609 results on '"A. Haverich"'
Search Results
2. The Treatment of Coronary Artery Disease: Current Status Six Decades After the First Bypass Operation.
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Doenst, Torsten, Thiele, Holger, Haasenritter, Jörg, Wahlers, Thorsten, Massberg, Steffen, and Haverich, Axel
- Abstract
Background: The first coronary artery bypass operation (CABG) was performed on May 2, 1960. The first percutaneous coro - nary intervention (PCI) was performed almost 20 years later. Since then, the invasive treatment of coronary artery disease (CAD) has moved into the spotlight of cardiac medical care. Methods: We summarize the current status of medical and invasive CAD treatment through a selective review of the literature. Results: More than 800 000 patients currently undergo invasive diagnostic and therapeutic procedures for CAD in Germany each year. The number of coronary artery bypass grafting (CABG) procedures rose to 65 000/year by the turn of the millennium and has been declining since then. In contrast, the number of PCIs in Germany rose to approximately 350 000/year by 2017, and a beginning decline is being observed at present. This development occurred even though, for elective patients, a survival advantage from an invasive procedure compared to medical therapy has been shown in direct comparison only for CABG. Conclusion: Conservative treatment is always the baseline treatment and has undergone major advances in the last few decades. Moreover, non-invasive coronary evaluation with computed tomography, as well as non-invasive cardiac stress imaging studies, are increasingly replacing primary invasive coronary evaluations. In this review, we illustrate a mechanistic concept of the appropriate use of CABG and PCI that can improve patient care, while underscoring the importance of interdisciplinary and intersectoral collaboration. [ABSTRACT FROM AUTHOR]
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- 2022
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3. Features and risk factors of early intraluminal thrombus formation within the frozen elephant trunk stent graft.
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Martens, Andreas, Beckmann, Erik, Kaufeld, Tim, Arar, Morsi, Natanov, Ruslan, Fleissner, Felix, Korte, Wilhelm, Krueger, Heike, Boethig, Dietmar, Haverich, Axel, and Shrestha, Malakh
- Abstract
The frozen elephant trunk is a standard treatment method for aortic arch pathologies extending into the descending aorta. We previously described the phenomenon of early postoperative intraluminal thrombosis within the frozen elephant trunk. We investigated the features and predictors of intraluminal thrombosis. A total of 281 patients (66% male, mean age 60 ± 12 years) underwent frozen elephant trunk implantation between May 2010 and November 2019. In 268 patients (95%), early postoperative computed tomography angiography was available to assess intraluminal thrombosis. The incidence of intraluminal thrombosis after frozen elephant trunk implantation was 8.2%. Intraluminal thrombosis was diagnosed early after the procedure (4.6 ± 2.9 days) and could be successfully treated with anticoagulation in 55% of patients. A total of 27% developed embolic complications. Mortality (27% vs 11%, P =.044) and morbidity were significantly higher in patients with intraluminal thrombosis. Our data showed a significant association of intraluminal thrombosis with prothrombotic medical conditions and anatomic slow flow features. The incidence of heparin-induced thrombopenia was higher in patients with intraluminal thrombosis (18% vs 3.3%, P =.011). Stent-graft diameter index, anticipated endoleak Ib, and degenerative aneurysm were significant independent predictors of intraluminal thrombosis. Therapeutic anticoagulation was a protective factor. Glomerular filtration rate, extracorporeal circulation time, postoperative rethoracotomy, and intraluminal thrombosis (odds ratio, 3.19, P =.047) were independent predictors of perioperative mortality. Intraluminal thrombosis is an underrecognized complication after frozen elephant trunk implantation. In patients with risk factors of intraluminal thrombosis indication for frozen elephant trunk should be carefully evaluated and postoperative anticoagulation considered. Early thoracic endovascular aortic repair extension should be considered in patients with intraluminal thrombosis to prevent embolic complications. Stent-graft designs should be improved to prevent intraluminal thrombosis after frozen elephant trunk implantation. [Display omitted] [ABSTRACT FROM AUTHOR]
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- 2024
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4. Does valve size impact hemodynamic, left ventricular mass regression, and prosthetic valve deterioration with a sutureless aortic valve?
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Aldea, Gabriel S., Burke, Christopher R., Fischlein, Theodor, Heimansohn, David A., Haverich, Axel, Suri, Rakesh M., and Ad, Niv
- Abstract
To assess the mid-term clinical outcomes, hemodynamics, left ventricular (LV) mass regression, and structural valve deterioration (SVD) in patients implanted with the Perceval aortic sutureless valve across valve sizes. Data were obtained from a multicenter European trial and a US Investigational Device Exemption trial. Echocardiography data were analyzed by an echocardiography core lab. A mixed-effects regression model was used to assess relationships between hemodynamic outcomes, time from the procedure, and valve sizes. The Valve Academic Research Consortium (VARC)-3 definition for bioprosthetic valve failure was applied. A Perceval sutureless valve was implanted in 970 patients. The median patient age was 77.8 years, 57.2% were female, the median Society of Thoracic Surgeons predicated risk of mortality was 3.3% (range, 2.1%-6.2%), and 33.4% had a concomitant procedure. The median clinical follow-up was 45.7 months (range, 28.2-76.1 months). Small and medium valves were implanted more commonly in women than in men (16.9% vs 1.9% for small and 55.1% vs 19.5% for medium; P <.001). The mean aortic valve gradients decreased significantly postimplantation and remained stable across all valve sizes throughout the follow-up period. All patients were free from severe patient–prosthesis mismatch (with an effective orifice area/m
2 of >0.8). Significant LV mass regression was documented regardless valve sizes, plateaued at -9.1% at 5 years. Freedom from SVD and reintervention were 95.2% and 96.3%, respectively, at 5 years and were independent of implanted valve size (P =.22). The VARC-3 stage 3 bioprosthetic valve failure rate was low, 2.8% at 5 years. The Perceval valve demonstrated low and stable mean gradients, significant LV mass regression, and low SVD and reintervention rates across all valve sizes. [Display omitted] [ABSTRACT FROM AUTHOR]- Published
- 2024
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5. In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study
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Lorusso, Roberto, De Piero, Maria Elena, Mariani, Silvia, Di Mauro, Michele, Folliguet, Thierry, Taccone, Fabio Silvio, Camporota, Luigi, Swol, Justyna, Wiedemann, Dominik, Belliato, Mirko, Broman, Lars Mikael, Vuylsteke, Alain, Kassif, Yigal, Scandroglio, Anna Mara, Fanelli, Vito, Gaudard, Philippe, Ledot, Stephane, Barker, Julian, Boeken, Udo, Maier, Sven, Kersten, Alexander, Meyns, Bart, Pozzi, Matteo, Pedersen, Finn M, Schellongowski, Peter, Kirali, Kaan, Barrett, Nicholas, Riera, Jordi, Mueller, Thomas, Belohlavek, Jan, Lorusso, Roberto, De Piero, Maria Elena, Mariani, Silvia, Di Mauro, Michele, Folliguet, Thierry, Taccone, Fabio Silvio, Camporota, Luigi, Swol, Justyna, Wiedemann, Dominik, Belliato, Mirko, Broman, Lars Mikael, Vuylsteke, Alain, Kassif, Yigal, Scandroglio, Anna Mara, Fanelli, Vito, Gaudard, Philippe, Ledot, Stephane, Barker, Julian, Boeken, Udo, Maier, Sven, Kersten, Alexander, Meyns, Bart, Pozzi, Matteo, Pedersen, Finn M, Schellongowski, Peter, Kirali, Kaan, Barrett, Nicholas, Riera, Jordi, Mueller, Thomas, Belohlavek, Jan, Lo Coco, Valeria, Van der Horst, Iwan C C, Van Bussel, Bas C T, Schnabel, Ronny M, Delnoij, Thijs, Bolotin, Gil, Lorini, Luca, Schmiady, Martin O, Schibilsky, David, Kowalewski, Mariusz, Pinto, Luis F, Silva, Pedro E, Kornilov, Igor, Blandino Ortiz, Aaron, Vercaemst, Leen, Finney, Simon, Roeleveld, Peter P, Di Nardo, Matteo, Hennig, Felix, Antonini, Marta Velia, Davidson, Mark, Jones, Tim J, Staudinger, Thomas, Mair, Peter, Kilo, Juliane, Krapf, Christoph, Erbert, Kathrin, Peer, Andreas, Bonaros, Nikolaos, Kotheletner, Florian, Krenner Mag, Niklas, Shestakova, Liana, Hermans, Greet, Dauwe, Dieter, Meersseman, Philippe, Stockman, Bernard, Nobile, Leda, Lhereux, Olivier, Nrasseurs, Alexandre, Creuter, Jacques, De Backer, Daniel, Giglioli, Simone, Michiels, Gregoire, Foulon, Pierre, Raes, Matthias, Rodrigus, Inez, Allegaert, Matthias, Jorens, Philippe, Debeucklare, Gerd, Piagnerelli, Michael, Biston, Patrick, Peperstraete, Harlinde, Vandewiele, Komeel, Germay, Olivier, Vandeweghe, Dimitri, Havrin, Sven, Bourgeois, Marc, Lagny, Marc-Gilbert, Alois, Genette, Lavios, Nathalie, Misset, Benoit, Courcelle, Romain, Timmermans, Philippe J, Yilmaz, Alaaddin, Vantomout, Michiel, Lehaen, Jerone, Jassen, Ame, Guterman, Herbert, Strauven, Maarten, Lormans, Piet, Verhamme, Bruno, Vandewaeter, catherine, Bonte, Frederik, Vionne, Dominique, Balik, Martin, Blàha, Jan, Lips, Michal, Othal, Michal, Bursa, Filip, Spacek, Radim, Christensen, Steffen, Jorgensen, Vibeke, Sorensen, Marc, Madsen, Soren A, Puss, Severin, Beljantsev, Aleksandr, Saiydoun, gabriel, Fiore, Antonio, Colson, Pascal, Bazalgette, Florian, Capdevila, Xavier, Kollen, Sebastien, Muller, Laurent, Obadia, Jean-Francois, Dubien, Pierre-Yves, Ajrhourh, Lucrezia, Guinot, Pierre G, Zarka, Jonathan, Besserve, Patricia, Malfertheiner, Maximilian V, Dreier, Esther, Heinze, Birgit, Akhyari, Payam, Lichtenberg, Artur, Aubin, Hug, Assman, Alexander, Saeed, Diyar, Thiele, Holger, Baumgaertel, Matthias, Schmitto, Jan