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Paukovitsch M, Felbel D, Tadic M, Keßler M, Scheffler J, Gröger M, Markovic S, Rottbauer W, Schneider LM. The effect of a smaller spacer in the PASCAL Ace on residual mitral valve orifice area. Clin Res Cardiol 2024:10.1007/s00392-023-02368-0. [PMID: 38270636 DOI: 10.1007/s00392-023-02368-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Mitral transcatheter edge-to-edge repair (M-TEER) is an established treatment for functional mitral regurgitation (FMR) associated with a risk of creating iatrogenic stenosis. OBJECTIVES To investigate the impact of the P10 and its larger spacer compared to the narrower Ace and its smaller spacer on reduction of mitral valve orifice area (MVOA) during M-TEER. METHODS Consecutive patients undergoing M-TEER for treatment of severe FMR were screened retrospectively. Patients with a single PASCAL device implantation within the central segments of the MV leaflets, non-complex anatomy, and baseline MVOA ≥ 3.5cm2 were selected. Intraprocedural transesophageal echocardiography was used to compare MVOA reduction with 3D multiplanar reconstruction and direct planimetry. Device selection did not follow a prespecified MVOA threshold. RESULTS Seventy-two patients (81.0 years, IQR {74.3-85.0}) were included. In 32 patients, the P10 was implanted (44.4%). MR severity (p = 0.66), MR reduction (p = 0.73), and body surface area (p = 0.56) were comparable. Baseline MVOA tended to be smaller in P10 patients with the larger spacer (5.0 ± 1.1 vs. 5.4 ± 1.3cm2, p = 0.18), however, residual MVOA was larger in these patients (2.7 ± 0.7 vs. 2.3 ± 0.6cm2, p = 0.03). Accordingly, relative MVOA reduction was significantly less in P10 patients (- 45.9 ± 7.6 vs. - 56.3 ± 7.0%, p < 0.01). Indirect annuloplasty was more pronounced in Ace patients whereas mean transmitral gradients were similar. CONCLUSION In FMR patients with non-complex anatomy, the larger spacer of the P10 maintains greater MVOA with similar MR reduction. Hence, the use of the PASCAL Ace device in patients with small MVOAs might correlate with a risk of both clinically relevant orifice reduction and even iatrogenic stenosis.
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Affiliation(s)
- Michael Paukovitsch
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dominik Felbel
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Marijana Tadic
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Mirjam Keßler
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Jinny Scheffler
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Matthias Gröger
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Sinisa Markovic
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Rottbauer
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Leonhard Moritz Schneider
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Gröger M, Friedl S, Ouerghemmi D, Tadic M, Bruß E, Felbel D, Paukovitsch M, Schneider LM, Dahme T, Rottbauer W, Markovic S, Keßler M. TRI-SCORE is superior to EuroSCORE II and STS-Score in mortality prediction following transcatheter edge-to-edge tricuspid valve repair. Clin Res Cardiol 2023; 112:1436-1445. [PMID: 37405481 PMCID: PMC10562344 DOI: 10.1007/s00392-023-02246-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND The development of transcatheter tricuspid edge-to-edge repair for tricuspid regurgitation is a therapeutic milestone but a specific periprocedural risk assessment tool is lacking. TRI-SCORE has recently been introduced as a dedicated risk score for tricuspid valve surgery. AIMS This study analyzes the predictive performance of TRI-SCORE following transcatheter edge-to-edge tricuspid valve repair. METHODS 180 patients who underwent transcatheter tricuspid valve repair at Ulm University Hospital were consecutively included and stratified into three TRI-SCORE risk groups. The predictive performance of TRI-SCORE was assessed throughout a follow-up period of 30 days and up to 1 year. RESULTS All patients had severe tricuspid regurgitation. Median EuroSCORE II was 6.4% (IQR 3.8-10.1%), median STS-Score 8.1% (IQR 4.6-13.4%) and median TRI-SCORE 6.0 (IQR 4.0-7.0). 64 patients (35.6%) were in the low TRI-SCORE group, 91 (50.6%) in the intermediate and 25 (13.9%) in the high-risk groups. The procedural success rate was 97.8%. 30-day mortality was 0% in the low-risk group, 1.3% in the intermediate-risk and 17.4% in the high-risk groups (p < 0.001). During a median follow-up of 168 days mortality was 0%, 3.8% and 52.2%, respectively (p < 0.001). The predictive performance of TRI-SCORE was excellent (AUC for 30-day mortality: 90.3%, for one-year mortality: 93.1%) and superior to EuroSCORE II (AUC 56.6% and 64.4%, respectively) and STS-Score (AUC 61.0% and 59.0%, respectively). CONCLUSION TRI-SCORE is a valuable tool for prediction of mortality after transcatheter edge-to-edge tricuspid valve repair and its performance is superior to EuroSCORE II and STS-Score. In a monocentric cohort of 180 patients undergoing edge-to-edge tricuspid valve repair TRI-SCORE predicted 30-day and up to one-year mortality more reliably than EuroSCORE II and STS-Score. AUC area under the curve, 95% CI 95% confidence interval.
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Affiliation(s)
- Matthias Gröger
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Sophia Friedl
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dhia Ouerghemmi
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Marijana Tadic
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Elene Bruß
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dominik Felbel
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Michael Paukovitsch
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Leonhard M Schneider
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Tillman Dahme
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Mirjam Keßler
- Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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Gröger M, Hirsch K, Felbel D, Paukovitsch M, Schneider LM, Markovic S, Rottbauer W, Keßler M. Predictors of Improvement in Concomitant Tricuspid Regurgitation Following Transcatheter Edge-to-Edge Mitral Valve Repair. J Clin Med 2023; 12:6191. [PMID: 37834835 PMCID: PMC10573471 DOI: 10.3390/jcm12196191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Improvement in concomitant tricuspid regurgitation (TR) after mitral valve transcatheter edge-to-edge repair (M-TEER) for mitral regurgitation (MR) occurs frequently; however factors determining the post-procedural course of TR are not well understood. We investigated the parameters associated with TR improvement after M-TEER. METHODS AND RESULTS A total of 300 patients were consecutively included in this retrospective analysis. MR and TR severity as well as heart chamber metrics were assessed before the procedure and at follow-up. Device success was achieved in 97.3% of patients. TR decreased in 30.2% of patients. Patients with improved TR were more often female, had more severe TR at baseline, and their right heart dimensions at baseline trended to be smaller. Female sex (odds ratio (OR) 2.997), baseline MR-Grade (OR 3.181) and baseline TR-Grade (OR 2.653) independently predicted TR reduction. More pronounced right heart reverse remodeling was observed in patients with improved TR. TR regression independently predicted lower mortality (hazard ratio (HR) 0.333, 95% confidence interval 0.112-0.996, p = 0.049). CONCLUSIONS A reduction in concomitant TR severity after M-TEER occurred mainly in females and in patients with high-grade TR and MR at baseline. TR regression is associated with better survival after M-TEER.
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Affiliation(s)
| | | | | | | | | | | | | | - Mirjam Keßler
- Department of Internal Medicine II, Ulm University Heart Center, 89081 Ulm, Germany; (M.G.); (K.H.); (D.F.); (M.P.); (L.M.S.); (S.M.); (W.R.)
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Gröger M, Zeiml KP, Schneider LM, Rottbauer W, Markovic S, Keßler M. Impact of concomitant tricuspid regurgitation on outcome after edge-to-edge mitral valve repair. Catheter Cardiovasc Interv 2023; 102:528-537. [PMID: 37506125 DOI: 10.1002/ccd.30787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/23/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
AIMS To evaluate the impact of tricuspid regurgitation (TR) on echocardiographic and functional outcome after mitral valve transcatheter edge-to-edge-repair (M-TEER). METHODS AND RESULTS A total of 740 patients underwent M-TEER at our center from 2010 to 2021. Patients were analyzed according to severity of concomitant TR at the time of M-TEER procedure: low-grade TR (grade ≤I [trace-mild], 279 patients [37.7%]), moderate TR (grade II, 170 patients [23.0%]) and high-grade TR (grade III-V [severe-torrential], 291 patients [39.3%]). Patients with moderate to high-grade TR had higher morbidity. Procedural success of M-TEER was achieved similarly in all groups (98.2% vs. 97.6% vs. 95.9%, p = 0.22). TR severity decreased rapidly and consistently after M-TEER to only 48.0% of high-grade TR patients after 3 months (p < 0.001) and to 46.8% after 12 months (p = 0.99). High-grade TR patients had significantly higher mortality (21.5% vs. 18.2% vs. 11.1%, p = 0.003) up to 12 months after M-TEER. However, high-grade TR did not independently predict mortality (HR 1.302, 95% CI 0.937-1.810; p = 0.116). Echocardiographic and functional outcome was similar in both secondary and primary MR patients. CONCLUSIONS High-grade concomitant TR did not independently predict adverse outcome following M-TEER. A wait-and-observe approach for these patients is reasonable.
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Affiliation(s)
- Matthias Gröger
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | - Katharina P Zeiml
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | - Sinisa Markovic
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
| | - Mirjam Keßler
- Department of Internal Medicine II, Ulm University Hospital, Ulm, Germany
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Felbel D, Bozic F, Mayer B, Krohn-Grimberghe M, Paukovitsch M, d’Almeida S, Mörike J, Gonska B, Imhof A, Buckert D, Rottbauer W, Markovic S, Stephan T. Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease-a meta-analysis. Front Cardiovasc Med 2023; 10:1213992. [PMID: 37671137 PMCID: PMC10475729 DOI: 10.3389/fcvm.2023.1213992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Background Small-vessel coronary artery disease (CAD) is frequently observed in coronary angiography and linked to a higher risk of lesion failure and restenosis. Currently, treatment of small vessels is not standardized while having drug-eluting stents (DES) or drug-coated balloons (DCBs) as possible strategies. We aimed to conduct a meta-analytic approach to assess the effectiveness of treatment strategies and outcomes for small-vessel CAD. Methods Comprehensive literature search was conducted using PubMed, Embase, MEDLINE, and Cochrane Library databases to identify studies reporting treatment strategies of small-vessel CAD with a reference diameter of ≤3.0 mm. Target lesion revascularization (TLR), target lesion thrombosis, all-cause death, myocardial infarction (MI), and major adverse cardiac events (MACE) were defined as clinical outcomes. Outcomes from single-arm and randomized studies based on measures by means of their corresponding 95% confidence intervals (CI) were compared using a meta-analytic approach. Statistical significance was assumed if CIs did not overlap. Results Thirty-seven eligible studies with a total of 31,835 patients with small-vessel CAD were included in the present analysis. Among those, 28,147 patients were treated with DES (24 studies) and 3,299 patients with DCB (18 studies). Common baseline characteristics were equally distributed in the different studies. TLR rate was 4% in both treatment strategies [0.04; 95% CI 0.03-0.05 (DES) vs. 0.03-0.07 (DCB)]. MI occurred in 3% of patients receiving DES and in 2% treated with DCB [0.03 (0.02-0.04) vs. 0.02 (0.01-0.03)]. All-cause mortality was 3% in the DES group [0.03 (0.02-0.05)] compared with 1% in the DCB group [0.01 (0.00-0.03)]. Approximately 9% of patients with DES developed MACE vs. 4% of patients with DCB [0.09 (0.07-0.10) vs. 0.04 (0.02-0.08)]. Meta-regression analysis did not show a significant impact of reference vessel diameter on outcomes. Conclusion This large meta-analytic approach demonstrates similar clinical and angiographic results between treatment strategies with DES and DCB in small-vessel CAD. Therefore, DES may be waived in small coronary arteries when PCI is performed with DCB.
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Affiliation(s)
- Dominik Felbel
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Filip Bozic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Marvin Krohn-Grimberghe
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Michael Paukovitsch
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sascha d’Almeida
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Johannes Mörike
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Birgid Gonska
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Armin Imhof
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Tilman Stephan
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
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d’Almeida S, Markovic S, Hermann P, Bracht H, Peifer J, Ettrich TJ, Imhof A, Zhou S, Weiss M, Viardot A, Rottbauer W, Dahme T. Thromboembolism after Astra Zeneca COVID-19 vaccine: Not always PF4- antibody mediated. Hum Vaccin Immunother 2023; 19:2252239. [PMID: 37655367 PMCID: PMC10478733 DOI: 10.1080/21645515.2023.2252239] [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: 05/08/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
Cases of thromboembolic events in 2021 flared up the discussion about the safety of Astra Zeneca's AZD1222 vaccine. We hereby report three cases of pulmonary embolism (PE), one case of extended portal vein thrombosis, and one case of combined portal vein thrombosis and PE within 2 weeks after vaccination with the Astra Zeneca AZD1222 vaccine in a 60-year-old, a 50-year old, a 33-year-old, a 30-year old, and a 40-year-old male in that year. All patients were healthy before. In three patients, we observed thrombocytopenia and to some extent unusually low antibody levels for the Spike Protein (S-protein), while the other two had normal thrombocyte counts. Only one patient had anti-platelet factor 4 (PF4)-antibodies detectable as it has been described in the "heparin-induced thrombocytopenia (HIT)-like" disease of "vaccine-induced prothrombotic immune thrombocytopenia" (VIPIT) and we therefore assume that heterogeneous mechanisms led to PE. Therefore, we advise to collect and report more cases, in order to determine the age-related risks of vaccination balanced against the benefits of immunity to SARS-COV-2 for the AZD1222 vaccine in order to gain knowledge for the next pandemic.
