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Comparison of two self-expanding transcatheter heart valves for degenerated surgical bioprostheses: the AVENGER multicentre registry. EUROINTERVENTION 2024; 20:e363-e375. [PMID: 38506737 PMCID: PMC10941672 DOI: 10.4244/eij-d-23-00779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/17/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND There is a lack of comparative data on transcatheter aortic valve implantation (TAVI) in degenerated surgical prostheses (valve-in-valve [ViV]). AIMS We sought to compare outcomes of using two self-expanding transcatheter heart valve (THV) systems for ViV. METHODS In this retrospective multicentre registry, we included consecutive patients undergoing transfemoral ViV using either the ACURATE neo/neo2 (ACURATE group) or the Evolut R/PRO/PRO+ (EVOLUT group). The primary outcome measure was technical success according to Valve Academic Research Consortium (VARC)-3. Secondary outcomes were 30-day all-cause mortality, device success (VARC-3), coronary obstruction (CO) requiring intervention, rates of severe prosthesis-patient mismatch (PPM), and aortic regurgitation (AR) ≥moderate. Comparisons were made after 1:1 propensity score matching. RESULTS The study cohort comprised 835 patients from 20 centres (ACURATE n=251; EVOLUT n=584). In the matched cohort (n=468), technical success (ACURATE 92.7% vs EVOLUT 88.9%; p=0.20) and device success (69.7% vs 73.9%; p=0.36) as well as 30-day mortality (2.8% vs 1.6%; p=0.392) were similar between the two groups. The mean gradients and rates of severe PPM, AR ≥moderate, or CO did not differ between the groups. Technical and device success were higher for the ACURATE platform among patients with a true inner diameter (ID) >19 mm, whereas a true ID ≤19 mm was associated with higher device success - but not technical success - among Evolut recipients. CONCLUSIONS ViV TAVI using either ACURATE or Evolut THVs showed similar procedural outcomes. However, a true ID >19 mm was associated with higher device success among ACURATE recipients, whereas in patients with a true ID ≤19 mm, device success was higher when using Evolut.
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Short- and long-term impact of nutrition in a large cohort of patients undergoing transcatheter aortic valve implantation: prognostic value of GNRI. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Nutritional status, as measured by Geriatric Nutritional Risk Index (GNRI), an easy-to-use tool combining both clinical and laboratory parameters, was shown to predict short-term survival in patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) by our group and others, and this has been extensively confirmed later on. However, data on the long-term impact of nutritional indexes on TAVI outcomes are still lacking.
Purpose
We aimed at confirming our previous short-term findings in a large population and to investigate the prognostic impact of GNRI in the long-term.
Methods
All consecutive patients who underwent TAVI between Oct. 2015 and Dec. 2021 at our centre were selected. Baseline nutritional parameters were consistently recorded. An up-to-6-year prospective follow-up was performed. Patients with missing albumin values or with no follow-up available were excluded. Taking into account the old age of patients usually being treated with TAVI, the geriatric version of NRI (GNRI for age>65) was used, and the very few patients younger than 65 years were excluded. GNRI was calculated as described by Bouillanne et al using the following formula: Geriatric (G) NRI = (1.489)×Albumin (g/L) + [(41.7×(present weight/ideal weight)]. The primary endpoint was long-term all-cause mortality. Patients were divided into: GNRI>98 (no risk of malnutrition) and ≤98 (risk of malnutrition). Kaplan-Meier curves were plotted and impact on prognosis was calculated using Cox regression analyses.
