%; p = 0.675) and mortality (14.5 vs. 6.7%; p = 0.167) did not differ significantly between the groups at follow-up. Myocardial infarction (0 vs. 2.5%; p = 1.000) and stroke (0 vs. 7.5%; p = 0.245) were observed exclusively in RA group. Percutaneous coronary intervention was required in single patients of RA group (0 vs. 15.0%; p = 0.028). No patient from either group underwent repeat coronary artery bypass grafting (CABG). The patients of SV group had angiographically competent grafts and open anastomoses. Graft failure was noted in a single patient in RA group, in which case both grafts and native coronary vessels were stented. Kaplan-Meier analysis revealed no significant survival disadvantage for SV group compared with RA group. CONCLUSION CABG with a composite T-graft between LIMA and a segment of SV may be comparable to bypass surgery with a composite T-graft between LIMA and RA. This might be true in terms of morbidity and mortality over an intermediate-term observation period. The results of our studies give rise to the hypothesis that the decision not to perform aortic bypass anastomosis may be more important than the choice of graft material.
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Affiliation(s)
- M Eide
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - J Jussli-Melchers
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - C Friedrich
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - A Haneya
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - G Lutter
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - J Cremer
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - J Schoettler
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
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De Silva N, Salem M, Friedrich C, Diraz S, Broll A, Pommert NS, Puehler T, Schoettler J, Cremer J, Haneya A. Does Duration of Aortic Cross Clamp Affect Outcome in Patients Undergoing Surgical Repair of Acute Dissection of Aorta Type A? A Large Retrospective Cohort Study. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761659] [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: 03/22/2023]
Affiliation(s)
- N. De Silva
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - M. Salem
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - C. Friedrich
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - S. Diraz
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A. Broll
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - N. S. Pommert
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - T. Puehler
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - J. Schoettler
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - J. Cremer
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A. Haneya
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
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Panholzer B, Gravert H, Borzikowsky C, Huenges K, Schoettler J, Schoeneich F, Attmann T, Haneya A, Frank D, Cremer J, Grothusen C. Outcome after surgical embolectomy for acute pulmonary embolism. J Cardiovasc Med (Hagerstown) 2022; 23:519-523. [PMID: 35905002 DOI: 10.2459/jcm.0000000000001349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Patients with pulmonary embolism (PE) and contraindications for or failed thrombolysis are at the highest risk for PE-related fatal events. These patients may benefit from surgical embolectomy, but data concerning this approach are still limited. METHODS The method used here was retrospective data analysis of 103 patients who underwent surgical embolectomy from 2002 to 2020 at our department. RESULTS Mean age was 58.4 (±15.1) years. Fifty-eight (56.3%) patients had undergone recent surgery; the surgery was tumor associated in 32 (31.1%) cases. Thirty (29.1%) patients had to be resuscitated due to PE, and 13 (12.6%) patients underwent thrombolysis prior to pulmonary embolectomy. Fifteen (14.5%) patients were placed on extra corporeal membrane oxygenation (ECMO) peri-operatively. Five patients (4.9%) died intra-operatively. Neurological symptoms occurred in four patients (3.9%). Thirty-day mortality was 23.3% ( n = 24). Re-thoracotomy due to bleeding was necessary in 12 (11.6%) patients. This parameter was also identified as an independent risk factor for mortality. CONCLUSION Surgical pulmonary embolectomy resulted in survival of the majority of patients with PE and contraindications for or failed thrombolysis. Given the excessive mortality when left untreated, an operative approach should become a routine part of discussions concerning alternative treatment options for these patients.
