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Yildirim Y, Yildirim S, Petersen J, Alassar Y, Sarwari H, Sinning C, Blankenberg S, Reichenspurner H, Pecha S. Left atrial strain predicts the rhythm outcome in patients with persistent atrial fibrillation undergoing left atrial cryoablation during minimally invasive mitral valve repair. Front Cardiovasc Med 2024; 11:1373310. [PMID: 38601047 PMCID: PMC11004374 DOI: 10.3389/fcvm.2024.1373310] [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: 01/19/2024] [Accepted: 02/27/2024] [Indexed: 04/12/2024] Open
Abstract
Objectives Patients with atrial fibrillation (AF) have lower left atrial (LA) strain, which is a predictor for LA function. Here, we evaluated the prognostic value of LA strain to predict the rhythm outcome in patients with persistent AF undergoing LA cryoablation concomitant to minimally invasive mitral valve repair. Methods Between 01/2016 and 12/2020, 72 patients with persistent AF underwent LA cryoablation during minimally invasive mitral valve surgery. All patients received a complete LA lesion set and left atrial appendage (LAA) closure with a clip. All patients received preoperative transthoracic echocardiography (TTE) with LA and left ventricular strain measurements. Preoperative LA and LV strain analysis was correlated with postoperative rhythm outcome. Results The mean age of the patients was 66.9 ± 7.2 years, of whom 42 (58%) were male patients. No major ablation-related complications occurred in any of the patients. Successful LAA closure was confirmed by intraoperative echocardiography in all patients. The 1-year survival rate was 97%. Freedom from AF at 12 months was 72% and 68% off antiarrhythmic drugs. Preoperative LA strain values were statistically significantly higher in patients with freedom from AF at 12 months of follow-up (12.7% ± 6.9% vs. 4.9% ± 4.1%, p = 0.006). Preoperative LV strain value was not associated with postoperative rhythm outcome. In multivariate logistic regression analysis, LA strain (p < 0.001) and AF duration (p = 0.017) were predictors for freedom from AF at 12 months of follow-up. Conclusions In our study, LA strain analysis predicted the rhythm outcome in patients with persistent AF undergoing concomitant surgical AF ablation. In the future, LA strain might be a useful tool to guide decision-making on ablation strategies in patients with persistent AF.
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Affiliation(s)
- Yalin Yildirim
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Sevenai Yildirim
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Johannes Petersen
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Yousuf Alassar
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Harun Sarwari
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Christoph Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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Bhadra OD, Pausch J, Aubin H, Akhyari P, Lichtenberg A, Barten MJ, Alassar Y, Reichenspurner H, Bernhardt AM. Left Ventricular Assist Device explantation using a new double patch technique. Interdiscip Cardiovasc Thorac Surg 2023:ivad110. [PMID: 37486261 PMCID: PMC10371393 DOI: 10.1093/icvts/ivad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/14/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVES There are several surgical approaches for explantation of an LVAD after recovery of cardiac function. Thus, remaining ventricular assist device components may bear significant risks of infection or thrombosis. We hereby report our technique and two-center experience with explantation of LVADs using a new double patch technique. METHODS From March 2019-April 2021, 5 patients underwent LVAD explantation after myocardial recovery (HVAD, n = 2; HeartMate 3, n = 3). Mean patient age was 50.3 years (100% male) and mean time on LVAD was 23.1 ± 20.8 months. Primary heart failure aetiology was dilated cardiomyopathy (n = 4) and myocarditis (n = 1).LVAD explantation was performed using a median sternotomy and cardiopulmonary bypass. The LVAD was stopped, and the outflow graft clamped. The outflow graft was ligated and sutured close to the aortic anastomosis. The driveline was clipped and removed. Under induced fibrillation, the attachment of the LVAD was released from the apical cuff and the LVAD was removed. A round pericardial patch was fixed from the inner of the ventricle. This already seals the apex of the heart. An additional Goretex patch is continuously sutured epicardially over the suture ring. RESULTS The 5 cases showed technically uncomplicated explantation of the LVADs. During the follow-up of mean 16.4 ± 16.9 months, survival of 100% was observed. There were no bleeding complications or thromboembolic events during follow-up. CONCLUSION LVAD explantation with the double patch technique is feasible and safe. This technique allows discontinuation of anticoagulation. There was a 30-day survival of 100%. Further studies are needed to provide better evidence for LVAD explantation and long-term follow-up.