Results
A total of 1084 patients, median (IQR) age 82.2 (78.5–85.5) years, 44.4% female, were included. Median (IQR) BMI was 26.6 (24.2–30.0) kg/m2, corresponding to a slightly overweight population. Median (IQR) GNRI at baseline was 113.7 (106–120.2). 8.6% of patients showed risk of malnutrition (GNRI ≤98). Kaplan-Meier curves showed a significant impact on long-term mortality in patients with risk of malnutrition compared to those with no malnutrition risk, with curves starting to diverge in the first weeks after the procedure. The effect of nutritional status measured by GNRI increased with time. A significant association was shown in univariate analyses (HR 2.3 [95% CI 1.7–3.1], p<0.001) and also in multivariate analyses after adjusting for potential confounding factors (including age, sex and Euroscore II, among others) (HR 1.7 [95% CI 1.2–2.5], p<0.002). According to area under curve for ROC curves, GNRI showed a better predictive value than the widely used BMI.
Conclusion
This study confirmed the negative impact of the malnutrition risk status, as measured by GNRI, on short-term mortality after TAVI, and showed an even more pronounced effect in the long-term. GNRI could be easily recorded on admission, before TAVI procedure, and considered for heart team decisions. Further studies may be warranted to identify potential mechanisms for nutritional effects and to investigate the potential use of nutrition-improving measures in selected patients.
Funding Acknowledgement
Type of funding sources: None.
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Personalized Preoperative Prediction of the Length of Hospital Stay after TAVI Using a Dedicated Decision Tree Algorithm. J Pers Med 2022; 12:jpm12030346. [PMID: 35330346 PMCID: PMC8950279 DOI: 10.3390/jpm12030346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to identify pre-operative parameters able to predict length of stay (LoS) based on clinical data and patient-reported outcome measures (PROMs) from a scorecard database in patients with significant aortic stenosis who underwent TAVI (transfemoral aortic valve implantation). Methods: 302 participants (51.7% males, age range 78.2−84.2 years.) were prospectively recruited. After computing the median LoS value (=6 days, range = 5−8 days), we implemented a decision tree algorithm by setting dichotomized values at median LoS as the dependent variable and assessed baseline clinical variables and PROMs (Clinical Frailty Scale (CFS), EuroQol-5 Dimension-5 Levels (EQ-5D) and Kansas City Cardiomyopathy Questionnaire (KCCQ)) as potential predictors. Results: Among clinical parameters, only peripheral arterial disease (p = 0.029, HR = 1.826) and glomerular filtration rate (GFR, cut-off < 33 mL/min/1.73 m2, p = 0.003, HR = 2.252) were predictive of LoS. Additionally, two PROMs (CFS; cut-off = 3, p < 0.001, HR = 1.324 and KCCQ; cut-off = 30, p = 0.003, HR = 2.274) were strong predictors. Further, a risk score for LoS (RS_LoS) was calculated based on these predictors. Patients with RS_LoS = 0 had a median LoS of 5 days; patients RS_LoS ≥ 3 had a median LoS of 8 days. Conclusions: based on the pre-operative values of the above four predictors, a personalized prediction of LoS after TAVI can be achieved.
