45 results on '"Kevin M Veen"'
Search Results
2. Outcomes after right ventricular outflow tract reconstruction with valve substitutes: A systematic review and meta-analysis
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Xu Wang, Wouter Bakhuis, Kevin M. Veen, Ad J. J. C. Bogers, Jonathan R. G. Etnel, Carlijn C. E. M. van Der Ven, Jolien W. Roos-Hesselink, Eleni-Rosalina Andrinopoulou, and Johanna J. M. Takkenberg
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right ventricular outflow tract reconstruction ,Tetralogy of Fallot ,truncus arteriosus ,ross procedure ,xenograft ,homograft ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
IntroductionThis study aims to provide an overview of outcomes after right ventricular outflow tract (RVOT) reconstruction using different valve substitutes in different age groups for different indications.MethodsThe literature was systematically searched for articles published between January 2000 and June 2021 reporting on clinical and/or echocardiographic outcomes after RVOT reconstruction with valve substitutes. A random-effects meta-analysis was conducted for outcomes, and time-related outcomes were visualized by pooled Kaplan–Meier curves. Subgroup analyses were performed according to etiology, implanted valve substitute and patient age.ResultsTwo hundred and seventeen articles were included, comprising 37,078 patients (age: 22.86 ± 11.29 years; 31.6% female) and 240,581 patient-years of follow-up. Aortic valve disease (Ross procedure, 46.6%) and Tetralogy of Fallot (TOF, 27.0%) were the two main underlying etiologies. Homograft and xenograft accounted for 83.7 and 32.6% of the overall valve substitutes, respectively. The early mortality, late mortality, reintervention and endocarditis rates were 3.36% (2.91–3.88), 0.72%/y (95% CI: 0.62–0.82), 2.62%/y (95% CI: 2.28–3.00), and 0.38%/y (95%CI: 0.31–0.47) for all patients. The early mortality for TOF and truncus arteriosus (TA) were 1.95% (1.31–2.90) and 10.67% (7.79–14.61). Pooled late mortality and reintervention rate were 0.59%/y (0.39–0.89), 1.41%/y (0.87–2.27), and 1.20%/y (0.74–1.94), 10.15%/y (7.42–13.90) for TOF and TA, respectively. Endocarditis rate was 0.21%/y (95% CI: 0.16–0.27) for a homograft substitute and 0.80%/y (95%CI: 0.60–1.09) for a xenograft substitute. Reintervention rate for infants, children and adults was 8.80%/y (95% CI: 6.49–11.95), 4.75%/y (95% CI: 3.67–6.14), and 0.72%/y (95% CI: 0.36–1.42), respectively.ConclusionThis study shows RVOT reconstruction with valve substitutes can be performed with acceptable mortality and morbidity rates for most patients. Reinterventions after RVOT reconstruction with valve substitutes are inevitable for most patients in their life-time, emphasizing the necessity of life-long follow-up and multidisciplinary care. Follow-up protocols should be tailored to individual patients because patients with different etiologies, ages, and implanted valve substitutes have different rates of mortality and morbidity.Systematic review registration[www.crd.york.ac.uk/prospero], identifier [CRD42021271622].
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- 2022
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3. Methylprednisolone Plasma Concentrations During Cardiac Surgery With Cardiopulmonary Bypass in Pediatric Patients
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Annewil van Saet, Gerdien A. Zeilmaker-Roest, Kevin M. Veen, Saskia N. de Wildt, Fritz Sorgel, Robert J. Stolker, Ad J. J. C. Bogers, and Dick Tibboel
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methyprednisolone ,pediatric ,cardiopulmonary bypass ,cardiac surgery ,in vivo ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Introduction: To our knowledge, methylprednisolone pharmacokinetics and plasma concentrations have not been comprehensively investigated in children with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass. It is unknown whether there is a significant influence of cardiopulmonary bypass on the plasma concentrations of methylprednisolone and whether this may be an explanation for the limited reported efficacy of steroid administration in cardiac surgery with cardiopulmonary bypass.Methods: The study was registered in the Dutch Trial Register (NTR3579; https://www.trialregister.nl/trial/3428). Methylprednisolone 30 mg/kg was administered as an intravenous bolus after induction of anesthesia. Methylprednisolone concentration was measured with liquid chromatography tandem mass spectrometry and analyzed using linear mixed-effects modeling.Results: Thirty-nine patients were included in the study, of which three were excluded. There was an acute decrease in observed methylprednisolone plasma concentration on initiation of cardiopulmonary bypass (median = 26.8%, range = 13.9–48.14%, p < 0.001). We found a lower intercept (p = 0.02), as well as a less steep slope of the model predicted methylprednisolone concentration vs. time curve for neonates (p = 0.048). A lower intercept (p = 0.01) and a less steep slope (p = 0.0024) if the volume of cell saver blood processed was larger than 91 ml/kg were also found.Discussion: We report similar methylprednisolone plasma concentrations as earlier studies performed in children undergoing cardiopulmonary bypass, and we confirmed the large interindividual variability in achieved methylprednisolone plasma concentrations with weight-based methylprednisolone administration. A larger volume of distribution and a lower clearance of methylprednisolone for neonates were suggested. The half-life of methylprednisolone in our study was calculated to be longer than 6 h for neonates, 4.7 h for infants, 3.6 h for preschool children and 4.7 h for school children. The possible influence of treatment of pulmonary hypertension with sildenafil and temperature needs to be investigated further.
