50 results on '"Kirov, Hristo"'
Search Results
2. Deactivation of LVAD support for myocardial recovery—surgical perspectives
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Nickel, Ian, Potapov, Evgenij, Sun, Benjamin, Zimpfer, Daniel, Koliopoulou, Antigone, Adachi, Iki, Anyanwu, Anelechi, Falk, Volkmar, Atluri, Pavan, Faerber, Gloria, Goldstein, Daniel, Yarboro, Leora, Slaughter, Mark S., Milano, Carmelo, Tsukashita, Masaki, D’Alessandro, David, Silvestry, Scott, Kirov, Hristo, Bommareddi, Swaroop, Lanmüller, Pia, Doenst, Torsten, and Selzman, Craig H.
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- 2024
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3. Colchicine in Patients With Coronary Disease Who Underwent Coronary Artery Bypass Surgery: A Meta-Analysis of Randomized Controlled Trials
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Kirov, Hristo, Caldonazo, Tulio, Runkel, Angelique, Medin, Darko, Fischer, Johannes, Dallan, Luis Roberto, Mukharyamov, Murat, Mejia, Omar A., Jatene, Fabio B., and Doenst, Torsten
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- 2024
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4. Comparing outcomes between coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with left main or multivessel disease
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Kirov, Hristo, Caldonazo, Tulio, Riedel, Leoni Lu, Tasoudis, Panagiotis, Moschovas, Alexandros, Diab, Mahmoud, Färber, Gloria, and Doenst, Torsten
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- 2023
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5. Subclinical hypothyroidism and clinical outcomes after cardiac surgery: A systematic review and meta-analysis
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Dell’Aquila, Michele, Rossi, Camilla S., Caldonazo, Tulio, Cancelli, Gianmarco, Harik, Lamia, Soletti, Giovanni J., An, Kevin R., Leith, Jordan, Kirov, Hristo, Ibrahim, Mudathir, Demetres, Michelle, Dimagli, Arnaldo, Rahouma, Mohamed, and Gaudino, Mario
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- 2024
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6. Respect Versus Resect Approaches for Mitral Valve Repair: A Meta-Analysis of Reconstructed Time-to-Event Data
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Caldonazo, Tulio, Sá, Michel Pompeu, Jacquemyn, Xander, Van den Eynde, Jef, Kirov, Hristo, Harik, Lamia, Fischer, Johannes, Vervoort, Dominique, Bonatti, Johannes, Sultan, Ibrahim, and Doenst, Torsten
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- 2024
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7. Antithrombotic Therapy in Patients With Infective Endocarditis: A Systematic Review and Meta-Analysis
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Caldonazo, Tulio, Musleh, Rita, Moschovas, Alexandros, Kirov, Hristo, Franz, Marcus, Haeusler, Karl Georg, Faerber, Gloria, Doenst, Torsten, Günther, Albrecht, and Diab, Mahmoud
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- 2024
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8. Outcomes of Concomitant Coronary Artery Bypass Grafting in Patients With Infective Endocarditis: A Systematic Review and Meta-Analysis
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Caldonazo, Tulio, Kirov, Hristo, Doenst, Torsten, Tasoudis, Panagiotis, Moschovas, Alexandros, Faerber, Gloria, Treml, Ricardo E., Sá, Michel Pompeu, Mukharyamov, Murat, and Diab, Mahmoud
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- 2023
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9. Structural valve degeneration of bioprosthetic aortic valves: A network meta-analysis
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Squiers, John J., Robinson, N. Bryce, Audisio, Katia, Ryan, William H., Mack, Michael J., Rahouma, Mohamed, Cancelli, Gianmarco, Kirov, Hristo, Doenst, Torsten, Gaudino, Mario, and DiMaio, J. Michael
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- 2023
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10. Atrial fibrillation after cardiac surgery: A systematic review and meta-analysis
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Dobrev, Dobromir, Borger, Michael A., Kiehntopf, Michael, Skoloff, Katherine, Caldonazo, Tulio, Kirov, Hristo, Rahouma, Mohamed, Robinson, N. Bryce, Demetres, Michelle, Gaudino, Mario, and Doenst, Torsten
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- 2023
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11. A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome
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Kirov, Hristo, Caldonazo, Tulio, Rahouma, Mohamed, Robinson, N. Bryce, Demetres, Michelle, Serruys, Patrick W., Biondi-Zoccai, Giuseppe, Gaudino, Mario, and Doenst, Torsten
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- 2022
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12. Comparing CABG and PCI across the globe based on current regional registry evidence
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Caldonazo, Tulio, Kirov, Hristo, Riedel, Leoni Lu, Gaudino, Mario, and Doenst, Torsten
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- 2022
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13. Cardiac Surgery 2023 Reviewed.
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Kirov, Hristo, Caldonazo, Tulio, Mukharyamov, Murat, Toshmatov, Sultonbek, Fischer, Johannes, Schneider, Ulrich, Siemeni, Thierry, and Doenst, Torsten
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MITRAL valve surgery , *TRICUSPID valve surgery , *CORONARY artery bypass , *HEART transplantation , *CARDIAC surgery , *HEART valve prosthesis implantation , *HEART failure - Abstract
We reviewed the cardiac surgical literature for 2023. PubMed displayed almost 34,000 hits for the search term "cardiac surgery AND 2023." We used a PRISMA approach for a results-oriented summary. Key manuscripts addressed the mid- and long-term effects of invasive treatment options in patient populations with coronary artery disease (CAD), comparing interventional therapy (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass graft [CABG]). The literature in 2023 again confirmed the excellent long-term outcomes of CABG compared with PCI in patients with left main stenosis, specifically in anatomically complex chronic CAD, but even in elderly patients, generating further support for an infarct-preventative effect as a prognostic mechanism of CABG. For aortic stenosis, a previous trend of an early advantage for transcatheter (transcatheter aortic valve implantation [TAVI]) and a later advantage for surgical (surgical aortic valve replacement) treatment was also re-confirmed by many studies. Only the Evolut Low Risk trial maintained an early advantage of TAVI over 4 years. In the mitral and tricuspid field, the number of interventional publications increased tremendously. A pattern emerges that clinical benefits are associated with repair quality, making residual regurgitation not irrelevant. While surgery is more invasive, it currently generates the highest repair rates and longest durability. For terminal heart failure treatment, donor pool expansion for transplantation and reducing adverse events in assist device therapy were issues in 2023. Finally, the aortic diameter related to adverse events and technical aspects of surgery dominated in aortic surgery. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for patient-specific decision-making. [ABSTRACT FROM AUTHOR]
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- 2024
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14. Percutaneous Versus Surgical Femoral Cannulation in Minimally Invasive Cardiac Surgery: A Systematic Review and Meta-Analysis.
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Kirov, Hristo, Caldonazo, Tulio, Runkel, Angelique, Fischer, Johannes, Tasoudis, Panagiotis, Mukharyamov, Murat, Cancelli, Gianmarco, Dell'Aquila, Michele, and Doenst, Torsten
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- 2024
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15. Conservative Versus Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication-Meta-Analysis of Reconstructed Time-to-Event Data.