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Affiliation(s)
- Oliver Daniel Bhadra
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - Jonas Pausch
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - Hug Aubin
- Heinrich Heine University Duesseldorf, Department for Cardiovascular Surgery, Duesseldorf, Germany
| | - Payam Akhyari
- Heinrich Heine University Duesseldorf, Department for Cardiovascular Surgery, Duesseldorf, Germany
- RWTH Aachen University, Department for Cardiovascular Surgery, Aachen, Germany
| | - Artur Lichtenberg
- Heinrich Heine University Duesseldorf, Department for Cardiovascular Surgery, Duesseldorf, Germany
| | - Markus Johannes Barten
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - Yousuf Alassar
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - Hermann Reichenspurner
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
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Bhadra O, Mersmann J, Pausch J, Barten M, Alassar Y, Reichenspurner H, Bernhardt A. Impact of Left Ventricular Unloading on Venoarterial Extracorporeal Membrane Oxygenation Support Prior to Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Petersen J, Alassar Y, Yildirim Y, Tönnis T, Reichenspurner H, Pecha S. Minimally invasive epicardial left-ventricular lead implantation and simultaneous left atrial appendage closure. Front Cardiovasc Med 2023; 10:1129410. [PMID: 36970346 PMCID: PMC10036564 DOI: 10.3389/fcvm.2023.1129410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundAtrial fibrillation (AF) is common in patients with heart failure resulting in a high prevalence of AF in patients receiving Cardiac Resynchronization Therapy (CRT) implantation. In patients, unsuitable for transvenous left ventricular (LV)-lead implantation, epicardial LV-lead implantation represents a valuable alternative. Epicardial LV-lead placement can be achieved totally thoracoscopical or via minimally invasive left lateral thoracotomy. In patients with atrial fibrillation, concomitant left atrial appendage (LAA) clipping is feasible via the same access. Therefore, the aim of our study was the analysis of safety and efficacy of epicardial LV lead implantation and concomitant LAA clipping via minimally invasive left-lateral thoracotomy.MethodsBetween December 2019 and March 2022, 8 patients received minimally invasive left atrial LV-lead implantation with concomitant LAA closure using the AtriClip. Transesophageal echocardiography (TEE) was performed to intraoperatively guide and control LAA closure.ResultsMean patients age was 64 ± 11.2 years, 67% were male patients. Minimally invasive left-lateral thoracotomy was used in 6 patients while a totally thoracoscopic approach was performed in 2 cases. Epicardial lead implantation was successfully performed in all patients with good pacing threshold (mean 0.8 ± 0.2 V) and sensing values (10.1 ± 2.3 mV). Posterolateral position of the LV lead was achieved in all patients. Furthermore, successful LAA closure was confirmed during TEE in all patients. No procedure-related complications occurred in any of the patients. Two patients additionally received simultaneous laser lead extraction during the same procedure. Complete lead extraction was achieved in both patients. All patients were extubated in the OR and had an uneventful postoperative course.ConclusionOur study highlights a novel treatment approach for patients with atrial fibrillation and the necessity of epicardial LV leads. Placement of a posterolateral LV lead position with concomitant occlusion of the left atrial appendage via a minimally-invasive left-lateral thoracotomy or even a totally thoracoscopic approach is safe and feasible with superior cosmetic result and complete occlusion of the left atrial appendage.