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A Novel Method to Predict Mortality and Length of Stay after Transfemoral Transcatheter Aortic Valve Implantation. Medicina (B Aires) 2021; 57:medicina57121332. [PMID: 34946277 PMCID: PMC8707781 DOI: 10.3390/medicina57121332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/25/2021] [Accepted: 12/04/2021] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: We tested if a novel combination of predictors could improve the accuracy of outcome prediction after transfemoral transcatheter aortic valve implantation (TAVI). Materials and Methods: This prospective study recruited 169 participants (49% female; median age 81 years). The primary endpoint was midterm mortality; secondary endpoints were acute Valve Academic Research Consortium (VARC)-3 complication rate and post-TAVI in-hospital length of stay (LoS). EuroSCORE II (ESII), comorbidities (e.g., coronary artery disease), eGFR (estimated glomerular filtration rate; based on cystatin C), hemoglobin, creatinine, N-Terminal pro-Brain Natriuretic Peptide (NTproBNP) levels and patient-reported outcome measures (PROMs, namely EuroQol-5-Dimension-5-Levels, EQ5D5L; Kansas City Cardiomyopathy Questionnaire, KCCQ; clinical frailty scale, CFS) at baseline were tested as predictors. Regression (uni- and multi-variate Cox; linear; binary logistic) and receiver operating characteristic (ROC)-curve analysis were applied. Results: Within a median follow-up of 439 (318–585) days, 12 participants died (7.1%). Independent predictors of mortality using multivariate Cox regression were baseline eGFR (p = 0.001) and KCCQ (p = 0.037). Based on these predictors, a Linear Prediction Score (LPS1) was calculated. The LPS1-area under the curve (AUC)-value (0.761) was significantly higher than the ESII-AUC value (0.597; p = 0.035). Independent predictors for LoS > 6 days (the median LoS) were eGFR (p = 0.028), NTproBNP (p = 0.034), and EQ5D5L values (p = 0.002); a respective calculated LPS2 provided an AUC value of 0.677 (p < 0.001). Eighty participants (47.3%) experienced complications. Male sex predicted complications only in the univariate analysis. Conclusions: The combination of KCCQ and eGFR can better predict midterm mortality than ES II alone. Combining eGFR, NTproBNP, and EQ5D5L can reliably predict LoS after TAVI. This novel method improves personalized TAVI risk stratification and hence may help reduce post-TAVI risk.
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Hemodynamic Outcome and Valve Durability Beyond Five Years After Transcatheter Aortic Valve Replacement. THE JOURNAL OF INVASIVE CARDIOLOGY 2020; 32:82-87. [PMID: 32123140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate hemodynamic outcome, structural valve deterioration, and bioprosthetic valve failure beyond 5 years after transcatheter aortic valve replacement (TAVR). METHODS Demographic, procedural, and outcome data were obtained from all patients treated with TAVR at our institution from 2006 to 2012. We included all patients with echocardiographic data at baseline and with a follow-up echocardiography more than 5 years after TAVR. Standardized definitions were used to assess durability of transcatheter aortic valves. RESULTS A total of 452 patients were treated with apical or transfemoral transcatheter aortic valve implantation (TAVI) from 2006-2012, and 103 (23%) patients were still alive more than 5 years post TAVI. Mean duration of follow-up was 7.0 ± 0.9 years, with a maximum duration of 9.8 years. Seventy-nine of the 103 patients (76.7%) underwent follow-up echocardiography. Mean aortic gradient decreased from 51.8 ± 14.3 mm Hg before TAVR to 11.7 ± 5.8 mm Hg after TAVR (P<.001), and remained stable at 10.6 ± 6.3 mm Hg during late follow-up (P=.26). Bioprosthetic valve failure occurred in 3 patients (3.8%); two of these patients required reintervention. Seven patients (8.9%) had moderate structural valve deterioration, and 1 patient (1.3%) had severe structural valve deterioration. CONCLUSION TAVR with self-expanding and balloon-expandable valves appears to be a long-lasting treatment strategy for severe aortic stenosis with excellent long-term hemodynamic function and very low incidence of structural valve deterioration and bioprosthetic valve failure.