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Affiliation(s)
- Bernd Panholzer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel
| | - Hanna Gravert
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein
| | - Katharina Huenges
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel
| | - Jan Schoettler
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel
| | - Felix Schoeneich
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel
| | - Tim Attmann
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel
| | - Derk Frank
- Department of Internal Medicine III/Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany and DZHK, partner site Hamburg, Kiel, Lübeck
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel
| | - Christina Grothusen
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel
- Medizinische Klinik I, St. Johannes Hospital Dortmund, Dortmund, Germany
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Grothusen C, Friedrich C, Ulbricht U, Meinert J, Attmann T, Huenges K, Borzikowsky C, Haneya A, Schoettler J, Cremer J. Coronary Artery Bypass Grafting in Patients with Acute Myocardial Infarction and Cardiogenic Shock. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2307237] [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: 11/06/2022] Open
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Salem M, Hillmer J, Friedrich C, Panholzer B, Saad M, Salem M, Frank D, Ernst M, Maetzler W, Puehler T, Lutter G, Schoeneich F, Haneya A, Cremer J, Schoettler J. Cardiac Myxomas Resembling Malignant Neoplasia: Incidentally Diagnosed vs. Cerebral Embolized Myxomas. Cancers (Basel) 2022; 14:cancers14051111. [PMID: 35267419 PMCID: PMC8909683 DOI: 10.3390/cancers14051111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Cardiac myxomas (CM) are the most common primary cardiac tumors in adults. They are usually benign; however, malignant changes are known to occur but are extremely rare. Embolization is a common complication of cardiac myxomas and can cause neurological deficits before their surgical removal. The current study analyzed the outcomes after operative myxoma excision in patients, with and without cerebral embolic events prior to excision. Methods: All 66 consecutive patients who underwent a surgical excision of CM between 2005 and 2019 at our department were analyzed retrospectively. Patients with (n = 14) and without (n = 52) preoperative strokes caused by cerebral tumor embolization were compared. Results: The mean age was 58.4 ± 12.7 years in the stroke group (SG) and 62.8 ± 11.7 years in the non-stroke group (N-SG) (p = 0.226). Gender (35.7% vs. 61.5% female; p = 0.084) did not differ significantly, and comorbidities were comparable in both groups. The left hemisphere in the territory of the middle cerebral artery was affected by preoperative cerebral infarction most commonly (28.6%). The time from diagnosis to cardiac surgery procedure was 7 (3−24) days in the SG and 23 (5−55) days in the N-SG (p = 0.120). Cardiac myxomas were localized in the left atrium in both groups more frequently (SG: 92.9% vs. N-SG: 78.8%; p = 0.436). In the SG, 57.1% of CM had a non-solid surface, were localized in the left heart, and had a pedunculated attachment away from the fossa ovalis. In the N-SG, 92.3% of CM did not meet all these criteria (p < 0.001). The maximal diameters of CM were comparable (SG: 3.4 ± 1.5 cm vs. N-SG: 3.8 ± 2.1 cm; p = 0.538). The operation times (192.5 (139.3−244.5) min vs. 215.5 (184.5−273.3) min; p = 0.046) and the cross-clamp times (54.5 (33.3−86.5) min vs. 78.5 (55−106.8) min; p = 0.035) were significantly shorter in the SG. Only in the N-SG were reconstructions of the endocardium with bovine pericardium required after resection (51.9% vs 0%; p < 0.001). In the N-SG, CM were explored via the right atrium more often (57.7% vs. 14.3%; p = 0.007). Patients in the N-SG required significantly shorter ICU care after surgery (p = 0.020). Other postoperative courses did not differ significantly. After tumor removal, 1.9% of the N-SG suffered their first stroke and 14.3% of the SG had a cerebral re-infarction (p = 0.111). The 30-day mortality rates were 1.9% in the N-SG and 7.1% in the SG (p = 0.382). In one case in the N-SG, a tumor recurrence was diagnosed. The Kaplan−Meiercurves showed a significantly better long-term prognosis for patients in the N-SG (p = 0.043). Conclusions: After the surgical removal of CM, the outcome is compromised if preoperative cerebral embolization occurs. Surgical treatment is therefore indicated as soon as possible, especially when CM have a non-solid surface, are localized in the left heart, and have a pedunculated attachment away from the fossa ovalis.
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Affiliation(s)
- Mohamed Salem
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
- Correspondence: ; Tel.: +49-(0431)-500-67089; Fax: +49-(0431)-500-22004
| | - Jonas Hillmer
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Christine Friedrich
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Bernd Panholzer
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Mohammed Saad
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (M.S.); (D.F.)
| | - Mostafa Salem
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (M.S.); (D.F.)
| | - Derk Frank
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (M.S.); (D.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Markus Ernst
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Walter Maetzler
- Department of Neurology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany;
| | - Thomas Puehler
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Felix Schoeneich
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Assad Haneya
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Jochen Cremer
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
| | - Jan Schoettler
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (J.H.); (C.F.); (B.P.); (M.E.); (T.P.); (G.L.); (F.S.); (A.H.); (J.C.); (J.S.)
