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Wert L, Stewart GC, Mehra MR, Milwidsky A, Jorde UP, Goldstein DJ, Selzman CH, Stehlik J, Alshamdin FD, Khaliel FH, Gustafsson F, Boschi S, Loforte A, Ajello S, Scandroglio AM, Tučanová Z, Netuka I, Schlöglhofer T, Zimpfer D, Zijderhand CF, Caliskan K, Dogan G, Schmitto JD, Maier S, Schibilsky D, Jawad K, Saeed D, Faerber G, Morshuis M, Hanuna M, Müller CS, Mulzer J, Kempfert J, Falk V, Potapov EV. A multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device. J Thorac Cardiovasc Surg 2024; 167:1322-1330.e6. [PMID: 36562497 DOI: 10.1016/j.jtcvs.2022.09.051] [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: 03/29/2022] [Revised: 09/18/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The HeartMate 3 (HM 3; Abbott) left ventricular assist device (LVAD) has improved hemocompatibility-related adverse outcomes. In sporadic cases, external compression of the outflow graft causing obstruction (eOGO) can result from substance accumulation between the outflow graft and its bend relief. We sought to evaluate the prevalence, course, and clinical implications of eOGO in an international study. METHODS A multicenter retrospective analysis of HM 3 LVADs implanted between November 2014 and April 2021 (n = 2108) was conducted across 17 cardiac centers in 8 countries. We defined eOGO as obstruction >25% in the cross-sectional area in imaging (percutaneous angiography, computed tomography, or intravascular ultrasound). The prevalence and annual incidence were calculated. Serious adverse events and outcomes (death, transplantation, or device exchange) were analyzed for eOGO cases. RESULTS Of 2108 patients, 62 were diagnosed with eOGO at a median LVAD support duration of 953 (interquartile range, 600-1267) days. The prevalence of eOGO was 3.0% and the incidence at 1, 2, 3, 4, and 5 years of support was 0.6%, 2.8%, 4.0%, 5.2%, and 9.1%, respectively. Of 62 patients, 9 were observed, 27 underwent surgical revision, 15 underwent percutaneous stent implantation, 8 received a heart transplant, and 2 died before intervention. One patient underwent surgical revision and later stent implantation. The mortality with therapeutic intervention was 9/53 (17.0%). CONCLUSIONS Although uncommon, HM 3 LVAD-supported patients might develop eOGO with an increasing incidence after 1 year of support. Although engineering efforts to reduce this complication are under way, clinicians must maintain a focus on early detection and remain vigilant.
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Affiliation(s)
- Leonhard Wert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
| | - Garrick C Stewart
- Division of Cardiovascular Medicine, Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, Mass
| | - Mandeep R Mehra
- Division of Cardiovascular Medicine, Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, Mass
| | - Assi Milwidsky
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Ulrich P Jorde
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Daniel J Goldstein
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Craig H Selzman
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Faisal D Alshamdin
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Feras H Khaliel
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Silvia Boschi
- Department of Cardiac Surgery, IRCCS Bologna, S. Orsola University Hospital, Bologna, Italy
| | - Antonio Loforte
- Department of Cardiac Surgery, IRCCS Bologna, S. Orsola University Hospital, Bologna, Italy
| | - Silvia Ajello
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Anna M Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Zuzana Tučanová
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Thomas Schlöglhofer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Casper F Zijderhand
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Günes Dogan
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Sven Maier
- Department of Cardiovascular Surgery, Heart Center University Freiburg-Bad Krozingen, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Schibilsky
- Department of Cardiovascular Surgery, Heart Center University Freiburg-Bad Krozingen, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Diyar Saeed
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Michiel Morshuis
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Maja Hanuna
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christoph S Müller
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Johanna Mulzer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Dieterlen MT, Messer EK, Klaeske K, Sieg F, Eifert S, Haunschild J, Jawad K, Saeed D, Dashkevich A, Borger MA. Pre-Implant Immune Status is Associated with Infection Risk After Left Ventricular Assist Device Implantation. J Inflamm Res 2024; 17:581-589. [PMID: 38318245 PMCID: PMC10840410 DOI: 10.2147/jir.s424879] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/10/2023] [Indexed: 02/07/2024] Open
Abstract
Purpose Infection is the most common complication after left ventricular assist device (LVAD) implantation. The immune status of LVAD patients is relevant for the incidence and severity of infection, but it is unknown if there is a predisposing immune status prior to LVAD implantation that contributes to an increased risk for infection in the post-implant period. We analyzed the pre-LVAD immune status in patients with infection within 3 months after LVAD implantation in comparison to infection-free patients. Patients and Methods Fifty-four consecutive LVAD patients were included in this study. According to their infectious history in the first 3 months after LVAD implantation, these patients were grouped into an infection (n=23) and an infection-free group (n=31). Pre-LVAD blood samples were obtained for flow cytometric analysis of immunological parameters including B cells, subsets of T, dendritic and natural killer cells. Patient-specific, clinical and laboratory data were recorded. Results Blood count analysis prior to LVAD implantation showed comparable counts of erythrocytes (p=0.19), platelets (p=0.33) and leukocytes (p=0.50) between patients with infection and infection-free patients in the post-implant period. Patients with infection in the first 3 months after LVAD implantation had lower concentrations of lymphocytes (p=0.02). Forty percent of the patients with infection showed more often pre-LVAD neutrophil-to-lymphocyte ratios (NLR) >7 than patients without infection in the first 3 months after LVAD implantation (14%, p=0.05). Patients with infection already had lower percentages of CD3+ T cells (p=0.03), CD19+ B cells (p<0.01), BDCA2+ pDCs (p=0.03) and BDCA4+ plasmacytoid DCs (pDCs) (p=0.05) prior to LVAD implantation than infection-free patients. Conclusion Our results demonstrated that patients with infection in the early post-implant period showed lower concentrations of lymphocytes, especially of CD3+ T cells and CD19+ B cells, decreased percentages of BDCA2+ and BDCA4+ pDCs, and had more often NLRs >7 indicating moderate-to-severe inflammation. Thus, we identified specific immunological changes pre-LVAD that could help to identify patients at risk for infection in the early post-implant period.
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Affiliation(s)
- Maja-Theresa Dieterlen
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Eva Katharina Messer
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Kristin Klaeske
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Franz Sieg
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Sandra Eifert
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Josephina Haunschild
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Khalil Jawad
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Diyar Saeed
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Alexey Dashkevich
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Michael Andrew Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
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Klaeske K, Messer EK, Klein S, Sieg F, Eifert S, Haunschild J, Jawad K, Saeed D, Dashkevich A, Borger MA, Dieterlen MT. Body mass index-dependent immunological profile changes after left ventricular assist device implantation. Front Immunol 2023; 14:1256725. [PMID: 37885885 PMCID: PMC10597783 DOI: 10.3389/fimmu.2023.1256725] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Purpose Infection is a common complication following left ventricular assist device (LVAD) implantation. Patients with obesity are particularly at risk due to their high percentage of adipose tissue and the resulting chronic inflammatory state and resulting immunological changes. This study investigated changes of immunological parameters in relation to body mass index (BMI) during the first year after LVAD implantation. Methods Blood samples were obtained prior to LVAD implantation and at 3 (1st FU), 6 (2nd FU) and 12 mo (3rd FU) after LVAD implantation. Patients were divided into three groups (normal weight: BMI of 18.5-24.9 kg/m2; n=12; pre-obesity: 25.0-29.9 kg/m2; n=15; obesity: ≥ 30.0 kg/m2; n=17) based on their BMI at the time of LVAD implantation. Flow cytometric analyses for CD4+ and CD8+ T cells, regulatory T cells (Tregs), B cells as well as dendritic cells (DCs) were performed. Results After LVAD implantation, obese patients (0.51 ± 0.20%) showed a higher proportion of overall DCs than normal-weight (0.28 ± 0.10%) and pre-obese patients (0.32 ± 0.11%, p<0.01) at 3rd FU. The proportion of BDCA3+ myeloid DCs was lower in obese patients (64.3 ± 26.5%) compared to normal-weight patients (82.7 ± 10.0%, pnormal-weight vs. obesity=0.05) at 2nd FU after LVAD implantation. The analysis of BDCA4+ plasmacytoid DCs revealed a reduced proportion in pre-obese (21.1 ± 9.8%, pnormal-weight vs. pre-obesity=0.01) and obese patients (23.7 ± 10.6%, pnormal-weight vs. obesity=0.05) compared to normal-weight patients (33.1 ± 8.2%) in the 1st FU. T cell analysis showed that CD4+ T cells of obese patients (62.4 ± 9.0%) significantly increased in comparison to pre-obese patients (52.7 ± 10.0%, ppre-obesity vs. obesity=0.05) and CD8+ T cells were lower in obese patients (31.8 ± 8.5%) than in normal-weight patients (42.4 ± 14.2%; pnormal-weight vs. obesity=0.04) at the 3rd FU. Furthermore, we observed significantly reduced proportions of Tregs in pre-obese patients compared to normal-weight and obese patients at 2nd FU (p=0.02) and 3rd FU (p=0.01) after LVAD implantation. Conclusion This study reported changes of the innate and adaptive immune system of pre-obese and obese compared to normal-weight patients one year after LVAD implantation. DCs and their subsets, CD8+ T cells and Tregs were affected immune cell populations that indicate immunological changes which might increase the incidence of postoperative infection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Maja-Theresa Dieterlen
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
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Saeed D, Stark C, Otto W, Loforte A, Zimpfer D, Bernhardt AM, Potapov E, Morshius M, Schibilsky D, Albert A, Raweh A, Riebandt J, Pappalardo F, Attisani M, Rinaldi M, Haneya A, Huenges K, Ramjankhan F, Jorde UP, Lewin D, Jawad K, Aubin H, Ayala R, Reichenspurner H, Lichtenberg A, Borger M, Gummert J. Outcome of patients supported with the HeartMate 3 after extracorporeal life support: On behalf of the Durable Mechanical Circulatory Support After Extracorporeal Life Support Study Group. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00763-8. [PMID: 37689237 DOI: 10.1016/j.jtcvs.2023.08.048] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/04/2023] [Accepted: 08/18/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES The Durable Mechanical Circulatory Support System After Extracorporeal Life Support registry is a multicenter registry of patients who were bridged from extracorporeal life support to a durable mechanical circulatory support system. Although numerous studies have highlighted the favorable outcomes after implantation of the HeartMate 3 (Abbott), the objective of our study is to examine the outcomes of patients who received HeartMate 3 support after extracorporeal life support. METHODS Data of patients undergoing HeartMate 3 implantation from January 2016 to April 2022 at 14 centers were collected and evaluated. Inclusion criteria were patients with extracorporeal life support before HeartMate 3 implantation. The outcome was reported and compared with patients receiving other types of pumps. RESULTS A total of 337 patients were bridged to durable mechanical circulatory support system after extracorporeal life support in the study period. Of those patients, 140 were supported with the HeartMate 3. The other types of pumps included 170 HeartWare HVADs (Medtronic) (86%), 14 HeartMate II devices (7%), and 13 (7%) other pumps (7%). Major postoperative complications included right heart failure requiring temporary right ventricular assist device in 60 patients (47%). Significantly lower postoperative stroke (16% vs 28%, P = .01) and pump thrombosis (3% vs 8%, P = .02) rates were observed in the patients receiving the HeartMate 3. The 30-day, 1-year, and 3-year survivals in patients receiving the HeartMate 3 were 87%, 73%, and 65%, respectively. CONCLUSIONS In this critically ill patient population, the survivals of patients who were transitioned to the HeartMate 3 are deemed acceptable and superior to those observed when extracorporeal life support was bridged to other types of durable mechanical circulatory support systems.