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Affiliation(s)
- Sascha d’Almeida
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Sinisa Markovic
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Patrick Hermann
- Department of Medicine I, Ulm University Medical Center, Ulm, Germany
| | - Hendrik Bracht
- Central Emergency Department, Ulm University Medical Center, Ulm, Germany
| | - Johannes Peifer
- Central Emergency Department, Ulm University Medical Center, Ulm, Germany
| | - Thomas J. Ettrich
- Department of Medicine I, Ulm University Medical Center, Ulm, Germany
| | - Armin Imhof
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Shaoxia Zhou
- Department of Laboratory Medicine, Ulm University Medical Center, Ulm, Germany
| | - Manfred Weiss
- Department of Anesthesiology and Intensive Care, Ulm University Medical Center, Ulm, Germany
| | - Andreas Viardot
- Department of Medicine III, Ulm University Medical Center, Ulm, Germany
| | | | - Tillman Dahme
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
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Paukovitsch M, Felbel D, Jandek M, Keßler M, Rottbauer W, Markovic S, Groeger M, Tadic M, Schneider LM. Transcatheter edge-to-edge-repair of functional mitral regurgitation induces significant remodeling of mitral annular geometry. Front Cardiovasc Med 2023; 10:1143702. [PMID: 37424917 PMCID: PMC10326617 DOI: 10.3389/fcvm.2023.1143702] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Abstract
Background Mitral annular alterations in the context of heart failure often lead to severe functional mitral regurgitation (FMR), which should be treated with transcatheter edge-to-edge repair (M-TEER) according to current guidelines. M-TEER's effects on mitral valve (MV) annular remodeling have not been well elucidated. Methods 141 consecutive patients undergoing M-TEER for treatment of FMR were included in this investigation. Comprehensive intraprocedural transesophageal echocardiography was used to assess the acute effects of M-TEER on annular geometry. Results Average patient age was 76.2 ± 9.6 years and 46.1% were female patients. LV ejection fraction was reduced (37.0% ± 13.7%) and all patients had mitral regurgitation (MR) grade ≥III. M-TEER achieved optimal MR reduction (MR ≤ I) in 78.6% of patients. Mitral annular anterior-posterior diameters (A-Pd) were reduced by -6.2% ± 9.5% on average, whereas anterolateral-posteromedial diameters increased (3.7% ± 8.9%). Overall, a reduction in MV annular areas was observed (2D: -1.8% ± 13.1%; 3D: -2.7% ± 13.7%), which strongly correlated with A-Pd reduction (2D: r = 0.6, p < 0.01; 3D: r = 0.65, p < 0.01). Patients that achieved A-Pd reduction above the median (≥6.3%) showed significantly lower rates of the composite endpoint rehospitalization for heart failure or all-cause mortality than those with less A-Pd reduction (9.9% vs. 28.6%, p = 0.037, log-rank p = 0.039). Furthermore, patients reaching the composite endpoint had an increase in annular area (2D: 3.0% ± 15.4%; 3D: 1.9% ± 15.3%), whereas those not reaching the endpoint showed a decrease (2D: -2.7% ± 12.4%; 3D: -3.6% ± 13.3%), although residual MR after M-TEER was similar between these groups (p = 0.57). In multivariate Cox regression adjusted for baseline MR, A-Pd reduction ≥6.3% remained a significant predictor of the combined endpoint (OR: 0.35, 95% CI: 0.14-0.85, p = 0.02). Conclusion Our findings indicate that effects of M-TEER in FMR are not limited to MR reduction, but also have significant impact on annular geometry. Moreover, A-Pd reduction, which mediates annular remodeling, has a significant impact on clinical outcome independent of residual MR.
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Paukovitsch M, Felbel D, Groeger M, Rottbauer W, Markovic S, Tadic M, Schneider LM, Keßler M. Diabetes Mellitus in Patients Undergoing Mitral Transcatheter Edge-to-Edge Repair-A Decade Experience in 1000+ Patients. J Clin Med 2023; 12:jcm12103502. [PMID: 37240610 DOI: 10.3390/jcm12103502] [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: 04/16/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Diabetes mellitus worsens outcomes in patients suffering from heart disease undergoing cardiac procedures. OBJECTIVES To investigate the impact of diabetes in patients undergoing mitral transcatheter edge-to-edge repair (M-TEER). METHODS 1118 patients treated with M-TEER for functional (FMR) and degenerative (DMR) mitral regurgitation (MR) between 2010 and 2021 were analyzed using the combined endpoint of death/rehospitalization for heart failure (HFH). RESULTS Among diabetics (N = 306; 27.4%), comorbidities such as coronary artery disease (75.2% vs. 62.7%; p < 0.001) and progressed (stage III/IV) chronic kidney disease (79.5% vs. 72.6%; p = 0.018) were more frequent. The rate of FMR was higher in diabetics (71.9% vs. 64.5%; p < 0.001). The combined endpoint occurred more frequently in diabetics (40.2% vs. 35.6%; log-rank = 0.035). While no difference was observed in FMR patients (36.8% vs. 37.6%; log-rank p = 0.710), rates of the combined endpoint differed significantly between diabetics and non-diabetics in DMR patients (48.8% vs. 31.9%; log-rank p = 0.001) only. However, diabetes did neither predict the combined endpoint in the overall (OR: 0.97; 95% CI 0.65-1.45; p = 0.890) nor in the DMR cohort (OR: 0.73; 95% CI 0.35-1.51; p = 0.389). Among diabetics treated with M-TEER, troponin (OR: 2.32; 95% CI 1.3-3.7; p = 0.002) and estimated glomerular filtration rate (OR: 0.52; 95% CI 0.3-0.88; p = 0.018) independently predicted the combined endpoint. CONCLUSIONS Diabetes is associated with adverse outcomes after M-TEER, particularly in DMR patients. However, diabetes does not predict the combined endpoint. In diabetics undergoing M-TEER, biochemical markers associated with organ function and damage independently predict the combined endpoint of death and rehospitalization.
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Affiliation(s)
- Michael Paukovitsch
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Dominik Felbel
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Matthias Groeger
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Wolfgang Rottbauer
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Sinisa Markovic
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Marijana Tadic
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | | | - Mirjam Keßler
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
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Felbel D, Paukovitsch M, Förg R, Stephan T, Mayer B, Keßler M, Tadic M, Dahme T, Rottbauer W, Markovic S, Schneider L. Comparison of transcatheter edge-to-edge and surgical repair in patients with functional mitral regurgitation using a meta-analytic approach. Front Cardiovasc Med 2023; 9:1063070. [PMID: 36762304 PMCID: PMC9905105 DOI: 10.3389/fcvm.2022.1063070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023] Open
Abstract
Background Evidence regarding favorable treatment of patients with functional mitral regurgitation (FMR) using transcatheter edge-to-edge repair (TEER) is constantly growing. However, there is only few data directly comparing TEER and surgical mitral valve repair (SMVr). Aims To compare baseline characteristics, short-term and 1-year outcomes in FMR patients undergoing mitral valve (MV) TEER or SMVr using a meta-analytic approach. Methods Systematic database search identified 1,703 studies reporting on TEER or SMVr for treatment of FMR between January 2010 and December 2020. A meta-analytic approach was used to compare outcomes from single-arm and randomized studies based on measures by means of their corresponding 95% confidence intervals (CI). Statistical significance was assumed if CIs did not overlap. A total of 21 TEER and 37 SMVr studies comprising 4,304 and 3,983 patients were included. Results Patients in the TEER cohort presented with higher age (72.0 ± 1.7 vs. 64.7 ± 4.7 years, p < 0.001), greater burden of comorbidities like hypertension (p < 0.001), atrial fibrillation (p < 0.001), lung disease (p < 0.001) and chronic renal disease (p = 0.005) as well as poorer left ventricular ejection fraction (30.9 ± 5.7 vs. 36.6 ± 5.3%, p < 0.001). In-hospital mortality was significantly lower with TEER [3% (95%-CI 0.02-0.03) vs. 5% (95%-CI 0.04-0.07)] and 1-year mortality did not differ significantly [18% (95%-CI 0.15-0.21) vs. 11% (0.07-0.18)]. NYHA [1.06 (95%-CI 0.87-1.26) vs. 1.15 (0.74-1.56)] and MR reduction [1.74 (95%-CI 1.52-1.97) vs. 2.08 (1.57-2.59)] were comparable between both cohorts. Conclusion Despite considerably higher age and comorbidity burden, in-hospital mortality was significantly lower in FMR patients treated with TEER, whereas a tendency toward increased 1-year mortality was observed in this high-risk population. In terms of functional status and MR grade reduction, comparable 1-year results were achieved.
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Affiliation(s)
- D. Felbel
- Department of Cardiology, Angiology, Pneumology and Intensive Care, University Hospital Ulm, Ulm, Germany
| | - M. Paukovitsch
- Department of Cardiology, Angiology, Pneumology and Intensive Care, University Hospital Ulm, Ulm, Germany
| | - R. Förg
- Department of Cardiology, Angiology, Pneumology and Intensive Care, University Hospital Ulm, Ulm, Germany
| | - T. Stephan
- Department of Cardiology, Angiology, Pneumology and Intensive Care, University Hospital Ulm, Ulm, Germany
| | - B. Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - M. Keßler
- Department of Cardiology, Angiology, Pneumology and Intensive Care, University Hospital Ulm, Ulm, Germany
| | - M. Tadic
- Department of Cardiology, Angiology, Pneumology and Intensive Care, University Hospital Ulm, Ulm, Germany
| | - T. Dahme
- Department of Cardiology, Angiology, Pneumology and Intensive Care, University Hospital Ulm, Ulm, Germany
| | - W. Rottbauer
- Department of Cardiology, Angiology, Pneumology and Intensive Care, University Hospital Ulm, Ulm, Germany
| | - S. Markovic
- Department of Cardiology, Angiology, Pneumology and Intensive Care, University Hospital Ulm, Ulm, Germany
| | - L. Schneider
- Department of Cardiology, Angiology, Pneumology and Intensive Care, University Hospital Ulm, Ulm, Germany,*Correspondence: L. Schneider,
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Schneider L, Markovic S, Mueller K, Felbel D, Gerçek M, Friedrichs K, Stolz L, Rudolph V, Hausleiter J, Rottbauer W, Keßler M. Mitral Valve Transcatheter Edge-to-Edge Repair Using MitraClip or PASCAL: A Multicenter Propensity Score-Matched Comparison. JACC Cardiovasc Interv 2022; 15:2554-2567. [PMID: 36543450 DOI: 10.1016/j.jcin.2022.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Since its introduction in 2003, Abbott's MitraClip (MC) has become the most established catheter-based treatment for mitral regurgitation (MR). Recent approval of Edwards Lifescience's PASCAL device has extended the field of TEER. OBJECTIVES The aim of this retrospective multicenter study was to compare the PASCAL and MC regarding procedural results and short- and long-term outcomes after mitral valve transcatheter edge-to-edge repair (TEER). METHODS Data from 3 high-volume centers were analyzed. The primary endpoint was residual MR at discharge. Secondary endpoints were technical success, MR reduction, and 30-day mortality. After 1 year, all-cause mortality and residual MR were reported. RESULTS A total of 412 patients (216 MC, 196 PASCAL) treated between 2018 and 2020 were included. A total of 184 patients (92 in each treatment group) remained after propensity score matching. The rate of baseline MR ≥3 was 98.9% in both groups (P = 1.00). Both TEER systems achieved equally high technical success rates (97.8%; P = 1.00), resulting in residual MR ≤1 in 69.6% vs 77.1% of patients (P = 0.24) and MR reduction by ≥2 grades in 83.7% vs 92.4% of patients (P = 0.13) using the MC and PASCAL, respectively. Thirty-day mortality was 1.1% in both cohorts (P = 0.98), and 1-year follow-up showed similar MR reductions (residual MR ≤1, 78.0% with MC vs 82.3% with PASCAL; P = 0.70) and comparable all-cause mortality (14.1% with MC vs 6.5% with PASCAL; P = 0.14). In multivariate regression analysis, Society of Thoracic Surgeons score independently correlated with an optimal result (MR ≤1), while device choice did not show a significant impact. CONCLUSIONS In this retrospective multicenter study, the established MC and the novel PASCAL mitral valve TEER systems were safe and offered excellent performance with comparable short- and long-term outcomes.
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Affiliation(s)
| | - Sinisa Markovic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | - Katharina Mueller
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | - Dominik Felbel
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | - Muhammed Gerçek
- Herz- und Diabetes Zentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Kai Friedrichs
- Herz- und Diabetes Zentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Volker Rudolph
- Herz- und Diabetes Zentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Mirjam Keßler
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany.
