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Baldan BU, Hegeman RRMJJ, Bos NMJP, Smeenk HG, Klautz RJM, Klein P. Comparative Analysis of Therapeutic Strategies in Post-Cardiotomy Cardiogenic Shock: Insight into a High-Volume Cardiac Surgery Center. J Clin Med 2024; 13:2118. [PMID: 38610884 PMCID: PMC11012770 DOI: 10.3390/jcm13072118] [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: 02/26/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Post-cardiotomy cardiogenic shock (PCCS), which is defined as severe low cardiac output syndrome after cardiac surgery, has a mortality rate of up to 90%. No study has yet been performed to compare patients with PCCS treated by conservative means to patients receiving additional mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation (ECMO). Methods: A single-center retrospective analysis from January 2018 to June 2022 was performed. Results: Out of 7028 patients who underwent cardiac surgery during this time period, 220 patients (3%) developed PCCS. The patients were stratified according to their severity of shock based on the Stage Classification Expert Consensus (SCAI) group. Known risk factors for shock-related mortality, including the vasoactive-inotropic score (VIS) and plasma lactate levels, were assessed at structured intervals. In patients treated additionally with ECMO (n = 73), the in-hospital mortality rate was 60%, compared to an in-hospital mortality rate of 85% in patients treated by conservative means (non-ECMO; n = 52). In 18/73 (25%) ECMO patients, the plasma lactate level normalized within 48 h, compared to 2/52 (4%) in non-ECMO patients. The morbidity of non-ECMO patients compared to ECMO patients included a need for dialysis (42% vs. 60%), myocardial infarction (19% vs. 27%), and cerebrovascular accident (17% vs. 12%). Conclusions: In conclusion, the additional use of ECMO in PCCS holds promise for enhancing outcomes in these critically ill patients, more rapid improvement of end-organ perfusion, and the normalization of plasma lactate levels.
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Affiliation(s)
- B. Ufuk Baldan
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | - Romy R. M. J. J. Hegeman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | | | - Hans G. Smeenk
- Department of Cardiothoracic Surgery, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | - Robert J. M. Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
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2
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Hegeman RRMJJ, van Ginkel DJ, Laengle S, Timmers L, Rensing BJWM, de Kroon TL, Sonker U, Kelder JC, Mach M, Andreas M, Swaans MJ, Ten Berg JM, Klein P. Preoperative computed tomography-imaging with patient-specific computer simulation in transcatheter aortic valve implantation: Design and rationale of the GUIDE-TAVI trial. Am Heart J 2024; 269:158-166. [PMID: 38163616 DOI: 10.1016/j.ahj.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/28/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is an established treatment option for patients with severe aortic valve stenosis, but is still associated with relatively high rates of pacemaker implantation and paravalvular regurgitation. Routine preoperative computed tomography (CT) combined with patient-specific computer modelling can predict the interaction between the TAVI device and the patient's unique anatomy, allowing physicians to assess the risk for paravalvular regurgitation and conduction disorders in advance to the procedure. The aim of this trial is to assess potential improvement in the procedural outcome of TAVI by applying CT-based patient-specific computer simulations in patients with suitable anatomy for TAVI. METHODS The GUIDE-TAVI trial is an international multicenter randomized controlled trial including patients accepted for TAVI by the Heart Team. Patients enrolled in the study will be randomized into 2 arms of each 227 patients. In patients randomized to the use of FEops HEARTGuide (FHG), patient-specific computer simulation with FHG is performed in addition to routine preoperative CT imaging and results of the FHG are available to the operator(s) prior to the scheduled intervention. In patients randomized to no use of FHG, only routine preoperative CT imaging is performed. The primary objective is to evaluate whether the use of FHG will reduce the incidence of mild to severe PVR, according to the Valve Academic Research Consortium 3. Secondary endpoints include the incidence of new conduction disorders requiring permanent pacemaker implantation, the difference between preoperative and final selected valve size, the difference between target and final implantation depth, change of preoperative decision, failure to implant valve, early safety composite endpoint and quality of life. CONCLUSIONS The GUIDE-TAVI trial is the first multicenter randomized controlled trial to evaluate the value of 3-dimensional computer simulations in addition to standard preprocedural planning in TAVI procedures.
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Affiliation(s)
- Romy R M J J Hegeman
- Department of Cardiothoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Dirk-Jan van Ginkel
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Severin Laengle
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Leo Timmers
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Benno J W M Rensing
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Thomas L de Kroon
- Department of Cardiothoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Uday Sonker
- Department of Cardiothoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Johannes C Kelder
- Department of Epidemiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Markus Mach
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria; Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Andreas
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin J Swaans
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Jurriën M Ten Berg
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
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3
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Herrmann K, Rahbar K, Eiber M, Sparks R, Baca N, Krause BJ, Lassmann M, Jentzen W, Tang J, Chicco D, Klein P, Blumenstein L, Basque JR, Kurth J. Renal and Multiorgan Safety of 177Lu-PSMA-617 in Patients with Metastatic Castration-Resistant Prostate Cancer in the VISION Dosimetry Substudy. J Nucl Med 2024; 65:71-78. [PMID: 38050121 PMCID: PMC10755516 DOI: 10.2967/jnumed.123.265448] [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] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/10/2023] [Indexed: 12/06/2023] Open
Abstract
In the VISION trial, [177Lu]Lu-PSMA-617 (177Lu-PSMA-617) plus protocol-permitted standard of care significantly improved overall survival and radiographic progression-free survival compared with standard of care alone in patients with prostate-specific membrane antigen-positive metastatic castration-resistant prostate cancer. This VISION dosimetry substudy quantified absorbed doses of 177Lu-PSMA-617 in the kidneys and other organs. Methods: Participants were a separate cohort of 30 nonrandomized patients receiving standard of care plus 177Lu-PSMA-617 at 7.4 GBq per cycle for up to 6 cycles. Blood samples, whole-body conjugate planar image scintigraphy, and abdominal SPECT/CT images were collected. SPECT/CT images were collected at 2, 24, 48, and 168 h after administration in cycle 1 and at a single time point 48 h after administration in cycles 2-6. Outcomes were absorbed dose per unit activity per cycle and cumulative absorbed dose over all cycles. Cumulative absorbed doses were predicted by extrapolation from cycle 1, and calculation of observed values was based on measurements of cycle 1 and cycles 2-6. Safety was also assessed. Results: Mean (±SD) absorbed doses per cycle in the kidneys were 0.43 ± 0.16 Gy/GBq in cycle 1 and 0.44 ± 0.21 Gy/GBq in cycles 2-6. The observed and predicted 6-cycle cumulative absorbed doses in the kidneys were 15 ± 6 and 19 ± 7 Gy, respectively. Observed and predicted cumulative absorbed doses were similar in other at-risk organs. Safety findings were consistent with those in the VISION study; no patients experienced renal treatment-emergent adverse events of a grade higher than 3. Conclusion: The renal cumulative absorbed 177Lu-PSMA-617 dose was below the established limit. 177Lu-PSMA-617 had a good overall safety profile, and low renal radiotoxicity was not a safety concern. Cumulative absorbed doses in at-risk organs over multiple cycles can be predicted by extrapolation from cycle 1 data in patients with metastatic castration-resistant prostate cancer receiving 177Lu-PSMA-617.
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Affiliation(s)
- Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium, University Hospital Essen, Essen, Germany;
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | | | | | | | - Bernd J Krause
- Department of Nuclear Medicine, Rostock University Medical Center, Rostock, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Walter Jentzen
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium, University Hospital Essen, Essen, Germany
| | - Jun Tang
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Daniela Chicco
- Advanced Accelerator Applications, a Novartis Company, Turin, Italy
| | - Patrick Klein
- Novartis Institutes for BioMedical Research, East Hanover, New Jersey
| | - Lars Blumenstein
- Novartis Institutes for BioMedical Research, Basel, Switzerland; and
| | | | - Jens Kurth
- Department of Nuclear Medicine, Rostock University Medical Center, Rostock, Germany
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Hegeman RRMJJ, Heeringa T, Beukers SHQ, Van Kuijk JP, Guglielmo M, Ten Berg JM, Swaans MJ, Klein P. Adding Surgical Edge-to-Edge Mitral Valve Repair to Myectomy in Hypertrophic Obstructive Cardiomyopathy: Long-Term Functional and Echocardiographic Outcome. Curr Probl Cardiol 2024; 49:102134. [PMID: 37852558 DOI: 10.1016/j.cpcardiol.2023.102134] [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: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023]
Abstract
This study evaluates the early and long-term clinical and echocardiographic outcome of edge-to-edge (E2E) mitral valve repair (MVr) concomitant to septal myectomy (SM) in patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM). A retrospective single-center analysis was performed of patients who underwent isolated SM or SM with E2E MVr from 2011 to 2022. Exclusion criteria were primary mitral valve (MV) disease or concomitant valve surgery. Early and long-term safety, functional and echocardiographic outcomes were compared between groups. Between January 2011 and April 2022, 76 consecutive patients underwent SM for HOCM: 42 patients (55%) underwent SM without additional E2E MVr (Group 1) and 34 patients (45%) underwent SM with additional E2E MVr (Group 2). At latest follow-up, 87% of patients were in New York Heart Association (NYHA) class I-II with no significant differences in NYHA class between groups. Incidence of safety events was comparable between groups. Echocardiographic relief of left ventricular outflow tract (LVOT) obstruction was comparable at early follow-up (P = 0.68), with a significant but small difference in maximum LVOT pressure gradient at latest follow-up in favor of E2E MVr (P = 0.04). Furthermore, patients who underwent SM with E2E MVr showed less residual systolic anterior motion at early and latest follow-up (P = 0.020; P = 0.178). Reintervention on the MV was absent in both groups at 1 year and equally low at follow-up (P = 0.27). This study demonstrates that adding E2E MVr to septal myectomy is as safe as isolated myectomy for the treatment of HOCM. Moreover, the addition of E2E MVr is associated with similar excellent functional improvement and freedom from MV reintervention.
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Affiliation(s)
- Romy R M J J Hegeman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Tijn Heeringa
- Department of Cardiothoracic Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Sophie H Q Beukers
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jan Peter Van Kuijk
- Departement of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marco Guglielmo
- Departement of Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Jurriën M Ten Berg
- Departement of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Martin J Swaans
- Departement of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Hegeman RRMJJ, McManus S, Tóth A, Ladeiras-Lopes R, Kitslaar P, Bui V, Dukker K, Harb SC, Swaans MJ, Ben-Yehuda O, Klein P, Puri R. Reference Values for Inward Displacement in the Normal Left Ventricle: A Novel Method of Regional Left Ventricular Function Assessment. J Cardiovasc Dev Dis 2023; 10:474. [PMID: 38132642 PMCID: PMC10744219 DOI: 10.3390/jcdd10120474] [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: 10/19/2023] [Revised: 11/11/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Regional functional left ventricular (LV) assessment using current imaging techniques remains limited. Inward displacement (InD) has been developed as a novel technique to assess regional LV function via measurement of the regional displacement of the LV endocardial border across each of the 17 LV segments. Currently, normal ranges for InD are not available for clinical use. The aim of this study was to validate the normal reference limits of InD in healthy adults across all LV segments. METHODS InD was analyzed in 120 healthy subjects with a normal LV ejection fraction, using the three standard long-axis views obtained during cardiac MRI that quantified the degree of inward endocardial wall motion towards the true LV center of contraction. For all LV segments, InD was measured in mm and expressed as a percentage of the theoretical degree of maximal segment contraction towards the true LV centerline. The arithmetic average InD was obtained for each of the 17 segments. The LV was divided into three regions, obtaining average InD at the LV base (segments 1-6), mid-cavity (segments 7-12) and apex (segments 13-17). RESULTS Average InD was 33.4 ± 4.3%. InD was higher in basal and mid-cavity LV segments (32.8 ± 4.1% and 38.1 ± 5.8%) compared to apical LV segments (28.6 ± 7.7%). Interobserver variability correlations for InD were strong (R = 0.80, p < 0.0001). CONCLUSIONS We provide clinically meaningful reference ranges for InD in subjects with normal LV function, which will emerge as an important screening and assessment imaging tool for a range of HFrEF therapies.
