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Marta M, Zada M, Theuerkauf N, Duerr GD, Zimmer S, Treede H, Oezkur M. Outcome of right ventricular microaxial pump support in patients undergoing cardiac surgery. Sci Rep 2024; 14:8078. [PMID: 38580761 PMCID: PMC10997586 DOI: 10.1038/s41598-024-58602-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 04/01/2024] [Indexed: 04/07/2024] Open
Abstract
Right ventricular failure (RVF) after cardiac surgery is associated with an in-hospital mortality rate of up to 75%. Microaxial flow pumps are one of the mechanical circulatory supports (MCS) options available for the treatment of RVF, however the specifics of timing and indication for MCS, as well as predictors for survival, remain unclear due to a dearth of published data. We evaluated the clinical outcome of patients treated with Impella-RP for predictors of mortality and the hemodynamic effects of the pump. This is a single-center retrospective observational study involving adult patients who underwent cardiac surgery with cardiopulmonary bypass between January 2019 and December 2020 in cardiac surgery and required therapeutic management of RVF with an Impella-RP. Overall, 18 patients were included and analyzed for factors that could be associated with mortality, or that could be predictors of patient outcomes for this population. Treatment of RVF with Impella-RP improved the patient hemodynamics significantly and had a survival rate of 61% within 30 days. Patients with isolated CABG or better liver function before implantation had a better survival rate, which may indicate that underlying disease and timing of implantation are significant for successful treatment of RVF.
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Affiliation(s)
- Medina Marta
- Department of Cardiovasular Surgery, University Hospital of Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Mahmoud Zada
- Department of Cardiology and Rhythmology, Hospital Mechernich, Mechernich, Germany
| | - Nils Theuerkauf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Georg Daniel Duerr
- Department of Cardiovasular Surgery, University Hospital of Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Sebastian Zimmer
- Department of Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Hendrik Treede
- Department of Cardiovasular Surgery, University Hospital of Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Mehmet Oezkur
- Department of Cardiovasular Surgery, University Hospital of Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
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Medina M, Wenzel P, Fathallah B, Ruf T, Oezkur M. Protected high risk percutaneous coronary intervention-Impella 5.0 as a single-access technique: a case report. Eur Heart J Case Rep 2024; 8:ytae060. [PMID: 38374984 PMCID: PMC10875922 DOI: 10.1093/ehjcr/ytae060] [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: 11/04/2023] [Revised: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 02/21/2024]
Abstract
Background Patients requiring coronary intervention after acute myocardial infarction, with decompensated heart failure and multiple co-morbidities, present a challenging clinical scenario. Addressing such high-risk cases has been a marked increase in the simultaneous support using microaxial flow pump devices, providing a crucial haemodynamic support during procedures. Case summary We report the case of a 58-year-old man, with a non-ST-segment elevation myocardial infarction in the context of a peripheral vascular surgery. Echocardiography revealed severely reduced left ventricular function and cardiac magnetic resonance imaging demonstrated transmural scars in all but left anterior descending artery area. The patient was of extreme high surgical risk due to the multiple co-morbidities, acute decompensation heart failure, and peripheral artery disease, and, therefore, the heart team preferred protected percutaneous coronary intervention (PCI) over coronary artery bypass graft for revascularization. The peripheral artery disease included severely calcified ascending aorta, occlusions of both femoral arteries, the left subclavian artery, and the right radial artery. Taken together, the heart team agreed on a hybrid approach with surgical implantation of Impella 5.0 via the left subclavian artery, by a single-access technique. Following the intervention procedure, haemostasis of the vascular prosthesis was achieved by an angio-seal technique without complications. The patient recovered satisfactorily, with improved left ventricular function, and discharged 10 days post-procedure. Discussion The single-access high-risk PCI technique offers a standardized approach for microaxial flow pump devices such as Impella 5.0 and PCI. The subclavian artery as a single-access route for high-risk PCI has demonstrated safety and efficacy.
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Affiliation(s)
- Marta Medina
- Department of Cardiac Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, Mainz 55131, Germany
| | - Philip Wenzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bilel Fathallah
- Department of Cardiac Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, Mainz 55131, Germany
| | - Tobias Ruf
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mehmet Oezkur
- Department of Cardiac Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, Mainz 55131, Germany
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Nersesian G, Ott S, Fardman A, Lanmueller P, Lewin D, Bernhardt A, Emrich F, Faerber G, Szabó G, Oezkur M, Panholzer B, Rojas SV, Saeed D, Schmack B, Warnecke G, Zimpfer D, Grubitzsch H, Falk V, Potapov E. Temporary Mechanical Circulatory Support in Cardiogenic Shock Patients after Cardiac Procedures: Selection Algorithm and Weaning Strategies. Life (Basel) 2023; 13:2045. [PMID: 37895427 PMCID: PMC10608612 DOI: 10.3390/life13102045] [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: 09/07/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Mechanical circulatory support has proven effective in managing postcardiotomy cardiogenic shock by stabilizing patients' hemodynamics and ensuring adequate organ perfusion. Among the available device modalities, the combination of extracorporeal life support and a microaxial flow pump for left ventricular unloading has emerged as a valuable tool in the surgical armamentarium. In this publication, we provide recommendations for the application and weaning of temporary mechanical circulatory support in cardiogenic shock patients, derived from a consensus among leading cardiac centers in German-speaking countries.
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Affiliation(s)
- Gaik Nersesian
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Sascha Ott
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany
| | - Alexander Fardman
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Pia Lanmueller
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Daniel Lewin
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Alexander Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, 20251 Hamburg, Germany
| | - Fabian Emrich
- Department of Cardiac Surgery, Goethe University Hospital, 60590 Frankfurt, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Gábor Szabó
- Department of Cardiac Surgery, Middle German Heart Centre, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Mehmet Oezkur
- Department of Cardiovascular Surgery, University Hospital Mainz, 55131 Mainz, Germany
| | - Bernd Panholzer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Sebastian V. Rojas
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany
| | - Diyar Saeed
- Department for Cardiac Surgery, Heart Center Niederrhein, 47805 Krefeld, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, 45147 Essen, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Daniel Zimpfer
- Department of Cardiothoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Herko Grubitzsch
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, Germany
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
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Kowalewski C, Schnürer P, Kopp S, Windschmitt J, Oezkur M, Kriege M, Münzel T, Kaes J, Sagoschen I, Wild J. VV-ECMO as bridge and safety net for successful therapeutic polypragmasy in a case of influenza-triggered near-fatal asthma. Clin Case Rep 2023; 11:e7709. [PMID: 37575460 PMCID: PMC10415585 DOI: 10.1002/ccr3.7709] [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: 02/24/2023] [Revised: 06/05/2023] [Accepted: 07/03/2023] [Indexed: 08/15/2023] Open
Abstract
Key Clinical Message In near-fatal asthma, the combination of ECMO therapy and isoflurane application via an intensive care ventilator with an anesthetic conservation device represents a therapeutic combination in seemingly hopeless clinical situations. Abstract We report a case of an adult patient with near-fatal asthma, who was implanted venovenous extracorporeal membrane oxygenation in an extern hospital before transfer to our tertiary center. After 13 days and various therapeutic approaches, including inhaled isoflurane therapy via an anesthetic-conserving device, the patient was decannulated and extubated 3 days later.