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Inferior vena cava ultrasound in acute decompensated heart failure: design rationale of the CAVA-ADHF-DZHK10 trial. ESC Heart Fail 2020; 7:973-983. [PMID: 31991063 PMCID: PMC7261559 DOI: 10.1002/ehf2.12598] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/04/2019] [Accepted: 11/27/2019] [Indexed: 12/20/2022] Open
Abstract
Aims Treating patients with acute decompensated heart failure (ADHF) presenting with volume overload is a common task. However, optimal guidance of decongesting therapy and treatment targets are not well defined. The inferior vena cava (IVC) diameter and its collapsibility can be used to estimate right atrial pressure, which is a measure of right‐sided haemodynamic congestion. The CAVA‐ADHF‐DZHK10 trial is designed to test the hypothesis that ultrasound assessment of the IVC in addition to clinical assessment improves decongestion as compared with clinical assessment alone. Methods and results CAVA‐ADHF‐DZHK10 is a randomized, controlled, patient‐blinded, multicentre, parallel‐group trial randomly assigning 388 patients with ADHF to either decongesting therapy guided by ultrasound assessment of the IVC in addition to clinical assessment or clinical assessment alone. IVC ultrasound will be performed daily between baseline and hospital discharge in all patients. However, ultrasound results will only be reported to treating physicians in the intervention group. Treatment target is relief of congestion‐related signs and symptoms in both groups with the additional goal to reduce the IVC diameter ≤21 mm and increase IVC collapsibility >50% in the intervention group. The primary endpoint is change in N‐terminal pro‐brain natriuretic peptide from baseline to hospital discharge. Secondary endpoints evaluate feasibility, efficacy of decongestion on other scales, and the impact of the intervention on clinical endpoints. Conclusions CAVA‐ADHF‐DZHK10 will investigate whether IVC ultrasound supplementing clinical assessment improves decongestion in patients admitted for ADHF.
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Aortic Root Surgery in Acute Aortic Dissection Type A: Comparison of Aortic Valve-sparing Repair versus Composite Grafting. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Extracorporeal life support with left ventricular decompression-improved survival in severe cardiogenic shock: results from a retrospective study. PeerJ 2017; 5:e3813. [PMID: 28975053 PMCID: PMC5624302 DOI: 10.7717/peerj.3813] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/25/2017] [Indexed: 02/06/2023] Open
Abstract
Objective Extracorporeal life support (ECLS) is a life-saving procedure used in the treatment of severe cardiogenic shock. Within this retrospective single centre study, we examined our experience in this critically ill patient cohort to assess outcomes and clinical parameters by comparison of ECLS with or without selective left ventricular decompression. Methods Between 2004 and 2014 we evaluated 48 adult patients with INTERMACS level 1 heart failure (age 49.7 ± 19.5 years), who received either central ECLS with (n = 20, 41.7%) or ECLS without (n = 28, 58.3%, including 10 peripheral ECLS) integrated left ventricular vent in our retrospective single centre trial. Results Follow up was 100% with a mean of 0.83 ± 1.85 years. Bridge to ventricular assist device was feasible in 29.2% (n = 14), bridge to transplant in 10.4% (n = 5) and bridge to recovery in 8.3% (n = 4). Overall 30-day survival was 37.5%, 6-month survival 27.1% and 1-year survival 25.0%. ECLS support with left ventricular decompression showed favourable 30-day survival compared to ECLS without left ventricular decompression (p = 0.034). Thirty-day as well as long-term survival did not differ between the subgroups (central ECLS with vent, ECLS without vent and peripheral ECLS without vent). Multivariate logistic regression adjusted for age and gender revealed ECLS without vent as independent factor influencing 30-day survival. Conclusion ECLS is an established therapy for patients in severe cardiogenic shock. Independent of the ECLS approach, 30-day mortality is still high but with superior 30-day survival for patients with ECLS and left ventricular venting. Moreover, by unloading the ventricle, left ventricular decompression may provide an important time window for recovery or further treatment, such as bridge to bridge or bridge to transplant.