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Salem M, Grothusen C, Salem M, Frank D, Saad M, Ernst M, Puehler T, Lutter G, Haneya A, Cremer J, Schoettler J. Surgery after Failed Transcatheter Aortic Valve Implantation: Indications and Outcomes of a Concerning Condition. J Clin Med 2021; 11:jcm11010063. [PMID: 35011800 PMCID: PMC8745245 DOI: 10.3390/jcm11010063] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The number of transcatheter aortic valve implantations (TAVI) has increased enormously in recent decades. Transcatheter valve prosthesis failure and the requirement of conventional surgical replacement are expected to attract more focus in the near future. Indeed, given the scarcity of research in this field, the next decade will likely represent the beginning of a period of meaningful exploration of the degenerative changes that occur with transcatheter valves. The current study represents-through a series of consecutive cases-one of the first analyses of the underlying causes of TAVI failure, i.e., degenerative, functional and infective, followed by surgical aortic valve replacement (SAVR) and postoperative outcome. METHODS Between October 2008 and March 2021, 2098 TAVI procedures, including 1423 with transfemoral, 309 with transapical, and 366 with transaortic access, were performed in our institution. Among these, 0.5% (number(n) = 11) required acute SAVR (n = 6) within 7 days (n = 3) or later (n = 2), and were included in the study. RESULTS Valve stent dislocation was the most common cause of replacement (83%). Causes of replacement within 7 days after TAVI were multifactorial. In the later course, endocarditis was the sole indication for SAVR after TAVI. TAVI with transapical or transaortal approach had a higher EuroSCORE II (10.9 (7.2-35.3) vs. 3.5 (1.8-7.8)). Their 30-day mortality after surgical conversion was higher (67% vs. 20%), when compared to those who underwent a transfemoral procedure. The longest documented survival beyond 30 days was 58 months. CONCLUSIONS The causes of SAVR after TAVI failure are multifactorial, and include biological, physical and infectious factors. An acceptable midterm prognosis may be expected in patients with physical causes when dislocation of the catheter prosthesis is observed; in such cases, emergency conversion is required. Conversion due to infection, as in cases of endocarditis, had the worst outcome. Prognosis after conversion due to degeneration is still problematic, due to a lack of autopsies and the recent history of prosthetic implantations.
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Affiliation(s)
- Mohamed Salem
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
- Correspondence: ; Tel.: +49-(0431)-5002-2002 (ext. 67089); Fax: +49-(0431)-5002-2004
| | - Christina Grothusen
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
| | - Mostafa Salem
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (D.F.); (M.S.)
| | - Derk Frank
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (D.F.); (M.S.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Mohammed Saad
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (D.F.); (M.S.)
| | - Markus Ernst
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
| | - Thomas Puehler
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
| | - Jochen Cremer
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
| | - Jan Schoettler
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
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Puehler T, Friedrich C, Lutter G, Kornhuber M, Salem M, Schoettler J, Ernst M, Saad M, Seoudy H, Frank D, Schoeneich F, Cremer J, Haneya A. Outcome of Unilateral Pulmonary Edema after Minimal-Invasive Mitral Valve Surgery: 10-Year Follow-Up. J Clin Med 2021; 10:2411. [PMID: 34072399 PMCID: PMC8198899 DOI: 10.3390/jcm10112411] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
The study was approved by the institutional review board (IRB) at the University Medical Center Campus Kiel, Kiel, Germany (reference number: AZ D 559/18) and registered at the German Clinical Trials Register (reference number: DRKS00022222). OBJECTIVE Unilateral pulmonary edema (UPE) is a complication after minimally invasive mitral valve surgery (MIMVS). We analyzed the impact of this complication on the short- and long-term outcome over a 10-year period. METHODS We retrospectively observed 393 MIMVS patients between 01/2009 and 12/2019. The primary endpoint was a radiographically and clinically defined UPE within the first postoperative 24 h, secondary endpoints were 30-day and long-term mortality and the percentage of patients requiring ECLS. Risk factors for UPE incidence were evaluated by logistic regression, and risk factors for mortality in the follow-up period were assessed by Cox regression. RESULTS Median EuroSCORE II reached 0.98% in the complete MIMVS group. Combined 30-day and in-hospital mortality after MIMVS was 2.0% with a 95, 93 and 77% survival rate after 1, 3 and 10 years. Seventy-two (18.3%) of 393 patients developed a UPE 24 h after surgery. Six patients (8.3%) with UPE required an extracorporeal life-support system. Logistic regression analysis identified a higher creatinine level, a worse LV function, pulmonary hypertension, intraoperative transfusion and a longer aortic clamp time as predictors for UPE. Combined in hospital mortality and 30-day mortality was slightly but not significantly higher in the UPE group (4.2 vs. 1.6%; p = 0.17). Predictors for mortality during follow-up were age ≥ 70 years, impaired RVF, COPD, drainage loss ≥ 800 mL and length of ventilation ≥ 48 h. During a median follow-up of 4.6 years, comparable survival between UPE and non-UPE patients was seen in our analysis after 5 years (89 vs. 88%; p = 0.98). CONCLUSIONS In-hospital outcome with UPE after MIMVS was not significantly worse compared to non-UPE patients, and no differences were observed in the long-term follow-up. However, prolonged aortic clamp time, worse renal and left ventricular function, pulmonary hypertension and transfusion are associated with UPE.