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Affiliation(s)
- Christoph Kowalewski
- Center for Cardiology, Cardiology IJohannes Gutenberg‐University MainzMainzGermany
| | - Peter Schnürer
- Center for Cardiology, Cardiology IJohannes Gutenberg‐University MainzMainzGermany
| | - Sabrina Kopp
- Center for Cardiology, Cardiology IJohannes Gutenberg‐University MainzMainzGermany
| | - Johannes Windschmitt
- Center for Cardiology, Cardiology IJohannes Gutenberg‐University MainzMainzGermany
| | - Mehmet Oezkur
- Department of Cardiac and Vascular SurgeryJohannes Gutenberg‐University MainzMainzGermany
| | - Marc Kriege
- Department of AnaesthesiologyJohannes Gutenberg‐University MainzMainzGermany
| | - Thomas Münzel
- Center for Cardiology, Cardiology IJohannes Gutenberg‐University MainzMainzGermany
| | - Joachim Kaes
- Center for Cardiology, Cardiology IJohannes Gutenberg‐University MainzMainzGermany
| | - Ingo Sagoschen
- Center for Cardiology, Cardiology IJohannes Gutenberg‐University MainzMainzGermany
| | - Johannes Wild
- Center for Cardiology, Cardiology IJohannes Gutenberg‐University MainzMainzGermany
- German Center for Cardiovascular Research (DZHK), Partner site RheinMainMainzGermany
- Center for Thrombosis and Hemostasis (CTH)Johannes Gutenberg‐University MainzMainzGermany
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Hamiko M, Konrad N, Lagemann D, Gestrich C, Masseli F, Oezkur M, Velten M, Treede H, Duerr GD. Follow-up and outcome after coronary bypass surgery preceded by coronary stent implantation. Thorac Cardiovasc Surg 2023. [PMID: 37286186 DOI: 10.1055/a-2107-0481] [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: 06/09/2023]
Abstract
BACKGROUND Guidelines on myocardial revascularization define recommendations for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Only little information exists on long-term follow-up and quality of life (QoL) after CABG preceded by PCI. The aim of our study was to evaluate the impact of prior PCI on outcome and QoL in patients with stable CAD who underwent CABG. METHODS In our retrospective study, 997 CABG-patients were divided in: CABG preceded by PCI: PCI-First (PCF)-, and CABG-only (CO)-groups. The PCF-group was further divided in guideline-conform (GCO) and guideline non-conform (GNC) sub-groups, according to the SYNTAX-Score (2014 ESC-guidelines). Thirty-days mortality, major adverse cardiac events and quality-of-life using EQ-5D were evaluated. RESULTS Re-infarction (PCF: 3.8% vs. CO: 1.0%; p=0.024), re-angiography (PCF: 17.6% vs. CO: 9.0%; p=0.004), and re-PCI (PCF: 10.4% vs. CO: 3.0%; p<0.001) were observed more frequently in PCF-patients. Also, patients reported better health-status in the CO- compared to PCF-group (CO: 72.48±19.31 vs. PCF: 68.20±17.86; p=0.01). Patients from the guideline non-conform subgroup reported poorer health-status compared to guideline-conform group (GNC: 64.23±14.56 vs. GCO: 73.42±17.66; p=0.041) and were more likely to require re-PCI (GNC: 18.8% vs. GCO: 2.4%; p=0.03). Also, GNC-patients were more likely to have left main stenosis (GCO: 19.7% vs. GNC: 37.5%; p<0.001) and showed higher pre-interventional SYNTAX-Score (GCO: 18.63±9.81 vs. GNC: 26.67±5.07; p<0.001). CONCLUSION PCI preceding CABG is associated with worse health-status and higher re-hospitalization. Nevertheless, results were better when PCI was guideline-conformant. This data should impact the Heart-Team decision.
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Affiliation(s)
- Marwan Hamiko
- Cardiac Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Nicole Konrad
- Cardiac Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | | | | | - Franz Masseli
- Cardiovascular Surgery, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Mehmet Oezkur
- Cardiovascular Surgery, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Markus Velten
- Anesthesiology and Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
| | - Hendrik Treede
- Cardiovascular Surgery, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Georg Daniel Duerr
- Cardiovascular Surgery, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
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Ali-Hasan-Al-Saegh S, Halloum N, Scali S, Kriege M, Abualia M, Stamenovic D, Bashar Izzat M, Bohan P, Kloeckner R, Oezkur M, Dorweiler B, Treede H, El Beyrouti H. A systematic review and meta-analysis of retrograde type A aortic dissection after thoracic endovascular aortic repair in patients with type B aortic dissection. Medicine (Baltimore) 2023; 102:e32944. [PMID: 37058052 PMCID: PMC10101253 DOI: 10.1097/md.0000000000032944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/23/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Retrograde type A dissection (RTAD) is a devastating complication of thoracic endovascular repair (TEVAR) with low incidence but high mortality. The objective of this study is to report the incidence, mortality, potential risk factors, clinical manifestation and diagnostic modalities, and medical and surgical treatments. METHODS A systematic review and single-arm and two-arm meta-analyses evaluated all published reports of RTAD post-TEVAR through January 2021. All study types were included, except study protocols and animal studies, without time restrictions. Outcomes of interest were procedural data (implanted stent-grafts type, and proximal stent-graft oversizing), the incidence of RTAD, associated mortality rate, clinical manifestations, diagnostic workouts and therapeutic management. RESULTS RTAD occurred in 285 out of 10,600 patients: an estimated RTAD incidence of 2.3% (95% CI: 1.9-2.8); incidence of early RTAD was approximately 1.8 times higher than late. Wilcoxon signed-rank testing showed that the proportion of RTAD patients with acute type B aortic dissection (TBAD) was significantly higher than those with chronic TBAD (P = .008). Pooled meta-analysis showed that the incidence of RTAD with proximal bare stent TEVAR was 2.1-fold higher than with non-bare stents: risk ratio was 1.55 (95% CI: 0.87-2.75; P = .13). Single arm meta-analysis estimated a mortality rate of 42.2% (95% CI: 32.5-51.8), with an I2 heterogeneity of 70.11% (P < .001). CONCLUSION RTAD is rare after TEVAR but with high mortality, especially in the first month post-TEVAR with acute TBAD patients at greater risk as well as those treated with proximal bare stent endografts.
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Affiliation(s)
- Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Nancy Halloum
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Salvatore Scali
- Division Vascular Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Marc Kriege
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mohannad Abualia
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Davor Stamenovic
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Roman Kloeckner
- Department of Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Mehmet Oezkur
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Bernhard Dorweiler
- Department of Vascular Surgery, Faculty of Medicine, University of Cologne, Koln, Germany
| | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Hazem El Beyrouti
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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7
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Leick J, Grottke O, Oezkur M, Mangner N, Sanna T, Al Rashid F, Vandenbriele C. What is known in pre-, peri-, and post-procedural anticoagulation in micro-axial flow pump protected percutaneous coronary intervention? Eur Heart J Suppl 2022; 24:J17-J24. [PMCID: PMC9731207 DOI: 10.1093/eurheartjsupp/suac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Interest in the use of percutaneous left ventricular assist devices (p-LVADs) for patients undergoing high-risk percutaneous coronary intervention (PCI) is growing rapidly. The Impella™ (Abiomed Inc.) is a catheter-based continuous micro-axial flow pump that preserves haemodynamic support during high-risk PCI. Anticoagulation is required to counteract the activation of the coagulation system by the patient’s procoagulant state and the foreign-body surface of the pump. Excessive anticoagulation and the effect of dual antiplatelet therapy (DAPT) increase the risk of bleeding. Inadequate anticoagulation leads to thrombus formation and device dysfunction. The precarious balance between bleeding and thrombosis in patients with p-LVAD support is often the primary reason that patients’ outcomes are jeopardized. In this chapter, we will discuss anticoagulation strategies and anticoagulant management in the setting of protected PCI. This includes anticoagulant therapy with unfractionated heparin, direct thrombin inhibitors, DAPT, purge blockage prevention by bicarbonate-based purge solution, and monitoring by activated clotting time, partial thromboplastin time, as well as anti-factor Xa levels. Here, we provide a standardized approach to the management of peri-interventional anticoagulation in patients undergoing protected PCI.
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Affiliation(s)
- Jürgen Leick
- Corresponding author. Tel: +49 651208981911, Fax: 00496512082786,
| | - Oliver Grottke
- Department of Anaesthesiology, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Mehmet Oezkur
- Department of Cardiovascular Surgery, University Hospital Mainz, 55131 Mainz, Germany
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitaet Dresden, Dresden, Germany
| | - Tommaso Sanna
- Institute of Cardiology, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Fadi Al Rashid
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, 45147 Essen, Germany
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Rissel R, Koelm S, Schepers M, Dohle DS, Albers J, Oezkur M, Kriege M, Bodenstein M. Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients. PLoS One 2022; 17:e0278139. [PMID: 36441698 PMCID: PMC9704663 DOI: 10.1371/journal.pone.0278139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
The use of extracorporeal life support (ECLS) as part of cardio-circulatory support has increased rapidly in recent years. Severe hyperlactatemia is not uncommon in this group of patients. Lactate peak concentrations and lactate clearance have already been identified as independent marker for mortality in critical ill patients without mechanical device support. The aim of this study was to determine a supposed correlation between the variables lactate peak concentration and clearance in the blood and mortality in the ECLS context. Therefore, a total of 51 cardiac surgery ICU patients with ECLS therapy were included in this retrospective, clinical observational study (survivors n = 23; non-survivors n = 28). Lactate measurement was performed before, during and after ECLS therapy. Further, common ICU scores (SAPSII, SOFA, TISS28), the rates of transfusion and the different vasopressor therapies will be compared. Significant elevated peak lactate levels and poor lactate clearance were associated with higher mortality during ECLS therapy (p < 0.001). Deceased patients had higher SAPSII scores (p < 0.001), received more transfusions (p < 0.001) and presented with higher rates of epinephrine (p < 0.001). In conclusion, hyperlactatemia during ECLS therapy is a time sensitive emergency. Lactate cannot be cleared in all patients. Reversible causes should be explored and treated. In cases where the cause is irreversible, the prognosis of elevated lactate concentrations and reduced clearance is very poor.