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AP-1 Oligodeoxynucleotides Reduce Aortic Elastolysis in a Murine Model of Marfan Syndrome. MOLECULAR THERAPY. NUCLEIC ACIDS 2017; 9:69-79. [PMID: 29246325 PMCID: PMC5608502 DOI: 10.1016/j.omtn.2017.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 11/28/2022]
Abstract
Marfan syndrome is characterized by high expression of matrix metalloproteinases (MMPs) in aortic smooth muscle cells (AoSMCs) associated with medial elastolysis and aortic root aneurysm. We aimed to reduce aortic elastolysis through decrease of MMP expression with decoy oligodeoxynucleotides (dODNs) neutralizing the transcription factor activating factor-1 (AP-1). AP-1 abundance in nuclear extracts as well as MMP-2 and MMP-9 expression were significantly increased in isolated mAoSMC of mgR/mgR Marfan mice compared to wild-type cells. Exposure to AP-1 neutralizing dODNs resulted in a significant reduction of basal and interleukin-1β-stimulated MMP expression and activity in mAoSMCs. Moreover, increased migration and formation of superoxide radical anions was substantially decreased in mAoSMCs by AP-1 dODN treatment. Aortic grafts from donor Marfan mice were treated with AP-1- dODN ex vivo and implanted as infrarenal aortic interposition grafts in mgR/mgR mice. Pretreatment of aortic grafts with AP-1 dODN led to reduced elastolysis, macrophage infiltration, and MMP activity. Permeability of the endothelial monolayer was increased for dODN in mgR/mgR aortae with observed loss of tight junction proteins ZO-1 and occludin, enabling dODN to reach the tunica media. Targeting AP-1 activity offers a new potential strategy to treat the vascular phenotype associated with Marfan syndrome.
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Colectomy due to Ischemic Colitis after Heart Surgery: A Matched-pairs Analysis. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Technical Improvements and Individualized Operations Result in Favorable Outcome in Patients with Acute Aortic Dissection Type A. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cardiopulmonary Bypass (CPB) in Low-birth Weight Premature Neonate with Double Aortic Arch, Congenital Heart Disease and Tracheal Stenosis. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Resection of thoracic malignancies infiltrating cardiac structures with use of cardiopulmonary bypass. J Cardiothorac Surg 2015; 10:87. [PMID: 26109311 PMCID: PMC4479230 DOI: 10.1186/s13019-015-0296-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/19/2015] [Indexed: 11/21/2022] Open
Abstract
Background Only few reports exist on malignant thoracic neoplasms that require cardiopulmonary bypass during resection. We aimed to investigate the early and late clinical outcome of these patients. Methods Patients with thoracic malignancies that underwent surgery between 2002 and 2014 were analyzed. All patients had cardiopulomonary bypass support during resection. Clinical and perioperative data was retrospectively reviewed for outcome and overall survival. Results Fifteen patients (12 female, mean age of 55 ± 15 years, range 24 to 80 years) were identified. Eleven (8 female) were diagnosed with primary thoracic malignomas and four with metastases. Three patients died early postoperatively. Patients diagnosed with sarcoma had a significantly worse outcome than non-sarcoma patients (83.3 ± 15.2 % after 1 year, 31.3 ± 24.5 % after 5 years vs. 83.3 ± 15.2 % after 1 year, 0 ± 0 % after 5 years, p = 0.005). Conclusions Malignancies with extension into cardiac structures or infiltration of great vessels can be resected with cardiopulmonary bypass support and tolerable risk. Carefully selected patients can undergo advanced operative procedures with an acceptable 1-year-survival, but only few patients achieved good long-term outcome.