D, Ruslan, Natanov, Haverich, Axel, Thielmann, Matthias, Brenner, Thorsten, Ruhpawar, Arjang, Benk, Christoph, Czerny, Martin, Staudacher, Dawid L, Beyersdorf, Fridhelm, Kalbhenn, Johannes, Henn, Philipp, Popov, Aron-Frederik, Iuliu, Torje, Muellenbach, Ralf, Reyher, Christian, Rolfes, Caroline, Lotz, Gosta, Sonntagbauer, Michael, Winkels, Helen, Fichte, Julia, Stohr, Robert, Kalverkamp, Sebastian, Karagiannidis, Christian, Schafer, Simone, Svetlitchny, Alexei, Fichte, Julia, Hopf, Hans-Bernd, Jarczak, Dominik, Groesdonk, Heinirich, Rommer, Magdalena, Hirsch, Jan, Kaehny, Christian, Soufleris, Dimitros, Gavriilidis, Georgios, Pontikis, Kostantinos, Kyriakopoulou, Magdalini, Kyriakoudi, Anna, O'Brien, Serena, Conrick-Martin, Ian, Carton, Edmund, Makhoul, Maged, Ben-Ari, Josef, Hadash, Amir, Kogan, Alexander, Kassif Lerner, Reut, Abu-Shakra, Anas, Matan, Moshe, Balawona, Ahmad, Kachel, Erez, Altshuler, Roman, Galante, Ori, Fuchs, Lior, Almog, Yaniv, Ishay, Yaron S, Lichter, Yael, Gal-oz, Amir, Carmi, Uri, Nini, Asaph, Soroksky, Arie, Dekel, Hagi, Rozman, Ziv, Tayem, Emad, Ilgiyaev, Eduard, Hochman, Yuval, Miltau, daniel, Rapoport, Avigal, Eden, Arieh, Kompanietz, Dmitry, Yousif, Michael, Golos, Miri, Grazioli, Lorenzo, Ghitti, Davide, Loforte, Antonio, Di Luca, Daniela, Baiocchi, Massimo, Pacini, Davide, Cappai, Antioco, Meani, Paolo, Mondino, Michele, Russo, Claudio F, Ranucci, Marco, Fina, Dario, Cotza, Marco, Ballotta, Andrea, Landoni, Giovanni, Nardelli, Pasquale, Fominski, Eygeny V, Brazzi, Luca, Montrucchio, Giorgia, Sales, Gabriele, Simonetti, Umberto, Livigni, Sergio, Silengo, Daniela, Arena, Giulia, Sovatzis, Stefania S, Degani, Antonella, Riccardi, Mariachiara, Milanesi, Elisa, Raffa, Giuseppe, Martucci, Gennaro, Arcadipane, Antonio, Panarello, Giovanna, Chiarini, Giovanni, Cattaneo, Sergio, Puglia, Carmine, Benussi, Stefano, Foti, Giuseppe, Giani, Marco, Bombino, Michela, Costa, Maria Cristina, Rona, Roberto, Avalli, Leonello, Donati, Abele, Carozza, Roberto, Gasparri, Francesco, Carsetti, Andrea, Picichè, Marco, Marinello, Anna, Danzi, Vinicio, Zanin, Anita, Condello, Ignazio, Fiore, Flavio, Moscarelli, Marco, Nasso, Giuseppe, Speziale, Giuseppe, Sandrelli, Luca, Montalto, Andrea, Musumeci, Francesco, Circelli, Alessandro, Russo, Emanuele, Agnoletti, Vanni, Rociola, Ruggero, Milano, Aldo D, Pilato, Emanuele, Comentale, Giuseppe, Montisci, Andrea, Alessandri, Francesco, Tosi, Antonella, Pugliese, Francesco, Giordano, Giovanni, Carelli, Simone, Grieco, Domenico L, Dell'Anna, Antonio M, Antonelli, Massimo, Ramoni, Enrico, Zulueta, Josè, Del Giglio, Mauro, Petracca, Sebastiano, Bertini, Pietro, Guarracino, Fabio, De Simone, Luigi, Angeletti, Paolo M, Forfori, Francesco, Taraschi, Francesco, Quintiliani, Veronica N, Samalavicius, Robertas, Jankuviene, Agne, Scupakova, Nadezda, Urbonas, Karolis, Kapturauskas, Juozas, Soerensen, Gro, Suwalski, Piotr, Linhares Santos, Luis, Marques, Ana, Miranda, Marisa, Teixeira, Sonia, Salgueiro, Andrea, Pereira, Filipe, Ketskalo, Michail, Tsarenko, Sergey, Shilova, Alexandra, Afukov, Ivan, Popugaev, Konstantin, Minin, Sergei, Shelukhin, Daniil, Malceva, Olga, Gleb, Moroz, Skopets, Alexander, Kornelyuk, Roman, Kulikov, Alexandr, Okhrimchuk, Vadim, Turchaninov, Alexandr, Shelukhin, Daniil, Petrushin, Maxim, Sheck, Anastasia, Mekulov, Akhmed, Ciryateva, Svetlana, Urusov, Dmitry, Gorjup, Vojka, Golicnik, Alenka, Goslar, Tomaz, Ferrer, Ricard, Martinez-Martinez, Maria, Argudo, Eduard, Palmer, Neiser, De Pablo Sanchez, Raul, Juan Higuera, Lucas, Arnau Blasco, Lucas, Marquez, Josè A, Sbraga, Fabrizio, Fuset, Mari Paz, De Gopegui, Pablo Ruiz, Claraco, Luis M, De Ayala, Josè A, Peiro, Maranta, Ricart, Pilar, Martinez, Sergio, Chavez, Fernando, Fabra, Marc, Sandoval, elena, Toapanta, David, Carraminana, Albert, Tellez, Adrian, Ososio, Jeysson, Milan, Pablo, Rodriguez, Jorge, Andoni, Garcia, Gutierrez, Carola, Perez de la Sota, Enrique, Eixeres-Esteve, Andrea, Garcia-Maellas, Maria Teresa, Gutierrez-Gutierrez, Judit, Arboleda-Salazar, Rafael, Santa Teresa, Patricia, Jaspe, Alexis, Garrido, Alberto, Castaneda, Galo, Alcantara, Sara, Martinez, Nuria, Perez, Marina, Villanueva, Hector, Vidal Gonzalez, Anxela, Paez, Juan, Santon, Arnoldo, Perez, Cesar, Lopez, Marta, Rubio Lopez, Maria Isabel, Gordillo, Antonio, Naranjo-Izurieta, Jose, Munoz, Javier, Alcalde, Immaculada, Onieva, Fernando, Gimeno Costa, Ricardo, Perez, Francisco, Madrid, Isabel, Gordon, Monica, Albacete Moreno, Carlos L, Perez, Daniel, Lopez, Nayara, Martinenz, Domingo, Blanco-Schweizer, Pablo, Diez, Cristina, Perez, David, Prieto, Ana, Renedo, Gloria, Bustamante, Elena, Cicuendez, Ramon, Citores, Rafael, Boado, Victoria, Garcia, Katherine, Voces, Roberto, Domezain, Monica, Nunez Martinez, Jose Maria, Vicente, Raimundo, Martin, David, Andreu, Antonio, Gomez Casal, Vanesa, Chico, Ignacio, Menor, Eva Maria, Vara, Sabela, Gamacho, Jose, Perez-Chomon, Helen, Javier Gonzales, Francisco, Barrero, Irene, Martin-Villen, Luis, Fernandez, Esperanza, Mendoza, Maria, Navarro, Joaquin, Colomina Climent, Joaquin, Gonzales-Perez, Alfredo, Muniz-Albaceita, Guillermo, Amado, Laura, Rodriguez, Raquel, Ruiz, Emilio, Eiras, Maria, Grins, Edgars, Magnus, Rosen, Kanetoft, Mikael, Eidevald, Marcus, Watson, Pia, Vogt, Paul R, Steiger, Peter, Aigner, Tobias, Weber, Alberto, Grunefelder, Jurg, Kunz, Martin, Grapow, Martin, Aymard, Thierry, Reser, Diana, Agus, Gianluca, Consiglio, Jolanda, Haenggi, Matthias, Hansjoerg, Jenni, Iten, Manuela, Doeble, Thomas, Zenklusen, Urs, Bechtold, Xavier, Faedda, Giovanni, Iafrate, Manuel, Rohjer, Amanda, Bergamaschi, Layla, Maessen, Jos, Reis Miranda, Dinis, Endeman, H, Gommers, D, Meuwese, C, Maas, Jacinta, Van Gijlswijk, MJ, Van Berg, RN, Candura, Dario, Van der Linden, Marcel, Kant, Merijin, Van der Heijden, JJ, Scholten, Eric, Van Belle-van Haren, Nicole, Lagrand, WK, Vlaar, Alexander P, De Jong, Syste, Cander, Basar, Sargin, Murat, Ugur, Murat, Kaygin, Mehmet A, Daly, Kathleen, Agnew, Nicola, Head, Laura, Kelly, Laura, Anoma, Gunawardena, Russell, Clare, Aquino, Verna, Scott, Ian, Flemming, Lucy, Gillon, Stuart, Moore, Olivia, Gelandt, Elton, Auzinger, George, Patel, Sameer, and Loveridge, Robert
- Abstract
Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation.
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- 2023
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6. Total Aortic Arch Replacements With a 4 Branched Frozen Elephant Trunk (FET) Graft in Acute Aortic Dissection (DeBakey type I).
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Shrestha, Malakh, Beckmann, Erik, Kaufeld, Tim, Haverich, Axel, and Martens, Andreas
- Abstract
The "frozen elephant trunk" (FET) technique was developed by Karck et al., who modified Borst's ET technique by using a stent graft to secure the distal ET section. Working in collaboration with Vascutek Terumo, we in Hannover Medical School introduced the 4-branched hybrid FET graft In 2012 (Thoraflex Hybrid). However, the results after open aortic arch repair mainly depend on perioperative management and patient factors. Over the years, peri-operative management and operative techniques have evolved greatly contributing to better results. We describe our surgical technique of implantation of this hybrid graft in acute aortic dissection Stanford type A, DeBakey type I (AADA DeBakey I) patients. [ABSTRACT FROM AUTHOR]
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- 2022
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7. Single-center experience with thoracoabdominal aortic replacement in patients with Marfan syndrome
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Rustum, Saad, Zahlout, Osama, Martens, Andreas, Kaufeld, Tim, Krüger, Heike, Rudolph, Linda, Haverich, Axel, Shrestha, Malakh, and Beckmann, Erik
- Abstract
Patients with Marfan syndrome are usually not suitable for endovascular repair of the thoracoabdominal aorta. This study was designed to analyze our center's experience with open surgical thoracoabdominal aortic replacement in Marfan patients.
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- 2022
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8. Novel Plug Device for HeartMate 3 Explantation: First Multicenter Experience
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Mariani, Silvia, Li, Tong, Meyer, Anna Lassia, Geoffrion, Tracy, Fittkau, Matthias, Schöde, Alexandra, Hanke, Jasmin S., Loforte, Antonio, Haverich, Axel, Schmitto, Jan D., and Dogan, Günes
- Abstract
Patients undergoing explantation of left ventricular assist devices (LVADs) after improvement of myocardial function remain a minority. Nevertheless, considering the growing population of LVAD patients, increasing demand for new explantation strategies is expected. Herein, we present a retrospective review of seven patients undergoing HeartMate3 explantation with the use of a custom-made apical ring plug in four medical centers. The primary outcome was status at intensive care unit discharge. Secondary outcomes included perioperative complications and transfusions. Six out of seven patients were males. The median age at explantation and time on LVAD support was 35 years (range:13–73) and 10 months (range:9–24), respectively. No technical difficulties were experienced during plug implantation viaa conventional sternotomy or through a left lateral thoracotomy, either with or without cardiopulmonary bypass. Perioperative transfusions ranged from 0 to 3 units/patient. No re-operations for bleeding, hemorrhagic, embolic, or plug-related infective events were observed. Heparin was started 6 hours after surgery as a bridge to oral anticoagulation (international normalized ratio: 2–2.5). All patients were discharged alive from intensive care unit. This novel plug device for HeartMate3 explantation was successfully and safely implanted in this first patient series. Notwithstanding, its use should still be considered off-label and larger studies are required to investigate its long-term results.
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- 2022
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9. Mid-term Outcome of the Edge-To-Edge Mitral Valve Repair Via Aortic Outflow Tract in High-Risk Patients.