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Felbel D, d’Almeida S, Rattka M, Andreß S, Reischmann K, Mayer B, Imhof A, Buckert D, Rottbauer W, Markovic S, Stephan T. Deferral of Non-Emergency Cardiovascular Interventions Triggers Increased Cardiac Emergency Admissions-Analysis of the COVID-19 Related Lockdown. Int J Environ Res Public Health 2022; 19:16579. [PMID: 36554458 PMCID: PMC9778764 DOI: 10.3390/ijerph192416579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Data on the relation between non-emergency and emergency cardiac admission rates during the COVID-19 lockdown and post-lockdown period are sparse. METHODS Consecutive cardiac patients admitted to our tertiary heart center between 1 January and 30 June 2020 were included. The observation period of 6 months was analyzed in total and divided into three defined time periods: the pre-lockdown (1 January-19 March), lockdown (20 March-19 April), and post-lockdown (20 April-30 June) period. These were compared to the reference periods 2019 and 2022 using daily admission rates and incidence rate ratios (IRR). RESULTS Over the observation period from 1 January to 30 June, cardiac admissions (including non-emergency and emergency) were comparable between 2019, 2020, and 2022 (n = 2889, n = 2952, n = 2956; p = 0.845). However, when compared to the reference period 2019, non-emergency admissions decreased in 2020 (1364 vs. 1663; p = 0.02), while emergency admissions significantly increased (1588 vs. 1226; p < 0.001). Further analysis of the lockdown period revealed that non-emergency admissions dropped by 82% (IRR 0.18; 95%-CI 0.14-0.24; p < 0.001) and 42% fewer invasive cardiac interventions were performed (p < 0.001), whereas the post-lockdown period showed a 52% increase of emergency admissions (IRR 1.47; 95%-CI 1.31-1.65; p < 0.001) compared to 2019. CONCLUSIONS We demonstrate a drastic surge of emergency cardiac admissions post-COVID-19 related lockdown suggesting that patients who did not keep their non-emergency appointment had to be admitted as an emergency later on.
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Affiliation(s)
- Dominik Felbel
- Department of Cardiology, Angiology, Pneumology and Intensive Care Medicine, University of Ulm, 89081 Ulm, Germany
| | - Sascha d’Almeida
- Department of Cardiology, Angiology, Pneumology and Intensive Care Medicine, University of Ulm, 89081 Ulm, Germany
| | - Manuel Rattka
- Department of Cardiology, Angiology, Pneumology and Intensive Care Medicine, University of Ulm, 89081 Ulm, Germany
| | - Stefanie Andreß
- Department of Cardiology, Angiology, Pneumology and Intensive Care Medicine, University of Ulm, 89081 Ulm, Germany
| | - Kathrin Reischmann
- Department of Cardiology, Angiology, Pneumology and Intensive Care Medicine, University of Ulm, 89081 Ulm, Germany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, 89075 Ulm, Germany
| | - Armin Imhof
- Department of Cardiology, Angiology, Pneumology and Intensive Care Medicine, University of Ulm, 89081 Ulm, Germany
| | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Intensive Care Medicine, University of Ulm, 89081 Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, Pneumology and Intensive Care Medicine, University of Ulm, 89081 Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology, Pneumology and Intensive Care Medicine, University of Ulm, 89081 Ulm, Germany
| | - Tilman Stephan
- Department of Cardiology, Angiology, Pneumology and Intensive Care Medicine, University of Ulm, 89081 Ulm, Germany
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12
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Bertsche D, Rottbauer W, Rasche V, Buckert D, Markovic S, Metze P, Gonska B, Luo E, Dahme T, Vernikouskaya I, Schneider LM. Computed tomography angiography/magnetic resonance imaging-based preprocedural planning and guidance in the interventional treatment of structural heart disease. Front Cardiovasc Med 2022; 9:931959. [PMID: 36324746 PMCID: PMC9620519 DOI: 10.3389/fcvm.2022.931959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022] Open
Abstract
Preprocedural planning and periprocedural guidance based on image fusion are widely established techniques supporting the interventional treatment of structural heart disease. However, these two techniques are typically used independently. Previous works have already demonstrated the benefits of integrating planning details into image fusion but are limited to a few applications and the availability of the proprietary tools used. We propose a vendor-independent approach to integrate planning details into periprocedural image fusion facilitating guidance during interventional treatment. In this work, we demonstrate the feasibility of integrating planning details derived from computer tomography and magnetic resonance imaging into periprocedural image fusion with open-source and commercially established tools. The integration of preprocedural planning details into periprocedural image fusion has the potential to support safe and efficient interventional treatment of structural heart disease.
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13
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Groeger M, Zeiml K, Scheffler JK, Schoesser F, Schneider LM, Rottbauer W, Markovic S, Kessler M. Edge-to-edge mitral valve repair improves concomitant high-grade tricuspid regurgitation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mitral regurgitation (MR) and tricuspid regurgitation (TR) often occur simultaneously and symptoms of biventricular heart failure can overlap. There is currently no consensus on the management of combined MR and TR.
Purpose
To evaluate the impact of TR on echocardiographic and functional outcome after M-TEER.
Methods
740 patients underwent M-TEER for moderate-to-severe MR at our center from 2010 to 2021. Patients were analyzed according to severity of concomitant TR: low-grade TR (grade ≤ I (trace - mild)), moderate TR (grade II) and high-grade TR (grade III - V (severe - torrential)). After M-TEER, patients were followed up for 12 months and their echocardiographic and functional outcome was evaluated.
Results
Low-grade TR was present in 279 patients (37.7%), moderate TR in 170 patients (23.0%) and high-grade TR in 291 patients (39.3%) at the time of M-TEER procedure. Patients with moderate to high-grade TR had higher morbidity resulting in higher EuroSCORE II and STS-Score. At baseline more patients had MR grade ≥III in the high-grade TR group (92.8% vs. 87.1% in the low-grade TR group; p=0.023).
Procedural success of M-TEER was achieved similarly in all groups (98.2% vs. 97.6% vs. 95.9%, p=0.22). At discharge 87.6% of patients with low-grade TR and 80.9% of patients with high-grade TR had residual MR grade ≤I (p=0.036). Residual MR grade ≥III was present in 6.0% of low-grade TR patients and 10.5% of high-grade TR patients at discharge (p=0.062). 3 months after M-TEER residual MR ≥III increased to 9.4% vs. 13.4% (p=0.23) and after 12 months further increased to 12.3% vs. 15.3%, respectively (p=0.52).
TR grade decreased rapidly and consistently after M-TEER. 3 months after the procedure only 48.0% of high-grade TR patients still had TR grade ≥III (p<0.001). After 12 months this proportion declined to 46.8% (p=0.99).
High-grade TR patients had significantly higher mortality (21.5% vs. 18.2% vs. 11.1%, p=0.003) up to 12 months after M-TEER. However, TR-grade ≥III did not independently predict mortality (HR 1.326, 95% CI 0.623–2.824, p=0.46).
Conclusion
M-TEER patients with concomitant moderate to high-grade TR had higher morbidity at baseline compared to low-grade TR patients. M-TEER was safe and effective in MR reduction independent of concomitant TR severity. However, high-grade TR patients had an increased risk for mortality after M-TEER, but high-grade TR did not independently predict adverse outcome. After M-TEER TR grade decreased rapidly and significantly in the high-grade TR group.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - K Zeiml
- University of Ulm , Ulm , Germany
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14
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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Nita N, Schneider L, Dahme T, Markovic S, Keßler M, Rottbauer W, Tadic M. Trends in Transcatheter Edge-to-Edge Mitral Valve Repair Over a Decade: Data From the MiTra ULM Registry. Front Cardiovasc Med 2022; 9:850356. [PMID: 35350535 PMCID: PMC8957866 DOI: 10.3389/fcvm.2022.850356] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/07/2022] [Accepted: 01/21/2022] [Indexed: 12/30/2022] Open
Abstract
Objective This study sought to determine the potential change in trends in the baseline characteristics of patients with symptomatic severe mitral regurgitation who underwent transcatheter edge-to-edge mitral valve repair (M-TEER) over the last decade in a high-volume center. Methodology The investigation included 942 symptomatic patients with moderate-to-severe and severe mitral regurgitation who underwent transcatheter edge-to-edge repair (TEER) at our institution between January 2010 and March 2021. Patients were divided into quintiles and compared separately. Results Patients treated in the last quintile had significantly lower surgical risk (Euro Score 7.2 ± 6.8% in the last quintile vs. 10.9 ± 9.4% in the first quintile, p < 0.001), better New York Heart Association (NYHA) status (NYHA IV 14% in the last quintile vs. 40% in the first quintile, p < 0.001), lower NT-pro-BNP, and smaller left ventricle diameter than patients who were treated in the first quintile. There was no difference in age between quintiles. However, an invasive hemodynamic assessment did not show significant changes over the last decade (sPAP 51.35 ± 16.2 mmHg in the first quintile vs. 51.02 ± 14.5 mmHg in the last quintile, p = 0.90, pulmonary capillary wedge V wave 30.7 ± 14.8 mmHg in the first quintile vs. 27.4 ± 10.3 mmHg in the last quintile, p = 0.40). There is a significant trend of a gradually increasing proportion of patients with degenerative mitral regurgitation (MR) over the last 10 years (p < 0.001). The experience gained in the M-TEER procedure brought a significant reduction in fluoroscopy time and hospitalization duration. Medical therapy significantly changed over the last decade in terms of higher use of angiotensin receptor blockers (ARBs), lower use of angiotensin-converting enzyme inhibitors (ACEIs), and the introduction of angiotensin receptor-neprilysin inhibitors (ARNIs). Conclusion Patients undergoing the M-TEER procedure nowadays have lower surgical risk and are treated before they develop a significant left ventricular (LV) remodeling than before. The increasing expertise on the procedure over the last decade led to a rising number of patients with complex degenerative pathology being treated.
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16
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Stephan T, Gierl MT, Felbel D, Rattka M, Rottbauer W, Gonska B, Markovic S. Vascular Access-Site Choice and Outcomes in Patients With Previous Coronary Artery Bypass Surgery Undergoing Coronary Catheterization in a High-Volume Transradial Center. J Invasive Cardiol 2022; 34:E237-E248. [PMID: 35235530] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Transradial access for coronary angiography was observed to be superior to femoral access. Nevertheless, femoral artery access is still frequently used, especially in challenging subgroups with high procedural complexity, like patients with previous coronary artery bypass grafting (CABG). PURPOSE We analyzed access-site choice and outcomes of CABG patients undergoing coronary catheterization in different clinical settings. METHODS A total of 1206 consecutive CABG patients undergoing coronary angiography and intervention were included in this study. Procedural and clinical outcomes were compared between transradial and transfemoral access. Multivariate logistic regression analysis was performed to identify predictors of access-site choice. RESULTS Coronary catheterization was performed via radial access in 753 patients (63.1%) and via femoral access in 442 patients (36.9%). During the study period, femoral artery utilization dropped from 55.2% to a minimum of 28.2% per year (P<.01). Short stature (odds ratio [OR], 1.62; P<.01), peripheral artery disease (OR, 1.42; P=.04), cardiopulmonary resuscitation (CPR) (OR, 4.17; P<.001), ST-segment elevation myocardial infarction (STEMI) (OR, 2.56; P=.01), and coexisting left and right internal mammary artery (LIMA/RIMA) bypass grafts (OR, 2.67; P<.001) were independently associated with femoral access-site choice. Study outcomes including access-site complications (4.3% vs 1.6%; P<.01) as well as short- and long-term mortality (30-day mortality: 6.8% vs 2.0%; hazard ratio, 3.52; 95% confidence interval, 1.84-6.70; P<.001) were more likely to occur with femoral access. Length of stay was shorter in the radial cohort (3.7 ± 5.1 days vs 5.3 ± 7.2 days; P<.001). CONCLUSION Radial access appears to be favorable even in complex CABG patients. Although radial access was set as the standard vascular approach, femoral access was chosen in one-third of all patients. Independent predictors for femoral access were short stature, peripheral artery disease, acute settings like CPR and STEMI, as well as coexisting LIMA and RIMA grafts.
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Affiliation(s)
| | | | | | | | | | | | - Sinisa Markovic
- University Hospital Ulm, Department of Cardiology, Angiology and Pneumology, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
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17
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Mangner N, Farah A, Ohlow MA, Möbius-Winkler S, Weilenmann D, Wöhrle J, Linke A, Stachel G, Markovic S, Leibundgut G, Rickenbacher P, Cattaneo M, Gilgen N, Kaiser C, Scheller B, Jeger RV. Safety and Efficacy of Drug-Coated Balloons Versus Drug-Eluting Stents in Acute Coronary Syndromes: A Prespecified Analysis of BASKET-SMALL 2. Circ Cardiovasc Interv 2022; 15:e011325. [PMID: 35000455 DOI: 10.1161/circinterventions.121.011325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drug-coated balloons (DCBs) are an established treatment strategy for coronary artery disease. Randomized data on the application of DCBs in patients with an acute coronary syndrome (ACS) are limited. We evaluated the impact of clinical presentation (ACS versus chronic coronary syndrome) on clinical outcomes in patients undergoing DCB or drug-eluting stent (DES) treatment in a prespecified analysis of the BASKET-SMALL 2 trial (Basel Kosten Effektivitäts Trial-Drug-Coated Balloons Versus Drug-Eluting Stents in Small Vessel Interventions). METHODS BASKET-SMALL 2 randomized 758 patients with small vessel coronary artery disease to DCB or DES treatment and followed them for 3 years regarding major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and target vessel revascularization). RESULTS Among 758 patients, 214 patients (28.2%) presented with an ACS (15 patients [7%], ST-segment-elevation myocardial infarction; 109 patients [50.9%], non-ST-segment-elevation myocardial infarction; 90 patients [42.1%], unstable angina pectoris). At 1-year follow-up, there was no significant difference in the incidence of the primary end point by randomized treatment in patients with ACS (hazard ratio, 0.50 [95% CI, 0.19-1.26] for DCB versus DES) or chronic coronary syndrome (hazard ratio, 1.29 [95% CI, 0.67-2.47] for DCB versus DES). There was no significant interaction between clinical presentation and treatment effect (P for interaction, 0.088). For cardiac death (P for interaction, 0.049) and nonfatal myocardial infarction (P for interaction, 0.010), a significant interaction between clinical presentation and treatment was seen at 1 year with lower rates of these secondary end points in patients with ACS treated by DCB. At 3 years, there were similar major adverse cardiac event rates throughout groups without significant interaction between clinical presentation and treatment (P for interaction, 0.301). All-cause mortality was higher in ACS compared with chronic coronary syndrome; however, there was no difference between DCB and DES irrespective of clinical presentation. CONCLUSIONS In this subgroup analysis of the BASKET-SMALL 2 trial, there was no interaction between indication for percutaneous coronary intervention (acute versus chronic coronary syndrome) and treatment effect of DCB versus DES in patients with small vessel coronary artery disease. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01574534.
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Affiliation(s)
- Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Germany (N.M., A.L.)
| | - Ahmed Farah
- Department of Internal Medicine III, Knappschaftskrankenhaus, Klinikum Westfalen, Dortmund, Germany (A.F.)
| | - Marc-Alexander Ohlow
- Department of Cardiology and Intensive Care, SRH Wald-Klinikum, Gera, Germany (M.-A.O.)
| | | | - Daniel Weilenmann
- Department of Cardiology, Cantonal Hospital St. Gallen, Switzerland (D.W.)
| | - Jochen Wöhrle
- Department of Cardiology and Intensive Care, Medizin Campus Bodensee, Friedrichshafen, Germany (J.W.)
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Germany (N.M., A.L.).,Dresden Cardiovascular Research Institute and Core Laboratories GmbH, Germany (A.L.)
| | - Georg Stachel
- Department of Cardiology, Heart Center Leipzig, University Hospital, Germany (G.S.)
| | - Sinisa Markovic
- Department of Internal Medicine II, University Hospital Ulm, Germany (S.M.)
| | - Gregor Leibundgut
- Department of Cardiology, Cantonal Hospital Baselland, Liestal, Switzerland (G.L.)
| | - Peter Rickenbacher
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (P.R., N.G., C.K., R.V.J.)
| | - Marco Cattaneo
- Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland (M.C.)
| | - Nicole Gilgen
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (P.R., N.G., C.K., R.V.J.)
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (P.R., N.G., C.K., R.V.J.)
| | - Bruno Scheller
- Department of Cardiology, Angiology and Intensive Care, University of Saarland, Homburg, Germany (B.S.)
| | - Raban V Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (P.R., N.G., C.K., R.V.J.)
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Pott A, Wirth H, Teumer Y, Weinmann K, Baumhardt M, Schweizer C, Markovic S, Buckert D, Bothner C, Rottbauer W, Dahme T. Predicting Phrenic Nerve Palsy in Patients Undergoing Atrial Fibrillation Ablation With the Cryoballoon-Does Sex Matter? Front Cardiovasc Med 2022; 8:746820. [PMID: 34970602 PMCID: PMC8712427 DOI: 10.3389/fcvm.2021.746820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Phrenicus nerve palsy (PNP) is a typical complication during pulmonary vein isolation (PVI) using the cryoballoon with the ominous potential to counteract the clinical benefit of restored sinus rhythm. According to current evidence incidence of PNP is about 5–10% of patients undergoing Cryo-PVI and is more frequent during ablation of the RSPV compared to the RIPV. However, information on patient specific characteristics predicting PNP and long-term outcome of patients suffering from this adverse event is sparse. Aim of the Study: To evaluate procedural and clinical characteristics of AF patients with PNP during cryoballoon PVI compared to patients without PNP. Methods and Results: Between 2013 and 2019 we included 632 consecutive AF patients undergoing PVI with the cryoballoon in our study. 84/632 (13.3%) patients experienced a total number of 89 PNP during the ablation procedure. 75/89 (84%) cryothermal induced PNP recovered until the end of the procedure (transient PNP, tPNP), whereas 14/89 (16%) PNP hold beyond the end of the procedure (non-transient PNP, ntPNP). Using multivariate logistic regression, we found that sex and BMI are strong and independent predictors of cryothermal induced non-transient PNP during cryoballoon PVI with an odds ratio of 3.9 (CI: 95%, 1.1–14.8, p = 0.04) for female gender. Interestingly, all patients (14/14, 100%) with a non-transient PNP experienced complete PNP resolution after a mean recovery time of 68 ± 79 days. Conclusion: Our data indicate for the first time, that female sex and lower BMI are independent predictors for non-transient PNP caused by cryoballoon PVI. Fortunately, during follow up all PNP patients resolved completely with a median recovery time of 35 days.
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Affiliation(s)
- Alexander Pott
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Hagen Wirth
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Yannick Teumer
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Karolina Weinmann
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Michael Baumhardt
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | | | - Sinisa Markovic
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Dominik Buckert
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Carlo Bothner
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | | | - Tillman Dahme
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
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19
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Rattka M, Rottbauer W, Markovic S. Acute Chest Pain Following Parenteral Infusion. Dtsch Arztebl Int 2021; 118:841. [PMID: 35264283 PMCID: PMC8941662 DOI: 10.3238/arztebl.m2021.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Manuel Rattka
- *Universitätsklinik Ulm, Klinik für Innere Medizin II,
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20
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Stephan T, Thoma E, Rattka M, Felbel D, Buckert D, Rottbauer W, Gonska B, Markovic S. Impact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement. BMC Cardiovasc Disord 2021; 21:568. [PMID: 34847875 PMCID: PMC8638523 DOI: 10.1186/s12872-021-02374-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives The aim of the study was to analyze the impact of concomitant coronary artery disease (CAD) assessed by the SYNTAX score (SS) and periprocedural percutaneous coronary intervention (PCI) on outcomes after transcatheter aortic valve replacement (TAVR). Background Due to controversial data regarding the effect of CAD on outcomes after TAVR, proper revascularization strategies remain a matter of debate. Methods 553 patients with severe aortic stenosis undergoing TAVR were included in this study. SS was calculated for each patient at baseline and after PCI. Primary outcome was one-year all-cause mortality. Results 60.2% of patients (N = 333) exhibited CAD with a mean SS of 10.8 ± 8.8. Of those, 120 patients (36.0%) received periprocedural PCI. In the treatment group, mean SS was decreased from 14.9 ± 9.1 to 6.3 ± 6.7. Patients with concomitant CAD suffered more frequently from myocardial infarction (MI) post TAVR compared to those without CAD (2.1% vs. 0.0%; P < 0.01). In the CAD cohort, MI rates were comparable between patients with and without PCI (2.2% vs. 2.5%; P = 0.71). Regarding SS, patients with a residual SS < 8 showed significant lower rates of one-year mortality (9.0% vs. 18.2%; P = 0.016) and MACCE (16.5% vs. 32.2%; P = 0.001). Besides left bundle brunch, predictors for an increased one-year mortality were a residual SS ≥ 8 in the CAD group (OR = 3.17; P = 0.011) and a EuroSCORE ≥ 4% in the entire study population (OR = 2.18; P = 0.017). Conclusion Our results suggest that a residual SS-guided revascularization strategy may improve prognosis after TAVR in patients with concomitant CAD. PCI aiming for a residual SS < 8 was associated with improved one-year clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02374-y.
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Affiliation(s)
- Tilman Stephan
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Eva Thoma
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Manuel Rattka
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dominik Felbel
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Birgid Gonska
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University Hospital Ulm, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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21
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Paukovitsch M, Schneider LM, Reichart C, Nita N, Rottbauer W, Keßler M, Markovic S. Prevalence of iatrogenic atrial septal defects (iASD) after mitral valve (MV) transcatheter edge-to-edge repair (TEER) in the long-term follow-up. Open Heart 2021; 8:openhrt-2021-001732. [PMID: 34702777 PMCID: PMC8549666 DOI: 10.1136/openhrt-2021-001732] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To investigate prevalence of iatrogenic atrial septal defects (iASDs) after mitral valve (MV) transcatheter edge-to-edge repair (TEER) with the MitraClip in the long-term follow-up. BACKGROUND MV TEER requires transseptal puncture using a large 22 F sheath. Prevalence, impact and haemodynamic effects of these iASDs remain unknown in the long-term follow-up. METHODS This prospective study enrolled patients who had undergone first-time TEER at our university hospital between January 2017 and June 2018 for a clinical long-term follow-up study. Prevalence of iASD was investigated 12 months post-TEER using transoesophageal echocardiography (TEE). Study protocol further consisted of transthoracic echocardiography (TTE) and exercise testing. Incidence of all-cause death was compared 12 months post-TEE follow-up. This study was approved by local ethics committee. RESULTS 48 patients participated in clinical follow-up examinations. Median time between TEER and clinical follow-up examination (TEE, TTE, exercise testing) was 19.5 (IQR: 7.0) months after TEER. Persistent iASD was found in 41.7% of patients. TEER was found to be equally effective in reducing MR and clinical symptoms in both groups at baseline as well as follow-up. Procedural fluoroscopy and device times were significantly longer in the iASD group. MR reduction and functional status (New York Heart Association Class, 6 Minute Walking Test distance) were similar in both groups. Nevertheless, a significant decrease in systolic pulmonary artery pressure (sPAP) and significantly smaller atrial diameters were observed in patients with iASD at follow-up. CONCLUSION Prevalence of iASDs after TEER in long-term follow-up was about 41%. Although a significant reduction of sPAP and better left atrial reverse remodelling were accomplished in patients with iASD, clinical impact appears low. Manipulation at the atrial septum might play a key role in creating persisting iASD.
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Affiliation(s)
- Michael Paukovitsch
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Baden-Württemberg, Germany
| | - Leonhard Moritz Schneider
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Baden-Württemberg, Germany
| | - Christine Reichart
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Baden-Württemberg, Germany
| | - Nicoleta Nita
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Baden-Württemberg, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Baden-Württemberg, Germany
| | - Mirjam Keßler
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Baden-Württemberg, Germany
| | - Sinisa Markovic
- Department of Cardiology, University Hospital Ulm Clinic for Internal Medicine II, Ulm, Baden-Württemberg, Germany
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22
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Markovic S, Felbel DF, Kessler MK, Schneider LMS, Gercek GM, Rudolph VR, Hausleiter JH, Rotblauer WR. Percutaneous edge-to-edge therapy with PASCAL or MitraClip: a multicenter propensity score matched comparison. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1654] [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
The MitraClip is the worldwide established transcatheter edge-to-edge repair system with over 100,000 treated patients. The recently approved PASCAL repair system is well adopted in the field of percutaneous mitral regurgitation (MR) treatment with growing acceptance both in mitral and tricuspid valves. The aim of this retrospective multicenter study was to compare the Edwards' PASCAL System with the Abbott MitraClip System in terms of procedural results and short-term outcome.
Methods
We retrospectively evaluated patient data of three high volume German centers that performed percutaneous edge to edge procedures either with the MitraClip or the PASCAL repair system. Primary endpoint was the amount of MR reduction. Secondary endpoints were residual MR at discharge, technical success, device success and 30-day mortality.
Results
Between 2018 and 2020 a total of 412 procedures were performed in the three centers. 216 cases were performed with the MitraClip compared to 196 procedures done with the PASCAL repair system. Patients were male in 55.6% of the cases (50.5% in the MitraClip cohort compared to 61.2% in the PASCAL cohort, p=0.028), mean Logistic Euro-Score II was 4.42 (3.58 in the MitraClip and 3.23 in the PASCAL cohort, p=0.038) and reduced LVEF beyond 45% was seen in 42.6% of the cases (49.5% in the MitraClip compared to 35.3% in the PASCAL cohort, p=0.004). Severe MR at baseline was seen in 98.5% in the MitraClip cohort compared to 98.6% in the PASCAL cohort, p=0.909). Mean number of implanted devices was 1.41±0.56 in the MitraClip cohort and 1.37±0.55 in the PASCAL cohort (p=0.401). Procedures were successfully conducted with both edge-to-edge systems (device success rate 93.2% in the MitraClip cohort and 94.0% in the PASCAL cohort, p=0.775), leading to comparably good results (final MR ≤2 in 94.4% with the MitraClip compared to 95.9% with the PASCAL system, p=0.448) and very good results (final MR ≤1 in 72.6% in the MitraClip compared to 79.5% in the PASCAL cohort, p=0.102).
After propensity score matching for adjustment of major differences among the two treatment strategies (including age, gender, MR etiology, EROA, Severe MR (III and IV), reduced LVEF and Mitral Valve orifice area) the achieved mean MR reduction remains comparable (2.29±0.82 with the MitraClip compared to 2.46±0.82 with the PASCAL system, p=0.191). In multivariate regression analysis STS Score independently correlates with a very good final result while device choice did not show a significant impact in this cohort.
Conclusion
In this retrospective multicenter study both the MitraClip and PASCAL system performed excellent with comparable procedural success rates. Achieved final average reduction of MR Grade was 2.29±0.82 with the MitraClip and 2.46±0.82 with the PASCAL system.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Markovic
- University of Ulm, Department of Internal Medicine II, Ulm, Germany
| | - D F Felbel
- University of Ulm, Department of Internal Medicine II, Ulm, Germany
| | - M K Kessler
- University of Ulm, Department of Internal Medicine II, Ulm, Germany
| | - L M S Schneider
- University of Ulm, Department of Internal Medicine II, Ulm, Germany
| | - G M Gercek
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - V R Rudolph
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - J H Hausleiter
- Clinic of the University of Munich Großhadern, Munich, Germany
| | - W R Rotblauer
- University of Ulm, Department of Internal Medicine II, Ulm, Germany
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23
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Wild M, Loew K, Boekstegers P, Markovic S, Rosch S, Lurz P, Hausleiter J. Multicentre experience with the transcatheter valve repair system for tricuspid regurgitation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1657] [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
Tricuspid regurgitation (TR) is associated with high morbidity and mortality, but many patients are ineligible for surgical treatment due to age and co-morbidities. As a consequence, transcatheter treatment techniques have evolved over the last years. Leaflet repair is one of the most commonly used techniques and has recently gained commercial approval for dedicated TR treatment. The device offers the possibility for independent leaflet grasping and a central spacer can bridge larger coaptation gaps. The hitherto evidence is mainly based on compassionate use data. This is the first report on commercial use in a multicenter study with a large patient cohort and long-term follow-up.
Purpose
To investigate safety and efficacy of the leaflet repair system in the treatment of TR in a commercial use setting.
Methods
We retrospectively collected clinical and imaging data from all consecutive patients undergoing leaflet repair for TR at four tertiary care centres. A core laboratory analysis of the echocardiographic data has been performed. Baseline, procedural and follow-up data has been included in the analysis.
Results
A total of 155 patients, treated between February 2019 and February 2021 has been included (mean age 77±8 years, 52% female). Mean STS score was 7.7±6.7%. TR was of functional etiology in the majority (82%) of patients and was severe or higher graded in 87% (mean EROA 68±47 mm2). Patients were highly symptomatic with exertional dyspnea NYHA functional class III/IV in 91%. Technical success was achieved in 97% and TR was successfully reduced to ≤2+ in 90% of patients (p<0.001). Three cases of intra-procedural single-leaflet device attachment (SLDA) occurred, and there was one case of access site bleeding requiring emergency surgery. There were no other in-hospital adverse events. Follow-up was available for 120 patients (median follow-up 182, IQR 54–356 days). TR reduction was sustained in most patients with TR ≤2+ in 83% (p<0.001). We found indications for right ventricular (RV) remodeling with a significant decrease of RV end-diastolic diameter (57±8 mm vs. 52±10 m, p<0.001). Dimensions of the inferior vena cava decreased significantly as a sign of less congestion (27±8 mm vs. 23±7 mm, p=0.004). During the follow-up period, 15 patients (10%) died, of which 7 (5%) were of a cardiovascular cause. Symptomatic improvement was significant with 66% of patients in NYHA functional class I or II at follow-up (p<0.001) and an improvement of the 6-meter walking distance (228±120 m vs. 276±121 m, p=0.001).
Conclusion
Transcatheter treatment of TR with the leaflet repair system is feasible and safe. According to our data, technical success rate is high and procedural complications are rare. Patients experienced significant symptomatic improvement at follow-up with echocardiographic sustained TR reduction. Furthermore, there are indications for RV remodeling and reduced congestion.
Funding Acknowledgement
Type of funding sources: None. Improving valve function and symptoms
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Affiliation(s)
- M Wild
- Ludwig Maximilians University Hospital, Cardiology, Munich, Germany
| | - K Loew
- Ludwig Maximilians University Hospital, Cardiology, Munich, Germany
| | - P Boekstegers
- Helios Hospital Siegburg-Bonn, Cardiology, Siegburg, Germany
| | - S Markovic
- University Hospital of Ulm, Cardiology, Ulm, Germany
| | - S Rosch
- Heart Center at University of Leipzig, Cardiology, Leipzig, Germany
| | - P Lurz
- Heart Center at University of Leipzig, Cardiology, Leipzig, Germany
| | - J Hausleiter
- Ludwig Maximilians University Hospital, Cardiology, Munich, Germany
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24
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Groeger M, Zeiml K, Scheffler J, Schoesser F, Schneider L, Rottbauer W, Markovic S, Kessler M. Severe tricuspid regurgitation worsens prognosis outcome after edge-to-edge mitral valve repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1660] [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
Introduction
MitraClip has been well established for treatment of severe mitral regurgitation (MR). MR and tricuspid regurgitation (TR) often occur simultaneously and symptoms of biventricular heart failure can overlap. While it has been shown that TR grade regression can be achieved through repair of MR1, presence of moderate to severe TR can increase all-cause mortality after MitraClip2. There is currently no consensus on the management of combined MR and TR. We evaluated the impact of TR on echocardiographic and functional outcome after MitraClip.
Methods
370 patients underwent MitraClip for moderate to severe MR at our center from 2010 to 2018. Patients were dichotomized into low grade TR (grade <I - I (trace - mild)) and high grade TR (grade III - V (severe - torrential)). Moderate TR (grade II) was excluded. After MitraClip for MR, patients were followed up for 12 months and their echocardiographic and functional outcome was evaluated. Use of diuretic drugs throughout 12 month follow-up was registered.
Results
Low grade TR (<I - I) occurred in 225 patients (67.0%), high grade TR (III - V) was present in 111 patients (33.0%). 34 patients (9.2%) with moderate TR (II) were excluded. Patients with high grade TR had an increased morbidity (higher age, worse renal function, higher prevalence of atrial fibrillation, higher levels of natriuretic peptides, increased left atrial and right heart diameters, higher TR gradient). These patients also received significantly higher doses of torasemid (33.5±36.7 mg vs. 21.6±20.9 mg, p=0.003) and furosemid (163.4±155.5 mg vs. 75.8±72.3 mg, p=0.01). Average grade of MR at baseline was similar in both groups (2.9±0.46 vs. 2.8±0.5, p=0.66).
Procedural success of MR repair was achieved similarly in both groups (96.4% vs. 96.9%, p=0.82) and residual MR grade immediately after device implantation was comparable (p=0.61). However, recurrent MR in the high grade TR group increased during follow up, while MR further decreased in the low grade TR group (3 months: 1.24±0.7 vs. 1.16±0.7, p=0.5; 12 months: 1.46±0.93 vs. 1.12±0.61, p=0.04). Accordingly, use of diuretic drugs after 12 months rose in the high grade TR group while it did not change or even decreased in the low grade TR group (torasemid: 40.2±48.4 mg vs. 24.1±30.0 mg, p=0.04; furosemid: 197.5±251.0 mg vs. 67.1±81.8 mg, p=0.22).
Kaplan-Meier-Analysis showed significantly higher mortality (24.9 vs. 14.1%, p=0.01), higher risk for heart failure induced rehospitalisation (25,4 vs. 12,5%, p=0.005) and for major adverse cardiac and cerebrovascular events (MACCE: 42.3 vs. 29.1%, p=0.008) in the high grade TR group after 12 months.
Conclusion
MitraClip patients for MR with concomitant high grade TR (≥ III) had an increased morbidity at baseline compared to low grade TR patients. By MitraClip comparable reduction of MR was achieved. However, during 12 month follow-up in the high grade TR group recurrent MR occurred more often while use of diuretics increased.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - K Zeiml
- University of Ulm, Ulm, Germany
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25
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Gröger M, Scheffler JK, Schösser F, Schneider LM, Rottbauer W, Markovic S, Keßler M. Percutaneous edge-to-edge mitral valve repair for mitral regurgitation improves heart failure symptoms in heart failure with preserved ejection fraction patients. ESC Heart Fail 2021; 8:5010-5021. [PMID: 34498430 PMCID: PMC8712801 DOI: 10.1002/ehf2.13561] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022] Open
Abstract
Aims Therapeutic options for patients with heart failure with preserved ejection fraction (HFpEF) are sparse. Mitral regurgitation (MR) is a common feature of HFpEF and worsens heart failure symptoms and prognosis. Our study examines the outcome of patients with preserved left ventricular ejection fraction (LVEF) and elevated left atrial (LAP) or left ventricular filling pressures (LVEDP), indicative of HFpEF, after undergoing percutaneous edge‐to‐edge mitral valve repair (pMVR) for moderate–severe MR. Methods and results Two hundred eleven patients with preserved LVEF (>50%), who underwent pMVR, were dichotomized by LAP (< / ≥15 mmHg) and LVEDP (< / ≥16 mmHg). Forty‐nine per cent of patients showed elevated LAP, and LVEDP was elevated in 55%, both indicating HFpEF. Patients with elevated filling pressures featured typical clinical characteristics of HFpEF, higher N‐terminal pro‐brain natriuretic peptide levels (5544.9 pg/mL in high LAP group vs. 3071.7 pg/mL in normal LAP group, P = 0.06; 5061.0 pg/mL in high LVEDP group vs. 3230.3 pg/mL in normal LVEDP group, P = 0.08), and higher prevalence of pulmonary hypertension (mean pulmonary artery pressure 36.4 mmHg in high LAP group vs. 26.3 mmHg in normal LAP group, P < 0.001; 35.2 mmHg in high LVEDP group vs. 29.7 mmHg in normal LVEDP group, P = 0.004) and atrial fibrillation (78.8% in normal LAP group vs. 61.0% in high LAP group, P = 0.04; 75.3% in high LVEDP group vs. 67.5% in normal LVEDP group, P = 0.25). Pre‐treatment MR grade and New York Heart Association (NYHA) class were similar in both normal filling pressure and HFpEF groups. pMVR in HFpEF patients achieved effective heart failure symptom relief comparable with patients with normal filling pressures: significant decrease of MR grade and NYHA class, as well as significant reduction of heart failure hospitalizations 12 months after compared with 12 months before MitraClip. Conclusion Percutaneous edge‐to‐edge mitral valve repair for moderate–severe MR is an effective treatment option for symptom relief in HFpEF patients.
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Affiliation(s)
- Matthias Gröger
- Department of Internal Medicine IIUniversity of UlmAlbert‐Einstein‐Allee 23Ulm89081Germany
| | - Jinny Karin Scheffler
- Department of Internal Medicine IIUniversity of UlmAlbert‐Einstein‐Allee 23Ulm89081Germany
| | - Florian Schösser
- Department of Internal Medicine IIUniversity of UlmAlbert‐Einstein‐Allee 23Ulm89081Germany
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine IIUniversity of UlmAlbert‐Einstein‐Allee 23Ulm89081Germany
| | - Sinisa Markovic
- Department of Internal Medicine IIUniversity of UlmAlbert‐Einstein‐Allee 23Ulm89081Germany
| | - Mirjam Keßler
- Department of Internal Medicine IIUniversity of UlmAlbert‐Einstein‐Allee 23Ulm89081Germany
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Kersten J, Eberhardt N, Prasad V, Keßler M, Markovic S, Mörike J, Nita N, Stephan T, Tadic M, Tesfay T, Rottbauer W, Buckert D. Non-invasive Imaging in Patients With Chronic Total Occlusions of the Coronary Arteries-What Does the Interventionalist Need for Success? Front Cardiovasc Med 2021; 8:713625. [PMID: 34527713 PMCID: PMC8435679 DOI: 10.3389/fcvm.2021.713625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/06/2021] [Indexed: 10/26/2022] Open
Abstract
Chronic total occlusion (CTO) of coronary arteries is a common finding in patients with known or suspected coronary artery disease (CAD). Although tremendous advances have been made in the interventional treatment of CTOs over the past decade, correct patient selection remains an important parameter for achieving optimal results. Non-invasive imaging can make a valuable contribution. Ischemia and viability, two major factors in this regard, can be displayed using echocardiography, single-photon emission tomography, positron emission tomography, computed tomography, and cardiac magnetic resonance imaging. Each has its own strengths and weaknesses. Although most have been studied in patients with CAD in general, there is an increasing number of studies with positive preselectional factors for patients with CTOs. The aim of this review is to provide a structured overview of the current state of pre-interventional imaging for CTOs.
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Affiliation(s)
- Johannes Kersten
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Nina Eberhardt
- Department for Nuclear Medicine, University of Ulm, Ulm, Germany
| | - Vikas Prasad
- Department for Nuclear Medicine, University of Ulm, Ulm, Germany
| | - Mirjam Keßler
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Johannes Mörike
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Nicoleta Nita
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Tilman Stephan
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Marijana Tadic
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | - Temsgen Tesfay
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
| | | | - Dominik Buckert
- Department for Internal Medicine II, University of Ulm, Ulm, Germany
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Schneider LM, Nicoleta N, Schepperle N, Paukovitsch M, Haide U, Feuerabendt S, Keßler M, Rottbauer W, Markovic S. Implications of concomitant obstructive or restrictive pulmonary diseases on functional and clinical results after MitraClip. Catheter Cardiovasc Interv 2021; 98:E1000-E1006. [PMID: 34358406 DOI: 10.1002/ccd.29893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 06/28/2021] [Accepted: 07/16/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We investigated the impact of underlying pulmonary limitations (PL) on symptoms and clinical outcomes after transcatheter mitral valve repair (TMVr). BACKGROUND Patients with pulmonary disease and patients with symptomatic mitral regurgitation (MR) suffer common symptoms like dyspnea and reduced exercise capacity. METHODS Datasets from the TMVr Ulm registry were retrospectively analyzed by a blinded specialist in pneumology. Patients were dichotomized according to an unambiguous manifestation of concomitant pulmonary disease in a PL-group and a non-PL-group and were analyzed regarding baseline characteristics and clinical follow-up. RESULTS Overall, 483 patients were included in the study of which 32.3% (n = 156) showed an underlying pulmonary disease. Patients in the PL-group were similar to patients in the non-PL-group, including Euro SCORE II (8.2 vs. 8.4, p = 0.39), New York Heart Association (NYHA) classification (3.2 ± 0.7 in both groups, p = 0.65) and the incidence of moderate-to-severe or severe MR after TMVr (5.8 vs. 8.3%, p = 0.32). Equal and significant symptom relief after TMVr was experienced in both cohorts according to NYHA functional class (2.24 ± 0.84 vs. 2.24 ± 0.86, p = 0.93) and rate of hospitalization during 2 years of follow-up decreased comparably from 61.1 to 19.3%. However, all-cause mortality for 2 year follow-up was significantly higher in the PL-group compared to the non-PL-group (31.4 vs. 21.4%, p = 0.018). CONCLUSION In patients with MR and concomitant pulmonary disorders, a significant increase of exercise capacity and a significant decrease of rehospitalization rate were observed after TMVr. Nevertheless, all-cause mortality remains significantly increased within a follow-up period of 2 years compared to patients without pulmonary disorders.
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Affiliation(s)
| | - Nita Nicoleta
- Department of Cardiology, Angiology, and Pneumology, University of Ulm, Ulm, Germany
| | - Niklas Schepperle
- Department of Cardiology, Angiology, and Pneumology, University of Ulm, Ulm, Germany
| | - Michael Paukovitsch
- Department of Cardiology, Angiology, and Pneumology, University of Ulm, Ulm, Germany
| | - Uli Haide
- Department of Cardiology, Angiology, and Pneumology, University of Ulm, Ulm, Germany
| | - Sieglinde Feuerabendt
- Department of Cardiology, Angiology, and Pneumology, University of Ulm, Ulm, Germany
| | - Mirjam Keßler
- Department of Cardiology, Angiology, and Pneumology, University of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, and Pneumology, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology, and Pneumology, University of Ulm, Ulm, Germany
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Bertsche D, Keßler M, Buckert D, Schneider LM, Rottbauer W, Rasche V, Markovic S, Vernikouskaya I. How to improve navigation during cardioband transcatheter tricuspid annuloplasty. Eur Heart J Cardiovasc Imaging 2021; 22:611-613. [PMID: 33471099 DOI: 10.1093/ehjci/jeab002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dagmar Bertsche
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Mirjam Keßler
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dominik Buckert
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Leonhard-Moritz Schneider
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Volker Rasche
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Sinisa Markovic
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Ina Vernikouskaya
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Baumhardt M, Dreyhaupt J, Winsauer C, Stuhler L, Thiessen K, Stephan T, Markovic S, Rottbauer W, Imhof A, Rattka M. The Effect of the Lockdown on Patients With Myocardial Infarction During the COVID-19 Pandemic–A Systematic Review and Meta-Analysis. Dtsch Arztebl Int 2021; 118:447-453. [PMID: 34114546 PMCID: PMC8383188 DOI: 10.3238/arztebl.m2021.0253] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/17/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The phenomenon of declining numbers of patients presenting with myocardial infarction was reported from the beginning of the COVID-19 pandemic onward. It was thought that measures introduced to stem the pandemic, such as the lockdown, contributed to this development. However, the data on hospital admissions, delay times, and mortality are not consistent. METHODS Our systematic literature review and meta-analysis embraced studies reporting the number of hospital admissions of patients with ST-segment elevation myocardial infarction (STEMI) and/or non-ST-segment elevation myocardial infarction (NSTEMI) during lockdown episodes. We also collected data on patient- and system-related delay times and on mortality. RESULTS Data from 27 studies on a total of 81 163 patients were included in our meta-analysis. We found that the number of hospital admissions of patients with myocardial infarction was significantly lower during the lockdown than before the pandemic (incidence rate ratio [IRR] = 0.516 [0.403; 0.660], I2 = 98%). This was true both for patients with STEMI (IRR = 0.620 [0.514; 0.746], I2 = 96%) and for patients with NSTEMI (IRR = 0.454 [0.354; 0.584], I2 = 96%). However, we found no significant difference in the time from hospital admission to cardiac catheterization, or in mortality, in relation to the time from symptom onset to first medical contact. CONCLUSION In this study, we have shown that the lockdown due to COVID-19 was associated with a marked decline in the number of hospital admissions of patients with myocardial infarction. As no significant effect on delay times or mortality was observed, it seems that timely medical care continued to be delivered.
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Affiliation(s)
- Michael Baumhardt
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Jens Dreyhaupt
- Institute for Epidemiology and Medical Biometrics, University of Ulm
| | - Claudia Winsauer
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Lina Stuhler
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Kevin Thiessen
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Tilman Stephan
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Sinisa Markovic
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Armin Imhof
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
| | - Manuel Rattka
- Department of Internal Medicine II, Cardiology, Pneumonology and Internal Intensive Care Medicine, University Hospital Ulm
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Stephan T, Felbel D, Rattka M, Rottbauer W, Markovic S. Impact of radial access on contrast-induced acute kidney injury in patients with coronary artery bypass grafts. Cardiovasc Revasc Med 2021; 36:123-131. [PMID: 33992588 DOI: 10.1016/j.carrev.2021.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We investigated the impact of radial access on contrast-induced acute kidney injury (CI-AKI) in patients with coronary artery bypass graft (CABG) undergoing cardiac catheterization. METHODS This retrospective monocenter study included 527 CABG patients undergoing cardiac catheterization via radial (58.1%, N = 306) or femoral access (41.9%, N = 221). Primary outcome measure was CI-AKI defined in accordance with the KDIGO criteria. Independent predictors for CI-AKI were assessed. 1-year mortality was assessed depending on the occurrence of CI-AKI. RESULTS In total, 99 CABG patients (18.8%) developed CI-AKI within 48 h after cardiac catheterization. Compared to patients without CI-AKI, amount of contrast media used (203.1 ± 102.6 ml vs. 204.2 ± 98.2 ml; P = 0.892) as well as procedural times (87.9 ± 44.8 vs. 79.8 ± 37.0; P = 0.190) were similarly. Regarding vascular access, there was no significant difference in the incidence of CI-AKI between radial and femoral approach (19.0% vs. 18.6%; p = 0.907). However, poor left ventricular ejection fraction (odds ratio [OR] = 1.72, P = 0.026), chronic kidney disease (OR = 2.30, P = 0.001) and acute coronary syndrome (OR = 1.64, P = 0.043) were independent predictors for CI-AKI. The occurrence of CI-AKI was significantly associated with an increased 1-year mortality (hazard ratio [HR] = 2.52, P = 0.003). CONCLUSIONS With 18.8%, CI-AKI is a frequent complication in CABG patients undergoing cardiac catheterization. Radial access did not decrease the risk when compared to the femoral approach.
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Affiliation(s)
- Tilman Stephan
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Dominik Felbel
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Manuel Rattka
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany.
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Rattka M, Stuhler L, Winsauer C, Dreyhaupt J, Thiessen K, Baumhardt M, Markovic S, Rottbauer W, Imhof A. Outcomes of Patients With ST-Segment Elevation Myocardial Infarction Admitted During COVID-19 Pandemic Lockdown in Germany - Results of a Single Center Prospective Cohort Study. Front Cardiovasc Med 2021; 8:638954. [PMID: 33959641 PMCID: PMC8093511 DOI: 10.3389/fcvm.2021.638954] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/15/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: Since the outbreak of the COVID-19 pandemic, healthcare professionals reported declining numbers of patients admitted with ST-segment myocardial infarction (STEMI) associated with increased in-hospital morbidity and mortality. However, the effect of lockdown on outcomes of STEMI patients admitted during the COVID-19 crisis has not been prospectively evaluated. Methods: A prospective, observational study on STEMI patients admitted to our tertiary care center during the COVID-19 pandemic was conducted. Outcomes of patients admitted during lockdown were compared to those patients admitted before and after pandemic-related lockdown. Results: A total of 147 patients were enrolled in our study, including 57 patients in the pre-lockdown group (November 1, 2019 to March 20, 2020), 16 patients in the lockdown group (March 21 to April 19, 2020), and 74 patients in the post-lockdown group (April 20 to September 30, 2020). Patients admitted during lockdown had significantly longer time to first medical contact, longer door-to-needle-time, higher serum troponin T levels, worse left ventricular end-diastolic pressure, and higher need for circulatory support. After a median follow-up of 142 days, survival was significantly worse in STEMI patients of the lockdown group (log-rank: p = 0.0035). Conclusions: This is the first prospective study on outcomes of STEMI patients admitted during public lockdown amid the COVID-19 pandemic. Our results suggest that lockdown might deteriorate outcomes of STEMI patients. Public health strategies to constrain spread of COVID-19, such as lockdown, have to be accompanied by distinct public instructions to ensure timely medical care in acute diseases such as STEMI.
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Affiliation(s)
- Manuel Rattka
- Clinic for Internal Medicine II, University Hospital Ulm - Medical Center, Ulm, Germany
| | - Lina Stuhler
- Clinic for Internal Medicine II, University Hospital Ulm - Medical Center, Ulm, Germany
| | - Claudia Winsauer
- Clinic for Internal Medicine II, University Hospital Ulm - Medical Center, Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kevin Thiessen
- Clinic for Internal Medicine II, University Hospital Ulm - Medical Center, Ulm, Germany
| | - Michael Baumhardt
- Clinic for Internal Medicine II, University Hospital Ulm - Medical Center, Ulm, Germany
| | - Sinisa Markovic
- Clinic for Internal Medicine II, University Hospital Ulm - Medical Center, Ulm, Germany
| | - Wolfgang Rottbauer
- Clinic for Internal Medicine II, University Hospital Ulm - Medical Center, Ulm, Germany
| | - Armin Imhof
- Clinic for Internal Medicine II, University Hospital Ulm - Medical Center, Ulm, Germany
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Paukovitsch M, Schepperle N, Pott A, Buckert D, Moritz Schneider L, Keßler M, Reichart C, Rottbauer W, Markovic S. Impact of bleeding complications after transcatheter mitral valve repair. Int J Cardiol Heart Vasc 2021; 32:100707. [PMID: 33457493 PMCID: PMC7797941 DOI: 10.1016/j.ijcha.2020.100707] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Bleeding in the context of cardiac catheterization is frequent and negatively impacts on short- and long-term patient outcome. We evaluated the clinical impact of in-hospital bleeding events after transcatheter mitral valve repair (TMVr) in the long-term follow- up. METHODS 586 consecutive patients treated with first-time TMVr were enrolled in this registry. In-hospital MVARC (Mitral Valve Academic Research Council) bleedings were assessed and patients were grouped according to the incidence of a bleeding event. Multivariate logistic regression was used to identify significant independent predictors of MVARC bleeding. This study received approval by local ethics committee. RESULTS 78 patients (13.3%) suffered from an MVARC bleeding event (Access site-related bleedings: 46.2%; GI tract bleeding: 35.9%; Other bleedings: 17.9%). Among these bleeding subgroups, neither relevant differences in baseline characteristics nor in severity of bleeding events were observed. Despite not being an independent predictor for overall death in the multivariate Cox regression analysis, MVARC bleeding was associated with prolonged hospital stay. The ORBIT bleeding score was the best match to predictors of any MVARC bleeding found in our cohort (c-score overall cohort: 0.68; c-score GI bleeding cohort: 0.72). CONCLUSION MVARC bleedings after TMVr are frequent findings but were only in half of the cases related to the access site. The ORBIT score could be useful for identification of patients at high risk for non-access site bleeding and especially GI bleeding.
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Key Words
- AKI, Acute Kidney Injury
- Bleeding
- CKD, Chronic Kidney Disease
- Chronic kidney disease
- Complications
- HAS-BLED, Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/Alcohol ATRIA, Anticoagulation and Risk factors In Atrial fibrillation
- MC, MitraClip
- MVARC, Mitral Valve Academic Research Council
- NOAC, Novel oral anticoagulant
- ORBIT, Outcomes Registry for Better Informed Treatment of Atrial Fibrillation
- Survival
- TMVr
- TMVr, Transcatheter Mitral Valve Repair
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Jeger RV, Farah A, Ohlow MA, Mangner N, Möbius-Winkler S, Weilenmann D, Wöhrle J, Stachel G, Markovic S, Leibundgut G, Rickenbacher P, Osswald S, Cattaneo M, Gilgen N, Kaiser C, Scheller B. Long-term efficacy and safety of drug-coated balloons versus drug-eluting stents for small coronary artery disease (BASKET-SMALL 2): 3-year follow-up of a randomised, non-inferiority trial. Lancet 2020; 396:1504-1510. [PMID: 33091360 DOI: 10.1016/s0140-6736(20)32173-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [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: 06/26/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the treatment of de-novo coronary small vessel disease, drug-coated balloons (DCBs) are non-inferior to drug-eluting stents (DESs) regarding clinical outcome up to 12 months, but data beyond 1 year is sparse. We aimed to test the long-term efficacy and safety of DCBs regarding clinical endpoints in an all-comer population undergoing percutaneous coronary intervention. METHODS In this prespecified long-term follow-up of a multicentre, randomised, open-label, non-inferiority trial, patients from 14 clinical sites in Germany, Switzerland, and Austria with de-novo lesions in coronary vessels <3 mm and an indication for percutaneous coronary intervention were randomly assigned 1:1 to DCB or second-generation DES and followed over 3 years for major adverse cardiac events (ie, cardiac death, non-fatal myocardial infarction, and target-vessel revascularisation [TVR]), all-cause death, probable or definite stent thrombosis, and major bleeding (Bleeding Academic Research Consortium bleeding type 3-5). Analyses were performed on the full analysis set according to the modified intention-to-treat principle. Dual antiplatelet therapy was recommended for 1 month after DCB and 6 months after DES with stable symptoms, but 12 months with acute coronary syndromes. The study is registered with ClinicalTrials.gov, NCT01574534 and is ongoing. FINDINGS Between April 10, 2012, and Feb 1, 2017, of 883 patients assessed, 758 (86%) patients were randomly assigned to the DCB group (n=382) or the DES group (n=376). The Kaplan-Meier estimate of the rate of major adverse cardiac events was 15% in both the DCB and DES groups (hazard ratio [HR] 0·99, 95% CI 0·68-1·45; p=0·95). The two groups were also very similar concerning the single components of adverse cardiac events: cardiac death (Kaplan-Meier estimate 5% vs 4%, HR 1·29, 95% CI 0·63-2·66; p=0·49), non-fatal myocardial infarction (both Kaplan-Meier estimate 6%, HR 0·82, 95% CI 0·45-1·51; p=0·52), and TVR (both Kaplan-Meier estimate 9%, HR 0·95, 95% CI 0·58-1·56; p=0·83). Rates of all-cause death were very similar in DCB versus DES patients (both Kaplan-Meier estimate 8%, HR 1·05, 95% CI 0·62-1·77; p=0·87). Rates of probable or definite stent thrombosis (Kaplan-Meier estimate 1% vs 2%; HR 0·33, 95% CI 0·07-1·64; p=0·18) and major bleeding (Kaplan-Meier estimate 2% vs 4%, HR 0·43, 95% CI 0·17-1·13; p=0·088) were numerically lower in DCB versus DES, however without reaching significance. INTERPRETATION There is maintained efficacy and safety of DCB versus DES in the treatment of de-novo coronary small vessel disease up to 3 years. FUNDING Swiss National Science Foundation, Basel Cardiovascular Research Foundation, and B Braun Medical.
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Affiliation(s)
- Raban V Jeger
- University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Ahmed Farah
- Knappschaftskrankenhaus, Klinikum Westfalen, Dortmund, Germany
| | | | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | | | | | - Jochen Wöhrle
- Klinikum Friedrichshafen, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Georg Stachel
- Heart Center Leipzig, University Hospital, Leipzig, Germany
| | | | | | | | - Stefan Osswald
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marco Cattaneo
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicole Gilgen
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kaiser
- University Hospital Basel, University of Basel, Basel, Switzerland
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Jung RG, Simard T, Kovach C, Flint K, Don C, Di Santo P, Adamo M, Branca L, Valentini F, Benito-González T, Fernández-Vázquez F, Estévez-Loureiro R, Berardini A, Conti N, Rapezzi C, Biagini E, Parlow S, Shorr R, Levi A, Manovel A, Cardenal-Piris R, Diaz Fernandez J, Shuvy M, Haberman D, Sala A, Alkhouli MA, Marini C, Bargagna M, Schiavi D, Denti P, Markovic S, Buzzatti N, Chan V, Hynes M, Mesana T, Labinaz M, Pappalardo F, Taramasso M, Hibbert B. Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis. JACC Cardiovasc Interv 2020; 14:1-11. [PMID: 33069653 DOI: 10.1016/j.jcin.2020.08.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/12/2020] [Accepted: 08/25/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the outcome of transcatheter mitral valve repair (TMVr) in patients with cardiogenic shock and significant mitral regurgitation (MR). BACKGROUND Patients in cardiogenic shock with severe MR have a poor prognosis in the setting of conventional medical therapy. Because of its favorable safety profile, TMVr is being increasingly used as an acute therapy in this population, though its efficacy remains unknown. METHODS A multicenter, collaborative, patient-level analysis was conducted. Patients with cardiogenic shock and moderate to severe (3+) or severe (4+) MR who were not surgical candidates were treated with TMVr. The primary outcome was in-hospital mortality. Secondary outcomes included 90-day mortality, heart failure (HF) hospitalization, and the combined event rate of 90-day mortality and HF hospitalization following dichotomization by TMVr device success. RESULTS Between January 2011 and February 2019, 141 patients across 14 institutions met the inclusion criteria. In-hospital mortality occurred in 22 patients (15.6%), at 90 days in 38 patients (29.5%), and at one year in 55 patients (42.6%). Median length of hospital stay following TMVr was 10 days (interquartile range: 6 to 20 days). HF hospitalization occurred in 26 patients (18.4%) at a median of 73 days (interquartile range: 26 to 546 days). When stratified by TMVr procedural results, successful TMVr reduced rates of in-hospital mortality (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.98; p = 0.04), 90-day mortality (HR: 0.36; 95% CI: 0.16 to 0.78; p = 0.01), and the composite of 90-day mortality and HF hospitalization (HR: 0.41; 95% CI: 0.19 to 0.90; p = 0.03). CONCLUSIONS TMVr may improve short- and intermediate-term mortality in high-risk patients with cardiogenic shock and moderate to severe MR. Randomized studies are needed to definitively establish MR as a therapeutic target in patients with cardiogenic shock.
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Affiliation(s)
- Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Christopher Kovach
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Kelsey Flint
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Rocky Mountain Regional VA Medical Center, Medicine Services, Cardiology, Aurora, Colorado, USA
| | - Creighton Don
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marianna Adamo
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | - Luca Branca
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | - Francesca Valentini
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | | | | | | | - Alessandra Berardini
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nicolina Conti
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Rapezzi
- Cardiological Center, Universitario di Ferrara, University of Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Elena Biagini
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Risa Shorr
- University of Ottawa Health Sciences Library, Ottawa, Ontario, Canada
| | - Amos Levi
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ana Manovel
- Juan Ramon Jimenez University Hospital, Huelva, Spain
| | | | | | - Mony Shuvy
- Cardiovascular Research Centre, Heart Institute, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Dan Haberman
- Heart Center, Kaplan Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alessandra Sala
- Department of Cardiovascular Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudia Marini
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Marta Bargagna
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Paolo Denti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Sinisa Markovic
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mark Hynes
- Department of Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario
| | - Thierry Mesana
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Maurizio Taramasso
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy; University Heart Center Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Jung R, Simard T, Don C, Di Santo P, Adamo M, Valentini F, Benito-González T, Fernandez-Vazquez F, Estevez-Loureiro R, Conti N, Rapezzi C, Biagini E, Parlow S, Shorr R, Levi A, Diaz Fernandez JF, Haberman D, Alessandra S, Alkhouli M, Marini C, Bargagna M, Schiavi D, Denti P, Buzzatti N, Hynes M, Mesana T, Labinaz M, Markovic S, Pappalardo F, Taramasso M, Hibbert B. TCT CONNECT-336 Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.357] [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: 10/23/2022]
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Stephan T, Keßler M, Goldberger N, Rottbauer W, Markovic S. Angiographic Results After Percutaneous Coronary Interventions in Ostial Versus Distal Left Main Lesions. Cardiovasc Revasc Med 2020; 23:22-27. [PMID: 32952077 DOI: 10.1016/j.carrev.2020.08.025] [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: 04/19/2020] [Revised: 08/02/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We sought to evaluate angiographic outcomes in ostial and distal LM lesions. METHODS 176 patients with LM disease undergoing PCI were retrospectively included in this study. 9 months of angiographic and 12 months of clinical follow-up was obtained. Quantitative coronary analysis (QCA) was performed for all lesions, using an 11-segment model. Clinical endpoint measure was a composite endpoint of cardiac death, myocardial infarction and target lesion revascularization (TLR). RESULTS During 12 months follow up after successful PCI, the composite endpoint occurred more frequently in distal LM bifurcation lesions mainly driven by elevated TLR rates (14.1% in distal LM disease vs. 5.6% in ostial/midshaft LM disease, P = 0.20). Concordantly angiographic binary restenosis (8.2% compared to 0.0%) and late lumen loss (LLL, 0.42 ± 0.97 vs. 0.28 ± 0.34 mm) were increased in distal LM bifurcation lesions compared to ostial LM lesions. In distal lesions highest values for LLL were observed in segments adjacent to the bifurcation (0.37 ± 1.13 mm and 0.37 ± 0.73 mm). On cox proportional regression analysis the angiographic parameter LLL in a bifurcation segment (P = 0.03, HR 1.68 [1.1-2.7]) as well as presence of diabetes mellitus as a clinical parameter (P = 0.046, HR 2.77 [1.0-7.5]) were independent correlates for occurrence of MACE in distal LM bifurcations lesions. CONCLUSION PCI of ostial LM in accomplished with low LLL (0.28 ± 0.34 mm) and binary restenosis rates. In distal left main lesions highest rates for LLL and binary restenosis were observed in segments nearest to the bifurcation and rather focused on the main vessel (0.42 ± 0.97 mm).
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Affiliation(s)
- Tilman Stephan
- Department of Cardiology, Angiology and Pneumology, University Hospital Ulm, Ulm, Germany
| | - Mirjam Keßler
- Department of Cardiology, Angiology and Pneumology, University Hospital Ulm, Ulm, Germany
| | - Nadine Goldberger
- Department of Cardiology, Angiology and Pneumology, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology and Pneumology, University Hospital Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology and Pneumology, University Hospital Ulm, Ulm, Germany.
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Rattka M, Baumhardt M, Dreyhaupt J, Rothenbacher D, Thiessen K, Markovic S, Rottbauer W, Imhof A. 31 days of COVID-19-cardiac events during restriction of public life-a comparative study. Clin Res Cardiol 2020; 109:1476-1482. [PMID: 32494921 PMCID: PMC7268583 DOI: 10.1007/s00392-020-01681-2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 01/17/2023]
Abstract
AIMS The coronavirus SARS-CoV-2 outbreak led to the most recent pandemic of the twenty-first century. To contain spread of the virus, many nations introduced a public lockdown. How the pandemic itself and measures of social restriction affect hospital admissions due to acute cardiac events has rarely been evaluated yet. METHODS AND RESULTS German public authorities announced measures of social restriction between March 21st and April 20th, 2020. During this period, all patients suffering from an acute cardiac event admitted to our hospital (N = 94) were assessed and incidence rate ratios (IRR) of admissions for acute cardiac events estimated, and compared with those during the same period in the previous three years (2017-2019, N = 361). Admissions due to cardiac events were reduced by 22% as compared to the previous years (n = 94 vs. an average of n = 120 per year for 2017-2019). Whereas IRR for STEMI 1.20 (95% CI 0.67-2.14) and out-of-hospital cardiac arrest IRR 0.82 (95% CI 0.33-2.02) remained similar, overall admissions with an IRR of 0.78 (95% CI 0.62-0.98) and IRR for NSTEMI with 0.46 (95% CI 0.27-0.78) were significantly lower. In STEMI patients, plasma concentrations of high-sensitivity troponin T at admission were significantly higher (644 ng/l, IQR 372-2388) compared to 2017-2019 (195 ng/l, IQR 84-1134; p = 0.02). CONCLUSION The SARS-CoV-2 pandemic and concomitant social restrictions are associated with reduced cardiac events admissions to our tertiary care center. From a public health perspective, strategies have to be developed to assure patients are seeking and getting medical care and treatment in time during SARS-CoV-2 pandemic.
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Affiliation(s)
- Manuel Rattka
- Clinic for Internal Medicine II, University Hospital Ulm-Medical Center, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Michael Baumhardt
- Clinic for Internal Medicine II, University Hospital Ulm-Medical Center, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Kevin Thiessen
- Clinic for Internal Medicine II, University Hospital Ulm-Medical Center, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Sinisa Markovic
- Clinic for Internal Medicine II, University Hospital Ulm-Medical Center, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Wolfgang Rottbauer
- Clinic for Internal Medicine II, University Hospital Ulm-Medical Center, Albert Einstein Allee 23, 89081, Ulm, Germany
| | - Armin Imhof
- Clinic for Internal Medicine II, University Hospital Ulm-Medical Center, Albert Einstein Allee 23, 89081, Ulm, Germany.
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Nita N, Scharnbeck D, Schneider LM, Seeger J, Wöhrle J, Rottbauer W, Keßler M, Markovic S. Predictors of left ventricular reverse remodeling after percutaneous therapy for mitral regurgitation with the MitraClip system. Catheter Cardiovasc Interv 2020; 96:687-697. [PMID: 32104977 DOI: 10.1002/ccd.28779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/26/2020] [Accepted: 02/07/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the predictors and clinical impact of left ventricular reverse remodeling (LVRR) after MitraClip (MC) therapy for degenerative (DMR) and functional mitral regurgitation (FMR). BACKGROUND MC therapy induces LVRR in patients with mitral regurgitation (MR) at high-risk for surgery. However, specific data on predictors of LVRR therapy are limited. METHODS This study included 164 patients treated by MC implantation with complete clinical and echocardiographic evaluation at baseline, 6 months, and 12 months. LVRR was defined as a decrease of ≥10% of the left ventricular end-diastolic diameter after 12 months and was found in 49% of the patients. RESULTS LVRR was associated with significantly reduced event rate 2 years after MC procedure. In the total cohort, multivariate regression analysis determined severe recurrent/residual MR after 12 months (p = .010, odds ratio [OR] = 0.26), male gender (p = .050, OR = 0.49) and left ventricular ejection fraction (LVEF) <20% (p = .046, OR = 0.24) as predictors of absence of LVRR. In the subgroup analysis according to etiology of MR, multivariate regression analysis revealed severe recurrent/residual MR after 12 months (p = .04, OR = 0.184) to inversely predict LVRR only in the DMR subgroup. In FMR, residual severe tricuspid regurgitation (TR) inversely predicts LVRR (p = .032, OR = 0.361). CONCLUSIONS LVRR occurs in half of the patients after MC and is associated with reduced MACCE rates at follow-up. Combined information on residual/recurrent MR, baseline LVEF and gender predict LVRR after MC procedure. While residual/recurrent MR is the independent predictor for the absence of LVRR in DMR, in FMR only severe residual TR independently predict LVRR.
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Affiliation(s)
- Nicoleta Nita
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | | | | | - Julia Seeger
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | | | - Mirjam Keßler
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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Seeger J, Markovic S, Kessler M, Rottbauer W, Wöhrle J. Apixaban After Percutaneous Edge-to-Edge Mitral Valve Repair in Patients With Maintained Sinus Rhythm. JACC Cardiovasc Interv 2019; 12:214-216. [PMID: 30678801 DOI: 10.1016/j.jcin.2018.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/22/2018] [Accepted: 11/06/2018] [Indexed: 11/27/2022]
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Reichart C, Wöhrle J, Markovic S, Rottbauer W, Seeger J. Clinical results of bioresorbable drug-eluting scaffolds in short and long coronary artery lesions using the PSP technique. BMC Cardiovasc Disord 2019; 19:22. [PMID: 30658574 PMCID: PMC6339442 DOI: 10.1186/s12872-018-0994-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data on bioresorbable vascular scaffolds (BVS) for the treatment of long lesions are limited. We studied the use of BVS-Absorb in routine clinical practice and compared the outcome of long lesions with short lesions. Implantation of drug-eluting scaffolds without PSP-technique (predilation, proper sizing and postdilation) is associated with an increased thrombotic risk. We compared the long-term outcome up to 36 months of patients with short (< 20 mm) and long (≥20 mm) coronary artery lesions after implantation of bioresorbable vascular scaffolds (BVS) via PSP-technique. METHODS Three hundred twenty-six patients with 424 lesions were enrolled in this prospective study and underwent percutaneous coronary intervention with the Absorb BVS. Clinical follow-up was scheduled after 12, 24 and 36 months. In all lesions the PSP-technique was used. The device oriented composite endpoint (DOCE) was defined as cardiac death, myocardial infarction (MI) not clearly related to a non-target vessel and target lesion revascularization (TLR). RESULTS Kaplan-Meier estimates for DOCE after 12 months were 2.63% for short lesions and 8.09% for long lesions (p = 0.0131), 5.51% vs. 11.35% (p = 0.0503) after 24 months and 8.00% vs. 18.00% (p = 0.0264) after 36 months of clinical follow-up. Kaplan-Meier estimates for TLR after 12 months were 1.46% for short and 7.69% for long lesions (p = 0.0012), 2.06% vs. 8.75% after 24 months (p = 0.0027) and 4.96% vs. 9.59% after 36 months of follow-up (p = 0.0109). Scaffold thrombosis rates were low. CONCLUSIONS In long lesions compared to short ones the bioresorbable scaffold Absorb implanted with the proper PSP technique Absorb has significant higher rates of DOCE. THE LEVEL OF EVIDENCE Is 3 (non-random sample).
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Affiliation(s)
- Christine Reichart
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Jochen Wöhrle
- Head Interventional Cardiology Research Group, University Hospital of Ulm, Albert-Einstein-Allee, 23 89081, Ulm, Germany.
| | - Sinisa Markovic
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Julia Seeger
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
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Weinmann K, Markovic S, Rottbauer W, Keßler M. First experience with the MitraClip XTR device for extensive mitral valve prolapse (Barlow's disease). EUROINTERVENTION 2018; 14:e1276-e1277. [PMID: 30277461 DOI: 10.4244/eij-d-18-00556] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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]
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Keßler M, Pott A, Mammadova E, Seeger J, Wöhrle J, Rottbauer W, Markovic S. Atrial Fibrillation Predicts Long-Term Outcome after Transcatheter Edge-to-Edge Mitral Valve Repair by MitraClip Implantation. Biomolecules 2018; 8:biom8040152. [PMID: 30463247 PMCID: PMC6316291 DOI: 10.3390/biom8040152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/04/2018] [Accepted: 11/08/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Atrial fibrillation is common in patients with mitral regurgitation (MR) and has a negative impact on the clinical outcome of patients with valvular heart disease. We aimed to evaluate the impact of pre-procedural atrial fibrillation on the long-term clinical outcomes of patients with MR undergoing transcatheter mitral valve repair by MitraClip implantation. Methods: We analysed 355 consecutive patients with and without atrial fibrillation with symptomatic, severe MR and inoperability or high surgical risk undergoing MitraClip implantation in a three-year follow-up. Results: In patients with pre-procedural atrial fibrillation undergoing MitraClip implantation, we found advanced age, higher baseline NT-pro-BNP levels, increased left atrial diameter, and higher rate of severe tricuspid regurgitation, compared to patients with sinus rhythm. In the three-year follow-up after MitraClip implantation, mortality and major adverse cardiovascular and cerebral events (MACCE) occur significantly more often in patients with atrial fibrillation, compared to patients without atrial fibrillation. Multivariate regression analysis confirmed atrial fibrillation (hazard ratio 2.39, 95%-confidence interval 1.06–5.41, p = 0.036) as an independent predictor for three-year-mortality after MitraClip implantation. Conclusions: Atrial fibrillation is an independent predictor for long-term mortality after MitraClip implantation. We demonstrate the association of atrial fibrillation with mortality and MACCE in the long-term follow-up of patients undergoing MitraClip implantation.
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Affiliation(s)
- Mirjam Keßler
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Alexander Pott
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Elnura Mammadova
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Julia Seeger
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Sinisa Markovic
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
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Bittlingmayer UH, Gerdes J, Pinheiro P, Dege M, Bauer U, Jäntsch C, Kirchhoff S, Knigge M, Köpfer A, Markovic S, Okcu G, Scharenberg K. Health Promoting Schools (HPS) and the impact of inclusion: The StiEL-project. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.842] [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: 11/15/2022] Open
Affiliation(s)
| | - J Gerdes
- University of Education Freiburg, Freiburg im Breisgau, Germany
| | - P Pinheiro
- Bielefeld University, Bielefeld, Germany
| | - M Dege
- University of Potsdam, Potsdam, Germany
| | - U Bauer
- Bielefeld University, Bielefeld, Germany
| | - C Jäntsch
- University of Potsdam, Potsdam, Germany
| | | | - M Knigge
- University of Potsdam, Potsdam, Germany
| | - A Köpfer
- University of Education Freiburg, Freiburg im Breisgau, Germany
| | - S Markovic
- Bielefeld University, Bielefeld, Germany
| | - G Okcu
- University of Education Freiburg, Freiburg im Breisgau, Germany
| | - K Scharenberg
- University of Education Freiburg, Freiburg im Breisgau, Germany
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Keßler M, Seeger J, Muche R, Wöhrle J, Rottbauer W, Markovic S. Predictors of rehospitalization after percutaneous edge-to-edge mitral valve repair by MitraClip implantation. Eur J Heart Fail 2018; 21:182-192. [DOI: 10.1002/ejhf.1289] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 03/20/2018] [Revised: 06/08/2018] [Accepted: 07/03/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Mirjam Keßler
- Department of Internal Medicine II; University of Ulm; Ulm Germany
| | - Julia Seeger
- Department of Internal Medicine II; University of Ulm; Ulm Germany
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry; University of Ulm; Ulm Germany
| | - Jochen Wöhrle
- Department of Internal Medicine II; University of Ulm; Ulm Germany
| | | | - Sinisa Markovic
- Department of Internal Medicine II; University of Ulm; Ulm Germany
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Vera-Aguilera J, Paludo J, Duma N, Tschautscher M, Markovic S. A clinical insight into therapeutic sequence in advanced melanoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx711.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mansfield A, Ren H, Sutor S, Dronca R, Park S, Markovic S, Nevala W, Jen J, Aubry M, Dong H. OA 13.07 Contraction of T Cell Clonality in Lung Cancer Metastases. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Buckert D, Markovic S, Kunze M, Wöhrle J, Rottbauer W, Walcher D. Percutaneous mitral valve repair with the MitraClip NT™ system in a patient presenting with prolonged cardiogenic shock. Clin Case Rep 2017; 5:1807-1810. [PMID: 29152276 PMCID: PMC5676288 DOI: 10.1002/ccr3.930] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/21/2017] [Accepted: 03/05/2017] [Indexed: 12/02/2022] Open
Abstract
The MitraClip NT™ system for the treatment of severe mitral valve regurgitation is effective and safe – even for patients suffering from cardiogenic shock. The use of an intra‐aortic balloon pump expands the range of possible applications to this particular group of challenging patients.
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Affiliation(s)
- Dominik Buckert
- Department of Internal Medicine II University Hospital Ulm Ulm Germany
| | - Sinisa Markovic
- Department of Internal Medicine II University Hospital Ulm Ulm Germany
| | - Markus Kunze
- Department of Internal Medicine II University Hospital Ulm Ulm Germany
| | - Jochen Wöhrle
- Department of Internal Medicine II University Hospital Ulm Ulm Germany
| | | | - Daniel Walcher
- Department of Internal Medicine II University Hospital Ulm Ulm Germany
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Markovic S, Kugler C, Rottbauer W, Wöhrle J. Long-term clinical results of bioresorbable absorb scaffolds using the PSP-technique in patients with and without diabetes. J Interv Cardiol 2017; 30:325-330. [PMID: 28568564 DOI: 10.1111/joic.12392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES We evaluated clinical results up to 36 months after implantation of Absorb BVS using PSP-technique and compared the outcome of patients with and without diabetes mellitus. BACKGROUND Absorb II demonstrated that interventional treatment of coronary artery disease with bioresorbable vascular scaffolds (BVS) without proper PSP-technique (pre-dilation, proper sizing, and post-dilation) is associated with an increased thrombotic risk, even in simple lesions. METHODS In this prospective study 319 patients with 420 lesions were enrolled and treated with the Absorb BVS. Pre-dilation was mandatory and post-dilation with a high-pressure balloon was performed in patients with a scaffold length >12 mm. Patients were clinically followed up to 3 years. Primary outcome measure was the device-oriented endpoint (DoCE) defined as cardiac death, myocardial infarction not clearly related to a non-target vessel and target lesion revascularization. RESULTS DoCE was 5.0%, 7.1%, and 10.0% after 12, 24, and 36 months for the total population. Rate of scaffold thrombosis was 0.5%, 0.8%, and 1.4% after 12, 24, and 36 months. Rate of DoCE was higher in the diabetic subgroup with 9.1%, 12.6%, and 12.9% after 12, 24, and 36 months compared with 4.0% (P = 0.13), 5.6% (P = 0.05), and 9.9% (P = 0.20) in patients without diabetes mellitus. CONCLUSIONS Patients treated with the Absorb BVS using the PSP-technique show good results up to 3 years with a low rate of scaffold thrombosis. Patients suffering from diabetes mellitus have an increased rate of DoCE compared with non-diabetic patients. CLINICAL TRIAL REGISTRATION clinicaltrials.gov_NCT02162056.
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Affiliation(s)
- Sinisa Markovic
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Christine Kugler
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | | | - Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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Seeger J, Müller P, Gonska B, Scharnbeck D, Markovic S, Walcher D, Rottbauer W, Wöhrle J. Percutaneous Mitral Valve Repair With the MitraClip in Primary Compared With Secondary Mitral Valve Regurgitation Using the Mitral Valve Academic Research Consortium Criteria. J Invasive Cardiol 2017; 29:145-150. [PMID: 28368846] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIMS To compare early device success, procedural success, and 30-day safety endpoint according to the new Mitral Valve Academic Research Consortium criteria (MVARC) in severe primary and secondary mitral regurgitation (MR) patients. METHODS AND RESULTS A total of 210 patients were enrolled; 105 patients with primary MR were compared with 105 patients with secondary MR. All patients were highly symptomatic (New York Heart Association III/IV 79.0% vs 87.6%). Decision for MitraClip therapy was done by the heart team. Patients were on optimal medical heart failure therapy. Preprocedural MR grade was 3.4 ± 0.5 in secondary MR vs 3.7 ± 0.4 in primary MR (P<.001). Device success according to MVARC was high in both groups (93.3% in secondary MR vs 94.3% in primary MR), treated with 1.4 ± 0.6 vs 1.3 ± 0.5 MitraClips (P=.14). Reduction of New York Heart Association class from baseline to 30-day follow-up was 1.7 ± 1.1 in secondary MR vs 2.2 ± 1.2 in primary MR (P<.01). Rate of MVARC minor vascular complications was low. Thirty-day safety endpoint according to MVARC criteria was low in both groups (4.8% in secondary MR vs 5.7% in primary MR (P=non-significant). CONCLUSION Percutaneous mitral valve repair using the MitraClip device is safe and effective in patients with primary and secondary MR, with a high early device success rate and low 30-day safety endpoint according to the MVARC criteria.
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Affiliation(s)
| | | | | | | | | | | | | | - Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
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Shenoy N, Esplin B, Barbosa N, Wieland C, Thanarajasingam U, Markovic S. Pembrolizumab induced severe sclerodermoid reaction. Ann Oncol 2017; 28:432-433. [DOI: 10.1093/annonc/mdw543] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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