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Surgical Repair after Palliative Stenting in Neonates with Critical Aortic Coarctation. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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296 * GENDER-SPECIFIC DIFFERENCES IN OUTCOME OF ASCENDING AORTIC SURGERY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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062 * PATIENTS WITH LUPUS ERYTHEMATODES AND ANTIPHOSPHOLIPID SYNDROME UNDERGOING CARDIAC VALVE SURGERY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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mgR/mgR-Maus-Modell für die Gentherapie des Marfan-Syndroms. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00398-014-1084-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Analysis of gender-specific differences in outcome of ascending aortic aneurysm surgery. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Long-term outcome of patients with lupus erythematodes and Antiphospholipid Syndrome after cardiac valve surgery. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Aortic Mispuncture during Routine Catheterization Requires Emergency Cardiac Operation. Thorac Cardiovasc Surg 2013; 61:610-1. [DOI: 10.1055/s-0033-1333846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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The fibrillin-1 hypomorphic mgR/mgR murine model of Marfan syndrome shows severe elastolysis in all segments of the aorta. J Vasc Surg 2013; 57:1628-36, 1636.e1-3. [DOI: 10.1016/j.jvs.2012.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 09/26/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
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Adenoviral gene therapy for reduction of Elastolysis causes severe inflammation in Fibrillin-1 deficient Marfan mice (mgR/mgR). Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Colectomy after heart surgery with use of extracorporeal circulation. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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AP-1 decoy oligodeoxynucleotide inhibition of matrix metalloproteinase expression in vascular smooth muscle cells of fibrillin-1-deficient mgR/mgR-mice. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Predictive risk factors for patients with cirrhosis undergoing heart surgery. Ann Thorac Surg 2012; 94:1947-52. [PMID: 22921237 DOI: 10.1016/j.athoracsur.2012.06.057] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/23/2012] [Accepted: 06/26/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Empiric experiences suggest higher mortality and complication risk for patients with cirrhosis of the liver after cardiac surgery. However, cirrhosis is not considered a risk factor in either the EuroSCORE or The Society of Thoracic Surgeons score. We report a large single-center experience of patients with cirrhosis undergoing cardiac surgery with extracorporeal circulation and aimed to evaluate the severity of cirrhosis as a predictor of outcome. METHODS During 2001 and 2011, we operated on 109 consecutive patients (average age, 64 years; 82 male) diagnosed for cirrhosis with cardiopulmonary bypass for different indications. Thirty-day mortality and long-term mortality were set as primary study end points. RESULTS Thirty-day mortality was 26%, and 5-year survival was 19%. Patients categorized as Child-Turcotte-Pugh (CHILD) C (n=6; 67% 30-day survival; 0% 5-year survival) and B (n=30; 60%; 5%) had worse 30-day and 5-year survival compared with patients categorized as CHILD A (n=73; 80%; 25%). For 30-day mortality, preoperative EuroSCORE (p=0.015), model for end-stage liver disease (MELD) score (p=0.006), albumin (p=0.023), total protein (p=0.01), and myocardial infarction (p=0.049) revealed significant differences between survivors and nonsurvivors. Multivariate logistic regression identified only MELD score (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.03 to 1.23; p=0.011) and total protein (OR, 0.97; 95% CI, 0.95 to 1; p=0.049) were connected with increased 30-day mortality. Cox regression analysis revealed EuroSCORE (OR, 1.02; 95% CI, 1.01 to 1.03; p<0.0001) and MELD (OR, 1.06; 95% CI, 1.01 to 1.12; p=0.016) predicting the overall mortality. Receiver operating characteristic analysis indicated significant predictive power of MELD (p=0.001) and EuroSCORE (p=0.027) for 30-day mortality. CONCLUSIONS Patients with cirrhosis undergoing heart surgery with extracorporeal circulation have a poor prognosis. Several preoperative factors are related to outcome. EuroSCORE and MELD score may help to evaluate operation risk and indication.
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The groin first approach for transcatheter aortic valve implantation: are we pushing the limits for transapical implantation? Clin Res Cardiol 2012; 102:111-7. [DOI: 10.1007/s00392-012-0502-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 07/24/2012] [Indexed: 11/30/2022]
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The groin first approach for transcatheter aortic valve implantation: Are we pushing the limits for transapical implantation? Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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An atrial-aortic malpuncture during routine transseptal cardiac catheterization required emergency cardiac operation: A case report. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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29
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Predictive risk factors, short- and long-term outcome of patients with liver cirrhosis undergoing heart surgery with extracorporeal circulation. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Fibrillin-1-deficient mice (mgR/mgR) show severe elastolysis pathognomonic for Marfan syndrome in all parts of the aorta. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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31
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Recondition of a murine model of Marfan syndrome (mgR/mgR): Safe genotype-phenotype correlation. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1268960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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