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- 2021
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4. Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome
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Stefano Mastrobuoni, Pascal J. Govers, Kevin M. Veen, Jama Jahanyar, Silke van Saane, Antonio Segreto, Luca Zanella, Laurent de Kerchove, Johanna J. M. Takkenberg, and Bardia Arabkhani
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SDG 3 - Good Health and Well-being ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Background: Current guidelines recommend valve-sparing aortic root replacement (VSRR) procedures over valve replacement for the treatment of root aneurysm. The reimplantation technique seems to be the most widely used valve-sparing technique, with excellent outcomes in mostly single-center studies. The aim of this systematic review and meta-analysis is to present a comprehensive overview of clinical outcomes after VSRR with the reimplantation technique, and potential differences for bicuspid aortic valve (BAV) phenotype. Methods: We conducted a systematic literature search of papers reporting outcomes after VSRR that were published since 2010. Studies solely reporting on acute aortic syndromes or congenital patients were excluded. Baseline characteristics were summarized using sample size weighting. Late outcomes were pooled using inverse variance weighting. Pooled Kaplan-Meier (KM) curves for time-to-event outcomes were generated. Further, a microsimulation model was developed to estimate life expectancy and risks of valve-related morbidity after surgery. Results: Forty-four studies, with 7,878 patients, matched the inclusion criteria and were included for analysis. Mean age at operation was 50 years and almost 80% of patients were male. Pooled early mortality was 1.6% and the most common perioperative complication was chest re-exploration for bleeding (5.4%). Mean follow-up was 4.8±2.8 years. Linearized occurrence rates for aortic valve (AV) related complications such as endocarditis and stroke were below 0.3% patient-year. Overall survival was 99% and 89% at 1 and 10-year respectively. Freedom from reoperation was 99% and 91% after 1 and 10 years, respectively, with no difference between tricuspid and BAVs. Conclusions: This systematic review and meta-analysis shows excellent short and long-term results of valve-sparing root replacement with the reimplantation technique in terms of survival, freedom from reoperation, and valve related complications with no difference between tricuspid and BAVs.
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- 2023
5. Mechanical Device Malfunction of the HeartMate II Versus the HeartMate 3 Left Ventricular Assist Device
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Cornelis W. van der Heiden, Casper F. Zijderhand, Kevin M. Veen, Alina A. Constantinescu, Olivier C. Manintveld, Jasper J. Brugts, Jos A. Bekkers, Ozcan Birim, Ad J. J. C. Bogers, Kadir Caliskan, Cardiothoracic Surgery, and Cardiology
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Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Abstract
Mechanical device malfunction remains a known issue in left ventricular assist devices (LVADs). We investigated the incidence of mechanical device malfunction in the HeartMate II and HeartMate 3 LVADs. We conducted a retrospective study of all HeartMate II and HeartMate 3 LVADs implanted in our center. We evaluated major malfunction, potential major malfunction, minor malfunction, and need of device exchange. In total, 163 patients received an LVAD; in 63 (39%) a HeartMate II, and in 100 (61%) a HeartMate 3, median support time of respectively 24.6 months (interquartile range [IQR]: 32.4) and 21.1 months [IQR: 27.2]. Mechanical device malfunction, consisting of both major and potential major malfunction, occurred significantly less in the HeartMate 3 patients with a hazard ratio (HR) of 0.37 (95% confidence interval [CI]: 0.15-0.87, p = 0.022). Major malfunction alone occurred significantly less in HeartMate 3 patients with a HR of 0.18 (95% CI: 0.05-0.66, p = 0.009). HeartMate 3 patients had a significantly decreased hazard of a pump or outflow graft exchange (HR 0.13, 95% CI: 0.08-0.81, p = 0.008). System controller defects occurred significantly less in HM 3 patients (p = 0.007), but battery-clips defects occurred significantly more in HM 3 patients (p = 0.039). Major device malfunction including pump or outflow graft exchange occurred significantly less in HeartMate 3 compared to HeartMate II, while minor malfunctions were similar. Periodical assessment of the technical integrity of the device remains necessary during long-term LVAD support.