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Affiliation(s)
- René Rissel
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
- * E-mail:
| | - Sascha Koelm
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Markus Schepers
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Daniel-Sebastian Dohle
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Joerg Albers
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mehmet Oezkur
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Marc Bodenstein
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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9
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Niemann B, Stoppe C, Wittenberg M, Rohrbach S, Saeed D, Billion M, Potapov E, Oezkur M, Akhyari P, Schmack B, Schibilsky D, Bernhardt AM, Schmitto JD, Hagl C, Masiello P, Böning A. Erratum to: Rational and Initiative of the Impella in Cardiac Surgery (ImCarS) Register Platform. Thorac Cardiovasc Surg 2022. [PMID: 35973777 DOI: 10.1055/s-0042-1755310] [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: 10/15/2022]
Affiliation(s)
- Bernd Niemann
- Department of Cardiovascular Surgery, University Hospital Giessen, Germany
| | - Christian Stoppe
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Abiomed, Abiomed, Danvers, Massachusetts, United States
| | - Michael Wittenberg
- Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg, Hessia, Germany
| | - Susanne Rohrbach
- Institute of Physiology, Justus-Liebig-University Giessen, Giessen, Hessen, Germany
| | - Diyar Saeed
- Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michael Billion
- Department of Cardiac Surgery, Schüchtermann Hospital Bad Rothenfelde, Bad Rothenfelde, Niedersachsen, Germany
| | - Evgenij Potapov
- Department of Cardiac Surgery, Deutsches Herzzentrum Berlin Ringgold Standard Institution, Berlin, Berlin, Germany
| | - Mehmet Oezkur
- Department of Cardiac and Vascular Surgery, University of Mainz, Mainz, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, University of Essen, Essen, Germany
| | - David Schibilsky
- Department of Cardiac Surgery, University of Freiburg, Freiburg, Germany
| | - Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Jan D Schmitto
- Department of Cardiac-, Thoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Hagl
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, München, Germany
| | - Paolo Masiello
- Department of Cardiac Surgery, San Giovanni di Dio e R.A. Hospital, Salerno, Salerno, Italy
| | - Andreas Böning
- Department of Cardiovascular Surgery, University Hospital Giessen, Germany
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10
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Oezkur M. HeartMate3 oder HeartWare – Wie sind Langzeitüberleben und Komplikationsraten? Z Herz- Thorax- Gefäßchir 2022. [DOI: 10.1007/s00398-022-00533-7] [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: 10/15/2022]
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11
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Niemann B, Stoppe C, Wittenberg M, Rohrbach S, Diyar S, Billion M, Potapov E, Oezkur M, Akhyari P, Schmack B, Schibilsky D, Bernhardt AM, Schmitto JD, Hagl C, Masiello P, Böning A. Rational and Initiative of the Impella in Cardiac Surgery (ImCarS) Register Platform. Thorac Cardiovasc Surg 2022; 70:458-466. [PMID: 35817063 DOI: 10.1055/s-0042-1749686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Cardiac support systems are being used increasingly more due to the growing prevalence of heart failure and cardiogenic shock. Reducing cardiac afterload, intracardiac pressure, and flow support are important factors. Extracorporeal membrane oxygenation (ECMO) and intracardiac microaxial pump systems (Impella) as non-permanent MCS (mechanical circulatory support) are being used increasingly. METHODS We reviewed the recent literature and developed an international European registry for non-permanent MCS. RESULTS Life-threatening conditions that are observed preoperatively often include reduced left ventricular function, systemic hypoperfusion, myocardial infarction, acute and chronic heart failure, myocarditis, and valve vitia. Postoperative complications that are commonly observed include severe systemic inflammatory response, ischemia-reperfusion injury, trauma-related disorders, which ultimately may lead to low cardiac output (CO) syndrome and organ dysfunctions, which necessitates a prolonged ICU stay. Choosing the appropriate device for support is critical. The management strategies and complications differ by system. The "heart-team" approach is inevitably needed.However despite previous efforts to elucidate these topics, it remains largely unclear which patients benefit from certain systems, when is the right time to initiate (MCS), which support system is appropriate, what is the optimal level and type of support, which therapeutic additive and supportive strategies should be considered and ultimately, what are the future prospects and therapeutic developments. CONCLUSION The European cardiac surgical register ImCarS has been established as an IIT with the overall aim to evaluate data received from the daily clinical practice in cardiac surgery. Interested colleagues are cordially invited to join the register. CLINICAL REGISTRATION NUMBER DRKS00024560. POSITIVE ETHICS VOTE AZ 246/20 Faculty of Medicine, Justus-Liebig-University-Gießen.
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Affiliation(s)
- Bernd Niemann
- Department of Cardiovascular Surgery, University Hospital Giessen, Germany
| | - Christian Stoppe
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Würzburg, Würzburg, Bavaria, Germany.,Abiomed, Abiomed, Danvers, Massachusetts, United States
| | - Michael Wittenberg
- Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg, Hessia, Germany
| | - Susanne Rohrbach
- Institute of Physiology, Justus-Liebig-University Giessen, Giessen, Hessen, Germany
| | - Saeed Diyar
- Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michael Billion
- Department of Cardiac Surgery, Schüchtermann Hospital Bad Rothenfelde, Bad Rothenfelde, Niedersachsen, Germany
| | - Evgenij Potapov
- Department of Cardiac Surgery, Deutsches Herzzentrum Berlin Ringgold Standard Institution, Berlin, Berlin, Germany
| | - Mehmet Oezkur
- Department of Cardiac and Vascular Surgery, University of Mainz, Mainz, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, University of Essen, Essen, Germany
| | - David Schibilsky
- Department of Cardiac Surgery, University of Freiburg, Freiburg, Germany
| | - Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Jan D Schmitto
- Department of Cardiac-, Thoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Hagl
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, München, Germany
| | - Paolo Masiello
- Department of Cardiac Surgery, San Giovanni di Dio e R.A. Hospital, Salerno, Salerno, Italy
| | - Andreas Böning
- Department of Cardiovascular Surgery, University Hospital Giessen, Germany
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12
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Oezkur M, Reda S, Rühl H, Theuerkauf N, Kreyer S, Duerr GD, Charitos E, Silaschi M, Medina M, Zimmer S, Putensen C, Treede H. Role of acquired von Willebrand syndrome in the development of bleeding complications in patients treated with Impella RP devices. Sci Rep 2021; 11:23722. [PMID: 34887445 PMCID: PMC8660831 DOI: 10.1038/s41598-021-02833-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/16/2021] [Indexed: 11/09/2022] Open
Abstract
Axial flow pumps are standard treatment in cases of cardiogenic shock and high-risk interventions in cardiology and cardiac surgery, although the optimal anticoagulation strategy remains unclear. We evaluated whether laboratory findings could predict bleeding complications and acquired von Willebrand syndrome (avWS) among patients who were treated using axial flow pumps. We retrospectively evaluated 60 consecutive patients who received Impella devices (Impella RP: n = 20, Impella CP/5.0: n = 40; Abiomed Inc., Danvers, USA) between January 2019 and December 2020. Thirty-two patients (53.3%) experienced major or fatal bleeding complications (Bleeding Academic Research Consortium score of > 3) despite intravenous heparin being used to maintain normal activated partial thromboplastin times (40–50 s). Extensive testing was performed for 28 patients with bleeding complications (87.5%). Relative to patients with left ventricular support, patients with right ventricular support were less likely to develop avWS (87.5% vs. 58.8%, p = 0.035). Bleeding was significantly associated with avWS (odds ratio [OR]: 20.8, 95% confidence interval [CI]: 3.3–128.5; p = 0.001) and treatment duration (OR: 1.3, 95% CI 1.09–1.55; p = 0.003). Patients with avWS had longer Impella treatment than patients without avWS (2 days [1–4.7 days] vs. 7.3 days [3.2–13.0 days]). Bleeding complications during Impella support were associated with avWS in our cohort, while aPTT monitoring was not sufficient to prevent bleeding complications. A more targeted anticoagulation monitoring might be needed for patients who receive Impella devices.
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Affiliation(s)
- Mehmet Oezkur
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany. .,Department of Cardiovascular Surgery, University Hospital Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Sara Reda
- Department of Haematology, University Hospital of Bonn, Bonn, Germany
| | - Heiko Rühl
- Department of Haematology, University Hospital of Bonn, Bonn, Germany
| | - Nils Theuerkauf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Stefan Kreyer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Georg Daniel Duerr
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany.,Department of Cardiovascular Surgery, University Hospital Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Efstratios Charitos
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Marta Medina
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Hendrik Treede
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany.,Department of Cardiovascular Surgery, University Hospital Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
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13
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Zachoval CF, Sedaghat A, Oezkur M, Tiyerili V, Becher MU, Sinning JM, Treede H, Nickenig G, Zimmer S. Feasibility and Safety of an 8 F Angioseal ® Vascular Closure Device for Closure of Large Bore Impella CP ® Access. J Endovasc Ther 2021; 29:336-342. [PMID: 34560827 DOI: 10.1177/15266028211047965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Percutaneous mechanical circulatory support (pMCS) with the Impella® device is routinely used in cardiogenic shock and high risk percutaneous coronary interventions (PCI). However, safety and feasibility to close the large bore access (LBA) post-hoc remain a challenge. MATERIALS AND METHODS In patients with planned termination of Impella therapy, corresponding LBA closure was attempted using an undersized AngioSeal® device, which was deployed after insertion of a 0.035 in J-wire through the guidewire access port. Cross-over angiographic visualization before and after deployment as well as in-hospital follow up were performed to assess closure success and screening for short-term adverse events. RESULTS We evaluated 17 patients (68 year old, IQR 58-76, 71% male) in whom 14 F LBA closure after pMCS using the Impella CP® was achieved with an undersized AngioSeal® device. Clinical indication for pMCS was cardiogenic shock in 94% and protected PCI in 6%. Impella CP® devices were withdrawn after a median of 4 days (IQR 3-6 days). Primary hemostasis was achieved in the majority of patients (14/17; 82%) while single cross-over balloon inflation led to hemostasis in the remaining patients. One patient suffered acute ischemia later in the course of the disease, but this was not directly related to the closure device. In this study, no major bleeding or other device-related adverse events were observed. CONCLUSION The 8 F AngioSeal® vascular closure device has been safely used for removal of the Impella CP® microaxial pump in most cases of predominantly normal weight patients. This technique may be considered feasible for post-hoc LBA closure in the context of pMCS, especially when preclosure options are not suitable or unavailable.