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Affiliation(s)
- Diyar Saeed
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
| | - Christoffer Stark
- Department of Cardiac Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Wolfgang Otto
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Antonio Loforte
- Department of Cardiac Surgery, Bologna University, Bologna, Italy; Department of Cardiac Surgery, Klinikum Dortmund, Dortmund, Germany
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Michiel Morshius
- Department of Cardiovascular and Thoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - David Schibilsky
- Department of Cardiac and Vascular Surgery, Freiburg University, Freiburg, Germany
| | | | | | - Julia Riebandt
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Matteo Attisani
- Department of Cardiac Surgery, Klinikum Dortmund, Dortmund, Germany
| | - Mauro Rinaldi
- Department of Cardiac Surgery, Klinikum Dortmund, Dortmund, Germany
| | - Assad Haneya
- Department of Cardiac Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Katharina Huenges
- Department of Cardiac Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Faiz Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ulrich P Jorde
- Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Daniel Lewin
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Hug Aubin
- Department for Cardiac Surgery, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Rafael Ayala
- Department of Cardiac and Vascular Surgery, Freiburg University, Freiburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Artur Lichtenberg
- Department for Cardiac Surgery, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Jan Gummert
- Department of Cardiovascular and Thoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
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Klaeske K, Schreiber C, Eifert S, Dieterlen T, Jawad K, Saeed D, Semmig-Könze S, Meyer AL, Borger MA, Dieterlen MT. Health status analysis is comparable in HM3 patients with different preoperative grades of mitral regurgitation. J Patient Rep Outcomes 2023; 7:86. [PMID: 37615830 PMCID: PMC10449706 DOI: 10.1186/s41687-023-00620-9] [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] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The guidelines for mechanical circulatory support of the International Society for Heart and Lung Transplantation do not recommend the routine replacement or repair of the mitral valve at the time point of left ventricular assist device (LVAD) implantation. We investigated different parameters of health status including exercise capacity, anxiety and depression after LVAD implantation in patients with different preoperative grades of mitral regurgitation (MR). METHODS A single-center analysis of health status was performed including 45 patients with HeartMate 3 (HM 3) implantation using the 12-items Short Form Health Survey (SF-12) and the Hospital Anxiety and Depression Score (HADS) questionnaires. The study groups were classified according to echocardiographically defined preoperative grade of MR. The group without severe MR comprised 33 patients; the group with severe MR comprised 12 patients. RESULTS Demographic and preclinical characteristics as well as LVAD complications such as thrombosis and bleeding events were comparable between LVAD patients with severe and not severe MR (p > 0.05). Severe MR resolved in all patients after LVAD implantation and improved to moderate, mild or no MR in both groups in a period ranging from 6 months until 2 years. The analyses of SF-12 questionnaire revealed that the physical (p = 0.44) and mental health (p = 0.64) was comparable. The grade of anxiety (p = 0.34) and depression (p = 0.44) was comparable between the groups. Exercise capacity measured by the 6 min walk test correlated positively with the SF-12-determined physical health (p < 0.01, r = 0.518) and negatively with the HADS anxiety (p = 0.01, r = -0.399) and depression (p < 0.01, r = -0.570) scores. CONCLUSIONS Our data showed that the health status is comparable in HM 3 patients with different preoperative MR severities in the post-LVAD period. Preoperative severe MR resolves in the majority of patients early after LVAD implantation and is not associated with concomitant mitral valve repair or replacement at the time of LVAD implantation.
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Affiliation(s)
- Kristin Klaeske
- Helios Clinic, Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
| | - Constantin Schreiber
- Helios Clinic, Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - Sandra Eifert
- Helios Clinic, Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - Tillmann Dieterlen
- Soteria Clinic, Clinic for Addiction Medicine, Helios Park-Klinikum, Leipzig, Germany
| | - Khalil Jawad
- Helios Clinic, Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - Diyar Saeed
- Helios Clinic, Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - Sandra Semmig-Könze
- Helios Clinic, Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - Anna Lassia Meyer
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Andrew Borger
- Helios Clinic, Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - Maja-Theresa Dieterlen
- Helios Clinic, Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
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Mariani S, Bari G, Ravaux JM, van Bussel BCT, De Piero ME, Schaefer AK, Jawad K, Pozzi M, Loforte A, Kalampokas N, Jankuviene A, Flecher E, Hou X, Bunge JJH, Sriranjan K, Salazar L, Meyns B, Mazzeffi MA, Matteucci S, Sponga S, Ramanathan K, Costetti A, Formica F, Sakiyalak P, Fiore A, Schmid C, Raffa GM, Castillo R, Wang IW, Jung JS, Grus T, Pellegrino V, Bianchi G, Pettinari M, Barbone A, Garcia JP, Kowalewski M, Shekar K, Whitman G. Heterogeneity in Clinical Practices for Post-Cardiotomy Extracorporeal Life Support: a Pilot Survey from the PELS-1 Multicenter Study. Artif Organs 2023. [PMID: 37351569 DOI: 10.1111/aor.14601] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND High-quality evidence for post-cardiotomy extracorporeal life support (PC-ECLS) management is lacking. This study investigated the real-world PC-ECLS clinical practices. METHODS This cross-sectional, multi-institutional, international pilot survey explored center organization, anticoagulation management, left ventricular unloading, distal limb perfusion, PC-ECLS monitoring and transfusions practices. Twenty-nine questions were distributed among 34 hospitals participating in the Post-cardiotomy Extra-Corporeal Life Support Study. RESULTS Of the 32 centers [16 low-volume (50%); 16 high-volume (50%)] that responded, 16 (50%) had dedicated ECLS specialists. Twenty-six centers (81.3%) reported using additional mechanical circulatory supports. Anticoagulation practices were highly heterogeneous: 24 hospitals (75%) reported using patient's bleeding status as a guide, without a specific threshold in 54.2% of cases. Transfusion targets ranged 7-10 g/dL. Most centers used cardiac venting on a case-by-case basis (78.1%) and regular distal limb perfusion (84.4%). Nineteen (54.9%) centers reported dedicated monitoring protocols including daily echocardiography (87.5%), Swan-Ganz catheterization (40.6%), cerebral near-infrared spectroscopy (53.1%) and multimodal assessment of limb ischemia. Inspection of the circuit (71.9%), oxygenator pressure drop (68.8%), plasma free hemoglobin (75%), d-dimer (59.4%), lactate dehydrogenase (56.3%) and fibrinogen (46.9%) are used to diagnose hemolysis and thrombosis. CONCLUSIONS This study shows remarkable heterogeneity in clinical practices for PC-ECLS management. More standardized protocols and better implementation of available evidence are recommended.
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Affiliation(s)
- Silvia Mariani
- Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Gabor Bari
- Clinic of Internal Medicine, Department of Cardiac Surgery, University of Szeged, Szeged, Hungary
| | - Justine M Ravaux
- Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Bas C T van Bussel
- Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
- Department of Intensive Care Medicine, and Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Maria Elena De Piero
- Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | | | - Khalil Jawad
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
| | - Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- University of Turin, Department of Surgical Sciences, Turin, Italy
| | - Nikolaos Kalampokas
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - Agne Jankuviene
- II Department of Anesthesiology, Centre of Anesthesia, Intensive Care and Pain management, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - Erwan Flecher
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jeroen J H Bunge
- Department of Intensive Care Adults, and Department of cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Kogulan Sriranjan
- Department of Intensive Care Medicine, Center of Applied Medical Research, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Leonardo Salazar
- Department of Cardiology, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Michael A Mazzeffi
- Departments of Medicine and Surgery, University of Maryland, Baltimore, USA
| | - Sacha Matteucci
- SOD Cardiochirurgia Ospedali Riuniti 'Umberto I - Lancisi - Salesi' Università Politecnica delle Marche, Ancona, Italy
| | - Sandro Sponga
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Kollengode Ramanathan
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Alessandro Costetti
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy
| | - Francesco Formica
- Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Department of Medicine and Surgery, University of Parma, Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Pranya Sakiyalak
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Antonio Fiore
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Créteil, Paris, France
| | - Chistof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Roberto Castillo
- ECLS Unit, Departamento de Anestesia, Clínica Las Condes, Las Condes, Santiago, Chile
| | - I-Wen Wang
- Division of Cardiac Surgery, Memorial Healthcare System, Hollywood, FL, USA
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Tomas Grus
- 2nd Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Vin Pellegrino
- Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia
| | - Giacomo Bianchi
- Ospedale del Cuore Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Matteo Pettinari
- Department of Cardiovascular Surgery, Ziekenhuis Oost-, Limburg, Genk, Belgium
| | - Alessandro Barbone
- Cardiac Surgery Unit, IRCCS Humanitas Research Hospital -, Rozzano(MI), Italy
| | - José P Garcia
- IU Health Advanced Heart & Lung Care, Indiana University Methodist Hospital, Indianapolis, IN, USA
| | - Mariusz Kowalewski
- Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia
| | - Glenn Whitman
- Cardiac Intensive Care Unit, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Nozdrzykowski M, Bauer JM, Schulz U, Jawad K, Bireta C, Eifert S, Sandri M, Jozwiak-Nozdrzykowska J, Borger MA, Saeed D. Stroke and pump thrombosis following left ventricular assist device implantation: The impact of the implantation technique. Front Cardiovasc Med 2023; 10:974527. [PMID: 37252124 PMCID: PMC10213891 DOI: 10.3389/fcvm.2023.974527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 03/20/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives Several studies have shown the potential advantage of less-invasive surgery (LIS) for left ventricular assist device (LVAD) implantation. This study aims to determine the impact of LIS on stroke and pump thrombosis events after LVAD implantation. Methods Between January 2015 and March 2021, 335 consecutive patients underwent LVAD implantation using either conventional sternotomy (CS) or the LIS technique. Patient characteristics was prospectively collected. All patients were followed up until October 2021. Logistic multivariate regression and propensity-matched analyses were performed to account for confounding factors. Results A total of 242 patients (F = 32; 13.0%) underwent LVAD implantation with CS and 93 patients (F = 8; 8.6%) with the LIS approach. Propensity matching generated two groups, including 98 patients in the CS group and 67 in the LIS group. Intensive care unit stay for the LIS group patients was significantly shorter than that for the CS group patients [2 (IQR: 2-5) days vs. 4 (IQR: 2-12) days, p < 0.01]. There were no significant differences in the incidence of stroke events (14% in CS vs. 16% in the LIS group; p = 0.6) or in pump thrombosis (6.1% in CS vs. 7.5% in the LIS group; p = 0.8) between the groups. The hospital mortality rate in the matched cohort was significantly lower in the LIS group (7.5% vs. 19%; p = 0.03). However, the 1-year mortality rate showed no significant difference between both groups (24.5% in CS and 17.9% in LIS; p = 0.35). Conclusions The LIS approach for LVAD implantation is a safe procedure with potential advantage in the early postoperative period. However, the LIS approach remains comparable to the sternotomy approach in terms of postoperative stroke, pump thrombosis, and outcome.