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Affiliation(s)
- Thomas Puehler
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
- DZHK (German-Centre for Cardiovascular-Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany;
| | - Christine Friedrich
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
- DZHK (German-Centre for Cardiovascular-Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany;
| | - Maike Kornhuber
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| | - Mohamed Salem
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| | - Jan Schoettler
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| | - Markus Ernst
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| | - Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University-Medical-Center Schleswig-Holstein, D-24105 Kiel, Germany; (M.S.); (H.S.)
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University-Medical-Center Schleswig-Holstein, D-24105 Kiel, Germany; (M.S.); (H.S.)
| | - Derk Frank
- DZHK (German-Centre for Cardiovascular-Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany;
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University-Medical-Center Schleswig-Holstein, D-24105 Kiel, Germany; (M.S.); (H.S.)
| | - Felix Schoeneich
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
| | - Jochen Cremer
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
- DZHK (German-Centre for Cardiovascular-Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany;
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Arnold-Heller-Str. 3, House C 2, D-24105 Kiel, Germany; (C.F.); (G.L.); (M.K.); (M.S.); (J.S.); (M.E.); (F.S.); (J.C.); (A.H.)
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Salem M, Friedrich C, Saad M, Frank D, Salem M, Puehler T, Schoettler J, Schoeneich F, Cremer J, Haneya A. Active Infective Native and Prosthetic Valve Endocarditis: Short- and Long-Term Outcomes of Patients after Surgical Treatment. J Clin Med 2021; 10:jcm10091868. [PMID: 33925866 PMCID: PMC8123486 DOI: 10.3390/jcm10091868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/18/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Active infective endocarditis (IE) is a serious disease associated with high mortality. The current study represents our experience over 18 years with surgical treatment for active infective native and prosthetic valve endocarditis (INVE, IPVE). Method: Analysis of 413 patients (171 with IPVE vs. 242 with INVE) who underwent cardiac surgery due to IE between 2002 and 2020. Results: Patients with IPVE were significantly older (64.9 ± 13.2 years vs. 58.3 ± 15.5 years; p < 0.001) with higher EuroSCORE II (21.2 (12.7; 41.8) vs. 6.9 (3.0; 17.0); p < 0.001)) and coronary heart disease (50.6% vs. 38.0%; p < 0.011). Preoperative embolization was significantly higher within INVE (35.5% vs. 16.4%; p < 0.001) with high incidence of cerebral embolization (18.6% vs. 7.6%; p = 0.001) and underwent emergency curative surgery than the IPVE group (19.6% vs. 10.6%; p < 0.001). However, patients with IPVE were significantly represented with intracardiac abscess (44.4% vs.15.7%; p < 0.001). Intraoperatively, the duration of surgery was expectedly significantly higher in the IPVE group (356 min vs. 244 min.; p = 0.001) as well as transfusion of blood (4 units (0–27) vs. 2 units (0–14); p < 0.001). Post-operatively, the incidence of bleeding was markedly higher within the IPVE group (700 mL (438; 1163) vs. 500 mL (250; 1075); p = 0.005). IPVE required significantly more permanent pacemakers (17.6% vs. 7.5%: p = 0.002). The 30-day mortality was higher in the IPVE group (24.6% vs. 13.2%; p < 0.003). Conclusion: Patients with INVE suffered from a higher incidence of cerebral embolization and neurological deficits than patients with IPVE. Surgical treatment in INVE is performed mostly as an emergency indication. However, patients with IPVE were represented commonly with intracardiac abscess, and had a higher indication of pacemaker implantation. The short- and long-term mortality rate among those patients was still high.
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Affiliation(s)
- Mohamed Salem
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
- Correspondence: or ; Tel.: +49-431500-67089
| | - Christine Friedrich
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Mohammed Saad
- Department of Cardiology and Angiology, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (D.F.); (M.S.)
| | - Derk Frank
- Department of Cardiology and Angiology, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (D.F.); (M.S.)
| | - Mostafa Salem
- Department of Cardiology and Angiology, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (D.F.); (M.S.)