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Affiliation(s)
- Christian F Zachoval
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Mehmet Oezkur
- Klinik und Poliklinik für Herzchirurgie, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Vedat Tiyerili
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Marc U Becher
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Hendrik Treede
- Klinik und Poliklinik für Herzchirurgie, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
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14
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Silaschi M, Eckert L, Hofmann B, Oezkur M, Charitos E, Sedding D, Treede H. Durability of Transcatheter Aortic Valves Beyond 5 Years: A Retrospective Single-Center Analysis. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705481] [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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15
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Adermann L, Hofmann B, Khizaneishvili L, Oezkur M, Sedding D, Wilbring M, Treede H, Silaschi M. Long-Term Pacemaker Dependency after Permanent Pacemaker Implantation Secondary to Heart Valve Surgery. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705424] [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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16
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Magyar A, Wagner M, Thomas P, Malsch C, Schneider R, Störk S, Heuschmann PU, Leyh RG, Oezkur M. HO-1 concentrations 24 hours after cardiac surgery are associated with the incidence of acute kidney injury: a prospective cohort study. Int J Nephrol Renovasc Dis 2019; 12:9-18. [PMID: 30774413 PMCID: PMC6350641 DOI: 10.2147/ijnrd.s165308] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Acute kidney injury (AKI) is a serious complication after cardiac surgery that is associated with increased mortality and morbidity. Heme oxygenase-1 (HO-1) is an enzyme synthesized in renal tubular cells as one of the most intense responses to oxidant stress linked with protective, anti-inflammatory properties. Yet, it is unknown if serum HO-1 induction following cardiac surgical procedure involving cardiopulmonary bypass (CPB) is associated with incidence and severity of AKI. Patients and methods In the present study, we used data from a prospective cohort study of 150 adult cardiac surgical patients. HO-1 measurements were performed before, immediately after and 24 hours post-CPB. In univariate and multivariate analyses, the association between HO-1 and AKI was investigated. Results AKI with an incidence of 23.3% (35 patients) was not associated with an early elevation of HO-1 after CPB in all patients (P=0.88), whereas patients suffering from AKI developed a second burst of HO-1 24 hours after CBP. In patients without AKI, the HO-1 concentrations dropped to baseline values (P=0.031). Furthermore, early HO-1 induction was associated with CPB time (P=0.046), while the ones 24 hours later lost this association (P=0.219). Conclusion The association of the second HO-1 burst 24 hours after CBP might help to distinguish between the causality of AKI in patients undergoing CBP, thus helping to adapt patient stratification and management.
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Affiliation(s)
- Attila Magyar
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany, .,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany,
| | - Martin Wagner
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany, .,Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Phillip Thomas
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany, .,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany,
| | - Carolin Malsch
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany,
| | - Reinhard Schneider
- Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Division of Cardiology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany, .,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Rainer G Leyh
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany,
| | - Mehmet Oezkur
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany, .,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany,
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17
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Oezkur M, Magyar A, Thomas P, Reif A, Störk S, Heuschmann PU, Leyh RG, Wagner M. The COMT-polymorphism is not associated with the incidence of acute kidney injury after cardiac surgery - a prospective cohort study. BMC Nephrol 2018; 19:34. [PMID: 29426301 PMCID: PMC5807752 DOI: 10.1186/s12882-018-0820-x] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 01/18/2018] [Indexed: 12/28/2022] Open
Abstract
Background The Catechol-O-methyltransferase (COMT) represents the key enzyme in catecholamine degradation. Recent studies suggest that the COMT rs4680 polymorphism is associated with the response to endogenous and exogenous catecholamines. There are, however, conflicting data regarding the COMT Met/Met phenotype being associated with an increased risk of acute kidney injury (AKI) after cardiac surgery. The aim of the current study is to prospectively investigate the impact of the COMT rs4680 polymorphism on the incidence of AKI in patients undergoing cardiac surgery. Methods In this prospective single center cohort study consecutive patients hospitalized for elective cardiac surgery including cardiopulmonary-bypass (CPB) were screened for participation. Demographic clinical data, blood, urine and tissue samples were collected at predefined time points throughout the clinical stay. AKI was defined according to recent recommendations of the Kidney Disease Improving Global Outcome (KDIGO) group. Genetic analysis was performed after patient enrolment was completed. Results Between April and December 2014, 150 patients were recruited. The COMT genotypes were distributed as follows: Val/Met 48.7%, Met/Met 29.3%, Val/Val 21.3%. No significant differences were found for demography, comorbidities, or operative strategy according to the underlying COMT genotype. AKI occurred in 35 patients (23.5%) of the total cohort, and no differences were evident between the COMT genotypes (20.5% Met/Met, 24.7% Val/Met, 25.0% Val/Val, p = 0.66). There were also no differences in the post-operative period, including ICU or in-hospital stay. Conclusions We did not find statistically significant variations in the risk for postoperative AKI, length of ICU or in-hospital stay according to the underlying COMT genotype.
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Affiliation(s)
- Mehmet Oezkur
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany. .,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany. .,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
| | - Attila Magyar
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Phillip Thomas
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Andreas Reif
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Medicine I, Division of Cardiology, University Hospital Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Rainer G Leyh
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Martin Wagner
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Medicine I, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany
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18
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Oezkur M, Wagner M, Morbach C, Wood D, Kotseva K, Bauer W, Ertl G, Karmann W, Heuschmann P, Leyh R. Acute Kidney Injury in the German EuroAspire IV Cohort: A Risk Factor for Rehospitalization. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Oezkur
- Department of Cardiac Surgery, University Hospital Halle, Halle, Germany
| | - M. Wagner
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - C. Morbach
- Department of Cardiology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - D. Wood
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - K. Kotseva
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - W. Bauer
- Department of Cardiology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - G. Ertl
- Department of Cardiology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - W. Karmann
- Klinik Kitzinger Land, Kardiologie und Hypertensiologie, Kitzingen, Germany
| | - P. Heuschmann
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - R. Leyh
- Department of Cardiac Surgery, University Hospital Halle, Halle, Germany
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19
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Wagner M, Wanner C, Schich M, Kotseva K, Wood D, Hartmann K, Fette G, Rücker V, Oezkur M, Störk S, Heuschmann PU. Patient's and physician's awareness of kidney disease in coronary heart disease patients - a cross-sectional analysis of the German subset of the EUROASPIRE IV survey. BMC Nephrol 2017; 18:321. [PMID: 29070030 PMCID: PMC5657122 DOI: 10.1186/s12882-017-0730-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/29/2017] [Indexed: 11/17/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a common comorbid condition in coronary heart disease (CHD). CKD predisposes the patient to acute kidney injury (AKI) during hospitalization. Data on awareness of kidney dysfunction among CHD patients and their treating physicians are lacking. In the current cross-sectional analysis of the German EUROASPIRE IV sample we aimed to investigate the physician’s awareness of kidney disease of patients hospitalized for CHD and also the patient’s awareness of CKD in a study visit following hospital discharge. Methods All serum creatinine (SCr) values measured during the hospital stay were used to describe impaired kidney function (eGFRCKD-EPI < 60 ml/min/1.73m2) at admission, discharge and episodes of AKI (KDIGO definition). Information extracted from hospital discharge letters and correct ICD coding for kidney disease was studied as a surrogate of physician’s awareness of kidney disease. All patients were interrogated 0.5 to 3 years after hospital discharge, whether they had ever been told about kidney disease by a physician. Results Of the 536 patients, 32% had evidence for acute or chronic kidney disease during the index hospital stay. Either condition was mentioned in the discharge letter in 22%, and 72% were correctly coded according to ICD-10. At the study visit in the outpatient setting 35% had impaired kidney function. Of 158 patients with kidney disease, 54 (34%) were aware of CKD. Determinants of patient’s awareness were severity of CKD (OReGFR 0.94; 95%CI 0.92–0.96), obesity (OR 1.97; 1.07–3.64), history of heart failure (OR 1.99; 1.00–3.97), and mentioning of kidney disease in the index event’s hospital discharge letter (OR 5.51; 2.35–12.9). Conclusions Although CKD is frequent in CHD, only one third of patients is aware of this condition. Patient’s awareness was associated with kidney disease being mentioned in the hospital discharge letter. Future studies should examine how raising physician’s awareness for kidney dysfunction may improve patient’s awareness of CKD.