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Caldonazo, Tulio, Hagel, Stefan, Doenst, Torsten, Kirov, Hristo, Sá, Michel Pompeu, Jacquemyn, Xander, Tasoudis, Panagiotis, Franz, Marcus, and Diab, Mahmoud
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- 2024
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16. Thorax support vest to prevent sternal wound infections in cardiac surgery patients—a systematic review and meta-analysis.
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Caldonazo, Tulio, Dell'Aquila, Michele, Cancelli, Gianmarco, Harik, Lamia, Soletti, Giovanni Jr, Fischer, Johannes, Kirov, Hristo, Rahouma, Mohamed, Ibrahim, Mudathir, Demetres, Michelle, An, Kevin R, Girardi, Leonard, Doenst, Torsten, and Gaudino, Mario
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- 2024
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17. Predictive Value of Serial Model of End-Stage Liver Disease Score Determination in Patients with Postcardiotomy Extracorporeal Membrane Oxygenation.
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Sommerfeld, Oliver, Neumann, Caroline, Pfeifer, Marcel-Dominic, Faerber, Gloria, Kirov, Hristo, von Loeffelholz, Christian, Doenst, Torsten, and Sponholz, Christoph
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EXTRACORPOREAL membrane oxygenation ,LIVER diseases ,MULTIPLE organ failure ,HOSPITAL mortality ,CARDIAC output - Abstract
(1) Background: The use of extracorporeal membrane oxygenation (ECMO) in low cardiac output states after cardiac surgery may aid in patient recovery. However, in some patients, the clinical state may worsen, resulting in multiple organ failure and high mortality rates. In these circumstances, calculating a model of end-stage liver disease (MELD) score was shown to determine organ dysfunction and predicting mortality. (2) Methods: We evaluated whether serial MELD score determination increases mortality prediction in patients with postcardiotomy ECMO support. (3) Results: Statistically, a cutoff of a 2.5 MELD score increase within 48 h of ECMO initiation revealed an AUC of 0.722. Further, we found a significant association between hospital mortality and 48 h MELD increase (HR: 2.5, 95% CI: 1.33–4.75, p = 0.005) after adjustment for possible confounders. (4) Conclusions: Therefore, serial MELD score determinations on alternate days may be superior to single measurements in this special patient cohort. [ABSTRACT FROM AUTHOR]
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- 2024
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18. Durability of Tricuspid Valve Repair in Patients Undergoing Left Ventricular Assist Device Implantation.
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Färber, Gloria, Schwan, Imke, Kirov, Hristo, Rose, Marcel, Tkebuchava, Sophie, Schneider, Ulrich, Caldonazo, Tulio, Diab, Mahmoud, and Doenst, Torsten
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HEART assist devices ,TRICUSPID valve ,DISEASE risk factors ,HEART transplantation ,DURABILITY - Abstract
Objectives: Benefits of tricuspid valve repair (TVR) in left ventricular assist device (LVAD) patients have been questioned. High TVR failure rates have been reported. Remaining or recurring TR was found to be a risk factor for right heart failure (RHF). Therefore, we assessed our experience. Methods: Since 12/2010, 195 patients have undergone LVAD implantation in our center. Almost half (n = 94, 48%) received concomitant TVR (LVAD+TVR). These patients were included in our analysis. Echocardiographic and clinical data were assessed. Median follow-up was 2.8 years (7 days–0.6 years). Results were correlated with clinical outcomes. Results: LVAD+TVR patients were 59.8 ± 11.4 years old (89.4% male) and 37.3% were INTERMACS level 1 and 2. Preoperative TR was moderate in 28 and severe in 66 patients. RV function was severely impaired in 61 patients reflected by TAPSE-values of 11.2 ± 2.9 mm (vs. 15.7 ± 3.8 mm in n = 33; p < 0.001). Risk for RHF according to EUROMACS-RHF risk score was high (>4 points) in 60 patients, intermediate (>2–4 points) in 19 and low (0–2 points) in 15. RHF occurred in four patients (4.3%). Mean duration of echocardiographic follow-up was 2.8 ± 2.3 years. None of the patients presented with severe and only five (5.3%) with moderate TR. The vast majority (n = 63) had mild TR, and 26 patients had no/trace TR. Survival at 1, 3 and 5 years was 77.4%, 68.1% and 55.6%, 30-day mortality was 11.7% (n = 11). Heart transplantation was performed in 12 patients (12.8%). Conclusions: Contrary to expectations, concomitant TVR during LVAD implantation may result in excellent repair durability, which appears to be associated with low risk for RHF. [ABSTRACT FROM AUTHOR]
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- 2024
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19. Effect of haemoadsorption during cardiac surgery for Staphylococcus aureus endocarditis: a REMOVE trial post hoc analysis.
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Caldonazo, Tulio, Eynde, Jef Van den, Doenst, Torsten, Kirov, Hristo, Franz, Marcus, Hagel, Stefan, Lehmann, Thomas, Diab, Mahmoud, and Investigators, the REMOVE Trial
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CARDIAC surgery ,STAPHYLOCOCCUS aureus ,ENDOCARDITIS ,INFECTIVE endocarditis ,MULTIPLE organ failure ,IMMUNOADSORPTION - Abstract
Open in new tab Download slide OBJECTIVES Multi-organ failure is one of the leading causes of mortality after cardiac surgery for infective endocarditis (IE). Although the randomized evidence does not support the use of haemoadsorption during cardiac surgery for IE, observational studies suggest a beneficial effect in selected patient groups. Staphylococcus aureus is the most common pathogen, and its presence is an independent mortality predictor. We aimed to analyse the effect of haemoadsorption in patients with IE caused by S. aureus. METHODS This is a post hoc analysis of the REMOVE trial that randomized 288 patients with IE who underwent cardiac surgery with haemoadsorption using CytoSorb
® or control. The primary outcome was ΔSequential Organ Failure Assessment (SOFA), defined as the difference between the mean total postoperative and baseline SOFA score within 24 h of surgery. RESULTS Among the total of 282 patients included in the modified intention-to-treat analysis of the REMOVE trial, 73 (25.9%) had S. aureus IE (38 patients in the haemoadsorption group and 35 patients in the control group). The overall ΔSOFA did not differ between the intervention groups in patients with S. aureus IE (mead difference = −0.4, 95% confidence interval −2.3 to 1.4, P = 0.66) and neither did 30-day mortality (hazard ratios = 1.32, 95% confidence interval 0.53–3.28, P = 0.55). No differences were observed with regard to any of the other secondary outcomes. CONCLUSIONS Based on a post hoc analysis from REMOVE trial, the intraoperative use of haemoadsorption in patients with S. aureus IE was not associated with reduction of postoperative organ dysfunction, 30-day mortality or other major clinical end points. [ABSTRACT FROM AUTHOR]- Published
- 2024
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20. ESR Bridges: CT builds bridges in coronary artery disease.