| | - Thomas Puehler
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Jan Schoettler
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Felix Schoeneich
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Jochen Cremer
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Assad Haneya
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
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Salem M, Salib M, Friedrich C, Salem M, Puehler T, Schoettler J, Schoeneich F, Cremer J, Haneya A. Influence of Age on Postoperative Neurological Outcomes after Surgery of Acute Type A Aortic Dissection. J Clin Med 2021; 10:jcm10081643. [PMID: 33921536 PMCID: PMC8068896 DOI: 10.3390/jcm10081643] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acute type A aortic dissection (AAAD) is considered a fatal disease which requires an emergent surgical intervention. This study focuses onthe neurological outcome after surgical repair in cases of AAAD in comparison between elderly and young patients. METHODS a retrospective analysis of 368 consecutive patients who underwent emergency surgery of ascending aorta in moderate hypothermic circulatory arrest (MHCA) (20-24 °C) and antegrade cerebral perfusion after AAAD between 2001 and 2016. Patients were divided into two groups: those aged 75 years and older (68 (18.5%)) and those younger than 75 years (300 (81.5%)). RESULTS Comparing both groups, average age was 79.0 ± 3.2 vs. 59.2 ± 10.7 years (p < 0.001); female gender represents 58.8% of elderly patients vs. 28.7% in younger patients (p < 0.001). Intraoperatively, cardiopulmonary bypass time (155 min (131; 187) vs. 171 min (137; 220); p = 0.012), cross-clamping time (79 min (60; 105) vs. 93 min (71; 134); p = 0.001] and circulatory arrest time (29 min (22; 40) vs. 33 min (26; 49); p = 0.011) were significantly shorter in elderly than younger group. Postoperatively, there was no significant difference in delirium (11.8% vs. 20.5%; p = 0.0968) or stroke (11.8% vs. 16.1%; p = 0.369). The 30-day mortality was satisfactory for both groups but significantly higher in the elderly group (27.9% vs. 14.3%; p = 0.007). CONCLUSION The current study concluded that surgical treatment of AAAD in elderly patients can be applied safely without increasing risk of neurological complication. However, minimizing operation time may help limit the occurrence of postoperative neurological complication.
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Affiliation(s)
- Mohamed Salem
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
- Correspondence: ; Tel.: +49-431500-67089
| | - Michael Salib
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Christine Friedrich
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Mostafa Salem
- Department of Cardiology and Angiology, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany;
| | - Thomas Puehler
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Jan Schoettler
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Felix Schoeneich
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Jochen Cremer
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Assad Haneya
- Department of Cardiovascular Surgery, School of Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
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Salem M, Friedrich C, Herbers L, Reimers J, Friedrichs A, Lutter G, Thiem A, Panholzer B, Puehler T, Schoettler J, Frank D, Schoeneich F, Cremer J, Haneya A. Surgical Treatment for Active Infective Prosthetic Valve Endocarditis: A Single-Center Experience. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725753] [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: 10/21/2022]
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Kapahnke J, Huenges K, Salem M, Kolat P, Schoettler J, Schoeneich F, Puehler T, Friedrich C, Cremer J, Haneya A. The Circulatory Arrest Time in Patients with Acute Type A Aortic Dissection: Does It Influence the Outcome? Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705505] [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: 10/24/2022]
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Tulun A, Panholzer B, Schoeneich F, Schoettler J, Puehler T, Cremer J, Haneya A. Outcome of Postinfarction Ventricular Septal Defect Repair in the Era of Mechanical Circulatory Support. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705347] [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: 10/24/2022]
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Puehler T, Salem M, Huenges K, Panholzer B, Friedrich C, Schoettler J, Schoeneich F, Cremer J, Haneya A. Is Total Arch Replacement Associated with an Increased Risk for 30-day Mortality after Surgery for Acute Type A Dissection. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627889] [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: 10/28/2022]
Affiliation(s)
- T. Puehler
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - M. Salem
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - K. Huenges
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - B. Panholzer
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - C. Friedrich
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - J. Schoettler
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - F. Schoeneich
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - J. Cremer
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - A. Haneya
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
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Salem M, Salem A, Düver S, Erdal Y, Psykalla N, Friedrich C, Panholzer B, Huenges K, Pühler T, Schoettler J, Schoeneich F, Cremer J, Haneya A. Effect of Deep Hypothermia Circulatory Arrest on Neurological Outcomes in Patients Undergoing Replacement of Ascending Aorta: A Comparison between Young and Elderly Adults. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628051] [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: 10/28/2022]
Affiliation(s)
- M. Salem
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A. Salem
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S. Düver