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Affiliation(s)
- Michal Nozdrzykowski
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Jessica-Marie Bauer
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Uwe Schulz
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Khalil Jawad
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian Bireta
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Sandra Eifert
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Marcus Sandri
- Department of Cardiology, Leipzig Heart Center, Leipzig, Germany
| | | | - Michael A. Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Diyar Saeed
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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Messer EK, Meyer AL, Klaeske K, Sieg F, Eifert S, Schmiedel D, Haunschild J, Jawad K, Saeed D, Hildebrandt L, Borger MA, Dieterlen MT. The Impact of Obesity on T and NK Cells after LVAD Implantation. Obes Facts 2023; 16:364-373. [PMID: 37232004 PMCID: PMC10427956 DOI: 10.1159/000530174] [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: 07/13/2022] [Accepted: 03/06/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Infections are a major problem after left ventricular assist device (LVAD) implantation that affects morbidity, mortality, and the quality of life. Obesity often increases the risk for infection. In the cohort of LVAD patients, it is unknown if obesity affects the immunological parameters involved in viral defense. Therefore, this study investigated whether overweight or obesity affects immunological parameters such as CD8+ T cells and natural killer (NK) cells. METHODS Immune cell subsets of CD8+ T cells and NK cells were compared between normal-weight (BMI 18.5-24.9 kg/m2, n = 17), pre-obese (BMI 25.0-29.9 kg/m2, n = 24), and obese (BMI ≥30 kg/m2, n = 27) patients. Cell subsets and cytokine serum levels were quantified prior to LVAD implantation and at 3, 6, and 12 months after LVAD implantation. RESULTS At the end of the first postoperative year, obese patients (31.8% ± 2.1%) had a lower proportion of CD8+ T cells than normal-weight patients (42.4% ± 4.1%; p = 0.04), and the percentage of CD8+ T cells was negatively correlated with BMI (p = 0.03; r = -0.329). The proportion of circulating NK cells increased after LVAD implantation patients in normal-weight (p = 0.01) and obese patients (p < 0.01). Patients with pre-obesity showed a delayed increase (p < 0.01) 12 months after LVAD implantation. Further, obese patients showed an increase in the percentage of CD57+ NK cells after 6 and 12 months (p = 0.01) of treatment, higher proportions of CD56bright NK cells (p = 0.01), and lower proportions of CD56dim/neg NK cells (p = 0.03) 3 months after LVAD implantation than normal-weight patients. The proportion of CD56bright NK cells positively correlated with BMI (p < 0.01, r = 0.403) 1 year after LVAD implantation. CONCLUSIONS This study documented that obesity affects CD8+ T cells and subsets of NK cells in patients with LVAD in the first year after LVAD implantation. Lower proportions of CD8+ T cells and CD56dim/neg NK cells and higher proportion of CD56bright NK cells were detected in obese but not in pre-obese and normal-weight LVAD patients during the first year after LVAD implantation. The induced immunological imbalance and phenotypic changes of T and NK cells may influence viral and bacterial immunoreactivity.
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Affiliation(s)
- Eva Katharina Messer
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Anna Lassia Meyer
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Kristin Klaeske
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Franz Sieg
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Sandra Eifert
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Dominik Schmiedel
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Josephina Haunschild
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Khalil Jawad
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Diyar Saeed
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Lea Hildebrandt
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Michael Andrew Borger
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Maja-Theresa Dieterlen
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
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Saeed D, Stark C, Loforte A, Zimpfer D, Bernhardt A, Schibilsky D, Riebandt J, Jawad K, Lichtenberg A, Haneya A, Potapov E, Albert A, Otto W, Huenges K, Aubin H, Lewin D, Raweh A, Morshuis M, Jorde U, Reichenspurner H, Borger M, Gummert J. Optimal Patient Selection on Extra-Corporeal Life Support for Durable Mechanical Circulatory Support: Validation Study on Behalf of Durable MCS after ECLS Study Group. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1532] [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: 04/05/2023] Open
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10
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Klaeske K, Brade A, Eifert S, Jawad K, Saeed D, Haunschild J, Borger M, Dieterlen M. Glycoprotein (GP)Ibα Protein Expression is Reduced in HeartMate 3 Patients with Non-Surgical Bleeding Complications Within the First 3 Months. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.151] [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: 04/05/2023] Open
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Aleksova N, Buchan TA, Foroutan F, Zhu A, Conte S, Macdonald P, Noly PE, Carrier M, Marasco SF, Takeda K, Pozzi M, Baudry G, Atik FA, Lehmann S, Jawad K, Hickey GW, Defontaine A, Baron O, Loforte A, Cavalli GG, Absi DO, Kawabori M, Mastroianni MA, Simonenko M, Sponga S, Moayedi Y, Orchanian-Cheff A, Ross HJ, Rao V, Guyatt G, Billia F, Alba AC. Extracorporeal Membrane Oxygenation for Graft Dysfunction Early After Heart Transplantation: A Systematic Review and Meta-analysis. J Card Fail 2023; 29:290-303. [PMID: 36513273 DOI: 10.1016/j.cardfail.2022.11.011] [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: 06/30/2022] [Revised: 08/27/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a prevailing option for the management of severe early graft dysfunction. This systematic review and individual patient data (IPD) meta-analysis aims to evaluate (1) mortality, (2) rates of major complications, (3) prognostic factors, and (4) the effect of different VA-ECMO strategies on outcomes in adult heart transplant (HT) recipients supported with VA-ECMO. METHODS AND RESULTS We conducted a systematic search and included studies of adults (≥18 years) who received VA-ECMO during their index hospitalization after HT and reported on mortality at any timepoint. We pooled data using random effects models. To identify prognostic factors, we analysed IPD using mixed effects logistic regression. We assessed the certainty in the evidence using the GRADE framework. We included 49 observational studies of 1477 patients who received VA-ECMO after HT, of which 15 studies provided IPD for 448 patients. There were no differences in mortality estimates between IPD and non-IPD studies. The short-term (30-day/in-hospital) mortality estimate was 33% (moderate certainty, 95% confidence interval [CI] 28%-39%) and 1-year mortality estimate 50% (moderate certainty, 95% CI 43%-57%). Recipient age (odds ratio 1.02, 95% CI 1.01-1.04) and prior sternotomy (OR 1.57, 95% CI 0.99-2.49) are associated with increased short-term mortality. There is low certainty evidence that early intraoperative cannulation and peripheral cannulation reduce the risk of short-term death. CONCLUSIONS One-third of patients who receive VA-ECMO for early graft dysfunction do not survive 30 days or to hospital discharge, and one-half do not survive to 1 year after HT. Improving outcomes will require ongoing research focused on optimizing VA-ECMO strategies and care in the first year after HT.
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Affiliation(s)
- Natasha Aleksova
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada.
| | - Tayler A Buchan
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Farid Foroutan
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Alice Zhu
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sean Conte
- Heart Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Peter Macdonald
- Heart Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Pierre-Emmanuel Noly
- Department of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Montréal, Canada
| | - Michel Carrier
- Department of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Montréal, Canada
| | - Silvana F Marasco
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia
| | - Koji Takeda
- Department of Surgery, Division of Cardiac, Thoracic & Vascular Surgery, Columbia University, New York, New York
| | - Matteo Pozzi
- Service de Chirurgie Cardiaque et Cardiologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France
| | - Guillaume Baudry
- Service de Chirurgie Cardiaque et Cardiologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France
| | - Fernando A Atik
- Instituto de Cardiologia e Transplantes do Distrito Federal (ICDF), Brasília, Brazil
| | - Sven Lehmann
- Clinic of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Khalil Jawad
- Clinic of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Gavin W Hickey
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Oliver Baron
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Antonio Loforte
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | | | - Daniel O Absi
- Cardiovascular and Intrathoracic Transplant Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Masashi Kawabori
- Department of Cardiovascular Surgery, Tufts Medical Center, Boston, Massachusetts
| | | | - Maria Simonenko
- Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Yasbanoo Moayedi
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Heather J Ross
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Vivek Rao
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario. Canada
| | - Filio Billia
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ana C Alba
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
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Fukunaga N, Al-Sarraf A, Jawad K, Lafreniere-Roula M, Rao V. Early and mid-term outcomes after aortic valve intervention in patients with previous stentless or stented bioprostheses. J Cardiothorac Surg 2023; 18:34. [PMID: 36653867 PMCID: PMC9847021 DOI: 10.1186/s13019-023-02118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Limited data are available concerning comparative outcomes of redo aortic valve interventions, including surgery after aortic valve replacement (AVR) with either stented or stentless bioprostheses. We investigated the comparative outcomes of redo aortic valve interventions, including surgery after AVR with either stented or stentless bioprostheses. METHODS The cohort consisted of 112 patients who underwent aortic valve intervention for infective endocarditis or structural valve deterioration between 2001 and 2020. One hundred patients received a stented valve (stented group) and 12 patients received a stentless valve (stentless group) during the initial surgery. Early and late outcomes were evaluated. RESULTS The mean [IQR] ages during the current interventions were 66 [54, 77] years in the stented group and 74 [67, 79] years in the stentless group (P = 0.13). In the stented group, aortic valve interventions included redo AVRs with stented valves (n = 54), mechanical valves (n = 26), stentless valves (n = 16), and transcatheter aortic valve implantations (n = 4). In the stentless group, redo AVRs were performed with stented valves (n = 4), mechanical valves (n = 2), stentless valves (n = 1), and transcatheter valve implantations (n = 5). Hospital mortality was observed in 2 (2%) patients in the stented group and 1 (8%) patients in the stentless group (P = 0.29). The 5-year survival was 80.8% [66.8, 88.5] in the stented group and 91.7% [53.9, 98.8] in stentless group. Statistically significant differences in thromboembolisms were observed between the groups. CONCLUSIONS No significant differences in early and mid-term outcomes (except thromboembolism) after aortic valve interventions were detected between patients with stented and stentless AVRs.