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Ismail, Issam, Wert, Leonhard, Hanke, Jasmin Sarah, Dogan, Günes, Chatterjee, Anamika, Feldmann, Christina, Cebotari, Serghei, Haverich, Axel, and Schmitto, Jan Dieter
- Abstract
The edge-to-edge mitral valve repair technique, invented by Alfieri and colleagues, introduced valve repair as a treatment option for patients with complex diseases where standard annuloplasty and related repair techniques are insufficient, due to annular calcification and patient frailty. We retrospectively evaluated the results of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) in high-risk patients who were undergoing aortic valve replacement. From February, 2012 to December, 2017, 43 patients underwent transaortic edge-to-edge mitral valve repair with concomitant aortic valve replacement at a single institution. Preoperative and postoperative echocardiograms were compared. Home telephone follow up was conducted and postoperative morbidity was examined, including the need for reoperation, stroke and cardiac arrhythmia. 30-day and long-term survival rates were also determined. Mitral regurgitation (MR) was graded semi-quantitatively as 0 (trace and/or none), mild (1), moderate (2) or moderate to severe (3-4). The patients were 74 ± 7.8 years old. 65% of the patients were male. Mean cardiopulmonary bypass time was 115 ± 37 minutes and mean cross-clamp time was 71 ± 23 minutes. There was a significant improvement in preoperative vs postoperative median MR grade (2 (IQR 2-3) vs 0 (IQR 0-1); P = 0.05). Follow-up transthoracic echocardiograms in 29 patients obtained at a median of 9 months' (range 3 - 19 months') and in 16 patients at a median of 34 months' postoperatively (range 21 - 53 months') showed mild (1 (IQR 1-2)) grade of mitral regurgitation. 30-day survival was 98%. Long term survival at 12 and 24 months' were 88% and 81% respectively. Mitral valve reoperation was conducted in 1 patient (2%), who was suffering of endocarditis. Stroke occurred in 2 patients (7%). Cardiac arrhythmia was observed in 15 patients (35%). 8 patients (19%) suffered from atrial fibrillation and 7 patients (16%) displayed atrioventricular blockage. 10 patients (23%) could be treated conservatively and 5 patients (12%) needed implantation of a pacemaker. Transaortic edge-to-edge mitral valve repair can be safely performed during aortic valve replacement in high-risk patients and improves even long-term MR grade. Postoperative cardiac arrhythmia occurs frequently. 66% of them could be treated successfully by conservative procedures. [ABSTRACT FROM AUTHOR]
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- 2022
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10. Knockdown of swine leukocyte antigen expression in porcine lung transplants enables graft survival without immunosuppression
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Figueiredo, Constanca, Chen-Wacker, Chen, Salman, Jawad, Carvalho-Oliveira, Marco, Monthé, Thierry Siemeni, Höffler, Klaus, Rother, Tamina, Hacker, Karolin, Valdivia, Emilio, Pogozhykh, Olena, Hammer, Sabine, Sommer, Wiebke, Yuzefovych, Yuliia, Wenzel, Nadine, Haverich, Axel, Warnecke, Gregor, and Blasczyk, Rainer
- Abstract
Immune rejection remains the major obstacle to long-term survival of allogeneic lung transplants. The expression of major histocompatibility complex molecules and minor histocompatibility antigens triggers allogeneic immune responses that can lead to allograft rejection. Transplant outcomes therefore depend on long-term immunosuppression, which is associated with severe side effects. To address this problem, we investigated the effect of genetically engineered transplants with permanently down-regulated swine leukocyte antigen (SLA) expression to prevent rejection in a porcine allogeneic lung transplantation (LTx) model. Minipig donor lungs with unmodified SLA expression (control group, n= 7) or with modified SLA expression (treatment group, n= 7) were used to evaluate the effects of SLA knockdown on allograft survival and on the nature and strength of immune responses after terminating an initial 4-week period of immunosuppression after LTx. Genetic engineering to down-regulate SLA expression was achieved during ex vivo lung perfusion by lentiviral transduction of short hairpin RNAs targeting mRNAs encoding β2-microglobulin and class II transactivator. Whereas all grafts in the control group were rejected within 3 months, five of seven animals in the treatment group maintained graft survival without immunosuppression during the 2-year monitoring period. Compared with controls, SLA-silenced lung recipients had lower donor-specific antibodies and proinflammatory cytokine concentrations in the serum. Together, these data demonstrate a survival benefit of SLA–down-regulated lung transplants in the absence of immunosuppression.
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- 2024
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11. Aktueller Stand der Transplantationsmedizin im Bereich Herz- und Lungentransplantation
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Niehaus, Heidi, Haverich, Axel, and Ius, Fabio
- Abstract
Die Transplantationsmedizin in Deutschland ist klar strukturiert und verbindlich geregelt. Zur Stärkung der Organspende wurden die rechtlichen Rahmenbedingungen in den letzten Jahren mehrfach angepasst. Dennoch bleibt die eingeschränkte Organverfügbarkeit die Hauptlimitation dieser Therapie, auch im Bereich der Herz- und Lungentransplantation. Beide Verfahren sind mittlerweile etablierte Therapieoptionen für selektierte Patienten mit terminalem Organversagen. Ziel ist die Verbesserung der Lebensqualität und des Überlebens. Der Erfolg der Therapie hängt maßgeblich von der Selektion geeigneter Empfänger sowie dem optimalen peri- und postoperativen Management ab, einschließlich einer lebenslangen spezialisierten Nachsorge. Die Komplexität der Therapie erfordert ein hohes Maß an speziellen Kenntnissen und Fertigkeiten. Der vorliegende Beitrag fasst den aktuellen Stand der Transplantationsmedizin thorakaler Organe mit dem Fokus auf den Inhalt der neuen Zusatzweiterbildung Transplantationsmedizin zusammen.
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- 2022
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12. Heart transplantation across preformed donor-specific antibody barriers using a perioperative desensitization protocol
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Sommer, Wiebke, Avsar, Murat, Aburahma, Khalil, Salman, Jawad, Kaufeld, Klaus Tim, Rojas, Sebastian V., Meyer, Anna L., Chichelnitskiy, Evgeny, Süsal, Caner, Kreusser, Michael M., Verboom, Murielle, Hallensleben, Michael, Bara, Christoph, Blasczyk, Rainer, Falk, Christine, Karck, Matthias, Haverich, Axel, Ius, Fabio, and Warnecke, Gregor
- Abstract
Heart transplantation across preformed donor-specific HLA-antibody barriers is associated with impaired short- and long-term survival. Therefore, in recipients with preformed anti-HLA antibodies, waiting for crossmatch-negative donors is standard practice. As an alternative strategy, recipients with preformed anti-HLA donor specific antibodies have been managed at our institutions with a perioperative desensitization regimen. A retrospective analysis was performed comparing heart transplant recipients with preformed donor-specific HLA-antibodies to recipients without donor-specific antibodies. Recipients with a positive virtual crossmatch received a perioperative desensitization protocol including tocilizumab intraoperatively, plasma exchange and rituximab followed by a six-month course of IgGAM. Among the 117 heart-transplanted patients, 19 (16%) patients underwent perioperative desensitization, and the remaining 98 (84%) patients did not. Cold ischemic time, posttransplant extracorporeal life support for primary graft dysfunction, and intensive care unit stay time did not differ between groups. At 1-year follow-up, freedom from pulsed steroid therapy for presumed rejection and biopsy-confirmed acute cellular or humoral rejection did not differ between groups. One-year survival amounted to 94.7% in the treated patients and 81.4% in the control group. Therefore, heart transplantation in sensitized recipients undergoing a perioperative desensitization appears safe with comparable postoperative outcomes as patients with a negative crossmatch.
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- 2022
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13. Heart transplantation across preformed donor‐specific antibody barriers using a perioperative desensitization protocol
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Sommer, Wiebke, Avsar, Murat, Aburahma, Khalil, Salman, Jawad, Kaufeld, Klaus Tim, Rojas, Sebastian V., Meyer, Anna L., Chichelnitskiy, Evgeny, Süsal, Caner, Kreusser, Michael M., Verboom, Murielle, Hallensleben, Michael, Bara, Christoph, Blasczyk, Rainer, Falk, Christine, Karck, Matthias, Haverich, Axel, Ius, Fabio, and Warnecke, Gregor
- Abstract
Heart transplantation across preformed donor‐specific HLA‐antibody barriers is associated with impaired short‐ and long‐term survival. Therefore, in recipients with preformed anti‐HLA antibodies, waiting for crossmatch‐negative donors is standard practice. As an alternative strategy, recipients with preformed anti‐HLA donor specific antibodies have been managed at our institutions with a perioperative desensitization regimen. A retrospective analysis was performed comparing heart transplant recipients with preformed donor‐specific HLA‐antibodies to recipients without donor‐specific antibodies. Recipients with a positive virtual crossmatch received a perioperative desensitization protocol including tocilizumab intraoperatively, plasma exchange and rituximab followed by a six‐month course of IgGAM. Among the 117 heart‐transplanted patients, 19 (16%) patients underwent perioperative desensitization, and the remaining 98 (84%) patients did not. Cold ischemic time, posttransplant extracorporeal life support for primary graft dysfunction, and intensive care unit stay time did not differ between groups. At 1‐year follow‐up, freedom from pulsed steroid therapy for presumed rejection and biopsy‐confirmed acute cellular or humoral rejection did not differ between groups. One‐year survival amounted to 94.7% in the treated patients and 81.4% in the control group. Therefore, heart transplantation in sensitized recipients undergoing a perioperative desensitization appears safe with comparable postoperative outcomes as patients with a negative crossmatch. A perioperative desensitization regimen leads to similar graft and patient survival rates for heart transplant recipients with preformed donor‐specific HLA antibodies, compared to those without pre‐formed donor‐specific antibodies.
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- 2022
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14. Intraoperative Extracorporeal Circulatory Support in Lung Transplantation for Pulmonary Fibrosis.
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Salman, Jawad, Bernhard, Beeke-Alina, Ius, Fabio, Poyanmehr, Reza, Sommer, Wiebke, Aburahma, Khalil, Alhadidi, Hani, Siemeni, Thierry, Kuehn, Christian, Avsar, Murat, Haverich, Axel, Warnecke, Gregor, and Tudorache, Igor
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Venous-arterial extracorporeal membrane oxygenation (ECMO) is an established technique for intraoperative cardiopulmonary support in patients undergoing lung transplantation. Patients with pulmonary fibrosis have a higher risk to require it. The aim of this study was to identify risk factors for the need of intraoperative ECMO use. Records of patients undergoing lung transplantation for pulmonary fibrosis at our institution between January 2010 and May 2018 were retrospectively reviewed. Univariate logistic regression analysis was used for statistical identification of risk factors. There were 105 patients (34%) who required intraoperative ECMO support (ECMO+ group), and 203 (66%) did not (ECMO− group). Preoperative proof of pulmonary hypertension was identified as a risk factor for intraoperative ECMO support (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.2-6.5; P <.01). Revealed mean pulmonary arterial pressure values exceeding 50 mm Hg and pulmonary vascular resistance values exceeding 9.4 Wood units were identified as risk factors for the need of intraoperative ECMO use with a prediction probability of 70%. Increased recipient body surface area (OR, 0.2; 95% CI, 0.1-0.5; P <.01) emerged as a protective factor against intraoperative ECMO (Hosmer-Lemeshow statistic, P =.71) as well as higher cardiac output (OR, 0.7; 95% CI, 0.6-0.9; P <.01). The postoperative course was more complicated in the ECMO+ group, whereas survival at 5 years did not differ among groups (70% vs 69%, P =.79). Pulmonary hypertension with elevated pulmonary vascular resistance values predicts the need of intraoperative ECMO in patients receiving lung transplantation for pulmonary fibrosis. Although the postoperative course was more complicated in the ECMO+ group, long-term survival did not differ significantly. [ABSTRACT FROM AUTHOR]
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- 2021
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15. The potential of ex vivolung perfusion on improving organ quality and ameliorating ischemia reperfusion injury
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Iske, Jasper, Hinze, Christopher A., Salman, Jawad, Haverich, Axel, Tullius, Stefan G., and Ius, Fabio
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Allogeneic lung transplantation (LuTx) is considered the treatment of choice for a broad range of advanced, progressive lung diseases resistant to conventional treatment regimens. Ischemia reperfusion injury (IRI) occurring upon reperfusion of the explanted, ischemic lung during implantation remains a crucial mediator of primary graft dysfunction (PGD) and early allo‐immune responses. Ex vivolung perfusion (EVLP) displays an advanced technique aiming at improving lung procurement and preservation. Indeed, previous clinical trials have demonstrated a reduced incidence of PGD following LuTx utilizing EVLP, while long‐term outcomes are yet to be evaluated. Mechanistically, EVLP may alleviate donor lung inflammation through reconditioning the injured lung and diminishing IRI through storing the explanted lung in a non‐ischemic, perfused, and ventilated status. In this work, we review potential mechanisms of EVLP that may attenuate IRI and improve organ quality. Moreover, we dissect experimental treatment approaches during EVLP that may further attenuate inflammatory events deriving from tissue ischemia, shear forces or allograft rejection associated with LuTx. This minireview examines the impact on ischemia reperfusion injury derived inflammation of ex vivo lung perfusion and other promising experimental approaches to improve donor lung quality.