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Affiliation(s)
- Johannes Petersen
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Hamburg/Kiel/lübeck, Germany
- Correspondence: Johannes Petersen
| | - Yousuf Alassar
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Yalin Yildirim
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Tobias Tönnis
- 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
- German Center for Cardiovascular Research (DZHK), Hamburg/Kiel/lübeck, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Hamburg/Kiel/lübeck, Germany
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Yildirim Y, Petersen J, Aydin A, Alassar Y, Reichenspurner H, Pecha S. Complete Left-Atrial Lesion Set versus Pulmonary Vein Isolation Only in Patients with Paroxysmal AF Undergoing CABG or AVR. Medicina (Kaunas) 2022; 58:1607. [PMID: 36363563 PMCID: PMC9697357 DOI: 10.3390/medicina58111607] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 09/10/2023]
Abstract
Background and Objectives: In patients with paroxysmal atrial fibrillation (AF) undergoing CABG or aortic valve surgery, many surgeons are not willing to open the left atrium to perform a complete left-sided Cox-Maze lesion set. Pulmonary vein isolation (PVI) is often favored in those patients. We investigated the outcome of patients with isolated pulmonary vein isolation compared to those receiving an extended left atrial (LA) lesion set. Materials and Methods: Between 2003 and 2016, 817 patients received concomitant surgical AF ablation in our institution. A total of 268 patients with paroxysmal AF were treated by surgical ablation concomitant to AVR or CABG. Of those, 86 patients underwent a complete left-sided lesion set, while 182 patients were treated with an isolated pulmonary vein isolation. The primary endpoint was freedom from atrial fibrillation at 12 months' follow-up. Results: There were no statistically significant differences regarding baseline characteristics. No major ablation-related complications were observed in any of the groups. In the PVI group, three patients (1.6%) had an intraoperative stroke, while two (2.3%) patients experienced a stroke in the LA ablation group (p = 0.98). In-hospital mortality was 3.4% in the PVI group, and 2.8% in the extended LA group (p = 0.33). Freedom from AF at 12 months' follow-up was 76% in the extended LA ablation group and 70% in the PVI group, showing no statistically significant difference (p = 0.32). Conclusion: Surgical AF ablation concomitant to CABG or AVR in patients with paroxysmal AF is safe and effective. There was no statistically significant difference between the compared lesion sets in terms of freedom from AF, survival or stroke rate after 12 months.
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Affiliation(s)
- Yalin Yildirim
- Department of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, Germany
| | - Johannes Petersen
- Department of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - Ali Aydin
- Heart Center Bremen-Kardiologic-Angiologic Practice (KAP) Bremen, 28277 Bremen, Germany
| | - Yousuf Alassar
- Department of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
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Petersen J, Naito S, Kloth B, Pecha S, Zipfel S, Alassar Y, Detter C, Conradi L, Reichenspurner H, Girdauskas E. Antegrade axillary arterial perfusion in 3D endoscopic minimally-invasive mitral valve surgery. Front Cardiovasc Med 2022; 9:980074. [PMID: 36247481 PMCID: PMC9561617 DOI: 10.3389/fcvm.2022.980074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Minimally-invasive (MIS) mitral valve (MV) surgery has become standard therapy in many cardiac surgery centers. While femoral arterial perfusion is the preferred cannulation strategy in MIS mitral valve surgery, retrograde arterial perfusion is known to be associated with an increased risk for cerebral atheroembolism, particularly in atherosclerosis patients. Therefore, antegrade perfusion may be beneficial in such cases. This analysis aimed to compare outcomes of antegrade axillary vs. retrograde femoral perfusion in the MIS mitral valve surgery. Methods This analysis includes 50 consecutive patients who underwent MIS between 2016 and 2020 using arterial cannulation of right axillary artery (Group A) due to severe aortic arteriosclerosis. Perioperative outcomes of the study group were compared with a historical control group of retrograde femoral perfusion (Group F) which was adjusted for age and gender (n = 50). Primary endpoint of the study was in-hospital mortality and perioperative cerebrovascular events. Results Patients in group A had a significantly higher perioperative risk as compared to Group F (EuroSCORE II: 3.9 ± 2.5 vs. 1.6 ± 1.5; p = 0.001; STS-Score: 2.1 ± 1.4 vs. 1.3 ± 0.6; p = 0.023). Cardiopulmonary bypass time (group A: 172 ± 46; group F: 178 ± 51 min; p = 0.627) and duration of surgery (group A: 260 ± 65; group F: 257 ± 69 min; p = 0.870) were similar. However, aortic cross clamp time was significantly shorter in group A as compared to group F (86 ± 20 vs. 111 ± 29 min, p < 0.001). There was no perioperative stroke in either groups. In-hospital mortality was similar in both groups (group A: 1 patient; group F: 0 patients; p = 0.289). In group A, one patient required central aortic repair due to intraoperative aortic dissection. No further cardiovascular events occurred in Group A patients. Conclusion Selective use of antegrade axillary artery perfusion in patients with systemic atherosclerosis shows similar in-hospital outcomes as compared to lower risk patients undergoing retrograde femoral perfusion. Patients with higher perioperative risk and severe atherosclerosis can be safely treated via the minimally invasive approach with antegrade axillary perfusion.