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Dewey, Marc, Henriques, José P. S., Kirov, Hristo, and Vliegenthart, Rozemarijn
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CHEST pain ,CORONARY artery disease ,ATHEROSCLEROTIC plaque ,HEART disease diagnosis ,CORONARY artery bypass - Abstract
This article discusses the use of computed tomography (CT) in the diagnosis and treatment of coronary artery disease (CAD). The evidence suggests that CT can accurately detect CAD and improve patient outcomes compared to invasive procedures. Three fundamental changes are proposed for integrating CT into clinical pathways for CAD: better prevention of cardiovascular events, individual determination of treatment strategy, and improved procedural planning. However, there are limitations to the current evidence base, and further research is needed to assess the use of CT in different patient populations. Overall, multidisciplinary research has made important advancements in CAD diagnosis and treatment, and there is potential for further improvements in non-invasive cardiovascular imaging. [Extracted from the article]
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- 2024
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21. Improving Preoperative Abscess Detection in Infective Endocarditis by Adding Troponin I: A REMOVE Trial Analysis.
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Diab, Mahmoud, Moschovas, Alexandros, Franz, Marcus, Hamadanchi, Ali, Faerber, Gloria, Caldonazo, Tulio, Kirov, Hristo, Lehmann, Thomas, Schulze, P. Christian, and Doenst, Torsten
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- 2024
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22. Impact of a 36-hour Nonstop Training Course on Academic, Physical, and Mental Skills as well as Psychological Stress Perception in Cardiac Surgery Residents.
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Caldonazo, Tulio, Kirov, Hristo, Schneider, Ulrich, Beckmann, Andreas, W., K., Weber, Günter, Iglauer-Sander, Regina, Färber, Gloria, and Doenst, Torsten
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CARDIAC surgery , *PSYCHOLOGICAL stress , *GROUP dynamics , *SLEEP deprivation , *LABOR laws , *SURGICAL education , *IRRITABILITY (Psychology) , *TRAINING of surgeons - Abstract
Background Making the right decision in stressful situations is required for goal-oriented action in cardiac surgery. Current labor laws prevent residents to be subjected to situations that test their stress tolerance. These situations often occur only later in the career. We simulated such conditions in a structured non-stop 36-hour cardiac surgical training course and assessed the participant's performance. Methods Fourteen advanced residents/junior staff surgeons were selected. The course was conducted in collaboration with the national antiterror police forces that provided coaching for teamplay, leadership, and responsibility awareness. The candidates attended graded and evaluated workshops/lectures and performed academic and surgical tasks. Psychological and surgical skill assessments were conducted at times 0, 12, 24, 36 hours. Results Progressive reductions in individual motivation, associated with increased stress and irritability levels, worsening mood, and fatigue were observed. Long- and short-term memory functions were unaffected and practical surgical performance even increased over time. Conclusion Among the candidates, 36 hours of sleep deprivation did not lead to relevant changes in the skills required from a cardiac surgeon in daily life. Importantly, group dynamics substantially improved during the course, suggesting advances in the perception of responsibility and teamwork. [ABSTRACT FROM AUTHOR]
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- 2023
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23. Myocardial protection in cardiac surgery—hindsight from the 2020s.
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Mukharyamov, Murat, Schneider, Ulrich, Kirov, Hristo, Caldonazo, Tulio, and Doenst, Torsten
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CARDIAC surgery ,TWENTY twenties ,CARDIOPULMONARY bypass ,INDUCED cardiac arrest ,MYOCARDIAL reperfusion ,BLOOD flow - Abstract
Open in new tab Download slide Myocardial protection and specifically cardioplegia have been extensively investigated in the beginnings of cardiac surgery. After cardiopulmonary bypass had become routine, more and more cardiac operations were possible, requiring reliable and reproducible protection for times of blood flow interruptions to the most energy-demanding organ of the body. The concepts of hypothermia and cardioplegia evolved as tools to extend cardiac ischaemia tolerance to a degree considered safe for the required operation. A plethora of different solutions and delivery techniques were developed achieving remarkable outcomes with cross-clamp times of up to 120 min and more. With the beginning of the new millennium, interest in myocardial protection research declined and, as a consequence, conventional cardiac surgery is currently performed using myocardial protection strategies that have not changed in decades. However, the context, in which cardiac surgery is currently performed, has changed during this time. Patients are now older and suffer from more comorbidities and, thus, other organs move more and more into the centre of risk assessment. Yet, systemic effects of cardioplegic solutions have never been in the focus of attention. They say hindsight is always 20–20. We therefore review the biochemical principles of ischaemia, reperfusion and cardioplegic extension of ischaemia tolerance and address the concepts of myocardial protection with 'hindsight from the 2020s'. In light of rising patient risk profiles, minimizing surgical trauma and improving perioperative morbidity management becomes key today. For cardioplegia, this means accounting not only for cardiac, but also for systemic effects of cardioplegic solutions. [ABSTRACT FROM AUTHOR]
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- 2023
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24. Differences in Postoperative Atrial Fibrillation Incidence and Outcomes After Cardiac Surgery According to Assessment Method and Definition: A Systematic Review and Meta-Analysis.
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Perezgrovas-Olaria, Roberto, Alzghari, Talal, Rahouma, Mohammed, Dimagli, Arnaldo, Harik, Lamia, Soletti, Giovanni J., An, Kevin R., Caldonazo, Tulio, Kirov, Hristo, Cancelli, Gianmarco, Audisio, Katia, Yaghmour, Mohammad, Polk, Hillary, Toor, Rajbir, Sathi, Swetha, Demetres, Michelle, Girardi, Leonard N., Biondi-Zoccai, Giuseppe, and Gaudino, Mario
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- 2023
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25. Cardiac Surgery 2022 Reviewed.
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Doenst, Torsten, Schneider, Ulrich, Caldonazo, Tulio, Toshmatov, Sultonbek, Diab, Mahmoud, Siemeni, Thierry, Färber, Gloria, and Kirov, Hristo
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CARDIAC surgery ,CORONARY artery bypass ,PROGNOSIS ,OPERATIVE surgery ,PERCUTANEOUS coronary intervention ,CARDIAC catheterization ,HEART failure - Abstract
PubMed displayed almost 37,000 hits for the search term "cardiac surgery AND 2022." As before, we used the PRISMA approach and selected relevant publications for a results-oriented summary. We focused on coronary and conventional valve surgery, their overlap with interventional alternatives, and briefly assessed surgery for aorta or terminal heart failure. In the field of coronary artery disease (CAD), key manuscripts addressed prognostic implications of invasive treatment options, classically compared modern interventions (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass grafting [CABG]), and addressed technical aspects of CABG. The general direction in 2022 confirms the superiority of CABG over PCI in patients with anatomically complex chronic CAD and supports an infarct-preventative effect as underlying mechanism. In addition, the relevance of proper surgical technique to achieve durable graft patency and the need for optimal medical treatment in CABG patients was impressively illustrated. In structural heart disease, the comparisons of interventional and surgical techniques have been characterized by prognostic and mechanistic investigations underscoring the need for durable treatment effects and reductions of valve-related complications. Early surgery for most valve pathologies appears to provide significant survival advantages, and two publications on the Ross operation prototypically illustrate an inverse association between long-term survival and valve-related complications. For surgical treatment of heart failure, the first xenotransplantation was certainly dominant, and in the aortic surgery field, innovations in arch surgery prevailed. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information. [ABSTRACT FROM AUTHOR]
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- 2023
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26. Hemoadsorption in Heart Failure Requiring Mechanical Circulatory Support--A Systematic Review and Meta-Analysis.