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Affiliation(s)
- Romy R. M. J. J. Hegeman
- Department of Cardiothoracic Surgery, Sint Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | | | - Attila Tóth
- Department of Radiology, Gottsegen György Hungarian Institute of Cardiology & Semmelweis University, 1096 Budapest, Hungary
| | - Ricardo Ladeiras-Lopes
- Department of Cardiology, Gaia/Espinho Hospital Centre, Rua Conceicao Fernandes, 4434-502 Vila Nova de Gaia, Portugal
| | - Pieter Kitslaar
- Medis Medical Imaging Systems, 2316 XG Leiden, The Netherlands
| | - Viet Bui
- Medis Medical Imaging Systems, 2316 XG Leiden, The Netherlands
| | - Kayleigh Dukker
- Medis Medical Imaging Systems, 2316 XG Leiden, The Netherlands
| | - Serge C. Harb
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA (R.P.)
| | - Martin J. Swaans
- Department of Cardiology, Sint Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Ori Ben-Yehuda
- Bioventrix Inc., Mansfield, MA 02048, USA
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA 92037, USA
| | - Patrick Klein
- Department of Cardiothoracic Surgery, Sint Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA (R.P.)
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Hegeman RRMJJ, Swaans MJ, Kara B, Heijmen RH, Smeenk HG, Timmers L, Sonker U, Klein P, Berg JMT. Transcatheter closure of postsurgical aortic pseudoaneurysms guided by three-dimensional image reconstruction: a single-centre experience. Neth Heart J 2023; 31:383-389. [PMID: 37256540 PMCID: PMC10516814 DOI: 10.1007/s12471-023-01784-1] [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] [Accepted: 02/07/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Postsurgical thoracic aortic pseudoaneurysms (PTAPs) are a potentially lethal complication after cardiac or aortic surgery. Surgical management can pose a challenge with high in-hospital mortality rates. Transcatheter closure is a less-invasive alternative treatment option for selected patients, although current experience is limited. AIMS We aimed to evaluate procedural and imaging outcomes of our first 11 cases of transcatheter PTAP closure with the use of closure devices. METHODS Patients with a high operative risk who underwent transcatheter PTAP closure at our centre from 2019 to 2021 were retrospectively included. Suitability was evaluated on preprocedural computed tomography (CT) scans and three-dimensional (3D) reconstructions. All procedures were performed in the catheterisation laboratory. Intraprocedural aortography and postprocedural CT scans with 3D reconstructions were used to evaluate PTAP occlusion. RESULTS Eleven consecutive patients with a high operative risk and a history of cardiac/aortic surgery who underwent transcatheter PTAP closure were included. PTAPs were predominantly located at the proximal or distal anastomosis of a supracoronary ascending aortic vascular graft or Bentall prosthesis (82%). Implanted closure devices included Amplatzer Valvular Plug III (82%), Amplatzer septal occluder (9%) and Occlutech atrial septal defect occluder (9%). No periprocedural complications occurred. After device deployment, residual flow was absent on aortography in 64% and minimal residual flow was present in 36% of patients. Subtotal or total occlusion of the PTAP on follow-up CT ranged between 45% and 73%. CONCLUSIONS Although subtotal or total occlusion of the PTAP was found at follow-up in only 45-73% of cases, transcatheter PTAP closure guided by preprocedural 3D reconstructions can offer a valuable minimally invasive primary treatment option for patients who otherwise would face a high-risk reoperation.
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Affiliation(s)
- Romy R M J J Hegeman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Basak Kara
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hans G Smeenk
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Leo Timmers
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Uday Sonker
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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Berounský K, Vacková I, Vištejnová L, Malečková A, Havránková J, Klein P, Kolinko Y, Petrenko Y, Pražák Š, Hanák F, Přidal J, Havlas V. Autologous Mesenchymal Stromal Cells Immobilized in Plasma-Based Hydrogel for the Repair of Articular Cartilage Defects in a Large Animal Model. Physiol Res 2023; 72:485-495. [PMID: 37795891 PMCID: PMC10634567 DOI: 10.33549/physiolres.935098] [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] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/02/2023] [Indexed: 01/05/2024] Open
Abstract
The treatment of cartilage defects in trauma injuries and degenerative diseases represents a challenge for orthopedists. Advanced mesenchymal stromal cell (MSC)-based therapies are currently of interest for the repair of damaged cartilage. However, an approved system for MSC delivery and maintenance in the defect is still missing. This study aimed to evaluate the effect of autologous porcine bone marrow MSCs anchored in a commercially available polyglycolic acid-hyaluronan scaffold (Chondrotissue®) using autologous blood plasma-based hydrogel in the repair of osteochondral defects in a large animal model. The osteochondral defects were induced in twenty-four minipigs with terminated skeletal growth. Eight animals were left untreated, eight were treated with Chondrotissue® and eight received Chondrotissue® loaded with MSCs. The animals were terminated 90 days after surgery. Macroscopically, the untreated defects were filled with newly formed tissue to a greater extent than in the other groups. The histological evaluations showed that the defects treated with Chondrotissue® and Chondrotissue® loaded with pBMSCs contained a higher amount of hyaline cartilage and a lower amount of connective tissue, while untreated defects contained a higher amount of connective tissue and a lower amount of hyaline cartilage. In addition, undifferentiated connective tissue was observed at the edges of defects receiving Chondrotissue® loaded with MSCs, which may indicate the extracellular matrix production by transplanted MSCs. The immunological analysis of the blood samples revealed no immune response activation by MSCs application. This study demonstrated the successful and safe immobilization of MSCs in commercially available scaffolds and defect sites for cartilage defect repair.
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Affiliation(s)
- K Berounský
- Motol University Hospital, Prague, Czech Republic.
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Hegeman RRMJJ, McManus S, van Kuijk JP, Harb SC, Swaans MJ, Klein P, Puri R. Inward Displacement: A Novel Method of Regional Left Ventricular Functional Assessment for Left Ventriculoplasty Interventions in Heart Failure with Reduced Ejection Fraction (HFrEF). J Clin Med 2023; 12:jcm12051997. [PMID: 36902783 PMCID: PMC10003768 DOI: 10.3390/jcm12051997] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Hybrid minimally invasive left ventricular reconstruction is used to treat patients with ischemic heart failure with reduced ejection fraction (HFrEF) and antero-apical scar. Pre- and post-procedural regional functional left ventricular assessment with current imaging techniques remains limited. We evaluated 'inward displacement' as a novel technique of assessing regional left ventricular function in an ischemic HFrEF population who underwent left ventricular reconstruction with the Revivent System. METHODS Inward displacement adopts three standard long-axis views obtained during cardiac MRI or CT and assesses the degree of inward endocardial wall motion towards the true left ventricular center of contraction. For each of the standard 17 left ventricular segments, regional inward displacement is measured in mm and expressed as a percentage of the maximal theoretical distance each segment can contract towards the centerline. The left ventricle was divided into three regions, obtaining the arithmetic average of inward displacement or speckle tracking echocardiographic strain at the left ventricular base (segments 1-6), mid-cavity (segments 7-12) and apex (segments 13-17). Inward displacement was measured using computed tomography or cardiac magnetic resonance imaging and compared pre- and post-procedurally in ischemic HFrEF patients who underwent left ventricular reconstruction with the Revivent System (n = 36). In a subset of patients who underwent baseline speckle tracking echocardiography, pre-procedural inward displacement was compared with left ventricular regional echocardiographic strain (n = 15). RESULTS Inward displacement of basal and mid-cavity left ventricular segments increased by 27% (p < 0.001) and 37% (p < 0.001), respectively, following left ventricular reconstruction. A significant overall decrease in both the left ventricular end systolic volume index and end diastolic volume index of 31% (p < 0.001) and 26% (p < 0.001), respectively, was detected, along with a 20% increase in left ventricular ejection fraction (p = 0.005). A significant correlation between inward displacement and speckle tracking echocardiographic strain was noted within the basal (R = -0.77, p < 0.001) and mid-cavity left ventricular segments (R = -0.65, p = 0.004), respectively. Inward displacement resulted in relatively larger measurement values compared to speckle tracking echocardiography, with a mean difference of absolute values of -3.33 and -7.41 for the left ventricular base and mid-cavity, respectively. CONCLUSIONS Obviating the limitations of echocardiography, inward displacement was found to highly correlate with speckle tracking echocardiographic strain to evaluate regional segmental left ventricular function. Significant improvements in basal and mid-cavity left ventricular contractility were demonstrated in ischemic HFrEF patients following left ventricular reconstruction of large antero-apical scars, consistent with the concept of reverse left ventricular remodeling at a distance. Inward displacement holds significant promise in the HFrEF population being evaluated pre- and post-left ventriculoplasty procedures.
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Affiliation(s)
- Romy R. M. J. J. Hegeman
- Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
- Correspondence: ; Tel.: +31-(0)631-103-506
| | | | - Jan-Peter van Kuijk
- Department of Cardiology, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Serge C. Harb
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Martin J. Swaans
- Department of Cardiology, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Ammenhäuser R, Klein P, Schmid E, Streicher S, Vogelsang J, Lehmann CW, Lupton JM, Meskers SCJ, Scherf U. Circularly Polarized Light Probes Excited-State Delocalization in Rectangular Ladder-type Pentaphenyl Helices. Angew Chem Int Ed Engl 2023; 62:e202211946. [PMID: 36345828 PMCID: PMC10107742 DOI: 10.1002/anie.202211946] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Indexed: 11/09/2022]
Abstract
Ladder-type pentaphenyl chromophores have a rigid, planar π-system and show bright fluorescence featuring pronounced vibrational structure. Such moieties are ideal for studying interchromophoric interactions and delocalization of electronic excitations. We report the synthesis of helical polymers with a rigid square structure based on spiro-linked ladder-type pentaphenyl units. The variation of circular dichroism with increasing chain length provides direct evidence for delocalization of electronic excitations over at least 10 monomeric units. The change in the degree of circular polarization of the fluorescence across the vibronic side bands shows that vibrational motion can localize the excitation dynamically to almost one single unit through breakdown of the Born-Oppenheimer approximation. The dynamic conversion between delocalized and localized excited states provides a new paradigm for interpreting circular dichroism in helical polymers such as proteins and polynucleic acids.