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Affiliation(s)
- Martin Wagner
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080, Würzburg, Germany. .,Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany. .,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Schich
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.,Department of Public Health, University of Ghent, Ghent, Belgium.,Fellow of the European Society of Cardiology, Sophia Antipolis, France
| | - David Wood
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Katrin Hartmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080, Würzburg, Germany.,Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Georg Fette
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Institute of Informatics VI, University of Würzburg, Würzburg, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080, Würzburg, Germany
| | - Mehmet Oezkur
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Division of Cardiology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
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20
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Oezkur M, Magyar A, Thomas P, Stork T, Schneider R, Bening C, Störk S, Heuschmann PU, Leyh RG, Wagner M. TIMP-2*IGFBP7 (Nephrocheck®) Measurements at Intensive Care Unit Admission After Cardiac Surgery are Predictive for Acute Kidney Injury Within 48 Hours. Kidney Blood Press Res 2017; 42:456-467. [PMID: 28750409 DOI: 10.1159/000479298] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 02/07/2017] [Accepted: 05/02/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Acute kidney injury (AKI) is a postoperative complication after cardiac surgery with a high impact on mortality and morbidity. Nephrocheck® [TIMP-2*IGFBP7] determines markers of tubular stress, which occurs prior to tubular damage. It is unknown at which time-point [TIMP-2*IGFBP7] measurement should be performed to ideally predict AKI. We investigated the association of [TIMP-2*IGFBP7] at various time-points with the incidence of AKI in patients undergoing elective cardiac surgery including cardio-pulmonary bypass. METHODS In a prospective cohort study, serial blood and urine samples were collected from 150 patients: pre-operative, at ICU-admission, 24h and 48h post-surgery. AKI was defined as Serum-Creatinine rise >0.3 mg/dl within 48hrs. Urinary [TIMP-2*IGFBP7] was measured at pre-operative, ICU-admission and 24h post-surgery; medical staff was kept blinded to these results. RESULTS A total of 35 patients (23.5%) experienced AKI, with a higher incidence in those with high [TIMP-2*IGFBP7] values at ICU admission (57.1% vs. 10.1%, p<0.001). In logistic regression [TIMP-2*IGFBP7] at ICU admission was independently associated with the occurrence of AKI (Odds Ratio 11.83; p<0.001, C-statistic= 0.74) after adjustment for EuroSCORE II and CBP-time. CONCLUSIONS Early detection of elevated [TIMP-2*IGFBP7] at ICU admission was strongly predictive for postoperative AKI and appeared to be more precise as compared to subsequent measurements.
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Affiliation(s)
- Mehmet Oezkur
- Department of Cardiovascular surgery, University Hospital Würzburg, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Attila Magyar
- Department of Cardiovascular surgery, University Hospital Würzburg, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Phillip Thomas
- Department of Cardiovascular surgery, University Hospital Würzburg, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Tabea Stork
- Department of Cardiovascular surgery, University Hospital Würzburg, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Reinhard Schneider
- Div. of Nephrology, Dept. of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Constanze Bening
- Department of Cardiovascular surgery, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
- Div of Cardiology, Dept. of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
- Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Rainer G Leyh
- Department of Cardiovascular surgery, University Hospital Würzburg, Würzburg, Germany
| | - Martin Wagner
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Div. of Nephrology, Dept. of Medicine I, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
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Bening C, Hamouda K, Oezkur M, Schimmer C, Schade I, Gorski A, Aleksic I, Leyh R. Rapid deployment valve system shortens operative times for aortic valve replacement through right anterior minithoracotomy. J Cardiothorac Surg 2017; 12:27. [PMID: 28511707 PMCID: PMC5434633 DOI: 10.1186/s13019-017-0598-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 05/10/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND There is growing evidence from the literature that right anterior minithoracotomy aortic valve replacement (RAT-AVR) improves clinical outcome. However, increased cross clamp time is the strongest argument for surgeons not performing RAT-AVR. Rapid deployment aortic valve systems have the potential to decrease cross-clamp time and ease this procedure. We assessed clinical outcome of rapid deployment and conventional valves through RAT. METHODS Sixty-eight patients (mean age 76 ± 6 years, 32% females) underwent RAT-AVR between 9/2013 and 7/2015. According to the valve type implanted the patients were divided into two groups. In 43 patients (R-group; mean age 74.1 ± 6.6 years) a rapid deployment valve system (Edwards Intuity, Edwards Lifesciences Corp; Irvine, Calif) and in 25 patients (C-group; mean age 74.2 ± 6.6 years) a conventional stented biological aortic valve was implanted. RESULTS Aortic cross-clamp (42.1 ± 12 min vs. 68.3 ± 20.3 min; p < 0.001) and bypass time (80.4 ± 39.3 min vs. 106.6 ± 23.2 min; p = 0.001) were shorter in the rapid deployment group (R-group). We observed no differences in clinical outcome. Postoperative gradients (R-group: max gradient, 14.3 ± 8 mmHg vs. 15.5 ± 5 mmHg (C-group), mean gradient, 9.2 ± 1.7 mmHg (R-group) vs. 9.1 ± 2.3 mmHg (C-group) revealed no differences. However, larger prostheses were implanted in C-group (25 mm; IQR 23-27 mm vs. 23 mm; IQR 21-25; p = 0.009). CONCLUSIONS Our data suggest that the rapid deployment aortic valve system reduced cross clamp and bypass time in patients undergoing RAT-AVR with similar hemodynamics as with larger size stented prosthesis. However, larger studies and long-term follow-up are mandatory to confirm our findings.
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Affiliation(s)
- Constanze Bening
- Department of Thoracic and Cardiovascular Surgery, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Khaled Hamouda
- Department of Thoracic and Cardiovascular Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Mehmet Oezkur
- Department of Thoracic and Cardiovascular Surgery, University Hospital Wuerzburg, Wuerzburg, Germany.,Institute for Clinical and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - Christoph Schimmer
- Department of Thoracic and Cardiovascular Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ina Schade
- Department of Thoracic and Cardiovascular Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Armin Gorski
- Department of Thoracic and Cardiovascular Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ivan Aleksic
- Department of Thoracic and Cardiovascular Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Rainer Leyh
- Department of Thoracic and Cardiovascular Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
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22
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Morbach C, Wagner M, Güntner S, Malsch C, Oezkur M, Wood D, Kotseva K, Leyh R, Ertl G, Karmann W, Heuschmann PU, Störk S. Heart failure in patients with coronary heart disease: Prevalence, characteristics and guideline implementation - Results from the German EuroAspire IV cohort. BMC Cardiovasc Disord 2017; 17:108. [PMID: 28476146 PMCID: PMC5420109 DOI: 10.1186/s12872-017-0543-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 04/28/2017] [Indexed: 01/10/2023] Open
Abstract
Background Adherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the optimization of guideline implementation. Methods Patients from the German sample of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EuroAspire) IV survey with a hospitalization for CHD within the previous six to 36 months providing valid data on echocardiography as well as on signs and symptoms of HF were categorized into stages of HF: A, prevalence of risk factors for developing HF; B, asymptomatic but with structural heart disease; C, symptomatic HF. A Guideline Adherence Indicator (GAI-3) was calculated for patients with reduced (≤40%) left ventricular ejection fraction (HFrEF) as number of drugs taken per number of drugs indicated; beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists (MRA) were considered. Results 509/536 patients entered analysis. HF stage A was prevalent in n = 20 (3.9%), stage B in n = 264 (51.9%), and stage C in n = 225 (44.2%) patients; 94/225 patients were diagnosed with HFrEF (42%). Stage C patients were older, had a longer duration of CHD, and a higher prevalence of arterial hypertension. Awareness of pre-diagnosed HF was low (19%). Overall GAI-3 of HFrEF patients was 96.4% with a trend towards lower GAI-3 in patients with lower LVEF due to less thorough MRA prescription. Conclusions In our sample of CHD patients, prevalence of HF stage C was high and a sizable subgroup suffered from HFrEF. Overall, pharmacotherapy was fairly well implemented in HFrEF patients, although somewhat worse in patients with more reduced ejection fraction. Two major targets were identified possibly suited to further improve the implementation of HF guidelines: 1) increase patients´ awareness of diagnosis and importance of HF; and 2) disseminate knowledge about the importance of appropriately implementing the use of mineralocorticoid receptor antagonists. Trial registration This is a cross-sectional analysis of a non-interventional study. Therefore, it was not registered as an interventional trial.