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Affiliation(s)
- Johannes Petersen
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
- *Correspondence: Johannes Petersen,
| | - Shiho Naito
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Benjamin Kloth
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
- Department of Cardiothoracic Surgery, Augsburg University Hospital, Augsburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Svante Zipfel
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Yousuf Alassar
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
- Department of Cardiothoracic Surgery, Augsburg University Hospital, Augsburg, Germany
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Stolfa P, Petersen J, Alassar Y, Reichenspurner H, Pecha S. Predictors of Rhythm Outcome in Patients Undergoing Concomitant AF Ablation: A Single-Center Experience of More than 1,000 Patients. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- P. Stolfa
- Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herzchirurgie, Hamburg, Deutschland
| | - J. Petersen
- Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herzchirurgie, Hamburg, Deutschland
| | - Y. Alassar
- Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herzchirurgie, Hamburg, Deutschland
| | - H. Reichenspurner
- Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herzchirurgie, Hamburg, Deutschland
| | - S. Pecha
- Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herzchirurgie, Hamburg, Deutschland
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Yildirim Y, Yildirim S, Petersen J, Alassar Y, Sinning C, Conradi L, Reichenspurner H, Pecha S. Left-Atrial Strain Predicts Rhythm Outcome in Patients with Persistent Atrial Fibrillation Undergoing Left-Atrial Cryoablation during Minimally Invasive Endoscopic Mitral Valve Repair. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Y. Yildirim
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - S. Yildirim
- Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Kardiologie, Hamburg, Deutschland
| | - J. Petersen
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - Y. Alassar
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - C. Sinning
- Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Kardiologie, Hamburg, Deutschland
| | - L. Conradi
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - H. Reichenspurner
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - S. Pecha
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
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Petersen J, Vettorazzi E, Hakmi S, Alassar Y, Meyer C, Willems S, Wagner FM, Girdauskas E, Reichenspurner H, Pecha S. Should concomitant surgical ablation for atrial fibrillation be performed in elderly patients? J Thorac Cardiovasc Surg 2021; 161:1816-1823.e1. [DOI: 10.1016/j.jtcvs.2019.10.186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 09/29/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
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Schaefer A, Schneeberger Y, Castro L, Sill B, Alassar Y, Rybczynski M, Barten MJ, Grahn H, Reichenspurner H, Philipp SA, Bernhardt AM. Left Ventricular Assist Device Implantation and Concomitant Dor Procedure: a Single Center Experience. Braz J Cardiovasc Surg 2020; 35:477-483. [PMID: 32864927 PMCID: PMC7454606 DOI: 10.21470/1678-9741-2019-0349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Left ventricular assist device (LVAD) implantation with concomitant Dor plasty is only reported anecdotally. We herein aimed to describe our experience with LVAD and concomitant Dor procedures and describe long-term outcomes of this special subset of heart failure patients. METHODS Between January/2010 and December/2018, 144 patients received LVAD therapy at our institution. Of those, five patients (80% male, 60.4±7.2 years) presented with an apical aneurysm and received concomitant Dor plasty. Apical aneurysms presented diameter between 75 and 98 mm, with one impending rupture. RESULTS Procedural success was achieved in all patients. No unplanned right ventricular assist device implantation occurred. Furthermore, no acute 30-day mortality was seen. In follow-up, one patient was lost due to intentional disconnection of the driveline. One patient underwent heart transplantation on postoperative day 630. The remaining three patients are still on device with sufficient flow; pump thromboses were successfully managed by lysis therapy in one patient. CONCLUSION LVAD implantation with concomitant Dor procedure is feasible, safe, and occasionally performed in patients with ischemic cardiomyopathy. Major advantages are prevention of thromboembolism and facilitation of LVAD placement by improving pump stability and warranting midventricular, coaxial alignment of the inflow cannula. In long-term follow-up, no adverse event associated with Dor plasty was observed.