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Affiliation(s)
- Robin Ammenhäuser
- Department of Chemistry, Macromolecular Chemistry group (BUWmakro), and Wuppertal Institute for Smart Materials and Systems (CM@S), Bergische Universität Wuppertal, Gauss-Str. 20, 42119, Wuppertal, Germany
| | - Patrick Klein
- Department of Chemistry, Macromolecular Chemistry group (BUWmakro), and Wuppertal Institute for Smart Materials and Systems (CM@S), Bergische Universität Wuppertal, Gauss-Str. 20, 42119, Wuppertal, Germany
| | - Eva Schmid
- Institut für Experimentelle und Angewandte Physik, Universität Regensburg, Universitätsstrasse 31, 93053, Regensburg, Germany
| | - Sabrina Streicher
- Institut für Experimentelle und Angewandte Physik, Universität Regensburg, Universitätsstrasse 31, 93053, Regensburg, Germany
| | - Jan Vogelsang
- Institut für Experimentelle und Angewandte Physik, Universität Regensburg, Universitätsstrasse 31, 93053, Regensburg, Germany
| | - Christian W Lehmann
- Max-Planck-Institut für Kohlenforschung, Kaiser-Wilhelm-Platz 1, 45470, Mülheim an der Ruhr, Germany
| | - John M Lupton
- Institut für Experimentelle und Angewandte Physik, Universität Regensburg, Universitätsstrasse 31, 93053, Regensburg, Germany
| | - Stefan C J Meskers
- Molecular Materials and Nanosystems and Institute of Complex Molecular Systems, Technische Universiteit Eindhoven, PO Box 513, 5600 MB, Eindhoven, The Netherlands
| | - Ullrich Scherf
- Department of Chemistry, Macromolecular Chemistry group (BUWmakro), and Wuppertal Institute for Smart Materials and Systems (CM@S), Bergische Universität Wuppertal, Gauss-Str. 20, 42119, Wuppertal, Germany
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10
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Ammenhaeuser R, Klein P, Schmid E, Streicher S, Vogelsang J, Lehmann CW, Lupton JM, Meskers SC, Scherf U. Circularly polarized light probes excited‐state delocalization in rectangular ladder‐type pentaphenyl helices. Angew Chem Int Ed Engl 2022. [DOI: 10.1002/ange.202211946] [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: 11/11/2022]
Affiliation(s)
- Robin Ammenhaeuser
- Bergische Universität Wuppertal: Bergische Universitat Wuppertal Chemie GERMANY
| | - Patrick Klein
- Bergische Universität Wuppertal: Bergische Universitat Wuppertal Chemie NETHERLANDS
| | - Eva Schmid
- Universität Regensburg: Universitat Regensburg Institut für Experimentelle und Angewandte Physik GERMANY
| | - Sabrina Streicher
- University of Regensburg: Universitat Regensburg Institut für Experimentelle und Angewandte Physik GERMANY
| | - Jan Vogelsang
- Universität Regensburg: Universitat Regensburg Institut für Experimentelle und Angewandte Physik GERMANY
| | - Christian W Lehmann
- Max-Planck-Institut für Kohlenforschung: Max-Planck-Institut fur Kohlenforschung Chemical Crystallography and Electron Microscopy GERMANY
| | - John M Lupton
- University of Regensburg: Universitat Regensburg Institut für Experimentelle und Angewandte Physik GERMANY
| | - Stefan C.J. Meskers
- Technische Universiteit Eindhoven Faculteit Scheikundige Technologie Macromolecular and Organic Chemistry Den Dolech 2PO BOX 513 5600 MB Eindhoven NETHERLANDS
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Hegeman RR, Swaans MJ, Van Kuijk JP, Klein P. Midterm Outcome of Hybrid Transcatheter and Minimally Invasive Left Ventricular Reconstruction for the Treatment of Ischemic Heart Failure. Struct Heart 2022; 6:100081. [PMID: 37288056 PMCID: PMC10242554 DOI: 10.1016/j.shj.2022.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 06/09/2023]
Abstract
Background Left ventricular (LV) remodeling after anterior myocardial infarction (AMI) can cause a pathological increase in LV volume, reduction in LV ejection fraction (EF), and symptomatic heart failure (HF). This study evaluates the midterm results of a hybrid transcatheter and minimally invasive surgical technique to reconstruct the negatively remodeled LV by myocardial scar plication and exclusion with microanchoring technology. Methods Retrospective single-center analysis of patients who underwent hybrid LV reconstruction (LVR) with the Revivent TransCatheter System. Patients were accepted for the procedure when they presented with symptomatic HF (New York Heart Association class ≥ II, EF < 40%) after AMI, in the presence of a dilated LV with either akinetic or dyskinetic scar in the anteroseptal wall and/or apex of ≥50% transmurality. Results Between October 2016 and November 2021, 30 consecutive patients were operated. Procedural success was 100%. Comparing echocardiographic data preoperatively and directly postoperatively, LVEF increased from 33 ± 8% to 44 ± 10% (p < 0.0001). LV end-systolic volume index decreased from 58 ± 24 mL/m2 to 34 ± 19 mL/m2 (p < 0.0001) and LV end-diastolic volume index decreased from 84 ± 32 mL/m2 to 58 ± 25 mL/m2 (p < 0.0001). Hospital mortality was 0%. After a mean follow-up of 3.4 ± 1.3 years, there was a significant improvement of New York Heart Association class (p = 0.001) with 76% of surviving patients in class I-II. Conclusions Hybrid LVR for symptomatic HF after AMI is safe and results in significant improvement in EF, reduction in LV volumes, and sustained improvement in symptoms.
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Affiliation(s)
- Romy R.M.J.J. Hegeman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Martin J. Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jan-Peter Van Kuijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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Zaman A, Hanke T, Neves P, Klein P. TCT-339 Less Invasive Ventricular Enhancement (LIVE) Procedure for the Treatment of Ischemic Heart Disease: Short- and Medium-Term Outcomes. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Hegeman R, Mcmanus S, Swaans M, Klein P. TCT-348 Evaluating Improvement in Regional Left Ventricular Function After Hybrid Minimally Invasive Left Ventricular Reconstruction in Ischemic Cardiomyopathy: CT- or MRI-Based Inward Displacement to Overcome Current Shortcomings in Imaging. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Hegeman RRMJJ, Swaans MJ, van Kuijk JP, Klein P. State-of-the-Art Review: Technical and Imaging Considerations in Hybrid Transcatheter and Minimally Invasive Left Ventricular Reconstruction for Ischemic Heart Failure. J Clin Med 2022; 11:jcm11164831. [PMID: 36013071 PMCID: PMC9409787 DOI: 10.3390/jcm11164831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Negative left ventricular (LV) remodeling consequent to acute myocardial infarction (AMI) is characterized by an increase in LV volumes in the presence of a depressed LVEF. In order to restore the shape, size, and function of the LV, operative treatment options to achieve volume reduction and shape reconstruction should be considered. In the past decade, conventional surgical LV reconstruction through a full median sternotomy has evolved towards a hybrid transcatheter and less invasive LV reconstruction. In order to perform a safe and effective hybrid LV reconstruction, thorough knowledge of the technical considerations and adequate use of multimodality imaging both pre- and intraoperatively are fundamental. In addition, a comprehensive understanding of the individual procedural steps from both a cardiological and surgical point of view is required.
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Affiliation(s)
| | - Martin John Swaans
- Department of Cardiology, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
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15
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Hegeman RMJJ, Gheorghe LL, de Kroon TL, van Putte BP, Swaans MJ, Klein P. State-of-the-Art Review: Technical and Imaging Considerations in Novel Transapical and Port-Access Mitral Valve Chordal Repair for Degenerative Mitral Regurgitation. Front Cardiovasc Med 2022; 9:850700. [PMID: 35497995 PMCID: PMC9039516 DOI: 10.3389/fcvm.2022.850700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Degenerative mitral regurgitation (DMR) based on posterior leaflet prolapse is the most frequent type of organic mitral valve disease and has proven to be durably repairable in most cases by chordal repair techniques either by conventional median sternotomy or by less invasive approaches both utilizing extracorporeal circulation and cardioplegic myocardial arrest. Recently, several novel transapical chordal repair techniques specifically targeting the posterior leaflet have been developed as a far less invasive and beating heart (off-pump) alternative to port-access mitral repair. In order to perform a safe and effective minimally invasive mitral chordal repair, thorough knowledge of the anatomy of the mitral valve apparatus and adequate use of multimodality imaging both pre- and intraoperatively are fundamental. In addition, comprehensive understanding of the available novel devices, their delivery systems and the individual procedural steps are required.
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Affiliation(s)
- Romy M. J. J. Hegeman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
- *Correspondence: Romy M. J. J. Hegeman,
| | | | - Thomas L. de Kroon
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Bart P. van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Martin J. Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
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16
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Herrmann K, Rahbar K, Eiber M, Krause BJ, Lassmann M, Jentzen W, Blumenstein L, Klein P, Basque JR, Kurth J. Dosimetry of 177Lu-PSMA-617 for the treatment of metastatic castration-resistant prostate cancer: results from the VISION trial sub-study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
97 Background: The phase 3 VISION trial (NCT03511664) evaluated the efficacy and safety of the radioligand [177Lu]Lu-PSMA-617 (177Lu-PSMA-617) in patients with metastatic castration-resistant prostate cancer. 177Lu-PSMA-617 plus protocol-permitted standard of care (SOC) significantly improved overall survival and radiographic progression-free survival of patients compared with SOC alone. The incidence of adverse events (AEs) of grade 3 or above was higher with 177Lu-PSMA-617 than without, but quality of life was not adversely affected. This dosimetry sub-study aimed to quantify the absorbed dose of 177Lu-PSMA-617 in organs at risk of radiotoxicity due to exposure levels or radiosensitivity. Methods: In a sub-study of VISION, dosimetry was performed in a separate cohort of 29 non-randomized participants at four German sites. Eligible patients received 177Lu-PSMA-617 (7.4 GBq per cycle) plus SOC every 6 weeks for a maximum of 6 cycles. Patients underwent planar whole-body scintigraphy scans and single-photon emission computed tomography/computed tomography (SPECT/CT) scans of the upper and lower abdomen at 2, 24, 48 and 168 hours after first administration. Blood and urine samples were collected throughout cycle 1. 177Lu-PSMA-617 dosimetry outcomes were based on biodistribution, assessed using whole-body conjugate planar-image data, SPECT/CT image data, blood assay data and urinary excretion data. Radiation exposure was estimated using Organ Level INternal Dose Assessment/EXponential Modeling (OLINDA/EXM) software code version 2.2. Results were expressed as absorbed dose per unit activity (Gy/GBq) and cumulative estimated absorbed dose (Gy) over all 6 cycles (44.4 GBq cumulative activity) extrapolated from cycle 1 data. Results: Radiation-absorbed doses per unit activity were highest in the lacrimal glands, followed by the salivary glands, with mean values of 2.1 Gy/GBq (standard deviation [SD], 0.47) and 0.63 Gy/GBq (0.36), respectively. The kidneys received 0.43 Gy/GBq (SD, 0.16) and the blood-based red marrow dose was 0.035 Gy/GBq (0.02). The 6-cycle cumulative estimated absorbed dose was 92 Gy (SD, 21) in the lacrimal glands, 28 Gy (16) in the salivary glands, 19 Gy (7.3) in the kidneys and 1.5 Gy (0.90) in the red marrow. In cycle 1, 20% of patients had at least one hematological AE of Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 2; no patient experienced any renal AE of CTCAE grade ≥ 2 or any lacrimal gland toxicity, and 2 patients had a grade 1 salivary gland AE. Conclusions: 177Lu-PSMA-617 dosimetry results in this sub-study were consistent with the published ranges, and cycle 1 AEs affecting at-risk organs were infrequent and of low-to-moderate severity. These findings indicate that patients with metastatic castration-resistant prostate cancer receiving 177Lu-PSMA-617 should be at low risk of radiation-induced AEs. Clinical trial information: NCT03511664.
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Affiliation(s)
- Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | | | | | | | - Walter Jentzen
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | | | - Patrick Klein
- Novartis Institutes for BioMedical Research, East Hanover, NJ
| | | | - Jens Kurth
- Rostock University Medical Center, Rostock, Germany
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Heimfarth D, Balcı Leinen M, Klein P, Allard S, Scherf U, Zaumseil J. Enhancing Electrochemical Transistors Based on Polymer-Wrapped (6,5) Carbon Nanotube Networks with Ethylene Glycol Side Chains. ACS Appl Mater Interfaces 2022; 14:8209-8217. [PMID: 35108486 DOI: 10.1021/acsami.1c23586] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Organic electrochemical transistors (ECTs) are an important building block for bioelectronics. To promote the required ion transport through the active layer, state-of-the-art semiconducting polymers feature hydrophilic ethylene glycol side chains that increase the volumetric capacitance and transconductance of the devices. Here, we apply this concept to polymer-wrapped single-walled carbon nanotubes (SWCNTs) as a high-mobility semiconducting material. We replace the polyfluorene copolymer (PFO-BPy), which is used for selectively dispersing semiconducting (6,5) SWCNTs and contains octyl side chains, by an equivalent polymer with tetraethylene glycol side chains. Aerosol-jet printed networks of these SWCNTs are applied as the active layer in water-gated ECTs. These show high hole mobilities (3-15 cm2·V-1·s-1), significantly improved volumetric capacitances and larger transconductances. Thin networks of SWCNTs reach (219 ± 16) F·cm-1·V-1·s-1 as the product of mobility and volumetric capacitance. In situ photoluminescence measurements show more efficient quenching of the near-infrared fluorescence for nanotube networks with hydrophilic glycol side chains compared to those with hydrophobic alkyl side chains, thus corroborating more complete charging under bias. Overall, networks of semiconducting SWCNTs with such tailored wrapping polymers provide excellent device performance. Combined with their inherent mechanical flexibility and durability, they constitute a competitive material for bioelectronics.