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Affiliation(s)
- Naoto Fukunaga
- grid.231844.80000 0004 0474 0428Division of Cardiovascular Surgery, 4PMB-457, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | - Ali Al-Sarraf
- grid.231844.80000 0004 0474 0428Division of Cardiovascular Surgery, 4PMB-457, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | - Khalil Jawad
- grid.231844.80000 0004 0474 0428Division of Cardiovascular Surgery, 4PMB-457, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | - Myriam Lafreniere-Roula
- grid.231844.80000 0004 0474 0428Division of Cardiovascular Surgery, 4PMB-457, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | - Vivek Rao
- grid.231844.80000 0004 0474 0428Division of Cardiovascular Surgery, 4PMB-457, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
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Jawad K, Bjelic M, Otto W, Igor G, Borger MA, Saeed D. Multicenter Study to Evaluate Less Invasive Ventricular Assist Device Implantation in Patients with History of Previous Cardiac Surgeries. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761729] [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)
- K. Jawad
- Heart Center Leipzig, Leipzig, Deutschland
| | - M. Bjelic
- University of Rochester, Rochester, United States
| | - W. Otto
- Heart Center Leipzig, Leipzig, Deutschland
| | - G. Igor
- University of Rochester, Rochester, United States
| | | | - D. Saeed
- Heart Center Leipzig, Leipzig, Deutschland
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Feder SH, Jawad K, Borger MA, Saeed D. The Parasternal Technique: Alternative Technique for Temporary Right Ventricular Assist Device Implantation. Eur J Cardiothorac Surg 2022; 62:6605852. [PMID: 35689617 DOI: 10.1093/ejcts/ezac335] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/16/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022] Open
Abstract
Right heart failure is a feared complication in cardiac surgery especially after heart failure surgery. Right ventricular assist devise (RVAD) implantation is inevitable in severe forms of right heart failure. Different techniques for RVAD implantation exist. We here present our experience with a novel parasternal cannulation technique that allows early mobilization, high RVAD flow rates and easy RVAD removal.
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Affiliation(s)
- Stefan H Feder
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Khalil Jawad
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Diyar Saeed
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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Jawad K, Nozdrzykowski M, Borger MA, Saeed D. Less Invasive Assist Device Implantation in Patients with History of Previous Cardiac Procedures. Ann Thorac Surg 2022; 114:383-386. [PMID: 35477017 DOI: 10.1016/j.athoracsur.2022.03.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/02/2022] [Accepted: 03/28/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Khalil Jawad
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | - Michael A Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Diyar Saeed
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
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16
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Dieterlen M, Klaeske K, Schreiber C, Meyer A, Dieterlen T, Jawad K, Saeed D, Borger M. Health-Related Quality of Life Analysis Supports the Recommendation for HeartMate3 Implantation without Concomitant Mitral Valve Surgery. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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17
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Jawad K, Feder S, Nozdrzykowski M, Borger M, Saeed D. Impact of Surgical Approach on Outcome in Patients with History of Previous Sternotomy Underwent LVAD Implantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1541] [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: 11/30/2022] Open
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Wert L, Stewart G, Mehra M, Milwidsky A, Jorde U, Goldstein D, Selzman C, Stehlik J, Alshamdin F, Khaliel F, Gustafsson F, Boschi S, Loforte A, Ajello S, Scandroglio A, Tučanová Z, Netuka I, Schlöglhofer T, Zimpfer D, Dogan G, Schmitto J, Maier S, Schibilsky D, Jawad K, Saeed D, Faerber G, Morshuis M, Hanuna M, Müller C, Mulzer J, Kempfert J, Falk V, Potapov E. A Multi-Center Evaluation of Outflow Graft Obstruction with a Fully Magnetically Levitated Left Ventricular Assist Device. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.052] [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: 11/24/2022] Open
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Eifert S, Cseke L, Schulz U, Jawad K, Feder S, Al-Naamani A, Garbade J, Nozdrzykowski M, Jozwiak-Nozdrzykowska J, Gunold H, Borger M, Saeed D. Treatment Results of LVAD Implantation and Heart Transplantation for Oncotherapy Induced Cardiomyopathy in Women and Men. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Nozdrzykowski M, Fahr F, Schulz U, Jawad K, Huhn S, Al-Naamani A, Eifert S, Garbade J, Borger M, Saeed D. Stroke and Pump Thrombosis following LVAD Implantation: Impact of the Implantation Approach. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742845] [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: 10/19/2022]
Affiliation(s)
| | - F. Fahr
- Herzzentrum Leipzig, Leipzig, Deutschland
| | - U. Schulz
- Heart Center Leipzig, Leipzig, Deutschland
| | - K. Jawad
- Heart Center Leipzig, Leipzig, Deutschland
| | - S. Huhn
- Herzzentrum Leipzig, Leipzig, Deutschland
| | | | - S. Eifert
- Heart Center Leipzig, Leipzig, Deutschland
| | - J. Garbade
- Herzchirurgie, Klinikum Links der Weser, Bremen, Deutschland
| | - M. Borger
- Herzzentrum Leipzig, Leipzig, Deutschland
| | - D. Saeed
- Heart Center Leipzig, Leipzig, Deutschland
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Jawad K, Sandri M, Feder S, Al-Naamani A, Fahr F, Nozdrzykowski M, Bireta C, Eifert S, Correia JC, Schulz U, Borger M, Saeed D. Percutaneous Decommissioning of Left Ventricular Assist Device: Is This a Safe Procedure? Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742841] [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: 10/19/2022]
Affiliation(s)
- K. Jawad
- Heart Center Leipzig, Leipzig, Deutschland
| | - M. Sandri
- Heart Center Leipzig, Leipzig, Deutschland
| | - S. Feder
- Heart Center Leipzig, Leipzig, Deutschland
| | | | - F. Fahr
- Heart Center Leipzig, Leipzig, Deutschland
| | | | - C. Bireta
- Heart Center Leipzig, Leipzig, Deutschland
| | - S. Eifert
- Heart Center Leipzig, Leipzig, Deutschland
| | | | - U. Schulz
- Heart Center Leipzig, Leipzig, Deutschland
| | - M. Borger
- Heart Center Leipzig, Leipzig, Deutschland
| | - D. Saeed
- Heart Center Leipzig, Leipzig, Deutschland
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Jawad K, Koziarz A, Dieterlen MT, Garbade J, Etz CD, Saeed D, Langer E, Stepan H, Scholz U, Krause M, Brenner P, Schulz U, Borger MA, Eifert S. Long-Term Follow-Up of Mechanical Circulatory Support in Peripartum Cardiomyopathy (PPCM) Refractory to Medical Management: A Multicenter Study. Life (Basel) 2022; 12:life12010087. [PMID: 35054480 PMCID: PMC8778047 DOI: 10.3390/life12010087] [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] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 01/04/2023]
Abstract
Background: Peripartum cardiomyopathy (PPCM) is a rare, life-threatening form of heart disease, frequently associated with gene alterations and, in some cases, presenting with advanced heart failure. Little is known about ventricular assist device (VAD) implantation in severe PPCM cases. We describe long-term follow-up of PPCM patients who were resistant to medical therapy and received mechanical circulatory support or heart transplant. Methods and results: A total of 13 patients were included with mean follow-up of eight years. Mean age of PPCM onset was 33.7 ± 7.7 years. All patients were initially treated with angiotensin-converting enzyme inhibitors and beta-blockers, and four received bromocriptine. Overall, five patients received VADs (three biventricular, two isolated left ventricular) at median 27 days (range: 3 to 150) following childbirth. Two patients developed drive line infection. Due to the short support time, none of those patients had a stroke or VAD thrombosis. In total, five patients underwent heart transplantation, of which four previously had implanted VADs. Median time to transplantation from PPCM onset was 140 days (range: 43 to 776), and time to transplantation from VAD implantation were 7, 40, 132, and 735 days, respectively. All patients survived until most recent follow up, with the exception of one patient who died following unrelated abdominal surgery two years after PPCM recovery. Conclusions: In patients with severe, life-threatening PPCM refractory to medical management, mechanical circulatory support with or without heart transplantation is a safe therapeutic option.
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Affiliation(s)
- Khalil Jawad
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
- Peter Munk Cardiac Center, University of Toronto, Cardiac Surgery, Toronto, ON M5S 1A1, Canada;
- Correspondence: ; Tel.: +49-341-8651421; Fax: +49-341-8651452
| | - Alex Koziarz
- Peter Munk Cardiac Center, University of Toronto, Cardiac Surgery, Toronto, ON M5S 1A1, Canada;
| | - Maja-Theresa Dieterlen
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
| | - Jens Garbade
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
| | - Christian D. Etz
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
| | - Diyar Saeed
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
| | - Elena Langer
- Department of Obstetrics, University of Leipzig, 04109 Leipzig, Germany; (E.L.); (H.S.)
| | - Holger Stepan
- Department of Obstetrics, University of Leipzig, 04109 Leipzig, Germany; (E.L.); (H.S.)
| | - Ute Scholz
- Centre of Coagulation Disorders, 04109 Leipzig, Germany; (U.S.); (M.K.)
| | - Michael Krause
- Centre of Coagulation Disorders, 04109 Leipzig, Germany; (U.S.); (M.K.)
| | - Paolo Brenner
- Department of Cardiac Surgery, University of Munich, 80539 Munich, Germany;
| | - Uwe Schulz
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
| | - Michael A. Borger
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
| | - Sandra Eifert
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
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Klaeske K, Dix M, Adams V, Jawad K, Eifert S, Etz C, Saeed D, Borger MA, Dieterlen MT. Differential Regulation of Myocardial E3 Ligases and Deubiquitinases in Ischemic Heart Failure. Life (Basel) 2021; 11:life11121430. [PMID: 34947961 PMCID: PMC8708923 DOI: 10.3390/life11121430] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
The pathological changes of ubiquitination and deubiquitination following myocardial infarction (MI) and chronic heart failure (CHF) have been sparsely examined. We investigated the expression of muscle-specific E3 ubiquitin ligases and deubiquitinases in MI and CHF. Therefore, mice were assigned to coronary artery ligation for 3 days or 10 weeks as well as for sham operation (each n = 10). Expression of E3 ligases (MAFBX, MURF1, CHIP, ITCH, MDM2) and deubiquitinases (A20, CYLD, UCH-L1, USP14, USP19) was determined. After MI and in CHF, the mRNA expression of MURF1, CHIP and MDM2 (all p < 0.05) was decreased. Protein expression analyses revealed that ITCH expression decreased in CHF (p = 0.01), whereas MDM2 expression increased in MI (p = 0.02) and decreased in CHF (p = 0.02). Except for USP19 mRNA expression that decreased at 3 days and 10 weeks (both p < 0.01), the expression of other deubiquitinases remained unaffected after MI and CHF. The expression of myocardial E3 ligases is differentially regulated following MI, raising the question of whether an upstream regulation exists that is activated by MI for tissue protection or whether the downregulation of E3 ligases enables myocardial hypertrophy following MI.