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Affiliation(s)
- Caroline Morbach
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany
| | - Martin Wagner
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany
| | - Stefan Güntner
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany
| | - Carolin Malsch
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany
| | - Mehmet Oezkur
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Cardiovascular Surgery, University Hospital Würzburg, Wuerzburg, Germany
| | - David Wood
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.,Department of Public Health, University of Ghent, Ghent, Belgium
| | - Rainer Leyh
- Department of Cardiovascular Surgery, University Hospital Würzburg, Wuerzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany
| | - Wolfgang Karmann
- Department of Medicine, Klinik Kitzinger Land, Kitzingen, Germany
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany. .,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany.
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23
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Oezkur M, Magyar A, Thomas P, Stork T, Reif A, Störk S, Heuschmann P, Leyh R, Wagner M. Nephrocheck Measurements at Intensive Care Unit Admission and 24 Hours after Cardiac Surgery Are Associated with the Incidence of Acute Kidney Injury: A Prospective Cohort Study. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Oezkur
- Universitätsklinikum Würzburg, Cardiovascular Surgery, Wurzburg, Germany
| | - A. Magyar
- Universitätsklinikum Würzburg, Cardiovascular Surgery, Wurzburg, Germany
| | - P. Thomas
- Universitätsklinikum Würzburg, Cardiovascular Surgery, Wurzburg, Germany
| | - T. Stork
- Universitätsklinikum Würzburg, Cardiovascular Surgery, Wurzburg, Germany
| | - A. Reif
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, Universitätsklinikum Würzburg, Würzburg, Germany
| | - S. Störk
- Comprehensive Heart Failure Center, Universität Würzburg, Würzburg, Germany
| | - P.U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, Universität Würzburg, Würzburg, Germany
| | - R.G. Leyh
- Universitätsklinikum Würzburg, Cardiovascular Surgery, Wurzburg, Germany
| | - M. Wagner
- Institute of Clinical Epidemiology and Biometry, Universität Würzburg, Würzburg, Germany
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24
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Bening C, Hamouda K, Leistner M, Radakovic D, Oezkur M, Leyh R, Schimmer C. Perioperative Results from Left Atrial Appendage Removal during Open Heart Surgery. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C. Bening
- Herzchirurgie, Universität Würzburg, Würzburg, Germany
| | - K. Hamouda
- Herzchirurgie, Universität Würzburg, Würzburg, Germany
| | - M. Leistner
- Herzchirurgie, Universität Würzburg, Würzburg, Germany
| | - D. Radakovic
- Herzchirurgie, Universität Würzburg, Würzburg, Germany
| | - M. Oezkur
- Herzchirurgie, Universität Würzburg, Würzburg, Germany
| | - R. Leyh
- Herzchirurgie, Universität Würzburg, Würzburg, Germany
| | - C. Schimmer
- Herzchirurgie, Universität Würzburg, Würzburg, Germany
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25
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Thomas P, Oezkur M, Magyar A, Reif A, Störk S, Heuschmann P, Leyh R, Wagner M. The Association of the COMT-Genotype and Postoperative Pain Perception at Hospital Discharge in Patients Undergoing Cardiac Surgery: An Analysis from the COMT-Cohort Study. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- P. Thomas
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - M. Oezkur
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - A. Magyar
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - A. Reif
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - S. Störk
- Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - P.U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - R.G. Leyh
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - M. Wagner
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
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26
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Bening C, Hamouda K, Schimmer C, Aleksic I, Radakovic D, Oezkur M, Gorski A, Leyh R. Aortic Root Replacement via A Minimally Invasive Approach is Safe. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C. Bening
- Universität Würzburg, Herzchirurgie, Würzburg, Germany
| | - K. Hamouda
- Universität Würzburg, Herzchirurgie, Würzburg, Germany
| | - C. Schimmer
- Universität Würzburg, Herzchirurgie, Würzburg, Germany
| | - I. Aleksic
- Universität Würzburg, Herzchirurgie, Würzburg, Germany
| | - D. Radakovic
- Universität Würzburg, Herzchirurgie, Würzburg, Germany
| | - M. Oezkur
- Universität Würzburg, Herzchirurgie, Würzburg, Germany
| | - A. Gorski
- Universität Würzburg, Herzchirurgie, Würzburg, Germany
| | - R. Leyh
- Universität Würzburg, Herzchirurgie, Würzburg, Germany
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27
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Oezkur M, Magyar A, Thomas P, Reif A, Störk S, Heuschmann P, Leyh R, Wagner M. The COMT-Polymorphism is not Associated with the Incidence of Acute Kidney Injury after Cardiac Surgery: A Prospective Cohort Study. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Oezkur
- Cardiovascular Surgery, Universitätsklinikum Würzburg, Würzburg, Germany
| | - A. Magyar
- Cardiovascular Surgery, Universitätsklinikum Würzburg, Würzburg, Germany
| | - P. Thomas
- Cardiovascular Surgery, Universitätsklinikum Würzburg, Würzburg, Germany
| | - A. Reif
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, Universitätsklinikum Würzburg, Würzburg, Germany
| | - S. Störk
- Universität Würzburg, Comprehensive Heart Failure Center, Würzburg, Germany
| | - P.U. Heuschmann
- Universität Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
| | - R.G. Leyh
- Cardiovascular Surgery, Universitätsklinikum Würzburg, Würzburg, Germany
| | - M. Wagner
- Universität Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
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28
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Hamouda K, Bening C, Engel P, Oezkur M, Leistner M, Leyh R, Schimmer C. Perioperative Course of Cardiac Surgery Patients Affected by Depressive Disorder: A Matched-Pair Analysis. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571763] [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: 10/22/2022]
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29
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Oezkur M, Gorski A, Magyar A, Leistner M, Hoffmann I, Blettner M, Weigang E, Leyh R. Higher Incidence of Acute Aortic Dissections in Winter Months: Results of the German Registry for Acute Aortic Dissection Type A (GERAADA). Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571540] [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: 10/22/2022]
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30
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Leyh R, Bening C, Schimmer C, Oezkur M, Gorski A, Hamouda K. "No touch" technique and hypothermic circulatory arrest for porcelain aorta in combined valve surgery. J Cardiothorac Surg 2015. [PMCID: PMC4693948 DOI: 10.1186/1749-8090-10-s1-a173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Schimmer C, Hamouda K, Oezkur M, Sommer SP, Leistner M, Leyh R. [End-of-life decisions and practices in critically ill patients in the cardiac intensive care unit. A nationwide survey]. Med Klin Intensivmed Notfmed 2015; 111:92-7. [PMID: 26065385 DOI: 10.1007/s00063-015-0045-8] [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: 12/16/2013] [Revised: 04/04/2014] [Accepted: 04/03/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ethical and medical criteria in the decision-making process of withholding or withdrawal of life support therapy in critically ill patients present a great challenge in intensive care medicine. OBJECTIVES The purpose of this work was to assess medical and ethical criteria that influence the decision-making process for changing the aim of therapy in critically ill cardiac surgery patients. MATERIALS AND METHODS A questionnaire was distributed to all German cardiac surgery centers (n = 79). All clinical directors, intensive care unit (ICU) consultants and ICU head nurses were asked to complete questionnaires (n = 237). RESULTS In all, 86 of 237 (36.3 %) questionnaires were returned. Medical reasons which influence the decision-making process for changing the aim of therapy were cranial computed tomography (cCT) with poor prognosis (91.9 %), multi-organ failure (70.9 %), and failure of assist device therapy (69.8 %). Concerning ethical reasons, poor expected quality of life (48.8 %) and the presumed patient's wishes (40.7 %) were reported. There was a significant difference regarding the perception of the three different professional groups concerning medical and ethical criteria as well as the involvement in the decision-making process. CONCLUSION In critically ill cardiac surgery patients, medical reasons which influence the decision-making process for changing the aim of therapy included cCT with poor prognosis, multi-organ failure, and failure of assist device therapy. Further studies are mandatory in order to be able to provide adequate answers to this difficult topic.