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Y. Erdal
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - N. Psykalla
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - C. Friedrich
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - B. Panholzer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - K. Huenges
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T. Pühler
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J. Schoettler
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - F. Schoeneich
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J. Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A. Haneya
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Grothusen C, Ohnewald E, Friedrich C, Ashbahs M, Meinert J, Huenges K, Attmann T, Haneya A, Schoettler J, Cremer J. Sex-dependent Differences after Early Operative Myocardial Revascularization in Acute Myocardial Infarction. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627489] [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: 10/28/2022]
Affiliation(s)
- C. Grothusen
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - E. Ohnewald
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - C. Friedrich
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M. Ashbahs
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J. Meinert
- Klinik für Innere Medizin IV mit den Schwerpunkten Nieren- und Hochdruckkrankheiten, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - K. Huenges
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T. Attmann
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A. Haneya
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J. Schoettler
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J. Cremer
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Grothusen C, Friedrich C, Loehr J, Meinert J, Ohnewald E, Ulbricht U, Attmann T, Haneya A, Huenges K, Freitag-Wolf S, Schoettler J, Cremer J. Outcome of Stable Patients With Acute Myocardial Infarction and Coronary Artery Bypass Surgery Within 48 Hours: A Single-Center, Retrospective Experience. J Am Heart Assoc 2017; 6:JAHA.117.005498. [PMID: 28974496 PMCID: PMC5721822 DOI: 10.1161/jaha.117.005498] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 12/04/2022]
Abstract
Background The optimal timing of coronary artery bypass grafting (CABG) in clinically stable patients with acute myocardial infarction who are unsuitable for percutaneous coronary intervention is unclear. We report our experience with early CABG in these patients. Methods and Results Between January 2001 and May 2015, 766 patients with ST‐segment–elevation myocardial infarction (STEMI, n=305) or non‐STEMI (NSTEMI, n=461) not including cardiogenic shock underwent CABG within 48 hours at our department. STEMI patients were younger than non‐STEMI patients (age 65 years [range: 58–72] versus 70 years [range: 62–75], P<0.001) with a lower EuroSCORE II (4.12 [range: 2.75–5.81] versus 4.58 [range: 2.80–7.74], P=0.009). STEMI patients had undergone preoperative percutaneous coronary intervention more often (20.3% versus 7.8%, P<0.001). Time to surgery was shorter in STEMI compared with non‐STEMI patients (5.0 hours [range: 3.2–8.8] versus 11.7 hours [range: 6.4–22.0], P<0.001). No significant differences concerning arterial graft use (93.8% versus 94.8%, P=0.540) or complete revascularization (87.5% versus 83.4%, P=0.121) were observed. The rate of strokes did not differ between the groups (2.0% versus 3.9%, P=0.134). Thirty‐day mortality was lower in STEMI patients (2.7% versus 6.6% P=0.018), especially when CABG was performed within 6 hours (1.8% versus 7.1%, P=0.041). Survival of STEMI and non‐STEMI patients was 94% versus 88% after 1 year (P<0.001), 87% versus 73% after 5 years (P<0.001), and 74% versus 57% after 10 years (P<0.001). Independent predictors of 30‐day and long‐term mortality included preoperatively increased lactate values, age, atrial fibrillation, and reduced left ventricular function. Conclusions Stable STEMI patients showed a lower rate of perioperative complications and better survival compared with non‐STEMI patients when CABG was performed within 48 hours.
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Affiliation(s)
- Christina Grothusen
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Christine Friedrich
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Johannes Loehr
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Jette Meinert
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Eva Ohnewald
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Ulysses Ulbricht
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Tim Attmann
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Katharina Huenges
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, Christian-Albrechts University Kiel, Kiel, Germany
| | - Jan Schoettler
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
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Grothusen C, Friedrich C, Attmann T, Meinert J, Ohnewald E, Ulbricht U, Huenges K, Haneya A, Frank D, Graesner JT, Schoettler J, Cremer J. Coronary artery bypass surgery within 48 hours after cardiac arrest due to acute myocardial infarction. Eur J Cardiothorac Surg 2017; 52:297-302. [DOI: 10.1093/ejcts/ezx112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 02/18/2017] [Indexed: 11/15/2022] Open
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Grothusen C, Friedrich C, Loehr J, Meinert J, Ohnewald E, Ulbricht U, Attmann T, Haneya A, Huenges K, Cremer J, Schoettler J. Short- and Long-Term Outcome of Patients with Acute Myocardial Infarction and Coronary Artery Bypass Surgery within 48 Hours. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598764] [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: 10/20/2022]
Affiliation(s)
- C. Grothusen
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - C. Friedrich
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - J. Loehr
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - J. Meinert
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - E. Ohnewald