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Affiliation(s)
- Kristin Klaeske
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
- Correspondence: ; Tel.: +49-341865251079; Fax: +49-3418651452
| | - Maria Dix
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
| | - Volker Adams
- Laboratory of Molecular and Experimental Cardiology, Heart Center Dresden, TU Dresden, Fetscherstraße 76, 01307 Dresden, Germany;
- Dresden Cardiovascular Research Institute and Core Laboratories GmbH, Bautzner Straße 122c, 01099 Dresden, Germany
| | - Khalil Jawad
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
| | - Sandra Eifert
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
| | - Christian Etz
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
| | - Diyar Saeed
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
| | - Michael A. Borger
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
| | - Maja-Theresa Dieterlen
- Department for Cardiac Surgery, HELIOS Clinic, Heart Center, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (M.D.); (K.J.); (S.E.); (C.E.); (D.S.); (M.A.B.); (M.-T.D.)
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Klaeske K, Lehmann S, Palitzsch R, Büttner P, Barten MJ, Jawad K, Eifert S, Saeed D, Borger MA, Dieterlen MT. Everolimus-Induced Immune Effects after Heart Transplantation: A Possible Tool for Clinicians to Monitor Patients at Risk for Transplant Rejection. Life (Basel) 2021; 11:life11121373. [PMID: 34947904 PMCID: PMC8703808 DOI: 10.3390/life11121373] [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: 10/29/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Patients treated with an inhibitor of the mechanistic target of rapamycin (mTORI) in a calcineurin inhibitor (CNI)-free immunosuppressive regimen after heart transplantation (HTx) show a higher risk for transplant rejection. We developed an immunological monitoring tool that may improve the identification of mTORI-treated patients at risk for rejection. Methods: Circulating dendritic cells (DCs) and regulatory T cells (Tregs) were analysed in 19 mTORI- and 20 CNI-treated HTx patients by flow cytometry. Principal component and cluster analysis were used to identify patients at risk for transplant rejection. Results: The percentages of total Tregs (p = 0.02) and CD39+ Tregs (p = 0.05) were higher in mTORI-treated patients than in CNI-treated patients. The principal component analysis revealed that BDCA1+, BDCA2+ and BDCA4+ DCs as well as total Tregs could distinguish between non-rejecting and rejecting mTORI-treated patients. Most mTORI-treated rejectors showed higher levels of BDCA2+ and BDCA4+ plasmacytoid DCs and lower levels of BDCA1+ myeloid DCs and Tregs than mTORI non-rejectors. Conclusion: An mTORI-based immunosuppressive regimen induced a sufficient, tolerance-promoting reaction in Tregs, but an insufficient, adverse effect in DCs. On the basis of patient-specific immunological profiles, we established a flow cytometry-based monitoring tool that may be helpful in identifying patients at risk for rejection.
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Affiliation(s)
- Kristin Klaeske
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Sven Lehmann
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Robert Palitzsch
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Petra Büttner
- Heart Center Leipzig, Department of Internal Medicine and Cardiology, University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany;
| | - Markus J. Barten
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany;
| | - Khalil Jawad
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Sandra Eifert
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Diyar Saeed
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Michael A. Borger
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Maja-Theresa Dieterlen
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
- Correspondence: ; Tel.: +49-341-865-256144
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Jawad K, Koziarz F, Koziarz A, Bouez JN, Fukunaga N, Borger MA, Rao V. Outflow cannula position for left ventricular assist device: A propensity score-matched study. J Card Surg 2021; 36:4095-4101. [PMID: 34431127 DOI: 10.1111/jocs.15869] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The clinical consequences of alternative outflow cannula positioning in patients undergoing left ventricular assist device implantation are unknown. We evaluated clinical outcomes in patients who underwent implantation with the outflow cannula implanted from the right side into the ascending aorta versus the left side of the pericardium. METHODS Fifty consecutive patients with terminal left heart failure underwent implantation using the Medtronic Heartware Ventricular Assist Device at Toronto General Hospital. Patients were divided between left and right outflow cannula positioning during implantation where anastomosis occurred in the ascending aorta. Propensity score matching using exact matching on the following pre-specified covariates: Interagency Registry for Mechanically Assisted Circulatory Support score, previous cardiac surgery, and preoperative inotrope use. RESULTS Fifty consecutive patients (25 left implantation and 25 right implantation) were included in the unmatched cohort and 45 patients (25 left implantation and 20 right implantation) were included in the matched cohort. No significant differences in baseline demographics. Pump thrombosis occurred in 10% (n = 2) receiving right-sided implantation and 8% (n = 2) with left implantation (p = 1.00). Postoperative stroke occurred in 10% (2/20) with right implantation and 16% (4/25) with left implantation (p = .88). No difference in 1-year mortality between right 20% (5/25) and left 25% (5/20) implantation (p = .97). CONCLUSION No observed difference in mortality when adjusting for competing risk of heart transplantation. There was also no difference in stroke, pump thrombosis, driveline infection. Larger studies are required to confirm these findings. These preliminary data support the use of left-sided anastomoses to facilitate subsequent re-entry during heart transplantation.
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Affiliation(s)
- Khalil Jawad
- Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany.,Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Frank Koziarz
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alex Koziarz
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joanna N Bouez
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Naoto Fukunaga
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael A Borger
- Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany
| | - Vivek Rao
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Klaeske K, Dieterlen MT, Eifert S, Scholz U, Garbade J, Jawad K, Sieg F, Borger MA, Meyer AL. Device-induced platelet dysfunction in patients after left ventricular assist device implantation. J Thromb Haemost 2021; 19:1331-1341. [PMID: 33636040 DOI: 10.1111/jth.15279] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 09/18/2020] [Revised: 01/26/2021] [Accepted: 02/22/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Non-surgical bleeding (NSB) is a major complication after left ventricular assist device (LVAD) implantation. It has been reported that non-physiological shear stress caused by LVADs could alter platelet receptor expression, which leads to bleeding disorders caused by coagulation dysfunctions. OBJECTIVES Because bleeding diathesis could be multifactorial, we focused on the combined characterization of platelet receptor expression patterns and oxidative stress to compare patients with NSB and patients without coagulation disorder in a monocentric, prospective study. METHODS Blood samples were obtained from LVAD patients with NSB (bleeder group, n = 19) and without NSB (non-bleeder group, n = 20). The platelet receptors platelet endothelial cell adhesion molecule-1 (PECAM-1), glycoprotein (GP)Ibα, P-selectin, CD63, and GPIIb/IIIa, as well as the production of intraplatelet reactive oxygen species (ROS) were quantified by flow cytometry. Aggregation capacity was evaluated by aggregometry. RESULTS The surface expression level of P-selectin and GPIbα on platelets was decreased in bleeders (P-selectin: 465 ± 72 U; GPIbα: 435 ± 41 U) compared to non-bleeders (P-selectin: 859 ± 115 U, P < .01; GPIbα: 570 ± 49 U, p = .04). Additionally, the mean fluorescence intensity of ADP-stimulated P-selectin and PECAM-1 expressing platelets were reduced in bleeders (P-selectin: 944 ± 84 U; PECAM-1: 6722 ± 419 U) compared to non-bleeders (P-selectin: 1269 ± 130 U, P = .04; PECAM-1: 8542 ± 665 U, P = .03). Bleeders showed a higher amount of ROS formation in platelets (88.0 ± 2.6%) than non-bleeders (81.5 ± 2.1%, P = .05). CONCLUSIONS These findings suggested that changes of three platelet receptors (GPIbα, P-selectin, and PECAM-1) and elevated oxidative stress may play a role in patients with bleeding complications following LVAD implantation. These results might help to explain the high incidence of spontaneous hemorrhage during LVAD support through an altered platelet function.
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Affiliation(s)
- Kristin Klaeske
- University Department for Cardiac Surgery, Leipzig Heart Center, Helios Clinic, Leipzig, Germany
| | - Maja-Theresa Dieterlen
- University Department for Cardiac Surgery, Leipzig Heart Center, Helios Clinic, Leipzig, Germany
| | - Sandra Eifert
- University Department for Cardiac Surgery, Leipzig Heart Center, Helios Clinic, Leipzig, Germany
| | - Ute Scholz
- MVZ Labor Dr. Reising-Ackermann und Kollegen, Center of Hemostasis, Leipzig, Germany
| | - Jens Garbade
- University Department for Cardiac Surgery, Leipzig Heart Center, Helios Clinic, Leipzig, Germany
| | - Khalil Jawad
- University Department for Cardiac Surgery, Leipzig Heart Center, Helios Clinic, Leipzig, Germany
| | - Franz Sieg
- University Department for Cardiac Surgery, Leipzig Heart Center, Helios Clinic, Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Helios Clinic, Leipzig, Germany
| | - Anna L Meyer
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Saeed D, Potapov E, Loforte A, Morshuis M, Schibilsky D, Zimpfer D, Riebandt J, Pappalardo F, Attisani M, Rinaldi M, Haneya A, Ramjankhan F, Donker D, Jorde U, Stein J, Tsyganenko D, Jawad K, Wieloch R, Ayala R, Cremer J, Borger M, Lichtenberg A, Gummert J. Neurological Complications in Patients Requiring Durable VAD Systems after ECLS Support. On Behalf of ECLS- Durable MCS Study Group. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1931] [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: 11/25/2022] Open
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Saeed D, Potapov E, Loforte A, Morshuis M, Schibilsky D, Zimpfer D, Riebandt J, Pappalardo F, Attisani M, Rinaldi M, Haneya A, Ramjankhan F, Donker DW, Jorde UP, Stein J, Tsyganenko D, Jawad K, Wieloch R, Ayala R, Cremer J, Borger MA, Lichtenberg A, Gummert J. Transition From Temporary to Durable Circulatory Support Systems. J Am Coll Cardiol 2021; 76:2956-2964. [PMID: 33334424 DOI: 10.1016/j.jacc.2020.10.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The decision to implant durable mechanical circulatory systems (MCSs) in patients on extracorporeal life support (ECLS) is challenging due to expected poor outcomes in these patients. OBJECTIVES The aim of this study was to identify outcome predictors that may facilitate future patient selection and decision making. METHODS The Durable MCS after ECLS registry is a multicenter retrospective study that gathered data on consecutive patients who underwent MCS implantation after ECLS between January 2010 and August 2018 in 11 high-volume European centers. Several perioperative parameters were collected. The primary endpoint was survival at 1 year after durable MCS implantation. RESULTS A total of 531 durable MCSs after ECLS were implanted during this period. The average patient age was 53 ± 12 years old. ECLS cannulation was peripheral in 87% of patients and 33% of the patients had history of cardiopulmonary resuscitation before ECLS implantation. The 30-day, 1-year, and 3-year actuarial survival rates were 77%, 53%, and 43%, respectively. The following predictors for 1-year outcome have been observed: age, female sex, lactate value, Model of End-Stage Liver Disease XI score, history of atrial fibrillation, redo surgery, and body mass index >30 kg/m2. On the basis of this data, a risk score and an app to estimate 1-year mortality was created. CONCLUSIONS The outcome in patients receiving durable MCS after ECLS remains limited, yet preoperative factors may allow differentiating futile patients from those with significant survival benefit.
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Affiliation(s)
- Diyar Saeed
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Department for Cardiac Surgery, Duesseldorf University Hospital, Duesseldorf, Germany.
| | - Evgenij Potapov
- Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Antonio Loforte
- Department of Cardiac Surgery, Bologna University, Bologna, Italy
| | - Michiel Morshuis
- Department of Cardiovascular and Thoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - David Schibilsky
- Department of Cardiac and Vascular Surgery, Freiburg University, Freiburg, Germany
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Julia Riebandt
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Matteo Attisani
- Department of Cardiac Surgery, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, University of Turin, Turin, Italy
| | - Assad Haneya
- Department of Cardiac Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Faiz Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dirk W Donker
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ulrich P Jorde
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Julia Stein
- Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany
| | - Dmytro Tsyganenko
- Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Radi Wieloch
- Department for Cardiac Surgery, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Rafael Ayala
- Department of Cardiac and Vascular Surgery, Freiburg University, Freiburg, Germany
| | - Jochen Cremer
- Department of Cardiac Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Artur Lichtenberg
- Department for Cardiac Surgery, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Jan Gummert
- Department of Cardiovascular and Thoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
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Al-Naamani A, Fahr F, Khan A, Bireta C, Nozdrzykowski M, Feder S, Deshmukh N, Jubeh M, Eifert S, Jawad K, Schulz U, Borger MA, Saeed D. Minimally invasive ventricular assist device implantation. J Thorac Dis 2021; 13:2010-2017. [PMID: 33841987 PMCID: PMC8024790 DOI: 10.21037/jtd-20-1492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Durable mechanical circulatory support (MCS) systems are established therapy option in patients with end-stage heart failure, with increasing importance during the last years due to donor organ shortage. Left ventricular assist devices (LVADs) are traditionally implanted through median sternotomy (MS). However, improvement in the pump designs during the last years led to evolvement of new surgical approaches that aim to reduce the invasiveness of the procedure. Numerous reports and studies have shown the viability and possible advantages of less-invasive approach compared to the sternotomy approach. The less invasive implant strategies for LVADs, while vague in definition, are characterized by minimizing surgical trauma and if possible, cardio-pulmonary bypass related complications. Usually it involves minimizing or completely avoiding sternal trauma, avoiding heart luxation while simultaneously leaving the major part of pericardium intact. There is no consensus between the centers regarding the ideal approach for LVAD implantation. Some centers, like our center, perform by default VAD implantation using less invasive approach in almost all patients and some centers use only sternotomy approach. The aim of this review article is to shed light on the currently available less invasive options of LVAD implantation, with particular focus on the centrifugal pumps, and their possible advantages compared to traditional sternotomy approach.
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Affiliation(s)
- Ameen Al-Naamani
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Florian Fahr
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Asim Khan
- Department of Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Christian Bireta
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Michael Nozdrzykowski
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Stefan Feder
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Nikhil Deshmukh
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Manal Jubeh
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Sandra Eifert
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.,Cardiac Surgery, Peter Munk Cardiac Center, University of Toronto, Toronto, Canada
| | - Uwe Schulz
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Diyar Saeed
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
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30
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Saeed D, Muslem R, Rasheed M, Caliskan K, Kalampokas N, Sipahi F, Lichtenberg A, Jawad K, Borger M, Huhn S, Cogswell R, John R, Schultz J, Shah H, Hsu S, Gilotra NA, Scheel PJ, Tomashitis B, Hajj ME, Lozonschi L, Houston BA, Tedford RJ. Less invasive surgical implant strategy and right heart failure after LVAD implantation. J Heart Lung Transplant 2021; 40:289-297. [PMID: 33509653 DOI: 10.1016/j.healun.2021.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 06/01/2020] [Revised: 12/16/2020] [Accepted: 01/07/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Conventional median sternotomy (CMS) is still the standard technique utilized to implant left ventricular assist devices (LVADs). Recent studies suggest that less invasive surgery (LIS) may be beneficial; however, robust data on differences in right heart failure (RHF) are lacking. This study aimed to determine the impact of LIS compared with that of CMS on RHF outcomes after LVAD implantation. METHODS An international multicenter retrospective cohort study was conducted across 5 centers. Patients were grouped according to their implantation technique (LIS vs CMS). Only centrifugal devices were included. RHF was defined as severe or severe acute RHF according to the 2013 Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) definition. Logistic multivariate regression and propensity score‒matched analyses were performed to account for confounding. RESULTS Overall, 427 implantations occurred during the study period, with 305 patients implanted using CMS and 122 using LIS. Pre-operative extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) use was more common in the CMS group; off-pump implantation was more common in the LIS group. Other pre-implant variables, including age, creatinine, hemodynamics, and tricuspid regurgitation, did not differ between the 2 groups. Post-operative RHF was less common in the patients who underwent LIS than in those who underwent CMS as was post-operative right ventricular assist device (RVAD) use. LIS remained associated with less RHF in the multivariate analysis. After propensity score matching conditional for age, sex, INTERMACS profile, ECMO, and IABP use in a ratio of 2:1 (CMS to LIS), RHF (29.9% vs 18.6%, p = 0.001) and the need for post-operative RVAD (18.6% vs 8.2%; p = 0.009) remained more common in the CMS group than in the LIS group. There were no significant differences in survival up to 1 year between the groups. CONCLUSIONS LIS may be associated with less RHF after LVAD implantation compared with CMS. Despite the possible reduction in RHF, there was no difference in 1-year survival. LIS is an alternative to traditional CMS.
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Affiliation(s)
- Diyar Saeed
- Leipzig Heart Center, Leipzig, Germany; Düsseldorf University Hospital, Düsseldorf, Germany
| | | | | | | | | | - Firat Sipahi
- Düsseldorf University Hospital, Düsseldorf, Germany
| | | | | | | | | | | | - Ranjit John
- University of Minnesota, Minneapolis, Minnesota
| | | | - Hirak Shah
- University of Minnesota, Minneapolis, Minnesota
| | - Steven Hsu
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Paul J Scheel
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brett Tomashitis
- Medical University of South Carolina, Charleston, South Carolina
| | - Milad El Hajj
- Medical University of South Carolina, Charleston, South Carolina
| | - Lucian Lozonschi
- Medical University of South Carolina, Charleston, South Carolina
| | - Brian A Houston
- Medical University of South Carolina, Charleston, South Carolina
| | - Ryan J Tedford
- Medical University of South Carolina, Charleston, South Carolina.
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31
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Saeed D, Potapov E, Loforte A, Morshuis M, Schibilsky D, Zimpfer D, Riebandt J, Pappalardo F, Attisani M, Haneya A, Ramjankhan F, Donker D, Tsyganenko D, Jorde U, Jawad K, Wieloch R, Ayala R, Cremer J, Borger M, Lichtenberg A, Gummert J. Stroke Complications in Patients Requiring Durable VAD Systems after VA-ECMO Support. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725609] [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]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - R. Ayala
- Freiburg im Breisgau, Deutschland
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Jawad K, Sipahi F, Koziarz A, Huhn S, Kalampokas N, Albert A, Borger MA, Lichtenberg A, Saeed D. Less-invasive ventricular assist device implantation: A multicenter study. J Thorac Cardiovasc Surg 2020; 164:1910-1918.e4. [PMID: 33487414 DOI: 10.1016/j.jtcvs.2020.12.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/08/2020] [Revised: 11/27/2020] [Accepted: 12/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Left ventricular assist device has been shown to be a safe and effective treatment option for patients with end-stage heart failure. However, there is limited evidence showing the effect of the implantation approach on postoperative morbidities and mortality. We aimed to compare left ventricular assist device implantation using conventional sternotomy versus less-invasive surgery including hemi-sternotomy and the minithoracotomy approach. METHODS Between January 2014 and December 2018, 342 consecutive patients underwent left ventricular assist device implantation at 2 high-volume centers. Patient characteristics were prospectively collected. The propensity score method was used to create 2 groups in a 1:1 fashion. A competing risk regression model was used to evaluate time to death adjusting for competing risk of heart transplantation. RESULTS The unmatched cohort included 241 patients who underwent left ventricular assist device implantation with the conventional sternotomy technique and 101 patients who underwent left ventricular assist device implantation with the less-invasive surgery technique. Propensity matching produced 2 groups each including 73 patients. In the matched groups, reexploration rate for bleeding was necessary in 17.9% (12/67) in the conventional sternotomy group compared with 4.1% (3/73) the less-invasive surgery group (P = .018). Intensive care unit stay for the less-invasive surgery group was significantly lower than for the sternotomy group (10.5 [interquartile range, 2-25.75] days vs 4 [interquartile range, 2-9.25] days, P = .008), as was hospital length of stay (37 [interquartile range, 27-61] days vs 25.5 [interquartile range, 21-42] days, P = .007). Mortality cumulative incidence for conventional surgery was 24% (95% confidence interval, 14.3-34.8) at 1 year and 26% (95% confidence interval, 15.9-37.4) at 2 years for patients without heart transplantation. Mortality cumulative incidence for less-invasive surgery was 22.5% (95% confidence interval, 12.8-33.8) at 1 year and 25.2% (95% confidence interval, 14.5-37.4) at 2 years for patients without heart transplantation. There was no difference in cumulative mortality incidence when adjusting for competing risk of heart transplantation (subdistribution hazard, 0.904, 95% confidence interval, 0.45-1.80, P = .77). CONCLUSIONS The less-invasive surgery approach is a safe technique for left ventricular assist device implantation. Less-invasive surgery was associated with a significant reduction in the postoperative bleeding complications and duration of hospital stay, with no significant difference in mortality incidence.
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Affiliation(s)
- Khalil Jawad
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany; Cardiac Surgery, Peter Munk Cardiac Center, University of Toronto, Toronto, Ontario, Canada
| | - Firat Sipahi
- Cardiac Surgery, Düsseldorf University Hospital, Dusseldorf, Germany
| | - Alex Koziarz
- Cardiac Surgery, Peter Munk Cardiac Center, University of Toronto, Toronto, Ontario, Canada
| | - Simone Huhn
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Nikos Kalampokas
- Cardiac Surgery, Düsseldorf University Hospital, Dusseldorf, Germany
| | - Alexander Albert
- Cardiac Surgery, Düsseldorf University Hospital, Dusseldorf, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Artur Lichtenberg
- Cardiac Surgery, Düsseldorf University Hospital, Dusseldorf, Germany
| | - Diyar Saeed
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany; Cardiac Surgery, Düsseldorf University Hospital, Dusseldorf, Germany.