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Affiliation(s)
- C Schimmer
- Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
| | - K Hamouda
- Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - M Oezkur
- Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - S-P Sommer
- Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - M Leistner
- Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - R Leyh
- Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
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32
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Oezkur M, Wagner M, Weismann D, Krannich JH, Schimmer C, Riegler C, Rücker V, Leyh R, Heuschmann PU. Chronic hyperglycemia is associated with acute kidney injury in patients undergoing CABG surgery--a cohort study. BMC Cardiovasc Disord 2015; 15:41. [PMID: 25964053 PMCID: PMC4443518 DOI: 10.1186/s12872-015-0028-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/21/2015] [Indexed: 12/12/2022] Open
Abstract
Background Chronic hyperglycemia (CHG) with HbA1c as an indicator affects postoperative mortality and morbidity after coronary artery bypass grafting surgery (CABG). Acute kidney injury (AKI) is one of the frequent postoperative complications after CABG impacting short-and long-term outcomes. We investigated the association between CHG and postoperative incidence of AKI in CABG patients with and without history of diabetes mellitus (DM). Methods This cohort study consecutively enrolled patients undergoing CABG in 2009 at the department for cardiovascular surgery. CHG was defined as HbA1c ≥ 6.0 %. Patients with advanced chronic kidney disease (CKD) were excluded. The incidence of postoperative AKI and its association with CHG was analyzed by univariate and multivariate logistic regression modeling. Results Three-hundred-seven patients were analyzed. The incidence of AKI was 48.2 %. Patients with CHG (n = 165) were more likely to be female and had greater waist circumference as well as other comorbid conditions, such as smoking, history of DM, CKD, hypertension, pulmonary hypertension, and chronic obstructive pulmonary disease (all p ≤ 0.05). Preoperative eGFR, atrial fibrillation (AF), history of DM and CHG were associated with an increased risk of postoperative AKI in univariate analyses. In multivariate modelling, history of DM as well as preoperative eGFR and AF lost significance, while age, CHG and prolonged OP duration (p < 0.05) were independently associated with postoperative AKI. Conclusions Our results suggest that CHG defined on a single measurement of HbA1c ≥ 6.0 % was associated with the incidence of AKI after CABG. This finding might implicate that treatment decisions, including the selection of operative strategies, could be based on HbA1c measurement rather than on a recorded history of diabetes.
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Affiliation(s)
- Mehmet Oezkur
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany.
| | - Martin Wagner
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany. .,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. .,Department of Internal Medicine I, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany.
| | - Dirk Weismann
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. .,Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany.
| | - Jens Holger Krannich
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany.
| | - Christoph Schimmer
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany.
| | - Christoph Riegler
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
| | - Victoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
| | - Rainer Leyh
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany.
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany. .,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. .,Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany.
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Hamouda K, Oezkur M, Sinha B, Hain J, Menkel H, Leistner M, Leyh R, Schimmer C. Different duration strategies of perioperative antibiotic prophylaxis in adult patients undergoing cardiac surgery: an observational study. J Cardiothorac Surg 2015; 10:25. [PMID: 25880032 PMCID: PMC4345000 DOI: 10.1186/s13019-015-0225-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 02/10/2015] [Indexed: 11/25/2022] Open
Abstract
Background All international guidelines recommend perioperative antibiotic prophylaxis (PAB) should be routinely administered to patients undergoing cardiac surgery. However, the duration of PAB is heterogeneous and controversial. Methods Between 01.01.2011 and 31.12.2011, 1096 consecutive cardiac surgery patients were assigned to one of two groups receiving PAB with a second-generation cephalosporin for either 56 h (group I) or 32 h (group II). Patients’ characteristics, intraoperative data, and the in-hospital follow-up were analysed. Primary endpoint was the incidence of surgical site infection (deep and superficial sternal wound-, and vein harvesting site infection; DSWI/SSWI/VHSI). Secondary endpoints were the incidence of respiratory-, and urinary tract infection, as well as the mortality rate. Results 615/1096 patients (56,1%) were enrolled (group I: n = 283 versus group II: n = 332). There were no significant differences with regard to patient characteristics, comorbidities, and procedure-related variables. No statistically significant differences were demonstrated concerning primary and secondary endpoints. The incidence of DSWI/SSWI/VHSI were 4/283 (1,4%), 5/283 (1,7%), and 1/283 (0,3%) in group I versus 6/332 (1,8%), 9/332 (2,7%), and 3/332 (0,9%) in group II (p = 0,76/0,59/0,63). In univariate analyses female gender, age, peripheral arterial obstructive disease, operating-time, ICU-duration, transfusion, and respiratory insufficiency were determinants for nosocomial infections (all ≤ 0,05). Subgroup analyses of these high-risk patients did not show any differences between the two regimes (all ≥ 0,05). Conclusions Reducing the duration of PAB from 56 h to 32 h in adult cardiac surgery patients was not associated with an increase of nosocomial infection rate, but contributes to reduce antibiotic resistance and health care costs.
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Affiliation(s)
- Khaled Hamouda
- Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
| | - Mehmet Oezkur
- Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
| | - Bhanu Sinha
- Medical Microbiology, University Medical Center Groningen, Groningen, Netherlands.
| | - Johannes Hain
- University of Würzburg, Institute of Mathematics and Informatics, Chair of Mathematics VIII (Statistics), Würzburg, Germany.
| | - Hannah Menkel
- Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
| | - Marcus Leistner
- Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
| | - Rainer Leyh
- Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
| | - Christoph Schimmer
- Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
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Schimmer C, Hamouda K, Oezkur M, Sommer S, Leistner M, Leyh R. Calculated Empiric Antibiotic Therapy of Nosocomial Infection in Cardiac Surgery Patients. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544507] [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]
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Schimmer C, Hamouda K, Oezkur M, Sommer S, Leistner M, Leyh R. Comparison of 56 Hours versus 32 Hours of Perioperative Antibiotic Prophylaxis in Adult Cardiac Surgery. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544502] [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]
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Schimmer C, Hamouda K, Oezkur M, Sommer S, Leistner M, Leyh R. Choice and Duration of Antibiotic Prophylaxis in Adult Cardiac Surgery. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544505] [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]
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Schimmer C, Hamouda K, Oezkur M, Sommer S, Leistner M, Leyh R. Early Onset of Stroke after Cardiac Surgery in Correlation to the Degree of Preoperative Carotid Stenosis. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544504] [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]
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Oezkur M, Gorski A, Peltz J, Wagner M, Lazariotou M, Schimmer C, Heuschmann PU, Leyh RG. Preoperative serum h-FABP concentration is associated with postoperative incidence of acute kidney injury in patients undergoing cardiac surgery. BMC Cardiovasc Disord 2014; 14:117. [PMID: 25212385 PMCID: PMC4169817 DOI: 10.1186/1471-2261-14-117] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background Fatty acid binding protein (FABP) is an intracellular transport protein associated with myocardial damage size in patients undergoing cardiac surgery. Furthermore, elevated FABP serum concentrations are related to a number of common comorbidities, such as heart failure, chronic kidney disease, diabetes mellitus, and metabolic syndrome, which represent important risk factors for postoperative acute kidney injury (AKI). Data are lacking on the association between preoperative FABP serum level and postoperative incidence of AKI. Methods This prospective cohort study investigated the association between preoperative h-FABP serum concentrations and postoperative incidence of AKI, hospitalization time and length of ICU treatment. Blood samples were collected according to a predefined schedule. The AKI Network definition of AKI was used as primary endpoint. All associations were analysed using descriptive and univariate analyses. Results Between 05/2009 and 09/2009, 70 patients undergoing cardiac surgery were investigated. AKI was observed in 45 patients (64%). Preoperative median (IQR) h-FABP differed between the AKI group (2.9 [1.7–4.1] ng/ml) and patients without AKI (1.7 [1.1–3.3] ng/ml; p = 0.04), respectively. Patients with AKI were significantly older. No statistically significant differences were found for gender, type of surgery, operation duration, CPB-, or X-Clamp time, preoperative cardiac enzymes, HbA1c, or CRP between the two groups. Preoperative h-FABP was also correlated with the length of ICU stay (rs = 0.32, p = 0.007). Conclusions We found a correlation between preoperative serum h-FABP and the postoperative incidence of AKI. Our results suggest a potential role for h-FABP as a biomarker for AKI in cardiac surgery.
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Affiliation(s)
- Mehmet Oezkur
- Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany.
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Ruppert C, Deiss K, Herrmann S, Vidal M, Oezkur M, Gorski A, Weidemann F, Lohse MJ, Lorenz K. Interference with ERK(Thr188) phosphorylation impairs pathological but not physiological cardiac hypertrophy. Proc Natl Acad Sci U S A 2013; 110:7440-5. [PMID: 23589880 PMCID: PMC3645583 DOI: 10.1073/pnas.1221999110] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [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] [Indexed: 12/12/2022] Open
Abstract
Extracellular signal-regulated kinases 1 and 2 (ERK1/2) are central mediators of cardiac hypertrophy and are discussed as potential therapeutic targets. However, direct inhibition of ERK1/2 leads to exacerbated cardiomyocyte death and impaired heart function. We have previously identified ERK(Thr188) autophosphorylation as a regulatory phosphorylation of ERK1/2 that is a key factor in cardiac hypertrophy. Here, we investigated whether interference with ERK(Thr188) phosphorylation permits the impairment of ERK1/2-mediated cardiac hypertrophy without increasing cardiomyocyte death. The impact of ERK(Thr188) phosphorylation on cardiomyocyte hypertrophy and cell survival was analyzed in isolated cells and in mice using the mutant ERK2(T188A), which is dominant-negative for ERK(Thr188) signaling. ERK2(T188A) efficiently attenuated cardiomyocyte hypertrophic responses to phenylephrine and to chronic pressure overload, but it affected neither antiapoptotic ERK1/2 signaling nor overall physiological cardiac function. In contrast to its inhibition of pathological hypertrophy, ERK2(T188A) did not interfere with physiological cardiac growth occurring with age or upon voluntary exercise. A preferential role of ERK(Thr188) phosphorylation in pathological types of hypertrophy was also seen in patients with aortic valve stenosis: ERK(Thr188) phosphorylation was increased 8.5 ± 1.3-fold in high-gradient, rapidly progressing cases (≥40 mmHg gradient), whereas in low-gradient, slowly progressing cases, the increase was not significant. Because interference with ERK(Thr188) phosphorylation (i) inhibits pathological hypertrophy and (ii) does not impair antiapoptotic ERK1/2 signaling and because ERK(Thr188) phosphorylation shows strong prevalence for aortic stenosis patients with rapidly progressing course, we conclude that interference with ERK(Thr188) phosphorylation offers the possibility to selectively address pathological types of cardiac hypertrophy.