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - U. Ulbricht
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - T. Attmann
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - A. Haneya
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - K. Huenges
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - J. Cremer
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - J. Schoettler
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
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Boldt J, Lutter G, Pohanke J, Fischer G, Schoettler J, Cremer J, Metzner A. Percutaneous Tissue-Engineered Pulmonary Valved Stent Implantation: Comparison of Bone Marrow-Derived CD133+-Cells and Cells Obtained from Carotid Artery. Tissue Eng Part C Methods 2013; 19:363-74. [DOI: 10.1089/ten.tec.2012.0078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jessica Boldt
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Judith Pohanke
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Gunther Fischer
- Department of Pediatric Cardiology School of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jan Schoettler
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Anja Metzner
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
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Grothusen C, Hagemann A, Attmann T, Braesen J, Broch O, Cremer J, Schoettler J. Impact of an interleukin-1 receptor antagonist and erythropoietin on experimental myocardial ischemia/reperfusion injury. ScientificWorldJournal 2012; 2012:737585. [PMID: 22649318 PMCID: PMC3354588 DOI: 10.1100/2012/737585] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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: 10/13/2011] [Accepted: 12/27/2011] [Indexed: 01/13/2023] Open
Abstract
Background. Revascularization of infarcted myocardium results in release of inflammatory cytokines mediating myocardial reperfusion injury and heart failure. Blockage of inflammatory pathways dampens myocardial injury and reduces infarct size. We compared the impact of the interleukin-1 receptor antagonist Anakinra and erythropoietin on myocardial ischemia/reperfusion injury. In contrast to others, we hypothesized that drug administration prior to reperfusion reduces myocardial damage. Methods and Results. 12–15 week-old Lewis rats were subjected to myocardial ischemia by a 1 hr occlusion of the left anterior descending coronary artery. After 15 min of ischemia, a single shot of Anakinra (2 mg/kg body weight (bw)) or erythropoietin (5000 IE/kg bw) was administered intravenously. In contrast to erythropoietin, Anakinra decreased infarct size (P < 0.05, N = 4/group) and troponin T levels (P < 0.05, N = 4/group). Conclusion. One-time intravenous administration of Anakinra prior to myocardial reperfusion reduces infarct size in experimental ischemia/reperfusion injury. Thus, Anakinra may represent a treatment option in myocardial infarction prior to revascularization.
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Affiliation(s)
- Christina Grothusen
- Department of Cardiovascular Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 18, 24105 Kiel, Germany.
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Metzner A, Boldt J, Pohanke J, Fischer G, Schoettler J, Cremer J, Lutter G. COMPARISON OF BONE-MARROW DERIVED CD133+-CELLS AND CELLS OBTAINED FROM CAROTID ARTERY AFTER PERCUTANEOUS TISSUE ENGINEERED PULMONARY VALVED STENT IMPLANTATION. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60812-2] [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: 11/16/2022]
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Iino K, Boldt J, Lozonschi L, Metzner A, Schoettler J, Petzina R, Cremer J, Lutter G. Off-pump transapical mitral valve replacement: evaluation after one month. Eur J Cardiothorac Surg 2012; 41:512-7. [DOI: 10.1093/ejcts/ezr106] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schoettler J, Jussli-Melchers J, Grothusen C, Stracke L, Schoeneich F, Stohn S, Hoffmann G, Cremer J. Highly flexible nitinol mesh to encase aortocoronary saphenous vein grafts: first clinical experiences and angiographic results nine months postoperatively. Interact Cardiovasc Thorac Surg 2011; 13:396-400. [PMID: 21724659 DOI: 10.1510/icvts.2010.265116] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Saphenous vein graft patency is frequently limited by degeneration. Experimental studies have indicated that rigid external support of venous grafts by a flexible, tubular nitinol mesh may improve graft patency. The study presented was part of a prospective, randomized, multicenter first-in-man trial investigating the safety and effectiveness of nitinol-supported venous grafts in coronary artery bypass graft (CABG) surgery. From our clinic, 25 subjects with multivessel coronary artery disease requiring saphenous vein graft CABG of the right coronary artery (RCA) and the circumflex artery were entered into the trial. Subjects were randomized to receive a mesh-supported graft on one of these arteries; the other vessel received an untreated vein graft. Graft patency was assessed by coronary angiography nine months after surgery. The implantation of mesh grafts was simple and safe. In 10 cases, a nitinol mesh-supported venous graft was anastomosed to the circumflex artery and in 15 cases to the RCA. All patients survived the observation period. A total of 72% of the patients underwent control coronary angiography. The patency rate of mesh-supported grafts was 27.8% nine months postoperatively. Conventional vein grafts showed an 85.7% patency, and arterial grafts had a 100% patency. No complications directly related to the implantation of mesh-supported grafts were observed. The promising experimental results of mesh-supported venous grafts could not be reproduced in the study presented. A critical item seems to be correct selection of nitinol mesh diameter, the anastomotic method and fixation of the mesh tube to the venous graft.
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Affiliation(s)
- Jan Schoettler
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany.