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Affiliation(s)
- Daniel Heimfarth
- Institute for Physical Chemistry, Universität Heidelberg, D-69120 Heidelberg, Germany
- Centre for Advanced Materials, Universität Heidelberg, D-69120 Heidelberg, Germany
| | - Merve Balcı Leinen
- Institute for Physical Chemistry, Universität Heidelberg, D-69120 Heidelberg, Germany
| | - Patrick Klein
- Macromolecular Chemistry and Wuppertal Center for Smart Materials and Systems, Bergische Universität Wuppertal, D-42097 Wuppertal, Germany
| | - Sybille Allard
- Macromolecular Chemistry and Wuppertal Center for Smart Materials and Systems, Bergische Universität Wuppertal, D-42097 Wuppertal, Germany
| | - Ullrich Scherf
- Macromolecular Chemistry and Wuppertal Center for Smart Materials and Systems, Bergische Universität Wuppertal, D-42097 Wuppertal, Germany
| | - Jana Zaumseil
- Institute for Physical Chemistry, Universität Heidelberg, D-69120 Heidelberg, Germany
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Moláček J, Vištejnová L, Klein P, Suchý T, Horný L, Kuželová Košťáková E, Kindermann M, Chlup H, Jenčová V, Lukáš D, Šupová M, Říha I, Soukupová V, Třeška V. Experimental surgery as part of the development of degradable biomaterials for cardiovascular surgery. Rozhl Chir 2022; 101:599-606. [PMID: 36759207 DOI: 10.33699/pis.2022.101.12.599-606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction: Cardiovascular diseases are responsible for significant morbidity and mortality in the population. Artificial vascular grafts are often essential for surgical procedures in radical or palliative treatment. Many new biodegradable materials are currently under development. Preclinical testing of each new material is imperative, both in vitro and in vivo, and therefore animal experiments are still a necessary part of the testing process before any clinical use. The aim of this paper is to present the options of using various experimental animal models in the field of cardiovascular surgery including their extrapolation to clinical medicine. Methods: The authors present their general experience in the field of experimental surgery. They discuss the selection process of an optimal experimental animal model to test foreign materials for cardiovascular surgery and of an optimal region for implantation. Results: The authors present rat, rabbit and porcine models as optimal experimental animals for material hemocompatibility and degradability testing. Intraperitoneal implantation in the rat is a simple and feasible procedure, as well as aortic banding in the rabbit or pig. The carotid arteries can also be used, as well. Porcine pulmonary artery banding is slightly more difficult with potential complications. The banded vessels, explanted after a defined time period, are suitable for further mechanical testing using biomechanical analyses, for example, the inflation-extension test. Conclusion: An in vivo experiment cannot be avoided in the last phases of preclinical research of new materials. However, we try to strictly observe the 3R concept – Replacement, Reduction and Refinement; in line with this concept, the potential of each animal should be used as much as possible to reduce the number of animals.
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19
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Willemsen LM, Vlot EA, Janssen PWA, Visser CD, Zheng K, Kelder JC, Noordzij PG, van den Dool E, Klein P, Hackeng CM, ten Berg JM. Blood loss after coronary artery bypass by aspirin responsiveness assessed with preoperative VerifyNow aspirin testing. Res Pract Thromb Haemost 2021; 5:e12623. [PMID: 34993386 PMCID: PMC8713006 DOI: 10.1002/rth2.12623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/01/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Aspirin is important for preventing thrombotic events but also increases bleeding complications. Minimizing bleeding while preventing thrombotic events remains challenging in patients undergoing coronary artery bypass grafting (CABG). Establishing the patient's preoperative aspirin response could distinguish patients at risk for perioperative blood loss. OBJECTIVE Aim was to compare 12-h blood loss after CABG between aspirin-sensitive and aspirin-resistant patients. PATIENTS/METHODS The primary analysis of this substudy of the POPular CABG trial (NCT02352402) included patients that used aspirin monotherapy preoperatively. A preoperative platelet function test by the VerifyNow aspirin assay was performed before CABG and patients were classified as aspirin-sensitive or aspirin-resistant based on an aspirin reaction units cutoff value of 550. The primary end point was 12-hour blood loss after CABG. The secondary end point was, among others, clinical bleeding events after CABG. RESULTS A total of 128 patients were included in the primary analysis. Of these, 116 patients were aspirin sensitive and 12 were aspirin resistant. Mean blood loss 12 hours after CABG was 555 ± 278 mL in aspirin-sensitive patients and 406±110 mL in aspirin-resistant patients (P = .04). All bleeding events (n = 15; 11.7%) occurred in aspirin-sensitive patients. CONCLUSIONS In patients who are on aspirin preoperatively, aspirin sensitivity was associated with 12-hour blood loss after CABG, suggesting that preoperative VerifyNow aspirin testing could identify patients undergoing CABG at high risk for perioperative bleeding.
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Affiliation(s)
| | - Eline A. Vlot
- Department of Anesthesiology, Intensive Care, and Pain MedicineSt Antonius HospitalNieuwegeinThe Netherlands
| | | | - Claire D. Visser
- Department of Clinical Pharmacy and ToxicologyLeiden University Medical CenterLeidenThe Netherlands
| | - Kai Zheng
- Department of CardiologySt Antonius HospitalNieuwegeinThe Netherlands
| | | | - Peter G. Noordzij
- Department of Anesthesiology, Intensive Care, and Pain MedicineSt Antonius HospitalNieuwegeinThe Netherlands
| | | | - Patrick Klein
- Department of Cardiothoracic SurgerySt Antonius HospitalNieuwegeinThe Netherlands
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20
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Růžička J, Grajciarová M, Vištejnová L, Klein P, Tichánek F, Tonar Z, Dejmek J, Beneš J, Bolek L, Bajgar R, Kuncová J. Hyperbaric oxygen enhances collagen III formation in wound of ZDF rat. Physiol Res 2021; 70:787-798. [PMID: 34505531 PMCID: PMC8820531 DOI: 10.33549/physiolres.934684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetic foot ulcer (DFU) is a serious complication of diabetes and hyperbaric oxygen therapy (HBOT) is also considered in comprehensive treatment. The evidence supporting the use of HBOT in DFU treatment is controversial. The aim of this work was to introduce a DFU model in ZDF rat by creating a wound on the back of an animal and to investigate the effect of HBOT on the defect by macroscopic evaluation, quantitative histological evaluation of collagen (types I and III), evaluation of angiogenesis and determination of interleukin 6 (IL6) levels in the plasma. The study included 10 rats in the control group (CONT) and 10 in the HBOT group, who underwent HBOT in standard clinical regimen. Histological evaluation was performed on the 18th day after induction of defect. The results show that HBOT did not affect the macroscopic size of the defect nor IL6 plasma levels. A volume fraction of type I collagen was slightly increased by HBOT without reaching statistical significance (1.35+/-0.49 and 1.94+/-0.67 %, CONT and HBOT, respectively). In contrast, the collagen type III volume fraction was ~120 % higher in HBOT wounds (1.41+/-0.81 %) than in CONT ones (0.63+/-0.37 %; p=0.046). In addition, the ratio of the volume fraction of both collagens in the wound ((I+III)w) to the volume fraction of both collagens in the adjacent healthy skin ((I+III)h) was ~65 % higher in rats subjected to HBOT (8.9+/-3.07 vs. 5.38+/-1.86 %, HBOT and CONT, respectively; p=0.028). Vessels density (number per 1 mm2) was found to be higher in CONT vs. HBOT (206.5+/-41.8 and 124+/-28.2, respectively, p<0.001). Our study suggests that HBOT promotes collagen III formation and decreases the number of newly formed vessels at the early phases of healing.
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Affiliation(s)
- J Růžička
- Department of Biophysics, Faculty of Medicine in Pilsen, Pilsen, Czech Republic.
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Puri R, Neves P, Pillay T, Hanke T, Swaans M, Klein P. TCT-352 A Safety and Efficacy Comparison Between the LIVE Versus Surgical Left Ventricular Reconstruction Techniques for Ischemic Heart Failure. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Klein P, Van Kuijk J, Swaans M. Updated results of hybrid transcatheter and minimally invasive left ventricular reconstruction for the treatment of ischemic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Remodelling of the left ventricle (LV) after anterior myocardial infarction can result in a pathological increase in LV volume and reduction in LV ejection fraction (EF). We describe the updated results of an l hybrid transcatheter and minimally invasive surgical technique to reconstruct the negatively remodelled LV by myocardial scar plication and exclusion to rehape and reduce the excess volume, decrease the wall stress and increase LVEF.
Methods and results
Patients were considered eligible for the procedure when they presented with symptomatic heart failure (NYHA-class ≥II or more) and ischemic cardiomyopathy (EF<40%) after anterior myocardial infarction. All patients had a dilated LV with either a- or dyskinetic scar in the anteroseptal wall and/or apex of ≥50% transmurality. Hybrid transcatheter and minimally technique that relies on micro-anchoring technology is used to reconstruct the LV by plication of the fibrous scar. A series of internal and external micro anchors are brought together over a PEEK (poly-ether-ether-ketone) tether to form a longitudinal line of apposition between the LV free wall and the anterior septum from the mid-ventricle to the apex. Internal anchors are deployed by transcatheter technique on the right side of the ventricular septum through the right internal jugular vein. Paired external anchors are advanced through a left sided mini-thoracotomy and deployed on the LV epicardium (figure 1). A specialized Force Gauge is used to bring these “RV-LV” anchors together under measured compression forces. “LV-LV” anchor pairs through the LV apex beyond the distal tip of the RV complete the reconstruction.
Between October 2016 and March 2021 28 patients (23 males, 5 females; mean age 61±12 years) were operated in a single Dutch centre. Procedural success was 100%. On average 2.3±0.8 anchor-pairs were used to reconstruct the LV. Comparing echocardiographic data pre- and directly postoperatively, LVEF increased from 33±8% to 44±10% (change +35%, P<0.0001) and LV-volumes decreased: LVESV 116 ml ± 52 ml to 69±39 ml (change −35%, P<0.0001) and LVEDV 170 ml ± 72 ml to 118±55 ml (change −29%, P<0.0001). Hospital mortality was 0%. Also no strokes occurred. Median duration of ICU–stay was 2 days (IQR 1–48 days) and median length of hospital stay was 7 days (IQR 5–61 days). Survival at 48 months was 84%. At latest follow-up, 9670% of surviving patients were in NYHA-class I-II compared to 18% preoperatively.
Conclusions
Hybrid transcatheter and minimally invasive LV reconstruction is a promising novel treatment option for patients with symptomatic heart failure and ischemic cardiomyopathy after anteroseptal myocardial infarction. Updated results demonstrate that the procedure is safe and results in significant improvement in EF, reduction in LV volumes and sustained improvement in heart failure symptoms.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- P Klein
- St Antonius Hospital, Nieuwegein, Netherlands (The)
| | | | - M.J Swaans
- St Antonius Hospital, Nieuwegein, Netherlands (The)
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Neves P, Pillay T, Annest L, van Bladel K, Kaiser E, Stahl F, Hanke T, Swaans M, Klein P, Ruf T, von Bardeleben RS. Patient selection for LIVE therapy: From clinical indications to multimodality imaging individual case planning. Echocardiography 2021; 38:1482-1488. [PMID: 34505315 DOI: 10.1111/echo.15182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/06/2021] [Revised: 06/22/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Less Invasive Ventricular Enhancement (LIVE) with Revivent TC is an innovative therapy for symptomatic ischemic heart failure (HF). It is designed to reconstruct a negatively remodeled left ventricle (LV) after an anterior myocardial infarction (MI) by plication of the scar tissue. Its indications are specific, and as with any other structural heart intervention, the success of the procedure starts with appropriate patient selection. We aim to present the indications of the technique, crucial aspects in patient selection, and individual case planning approach. METHODS AND RESULTS After clinical evaluation, transthoracic echocardiography is the first imaging modality to be performed in a potential candidate for the therapy. However, definitive indication and detailed case planning rely on late gadolinium-enhanced cardiac magnetic resonance imaging or multiphasic contrast-enhanced cardiac computed tomography. These imaging modalities also assist with relative or absolute contra-indications for the procedure. Individual assessment is done to tailor the procedure to the specifics of the LV anatomy and location of the myocardial scar. CONCLUSION LIVE procedure is a unique intervention to treat symptomatic HF and ischemic cardiomyopathy after anterior MI. It is a highly customizable intervention that allows a patient-tailored approach, based on multimodality imaging assessment and planification.
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Affiliation(s)
- Paulo Neves
- Cardiothoracic Surgery Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Lon Annest
- BioVentrix Inc., San Ramon, California, USA
| | | | - Erhard Kaiser
- Private Practice for Internal Medicine and Cardiology, Frankfurt am Main, Germany
| | | | - Thorsten Hanke
- Department of Cardiac Surgery, Asklepios Hospital Harburg, Hamburg, Germany
| | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Tobias Ruf
- Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
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Affiliation(s)
- Carla Cunha
- CQC, Department of Chemistry, University of Coimbra, Coimbra P3004-535, Portugal
| | - Patrick Klein
- Macromolecular Chemistry Group (buwmakro) and Institute for Polymer Technology, Bergische Universitat Wuppertal, Gauss-Str. 20, Wuppertal D-42119, Germany
| | - Christine Rosenauer
- Max-Planck-Institute for Polymer Research, Ackermannweg 10, Mainz D-55128, Germany
| | - Ullrich Scherf
- Macromolecular Chemistry Group (buwmakro) and Institute for Polymer Technology, Bergische Universitat Wuppertal, Gauss-Str. 20, Wuppertal D-42119, Germany
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Neves P, Pillay T, Annest L, Van Bladel K, Kaiser E, Wechsler A, Klein P, Hanke T, Von Bardeleben RS. LIVE PROCEDURE FOR THE TREATMENT OF ISCHEMIC HEART FAILURE - CURRENT SHORT AND MID-TERM OUTCOMES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Klop IDG, Kougioumtzoglou AM, Kloppenburg GTL, van Putte BP, Sprangers MAG, Klein P, Nieuwkerk PT. Short-term outcome of the intuity rapid deployment prosthesis: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2021; 31:427-436. [PMID: 32910171 DOI: 10.1093/icvts/ivaa131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/28/2020] [Revised: 05/15/2020] [Accepted: 06/17/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Limited access aortic valve replacement is an alternative approach for the treatment of calcified aortic valve disease. To facilitate limited access aortic valve replacement, rapid deployment valve prostheses have been developed aiming to reduce surgical impact. This systematic review gives an overview of current literature regarding the INTUITY or INTUITY Elite rapid deployment biological valve prosthesis. METHODS Cochrane, Embase and MEDLINE were searched to identify relevant studies. All studies reporting on patients who underwent isolated or combined surgical aortic valve replacement with the INTUITY or INTUITY Elite valve prosthesis were considered eligible. Primary end points were technical success rate, 30-day mortality, cerebrovascular accident, paravalvular leak and permanent pacemaker implantation. Secondary end points included procedural data such as aortic cross-clamping time, cardiopulmonary bypass time and procedural approach. RESULTS A total of 16 articles fulfilled the inclusion and exclusion criteria and comprised 4.184 patients. Thirty-day mortality was 2.7% (1.9-3.7%), cerebrovascular accident 2.6% (1.4-4.7%), permanent pacemaker implantation 7.9% (6.6-9.5%) and severe postoperative paravalvular leak requiring a reintervention 3.3% (1.7-6.1%). Technical success rate varied between 93.9% and 100%. Conventional median sternotomy was most commonly performed, ranging from 21.7% to 89.6%. Upper hemi-sternotomy was performed more often than anterior right thoracotomy, ranging from 10.4% to 63.3% and 2.2% to 26.1%. The mean transvalvular pressure gradient ranged between 9.0 and 10.3 mmHg at 1 year postoperatively. CONCLUSIONS This review demonstrates that the technical success rate of the INTUITY or INTUITY Elite rapid deployment valve system is high, also in limited access aortic valve replacement. Mortality and cerebrovascular accident rates are low, but the need for postoperative permanent pacemaker implantation and reintervention rate for paravalvular leakage is increased.
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Affiliation(s)
| | - Athiná M Kougioumtzoglou
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands
| | | | - Bart P van Putte
- Department of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands.,Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands
| | - Mirjam A G Sprangers
- Department of Psychology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Pythia T Nieuwkerk
- Department of Psychology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Klop IDG, van Putte BP, Kloppenburg GTL, Sprangers MAG, Nieuwkerk PT, Klein P. Comparing quality of life and postoperative pain after limited access and conventional aortic valve replacement: Design and rationale of the LImited access aortic valve replacement (LIAR) trial. Contemp Clin Trials Commun 2021; 21:100700. [PMID: 33506139 PMCID: PMC7815656 DOI: 10.1016/j.conctc.2021.100700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/04/2020] [Accepted: 01/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background Surgical aortic valve replacement (SAVR) via limited access approaches (‘mini-AVR’) have proven to be safe alternative for the surgical treatment of aortic valve disease. However, it remains unclear whether these less invasive approaches are associated with improved quality of life and/or reduced postoperative pain when compared to conventional SAVR via full median sternotomy (FMS). Study design The LImited access Aortic valve Replacement (LIAR) trial is a single-center, single blind randomized controlled clinical trial comparing 2 arms of 80 patients undergoing limited access SAVR via J-shaped upper hemi-sternotomy (UHS) or conventional SAVR through FMS. In all randomized patients, the diseased native aortic valve is planned to be replaced with a rapid deployment stented bioprosthesis. Patients unwilling or unable to participate in the randomized trial will be treated conventionally via SAVR via FMS and with implantation of a sutured valve prosthesis. These patients will participate in a prospective registry. Study methods Primary outcome is improvement in cardiac-specific quality of life, measured by two domains of the Kansas City Cardiomyopathy Questionnaire up to one year after surgery. Secondary outcomes include, but are not limited to: generic quality of life measured with the Short Form-36, postoperative pain, perioperative (technical success rate, operating time) and postoperative outcomes (30-day and one-year mortality), complication rate and hospital length of stay. Conclusion The LIAR trial is designed to determine whether a limited access approach for SAVR (‘mini-AVR’) is associated with improved quality of life and/or reduced postoperative pain compared with conventional SAVR through FMS. The study is registered at ClinicalTrials.gov, number NCT04012060.
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Affiliation(s)
- Idserd D G Klop
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Bart P van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.,Department of Cardiothoracic Surgery, AMC Heart Centre, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Amsterdam University Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
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Ganss C, Klein P, Giese-Kraft K, Meyners M. Validation of motion tracking as tool for observational toothbrushing studies. PLoS One 2020; 15:e0244678. [PMID: 33378368 PMCID: PMC7773234 DOI: 10.1371/journal.pone.0244678] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022] Open
Abstract
Video observation (VO) is an established tool for observing toothbrushing behaviour, however, it is a subjective method requiring thorough calibration and training, and the toothbrush position is not always clearly visible. As automated tracking of motions may overcome these disadvantages, the study aimed to compare observational data of habitual toothbrushing as well as of post-instruction toothbrushing obtained from motion tracking (MT) to observational data obtained from VO. One-hundred-three subjects (37.4±14.7 years) were included and brushed their teeth with a manual (MB; n = 51) or a powered toothbrush (PB; n = 52) while being simultaneously video-filmed and tracked. Forty-six subjects were then instructed how to brush their teeth systematically and were filmed/tracked for a second time. Videos were analysed with INTERACT (Mangold, Germany); parameters of interest were toothbrush position, brushing time, changes between areas (events) and the Toothbrushing Systematic Index (TSI). Overall, the median proportion (min; max) of identically classified toothbrush positions (both sextant/surface correct) in a brushing session was 87.8% (50.0; 96.9), which was slightly higher for MB compared to PB (90.3 (50.0; 96.9) vs 86.5 (63.7; 96.5) resp.; p = 0.005). The number of events obtained from MT was higher than from VO (p < 0.001) with a moderate to high correlation between them (MB: ρ = 0.52, p < 0.001; PB: ρ = 0.87; p < 0.001). After instruction, both methods revealed a significant increase of the TSI regardless of the toothbrush type (p < 0.001 each). Motion tracking is a suitable tool for observing toothbrushing behaviour, is able to measure improvements after instruction, and can be used with both manual and powered toothbrushes.
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Affiliation(s)
- Carolina Ganss
- Department of Conservative and Preventive Dentistry, Dental Clinic of the Justus-Liebig-University Giessen, Giessen, Germany
- * E-mail:
| | - Patrick Klein
- Department of Conservative and Preventive Dentistry, Dental Clinic of the Justus-Liebig-University Giessen, Giessen, Germany
| | - Katja Giese-Kraft
- Department of Conservative and Preventive Dentistry, Dental Clinic of the Justus-Liebig-University Giessen, Giessen, Germany
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Klein P, Van Kuijk J, Swaans M. Hybrid transcatheter and minimally invasive left ventricular reconstruction for the treatment of ischemic cardiomyopathy: mid-term results. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Remodelling of the left ventricle (LV) after anterior myocardial infarction can result in a pathological increase in LV volume and reduction in LV ejection fraction (EF).
Purpose
We describe the mid-term results of a novel hybrid transcatheter and minimally invasive surgical technique to reconstruct the remodelled LV by plication and exclusion of the scar and reduction of the excess volume, resulting in decreased wall stress and increased EF.
Methods
Patients were considered eligible for the procedure when the presented with symptomatic heart failure (NYHA-class II or more) and ischemic cardiomyopathy (EF<40%) after anterior myocardial infarction. All patients had a dilated LV with either an a- or dyskinetic scar in the anteroseptal wall and/or apex of >50% transmurality. An hybrid transcatheter and minimally technique was used that relies on deploying a series of paired internal and external micro-anchors to plicate fibrous scar of infarcted anterior wall myocardial tissue to reconstruct the LV.
Results
Between October 2016 and January 2020 24 patients (21 males, 3 females; mean age 61±13 years) were operated in a single Dutch centre. Procedural success was 100%. On average 2.3±0.9 anchor-pairs were used to reconstruct the LV. Comparing echocardiographic data pre- and directly postoperatively, LVEF increased from 34±9% to 44±11% (change +34%, P<0.0001) and LV-volumes decreased: LVESV 113 ml ± 54 ml to 68±41 ml (change −39%, P<0.0001) and LVEDV 166 ml ± 75 ml to 116±57 ml (change −30%, P<0.0001). One patient was converted peroperatively to full sternotomy, ECC and cardioplegic arrest because of partial dislodgement of an apical mural thrombus. After removal of the thrombus, the LV was reconstructed with 2 anchor-pairs. One patient underwent a postoperative revision because of RV restriction. After removal of 1 “RV-LV” anchor-pair, the patient made a full recovery. One patient underwent an uncomplicated minimally invasive tricuspid valve replacement because of a lesion to the tricuspid valve during the procedure. Hospital mortality was 0%. Median duration of ICU–stay was 2 days (IQR 1–46 days) and median length of hospital stay was 7 days (IQR 5–57 days). Survival at 36 months was 88%. At latest follow-up, 86% of surviving patients were in NYHA-class I-II compared to 21% preoperatively.
Conclusions
Hybrid transcatheter and minimally invasive LV reconstruction is a promising novel treatment option for patients with symptomatic heart failure and ischemic cardiomyopathy after anteroseptal myocardial infarction. Mid-term results demonstrate that the procedure is safe and results in significant improvement in EF, reduction in LV volumes and improvement in heart failure symptoms.
Revivent TC technique
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Klein
- St Antonius Hospital, Nieuwegein, Netherlands (The)
| | | | - M.J Swaans
- St Antonius Hospital, Nieuwegein, Netherlands (The)
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Klein P, Annest L, Stephan von Bardeleben R, Kelle S, Stone G, Wechsler A, Haneya A, Hanke T. TCT CONNECT-435 Improved Safety With Superior Efficacy of Less-Invasive Hybrid Ventricular Reconstruction for Ischemic Heart Failure. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hodges-Gallagher L, Sun R, Myles D, Klein P, Zujewski J, Harmon C, Kushner P. OP-1250: A potent orally available complete antagonist of estrogen receptor-mediated signaling that shrinks wild type and mutant breast tumors. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31223-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Willemsen LM, Janssen PWA, Peper J, Soliman-Hamad MA, van Straten AHM, Klein P, Hackeng CM, Sonker U, Bekker MWA, von Birgelen C, Brouwer MA, van der Harst P, Vlot EA, Deneer VHM, Chan Pin Yin DRPP, Gimbel ME, Beukema KF, Daeter EJ, Kelder JC, Tijssen JGP, Rensing BJWM, van Es HW, Swaans MJ, Ten Berg JM. Effect of Adding Ticagrelor to Standard Aspirin on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting (POPular CABG): A Randomized, Double-Blind, Placebo-Controlled Trial. Circulation 2020; 142:1799-1807. [PMID: 32862716 DOI: 10.1161/circulationaha.120.050749] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Approximately 15% of saphenous vein grafts (SVGs) occlude during the first year after coronary artery bypass graft surgery (CABG) despite aspirin use. The POPular CABG trial (The Effect of Ticagrelor on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting Surgery) investigated whether ticagrelor added to standard aspirin improves SVG patency at 1 year after CABG. METHODS In this investigator-initiated, randomized, double-blind, placebo-controlled, multicenter trial, patients with ≥1 SVGs were randomly assigned (1:1) after CABG to ticagrelor or placebo added to standard aspirin (80 mg or 100 mg). The primary outcome was SVG occlusion at 1 year, assessed with coronary computed tomography angiography, in all patients that had primary outcome imaging available. A generalized estimating equation model was used to perform the primary analysis per SVG. The secondary outcome was 1-year SVG failure, which was a composite of SVG occlusion, SVG revascularization, myocardial infarction in myocardial territory supplied by a SVG, or sudden death. RESULTS Among 499 randomly assigned patients, the mean age was 67.9±8.3 years, 87.1% were male, the indication for CABG was acute coronary syndrome in 31.3%, and 95.2% of procedures used cardiopulmonary bypass. Primary outcome imaging was available in 220 patients in the ticagrelor group and 223 patients in the placebo group. The SVG occlusion rate in the ticagrelor group was 10.5% (51 of 484 SVGs) versus 9.1% in the placebo group (43 of 470 SVGs), odds ratio, 1.29 [95% CI, 0.73-2.30]; P=0.38. SVG failure occurred in 35 (14.2%) patients in the ticagrelor group versus 29 (11.6%) patients in the placebo group (odds ratio, 1.22 [95% CI, 0.72-2.05]). CONCLUSIONS In this randomized, placebo-controlled trial, the addition of ticagrelor to standard aspirin did not reduce SVG occlusion at 1 year after CABG. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02352402.
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Affiliation(s)
- Laura M Willemsen
- Department of Cardiology (L.M.W., P.W.A.J., J.P., D.R.P.P.C.P.Y., M.E.G., K.F.B., J.C.K., B.J.W.M.R., M.J.S., J.M.t.B.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Paul W A Janssen
- Department of Cardiology (L.M.W., P.W.A.J., J.P., D.R.P.P.C.P.Y., M.E.G., K.F.B., J.C.K., B.J.W.M.R., M.J.S., J.M.t.B.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Joyce Peper
- Department of Cardiology (L.M.W., P.W.A.J., J.P., D.R.P.P.C.P.Y., M.E.G., K.F.B., J.C.K., B.J.W.M.R., M.J.S., J.M.t.B.), St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Radiology (J.P.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mohamed A Soliman-Hamad
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands (M.A.S.-H., A.H.M.v.S.)
| | - Albert H M van Straten
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands (M.A.S.-H., A.H.M.v.S.)
| | - Patrick Klein
- Department of Cardiothoracic Surgery (P.K., U.S., E.J.D.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Chris M Hackeng
- Department of Clinical Chemistry (C.M.H.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Uday Sonker
- Department of Cardiothoracic Surgery (P.K., U.S., E.J.D.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Margreet W A Bekker
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands (M.W.A.B.)
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands (C.v.B.).,Health Technology and Services Research, University of Twente, Enschede, The Netherlands (C.v.B.)
| | - Marc A Brouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (M.A.B.)
| | - Pim van der Harst
- Department of Cardiology (P.v.d.H.), University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Groningen, The Netherlands (P.v.d.H.)
| | - Eline A Vlot
- Department of Anesthesiology, Intensive Care, and Pain Medicine (E.A.V.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Vera H M Deneer
- Department of Clinical Pharmacy, Division of Laboratories, Pharmacy, and Biomedical Genetics (V.H.M.D.), University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands (V.H.M.D.)
| | - Dean R P P Chan Pin Yin
- Department of Cardiology (L.M.W., P.W.A.J., J.P., D.R.P.P.C.P.Y., M.E.G., K.F.B., J.C.K., B.J.W.M.R., M.J.S., J.M.t.B.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Marieke E Gimbel
- Department of Cardiology (L.M.W., P.W.A.J., J.P., D.R.P.P.C.P.Y., M.E.G., K.F.B., J.C.K., B.J.W.M.R., M.J.S., J.M.t.B.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Kasper F Beukema
- Department of Cardiology (L.M.W., P.W.A.J., J.P., D.R.P.P.C.P.Y., M.E.G., K.F.B., J.C.K., B.J.W.M.R., M.J.S., J.M.t.B.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Edgar J Daeter
- Department of Cardiothoracic Surgery (P.K., U.S., E.J.D.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Johannes C Kelder
- Department of Cardiology (L.M.W., P.W.A.J., J.P., D.R.P.P.C.P.Y., M.E.G., K.F.B., J.C.K., B.J.W.M.R., M.J.S., J.M.t.B.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Jan G P Tijssen
- Department of Cardiology, Amsterdam University Medical Centers, The Netherlands (J.G.P.T.).,Cardialysis B.V. Rotterdam, The Netherlands (J.G.P.T.)
| | - Benno J W M Rensing
- Department of Cardiology (L.M.W., P.W.A.J., J.P., D.R.P.P.C.P.Y., M.E.G., K.F.B., J.C.K., B.J.W.M.R., M.J.S., J.M.t.B.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Hendrik W van Es
- Department of Radiology (H.W.v.E.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Martin J Swaans
- Department of Cardiology (L.M.W., P.W.A.J., J.P., D.R.P.P.C.P.Y., M.E.G., K.F.B., J.C.K., B.J.W.M.R., M.J.S., J.M.t.B.), St Antonius Hospital, Nieuwegein, The Netherlands
| | - Jurrien M Ten Berg
- Department of Cardiology (L.M.W., P.W.A.J., J.P., D.R.P.P.C.P.Y., M.E.G., K.F.B., J.C.K., B.J.W.M.R., M.J.S., J.M.t.B.), St Antonius Hospital, Nieuwegein, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands (J.M.t.B.)
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Wolf M, Klein P, Engelmohr R, Erb J, Gübler R. Data on toothbrushing study comparing infrared-based motion tracking versus video observation. Data Brief 2020; 31:105867. [PMID: 32613045 PMCID: PMC7316997 DOI: 10.1016/j.dib.2020.105867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
Investigations of toothbrushing habits are an important vector to understand their influence on brushing effectiveness. User compliance in toothbrushing is known to deviate from professional recommendations in brushing time, evenness across all areas of the dentition, and brushing force [1,2]. Despite the recent development of tools designed to guide users to optimised brushing habits [3,4], research on habit evaluation and tracking is limited and typically relies on labour-intensive video observation (VO) [5]. Here we present raw data on toothbrush position as determined by an automated motion tracking (MT) capability and by human VO and provide a technical description of the MT capability. The MT system described in this article was developed in collaboration with Soft2Tec GmbH (Rüsselsheim, Germany) as a potential substitute for the VO tool. The MT system consists of a monocular vision module and a target module with active infrared LED trackers. The MT system determined the position and orientation of a toothbrush relative to the jaw while subjects brushed under realistic conditions. For VO, a trained assessor coded video recording data from toothbrushing sessions. The data presented here describes a clinical study (103 subjects; 46 completed two sessions, 57 completed one session, altogether 149 events) comparing toothbrushing behaviour recorded with the MT system and with VO simultaneously. The raw data was deposited in Mendeley Data, under data identification number doi:10.17632/4f384xrbhm.1 [https://data.mendeley.com/datasets/4f384xrbhm/1].
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Affiliation(s)
- Michael Wolf
- Procter & Gamble Service GmbH, Kronberg, Germany
| | - Patrick Klein
- Department of Conservative and Preventive Dentistry, Dental Clinic of the Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Jasmin Erb
- Procter & Gamble Service GmbH, Kronberg, Germany
| | - René Gübler
- Procter & Gamble Service GmbH, Kronberg, Germany
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Fischer A, Klein P, Radulescu P, Gulsun M, Mohamed Ali A, R.S V, Schoebinger M, Sahbaee P, Sharma P, Schoepf U. Deep Learning Based Automated Coronary Labeling For Structured Reporting Of Coronary CT Angiography In Accordance With SCCT Guidelines. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Klein P, Anker SD, Wechsler A, Kelle S. Left ventricular volume reduction and reshape - 'Re-STICHING' the field. Reply. Eur J Heart Fail 2020; 22:1053-1054. [PMID: 32463544 DOI: 10.1002/ejhf.1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Patrick Klein
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Stefan D Anker
- BIH Center for Regenerative Therapies (BCRT), Charité, Universitätsmedizin Berlin, Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Andrew Wechsler
- Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Sebastian Kelle
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
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Willemsen LM, Janssen PW, Hackeng CM, Kelder JC, Tijssen JG, van Straten AH, Soliman-Hamad MA, Deneer VH, Daeter EJ, Sonker U, Klein P, ten Berg JM. A randomized, double-blind, placebo-controlled trial investigating the effect of ticagrelor on saphenous vein graft patency in patients undergoing coronary artery bypass grafting surgery-Rationale and design of the POPular CABG trial. Am Heart J 2020; 220:237-245. [PMID: 31884246 DOI: 10.1016/j.ahj.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/06/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE An estimated 15% of saphenous vein grafts (SVGs) occlude in the first year after coronary artery bypass grafting (CABG) despite aspirin therapy. Graft occlusion can result in symptoms, myocardial infarction, and death. SVG occlusion is primarily caused by atherothrombosis, in which platelet activation plays a pivotal role. Evidence regarding the effect of stronger platelet inhibition on SVG patency after CABG is limited. The main objective of the POPular CABG trial is to determine whether dual antiplatelet therapy with aspirin plus ticagrelor improves SVG patency when compared to aspirin alone. STUDY The POPular CABG is a randomized, double-blind, placebo-controlled, multicenter trial investigating the effect of adding ticagrelor to standard aspirin therapy on the rate of SVG occlusion. A total of 500 patients undergoing CABG with ≥ 1 SVG are randomized to ticagrelor or placebo. The primary end point is SVG occlusion rate, assessed with coronary computed tomography angiography at 1 year. Secondary end points are stenoses and occlusions in both SVGs and arterial grafts and SVG failure at 1 year, defined as a composite of SVG occlusion on coronary computed tomography angiography or coronary angiography, SVG revascularization, myocardial infarction in the territory supplied by an SVG, or sudden death. Safety end points are bleeding events at 30 days and 1 year. CONCLUSION The POPular CABG trial investigates whether adding ticagrelor to standard aspirin after CABG reduces the rate of SVG occlusion at 1 year.
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Klein P, Anker SD, Wechsler A, Skalsky I, Neuzil P, Annest LS, Bifi M, McDonagh T, Frerker C, Schmidt T, Sievert H, Demaria AN, Kelle S. Less invasive ventricular reconstruction for ischaemic heart failure. Eur J Heart Fail 2019; 21:1638-1650. [DOI: 10.1002/ejhf.1669] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/06/2019] [Accepted: 10/11/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Patrick Klein
- Department of Cardiothoracic SurgerySt Antonius Hospital Nieuwegein The Netherlands
| | - Stefan D. Anker
- BIH Center for Regenerative Therapies (BCRT), CharitéUniversitätsmedizin Berlin Berlin Germany
- Division of Cardiology and Metabolism, Department of Cardiology (CVK) Charité, Berlin Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin Germany
| | - Andrew Wechsler
- Department of Cardiothoracic SurgeryDrexel University College of Medicine Philadelphia PA USA
| | - Ivo Skalsky
- Department of Cardiac SurgeryNa Homolce Hospital Prague Czech Republic
| | - Petr Neuzil
- Department of CardiologyNa Homolce Hospital Prague Czech Republic
| | | | - Mauro Bifi
- Intituto di Cardiologia, Azienda OspedalieroUniversitaria di Bologna Bologna Italy
| | | | | | - Tobias Schmidt
- Department of CardiologyAsklepios Klinik St Georg Hamburg Germany
| | - Horst Sievert
- CardioVascular Center Frankfurt Frankfurt am Main Germany
- Anglia Ruskin University Chelmsford UK
| | - Anthony N. Demaria
- Division of Cardiology, Department of MedicineUniversity of California, Sulpizio Cardiovascular Center San Diego CA USA
| | - Sebastian Kelle
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin Germany
- Department of Internal MedicineCardiology German Heart Center Berlin Berlin Germany
- Department of Internal Medicine/CardiologyCharité Campus Virchow Clinic Berlin Germany
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van den Brink FS, van Tooren R, Sonker U, Klein P, Waanders F, Zivelonghi C, Eefting FD, Scholten E, Ten Berg JM. Veno arterial-extra corporal membrane oxygenation for the treatment of cardiac failure in patients with infective endocarditis. Perfusion 2019; 34:613-617. [PMID: 31027458 DOI: 10.1177/0267659119842807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Surgery for infective endocarditis imposes great challenges in post-operative circulatory and pulmonary support but the role of veno-arterial extra-corporal membrane oxygenation in this respect is unclear. METHODS All patients undergoing veno-arterial extra-corporal membrane oxygenation after infective endocarditis surgery were analysed for age, gender, medical history, microorganisms, clinical outcome, complications and surgical procedure. RESULTS Between 2012 and 2016, 13 patients received veno-arterial extra-corporal membrane oxygenation following infective endocarditis surgery. The median age was 62 years (33-73) and 8/13 were male. Previous cardiac surgery was present in nine patients. Surgery for infective endocarditis consisted of a Bentall procedure in 10 patients, 2 of which received concomitant mitral valve surgery and 2 received concomitant coronary artery bypass graft. Valvular surgery alone was performed in three patients. Mortality on veno-arterial extra-corporal membrane oxygenation was 62% (8/13). Mortality during intensive care unit stay was 77% (10/13). Survival to discharge was 23% (3/13). One patient reached the 1 year survival point. Two patients who survived to discharge have not yet reached the 1 year survival point. Patient-related complications occurred in 54% (7/13) of patients and consisted of haemorrhage at the cannula site in four patients, leg ischaemia in one patient, haemorrhage at another site in one patient and infection of the cannula in one patient. Extra-corporal membrane oxygenation hardware-related complications occurred in one case consisting of clot formation in the oxygenator. CONCLUSION Veno-arterial extra-corporal membrane oxygenation in post-cardiotomy patients who were operated on for infective endocarditis is feasible, but outcome is poor.
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Affiliation(s)
- Floris S van den Brink
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Rob van Tooren
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Uday Sonker
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Frans Waanders
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Carlo Zivelonghi
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Frank D Eefting
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Erik Scholten
- Department of Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jurrien M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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Anker S, Kelle S, Klein P, Wechsler A, Annest L, Sievert H, Neuzil P. MID-TERM FOLLOW-UP OF THE REVIVENT SYSTEM AS A LESS-INVASIVE VENTRICULAR RECONSTRUCTION PROCEDURE: PRELIMINARY RESULTS FROM A MULTICENTER-TRIAL. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berger N, Fitzpatrick K, Klein P. Abstract P6-16-10: Is pregnancy testing during chemotherapy standardized? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-16-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The initiative to improve awareness about the risks of infertility for premenopausal patients receiving chemotherapy has improved significantly over time. While the risks for infertility are high, there is still a small risk of pregnancy during chemotherapy. The incidence of cancer diagnosed during pregnancy is 0.1-0.2%. The incidence of women who become pregnant while on chemotherapy is less clear but does occur. Amenorrhea commonly occurs during chemotherapy but this does not necessarily correlate with lack of ovarian function. Treating a patient with an unidentified pregnancy is an adverse event which must be avoided given the high risk it poses to the fetus, especially during the first trimester. Pregnancy testing prior to the initiation of chemotherapy is recommended by the NCCN and ASCO. However, recommendations on how to monitor for pregnancy after an initial screen are inconsistent and lack standardization. Formal guidelines and policies are needed to prevent and/or identify pregnancies while on chemotherapy.
We surveyed five breast medical oncologists and six infusion nurses at a busy urban breast center to determine their baseline practices in regards to pregnancy counseling and testing. Of physicians and nurses surveyed, 40% (2/5) and 33% (2/6) respectively have diagnosed a pregnancy while on chemotherapy. When surveyed about counseling patients on the risks of pregnancy, 80% of physicians counsel patients prior to initiation of chemotherapy, but one physician and one infusion nurse said they do not counsel patients about the risk of pregnancy at any time but do discuss the risks of infertility. All physicians surveyed check a pregnancy test prior to the initiation of chemotherapy, but 60% check urine and 40% check serum. Thereafter 60% will check a pregnancy test after initial screen if the patient is concerned and 40% will check intermittently during chemotherapy. Of the nurses surveyed, 33% will check a pregnancy test after initial screen if the patient is concerned and 50% check intermittently during treatment. Half of the infusion nurses said they ask patients if they are concerned they may be pregnant intermittently during chemotherapy and 50% answered that they do not ask again after the initial screen. On subsequent screens the choice of urine or serum hCG testing varies and is not standardized.
These survey results demonstrate that both pregnancy counseling and pregnancy screening practices vary widely even within the same institution. A standardized approach is essential to increase awareness of pregnancy risk while on chemotherapy, improve education of this risk to patients, prevent unwanted pregnancies, and identify pregnancies as soon as possible. We have initiated a quality improvement project to check urine pregnancy tests monthly in all premenopausal patients (age <55) receiving chemotherapy for breast cancer. Based on our findings we will institute a protocol at our institution for uniform teaching on the small risk of pregnancy and uniform pregnancy testing while on chemotherapy.
Citation Format: Berger N, Fitzpatrick K, Klein P. Is pregnancy testing during chemotherapy standardized? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-10.
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Affiliation(s)
- N Berger
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Fitzpatrick
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - P Klein
- Icahn School of Medicine at Mount Sinai, New York, NY
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Rugo HS, Klein P, Melin SA, Hurvitz SA, Melisko ME, Moore A, D'Agostino RB, Deluca A, Cigler T. Abstract P1-17-04: Long-term safety follow-up of patients with early stage breast cancer treated with scalp cooling on the Dignitana scalp cooling trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-17-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Scalp cooling has demonstrated efficacy in preventing hair loss in women with early stage breast cancer receiving neo/adjuvant chemotherapy. Data from 2 prospective trials (Rugo et al, and Nangia et al, JAMA 2017) led to FDA clearance of 2 automated scalp-cooling devices to prevent chemotherapy induced alopecia (CIA). Although scalp metastases from breast cancer are rare, historical concerns about scalp cooling included a theoretical increase in risk of recurrence in scalp due to reduced delivery of chemotherapy to the scalp.
Methods
We conducted a multicenter prospective trial evaluating the efficacy and safety of the DigniCap in women with stage I-II breast cancer receiving neo/adjuvant chemotherapy excluding sequential or combination anthracycline/taxanes with concurrent matched controls. The primary endpoint was unblinded patient self-assessment of 5 photographs using the Dean scale to estimate hair loss 4 weeks following the last dose of chemotherapy, with success defined as a Dean score of 0-2 (≤ 50% hair loss); additional endpoints included quality of life (QOL) and both short and long-term safety.
Results
106 patients using the scalp cooling device and 16 concurrent controls were enrolled. As previously reported, the use of scalp cooling was associated with less alopecia and improvement in several measures of QOL (Rugo et al, JAMA 2017). 91 patients have follow-up (FU) out to 3 years; 73 with estrogen receptor (ER) positive and 18 with ER negative disease. 5 DigniCap patients have developed recurrent breast cancer in breast (n=1), liver (n=1), bone, liver and breast (n=1), bone, liver, lung, and nodes (1), and bone, breast, GI tract and bladder (n=1). Of 12 control patients with available FU, 1 developed metastases to liver. 2 patients have died of metastatic disease, one in the DigniCap arm and one in the control arm. No new safety signals have been detected.
Conclusion
Scalp cooling using the DigniCap system in patients with early stage breast cancer receiving taxane based neo/adjuvant chemotherapy is safe and effective. No scalp metastases have been reported 3 years following completion of study treatment. 4 year FU data will be presented.
The study was funded by The Lazlo Tauber Family Foundation (UCSF), the Anne Moore Breast Cancer Research Fund (Weil Cornell), and the Friedman Family Foundation (Mount Sinai Beth Israel), as well as partially by Dignitana.
Citation Format: Rugo HS, Klein P, Melin SA, Hurvitz SA, Melisko ME, Moore A, D'Agostino, Jr. RB, Deluca A, Cigler T. Long-term safety follow-up of patients with early stage breast cancer treated with scalp cooling on the Dignitana scalp cooling trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-17-04.
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Affiliation(s)
- HS Rugo
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - P Klein
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - SA Melin
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - SA Hurvitz
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - ME Melisko
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - A Moore
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - RB D'Agostino
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - A Deluca
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - T Cigler
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
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Petrus AHJ, Klein P, Tops LF, Dekkers OM, Hoogervorst LA, Couperus LE, Beeres SLMA, Klautz RJM, Braun J. 10-Year Outcomes After Left Ventricular Reconstruction: Rethinking the Impact of Mitral Regurgitation. Ann Thorac Surg 2019; 108:81-88. [PMID: 30710521 DOI: 10.1016/j.athoracsur.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/03/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Heart failure with reduced ejection fraction due to a post-infarction anteroseptal aneurysm carries a poor prognosis. Patients with refractory heart failure may be considered for advanced surgery, including left ventricular assist device implantation, heart transplantation and left ventricular reconstruction. The aim of this study was to evaluate outcomes after an integrated approach of left ventricular reconstruction with concomitant procedures (mitral/tricuspid valve repair, coronary revascularization), and assess risk factors for event-free survival, focusing on left ventricular geometry/function and presence of functional mitral regurgitation (MR). METHODS A total of 159 consecutive heart failure patients who underwent left ventricular reconstruction between 2002 and 2011 were included. Mid-term echocardiographic and long-term clinical outcomes were evaluated. Preoperative risk factors were correlated to event-free survival (freedom from mortality, left ventricular assist device implantation, and heart transplantation). RESULTS Mid-term echocardiography demonstrated decreased indexed left ventricular end-systolic volumes (89 ± 42 mL/m2 preoperatively; 51 ± 18 at mid-term, p < 0.001), and absence of MR ≥ grade 2. Event-free survival was 83% ± 3% at 1-year, 68% ± 4% at 5-year, and 46% ± 4% at 10-year follow-up. Preoperative wall motion score index (WMSI; hazard ratio [HR] 3.1, 95% confidence interval [CI] 1.7-5.8, p < 0.001) and presence of MR ≥ grade 2 (HR 1.9, 95% CI 1.1-3.1, p = 0.014) were independently associated with adverse event-free survival. CONCLUSIONS Event-free survival is favorable in patients with WMSI < 2.5 and significantly worse when WMSI is ≥ 2.5. In both groups, the presence of preoperative MR ≥ grade 2 negatively affects event-free survival, despite successful correction of MR. Risk stratification by preoperative WMSI and MR grade supports the Heart team in choosing the optimal surgical strategy for patients with refractory heart failure.
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Affiliation(s)
- Annelieke H J Petrus
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lotje A Hoogervorst
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lotte E Couperus
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia L M A Beeres
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Klein P, Klop IDG, Kloppenburg GLT, van Putte BP. Planning for minimally invasive aortic valve replacement: key steps for patient assessment. Eur J Cardiothorac Surg 2019; 53:ii3-ii8. [PMID: 29718230 DOI: 10.1093/ejcts/ezy086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/06/2018] [Indexed: 12/12/2022] Open
Abstract
Minimally invasive aortic valve replacement (MIAVR) has proved to be a safe approach for the treatment of aortic valve stenosis and/or insufficiency and is associated with a number of additional benefits for patients. This includes reduced blood loss, reduced transfusion requirements, reduced length of hospital stay and improved aesthetic appearance. As all types of minimally invasive surgery rely on optimizing exposure within a more limited field of view, a thorough preoperative assessment of patients is important to identify and address potential exposure problems. MIAVR through an upper hemisternotomy is considered feasible in almost every patient, but various clinical conditions or anatomical variations can complicate the procedure and may impact on the postoperative outcome. MIAVR through an anterior right thoracotomy requires suitable anatomy, and this should be evaluated preoperatively through a computed tomography or magnetic resonance imaging scan. In this review, we aimed to present an overview of the current literature and to reflect on our personal experiences with MIAVR techniques. This should provide an aid-especially to surgeons wanting to start or have little experience with MIAVR-for a structured preoperative patient assessment and planning to increase the chance of a safe procedure with a good outcome.
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Affiliation(s)
- Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Idserd D G Klop
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Bart P van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
- Department of Cardiothoracic Surgery, AMC Heart Centre, Academic Medical Center, Amsterdam, Netherlands
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Klein P, Jötten HJ, Aitchison CM, Clowes R, Preis E, Cooper AI, Sprick RS, Scherf U. Aromatic polymers made by reductive polydehalogenation of oligocyclic monomers as conjugated polymers of intrinsic microporosity (C-PIMs). Polym Chem 2019. [DOI: 10.1039/c9py00869a] [Citation(s) in RCA: 5] [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: 01/14/2023]
Abstract
Incorporation of tetrabenzohepta- or -pentafulvalene connectors into soluble, aromatic polymers results in significantly different optical spectra and intrinsic microporosity.
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Affiliation(s)
- Patrick Klein
- Macromolecular Chemistry
- University of Wuppertal
- 42119 Wuppertal
- Germany
| | - Hauke J. Jötten
- Macromolecular Chemistry
- University of Wuppertal
- 42119 Wuppertal
- Germany
| | | | - Rob Clowes
- Materials Innovation Factory
- University of Liverpool
- Liverpool
- UK
| | - Eduard Preis
- Macromolecular Chemistry
- University of Wuppertal
- 42119 Wuppertal
- Germany
| | | | | | - Ullrich Scherf
- Macromolecular Chemistry
- University of Wuppertal
- 42119 Wuppertal
- Germany
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Abstract
Zusammenfassung
Hintergrund Die richtige Diagnosestellung und daraus eine Behandlung ableiten, gehören zu den erforderlichen Grundfähigkeiten von Physiotherapeuten. Unklar ist, ob die unterschiedlichen Ausbildungsformen in Deutschland diese Qualifikationen auch hinreichend gut vermitteln und sich die Absolventen in ihren Leistungen unterscheiden.
Ziel Ziel dieser Fragebogenuntersuchung war es herauszufinden, inwieweit sich Teilnehmer einer physiotherapeutischen Ausbildung oder Studium in Deutschland und den Niederlanden bei vorgegebenen Fallvignetten für die richtige Diagnose und das richtige Prozedere entscheiden.
Methode Der Fragebogen nach Jette et al. 1 mit 12 Fallbeispielen wurde an Auszubildende und Studierende der Physiotherapie im letzten Ausbildungs- bzw. Studienjahr geschickt. Insgesamt nahmen 428 Auszubildende und Studierende aus Deutschland und 51 aus den Niederlanden an der Studie teil. Bei jeder Fallschilderung mussten sie sich für eine rein physiotherapeutische, medizinische oder gemischte Intervention entscheiden.
Ergebnisse Durchschnittlich 75 % der Teilnehmer entschieden sich für das richtige Prozedere. In Deutschland gaben Studierende eine signifikant höhere Anzahl richtiger Antworten im Vergleich zu den Auszubildenden. Im deutsch-niederländischen Vergleich waren die niederländischen Studierenden signifikant besser. Deutsche Auszubildende und Studierende wiesen vor allem bei medizinisch kritischen Beschwerdebildern schlechtere Ergebnisse auf.
Schlussfolgerungen In der Ausbildung und im Studium sollte die Vermittlung von Screening-Kenntnissen, besonders in Bezug auf medizinisch kritische Beschwerdebilder (Red Flags) verbessert werden.
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Affiliation(s)
| | - Edit Rottler
- Universitätsklinikum Ulm, Klinik für Psychosomatische Medizin und Psychotherapie
| | - Jörn von Wietersheim
- Universitätsklinikum Ulm, Klinik für Psychosomatische Medizin und Psychotherapie
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Klein P, Agostoni P, van Boven WJ, de Winter RJ, Swaans MJ. Transcatheter and minimally invasive surgical left ventricular reconstruction for the treatment of ischaemic cardiomyopathy: preliminary results†. Interact Cardiovasc Thorac Surg 2018; 28:441-446. [DOI: 10.1093/icvts/ivy259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 07/13/2018] [Accepted: 07/25/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patrick Klein
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands
| | | | - Wim-Jan van Boven
- Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands
| | - Rob J de Winter
- Department of Cardiology, Academic Medical Centre, Amsterdam, Netherlands
| | - Martin J Swaans
- Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands
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Le Bot A, Duval G, Klein P, Lelong J. Analytical solution for bending vibration of a thin-walled cylinder rolling on a time-varying force. R Soc Open Sci 2018; 5:180639. [PMID: 30109107 PMCID: PMC6083697 DOI: 10.1098/rsos.180639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
This paper presents the analytical solution of radial vibration of a rolling cylinder submitted to a time-varying point force. In the simplest situation of simply supported edges and zero in-plane vibration, the cylinder is equivalent to an orthotropic pre-stressed plate resting on a visco-elastic foundation. We give the closed-form solution of vibration as a series of normal modes whose coefficients are explicitly calculated. Cases of both deterministic and random forces are examined. We analyse the effect of rolling speed on merging of vibrational energy induced by Doppler's effect for the example of rolling tyre.
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Affiliation(s)
- A. Le Bot
- Université de Lyon, Lyon, France
- CNRS, Laboratoire de Tribologie et Dynamique des Systèmes, Ecole centrale de Lyon, Ecully, France
| | - G. Duval
- Université de Lyon, Lyon, France
- CNRS, Laboratoire de Tribologie et Dynamique des Systèmes, Ecole centrale de Lyon, Ecully, France
| | - P. Klein
- Université de Lyon, Lyon, France
- IFSTTAR, Laboratoire d'acoustique environnementale, Bron, France
| | - J. Lelong
- Université de Lyon, Lyon, France
- IFSTTAR, Laboratoire d'acoustique environnementale, Bron, France
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van Huls van Taxis CF, Wijnmaalen AP, Klein P, Dekkers OM, Braun J, Verwey HF, Schalij MJ, Klautz RJ, Zeppenfeld K. Programmed electrical stimulation-guided encircling cryoablation concomitant to surgical ventricular reconstruction for primary prevention of ventricular arrhythmias. Eur J Cardiothorac Surg 2018; 54:98-105. [PMID: 29365077 DOI: 10.1093/ejcts/ezx496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 08/28/2017] [Accepted: 12/13/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Surgical ventricular reconstruction (SVR) is an effective treatment to improve left ventricular (LV) function in patients with ischaemic heart failure and an LV anterior-apical aneurysm. Ventricular arrhythmia (VA) is an important cause for morbidity and mortality in these patients. Therefore, encircling cryoablation targeting the VA substrate may be required. Programmed electrical stimulation (PES) can identify patients at risk for VA. The objective of this study was to evaluate the incidence and type of VA during long-term follow-up after PES-guided encircling cryoablation concomitant to SVR for primary prevention of VA. METHODS Thirty-eight patients without spontaneous VA referred for SVR who underwent preoperative PES were included (PES group); 27 (71%) patients inducible for aneurysm-related VA received cryoablation. A historical cohort of 39 patients without spontaneous VA, preoperative PES and antiarrhythmic surgery served as the control group. Patients were discharged with an implantable cardioverter defibrillator (ICD). RESULTS During 74 ± 35 months of follow-up, no arrhythmic deaths occurred. Five-year survival for the total study population was 78%. Twenty-eight (36%) patients experienced ≥1 VA. There were no differences in the number and type of ICD therapies between groups: shocks, P = 0.699 and antitachypacing, P = 0.403. Five-year VA-free survival was 61% for the PES group and 65% for the control group (hazard ratio 1.67, P = 0.290). CONCLUSIONS The majority of the patients referred for SVR without previously documented VA was inducible for aneurysm-related VA. During the follow-up, more than one-third of the patients experienced sustained VA and 25% received appropriate ICD therapy. No difference in VA occurrence or ICD therapy was observed between groups.
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Affiliation(s)
| | | | - Patrick Klein
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Harriette F Verwey
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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Abstract
Standardized clinical diagnostic procedures cannot assess the functionality of the anatomical structures in sport-specific movement. Biomechanical screening is able to detect deficits but is not sufficiently and objectively precise with the current clinical examination tools including conventional imaging techniques. The fields of use of functional testing methods are versatile and range from injury prevention analysis, screening during rehabilitation phases up to the return-to-play decision. Using simple musculoskeletal function analysis it is difficult to assess the risk of injuries. The main advantage of instrumented 3D-motion analysis is its potential to generate objective, reliable and reproducible data with exact joint angles, muscle activity, as well as loading inside the joints during movement. These marker-based motion analysis procedures are more time-consuming and more cost intensive and necessitate in particular biomechanical and medical knowledge to assess the analytical data in terms of clinical relevance. In the absence of scientific studies on biomechanical analyses in professional sports, this study shows preliminary approaches to this topic.
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Affiliation(s)
- H Dewitz
- Institut für Funktionelle Diagnostik (IFD Cologne), Im MediaPark 2, 50670, Köln, Deutschland.
| | - B Yildirim
- Institut für Funktionelle Diagnostik (IFD Cologne), Im MediaPark 2, 50670, Köln, Deutschland
| | - P Klein
- Institut für Funktionelle Diagnostik (IFD Cologne), Im MediaPark 2, 50670, Köln, Deutschland
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Zivelonghi C, Klein P, Swaans MJ, Agostoni P. Hybrid transcatheter left ventricular reconstruction for the treatment of ischaemic cardiomyopathy. EUROINTERVENTION 2018; 13:1899-1901. [PMID: 28966158 DOI: 10.4244/eij-d-17-00413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Carlo Zivelonghi
- Department of Cardiology and Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
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