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Vogeler E, Dieterlen MT, Garbade J, Lehmann S, Jawad K, Borger MA, Meyer AL. Benefit of Self-Managed Anticoagulation in Patients with Left Ventricular Assist Device. Thorac Cardiovasc Surg 2020; 69:518-525. [PMID: 33260235 DOI: 10.1055/s-0040-1719153] [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: 10/22/2022]
Abstract
BACKGROUND The exact monitoring of the therapeutic-range international normalized ratio (INR) after left ventricular assist device (LVAD) implantation is an important aim to reduce the risk of thrombosis or bleeding complications. Service providers offer a telemedical anticoagulation service (CS). METHODS We compared LVAD patients using the CS (n = 15) to those who received regular medical care (RMC; n = 15) to investigate if telemedicine supervision increased the INR-specific time in the therapeutic range (TTR) during anticoagulation. All patients received self-management training for phenprocoumon medication according to their INR value. INR values were documented for 12 months. A survey (scale: 1 = not satisfied and 10 = very satisfied) was used to determine patient's satisfaction and psychological well-being. RESULTS A total of 1,798 INR measurements were analyzed. The TTRRosendaal was higher in patients undergoing RMC (78.1 ± 14.3%) compared with that in patients using the CS (58.3 ± 28.0%, p = 0.03). The patient's satisfaction with the coagulation setting at the beginning of the study (RMC: 6.7 ± 3.1, CS: 7.2 ± 3.0, p = 0.74) and psychological wellbeing (RMC: 6.5 ± 1.9, CS: 6.5 ± 2.7, p = 0.97) were comparable between both groups. CONCLUSION We found that INR self-management is superior regarding the efficiency of post-LVAD anticoagulation therapy when compared with telemedical (CS)-based INR management in a small study cohort. Intensive training by experienced staff was able to replace CS.
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Affiliation(s)
- Elisa Vogeler
- Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | | | - Jens Garbade
- Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Sven Lehmann
- Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Khalil Jawad
- Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Michael A Borger
- Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Anna L Meyer
- Department of Cardiac Surgery, University Hospital, Heidelberg, Germany
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Jawad K, Lehmann S, Koziarz A, Dieterlen M, Feder S, Misfeld M, Garbade J, Rao V, Borger M. Midterm results after St Jude Medical Epic porcine xenograft for aortic, mitral, and double valve replacement. J Card Surg 2020; 35:1769-1777. [PMID: 32598528 DOI: 10.1111/jocs.14554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the results after stented porcine xenograft implantation (Epic, SJM, St Paul, MN) with Linx anticalcification treatment in elderly patients at our high-volume tertiary care center. METHODS A total of 3825 patients undergoing aortic (AVR = 2441), mitral (MVR = 892), or double valve (DVR = 492) replacement between 11/2001 and 12/2017 with Epic xenografts were evaluated. Outcomes were assessed by reviewing the prospectively acquired hospital database results, and regular annual follow-up information was acquired from questionnaires or telephone interviews. RESULTS For patients undergoing AVR, MVR, DVR, age at surgery were 76.4 ± 6, 71.2 ± 9, 72.9 ± 8 years; active endocarditis was an indication for valve surgery in 4.5%, 20.7%, 19.7%; and the predicted median (interquartile range [IQR]) mortality risk (EuroSCORE II) was 5.2% (3.1%-9.4%), 7.5% (3.9%-16.2%), 9.9% (6.0%-19.6%), respectively. Median follow-up was 3.04 (IQR: 0.18-5.21). Thirty-day survival was 91.2% ± 0.6%, 87.6% ± 0.1.1%, 84.7% ± 1.6%; and 10-year survival was 56.7% ± 1.0%, 59.4% ± 2.5%, 50.45% ± 3.1%, respectively. Patients who underwent MVR versus AVR were at significant increased risk for reoperation for endocarditis (adjusted odds ratio; 2.2, 95% confidence interval; 1.29-3.7; P = .003). There was no significant difference in all-cause mortality at midterm in AVR vs MVR in the matched cohort (P = .85). CONCLUSIONS Implantation of the Epic stented porcine xenograft is associated with acceptable survival and freedom from valve-related complications or reoperation due to structural valve disease at midterm follow-up.
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Affiliation(s)
- Khalil Jawad
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany.,Department of Cardiac Surgery, Peter Munk Cardiac Center, Toronto, Canada
| | - Sven Lehmann
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany
| | | | - Maja Dieterlen
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany
| | - Stefan Feder
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany
| | - Jens Garbade
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany
| | - Vivek Rao
- Department of Cardiac Surgery, Peter Munk Cardiac Center, Toronto, Canada
| | - Michael Borger
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany
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35
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Saeed D, Jawad K, Sipahi F, Huhn S, Kalampokas N, Albert A, Borger M, Lichtenberg A. Reduced Rethoracotomy Rate for Bleeding and Postoperative Hospital Stay with Less Invasive Ventricular Assist Device Implantation, Multicenter Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1082] [Citation(s) in RCA: 1] [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] [Indexed: 10/24/2022] Open
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36
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Klaeske K, Dieterlen M, Eifert S, Sieg F, Wittke J, Garbade J, Jawad K, Borger M, Meyer A. Device-Induced Platelet Dysfunction in Patients after Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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37
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Klaeske K, Lehmann S, Büttner P, Palitzsch R, Fischer J, Jawad K, Garbade J, Borger MA, Barten MJ, Dieterlen MT. Identification of the immunological profile in rejection-free heart transplantation. Transpl Immunol 2020; 59:101259. [DOI: 10.1016/j.trim.2019.101259] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 01/08/2023]
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38
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Saeed D, Muslem R, Rasheed M, Caliskan K, Kalampokas N, Sipahi F, Lichtenberg A, Jawad K, Borger M, Huhn S, Cogswell R, John R, Schultz J, Shah H, Hsu S, Gilotra N, Tomashitis B, Hajj ME, Lozonschi L, Houston B, Tedford R. Less Invasive Surgical Implant Strategy is Associated with Significant Reduction in INTERMACS Defined Right Heart Failure Following LVAD Implantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1005] [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: 11/26/2022] Open
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39
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Saeed D, Jawad K, Huhn S, Schulz U, Eifert S, Sipahi N, Kalampokas N, Garbade J, Lichtenberg A, Borger M. Less Invasive Ventricular Assist Device Implantation Lowers Rethoracotomy Rate for Bleeding and Reduces Postoperative Hospital Stay: Multicenter Experience. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705352] [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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40
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Klaeske K, Dieterlen MT, Eifert S, Sieg F, Wittke J, Garbade J, Jawad K, Borger M, Meyer A. Impaired Platelet Activation in Patients after Left Ventricular Assist Device Implantation. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705497] [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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41
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Vogeler E, Dieterlen MT, Garbade J, Lehmann S, Julia F, Jawad K, Alaeldin A, Borger M, Meyer A. Telemedicine-Managed Anticoagulation Is Not Superior to Self-Management in LVAD Patients. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705392] [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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Kroegh G, Jawad K, Davierwala P, Borger M, Misfeld M. Diagnostic tools in surgically treated patients with infective valve endocarditis. Ann Cardiothorac Surg 2019; 8:654-660. [PMID: 31832355 DOI: 10.21037/acs.2019.10.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Infective valve endocarditis (IE) is associated with significant mortality and complication rates. The diagnosis impacts not only the prognosis but also the management of the disease. The aim of this article is to show the findings obtained from the implementation of our most important diagnostic tools and discuss our standard diagnostic process for patients with IE who underwent surgical treatment between 1994 and 2017. Methods Between December 1994 and January 2017 a total of 2,458 patients with IE underwent surgery at our institution. We analyzed clinical, microbiological, echocardiographic, and multi slice computer tomographic (MSCT) features in this group. Results The most often isolated involved valve was the aortic valve (59%). Prosthetic valve endocarditis (PVE) was present in almost one third of all cases. The most common valve failures were mitral valve insufficiency (MI) and aortic valve insufficiency (AI) (65% and 57% respectively). Almost one half of the aortic insufficiencies were severe. 63% of all vegetations assessed by echocardiography were larger than 1 cm. We detected a septic embolism in 44% of patients and the most common target organ was the spleen (25%). The most common isolated pathogen was Staphylococcus aureus (26%) and affected patients had a significant correlation with in-hospital mortality (P=0.004). Conclusions Echocardiography offers valuable information and is the most important diagnostic method in patients with IE. Preoperative MSCT contributes to the entire perioperative decision-making process. Microbiological diagnosis is mandatory in choosing and adjusting antibiotic therapy and also has prognostic value.
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Affiliation(s)
- Guenther Kroegh
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Piroze Davierwala
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
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Jawad K, Kroeg G, Koziarz A, Lehmann S, Dieterlen M, Feder S, Garbade J, Rao V, Borger M, Misfeld M. Surgical options in infective valve endocarditis with neurological complications. Ann Cardiothorac Surg 2019; 8:661-666. [PMID: 31832356 DOI: 10.21037/acs.2019.10.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgery is a common treatment option for patients with infective endocarditis. We present a large cohort of surgically managed patients with infective endocarditis and evaluate the long-term mortality of those with and without neurological complications. Methods We performed a retrospective review of patients surgically managed for infective endocarditis between 1994 and 2017. Demographic and outcome data were collected using a hospital database. Time-to-event analysis was performed with Kaplan-Meier curve and compared statistically with log-rank testing. Results At the time of admission, 680 (27.7%) patients with infective endocarditis showed neurological complications. The mean age was 62.6±14.0 years and 70% were male. Two thousand two hundred and sixty-one (92%) patients had left-sided valve endocarditis. Isolated aortic valve endocarditis was present in 59% of patients and 35% of patients had isolated infective endocarditis of the mitral valve. Mean logistic EuroSCORE was 21.2±21.6. Microbiologic cultures were positive in 1,939 patients (79%). The most common bacteria were Staphylococcus aureus (26%). In-hospital mortality in the group of patients with Staphylococcus aureus was significantly higher than in the group infected with other pathogens (18.2% vs. 13.4%, P=0.004). Patients with vegetations ≥1 cm had significantly more systemic embolization (P<0.001). 44% of patients had septic embolization with the most common site being the spleen, followed by the brain. Patients presenting with neurological complications had significantly higher in-hospital and long-term mortality (P<0.0001). Conclusions Infective endocarditis patients with neurological complications have a significantly higher risk of mortality than patients without neurological complications. Surgery is an effective treatment in patients presenting with infective endocarditis, and may be undertaken in patients with neurological complications to prevent poorer prognosis.