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Attmann T, Pokorny S, Lozonschi L, Metzner A, Marcynski-Bühlow M, Schoettler J, Cremer J, Lutter G. Mitral valved stent implantation: An overview. MINIM INVASIV THER 2011; 20:78-84. [DOI: 10.3109/13645706.2011.554559] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Boening A, Friedrich C, Hedderich J, Schoettler J, Fraund S, Cremer JT. Early and medium-term results after on-pump and off-pump coronary artery surgery: a propensity score analysis. Ann Thorac Surg 2003; 76:2000-6. [PMID: 14667630 DOI: 10.1016/s0003-4975(03)01298-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Comparative publications on beating-heart off-pump coronary artery bypass grafting (OPCAB) surgery versus conventional coronary artery bypass grafting (CCAB) surgery frequently do not offer conclusive information because of investigator bias. METHODS Trying to eliminate this problem, a propensity score analysis of the data of all CCAB patients (n = 517) and OPCAB patients (n = 133) operated on by the same surgeons during the same time period (1998 to 2001) was applied. After matching patients with similar propensity score values, 97 CCAB patients and 72 OPCAB patients entered the final analysis. RESULTS Early results were similar in both groups: the 30-day mortality reached 1.4% in the CCAB group and 2.8% in the OPCAB group; strokes did not happen. Perioperative myocardial infarctions occurred in 4.1% of the CCAB patients and 4.3% of the OPCAB patients. Drainage blood loss in the first 24 hours after surgery (830 +/- 687 mL, CCAB group; and 909 +/- 678 mL, OPCAB group) was similar (p = 0.06) in both groups. Medium term results (freedom from percutaneous transluminal coronary angioplasty or reoperation, freedom from myocardial infarction, freedom from stroke, and the quality of life) also were not significantly different between the off-pump and on-pump groups after a mean follow-up of 27 +/- 11 months. CONCLUSIONS Our results suggest that elective-surgery patients with coronary artery disease can be operated on either on-pump or off-pump with the same early and late mortality and morbidity.
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Affiliation(s)
- Andreas Boening
- Department of Cardiovascular Surgery, University Hospital, Kiel, Germany.
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30
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Katz RM, Friedman S, Diament M, Siegel SC, Rachelefsky GS, Spector SL, Rohr AS, Schoettler J, Dorris A. A comparison of imaging techniques in patients with chronic sinusitis (X-ray, MRI, A-mode ultrasound). Allergy Proc 1995; 16:123-7. [PMID: 7557370 DOI: 10.2500/108854195778690273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Thirty-five patients age 9 to 67 were evaluated for chronic sinusitis by history, physical and laboratory examination, and imaging techniques (X-ray, magnetic resonance imaging (MRI) and flexible rhinoscopy). MRI was the most predictive. To establish the diagnosis of sinusitis, it was more sensitive than plain X-ray for intrasinus disease. Findings of edema, erythema, and drainage on flexible rhinoscopy were consistent with chronic sinusitis and were confirmed by MRI and sinus X-rays in 41% of the cases. Nasal smears for polymorphonuclear cells and eosinophils were suggestive of a diagnosis of chronic sinusitis, but other laboratory tests (CBC, sedimentation rate, quantitative immunoglobulins, total IgEs) were of very limited value in the diagnosis of chronic sinusitis.
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Affiliation(s)
- R M Katz
- Department of Pediatrics, UCLA School of Medicine, USA
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31
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Arruda LK, Mimica IM, Solé D, Weckx LL, Schoettler J, Heiner DC, Naspitz CK. Abnormal maxillary sinus radiographs in children: do they represent bacterial infection? Pediatrics 1990; 85:553-8. [PMID: 2107515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Thirty-three children with chronic tonsillitis and/or adenoid enlargement and without previous diagnosis of sinusitis were studied regarding the bacterial flora of their maxillary sinuses. Puncture of maxillary sinus was performed at surgery (adenoidectomy and/or tonsillectomy) and aspirates were cultured. Streptococcus pneumoniae was isolated from 8 of 12 (66.7%) patients whose x-rays showed completely opacified maxillary sinus. Streptococcus viridans, Streptococcus faecalis, and Staphylococcus epidermidis were recovered from 6 (28.6%) of the 21 patients with normal maxillary sinus radiographs. Bacterial titers were greater than 10(4) colonies/mL in all but one of the positive cultures. No anaerobic bacteria were isolated. History of bronchial asthma, presence of nasal purulent secretion, elevated blood eosinophils, and elevated serum IgE were found more frequently in children with complete opacification of maxillary sinus. Serum levels of IgG2 were low in 29% of the children, but no correlation was found between low IgG2 levels and positive cultures from maxillary sinus aspirates. We concluded that children with complete radiologic opacification of maxillary sinus had bacterial infection in almost 70% of the cases with symptoms that did not prompt their physicians to consider the diagnosis of sinusitis.
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Affiliation(s)
- L K Arruda
- Division of Allergy, Paulista School of Medicine, São Paulo, Brazil
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