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Freiburger, Sebastian, Caldonazo, Tulio, Tasoudis, Panagiotis, Färber, Gloria, Schulze, Paul Christian, Franz, Marcus, Doenst, Torsten, Kirov, Hristo, and Diab, Mahmoud
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Background: Left ventricular assist devices (LVAD) and extracorporeal membrane oxygenation (ECMO) are well established therapies in heart failure (HF) management. Their use is generally associated with a sudden increase in inflammatory mediators, which are often already elevated in patients with HF prior to device implantation. An exaggerated release of proinflammatory cytokines is associated with organ dysfunction and increased mortality. Hemoadsorption has been shown to reduce inflammatory mediators during cardiopulmonary bypass. Objective: To investigate the role of hemoadsorption during the management of acute or chronic heart failure with mechanical circulatory support and its impact on survival. Methods: We systematically searched MEDLINE selecting all studies comparing the use of hemoadsorption during LVAD implantation or veno-arterial (v.a.) ECMO therapy. Records were screened by two different investigators. Reports without a control group and duplicates were excluded. Results: Our search delivered six studies. One was randomized and five were retrospective studies, of which three were risk-adjusted. During LVAD implantation, one study showed no difference in mortality but higher incidence of respiratory insufficiency in the hemoadsorption group (54% vs 30%, p = 0.024) and the other study found higher mortality in the hemoadsorption group (33% vs 0%, p = 0.01). During ECMO therapy, three of four studies including the randomized one found no difference in survival or major adverse cardiac events between the hemoadsorption and the control groups. Only one study found lower mortality in the hemoadsorption group (20% vs 60%. p = 0.02). Conclusions: The results of this literature review suggest that the use of hemoadsorption in patients undergoing LVAD implantation might be associated with higher morbidity and mortality. The majority of studies on the use of hemoadsorption during v.a. ECMO therapy showed no effect on mortality or organ dysfunction, while only one small study showed that hemoadsorption was able to reduce mortality. The results are limited by the retrospective nature and the small sample sizes of the majority of the studies included. [ABSTRACT FROM AUTHOR]
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- 2023
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27. Importance of valve competence—what do repair durability and pharmacoadherence have in common?
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Mukharyamov, Murat, Caldonazo, Tulio, Kirov, Hristo, and Doenst, Torsten
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MITRAL valve insufficiency ,VALVES ,DURABILITY ,TRICUSPID valve ,MITRAL valve ,HEART valve diseases - Abstract
The article discusses the importance of valve competence in heart surgery and its impact on patient life expectancy. It explains that the mechanical correction of valve competency is a focus of therapy because medical treatment is unable to cure the problem. The article compares the durability of repair strategies for functional and structural regurgitation and suggests that the lack of repair durability in functional regurgitation may be responsible for the inability to demonstrate a survival impact. The article also presents a technique for repair of functional tricuspid regurgitation that potentially improves durability. Overall, the article emphasizes the need for lasting repair successes in valve surgery to improve patient outcomes. [Extracted from the article]
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- 2024
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28. Outcomes comparison between the first and the subsequent SARS-CoV-2 waves - a systematic review and meta-analysis.
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Caldonazo, Tulio, Treml, Ricardo E., Vianna, Felipe S. L., Tasoudis, Panagiotis, Kirov, Hristo, Mukharyamov, Murat, Doenst, Torsten, and Silva Jr, João M.
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MEDICAL personnel ,ACUTE kidney failure ,EXTRACORPOREAL membrane oxygenation ,VENTILATOR-associated pneumonia ,SARS-CoV-2 - Abstract
Background: In the beginning of the SARS-CoV-2 pandemic, health care professionals dealing with COVID-19 had to rely exclusively on general supportive measures since specific treatments were unknown. The subsequent waves could be faced with new diagnostic and therapeutic tools (e.g., anti-viral medications and vaccines). We performed a meta-analysis and systematic review to compare clinical endpoints between the first and subsequent waves. Methods: Three databases were assessed. The primary outcome was in-hospital mortality. The secondary outcomes were intensive care unit (ICU) mortality, ICU length of stay (LOS), acute renal failure, extracorporeal membrane oxygenation (ECMO) implantation, mechanical ventilation time, hospital LOS, systemic thromboembolism, myocarditis and ventilator associated pneumonia. Results: A total of 25 studies with 126,153 patients were included. There was no significant difference for the primary endpoint (OR=0.94, 95% CI 0.83-1.07, p=0.35). The first wave group presented higher rates of ICU LOS (SMD= 0.23, 95% CI 0.11-0.35, p<0.01), acute renal failure (OR=1.71, 95% CI 1.36-2.15, p<0.01) and ECMO implantation (OR=1.64, 95% CI 1.06-2.52, p=0.03). The other endpoints did not show significant differences. Conclusions: The analysis suggests that the first wave group, when compared with the subsequent waves group, presented higher rates of ICU LOS, acute renal failure and ECMO implantation, without significant difference in in-hospital or ICU mortality, mechanical ventilation time, hospital LOS, systemic thromboembolism, myocarditis or ventilator-associated pneumonia. [ABSTRACT FROM AUTHOR]
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- 2023
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29. Association of liver dysfunction with outcomes after cardiac surgery—a meta-analysis.
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Kirov, Hristo, Caldonazo, Tulio, Audisio, Katia, Rahouma, Mohamed, Robinson, N Bryce, Cancelli, Gianmarco, Soletti, Giovanni J, Demetres, Michelle, Ibrahim, Mudathir, Faerber, Gloria, Gaudino, Mario, and Doenst, Torsten
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- 2022
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30. Bend relief fenestration might prevent outflow graft obstruction in patients with left ventricular assist device.
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Färber, Gloria, Kirov, Hristo, Schwan, Imke, Gräger, Stephanie, Diab, Mahmoud, Tkebuchava, Sophie, and Doenst, Torsten
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- 2022
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31. Diabetes Is an Independent Risk Factor for Cancer after Heart and/or Lung Transplantation.