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Affiliation(s)
- Andreas Schaefer
- 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
| | - Liesa Castro
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Bjoern Sill
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Yousuf Alassar
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Meike Rybczynski
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Markus J Barten
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Hanno Grahn
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Sebastian A Philipp
- Department of Cardiology and Intensive Care Medicine, Elbe Clinic, Stade, Germany
| | - Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Westhofen S, Girdauskas E, Alassar Y, Detter C, Reichenspurner H, Conradi L. Isolated Repair versus Replacement for Infective Native Mitral Valve Endocarditis. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Westhofen S, Girdauskas E, Alassar Y, Detter C, Reichenspurner H, Conradi L. Impact of Minimally Invasive Mitral Valve Repair on Inflammatory, Coagulatory, and Functional Laboratory Parameters: A Comparative Analysis. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S. Westhofen
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | | | - Y. Alassar
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - C. Detter
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | | | - L. Conradi
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
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Pecha S, Petersen J, Alassar Y, Hakmi S, Meyer C, Willems S, Reichenspurner H. Outcome Predictors for Surgical Atrial Fibrillation Ablation Concomitant to Mitral Valve Surgery. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S. Pecha
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - J. Petersen
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - Y. Alassar
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - S. Hakmi
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - C. Meyer
- Universitäres Herzzentrum Hamburg, Elektrophysiologie, Hamburg, Germany
| | - S. Willems
- Universitäres Herzzentrum Hamburg, Elektrophysiologie, Hamburg, Germany
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Petersen J, Hakmi S, Alassar Y, Subbotina I, Wagner M, Meyer C, Willems S, Reichenspurner H, Pecha S. Which Energy Source Is Superior? Bipolar Radiofrequency versus Cryoablation in Concomitant Atrial Fibrillation Surgery. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J. Petersen
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Hakmi
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - Y. Alassar
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - I. Subbotina
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - M. Wagner
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - C. Meyer
- Department of Cardiology - Electrophysiology, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Willems
- Department of Cardiology - Electrophysiology, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Pecha
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
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Yildirim Y, Pecha S, Hakmi S, Alassar Y, Zipfel S, Braune S, Kluge S, Reichenspurner H. Veno-venous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544486] [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: 10/20/2022]
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Westhofen S, Detter C, Deuse T, Treede H, Alassar Y, Kubik M, Reichenspurner H, Wagner F. Surgical Tricuspid Valve Reconstruction with a New 3 Dimensional Ring: Improved 1 Year Outcome. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pecha S, Ahmadzade T, Hakmi S, Subbotina I, Alassar Y, Deuse T, Willems S, Reichenspurner H, Wagner F. Concomitant Surgical Ablation for Atrial Fibrillation in Patients with Significant Atrial Dilation > 55 mm. Worth the Effort? Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pecha S, Hartel F, Ahmadzade T, Alassar Y, Deuse T, Aydin A, Willems S, Reichenspurner H, Wagner F. Event Recorder Monitoring to Compare the Efficacy of a Left Versus Biatrial Lesion Set in Patients Undergoing Concomitant Surgical Ablation for Atrial Fibrillation. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yildirim Y, Pecha S, Kubik M, Alassar Y, Deuse T, Hakmi S, Reichenspurner H. Efficacy of prophylactic intra-aortic balloon pump therapy in chronic heart failure patients undergoing cardiac surgery. Artif Organs 2014; 38:967-72. [PMID: 24571119 DOI: 10.1111/aor.12276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study investigated the efficacy of prophylactic intraoperative intra-aortic balloon pump (IABP) usage in chronic heart failure patients with severely reduced left ventricular function undergoing elective cardiac surgery. Between January 2008 and December 2012, 107 patients with severely reduced left ventricular ejection fraction (LVEF <35%) received prophylactic intraoperative IABP implantation during open-heart surgery. Surgical procedures performed were isolated coronary artery bypass grafting (CABG) in 35 patients (32.7%), aortic valve replacement in 12 (11.2%), mitral valve repair or replacement in 15 (14.0%), combined valve and CABG procedures in 27 (25.2%), and other surgical procedures in 18 (16.8%). Results and outcomes were compared with those in a propensity score-matched cohort of 107 patients who underwent cardiac surgery without intraoperative IABP implantation. Matching criteria were age, gender, LVEF, and surgical procedure. Duration of intensive care unit (ICU) stay, duration of hospital stay, and 30-day mortality were markers of outcome. In the IABP group, mean patient age was 69.1 ± 13.7 years; 66.4% (70) were male. All IABPs were placed intraoperatively. Mean duration of IABP application time was 42.4 ± 8.7 h. IABP-related complications occurred in five patients (4.7%), including one case of inguinal bleeding, one case of mesenteric ischemia, and ischemia of the lower limb in three patients. No stroke or major bleeding occurred during IABP support. Mean durations of ICU and hospital stay were 3.38 ± 2.15 days and 7.69 ± 2.02 days, respectively, in the IABP group, and 4.20 ± 3.14 days and 8.57 ± 3.26 days in the control group, showing statistically significant reductions in duration of ICU and hospital stay in the IABP group (ICU stay, P = 0.036; hospital stay, P = 0.015). Thirty-day survival rates were 92.5 and 94.4% in the IABP and control group, respectively, showing no statistically significant difference (P = 0.75). IABP usage in chronic heart failure patients with severely reduced LVEF undergoing cardiac surgery was safe and resulted in shorter ICU and hospital stay but did not influence 7- and 30-day survival rates.