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Affiliation(s)
- Catharina Ruppert
- Institute of Pharmacology and Toxicology, University of Würzburg, 97078 Würzburg, Germany
- Comprehensive Heart Failure Center, and
| | - Katharina Deiss
- Institute of Pharmacology and Toxicology, University of Würzburg, 97078 Würzburg, Germany
| | - Sebastian Herrmann
- Comprehensive Heart Failure Center, and
- Departments of Internal Medicine I and
| | - Marie Vidal
- Institute of Pharmacology and Toxicology, University of Würzburg, 97078 Würzburg, Germany
| | - Mehmet Oezkur
- Comprehensive Heart Failure Center, and
- Thoracic and Cardiovascular Surgery, University Hospital Würzburg, 97080 Würzburg, Germany; and
| | - Armin Gorski
- Comprehensive Heart Failure Center, and
- Thoracic and Cardiovascular Surgery, University Hospital Würzburg, 97080 Würzburg, Germany; and
| | - Frank Weidemann
- Comprehensive Heart Failure Center, and
- Departments of Internal Medicine I and
| | - Martin J. Lohse
- Institute of Pharmacology and Toxicology, University of Würzburg, 97078 Würzburg, Germany
- Comprehensive Heart Failure Center, and
| | - Kristina Lorenz
- Institute of Pharmacology and Toxicology, University of Würzburg, 97078 Würzburg, Germany
- Comprehensive Heart Failure Center, and
- Department of Pharmacology and Toxicology, Medical Faculty, Dresden University of Technology, 01307 Dresden, Germany
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Schimmer C, Yildirim C, Oezkur M, Sommer SP, Hörning B, Leyh R. Practice of end-of-life care in intensive care unit. A national survey. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269175] [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]
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Schimmer C, Oezkur M, Gorski A, Hamouda K, Hager B, Leyh R. Comparison of local gentamicin-collagen versus a simple collagen sponge on the incidence of sternal wound infections: A prospective randomized double-blind controlled trial. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1268987] [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]
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Hamouda K, Schimmer C, Oezkur M, Szabó AK, Gorski A, Leyh R. Preoperative placement of an Intra-Aortic Balloon Pump (IABP) in patients with acute coronary syndrome (ACS): A follow-up. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269106] [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]
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Oezkur M, Lazariotou M, Peltz J, Krannich JH, Schimmer C, Hamouda K, Leyh R. Intraoperative h-FABP increase predicts postoperative increase in ischaemic markers. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269363] [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]
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Aleksic I, Sommer SP, Kottenberg-Assenmacher E, Lange V, Schimmer C, Oezkur M, Leyh RG, Gorski A. Cardiac operations in the presence of meningioma. Ann Thorac Surg 2009; 88:1264-8. [PMID: 19766819 DOI: 10.1016/j.athoracsur.2009.06.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 06/17/2009] [Accepted: 06/19/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated the effect of concomitant intracranial meningiomas on perioperative and postoperative complications after cardiac operations. Also studied was the intraoperative and perioperative management and long-term outcome of such patients. METHODS We retrospectively evaluated 16 cardiac surgical patients with intracranial meningiomas between January 1996 and July 2007. Neurologic outcome, incidence of transient neurologic deficits, and long-term follow-up focusing on freedom from any cardiac or neurosurgical intervention were assessed. RESULTS Five men and 11 women with a concomitant diagnosis of intracranial meningioma underwent cardiac operations using extracorporeal circulation. One patient received additional edema prophylaxis by intravenous dexamethasone. All patients were discharged home in good physical condition. Data on long-term survival were available on 14 patients, with 12 alive. Postoperatively, 2 patients died from myocardial infarction at 26.8 months and 2 from metastatic colon cancer at 57.9 months. Perioperative neurologic disorders were observed in 2 patients, comprising one stroke after intervention for aortic dissection and one thromboembolic event 2 weeks after biologic mitral valve replacement due to anticoagulation disorders. No meningioma-related adverse event was observed. CONCLUSIONS The presence of intracranial meningioma does not appear to be a risk factor for patients undergoing cardiac operations. No meningioma-related neurologic sequelae were documented postoperatively. Neurosurgical consultation should be obtained in all patients preoperatively.
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Affiliation(s)
- Ivan Aleksic
- Department of Thoracic and Cardiovascular Surgery, Julius-Maximilians-University Würzburg, Würzburg, Germany.
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Abstract
BACKGROUND Removal of xenoreactive antibodies in pig-to-human lung transplantation by columns or organ perfusions proofed to be unsatisfactory and associated with adverse effects. In an ex-vivo lung perfusion model, we evaluated the potential of a soluble trisaccharide polymer (GAS914) to bind alpha-Gal antibodies and to protect a pulmonary xenograft from hyperacute rejection (HAR) and pulmonary xenograft dysfunction. METHODS Porcine lungs were perfused with fresh human blood for 240 min. In the GAS914 treated group (n=6) the polymer was applied in three different concentrations. The control group (n=6) received no GAS914. Survival and function of perfused xenografts were monitored, and alpha-Gal antibodies as well as cytolytic anti-porcine antibodies analyzed. RESULTS In the GAS-treated group survival of lungs was significantly prolonged, pulmonary vascular resistance reduced, pulmonary edema prevented, and oxygenation improved. On histopathological evaluation application of GAS resulted in minimal graft injury and significantly less deposition of the terminal complement complex C5b-9. Following application of GAS914, up to 89.8% of IgG alpha-Gal, 79.5% of IgM and 73.6% of anti-porcine antibodies in the human blood were bound by the polymer. Subsequent perfusion of porcine lungs resulted in absorption of only 3% of the baseline IgG alpha-Gal antibodies in the GAS914 group, compared to 87% in the controls. CONCLUSIONS In this ex-vivo lung perfusion model, a trisaccharide polymer prevented immediate HAR, due to effective removal of alpha-Gal antibodies. In combination with additional strategies GAS914 may be a valuable tool in overcoming HAR and dysfunction of pulmonary xenografts.
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Affiliation(s)
- Karsten Wiebe
- Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
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Pöling J, Oezkur M, Kogge K, Mengel M, Niemann H, Winkler M, Haverich A, Wiebe K. Hyperacute rejection in ex vivo-perfused porcine lungs transgenic for human complement regulatory proteins. Transpl Int 2006; 19:225-32. [PMID: 16441772 DOI: 10.1111/j.1432-2277.2006.00267.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Inhibition of complement activation via human membrane-associated complement regulators is known to prevent hyperacute rejection in heart and kidney pig-to-primate transplantation. The protective effect of such strategies in pulmonary xenografts, however, seems to be insufficient. In an ex vivo perfusion, model lungs from donor pigs transgenic for human CD55 (n = 6) or human CD59 (n = 5) were perfused with fresh human blood and compared with nontransgenic organs (n = 6). In addition, a soluble complement component 1 esterase inhibitor (C1-Inh) was applied in h-CD55 transgenic lungs (n = 3). In the h-CD55 transgenic group, survival was prolonged (P < 0.05), quality and maximal time of oxygenation significantly improved and pulmonary vascular resistance reduced compared with the control group. There was a decreased sequestration of platelets, less parenchymal injury and reduced deposition of C(5b-9) in the h-CD55 transgenic group. Additional soluble complement inhibition (C1-Inh) did not prolong survival of h-CD55 transgenic lungs. Survival and pulmonary function in lungs expressing h-CD59 was not significantly different from parameters observed in nontransgenic lungs. In this ex vivo model of pig-to-primate lung transplantation, membrane-based complement inhibition resulted in significantly improved pulmonary function. However, minor histopathological injuries observed in these transgenic xenografts suggested only partial protection from pulmonary dysfunction by complement inhibition alone.
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Affiliation(s)
- Jochen Pöling
- Klinik für Herz-,Thorax- und Gefäbchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
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Wiebe K, Schuerholz T, Oezkur M, Mengel M, Schwinzer R, Winkler M, Haverich A. Ex-vivo and in-vivo effects of GAS 914 on pulmonary xenograft rejection. J Heart Lung Transplant 2004. [DOI: 10.1016/j.healun.2003.11.132] [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: 11/29/2022] Open
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