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Affiliation(s)
- Khalil Jawad
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany.,Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Guenther Kroeg
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Alex Koziarz
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sven Lehmann
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Maja Dieterlen
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Stefan Feder
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Jens Garbade
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Vivek Rao
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Borger
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
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Jawad K, Feder S, Barten M, Garbade J. Curative therapy of a hepatitis C infection due to an infected heart donor: 5-year outcomes after heart transplantation. Eur J Cardiothorac Surg 2019. [PMID: 29514173 DOI: 10.1093/ejcts/ezy051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/16/2022] Open
Abstract
Heart transplantation is the gold standard therapy for patients diagnosed with end-stage heart failure. Despite the shortage of appropriate donor organs, the transplantation of hepatitis C-infected hearts is disputed. Previous research has shown that long-term results are controversial, and the risk of severe clinical infection should not be underestimated.
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Affiliation(s)
- Khalil Jawad
- Department of Cardiac Surgery, University Hospital Leipzig, Heart Center, Leipzig, Germany
| | - Stefan Feder
- Department of Cardiac Surgery, University Hospital Leipzig, Heart Center, Leipzig, Germany
| | - Markus Barten
- Department of Cardiovascular Surgery, University Heart Center Hamburg Eppendorf, Hamburg, Germany
| | - Jens Garbade
- Department of Cardiac Surgery, University Hospital Leipzig, Heart Center, Leipzig, Germany
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Jawad K, Erdmann J, Borger M, Eifert S. Positive Familial History Poses a Higher Risk for No Spontaneous Recovery in Patients with Peripartum Heart Failure: Left Ventricular Assist Device Implantation and Transplantation with Bromocriptine as Novel Therapeutic Options in These Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Klaeske K, Dieterlen MT, Scholz U, Lehmann S, Garbade J, Fischer J, Jawad K, Borger MA, Meyer A. Acquired von Willebrand factor deficiency is reduced in HeartMate 3 patients†. Eur J Cardiothorac Surg 2019; 56:444-450. [DOI: 10.1093/ejcts/ezz045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/08/2019] [Accepted: 01/30/2019] [Indexed: 12/15/2022] Open
Abstract
Abstract
OBJECTIVES
The acquired von Willebrand syndrome (AvWS), which is associated with left ventricular assist device support, is caused by the loss of the von Willebrand factor (vWF) high molecular weight multimers (HMWMs). We investigated whether the implantation of the left ventricular assist device HeartMate 3 (HM 3) is superior to the HeartWare ventricular assist device (HVAD) in preserving the multimeric structure of vWF.
METHODS
In total, 70 patients with implanted HM 3 (n = 35) or HVAD (n = 35) were retrospectively investigated. HMWMs, intermediate molecular weight multimers and low molecular weight multimers were quantified by using a densitometric methodology. vWF antigen, vWF activity and vWF collagen-binding activity, as well as demographic and clinical data, were analysed.
RESULTS
AvWS, which is characterized by a decrease in vWF HMWMs, was found in 97.1% of patients in the HM 3 group and 100% of patients in the HVAD group. Compared to normal pooled plasma, HM 3 induced a reduction in HMWMs (40.7 ± 8.2% vs 26.7 ± 7.5%, P < 0.01) and an increase in low molecular weight multimers (31.3 ± 11.8% vs 42.7 ± 9.8%, P < 0.01), whereas HVAD patients exhibited an increase in the percentage of intermediate molecular weight multimers (28.0 ± 5.0% vs 38.4 ± 7.7%, P < 0.01) in addition to a decrease in the percentage of HMWM (23.0 ± 11.0%, P < 0.01). A comparison of both left ventricular assist device types showed a difference in vWF multimeric structure (HMWMs: P < 0.01, intermediate molecular weight multimer: P = 0.05, low molecular weight multimer: P = 0.03). Furthermore, vWF activity was elevated in patients with an implanted HM 3 device (153.7 ± 54.4%) compared to those with an HVAD device (126.3 ± 39.7%, P = 0.02).
CONCLUSIONS
Patients with an implanted HM 3 had more intact HMWMs and a higher vWF activity during device support. This may reduce the manifestation of AvWS in HM 3 patients and could thus lead to a lower bleeding complication rate.
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Affiliation(s)
- Kristin Klaeske
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Maja-Theresa Dieterlen
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Ute Scholz
- Zentrum für Blutgerinnungsstörungen, MVZ Labor Dr. Reising-Ackermann und Kollegen, Leipzig, Germany
| | - Sven Lehmann
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Jens Garbade
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Julia Fischer
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Anna Meyer
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
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Neidhardt S, Garbade J, Emrich F, Klaeske K, Borger MA, Lehmann S, Jawad K, Dieterlen MT. Ischemic Cardiomyopathy Affects the Thioredoxin System in the Human Myocardium. J Card Fail 2019; 25:204-212. [PMID: 30721734 DOI: 10.1016/j.cardfail.2019.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Received: 07/16/2018] [Revised: 12/03/2018] [Accepted: 01/23/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Oxidative stress due to reactive oxygen species (ROS) production is a key factor in the development of heart failure (HF). This study investigated the thioredoxin (Trx) system, which plays a major role in antioxidant defense, in patients suffering from ischemic (ICM) or dilated (DCM) cardiomyopathy. METHODS AND RESULTS Myocardial tissue from ICM (n = 13) and DCM (n = 13) patients, as well as septal tissue of patients with aortic stenosis but without diagnosed hypertrophic cardiomyopathy or subaortic stenosis (control; n = 12), was analyzed for Trx1, Trx-interacting protein (TXNIP) and E3 ligase ITCH (E3 ubiquitin-protein ligase Itchy homolog) expression. Trx-reductase 1 (TXNRD1) amount and activity, cytosolic cytochrome C content, and apoptosis markers were quantified by means of enzyme-linked immunosorbent assay and multiplexing. Compared with control samples, ITCH and Trx1 expression, TXNRD1 amount and activity were reduced and TXNIP expression was increased in ICM (ITCH: P = .013; Trx1: P = .028; TXNRD1 amount: P = .035; TXNRD1 activity: P = .005; TXNIP: P = .014) but not in DCM samples. A higher level of the downstream apoptosis marker caspase-9 (ICM: 582 ± 262 MFI [P = .995]; DCM: 1251 ± 548 MFI [P = .002], control: 561 ± 214 MFI) was detected in DCM tissue. A higher expression of Bcl-2 was found in DCM (P = .011). CONCLUSION The Trx system was impaired in ICM but not in DCM. ITCH appeared to be responsible for the down-regulation of the Trx system. ROS-induced mitochondrial instability appeared to play a role in DCM.
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Affiliation(s)
- Stephan Neidhardt
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Jens Garbade
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Fabian Emrich
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Kristin Klaeske
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Sven Lehmann
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany
| | - Maja-Theresa Dieterlen
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany.
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Lehmann S, Dieterlen MT, Flister A, Klaeske K, Jawad K, Garbade J, Borger MA, Kostelka M. Differences of early immunological responses in on-pump versus off-pump cardiac surgery. Perfusion 2019; 34:399-407. [PMID: 31234755 DOI: 10.1177/0267659118823137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cardiopulmonary bypass surgery is accompanied by an inflammatory response and pulmonary dysfunction that renders patients vulnerable to postoperative complications. The majority of studies investigating the inflammatory response in cardiopulmonary bypass focus on cytokine measurements. This study investigated the early response of peripheral blood cell types and early changes in lung tissue in on-pump versus off-pump cardiopulmonary bypass surgery. METHODS Landrace pigs were assigned to the following groups (n = 6 per group): 1. off-pump cardiopulmonary bypass, 2. conventional cardiopulmonary bypass, 3. heparin-coated cardiopulmonary bypass, 4. surface-reduced cardiopulmonary bypass, and 5. surface-reduced cardiopulmonary bypass plus lung perfusion. Surgery was performed under mild hyperthermia (32°C), with 90-minute ischemia and 180-minute reperfusion. Histological and flow cytometric analyses were performed. RESULTS Lung water content increased during reperfusion in heparin-coated (84.63 ± 2.99%) compared to conventional cardiopulmonary bypass (76.33 ± 4.56%, p = 0.04). Alveolar septal thickness increased during ischemia at heparin-coated (p < 0.01) and surface-reduced cardiopulmonary bypass plus lung perfusion (p = 0.05). Tumor necrosis factor expression increased significantly (p < 0.01) in peribronchial, perivascular, and peripheral lung areas in all on-pump groups, but not in off-pump cardiopulmonary bypass. The usage of heparin-coated cardiopulmonary bypass led to increased percentages of CD3+CD4+ (p = 0.03) and CD3+CD8+ (p = 0.01) T cells compared to an uncoated device. Natural killer and mature B lymphocytes decreased at conventional and surface-reduced cardiopulmonary bypass plus lung perfusion. Activated granulocytes and macrophages increased at conventional cardiopulmonary bypass and heparin-coated cardiopulmonary bypass. CONCLUSION Off-pump cardiopulmonary bypass induces less immunological response and lung injury than on-pump surgery. The reduction of cardiopulmonary bypass surface reduces the inflammatory immune response induced by cardiopulmonary bypass. Lung perfusion of surface-reduced cardiopulmonary bypass diminished the extravasation caused by surface reduction of the cardiopulmonary bypass.
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Affiliation(s)
- Sven Lehmann
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Maja-Theresa Dieterlen
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Anja Flister
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Kristin Klaeske
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Jens Garbade
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Martin Kostelka
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
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Lehmann S, Jawad K, Hoyer A, Dieterlen T, Funkat K, Meyer A, Garbade J, Davierwala P, Borger M. Is Extracorporeal Membrane Oxygenation an Option in Patients with Refractory Postcardiotomy Cardiogenic Shock? Long-Term Follow-up Over 1,500 Consecutive Adult Patients. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678800] [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: 10/27/2022]
Affiliation(s)
- S. Lehmann
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - K. Jawad
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - A. Hoyer
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - T. Dieterlen
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - K. Funkat
- Leipzig Heart Institute, Leipzig, Germany
| | - A. Meyer
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - J. Garbade
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - P. Davierwala
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - M.A. Borger
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
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50
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Lehmann S, Dieterlen MT, Garbade J, Meyer A, Funkat K, Hoyer A, Jawad K, Leontyev S, Davierwala P, Borger M. Impact of ABO Blood Group on Survival after Isolated Xenograft Aortic Valve Replacement. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678811] [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: 10/27/2022]
Affiliation(s)
- S. Lehmann
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - M.-T. Dieterlen
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - J. Garbade
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - A. Meyer
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - K. Funkat
- Leipzig Heart Institute, Leipzig, Germany
| | - A. Hoyer
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - K. Jawad
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - S. Leontyev
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - P. Davierwala
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - M.A. Borger
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
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