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Affiliation(s)
- Yalin Yildirim
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
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Yildirim Y, Pecha S, Hakmi S, Alassar Y, Zimmermann W, Eschenhagen T, Reichenspurner H. Development of recipient-matched engineered heart tissue using 3D printing. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367128] [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: 10/25/2022]
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Yildirim Y, Pecha S, Alassar Y, Hakmi S, Deuse T, Reichenspurner H. Development of a retrograde flow inhibition device in continues flow VAD for emergency rescue. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367152] [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: 10/25/2022]
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Pecha S, Mudersbach E, Wagner F, Alassar Y, Hakmi S, Yildirim Y, Reichenspurner H, Eschenhagen T, Christ T. Prostaglandin E2 does not attenuate adrenergic-induced cardiac contractile response. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367255] [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: 10/25/2022]
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Arunagirinathan U, Alassar Y, Muth A, Biermann D, Reiter B, Reichenspurner H, Detter C. Hemodynamic performance of 3 difference bioprothesis: SJM Trifecta vs. Sorin Mitroflow and stentless Sorin Solo. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367318] [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: 10/25/2022]
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Alassar Y, Yildirim Y, Pecha S, Detter C, Deuse T, Reichenspurner H. Minimal access median sternotomy for aortic valve replacement in elderly patients. J Cardiothorac Surg 2013; 8:103. [PMID: 23601376 PMCID: PMC3652735 DOI: 10.1186/1749-8090-8-103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 01/04/2013] [Accepted: 04/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We report our clinical experience with a approach for aortic valve replacement (AVR) via minimal access skin incision and complete median sternotomy. This approach was used in patients with higher age and multiple co-morbidities, facilitating an easy access with short bypass and cross clamp times. It was especially performed in patients asking for an excellent cosmetic result, who did not qualifying for minimally-invasive AVR via partial upper sternotomy. METHODS AVR via minimal-access median sternotomy, was performed in 58 patients between 01/2009 and 11/2011. Intra- and postoperative data including cross clamp time, cardiopulmonary bypass time, mortality, stroke, pacemaker implantation, re-operation for bleeding, ventilation time, ICU and hospital stay, wound infection, sternal dehiscence or fracture and 30 day mortality were collected. RESULTS Mean patients age was 76.1 +/-9.4 years, 72% were female. Minimal-access AVR could be performed with a mean length of midline skin incision of 7.8 cm. Aortic cross-clamping time was 54.6 +/-6.3 min, cardiopulmonary bypass time 71.2+/-11.3 min and time of surgery 154.1 +/-26.8 min. Re-operation for bleeding had to be performed in 1 case (1.7%). There were no strokes or pacemaker implantations needed. Mean ventilation time was 4.5 h, ICU stay was 2 days and mean length of hospital stay was 6 days. 6 months follow up showed mortality of 0% and no sternal dehiscence or wound infection was observed. CONCLUSION Minimal-access AVR via complete median sternotomy can be performed safely,in this elderly patient cohort without adding additional operative risk compared to conventional AVR. By avoidiance of large skin incisions this approach combines excellent cosmetic results with fast surgery time and excellent postoperative recovery.
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Affiliation(s)
- Yousuf Alassar
- Department of Cardiovascular Surgery, Univeity Heart Center Hamburg, Martinistr, 52, Hamburg, 20246, Germany.
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Arunagirinathan U, Alassar Y, Muth A, Reiter B, Reichenspurner H, Detter C. Hemodynamic performance of the SJM Trifecta bioprothesis: Comparison of three different bioprosthesis. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332699] [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: 10/27/2022]
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26
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Alassar Y, Pecha S, Yildirim Y, Deuse T, Detter C, Reichenspurner H. Minimal access median sternotomy for aortic valve replacement. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332708] [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: 10/27/2022]
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27
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Brickwedel J, Alassar Y, Salman M, Reiter B, Gulbins H, Reichenspurner H. Influence of different brain protection strategies for the treatment of acute type A aortic dissection. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269326] [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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