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- 2021
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16. The potential of ex vivolung perfusion on improving organ quality and ameliorating ischemia reperfusion injury
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Iske, Jasper, Hinze, Christopher A., Salman, Jawad, Haverich, Axel, Tullius, Stefan G., and Ius, Fabio
- Abstract
Allogeneic lung transplantation (LuTx) is considered the treatment of choice for a broad range of advanced, progressive lung diseases resistant to conventional treatment regimens. Ischemia reperfusion injury (IRI) occurring upon reperfusion of the explanted, ischemic lung during implantation remains a crucial mediator of primary graft dysfunction (PGD) and early allo-immune responses. Ex vivolung perfusion (EVLP) displays an advanced technique aiming at improving lung procurement and preservation. Indeed, previous clinical trials have demonstrated a reduced incidence of PGD following LuTx utilizing EVLP, while long-term outcomes are yet to be evaluated. Mechanistically, EVLP may alleviate donor lung inflammation through reconditioning the injured lung and diminishing IRI through storing the explanted lung in a non-ischemic, perfused, and ventilated status.
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- 2021
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17. Implantation of two HeartMate 3s in the setting of a Total Artificial Heart.
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Hanke, Jasmin S., Dogan, Günes, Haverich, Axel, and Schmitto, Jan D.
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Irreversible, end-stage biventricular heart failure is associated with mortality rates of up to 100%. Despite the increasing application of ventricular assist devices (VADs), many centers lack experience with total artificial heart (TAH) implantation techniques. We present a surgical technique consisting of the implantation of 2 HeartMate 3 VADs in the setting of a TAH as a bridge to transplantation strategy. [ABSTRACT FROM AUTHOR]
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- 2021
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18. First-in-man Implantation of a Cardiac Microcurrent Device for Chronic Systolic Heart Failure
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Schmitto, Jan D., Napp, L. Christian, Mariani, Silvia, Hanke, Jasmin S., Li, Tong, Vogel-Claussen, Jens, Brandes, Kersten, Göttel, Peter, Müller, Johannes, Dogan, Guenes, Bauersachs, Johann, and Haverich, Axel
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Current therapies significantly improve survival and clinical endpoints in patients suffering from chronic heart failure with reduced ejection fraction (HFrEF), but most are not sufficient to reverse adverse remodeling and improve myocardial contractility. Herein, we report the first-in-man experience with a novel fully implantable device for cardiac electrical microcurrent (C-MIC) application. A 79-year-old man suffering from HFrEF (dilated cardiomyopathy, NYHA class III, left ventricular ejection fraction 30%) successfully underwent implantation of the C-MIC device through left anterolateral thoracotomy. At 30-day follow-up, no device-related complications were observed, demonstrating feasibility of C-MIC implantation in a patient suffering from HFrEF.
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- 2022
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19. Telemonitoring and Care Program for Left Ventricular Assist Device Patients During COVID-19 Outbreak: A European Experience
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Mariani, Silvia, Schöde, Alexandra, Homann, Katharina, Feueriegel, Silke, Nöth, Sandra, Warnke, Katharina, Bounader, Karl, Andreeva, Alexandra, Li, Tong, Dogan, Günes, Haverich, Axel, and Schmitto, Jan D.
- Abstract
Supplemental Digital Content is available in the text.Coronavirus disease 2019 (COVID-19) radically modified the organization of healthcare systems with shutdown of routine activities and outpatient clinics. Herein, we report our institutional experience with a Telemonitoring and Care Program (TC-Program) to monitor and support left ventricular assist device (LVAD) patients during COVID-19 outbreak. This single-arm cohort study analyzed 156 patients who entered the TC-Program at our institution between April and August 2020. The TC-Program was based on routine phone calls to patients and a 24/7 emergency line. In November 2020, patients were asked for feedback on the TC-Program and checked for survival, transplant, or explant. The primary endpoint was the rate of TC-Program-driven interventions. Patients (males: 82.8%) were 61 years old (interquartile range [IQR]: 53.0–67.5) and on LVAD support for 1,266 days (IQR: 475–2,211). Patients were included in the TC-Program for a median time of 99 days (min:15, max:120) and received a median number of six phone calls (min:1, max:14). Twenty-three patients (14.7%) were referred for clinical evaluation after phone contact. Two patients (1.27%) were diagnosed with COVID-19: one of them died after intensive care, and one remained paucisymptomatic and recovered. Three patients asked to exit the program considering it not useful while the others gave high rates in terms of usefulness (median: 9, IQR: 8–10), information (median: 9, IQR: 8–10), good medical care (median: 9, IQR: 8–10), and psychologic support (median: 8, IQR: 7–10). A TC-Program based on the four ICSA principles (Inform, Care, Support, and Adapt) is feasible in LVAD patients and can be rapidly implemented during the COVID-19 pandemic.
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- 2021
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20. Total aortic arch replacement with frozen elephant trunk technique: Results from two European institutes.
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Leone, Alessandro, Beckmann, Erik, Aandreas, Martens, Di Marco, Luca, Pantaleo, Antonio, Reggiani, Letizia Bacchi, Haverich, Axel, Di Bartolomeo, Roberto, Pacini, Davide, and Sherestha, Malakh
- Abstract
We report on a large series of patients treated at the S. Orsola Hospital, University of Bologna (Bologna, Italy) and Hannover Medical School (Hannover, Germany), with the aim to evaluate the early and midterm results. Between January 2007 and March 2017, 437 patients underwent total aortic arch replacement with the frozen elephant trunk technique. The frozen elephant trunk prostheses used were the custom-made Chavan-Haverich (Hanover, Germany) (n = 27, 6%), Jotec E-vita open (Jotec Inc, Hechingen, Germany) (n = 192, 44%), and Vascutek Thoraflex-Hybrid (Vascutek, Inchinnan, Scotland) (n = 218, 50%). The main indications were thoracic aortic aneurysm (n = 135, 31%), chronic aortic dissection (n = 182, 41.6%), and acute aortic dissection (n = 120, 27.5%). Overall in-hospital mortality was 14.9%, and permanent neurologic deficit and spinal cord injury were 10.8% and 5.5%, respectively. Patients with chronic aortic dissection presented a better in-hospital mortality rate than the thoracic aortic aneurysm and acute aortic dissection groups. Independent risk factors for mortality in the overall population were prolonged cardiopulmonary bypass time, age, urgent/emergency surgery, and Marfan syndrome. The median (p25, p75) follow-up time was 2.6 (1.4-4.4) years, and the mortality rate was 7.01 (95% confidence interval, 5.7-8.7) per 100 patient-years. A total of 86 patients (23.1%) required an additional procedure during the follow-up; 61 (16.3%) required endovascular extensions, and 25 (6.7%) required aortic surgery. The frozen elephant trunk technique is a treatment option for all complex pathologies of the thoracic aorta. Patients with thoracic aortic aneurysms presented a higher mortality rate, and in patients with acute aortic dissection, the malperfusion syndrome still remains a catastrophic complication. The midterm follow-up showed satisfactory results in terms of survival and freedom from reintervention. [ABSTRACT FROM AUTHOR]
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- 2020
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21. Comparison of Two Strategies for Aortic Valve-Sparing Root Replacement.
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Beckmann, Erik, Leone, Alessandro, Martens, Andreas, Mariani, Carlo, Krueger, Heike, Cebotari, Serghei, Di Bartolomeo, Roberto, Haverich, Axel, Shrestha, Malakh Lal, and Pacini, Davide
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Since its introduction in 1992, multiple variations of the aortic valve-sparing David procedure technique have been described. Here, we present the short- and midterm outcomes of 2 centers using the straight tube graft (David-I) and the Valsalva prosthesis in patients who underwent isolated David procedure. Between March 2002 and October 2015, 232 patients underwent the David procedure at 2 European centers. Patients received either a straight tube graft (David-I, group A, n = 103, 74% men) or Valsalva graft (group B, n = 129, 85% men). Mean age was 47 ± 17 years in group A and 48 ± 17 years in group B (P =.916). There were significantly more cusp repairs in group B (n=28, 22%) compared with group A (n = 4, 4%, P <.001). The 30-day mortality rate was 1% (n = 1) in group A and 2% (n = 2, P =.698) in group B. Postoperative echocardiography showed aortic insufficiency ≥II in 0% (n = 0) of group A and 17% (n = 21) of group B (P <.001). Follow-up comprised 1530 patient-years, and survival was comparable between the 2 groups (P =.799). Follow-up echocardiography showed aortic insufficiency ≥II in 22% (n = 15) of group A and 39% (n = 33) of group B (P <.026). The rates for aortic valve-related reoperation were 8% (n = 8) in group A and 13% (n = 16) in group B (P =.241). Logistic Cox regression analysis identified bicuspid aortic valve (odds ratio, 3.435; 95% confidence interval, 1.459-8.083, P =.005) and postoperative aortic insufficiency ≥II (odds ratio, 5.988; 95% confidence interval, 2.545-14.088, P <.001) as risk factors for aortic valve-related reoperation. The aortic valve-sparing David procedure has acceptable midterm results. Our results show that the David-I procedure with straight tube graft is not inferior to those performed with Valsalva prosthesis. [ABSTRACT FROM AUTHOR]
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- 2020
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22. Permanent Implantable Cardiac Support Systems.
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Gummert, Jan F., Haverich, Axel, Schmitto, Jan D., Potapov, Evgenij, Schramm, René, and Falk, Volkmar
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Background: Nearly 1000 permanent ventricular assist devices (VADs) are implanted in patients with severe congestive heart failure in Germany each year. VADs are miniaturized centrifugal pumps that generate continuous blood flow; they are powered and controlled through a cable that passes through the skin. Para-corporeal systems are only rarely implanted, usually in children. Methods: In this selective review of the literature, including guidelines and registry data, we discuss the indications, therapeutic effects, and complications of permanently implantable cardiac support systems. Results: The optimal time for VAD implantation cannot be precisely defined. A comparative assessment of the various available systems is not possible, as no randomized trials have been performed on this topic. Registry data indicate that 69% to 81% of patients survive one year after VAD implantation, which is significantly better than the natural course of (conservatively treated) severe congestive heart failure. The distance patients are able to walk is 129 to 220 m longer at six months, depending on the system implanted. Scores on the EQ-5D health status questionnaire are 28 to 37 points better at six months. The potential severe complications include infection, right-heart failure, hemorrhage, pump thrombosis, stroke, and death. Conclusion: A VAD system can be implanted as an alternative to cardiac transplantation or as a bridging treatment until the patient can be listed for transplantation and receive the transplant. Because of the organ shortage in Germany, only a minority of VAD patients ever receive a transplant. [ABSTRACT FROM AUTHOR]
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- 2019
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23. Portable normothermic ex-vivo lung perfusion, ventilation, and functional assessment with the Organ Care System on donor lung use for transplantation from extended-criteria donors (EXPAND): a single-arm, pivotal trial.
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Loor, Gabriel, Warnecke, Gregor, Villavicencio, Mauricio A, Smith, Michael A, Kukreja, Jasleen, Ardehali, Abbas, Hartwig, Matthew, Daneshmand, Mani A, Hertz, Marshall I, Huddleston, Stephen, Haverich, Axel, Madsen, Joren C, and Van Raemdonck, Dirk
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LUNG transplantation ,FUNCTIONAL assessment ,LUNGS ,PERFUSION ,PARTIAL pressure - Abstract
Donor lung use for transplantation is the lowest among solid organ tranplants because of several complex and multifactorial reasons; one area that could have a substantial role is the limited capabilities of cold ischaemic storage. The aim of the EXPAND trial was to evaluate the efficacy of normothermic portable Organ Care System (OCS) Lung perfusion and ventilation on donor lung use from extended-criteria donors and donors after circulatory death, which are rarely used. In this single-arm, pivotal trial done in eight institutions across the USA, Germany, and Belgium, lungs from extended-criteria donors were included if fulfilling one or more of the following criteria: a ratio of partial pressure of arterial oxygen (PaO 2) to fractional concentration of oxygen inspired air (FiO 2) in the donor lung of 300 mm Hg or less; expected ischaemic time longer than 6 h; donor age 55 years or older; or lungs from donors after circulatory death that were recruited and assessed using OCS Lung. Lungs were transplanted if they showed stability of OCS Lung variables, PaO 2 :FiO 2 was more than 300 mm Hg, and they were accepted by the transplanting surgeon. Patients were adult bilateral lung transplant recipients. The primary efficacy endpoint was a composite of patient survival at day 30 post-transplant and absence of The International Society for Heart & Lung Tranplantation primary-graft dysfunction grade 3 (PGD3) within 72 h post-transplantation, with a prespecified objective performance goal of 65%. The primary analysis population was all transplanted recipients. This trial is registered with ClinicalTrials.gov , number NCT01963780 , and is now complete. Between Jan 23, 2014, and Oct 23, 2016, 93 lung pairs were perfused, ventilated, and assessed on the OCS Lung. 12 lungs did not meet OCS transplantation criteria so 81 lungs were suitable for transplantation. Two lungs were excluded for logistical reasons, hence 79 (87%) of eligible lungs were transplanted. The primary endpoint was achieved in 43 (54%) of 79 patients and did not meet the objective performance goal. 35 (44%) of 79 patients had PGD3 within the initial 72 h. 78 (99%) of 79 patients had survived at 30 days post-transplant. The mean number of lung graft-related serious adverse events (respiratory failure and major pulmonary-related infection) was 0·3 events per patient (SD 0·5). Despite missing the objective primary endpoint, the portable OCS Lung resulted in 87% donor lung use for transplantation with excellent clinical outcomes. Many lungs declined by other transplant centres were successfully transplanted using this new technology, which implies its use has the potential to increase the number of lung transplants performed worldwide. Whether similar outcomes could be obtained if these lungs were preserved on ice is unknown and remains an area for future research. TransMedics Inc. [ABSTRACT FROM AUTHOR]
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- 2019
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24. First-in-Man Use of the Percutaneous 10F Reitan Catheter Pump for Cardiorenal Syndrome
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Napp, Lars Christian, Mariani, Silvia, Ruhparwar, Arjang, Schmack, Bastian, Keeble, Thomas R., Reitan, Oyvind, Hanke, Jasmin S., Dogan, Guenes, Hiss, Marcus, Bauersachs, Johann, Haverich, Axel, and Schmitto, Jan D.
- Abstract
Cardiorenal syndrome worsens outcome in patients with decompensated chronic heart failure, and complicates recompensation by medical therapy. Mechanical circulatory support has the potential to improve renal function, and likely mitigates diuretic resistance in patients with severe cardiorenal syndrome. The Reitan catheter pump (RCP) is a novel temporary percutaneous circulatory support system for reducing cardiac afterload and increasing renal preload. Here, we report on the first-in-man use of the 10F-version of the RCP device, which was associated with favorable effects on hemodynamics and diuresis. Further investigation to evaluate safety and efficacy of this promising approach is warranted.
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- 2022
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25. Development, comparative structural analysis, and first in vivo evaluation of acellular implanted highly compacted fibrin tubes for arterial bypass grafting.
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Regenberg, Marie-Claire, Wilhelmi, Mathias, Hilfiker, Andres, Haverich, Axel, and Aper, Thomas
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ARTERIAL grafts ,FIBRIN ,CENTRIFUGAL casting ,VASCULAR grafts ,TISSUE engineering ,X-ray computed microtomography - Abstract
The generation of small-caliber vascular grafts remains a significant challenge within the field of tissue engineering. In pursuit of this objective, fibrin has emerged as a promising scaffold material. However, its lack of biomechanical strength has limited its utility in the construction of tissue engineered vascular grafts. We have previously reported about the implementation of centrifugal casting molding to generate compacted fibrin tubes with a highly increased biomechanical strength. In this study, we conducted a structural analysis of compacted fibrin tubes using the open-source software Fiji/BoneJ. The primary aim was to validate the hypothesis that the compaction of fibrin leads to a more complex structure characterized by increased crosslinking of fibrin fibers. Structural analysis revealed a strong correlation between fibrin's structure and its biomechanical strength. Moreover, we enhanced fibrin compaction in a subsequent dehydration process, leading to a significant increase of biomechanical strength. Thus, the presented method in combination with an adequate imaging, e.g., micro-CT, has substantial potential as a powerful tool for quality assurance in the development of fibrin-based vascular grafts. To validate this concept, acellular highly compacted fibrin tubes were implanted as substitutes of a segment of the carotid artery in a sheep model (n = 4). After 6 months explanted segments exhibited distinct remodeling, transitioning into newly formed arteries. [Display omitted] • Rotational molding leads to a significant compaction of fibrin. • Compaction of fibrin results in a significantly more complex and crosslinked fibrin structure. • Further dehydration improves fibrin's structure and biomechanical strength. [ABSTRACT FROM AUTHOR]
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- 2023
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26. Valve-sparing aortic root replacement using a straight tube graft (David I procedure).
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Shrestha, Malakh, Boethig, Dietmar, Krüger, Heike, Kaufeld, Tim, Martens, Andreas, Haverich, Axel, and Beckmann, Erik
- Abstract
We present our 25-year experience with valve-sparing aortic root replacement using a straight tube graft (David-I). From 1993 to 2019, 677 patients (median age, 56.0 years; range, 42-65) underwent the David-I procedure with a straight tube graft. A total of 24 different surgeons performed these operations. Marfan syndrome was present in 111 patients (16.4%), and bicuspid aortic valve was present in 71 patients (10.5%). Aortic root aneurysm was present in 544 patients (80.4%), and acute dissection was present in 133 patients (19.6%). Ministernotomy was used in 57 patients (8.4%). Additional cusp plasty was performed in 84 patients (12.4%). Concomitant procedures were coronary artery bypass grafting (n = 122, 18.0%), mitral valve surgery (n = 34, 5%), proximal arch replacement (n = 125, 18.4%), subtotal arch replacement (n = 43, 6.4%), and total arch replacement (n = 102, 15.1%). Overall in-hospital mortality was 4.0% (n = 27), and perioperative stroke occurred in 26 patients (3.8%). Postoperative echocardiography showed aortic insufficiency less than I° in 600 of 623 (96.3%). The 1-, 5-, 10-, 15-, and 20-year survivals were 97%, 92%, 79%, 68%, and 50%, respectively. The rates for freedom from aortic valve-related reoperation at 1, 5, 10, 15, and 20 years were 97%, 92%, 87%, 84%, and 80%, respectively. Multivariate Cox regression analysis identified age (odds ratio, 0.974; 95% confidence interval, 0.957-0.992; P =.004), senior surgeon (odds ratio, 0.546; 95% confidence interval, 0.305-0.979; P =.042), and residual postoperative aortic insufficiency (odds ratio, 4.864; 95% confidence interval, 1.124-21.052; P =.034) as independent risk factors for aortic valve-related reoperation. The aortic valve-sparing David-I procedure can be performed with very low perioperative morbidity and mortality. The short- and long-term results are excellent. The straight tube graft does not lead to increased leaflet erosion. This procedure is reproducible by multiple surgeons. [Display omitted] [ABSTRACT FROM AUTHOR]
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- 2023
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27. Perfusion promotes endothelialized pore formation in high concentration fibrin gels otherwise unsuitable for tube development
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Zippusch, Sarah, Helms, Florian, Lau, Skadi, Klingenberg, Melanie, Schrimpf, Claudia, Haverich, Axel, Wilhelmi, Mathias, and Böer, Ulrike
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Vascularization of tissue engineered implants is crucial for their survival and integration in the recipient’s body. Pre-vascularized, fibrin-based implants offer a solution since low concentration fibrin hydrogels (1 mg/mL) have been shown to promote tube formation of endothelial cells in co-culture with adipogenic stem cells. However, higher fibrinogen concentrations (> 20 mg/mL) enabling the fabrication of stable implants are necessary.We here characterized fibrin gels of 1–30 mg/mL for their rheological properties and whether they support tube formation of endothelial cell–adipogenic stem cell co-cultures for up to 7 days. Moreover, 20 mg/mL gels containing preformed channels and endothelial cell–adipogenic stem cell co-culture were perfused continuously in a customized flow chamber with 3.9 dyn/cm2for 12 days and analyzed for capillary formation.Rheology of fibrin gels showed increasing stability proportional to fibrinogen concentration with 20 mg/mL gels having a storage module of 465 Pa. Complex tube networks stable for 7 days were observed at 1–5 mg/mL gels whereas higher concentrations showed initial sprouting only. However, perfusion of 20 mg/mL fibrin gels resulted in endothelialized pore formation in several layers of the gel with endothelial cell–adipogenic stem cell co-culture.Thus, perfusion supports the formation of capillary-like structures in fibrin gels that are too dense for spontaneous tube formation under static conditions. Future studies are necessary to further increase pore density and to investigate proper nutrition of tissue-specific target cells in the scaffold.
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- 2021
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28. Upper-body cannulation for midterm mechanical circulatory support: A novel bridging strategy to cardiac retransplantation
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Mogaldea, Alexandru, Rojas, Sebastian V, Ius, Fabio, Kaufeld, Tim, Sommer, Wiebke, Avsar, Murat, Bara, Christoph, Haverich, Axel, Warnecke, Gregor, and Kuehn, Christian
- Abstract
Heart retransplantation remains a controversial issue, due to the overall shortage of donor organs. Many patients put on the waiting list for retransplantation, decompensate rapidly, and do not survive. The use of veno-arterial extracorporeal life support remains an option in such emergency situations as bridge-to-recovery or bridge-to-transplantation therapy. In peripheral femoral configuration, veno-arterial extracorporeal life support improves the patient’s condition by relieving low-cardiac output but immobilizes him or her for an uncertain period of time. The upper-body cannulation is an alternative approach, which allows to maintain the patient awake and mobile. We present two cases of midterm circulatory support as a bridge to heart retransplantation, using upper-body cannulation veno-arterial extracorporeal life support. Two male patients, presenting with progressive cardiac decompensation due to severe graft rejection, were placed on upper-body veno-arterial extracorporeal life support. The stabilization of hemodynamics and improvement of end-organ perfusion could be achieved after extracorporeal life support initiation. After 48 and 40 days, respectively, on extracorporeal life support with active physical therapy and no major adverse events, both patients received a cardiac retransplantation and were eventually discharged home. The presented cases are the first reported where a successful cardiac retransplant was performed following prolonged upper-body extracorporeal life support.
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- 2020
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29. Abdominal Surgery in Patients with Ventricular Assist Devices: a Single-Center Report
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Beetz, Oliver, Bajunaid, Anwar, Meißler, Luise, Vondran, Florian W. R., Kleine, Moritz, Cammann, Sebastian, Hanke, Jasmin S., Schmitto, Jan D., Haverich, Axel, Klempnauer, Jürgen, Ringe, Kristina I., Oldhafer, Felix, and Timrott, Kai
- Abstract
Supplemental Digital Content is available in the text.This study was performed to evaluate the incidence and outcome of patients with ventricular assist devices (VADs) undergoing abdominal surgery at our institution. A total of 604 adult patients who underwent VAD implantation between February 2004 and February 2018 were analyzed retrospectively with a median follow-up time of 66 (6–174) months. Thirty-nine patients (6.5%) underwent abdominal surgery. Elective surgical procedures were performed in 22 patients (56.4%), mainly for abdominal wall hernia repairs, partial colectomies, and cholecystectomies. Early after elective abdominal surgery no patient died, resulting in a median survival of 23 (1–78) months. Emergency surgery was performed in 17 patients (43.6%). The most common emergency indications were intestinal ischemia and/or perforation. Eight patients undergoing emergent surgery (44.4%) died within the first 30 days after primary abdominal operation, mainly due to sepsis and consecutive multiple organ failure, resulting in a dismal median survival of one month (0–52). Patients undergoing abdominal surgery had significantly lower rates of realized heart-transplantation (p= 0.031) and a significantly higher rate of VAD exchange, before or after abdominal surgery, due to thromboses or infections (p= 0.037). Nonetheless, overall survival after primary VAD implantation in these patients (median 38 months; 0–107) was not significantly impaired when compared to all other patients undergoing VAD implantation (median 30 months; 0–171). In summary, elective abdominal surgery can be performed safely when well planned by an experienced multidisciplinary team. Abdominal complications in VAD patients requiring emergent surgery, however, lead to a significant increase in short-term morbidity and a high 30-day mortality rate.
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- 2020
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30. Toward a Long-Term Artificial Lung
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Arens, Jutta, Grottke, Oliver, Haverich, Axel, Maier, Lars S., Schmitz-Rode, Thomas, Steinseifer, Ulrich, Wendel, H.P., and Rossaint, Rolf
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Only a very small portion of end-stage organ failures can be treated by transplantation because of the shortage of donor organs. Although artificial long-term organ support such as ventricular assist devices provide therapeutic options serving as a bridge-to-transplantation or destination therapy for end-stage heart failure, suitable long-term artificial lung systems are still at an early stage of development. Although a short-term use of an extracorporeal lung support is feasible today, the currently available technical solutions do not permit the long-term use of lung replacement systems in terms of an implantable artificial lung. This is currently limited by a variety of factors: biocompatibility problems lead to clot formation within the system, especially in areas with unphysiological flow conditions. In addition, proteins, cells, and fibrin are deposited on the membranes, decreasing gas exchange performance and thus, limiting long-term use. Coordinated basic and translational scientific research to solve these problems is therefore necessary to enable the long-term use and implantation of an artificial lung. Strategies for improving the biocompatibility of foreign surfaces, for new anticoagulation regimes, for optimization of gas and blood flow, and for miniaturization of these systems must be found. These strategies must be validated by in vitroand in vivotests, which remain to be developed. In addition, the influence of long-term support on the pathophysiology must be considered. These challenges require well-connected interdisciplinary teams from the natural and material sciences, engineering, and medicine, which take the necessary steps toward the development of an artificial implantable lung.
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- 2020
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31. Infrastructural needs and expected benefits of telemonitoring in left ventricular assist device therapy: Results of a qualitative study using expert interviews and focus group discussions with patients
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Walter, Christin, Fischer, Florian, Hanke, Jasmin S, Dogan, Günes, Schmitto, Jan Dieter, Haverich, Axel, Reiss, Nils, Schmidt, Thomas, Hoffmann, Jan-Dirk, and Feldmann, Christina
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Background: Heart failure is one of the most expensive chronic diseases, as it leads to considerable expenses due to increasing hospitalisation rates. In addition to the implications of the demographic transition and the lack of available organs for transplantation, a major challenge in this context is that conservative treatment options are limited. This has led to the research and development of mechanical circulatory assist systems. Telemonitoring is anticipated to be an effective tool in outpatient management, which may be a key to improved outcomes of left ventricular assist devices therapy. In patients with chronic cardiac diseases, telemedicine is already used and has been shown to reduce premature mortality. This study aims to provide insights into the left ventricular assist device–specific requirements for telemonitoring and infrastructural translation from caregivers’ and patients’ points of view.Method: A qualitative investigation based on guided interview and focus group techniques was conducted at two German heart centres. The study included 15 patients and 7 caregivers (4 cardiac surgeons, 3 ventricular assist device coordinators). Qualitative content analysis was used for data analysis. The categories for analysis were (1) benefits for patients, (2) benefits for hospitals and the healthcare system, (3) acceptance and causative factors and (4) infrastructural implementation.Results: Patients and experts expect the following benefits for telemonitored patients: added safety, early detection of complications, rapid intervention in case of emergency, regular inspection of pump parameters, fewer outpatient clinic visits and the ability to provide more informed feedback and instructions to the family members who take care of the patient. However, the expected acceptance of telemonitoring in left ventricular assist device therapy differed among the interviewed groups. Alongside the aforementioned expected benefits, patients and clinical experts criticised the reduced self-determination for the patient, probable large amounts of time/effort required of the patient and caregiver and data protection/integrity issues (data misuse, device manipulation and mistransfer). Interviewees expected easy handling, proper education and safe data transmission to be necessary factors leading to acceptance. Complication rate reduction, fewer hospitalisations and cost reductions were benefits recorded for the healthcare system and clinics. Clinical experts preferred a telemonitoring centre run by ventricular assist device coordinators.Conclusion: Although positive expectations are associated with the use of telemonitoring in left ventricular assist device therapy, further action is needed. For example, software and infrastructure developers will need to address issues such as variations among patients and may need to find a balance between designing individualised solutions for compliant patients and a safe and easy-to-handle set-up. In addition, proper elucidation of users will contribute to the successful implementation of a left ventricular assist device telemonitoring programme among patients and caregivers.
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- 2020
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32. Effects of personalized endurance training on cellular age and vascular function in middle-aged sedentary women
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Eigendorf, Julian, Melk, Anette, Haufe, Sven, Boethig, Dietmar, Berliner, Dominik, Kerling, Arno, Kueck, Momme, Stenner, Hedwig, Bara, Christoph, Stiesch, Meike, Schippert, Cordula, Hilfiker, Andres, Falk, Christine, Bauersachs, Johann, Thum, Thomas, Lichtinghagen, Ralf, Haverich, Axel, Hilfiker-Kleiner, Denise, and Tegtbur, Uwe
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- 2019
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33. Portable normothermic ex-vivo lung perfusion, ventilation, and functional assessment with the Organ Care System on donor lung use for transplantation from extended-criteria donors (EXPAND): a single-arm, pivotal trial
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Loor, Gabriel, Warnecke, Gregor, Villavicencio, Mauricio A, Smith, Michael A, Kukreja, Jasleen, Ardehali, Abbas, Hartwig, Matthew, Daneshmand, Mani A, Hertz, Marshall I, Huddleston, Stephen, Haverich, Axel, Madsen, Joren C, and Van Raemdonck, Dirk
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Donor lung use for transplantation is the lowest among solid organ tranplants because of several complex and multifactorial reasons; one area that could have a substantial role is the limited capabilities of cold ischaemic storage. The aim of the EXPAND trial was to evaluate the efficacy of normothermic portable Organ Care System (OCS) Lung perfusion and ventilation on donor lung use from extended-criteria donors and donors after circulatory death, which are rarely used.
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- 2019
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34. Assessment of cytocompatibility and mechanical properties of detergent-decellularized ovine pericardial tissue
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Mogaldea, Alexandru, Theodoridis, Karolina, Goecke, Tobias, Tudorache, Igor, Haverich, Axel, Cebotari, Serghei, and Hilfiker, Andres
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Background: Autologous pericardium is widely used for the repair of different sized cardiovascular defects. However, its use is limited especially in redo cardiac surgery. We developed an engineered tissue based on decellularized pericardium reseeded with blood-derived endothelial cells.Materials and Methods: Decellularization of ovine pericardium was performed using detergent treatment. Ovine outgrowth blood-derived and green fluorescent protein–labeled endothelial cells were used to reseed the decellularized ovine pericardium on the mesothelial side. The cell adhesion was assessed using fluorescent microscopy up to 15 days of in vitro cultivation. The mechanical properties of the pericardium were evaluated using suturability, burst pressure, and suture retention strength tests.Results: After decellularization the pericardial sheets appeared cell-free and repopulation using ovine blood-derived endothelial cells was successful by forming a robust monolayer. Detergent treatment did not affect the extracellular matrix. The thickness of decellularized tissue was similar to native ovine pericardium (285.3 ± 28.2 µm, respective 276.9 ± 23.8 µm, p= 0.48). Decellularized patch showed similar suturability comparable to the native ovine pericardium. Resulted burst pressure was not significantly different (native/decellularized: 312.5 ± 13.6/304.2 ± 16, p= 0.35). The suture retention strength of native pericardium was 638.33 ± 90.2 gr and comparable to decellularized tissue (622.2 ± 89.9 gr, p= 0.76). No differences were observed concerning elongation of native and decellularized pericardium (8.33 ± 1.5 and 8.5 ± 0.84 mm, respectively; p= 0.82).Conclusion: Mesothelial surface of decellularized ovine pericardium is suitable for reseeding with ovine blood-derived endothelial cells. The mechanical properties of detergent-treated pericardium were comparable to native tissue.
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- 2019
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35. Effects of personalized endurance training on cellular age and vascular function in middle-aged sedentary women
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Eigendorf, Julian, Melk, Anette, Haufe, Sven, Boethig, Dietmar, Berliner, Dominik, Kerling, Arno, Kueck, Momme, Stenner, Hedwig, Bara, Christoph, Stiesch, Meike, Schippert, Cordula, Hilfiker, Andres, Falk, Christine, Bauersachs, Johann, Thum, Thomas, Lichtinghagen, Ralf, Haverich, Axel, Hilfiker-Kleiner, Denise, and Tegtbur, Uwe
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- 2019
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36. Prognostic Value of the Nutritional Risk Index in Candidates for Continuous Flow Left Ventricular Assist Device Therapy.
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Uribarri, Aitor, Rojas, Sebastian V., Hanke, Jasmin S., Dogan, Günes, Siemeni, Thierry, Kaufeld, Tim, Ius, Fabio, Goecke, Tobias, Rojas-Hernandez, Sara, Warnecke, Gregor, Bara, Christoph, Avsar, Murat, and Haverich, Axel
- Abstract
Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2019
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37. Early Insight Into In Vivo Recellularization of Cell-Free Allogenic Heart Valves.
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Sarikouch, Samir, Theodoridis, Karolina, Hilfiker, Andres, Boethig, Dietmar, Laufer, Günther, Andreas, Martin, Cebotari, Serghei, Tudorache, Igor, Bobylev, Dmitry, Neubert, Lavinia, Teiken, Kristin, Robertus, Jan Lukas, Jonigk, Danny, Beerbaum, Philipp, Haverich, Axel, and Horke, Alexander
- Abstract
Unlike the vast amount of animal data available on the recellularization of allogenic decellularized heart valves (DHVs), there have only been sporadic histologic reports on such grafts in humans. Two experienced cardiac pathologists independently evaluated human specimens obtained during reoperation between December 2010 and April 2017 DHVs in seven categories after automated staining (scores: 0 to 6) in comparison with published data. An optimal result of 42 points was classified as 100%. We found that 364 DHVs, 236 decellularized pulmonary homografts (DPHs), and 128 decellularized aortic homografts (DAHs) were implanted, and freedom from explantation was 96.1% (DAH) and 98.7% (DPH). Reoperations were because of (suspected) endocarditis in 5 of 11 patients, stenosis at the subvalvular or valvular or supravalvular level in 3 of 11 patients, planned staged reoperation in 2 of 11 patients, and 1 heart transplantation. Good reader agreement was reflected by an interagreement weighted κ of 0.783 (95% confidence interval: 0.707 to 0.859). The relative histologic score in nonendocarditis specimens was 76% ± 4.3% (maximum 81%). Intracellular procollagen type 1 production was found in recipient mesenchymal cells within the transplanted grafts. In endocarditis specimens the histologic score was significantly lower with 48% ± 7.3% (minimum 41%, p = 0.0004) because of leucocyte infiltration and matrix degradation. One DPH showed immune system-mediated graft failure. Grafts obtained during the first 12 months after implantation were not evenly repopulated with less recellularization in the inner parts; no difference was found between DAH and DPH with respect to extent of recellularization. Substantial in vivo recellularization with noninflammatory cells was observed in this study. Spontaneous recellularization appears to require multiple months, which correspondingly has an impact on size selection for growing patients. [ABSTRACT FROM AUTHOR]
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- 2019
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38. Transplant arteriosclerosis in humanized mice reflects chronic lung allograft dysfunction and is controlled by regulatory T cells.
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Siemeni, Thierry, Knöfel, Ann-Kathrin, Ius, Fabio, Sommer, Wiebke, Salman, Jawad, Böthig, Dietmar, Falk, Christine S., Tudorache, Igor, Haverich, Axel, and Warnecke, Gregor
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Chronic lung allograft dysfunction (CLAD) is a severe complication of lung transplantation limiting long-term survival. We studied correlations between CLAD after clinical lung transplantation and leukocyte-mediated development of transplant arteriosclerosis (TA) in a humanized mouse model. The pericardiophrenic artery was procured from surplus tissue of donor lungs (n = 22) transplanted in our clinical program and was implanted into the abdominal aorta of immune-deficient mice. Allogeneic human peripheral blood mononuclear cells (PBMCs) had been procured 1 day after lung transplantation from the respective recipients with or without enriching for CD4
+ CD25high T cells were used. TA was assessed in mice 28 days later by histology. The respective clinical lung recipients were later divided into 2 groups. Eight patients (36.3%) had developed CLAD 23 ± 5 months after lung transplantation, whereas the remaining 14 (63.6%) did not develop CLAD within 25 ± 5 months. In the PBMC CLAD+ group of mouse experiments, TA was significantly more severe than in the PBMC CLAD– group (39.9% ± 13% vs 14.9% ± 4% intimal thickening; P =.0081). Then, intimal thickening was significantly inhibited in the PBMC+ regulatory T cells CLAD+ group compared with the PBMC CLAD+ group (0.4% ± 4% vs 39.9% ± 13%; P =.003). In the experiments using PBMCs from lung recipients without CLAD, enriching regulatory T cells also suppressed the development of TA (0.9% ± 3% PBMC CLAD– vs 14.9% ± 4% PBMC+ regulatory T cells CLAD–; P =.001). Lung transplant recipients who later develop CLAD have peripheral leukocytes already at the time of transplant that transfer proinflammatory properties leading to TA in a humanized mouse model. TA remains sensitive to inhibition by autologous regulatory T cells, suggesting a cell therapy-based approach for the prevention of CLAD after lung transplantation. [ABSTRACT FROM AUTHOR]- Published
- 2019
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39. Functional Pulmonary Magnetic Resonance Imaging for Detection of Ischemic Injury in a Porcine Ex-Vivo Lung Perfusion System Prior to Transplantation.
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Renne, Julius, Gutberlet, Marcel, Voskrebenzev, Andreas, Kern, Agilo, Kaireit, Till, Hinrichs, Jan B, Braubach, Peter, Falk, Christine S, Höffler, Klaus, Warnecke, Gregor, Zardo, Patrick, Haverich, Axel, Wacker, Frank, Vogel-Claussen, Jens, and Zinne, Norman
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Rationale and Objectives: To evaluate the feasibility of multiparametric magnetic resonance imaging (MRI) of the lungs to detect impaired organ function in a porcine model of ischemic injury within an ex-vivo lung perfusion system (EVLP) prior to transplantation.Materials and Methods: Twelve pigs were anesthetized, and left lungs were clamped to induce warm ischemia for 3 hours. Right lungs remained perfused as controls. Lungs were removed and installed in an EVLP for 12 hours. Lungs in the EVLP were imaged repeatedly using computed tomography, proton MRI (1H-MRI) and fluorine MRI (19F-MRI). Dynamic contrast-enhanced derived parenchymal blood volume, oxygen washout times, and 19F washout times were calculated. PaO2 was measured for ischemic and normal lungs, wet/dry ratio was determined, histologic samples were assessed, and cytokines in the lung tissue were analyzed. Statistical analysis was performed using nonparametric testing.Results: Eleven pigs were included in the final analysis. Ischemic lungs showed significantly higher wet/dry ratios (p = 0.024), as well as IL-8 tissue levels (p = 0.0098). Histologic assessment as well as morphologic scoring of computed tomography and 1H-MRI did not reveal significant differences between ischemic and control lungs. 19F washout (p = 0.966) and parenchymal blood flow (p = 0.32) were not significantly different. Oxygen washout was significantly prolonged in ischemic lungs compared to normal control lungs at the beginning (p = 0.018) and further prolonged at the end of the EVLP run (p = 0.005).Conclusion: Multiparametric pulmonary MRI is feasible in lung allografts within an EVLP system. Oxygen-enhanced imaging seems to be a promising marker for ischemic injury, enabling detection of affected lung segments prior to transplantation. [ABSTRACT FROM AUTHOR]- Published
- 2019
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40. Echocardiographic Changes in Patients Implanted With a Fully Magnetically Levitated Left Ventricular Assist Device (Heartmate 3).
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Uriel, Nir, Medvedofsky, Diego, Imamura, Teruhiko, Maly, Jiri, Kruse, Eric, Ivák, Peter, Sood, Poornima, Lang, Roberto M., Maffessanti, Francesco, Berliner, Dominik, Bauersachs, Johann, Haverich, Axel, Želízko, Michael, Netuka, Ivan, and Schmitto, Jan D.
- Abstract
Background: The Heartmate 3 (HM3) is a Conformiteé Européenne mark-approved left ventricular (LV) assist device (LVAD) with fully magnetically levitated rotor and features consisting of a wide range operational speeds, wide flow paths, and artificial pulse. We performed a hemodynamic-echocardiographic speed optimization evaluation in HM3-implanted patients to achieve optimal LV- and right ventricular (RV) shape.Methods and Results: Sixteen HM3 patients underwent pump speed ramp tests with right heart catheterization. Three-dimensional echocardiographic (3DE) LV and RV datasets (Philips) were acquired, and volumetric (Tomtec) and shape (custom software) analyses were performed (LV: sphericity, conicity; RV: septal and free-wall curvatures). Data were recorded at up to 13 speed settings. Speed changes were in 100-rpm steps, starting at 4600 rpm and ramping up to 6200 rpm. 3DE was feasible in 50% of the patients. Mean original speed was 5306 ± 148 rpm. LV end-diastolic (ED) diameter (-0.15 ± 0.09 cm/100 rpm) and volumes (ED: 269 ± 109 mL to 175 ± 90 mL; end-systolic [ES]: 234 ± 111 mL to 146 ± 81 mL) progressively decreased as the shape became less spherical and more conical; RV volumes initially remained stable, but at higher speeds increased (ED: from 148 ± 64 mL to 181 ± 92 mL; ES: 113 ± 63 mL to 130 ± 69 mL). On average, the RV septum became less convex (bulging toward the LV) at the highest speeds.Conclusions: LV and RV shape changes were noted in HM3-supported patients. Although a LV volumetric decrease and shape improvement was consistently noted, RV volumes grew in response to increase in speed above a certain point. A next concern would be whether understanding of morphologic and function changes in LV and RV during LVAD speed change assessed with the use of 3DE helps to optimize LVAD speed settings and improve clinical outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2019
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41. Commentary: Total aortic arch replacement and the frozen elephant trunk: Out with the old, in with the new?
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Beckmann, Erik and Haverich, Axel
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- 2022
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42. One-year outcomes with the HeartMate 3 left ventricular assist device.
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Hanke, Jasmin S., Dogan, Günes, Zoch, Amelie, Ricklefs, Marcel, Wert, Leonhard, Feldmann, Christina, Bara, Christoph, Shrestha, Malakh, Tillmanns, Jochen, Kempf, Tibor, Bauersachs, Johann, Haverich, Axel, and Schmitto, Jan D.
- Abstract
Background The HeartMate 3 (HM3; Abbott Laboratories, Lake Forest, Ill) left ventricular assist device (LVAD) received its Conformité Européenne mark for Europe in October 2015 and is currently under investigation of the Food and Drug Administration to gain approval in the United States. Within this study, we present the first real-world experiences, 1-year outcomes, and adverse events of a single-center cohort treated with the HM3. Methods We prospectively studied midterm results of 27 consecutive patients receiving the HM3 at a single institution. After HM 3 implantation, survival, causes of death, and complications were recorded for all patients. Follow up was 100% complete. Results Twenty-seven patients were enrolled into the study. Within 1 year after HM3 implantation, 3 patients underwent heart transplantation and 3 patients died. Thirty-day survival was 88.9%, 6-month 85.2%, and 1-year survival 85.2%. No pump thrombosis and no strokes were observed within the study group. One incident of gastrointestinal bleeding was observed (3.7%). Right heart failure was diagnosed in 1 patient after HM3 implantation (3.7%). No technical complications of the pump were documented. No pump exchanges were necessary. The main complication was LVAD-related infection (22.2%). Conclusions The novel LVAD HM3 has already shown excellent Conformité Européenne mark trial results. Within this cohort, 1-year survival after HM3 implantation was 85%. The HM3 showed excellent midterm results with 0% stroke and 0% pump thrombosis rates 1 year after implantation. [ABSTRACT FROM AUTHOR]
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- 2018
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43. Exchange of a HeartMate 3 Left Ventricular Assist Device through Thoracotomy.
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Hanke, Jasmin S., Dogan, Günes, Haverich, Axel, and Schmitto, Jan D.