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- 2023
6. Optimal temperature management in aortic arch surgery: A systematic review and network meta‐analysis
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Djamila Abjigitova, Maximiliaan L. Notenboom, Kevin M. Veen, Gabriëlle van Tussenbroek, Jos A. Bekkers, Mostafa M. Mokhles, and Ad J. J. C. Bogers
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Pulmonary and Respiratory Medicine ,Aortic Aneurysm, Thoracic ,Network Meta-Analysis ,Temperature ,Aorta, Thoracic ,Stroke ,Perfusion ,Circulatory Arrest, Deep Hypothermia Induced ,Treatment Outcome ,Cerebrovascular Circulation ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
Objectives: New temperature management concepts of moderate and mild hypothermic circulatory arrest during aortic arch surgery have gained weight over profound cooling. Comparisons of all temperature levels have rarely been performed. We performed direct and indirect comparisons of deep hypothermic circulatory arrest (DHCA) (≤20°C), moderate hypothermic circulatory arrest (MHCA) (20.1–25°C), and mild hypothermic circulatory arrest (mild HCA) (≥25.1°C) in a network meta-analysis. Methods: The literature was systematically searched for all papers published through February 2022 reporting on clinical outcomes after aortic arch surgery utilizing DHCA, MHCA and mild HCA. The primary outcome was operative mortality. The secondary outcomes were postoperative stroke and acute kidney failure (AKI). Results: A total of 34 studies were included, with a total of 12,370 patients. DHCA was associated with significantly higher postoperative incidence of stroke when compared with MHCA (odds ratio [OR], 1.46, 95% confidence interval [CI], 1.19–1.78) and mild HCA: (OR, 1.50, 95% CI, 1.14–1.98). Furthermore, DHCA and MHCA were associated with higher operative mortality when compared with mild HCA (OR 1.71, 95% CI, 1.23–2.39 and OR 1.50, 95% CI, 1.12–2.00, respectively). Separate analysis of randomized and propensity score matched studies showed sustained increased risk of stroke with DHCA in contrast to MHCA and mild HCA (OR, 1.61, 95% CI, 1.18–2.20, p value =.0029 and OR, 1.74, 95% CI, 1.09–2.77, p value =.019). Conclusions: In the included studies, the moderate to mild hypothermia strategies were associated with decreased operative mortality and the risk of postoperative stroke. Large-scale prospective studies are warranted to further explore appropriate temperature management for the treatment of aortic arch pathologies.
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- 2022
7. Prognostic value of brain natriuretic peptides in patients with pulmonary arterial hypertension
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Paul M. Hendriks, Liza D. van de Groep, Kevin M. Veen, Mitch C.J. van Thor, Sabrina Meertens, Eric Boersma, Karin A. Boomars, Marco C. Post, and Annemien E. van den Bosch
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Pulmonary Arterial Hypertension ,Natriuretic Peptide, Brain ,Brain ,Humans ,Middle Aged ,Cardiology and Cardiovascular Medicine ,Prognosis ,Biomarkers ,Peptide Fragments ,Aged ,Proportional Hazards Models - Abstract
Background: Multiple biomarkers have been investigated in the risk stratification of patients with pulmonary arterial hypertension (PAH). This systematic review and meta-analysis is the first to investigate the prognostic value of (NT-pro)BNP in patients with PAH. Methods: A systematic literature search was performed using MEDLINE, Embase, Web of Science, the Cochrane Library and Google scholar to identify studies on the prognostic value of baseline (NT-pro)BNP levels in PAH. Studies reporting hazard ratios (HR) for the endpoints mortality or lung transplant were included. A random effects meta-analysis was performed to calculate the pooled HR of (NT-pro)BNP levels at the time of diagnosis. To account for different transformations applied to (NT-pro)BNP, the HR was calculated for a 2-fold difference of the weighted mean (NT-pro)BNP level of 247 pmol/L, for studies reporting a HR based on a continuous (NT-pro)BNP measurement. Results: Sixteen studies were included, representing 6999 patients (mean age 45.2-65.0 years, 97.3% PAH). Overall, 1460 patients reached the endpoint during a mean follow-up period between 1 and 10 years. Nine studies reported HRs based on cut-off values. The risk of mortality or lung transplant was increased for both elevated NT-proBNP and BNP with a pooled HR based on unadjusted HRs of 2.75 (95%-CI: 1.86-4.07) and 3.87 (95% CI 2.69-5.57) respectively. Six studies reported HRs for (NT-pro)BNP on a continues scale. A 2-fold difference of the weighted mean NT-proBNP resulted in an increased risk of mortality or lung transplant with a pooled HR of 1.17 (95%-CI: 1.03-1.32). Conclusions: Increased levels of (NT-pro)BNP are associated with a significantly increased risk of mortality or lung transplant in PAH patients.
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- 2022
8. Optimized Preoperative Planning of Double Outlet Right Ventricle Patients by 3D Printing and Virtual Reality
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Jette J Peek, Wouter Bakhuis, Amir H Sadeghi, Kevin M Veen, Arno A W Roest, Nico Bruining, Theo van Walsum, Mark G Hazekamp, and Ad J J C Bogers
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OBJECTIVES In complex double outlet right ventricle (DORV) patients, the optimal surgical approach may be difficult to assess based on conventional two-dimensional (2D) ultrasound (US) and computed tomography (CT) imaging. The aim of this study is to assess the added value of 3D printed and 3D Virtual Reality (VR) models of the heart used for surgical planning in DORV patients, supplementary to the gold standard 2D imaging modalities. METHODS Five patients with different DORV-subtypes and high-quality CT scans were selected retrospectively. 3D prints and 3D-VR models were created. Twelve congenital cardiac surgeons and paediatric cardiologists, from three different hospitals, were shown 2D-CT first, after which they assessed the 3D print and 3D-VR models in random order. After each imaging method, a questionnaire was filled in on the visibility of essential structures and the surgical plan. RESULTS Spatial relationships were generally better visualized using 3D methods (3D printing/3D-VR) than in 2D. The feasibility of VSD patch closure could be determined best using 3D-VR reconstructions (3D-VR 92%, 3D print 66%, and US/CT 46%, P CONCLUSIONS This study shows that both 3D printing and 3D-VR have additional value for cardiac surgeons and cardiologists over 2D imaging, because of better visualization of spatial relationships. As a result, the proposed surgical plans based on the 3D visualizations matched the actual performed surgery to a greater extent.
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- 2023
9. Rate of thromboembolic and bleeding events in patients undergoing concomitant aortic valve surgery with left ventricular assist device implantation
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Kevin M Veen, Yunus C. Yalcin, Christiaan F J Antonides, Finn Gustafsson, Rahatullah Muslem, Jasper J. Brugts, Jos A. Bekkers, Jesse F. Veenis, Ad J.J.C. Bogers, Ryan J. Tedford, Kadir Caliskan, Cardiothoracic Surgery, and Cardiology
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Aortic valve ,Male ,medicine.medical_specialty ,Aortic insufficiency ,medicine.medical_treatment ,Aortic Valve Insufficiency ,Left ventricular assist device ,Regurgitation (circulation) ,Independent predictor ,Thromboembolism ,medicine ,Humans ,In patient ,Mechanical circulatory support, aortic regurgitation ,Retrospective Studies ,Heart Failure ,business.industry ,Proportional hazards model ,Thromboembolic event ,Bleeding ,Middle Aged ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Ventricular assist device ,Concomitant ,Aortic Valve ,Aortic valve surgery ,Female ,Heart-Assist Devices ,business ,Cardiology and Cardiovascular Medicine - Abstract
Background: Significant aortic regurgitation at the time of left ventricular assist device (LVAD) implantation, requires concomitant aortic valve (AoV) replacement or repair. However, the impact of concomitant AoV surgery on morbidity remains unknown. Therefore, our aim is to determine the impact of concomitant AoV surgery on thromboembolic and bleeding events. Methods: A retrospective IMACS registry study, including patients implanted from 2013 until September 2017. Differences between different concomitant AoV surgery modalities were analyzed. Results: In total, 785 (5.1%) out of 15.267 patients (median age 58 IQR 49-66 years, 79% male) underwent concomitant AoV surgery (median age 63 IQR 54-69 years, 84% male); 386 (49%) patients received biological prostheses, 71 (9%) mechanical prostheses and 328 (42%) AoV repairs. In total, 54 (8%) patients with AoV surgery experienced a thromboembolic event and 1016 (9%) patients with no AoV surgery. Only AoV repair surgery was associated with an increased rate of pump thrombosis (p=0.024). Furthermore, concomitant AoV surgery was associated with an increased rate of all and nonsurgical bleedings. Following a multivariable Cox regression, concomitant AoV surgery remained an independent predictor for bleeding events. Conclusions: In LVAD patients undergoing concomitant AoV surgery, thromboembolic event rates were not higher, however both all and nonsurgical bleeding event rates were higher. Furthermore, concomitant AoV repair surgery was associated with an increased rate of pump thrombosis.
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- 2022
10. Elective Ascending Aortic Aneurysm Surgery in the Elderly
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Feyza Memis, Carlijn G. E. Thijssen, Arjen L. Gökalp, Maximiliaan L. Notenboom, Frederike Meccanici, Mohammad Mostafa Mokhles, Roland R. J. van Kimmenade, Kevin M. Veen, Guillaume S. C. Geuzebroek, Jelena Sjatskig, Franciscus J. ter Woorst, Jos A. Bekkers, Johanna J. M. Takkenberg, Jolien W. Roos-Hesselink, Cardiology, and Cardiothoracic Surgery
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aortic root ,All institutes and research themes of the Radboud University Medical Center ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,aortic surgery ,ascending aorta ,General Medicine ,aortic aneurysm ,elderly - Abstract
Contains fulltext : 291064.pdf (Publisher’s version ) (Open Access) BACKGROUND: No clear guidelines exist for performing preventive surgery for ascending aortic (AA) aneurysm in elderly patients. This study aims to provide insights by: (1) evaluating patient and procedural characteristics and (2) comparing early outcomes and long-term mortality after surgery between elderly and non-elderly patients. METHODS: A multicenter retrospective observational cohort-study was performed. Data was collected on patients who underwent elective AA surgery in three institutions (2006-2017). Clinical presentation, outcomes, and mortality were compared between elderly (≥70 years) and non-elderly patients. RESULTS: In total, 724 non-elderly and 231 elderly patients were operated upon. Elderly patients had larger aortic diameters (57.0 mm (IQR 53-63) vs. 53.0 mm (IQR 49-58), p < 0.001) and more cardiovascular risk factors at the time of surgery than non-elderly patients. Elderly females had significantly larger aortic diameters than elderly males (59.5 mm (55-65) vs. 56.0 mm (51-60), p < 0.001). Short-term mortality was comparable between elderly and non-elderly patients (3.0% vs. 1.5%, p = 0.16). Five-year survival was 93.9% in non-elderly patients and 81.4% in elderly patients (p < 0.001), which are both lower than that of the age-matched general Dutch population. CONCLUSION: This study showed that in elderly patients, a higher threshold exists to undergo surgery, especially in elderly females. Despite these differences, short-term outcomes were comparable between 'relatively healthy' elderly and non-elderly patients.
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- 2023
11. An external validation of a novel predictive algorithm for male nipple areolar positioning : an improvement to current practice through a multicenter endeavor
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Mark-Bram Bouman, Sterre E Mokken, Kevin M Veen, Stanislas Monstrey, Marlon E. Buncamper, Floyd W Timmermans, Timotheus C van de Grift, Margriet G Mullender, Laure Ruyssinck, Karel E.Y. Claes, Cardiothoracic Surgery, Plastic, Reconstructive and Hand Surgery, AMS - Rehabilitation & Development, AMS - Tissue Function & Regeneration, APH - Quality of Care, APH - Methodology, Other Research, and Psychiatry
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TRANSGENDER ,anthropometry ,COMPLEX ,business.industry ,SURGERY ,External validation ,Anthropometry ,gender surgery ,Current practice ,transgender individual ,Cohort ,Transgender ,morphology ,MASTECTOMY ,Medicine and Health Sciences ,TO-MALE TRANSSEXUALS ,Medicine ,Surgery ,nipple reconstruction ,Chest surgery ,business ,Algorithm ,Validation cohort ,Male nipple - Abstract
The correct positioning of nipple-areolar complexes (NAC) during gender-affirming mastectomies remains a particular challenge. Recently, a Dutch two-step algorithm was proposed predicting the most ideal NAC-position derived from a large cisgender male cohort. We aimed to externally validate this algorithm in a Belgian cohort. The Belgian validation cohort consisted of cisgender men. Based on patient-specific anthropometry, the algorithm predicts nipple-nipple distance (NN) and sternal-notch-to-nipple distance (SNN). Predictions were externally validated using the performance measures: R2-value, means squared error (MSE) and mean absolute percentage error (MAPE). Additionally, data were collected from a Belgian and Dutch cohort of transgender men having undergone mastectomy with free nipple grafts. The observed and predicted NN and SNN were compared and the inter-center variability was assessed. A total of 51 Belgian cisgender and 25 transgender men were included, as well as 150 Dutch cisgender and 96 transgender men. Respectively, the performance measures (R2-value, MSE and MAPE) for NN were 0.315, 2.35 (95%CI:0–6.9), 4.9% (95%CI:3.8–6.1) and 0.423, 1.51 (95%CI:0–4.02), 4.73%(95%CI:3.7–5.7) for SNN. When applying the algorithm to both transgender cohorts, the predicted SNN was larger in both Dutch (17.1measured(±1.7) vs. 18.7predicted(±1.4), p= measured(±1.8) vs. 18.4predicted(±1.5), p= measured(±2.6) vs. 21.2predicted(±1.6), p = 0.025) and too short in the Dutch cohort (19.8measured(±1.8) vs. 20.7predicted(±1.9), p = 0.001). Both models performed well in external validation. This indicates that this two-step algorithm provides a reproducible and accurate clinical tool in determining the most ideal patient-tailored NAC-position in transgender men seeking gender-affirming chest surgery.
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- 2023
12. Statistical primer: an introduction to the application of linear mixed-effects models in cardiothoracic surgery outcomes research-a case study using homograft pulmonary valve replacement data
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Xu Wang, Eleni-Rosalina Andrinopoulou, Kevin M Veen, Ad J J C Bogers, Johanna J M Takkenberg, Cardiothoracic Surgery, Epidemiology, and Department of Business-Society Management
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Pulmonary and Respiratory Medicine ,Pulmonary Valve ,Outcome Assessment, Health Care ,Linear Models ,Humans ,Surgery ,General Medicine ,Allografts ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
Summary OBJECTIVES The emergence of big cardio-thoracic surgery datasets that include not only short-term and long-term discrete outcomes but also repeated measurements over time offers the opportunity to apply more advanced modelling of outcomes. This article presents a detailed introduction to developing and interpreting linear mixed-effects models for repeated measurements in the setting of cardiothoracic surgery outcomes research. METHODS A retrospective dataset containing serial echocardiographic measurements in patients undergoing surgical pulmonary valve replacement from 1986 to 2017 in Erasmus MC was used to illustrate the steps of developing a linear mixed-effects model for clinician researchers. RESULTS Essential aspects of constructing the model are illustrated with the dataset including theories of linear mixed-effects models, missing values, collinearity, interaction, nonlinearity, model specification, results interpretation and assumptions evaluation. A comparison between linear regression models and linear mixed-effects models is done to elaborate on the strengths of linear mixed-effects models. An R script is provided for the implementation of the linear mixed-effects model. CONCLUSIONS Linear mixed-effects models can provide evolutional details of repeated measurements and give more valid estimates compared to linear regression models in the setting of cardio-thoracic surgery outcomes research.
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- 2022
13. The European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery: third report
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Theo M M H de By, Felix Schoenrath, Kevin M Veen, Paul Mohacsi, Julia Stein, Khalid M M Alkhamees, Kyriakos Anastasiadis, Alexander Berhnardt, Friedhelm Beyersdorf, Kadir Caliskan, David Reineke, Kevin Damman, Arnt Fiane, Angeliki Gkouziouta, Can Gollmann-Tepeköylü, Finn Gustafsson, Michal Hulman, Attilio Iacovoni, Antonio Loforte, Bela Merkely, Francesco Musumeci, Petr Němec, Ivan Netuka, Mustafa Özbaran, Evgenij Potapov, Yuri Pya, Gregorio Rábago, Faiz Ramjankhan, Hermann Reichenspurner, Diyar Saeed, Elena Sandoval, Bernard Stockman, Marc Vanderheyden, Laurens Tops, Thorsten Wahlers, Michael Zembala, Daniel Zimpfer, Thierry Carrel, