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Beyer M, Demal TJ, Bhadra OD, Linder M, Ludwig S, Grundmann D, Voigtlaender-Buschmann L, Waldschmidt L, Schirmer J, Schofer N, Pecha S, Blankenberg S, Reichenspurner H, Conradi L, Seiffert M, Schaefer A. Transcatheter aortic valve implantation in patients with significant septal hypertrophy. Clin Res Cardiol 2024:10.1007/s00392-024-02432-3. [PMID: 38466346 DOI: 10.1007/s00392-024-02432-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Previous reports suggest septal hypertrophy with an interventricular septum depth (IVSD) ≥ 14 mm may adversely affect outcomes after transcatheter aortic valve implantation (TAVI) due to suboptimal valve placement, valve migration, or residual increased LVOT pressure gradients. AIMS This analysis investigates the impact of interventricular septal hypertrophy on acute outcomes after TAVI. METHODS Between 2009 and 2021, 1033 consecutive patients (55.8% male, 80.5 ± 6.7 years, EuroSCORE II 6.3 ± 6.5%) with documented IVSD underwent TAVI at our center and were included for analysis. Baseline, periprocedural, and 30-day outcome parameters of patients with normal IVSD (< 14 mm; group 1) and increased IVSD (≥ 14 mm; group 2) were compared. Data were retrospectively analyzed according to updated Valve Academic Research Consortium-3 (VARC-3) definitions. Comparison of outcome parameters was adjusted for baseline differences between groups using logistic and linear regression analyses. RESULTS Of 1033 patients, 585 and 448 patients were allocated to groups 1 and 2, respectively. There was no significant difference between groups regarding transfemoral access rate (82.6% (n = 478) vs. 86.0% (n = 381), p = 0.157). Postprocedural mean transvalvular pressure gradient was significantly increased in group 2 (group 1, 7.8 ± 4.1 mmHg, vs. group 2, 8.9 ± 4.9 mmHg, p = 0.046). Despite this finding, there was no significant difference between groups regarding the rates of VARC-3 adjudicated composite endpoint device success (90.0% (n = 522) vs. 87.6% (n = 388), p = 0.538) or technical success (92.6% (n = 542) vs. 92.6% (n = 415), p = 0.639). Moreover, the groups showed no significant differences regarding the rates of paravalvular leakage ≥ moderate (3.1% (n = 14) vs. 2.6% (n = 9), p = 0.993), postprocedural permanent pacemaker implantation (13.4% (n = 77) vs. 13.8% (n = 61), p = 0.778), or 30-day mortality (5.1% (n = 30) vs. 4.5% (n = 20), p = 0.758). CONCLUSION Although transvalvular mean pressure gradients were significantly higher in patients with increased IVSD after TAVI, acute outcomes were comparable between groups suggesting no early impact of adverse hemodynamics due to elevated IVSD. However, how these differences in hemodynamic findings may affect mid- and long-term outcomes, especially in terms of valve durability, needs to be evaluated in further investigations.
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Affiliation(s)
- Martin Beyer
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany.
| | - Till Joscha Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Oliver D Bhadra
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Matthias Linder
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | - David Grundmann
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | | | - Lara Waldschmidt
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246, Hamburg, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
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Demal TJ, Conradi L. Management of valve dysfunction in patients with mitral annular calcification. Heart 2023; 109:1639-1646. [PMID: 37137678 DOI: 10.1136/heartjnl-2022-321572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Affiliation(s)
- Till Joscha Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Schaefer A, Demal TJ, Bhadra OD, Grundmann D, Voigtländer L, Waldschmidt L, Schirmer J, Pecha S, Schneeberger Y, Schofer N, Sörensen N, Blankenberg S, Reichenspurner H, Seiffert M, Conradi L. Valve-in-valve procedures for degenerated surgical and transcatheter aortic valve bioprostheses using a latest-generation self-expanding intra-annular transcatheter heart valve. Front Cardiovasc Med 2023; 10:1209184. [PMID: 37727306 PMCID: PMC10505706 DOI: 10.3389/fcvm.2023.1209184] [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: 04/20/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023] Open
Abstract
Background Valve-in-valve (ViV) transfemoral transcatheter aortic valve implantation (TAVI) for failing aortic surgical bioprostheses or transcatheter heart valves (THV) has demonstrated a reasonable clinical and hemodynamic efficacy. Traditionally, self-expanding (SE) supra-annular THV are considered to result in superior hemodynamics compared with balloon-expandable intra-annular THV after ViV. However, so far no data are found on latest-generation intra-annular SE THV for aortic ViV procedures which might be superior with regard to coronary access or subsequent valve reintervention. Aim We herein aim to evaluate a latest-generation SE intra-annular THV for aortic ViV procedures. Materials and methods Between May 2022 and November 2022, five consecutive patients (4/5 female with mean age of 76.2 years and mean Society of Thoracic Surgeons predicted risk of mortality score of 2.9%) received ViV TAVI using the Navitor system (Abbott, Chicago, IL, USA) for treatment of failing surgical bioprostheses or THV. Data were retrospectively analyzed according to updated Valve Academic Research Consortium 3 (VARC-3) definitions. Results At 30 days, absence of mortality and VARC-3 adjudicated clinical endpoints were documented. Echocardiography at 30 days revealed complete absence of paravalvular leakage and single-digit mean transvalvular gradients (mean of 6.0 mmHg) in all patients. Conclusion The investigated intra-annular SE THV results in excellent 30-day outcomes for aortic ViV procedures for failing surgical bioprostheses or THV. Despite the intra-annular design, hemodynamic results were excellent, even in small bioprostheses. Ease of use of this valve platform is reflected by only two cycles of resheathing in five ViV procedures with hemodynamic stability during all steps of valve deployment.
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Affiliation(s)
- Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Till Joscha Demal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Oliver D. Bhadra
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - David Grundmann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lisa Voigtländer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Yvonne Schneeberger
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Nils Sörensen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Brickwedel J, Demal TJ, Detter C. Analysing debranching techniques in Frozen Elephant Trunk procedures: a narrative literature review. Cardiovasc Diagn Ther 2023; 13:427-439. [PMID: 37583690 PMCID: PMC10423730 DOI: 10.21037/cdt-22-502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/15/2023] [Indexed: 08/17/2023]
Abstract
Background and Objective Since 2003, the Frozen Elephant Trunk (FET) technique has attained rising popularity for treating extensive aortic arch pathologies such as acute and chronic aortic dissection, as well as thoracic aortic aneurysm. Conventionally, the FET procedure included a complete resection of the aortic arch and, subsequently, a distal aortic anastomosis of the prosthetic part of the hybrid graft in arch zone 3. Simultaneous to the introduction of the FET technique, the traditional Elephant Trunk technique was simplified by adding debranching techniques which allows for proximalization of the distal aortic anastomosis. Nowadays, modern concepts of aortic arch surgery combine the FET technique with proximalization of the distal anastomosis in arch zone 2 or further proximal, achieved by using different debranching techniques. This review describes different debranching techniques to facilitate arch reconstruction, and aims to critically assess the outcomes and potential clinical advantages of proximalization using debranching in FET surgery. Methods We conducted a search using the PubMed and Google Scholar electronic databases to evaluate published outcomes of different debranching techniques. An overview of the data synthesis of 21 included studies is reported. Key Content and Findings Most studies report numeric, but not statistically significant improved outcomes after debranching in FET surgery for mortality, neurological complications, spinal cord injury, kidney failure, bowel ischemia and recurrent nerve palsy. Some studies report statistically significant improved results in isolated endpoints such as neurological, bowel ischemia, and recurrent nerve palsy. Most studies report debranching to be technically easier, but this is difficult to objectively assess and measure. Conclusions There is an improved numeric outcome of different debranching techniques with proximalization of the distal anastomosis, but without reaching statistical significance. This review shows marked heterogeneity across included studies and highlights the scarce use of existing guidelines in clinical research of open aortic arch surgery as proposed by the International Aortic Arch Surgery Study Group. Furthermore, this review demonstrates the urgent need for multicenter registries or studies to be able to compare the outcome of different surgical techniques for various aortic arch pathologies.
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Affiliation(s)
- Jens Brickwedel
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Till Joscha Demal
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Linder M, Higgen FL, Voigtländer L, Weimann J, Ludwig S, Waldschmidt L, Focke C, Bhadra OD, Grundmann D, Demal TJ, von Zastrow A, Schäfer A, Schirmer J, Reichenspurner H, Blankenberg S, Westermann D, Schofer N, Conradi L, Thomalla G, Seiffert M. Stroke events after transcatheter aortic valve implantation: Temporal relationships and affected brain regions. Am Heart J 2022; 247:112-122. [PMID: 35149038 DOI: 10.1016/j.ahj.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/17/2022] [Accepted: 02/03/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite continuous improvements in transcatheter aortic valve implantation (TAVI), periprocedural strokes remain a devastating complication. Randomized controlled trials failed to demonstrate a reduction in clinically apparent strokes or mortality after TAVI due to cerebral embolic protection (CEP). To identify potential targets of CEP strategies during TAVI, we evaluated affected brain regions, and temporal patterns of stroke onset in a routine clinical sample. METHODS AND RESULTS A total of 3,164 consecutive patients treated with TAVI from 2008 to 2019 at a single center were screened for cerebrovascular events. Affected cerebral regions were determined according to clinical symptoms and brain imaging. Rates of disabling stroke and non-disabling stroke at 30 days were 2.2% and 1.4%, respectively. The frequency of all strokes decreased from 5.0% to 3.0% over time (P = .012). Patients with impaired left-ventricular function (OR 2.19), increased CHA2DS2-VASc (OR 1.39) and moderate/severe spontaneous echo contrast (OR 3.60) had a higher stroke risk. Acute symptom onset occurred during TAVI (19.4%), within 24 hours (40.3%) or later (25.0%); 98.3% of strokes were of ischemic origin. In intraprocedural strokes, 53.2% of lesions were found in locations considered protected by current CEP devices, and 37.5% of patients with intraprocedural strokes were exclusively affected in these areas. Baseline or procedural parameters were not associated with embolic distribution patterns. CONCLUSIONS Most strokes occurred early after TAVI - but not necessarily during the procedure - and affected multiple brain regions only partially protected by current CEP devices. Efficient prevention of cerebrovascular events may require strategies beyond the TAVI procedure to minimize stroke risk and additional randomized controlled trials will be required to clarify the role of CEP in efficient stroke prevention during TAVI.
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Affiliation(s)
- Matthias Linder
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Focko Lorenz Higgen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Voigtländer
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Focke
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Daniel Bhadra
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David Grundmann
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Joscha Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas von Zastrow
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Schäfer
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany.
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Demal TJ, Reichenspurner H, Conradi L. Prognoserelevanz des „Heart Teams“ bei Mitralklappenerkrankungen. Z Herz- Thorax- Gefäßchir 2022. [DOI: 10.1007/s00398-022-00492-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Demal TJ, Bax L, Brickwedel J, Kölbel T, Vettorazzi E, Sitzmann F, Reichenspurner H, Detter C. Outcome of the frozen elephant trunk procedure as a redo operation. Interact Cardiovasc Thorac Surg 2021; 33:85-92. [PMID: 33667306 DOI: 10.1093/icvts/ivab059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/01/2020] [Accepted: 01/01/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The goal of this study was to determine the outcome of patients undergoing an elective frozen elephant trunk (FET) procedure as a redo operation following previous cardiac surgery. METHODS One hundred and eighteen consecutive patients underwent FET procedures between October 2010 and October 2019 at our centre. Patients were registered in a dedicated database and analysed retrospectively. Clinical and follow-up characteristics were compared between patients undergoing a FET operation as a primary (primary group) or a redo procedure (redo group) using logistic regression and Cox regression analysis. Emergency procedures (n = 33) were excluded from the analysis. RESULTS A total of 36.5% (n = 31) of the FET procedures were redo operations (redo group) and 63.5% (n = 54) of the patients underwent primary surgery (primary group). There was no significant difference in the 30-day mortality [primary group: 7.4%; redo group: 3.2%; 95% confidence interval (CI) (0.19-35.29); P = 0.63] and the 3-year mortality [primary group: 22.2%; redo group: 16.7%; 95% CI (0.23-3.23); P = 0.72] between redo and primary cases. Furthermore, the adjusted statistical analysis did not reveal significant differences between the groups in the occurrence of transient or permanent neurological deficit, paraplegia, acute renal failure and resternotomy. The redo group showed a higher rate of recurrent nerve palsy, which did not reach statistical significance [primary group: 3.7% (n = 2); redo group: 19.4% (n = 6); P = 0.091]. CONCLUSIONS Elective FET procedures as redo operations performed by a dedicated aortic team following previous cardiac surgery demonstrate an adequate safety profile.
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Affiliation(s)
- Till Joscha Demal
- Department of Cardiovascular Surgery, German Aortic Centre Hamburg, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Lennart Bax
- Department of Cardiovascular Surgery, German Aortic Centre Hamburg, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Jens Brickwedel
- Department of Cardiovascular Surgery, German Aortic Centre Hamburg, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Sitzmann
- Department of Cardiovascular Surgery, German Aortic Centre Hamburg, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, German Aortic Centre Hamburg, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, German Aortic Centre Hamburg, University Heart & Vascular Centre Hamburg, Hamburg, Germany
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Chung DU, Müller L, Ubben T, Yildirim Y, Petersen J, Sinning C, Castro L, Demal TJ, Kaiser L, Gosau N, Reichenspurner H, Willems S, Pecha S, Hakmi S. Benefits of routine prophylactic femoral access during transvenous lead extraction. Heart Rhythm 2021; 18:970-976. [PMID: 33577972 DOI: 10.1016/j.hrthm.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The number of patients requiring lead extraction has been increasing in recent years. Despite significant advances in operator experience and technique, unexpected complications may occur. Prophylactic placement of femoral sheaths allows for immediate endovascular access for emergency procedures and may shorten response time in the event of complications. OBJECTIVE The purpose of this study was to assess the benefits of routine prophylactic femoral access in patients undergoing transvenous lead extraction (TLE) and to evaluate the methods, frequency, and efficacy of the emergency measures used in those patients. METHODS We conducted a retrospective analysis of patients who underwent TLE from January 2012 to February 2019. The data were analyzed with regard to procedural complications and deployment of emergency measures via femoral access. RESULTS Two hundred eighty-five patients (mean age 65.3 ± 15.5 years) were included in the study. Median lead dwell time was 84 months (interquartile range 58-144). Overall complication rate was 4.2% (n = 12), with 1.8% major complications (n = 5). Clinical success rate was 97.2%. Procedure-related mortality was 1.1% (n = 3). Femoral sheaths were actively engaged in 9.1% (n = 26) of cases. Deployment of snares was the most common intervention (n = 10), followed by prophylactic (n = 6) or emergency placement (n = 1) of occlusion balloons, temporary pacing (n = 3), venous angioplasty (n = 3), diagnostic venography (n = 3), and extracorporeal membrane oxygenation (n = 1). We did not observe any femoral vascular complications due to prophylactic sheath placement. CONCLUSION Routine prophylactic placement of femoral sheaths shortens response time and quickly establishes control in the event of various complications that may occur during TLE procedures.
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Affiliation(s)
- Da-Un Chung
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Lisa Müller
- Department of Cardiac Surgery, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany
| | - Timm Ubben
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Yalin Yildirim
- Department of Cardiac Surgery, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany
| | - Johannes Petersen
- Department of Cardiac Surgery, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany
| | - Christoph Sinning
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany
| | - Liesa Castro
- Department of Cardiology, Angiology & Critical Care Medicine, University Hospital Lübeck, Germany
| | - Till Joscha Demal
- Department of Cardiac Surgery, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany
| | - Lukas Kaiser
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Nils Gosau
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiac Surgery, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Simon Pecha
- Department of Cardiac Surgery, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany.
| | - Samer Hakmi
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
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Detter C, Demal TJ, Bax L, Tsilimparis N, Kölbel T, von Kodolitsch Y, Vettorazzi E, Reichenspurner H, Brickwedel J. Corrigendum to ‘Simplified frozen elephant trunk technique for combined open and endovascular treatment of extensive aortic diseases’ [Eur J Cardiothoracic Surg 2019; doi:10.1093/ejcts/ezz082]. Eur J Cardiothorac Surg 2019; 56:817-817. [DOI: 10.1093/ejcts/ezz181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/30/2023] Open
Affiliation(s)
- Christian Detter
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Till Joscha Demal
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Lennart Bax
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of General and Interventional Cardiology, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Jens Brickwedel
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
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Detter C, Demal TJ, Bax L, Tsilimparis N, Kölbel T, von Kodolitsch Y, Vettorazzi E, Reichenspurner H, Brickwedel J. Simplified frozen elephant trunk technique for combined open and endovascular treatment of extensive aortic diseases. Eur J Cardiothorac Surg 2019; 56:738-745. [DOI: 10.1093/ejcts/ezz082] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 08/30/2023] Open
Abstract
Abstract
OBJECTIVES:
This study aims to analyse the impact of a simplified frozen elephant trunk (FET) technique on early outcome.
METHODS:
Between October 2010 and August 2018, 92 consecutive patients (mean age 64.4 ± 12.2 years) underwent FET surgery. Underlying pathologies were thoracic aneurysm in 35 patients, acute aortic dissection in 25 patients and chronic dissection in 32 patients. Thirty patients underwent a simplified FET technique with deployment of the stent graft in arch zone 2 with an extra-anatomic bypass to the distal left subclavian artery using the third branch of the Thoraflex™ Hybrid Plexus prosthesis via a supraclavicular access during reperfusion. These patients were compared to 62 patients who received the conventional FET procedure, in which a distal anastomosis is performed in arch zone 3.
RESULTS:
Circulatory arrest (41.7 ± 10.5 vs 76.5 ± 33.0 min; P < 0.001) and antegrade cerebral perfusion times (60.9 ± 13.5 vs 92.1 ± 33.1 min; P < 0.001) were significantly reduced in zone 2 vs zone 3 patients, respectively. The 30-day mortality rate was 3.3% (n = 1) in zone 2 patients vs 17.7% (n = 11) in zone 3 patients (P = 0.75). Stent deployment in zone 2 was associated with significantly reduced rates of postoperative stroke [zone 2: n = 0 (0.0%); zone 3: n = 11 (17.7%), P = 0.046] and recurrent nerve palsy [zone 2: n = 1 (3.3%); zone 3: n = 14 (22.6%), P = 0.020).
CONCLUSIONS:
Simplifying the FET procedure leads to reduced circulatory arrest and cerebral perfusion times and improves early outcome.
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Affiliation(s)
- Christian Detter
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Till Joscha Demal
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Lennart Bax
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of General and Interventional Cardiology, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Jens Brickwedel
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
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