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Despite great advances in technology and medical care, device infection and pump thrombosis remain major difficulties in the therapy with left ventricular assist devices. When medical treatment fails, operative left ventricular assist devices exchange is the only curative option. We present a step by step guide to the conventional exchange procedure via lateral thoracotomy as well as a guide to the exchange from an older to a new generation device. [ABSTRACT FROM AUTHOR]
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- 2018
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44. In vivo performance of freeze-dried decellularized pulmonary heart valve allo- and xenografts orthotopically implanted into juvenile sheep.
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Ciubotaru, Anatol, Höffler, Klaus, Sarikouch, Samir, Goecke, Tobias, Theodoridis, Karolina, Tudorache, Igor, Cebotari, Serghei, Haverich, Axel, Ramm, Robert, Hilfiker, Andres, Vásquez Rivera, Andrés, and Wolkers, Willem F.
- Subjects
PULMONARY valve ,GUIDED tissue regeneration ,BIOMATERIALS ,XENOGRAFTS ,SHEEP physiology - Abstract
The decellularization of biological tissues decreases immunogenicity, allows repopulation with cells, and may lead to improved long-term performance after implantation. Freeze drying these tissues would ensure off-the-shelf availability, save storage costs, and facilitates easy transport. This study evaluates the in vivo performance of freeze-dried decellularized heart valves in juvenile sheep. TritonX-100 and sodium dodecylsulfate decellularized ovine and porcine pulmonary valves (PV) were freeze-dried in a lyoprotectant sucrose solution. After rehydration for 24 h, valves were implanted into the PV position in sheep as allografts (fdOPV) and xenografts (fdPPV), while fresh dezellularized ovine grafts (frOPV) were implanted as controls. Functional assessment was performed by transesophageal echocardiography at implantation and at explantation six months later. Explanted grafts were analysed histologically to assess the matrix, and immunofluorescence stains were used to identify the repopulating cells. Although the graft diameters and orifice areas increased, good function was maintained, except for one insufficient, strongly deteriorated frOPV. Cells which were positive for either endothelial or interstitial markers were found in all grafts. In fdPPV, immune-reactive cells were also found. Our findings suggest that freeze-drying does not alter the early hemodynamic performance and repopulation potential of decellularized grafts in vivo , even in the challenging xenogeneic situation. Despite evidence of an immunological reaction for the xenogenic valves, good early functionalities were achieved. Statement of Significance Decellularized allogeneic heart valves show excellent results as evident from large animal experiments and clinical trials. However, a long-term storing method is needed for an optimal use of this limited resource in the clinical setting, where an optimized matching of graft and recipient is requested. As demonstrated in this study, freeze-dried and freshly decellularized grafts reveal equally good results after implantation in the juvenile sheep concerning function and repopulation with recipients’ cells. Thus, freeze-drying arises as a promising method to extend the shelf-life of valvular grafts compared to those stored in antibiotic-solution as currently practised. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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45. Less Invasive Surgical Approaches for Left Ventricular Assist Device Implantation.
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Ricklefs, Marcel, Hanke, Jasmin S., Dogan, Günes, Napp, L. Christian, Feldmann, Christina, Haverich, Axel, and Schmitto, Jan D.
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For several years, the standard implantation strategy of ventricular assist devices has involved a full sternotomy approach. However, less invasive implantation techniques are now becoming increasingly popular as they are associated with reduction of trauma, blood loss, and arrhythmogenic complications, as well as a decreased duration of intensive care unit and in-hospital stay. Thus, due to miniaturization and increasing technical improvement of ventricular assist devices, less invasive strategies for implantation, explantation, exchange, and concomitant cardiac procedures are on the rise. In this review article, we report on the state of the art of less invasive techniques for implantation, explantation, exchange, and combined cardiac procedures of ventricular assist devices. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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46. Elective David I Procedure Has Excellent Long-Term Results: 20-Year Single-Center Experience.
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Shrestha, Malakh L., Beckmann, Erik, Abd Alhadi, Firas, Krueger, Heike, Meyer-Bockenkamp, Fiona, Bertele, Sebastian, Koigeldiyev, Nurbol, Kaufeld, Tim, Fleissner, Felix, Korte, Wilhelm, Schmitto, Jan, Cebotari, Serghei, Harringer, Wolfgang, Haverich, Axel, and Martens, Andreas
- Abstract
Background We present our results after elective, isolated David I procedures over the past 20 years. Methods Between 1993 and 2015, 197 patients (mean age 46 ± 17 years, 73% men) underwent isolated aortic valve reimplantation using straight tube grafts (David I procedure). Sixty patients (31%) had Marfan syndrome, and 24 (12%) had a bicuspid aortic valve. Twenty-four patients (12%) were operated through upper mini-sternotomy. Results There were no perioperative deaths. Stroke rate was 1% (2 of 197). Discharge echocardiography showed none to trivial aortic regurgitation (AR) in 71% (139 of 197 patients) and mild AR in 26% (51 of 197 patients). Thirty-two patients (16%) died during follow-up (9.0 ± 5.5 years after operation). One death was aortic valve related. Twenty-six patients (13%) underwent aortic valve reoperations during follow-up (5.5 ± 5.0 years after operation). Late endocarditis occurred in 2 patients (1.0%). More than trivial AR at discharge predicted a higher reoperation rate. In 144 non-reoperated survivors, echocardiography showed none to trivial AR in 56 (39%), mild AR in 53 (37%), moderate AR in 19 (6.3%), and severe AR in 4 (2.7%) of the patients after 12 ± 5.3 years. Conclusions The valve-sparing David I procedure has excellent short- and long-term results. Erosion due to supposed leaflet contact with the straight tube graft was not observed in any patient, proving that using a straight graft has no negative impact on the leaflets. The “spared valve” (being native living tissue) seems to be more resistant to infection than prosthetic valves. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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47. Left Ventricular Assist Device Therapy for Destination Therapy: Is Less Invasive Surgery a Safe Alternative?
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Rojas, Sebastian V., Hanke, Jasmin S., Avsar, Murat, Ahrens, Philipp R., Deutschmann, Ove, Tümler, Kirstin A., Uribarri, Aitor, Rojas-Hernández, Sara, Sánchez, Pedro L., González-Santos, José M., Haverich, Axel, and Schmitto, Jan D.
- Abstract
Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2018
- Full Text
- View/download PDF
48. TIMP3 is Regulated by Pericytes upon Shear Stress Detection Leading to a Modified Endothelial Cell Response.
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Schrimpf, C., Koppen, T., Duffield, J.S., Böer, U., David, S., Ziegler, W., Haverich, A., Teebken, O.E., and Wilhelmi, M.
- Abstract
Objectives Atherosclerosis is a hallmark of cardiovascular disease. Shear stress on endothelial cells has been linked to atherogenesis and to fibrous cap thinning and rupture. Pericytes reside in the sub-endothelial space of vessels and have vasoprotective effects. They are subjected to shear stress when endothelial cell integrity is disrupted. The aim was to investigate the susceptibility and response of pericytes to shear stress. Methods Endothelial cells and pericytes were seeded in two dimensional monocultures and co-cultures, and in a novel three dimensional co-culture system and were subjected to no, low and high shear stress (0, 10, 30 dyne/cm 2 ) for 48 h. The morphological response to flow was assessed by histology and the expression of extracellular matrix proteins was analysed using quantitative polymerase chain reaction, immunoblotting, and ELISA. Results While endothelial cells aligned into flow direction, pericytes aligned perpendicularly ( p < .001), indicating that they must be capable of sensing flow. When pericytes were embedded into a 3D matrix they showed similar alignment and pericytes built long processes towards the lumen. Under shear stress endothelial cells upregulated “a disintegrin and metalloproteinase with thrombospondin motif 1” (ADAMTS-1) ( p < .01) and pericytes upregulated “tissue inhibitor of matrix metalloproteinase” (TIMP) 3 ( p < .05), an inhibitor of ADAMTS-1, meanwhile differential expression of extracellular matrix (ECM) proteins could be detected in co-cultures of both cells. For TIMP3 expression direct cell–cell contact between endothelial cells and pericytes was required. Conclusion The experiments highlight that pericytes are able to sense direct flow thereby regulating ECM proteins known to be involved in vascular remodelling. Furthermore, pericytes counter-regulate endothelial ADAMTS-1 by protective TIMP3 expression to prevent matrix degradation and maintain vascular stability. For this protective effect direct cell contact was necessary. This observation might represent an adaptive, protective mechanism of pericytes to counteract endothelial damage in the onset of atherosclerosis. [ABSTRACT FROM AUTHOR]
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- 2017
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49. Valor pronóstico del índice de riesgo nutricional para los candidatos a implante de un dispositivo de asistencia ventricular izquierda de flujo continuo
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Uribarri, Aitor, Rojas, Sebastian V., Hanke, Jasmin S., Dogan, Günes, Siemeni, Thierry, Kaufeld, Tim, Ius, Fabio, Goecke, Tobias, Rojas-Hernandez, Sara, Warnecke, Gregor, Bara, Christoph, Avsar, Murat, and Haverich, Axel
- Abstract
La desnutrición influye en la evolución clínica de los pacientes con insuficiencia cardiaca. El objetivo es analizar el impacto del estado nutricional preoperatorio evaluado mediante el índice de riesgo nutricional (IRN) en el pronóstico de los pacientes que recibieron dispositivos de asistencia ventricular izquierda de flujo continuo (DAVI-fc).
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- 2019
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50. Biochemical Myogenic Differentiation of Adipogenic Stem Cells Is Donor Dependent and Requires Sound Characterization
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Lau, Skadi, Klingenberg, Melanie, Mrugalla, Anna, Helms, Florian, Sedding, Daniel, Haverich, Axel, Wilhelmi, Mathias, and Böer, Ulrike
- Abstract
Vascular tissue engineering approaches often require autologous smooth muscle cells (SMCs) obtained by biochemical differentiation of donor-derived adipogenic mesenchymal stem cells (ASCs) by transforming growth factor-β (TGFβ), bone morphogenetic protein-4 (BMP4), and/or sphingosylphosphorylcholine (SPC). However, data on myogenic marker proteins and contractility indicating fully functional SMC are contradicting and incomplete. We here investigated (1) the ideal combination of TGFβ, BMP4, and/or SPC; the time frame (2) necessary to trigger myogenic differentiation and (3) for a sustained differentiation status up to 29 days; and (4) donor diversity in myogenic differentiation potential and contractility using collagen and fibrin gel assays. Western blots showed that a combination of TGFβ, BMP4, and SPC most effectively induced both expression of α-smooth muscle actin (αSMA) and smoothelin after 8 days and their maintenance up to 29 days. Moreover, only three of seven ASC donors revealed effective coexpression of αSMA, smoothelin, and myosin heavy chain 11 and pronounced SMC contractility, whereas the latter was weaker (61%) and 6 days delayed in fibrin gels. Thus, a thorough biochemical and functional characterization of differentiated SMC is necessary before their use for autologous vascular graft cellularization. Moreover, strategies to improve fibrin scaffolds in terms of contractility should be developed.Impact StatementWe here showed that even under optimized conditions for biochemical differentiation of adipose-derived stem cells (with respect to a pronounced marker protein expression for a reasonable period of time) it was not possible to obtain functional smooth muscle cells from all donors. Moreover, an underestimated role may play the effect of the scaffold material on smooth muscle cell functionality. Both aspects are crucial for the successful tissue engineering of the vascular medial layer combining autologous cells with a suitable scaffold material and thus should be thoroughly addressed in each individualized therapeutic approach.
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- 2019
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