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Kirov, Hristo, Moschovas, Alexandros, Caldonazo, Tulio, Schwan, Imke, Faerber, Gloria, Sandhaus, Tim, Lehmann, Thomas, and Doenst, Torsten
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LUNG transplantation , *DISEASE risk factors , *HEART transplantation , *PEOPLE with diabetes , *DIABETES - Abstract
Background: De novo cancers are feared complications after heart or lung transplantation. Recent data suggest that diabetes mellitus (DM) might also be a risk factor for cancer. We hypothesized that transplanted diabetic patients are at greater risk of developing cancer compared to non-diabetic ones. Methods: We reviewed 353 patients post-heart and/or -lung transplantation from our center between October 1999 and June 2021. Patients with follow-up <180 days (n = 87) were excluded from the analysis. The remaining 266 patients were divided into patients who had preoperative DM (n = 88) or developed it during follow-up (n = 40) and patients without DM (n = 138). Results: The diabetic cohort showed higher rates of malignancies in all patients (30.33 vs. 15.97%, p = 0.005) and in the matched population (31.9 vs. 16.1%, p < 0.001). There were also significantly more solid tumors (17.9 vs. 9.4%, p = 0.042; matched: 16.6 vs. 9.1%, p = 0.09) The presence of diabetes was associated with a 13% increased risk of cancer when compared to non-diabetic patients. New-onset post-transplant diabetes doubled the likelihood of cancer development. Conclusions: Pre-transplant diabetes mellitus increases the risk of cancer after heart and/or lung transplantation. However, new-onset diabetes after transplantation is associated with a much greater cancer risk. This information is relevant for screening during follow-up. [ABSTRACT FROM AUTHOR]
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- 2022
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32. Cardiac Surgery 2021 Reviewed.
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Doenst, Torsten, Schneider, Ulrich, Can, Tolga, Caldonazo, Tulio, Diab, Mahmoud, Siemeni, Thierry, Färber, Gloria, and Kirov, Hristo
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HEART valve prosthesis implantation ,CARDIAC surgery ,CORONARY artery bypass ,MYOCARDIAL revascularization ,MITRAL valve surgery ,AORTIC valve transplantation - Abstract
PubMed displayed more than 35,000 hits for the search term "cardiac surgery AND 2021." We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term "myocardial revascularization" is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information. [ABSTRACT FROM AUTHOR]
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- 2022
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33. Surgical Timing in Patients With Infective Endocarditis and With Intracranial Hemorrhage: A Systematic Review and Meta-Analysis.
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Musleh, Rita, Schlattmann, Peter, Caldonazo, Túlio, Hristo Kirov, Witte, Otto W., Doenst, Torsten, Günther, Albrecht, Diab, Mahmoud, and Kirov, Hristo
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- 2022
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34. Treatment of valvular heart disease in young patients—"early evidence" versus "latest fashion".
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Kirov, Hristo, Caldonazo, Tulio, and Doenst, Torsten
- Abstract
Is the performance of locally manufactured mechanical valve prostheses relevant for modern cardiac surgery, in which mechanical valve replacement has become a rarity? This question comes to mind reading the article in this issue of the Journal demonstrating equal outcomes of the TTK Chitra tilting disk mechanical heart valve prostheses in comparison to the SJM bi‐leaflet blockbuster. The evidence documenting efficacy of mechanical valve replacement stems from the early ages of cardiac surgery, but often demonstrates superior outcomes in terms of survival and hemodynamics. Yet, the latest fashion in the Western world consists biological choices in combination with new transcatheter techniques (valve in valve options) or the Ozaki or Ross procedures. As long‐term results are often missing and documented advantages for mechanical valves stems from early evidence, the local emphasis of mechanical valve replacement may possibly result in superior individual prognoses compared to following the Western world's latest fashions. Individual patient information and decision making moves into focus. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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35. Reply to Condello.
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Mukharyamov, Murat, Kirov, Hristo, Caldonazo, Tulio, and Doenst, Torsten
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- *
CARDIAC surgery , *AORTIC valve insufficiency , *INDUCED cardiac arrest , *MYOCARDIAL infarction - Abstract
This document is a reply to a letter from Dr. Condello regarding a review on myocardial protection. The authors of the review agree with Dr. Condello's comments on technical aspects such as post-conditioning, the impact of aortic regurgitation on cardioplegia delivery, and differences in delivery routes. They also acknowledge that there are other factors to consider, such as the timing and temperature of cardioplegia delivery. However, the authors emphasize that none of these individual factors have been shown to make a significant difference in myocardial protection. They believe that the quality of myocardial protection is more related to the surgeon's attention to avoiding damage rather than one specific aspect. The authors appreciate the discussion and consider it valuable for surgeons to adapt their myocardial protection strategies as needed. [Extracted from the article]
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- 2024
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36. Neurocognitive decline in cardiac surgery—Distraction rather than destruction?
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Caldonazo, Tulio, Kirov, Hristo, and Doenst, Torsten
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- *
CARDIAC surgery , *CORONARY artery disease , *GLYCEMIC control , *CARDIOPULMONARY bypass , *PERCUTANEOUS coronary intervention - Abstract
Background: A neurocognitive decline is an undesirable event that can be observed in patients after cardiac surgery. It has been related to the use of cardiopulmonary bypass (CPB). Minor embolic or hyperinflammatory mechanisms are thought to be responsible. In this issue of the Journal of Cardiac Surgery, the neurocognitive decline was observed in 22 of 30 patients after cardiac surgery with CPB. Repeatable neuropsychological status tests were used and scores 4 days after surgery were 5%–15% lower than before. Mechanistic investigations with glycemic control and transcriptomic and cytokine analyses failed to provide an explanation but the frequency of this observation is worrisome. Discussion: However, available evidence suggests that neurocognitive dysfunction disappears within a few months, and later on no difference to controls that did not undergo surgery can be detected. In addition, similar degrees of neurocognitive dysfunction can be observed after noncardiac surgery and even after percutaneous coronary intervention (PCI). A most recent comparison of memory decline after CABG and PCI also suggests no difference between the two invasive treatment options for coronary artery disease. All these findings argue against a primarily CPB‐associated mechanism. Interestingly, test subjects from a consumer investigation showed a 10% decline in their working memory just by placing their cell phone on the table, suggesting that being distracted may also affect neurocognitive function. Given the reversibility of surgery‐ and intervention‐associated neurocognitive dysfunction, we question destructive, embolic, or inflammatory‐associated mechanisms. Distractive aspects of intervention‐associated stress may also play a role. Conclusion: In any case, neurocognitive decline after cardiac surgery does not appear to be surgery‐specific. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
37. Predictors of Outcome for Aortic Valve Reimplantation Including the Surgeon—A Single-Center Experience.
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Tkebuchava, Sophie, Tasar, Raphael, Lehmann, Thomas, Faerber, Gloria, Diab, Mahmoud, Breuer, Martin, Franke, Ulrich, Kirov, Hristo, Gummert, Jan, Lichtenberg, Artur, Wahlers, Thorsten, and Doenst, Torsten
- Subjects
REIMPLANTATION (Surgery) ,AORTIC valve ,DISEASE risk factors ,SURGICAL complications ,CORONARY artery bypass ,OBSTRUCTIVE lung diseases - Abstract
Introduction Aortic valve reimplantation is considered technically demanding. We searched for predictors of long-term outcome including the surgeon as risk factor. Methods We selected all aortic valve reimplantations performed in our department between December 1999 and January 2017 and obtained a complete follow-up. The main indications were combined aortic aneurysm plus aortic valve regurgitation (AR), 69% and aortic dissections (15%). In 14%, valves were bicuspid. Cusp repair was performed in 27% of patients. One-third received additional procedures (coronary artery bypass grafting, mitral, or arch surgery). We performed multivariable analyses for independent risk factors of short- and long-term outcomes, including "surgeon" as variable. Twelve different surgeons operated on 193 patients. We created three groups: surgeons A and B with 84 and 64 procedures, respectively, and surgeon C (10 surgeons for 45 patients). Results Cardiopulmonary bypass and clamp times were 176 ± 45 and 130 ± 24 minutes, respectively. In-hospital mortality was 2%. Postoperatively, 5% had mild and 0.5% had moderate AR. Kaplan–Meier's survival estimates, freedom from reoperation, and freedom from severe AR at 12 years were 97 ± 1, 93 ± 2, and 91 ± 3%, respectively. Age and chronic obstructive pulmonary disease appeared as risk factors for perioperative complications by univariate analysis. Age, coronary artery disease, and duration of cardiopulmonary bypass, but not surgeon, presented as risk factors by multivariable analysis. Conclusion The results suggest that if a David procedure is performed successfully, long-term durability may be excellent. They also suggest that good and durable results are possible even with limited experience of the operating surgeon. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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38. Lost in circulation.
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Kirov, Hristo, Tkebuchava, Sophio, Faerber, Gloria, Diab, Mahmoud, Sandhaus, Tim, and Doenst, Torsten
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PERCUTANEOUS coronary intervention , *BODY mass index , *RETAINED surgical items , *FOREIGN bodies , *MULTIPLE organ failure , *CORONARY arteries - Abstract
Background: Device complications in complex percutaneous coronary interventions are rare but potentially deadly. Surgical removal is often required. However, an evaluation of surgical therapy beyond case reports is practically not existent.Methods: We prospectively followed all cases of retained guide wires and/or other devices referred to us for surgical removal between 2015 and 2019 and retrospectively searched our database for such cases between 2010 and 2014.Results: From 2015 on, eight cases were referred for surgical removal from six different cardiology departments. In the 5 years before, there was not a single case. Six patients were operated emergently. Patients were 60.5 ± 5.42 years old, overweight (body mass index 30.1 ± 3.77) and except for one case (left ventricular-assist device) showed preserved ejection fraction (EF) (mean EF 57 ± 18.01). The retained devices were mostly located in the right coronary artery (50%), followed by the circumflex artery (37.5%) and diagonal branch (12.5%). The devices were remnants of guide wires (n = 4), balloon catheters (n = 3), and in one case a rotablator. Full sternotomy was performed in six patients and two received a left-sided minithoracotomy (n = 2). The operations were performed on-pump in five (62.5%) and off-pump in three patients. Complete extraction of the foreign bodies was possible in all patients. Two patients died; one in unrelated multiorgan failure and one due to retained-device-related right heart failure. The other patients survived and had uneventful postoperative courses.Conclusions: Retained foreign bodies from cardiac interventions can be completely removed surgically using individualized approaches. There appears to be a trend toward a rising incidence of such interventional complications. [ABSTRACT FROM AUTHOR]- Published
- 2020
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39. Cardiac Surgery 2019 Reviewed.
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Doenst, Torsten, Bargenda, Steffen, Kirov, Hristo, Moschovas, Alexandros, Tkebuchava, Sophie, Safarov, Rauf, Velichkov, Ilia, and Diab, Mahmoud
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CARDIAC surgery ,HEART valve prosthesis implantation ,AORTIC valve surgery ,HEART assist devices ,AORTIC valve transplantation ,HEART transplantation - Abstract
For the year 2019, almost 25,000 published references can be found in PubMed when entering the search term "cardiac surgery." We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach for article selection and reviewed the main fields of adult cardiac surgery (i.e., coronary, valve, aortic, and heart failure surgery). The past decade has experienced an enormous development of interventional techniques that compete more and more with classic surgery. This contest was broadly visible in 2019. It peaked over the interpretation of the EXCEL trial data, where percutaneous coronary intervention and coronary artery bypass grafting (CABG) for left main disease were compared. A novel pathomechanism for CABG was proposed, potentially answering open questions in the field. In aortic valve surgery, two low-risk trials comparing transcatheter aortic valve implantation (TAVI) to classic aortic valve replacement (surgical aortic valve replacement) received attention for showing equal or superior short-term outcomes for TAVI. Longer follow-up information from recent trials became available presenting results emphasizing the need for joint decision making. While publications addressing surgery on the aorta and the mitral and tricuspid valves were less abundant, there was substantial activity regarding left ventricular assist device support and heart transplantation. This article attempts to summarize the most pertinent publications. It does not expect to be complete and cannot be free of individual interpretation. We aimed to provide a condensed summary of 2019s publications with a stimulus for in-depth reading and a basis supporting patient information. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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40. Cardiac surgery 2018 reviewed.
- Author
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Doenst, Torsten, Bargenda, Steffen, Kirov, Hristo, Moschovas, Alexandros, Tkebuchava, Sophie, Safarov, Rauf, Diab, Mahmoud, and Faerber, Gloria
- Abstract
For the year 2018, more than 22,000 published references can be found in PubMed when entering the search term "cardiac surgery". As in the last 4 years, this review focusses on conventional cardiac surgery publications which provide important and interesting information especially relevant for non-surgical colleagues. Interventional techniques have been considered if they were published in the context of classic surgical techniques. We have again reviewed the fields of coronary revascularization and valve surgery and briefly touched on aortic surgery and surgery for terminal heart failure. For revascularization of complex coronary artery disease, bypass grafting was reconfirmed as gold standard and computer-tomographic angiography established equipoise for decision-making with classic angiography. For aortic valve treatment, some new longer-term outcomes from TAVI vs. SAVR trials confirmed equipoise of both treatments for high and medium risk. New information was provided for INR-management of mechanical aortic valves as well as long-term experiences for alternatives to mechanical valves (i.e., Ross and the relatively new Ozaki procedure). In the mitral and tricuspid field, prevalence data illustrate a significant amount of under-treatment for mitral and tricuspid valve regurgitation and evidence for life prolonging-effects of surgery. Finally, elongation of the ascending aorta was identified as new risk factor for aortic dissection and 2 years outcome of the newest generation of left ventricular assist devices demonstrate impressive improvements in outcome. While this article attempts to summarize the most pertinent publications, it does not expect to be complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery and a stimulus for in-depth reading. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
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41. Cardiac surgery 2017 reviewed.
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Doenst, Torsten, Kirov, Hristo, Moschovas, Alexandros, Gonzalez-Lopez, David, Safarov, Rauf, Diab, Mahmoud, Bargenda, Steffen, and Faerber, Gloria
- Abstract
For the year 2017, more than 21,000 published references can be found in PubMed when entering the search term “cardiac surgery”. This review focusses on conventional cardiac surgery, considering the new interventional techniques only if they were directly compared to classic techniques but also entails aspects of perioperative intensive care management. The publications last year provided a plethora of new and interesting information that helped to quantify classic surgical treatment effects and provided new guidelines for the management of structural heart disease, which made comparisons to interventional techniques easier. The field of coronary bypass surgery was primarily filled with confirmatory evidence for the beneficial role of coronary artery bypass grafting for complex coronary disease and equal outcomes for percutaneous coronary intervention for less complex disease including main stem lesions. For aortic valve treatment, the new guidelines provide an equal recommendation for surgical and transcatheter aortic valve replacement for high and intermediate risk giving specific check lists to individualize decision-making by the heart team. For low-risk aortic stenosis, surgical valve replacement remains the primary indication. For the mitral valve, the importance of surgical experience of the individual surgeon on short- and long-term outcome was presented and the prognostic impact of mitral repair for primary mitral regurgitation was emphasized. In addition, there were many relevant and interesting other contributions from the purely operative arena in the fields of tricuspid disease as well as terminal heart failure (i.e., transplantation and ventricular assist devices). While this article attempts to summarize the most pertinent publications, it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader “solid ground” for up-to-date decision-making in cardiac surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
42. Minimally Invasive, Isolated Tricuspid Valve Redo Surgery: A Safety and Outcome Analysis.
- Author
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Färber, Gloria, Tkebuchava, Sophie, Dawson, Rodolfo Siordia, Kirov, Hristo, Diab, Mahmoud, Schlattmann, Peter, and Doenst, Torsten
- Subjects
TRICUSPID valve ,CARDIAC surgery ,TREATMENT effectiveness ,SURGICAL complications ,LOGISTIC regression analysis - Abstract
Background Isolated tricuspid valve (TV) surgery is considered a high risk-procedure. The optimal surgical approach is controversial. We analyzed our experience with isolated TV redo surgery performed either minimally invasively (redo-MITS) or through sternotomy. Methods We retrospectively analyzed all patients with previous cardiac surgery who underwent redo-MITS (n ¼ 26) and compared them to redo-Sternotomy (n ¼ 17). A group of primary-MITS (n ¼ 61) served as control. Results The redo-MITS approach consisted of a right anterolateral mini-thoracotomy, transpericardial right atrial access, and beating heart TV surgery without caval occlusion. Redo-MITS patients were oldest and had the most comorbidities (EuroScore II: 9.83 ± 6.05% versus redo-Sternotomy: 8.42 ± 7.33% versus primary-MITS: 4.15 ± 4.84%). There were no intraoperative complications or conversions to sternotomy in both MITS groups. Redo-Sternotomy had the highest 30-day mortality (24%), the poorest long-term survival, and the highest perioperative complication rate. Redo- MITS did not differ in perioperative outcome from primary-MITS. Multivariable logistic regression analysis identified redo-Sternotomy (odds ratio [OR] ¼ 9.76; 95% confidence interval [CI] 1.88-63.26), liver cirrhosis (OR ¼ 9.88; 95% CI 2.20-54.20), and body mass index (BMI) (OR ¼ 1.16; 95% CI 1.02-1.35) as independent predictors of 30- day mortality. The Cox model revealed redo-Sternotomy (hazard ratio [HR] ¼ 2.67; 95% CI 1.18-6.03), liver cirrhosis (HR ¼ 3.31; 95% CI 1.45-7.58), and pulmonary hypertension (HR ¼ 2.26; 95% CI 1.04-4.92) as risk factors for poor long-termsurvival. TV surgery significantly reduces NYHA class. Conclusion Minimally invasive, isolated TV surgery as reoperation without caval occlusion and on the beating heart can be safe and may improve clinical outcome. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
43. Cardiac surgery 2016 reviewed.
- Author
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Doenst, Torsten, Essa, Yasin, Jacoub, Khalil, Moschovas, Alexandros, Gonzalez-Lopez, David, Kirov, Hristo, Diab, Mahmoud, Bargenda, Steffen, and Faerber, Gloria
- Abstract
For the year 2016, more than 20,000 published references can be found in Pubmed when entering the search term 'cardiac surgery'. Publications last year have helped to more clearly delineate the fields where classic surgery and modern interventional techniques overlap. The field of coronary bypass surgery (partially compared to percutaneous coronary intervention) was enriched by five large prospective randomized trials. The value of CABG for complex coronary disease was reconfirmed and for less complex main stem lesions, PCI was found potentially equal. For aortic valve treatment, more evidence was presented for the superiority of transcatheter aortic valve implantation for patients with intermediate risk. However, the 2016 evidence argued against the liberal expansion to the low-risk field, where conventional aortic valve replacement still appears superior. For the mitral valve, many publications emphasized the significant impact of mitral valve reconstruction on survival in structural mitral regurgitation. In addition, there were many relevant and other interesting contributions from the purely operative arena in the fields of coronary revascularization, surgical treatment of valve disease, terminal heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While this article attempts to summarize the most pertinent publications it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader 'solid ground' for up-to-date decision-making in cardiac surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
44. Atrial fibrillation after cardiac surgery: A systematic review and meta-analysis.
- Author
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Caldonazo, Tulio, Kirov, Hristo, Rahouma, Mohamed, Robinson, N. Bryce, Demetres, Michelle, Gaudino, Mario, and Doenst, Torsten
- Abstract
New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is common, with rates up to 60%. POAF has been associated with early and late stroke, but its association with other cardiovascular outcomes is less known. The objective was to perform a meta-analysis of the studies reporting the association of POAF with perioperative and long-term outcomes in patients with cardiac surgery. We performed a systematic review and a meta-analysis of studies that presented outcomes for cardiac surgery on the basis of the presence or absence of POAF. MEDLINE, EMBASE, and the Cochrane Library were assessed; 57 studies (246,340 patients) were selected. Perioperative mortality was the primary outcome. Inverse variance method and random model were performed. Leave-one-out analysis, subgroup analyses, and metaregression were conducted. POAF was associated with perioperative mortality (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.58-2.33), perioperative stroke (OR, 2.17; 95% CI, 1.90-2.49), perioperative myocardial infarction (OR, 1.28; 95% CI, 1.06-1.54), perioperative acute renal failure (OR, 2.74; 95% CI, 2.42-3.11), hospital (standardized mean difference, 0.80; 95% CI, 0.53-1.07) and intensive care unit stay (standardized mean difference, 0.55; 95% CI, 0.24-0.86), long-term mortality (incidence rate ratio [IRR], 1.54; 95% CI, 1.40-1.69), long-term stroke (IRR, 1.33; 95% CI, 1.21-1.46), and longstanding persistent atrial fibrillation (IRR, 4.73; 95% CI, 3.36-6.66). The results suggest that POAF after cardiac surgery is associated with an increased occurrence of most short- and long-term cardiovascular adverse events. However, the causality of this association remains to be established. [Display omitted] Postoperative atrial fibrillation (POAF) after cardiac surgery appears to be associated with increased occurrence of perioperative mortality, perioperative stroke, perioperative myocardial infarction, perioperative acute renal failure, hospital length of stay, intensive care unit (ICU) length of stay, long-term mortality, long-term stroke, and longstanding persistent atrial fibrillation. OR , Odds ratio; SMD , standardized mean difference; IRR , incidence rate ratio; AF , atrial fibrillation. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
45. Cardiac surgery 2015 reviewed.
- Author
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Doenst, Torsten, Strüning, Constanze, Moschovas, Alexandros, Gonzalez-Lopez, David, Essa, Yasin, Kirov, Hristo, Diab, Mahmoud, and Faerber, Gloria
- Abstract
For the year 2015, almost 19,000 published references can be found in PubMed when entering the search term 'cardiac surgery'. The last year has been again characterized by lively discussions in the fields where classic cardiac surgery and modern interventional techniques overlap. Lacking evidence in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery has been added. As in the years before, CABG remains the gold standard for the revascularization of complex stable triple-vessel disease. Plenty of new information has been presented comparing the conventional to transcatheter aortic valve implantation (TAVI) demonstrating similar short- and mid-term outcomes at high and low risk, but even a survival advantage with transfemoral TAVI at intermediate risk. In addition, there were many relevant and interesting other contributions from the purely operative arena. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While the article does not have the expectation of being complete and cannot be free of individual interpretation, it provides a condensed summary that is intended to give the reader 'solid ground' for up-to-date decision-making in cardiac surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
46. Cardiac surgery 2014 reviewed.
- Author
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Doenst, Torsten, Strüning, Constanze, Moschovas, Alexandros, Gonzalez-Lopez, David, Valchanov, Ilija, Kirov, Hristo, Diab, Mahmoud, and Faerber, Gloria
- Abstract
For the year 2014, more than 17,000 published references can be found in Pubmed when entering the search term 'cardiac surgery'. The last year has been characterized by a vivid discussion in the fields where classic cardiac surgery and modern interventional techniques overlap. Specifically, there have been important contributions in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery as well as in the fields of interventional valve therapy. Here, the US core valve trial with the first demonstration of a survival advantage at 1 year with transcatheter valves compared to surgical aortic valve replacement or the 5-year outcome of the SYNTAX trial with significant advantages for bypass surgery has been the landmark. However, in addition to these most visible publications, there have been several highly relevant and interesting contributions. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices) and aortic surgery. This condensed summary will provide the reader with 'solid ground' for up-to-date decision-making in cardiac surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
47. Aortic regurgitation in left ventricular assist device patients – Does aortic root dilatation contribute to valve incompetence?
- Author
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Färber, Gloria, Schneider, Ulrich, Gräger, Stephanie, Elayan, Yousef, Schwan, Imke, Tkebuchava, Sophie, Kirov, Hristo, Caldonazo, Tulio, Diab, Mahmoud, and Doenst, Torsten
- Abstract
Background Methods Results Conclusions Aortic regurgitation (AR) is a known complication after left ventricular assist device (LVAD) implantation potentially leading to recurrent heart failure. Possible pathomechanisms include valvular pathologies and aortic root dilatation. We assessed aortic root dimensions in a group of consecutive LVAD patients who received HeartMate 3.Since 11/2015, we identified 68 patients with no or mild AR at the time of HeartMate 3 implantation who underwent serial echocardiography to assess AR and aortic root dimensions (annulus, sinus, and sinotubular junction). Median follow‐up was 40 months (2–94 months). Results were correlated with clinical outcomes.Patients were 60 ± 10 years old, predominantly male (88%) and 35% presented in preoperative critical condition as defined by INTERMACS levels 1 and 2. During follow‐up, 23 patients developed AR ≥ II (34%). Actuarial incidence was 8% at 1 year, 29% at 3 years and 41% at 5 years. Echocardiography revealed practically stable root dimensions at the latest follow‐up compared to the preoperative state (annulus: 23 ± 3 mm vs. 23 ± 2 mm, sinus: 32 ± 4 mm vs. 33 ± 3 mm, sinotubular junction: 27 ± 3 mm vs. 28 ± 3 mm), irrespective of the development of AR. Serial CT angiograms were performed in 13 patients to confirm echocardiographic findings. Twenty‐one patients died during LVAD support leading to a 5‐year survival of 71%, showing no difference between patients with and without AR ≥ II (p = 0.573).At least moderate AR develops over time in a substantial fraction of patients (one‐third over 3 years). The mechanism does not seem to be related to dilatation of the aortic annulus or root. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
48. Deformation of a Transapical Aortic Valve After Cardiopulmonary Resuscitation: A Potential Risk of Stainless Steel Stents
- Author
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Kirov, Hristo Mihaylov, Bothe, Wolfgang, Breuer, Martin, Clasen, Ina, Mall, Else-Gita, Schlüter, Andrea, Ferrari, Markus, and Doenst, Torsten
- Published
- 2012
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49. Extracorporeal life support after surgical repair for acute type a aortic dissection: A systematic review and meta-analysis.
- Author
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Sá, Michel Pompeu, Jacquemyn, Xander, Hess, Nicholas, Brown, James A., Caldonazo, Tulio, Kirov, Hristo, Doenst, Torsten, Serna-Gallegos, Derek, Kaczorowski, David, and Sultan, Ibrahim
- Abstract
The use of extracorporeal life support (ECLS) in patients after surgical repair for acute type A aortic dissection (ATAAD) has not been well documented.We performed a systematic review and meta-analysis to assess the outcomes of ECLS after surgery for ATAAD with data published by October 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. The protocol was registered in PROSPERO (CRD42023479955).Twelve observational studies met our eligibility criteria, including 280 patients. Mean age was 55.0 years and women represented 25.3% of the overall population. Although the mean preoperative left ventricle ejection fraction was 59.8%, 60.8% of patients developed left ventricle failure and 34.0% developed biventricular failure. Coronary involvement and malperfusion were found in 37.1% and 25.6%, respectively. Concomitant coronary bypass surgery was performed in 38.5% of patients. Regarding ECLS, retrograde flow (femoral) was present in 39.9% and central cannulation was present in 35.4%. In-hospital mortality was 62.8% and pooled estimate of successful weaning was 50.8%. Neurological complications, bleeding and renal failure were found in 25.9%, 38.7%, and 65.5%, respectively.ECLS after surgical repair for ATAAD remains associated with high rates of in-hospital death and complications, but it still represents a chance of survival in critical situations. ECLS remains a salvage attempt and surgeons should not try to avoid ECLS at all costs after repairing an ATAAD case. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
50. Transcatheter Harvest of a Dislocated Sapien Valve With an Inoue Balloon Through the Left Subclavian Artery
- Author
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Tkebuchava, Sophie, Bothe, Wolfgang, Figulla, Hans-Reiner, Ferrari, Marcus, Kirov, Hristo M., Hekmat, Khosro, Gastmann, Oliver, and Doenst, Torsten
- Published
- 2012
- Full Text
- View/download PDF
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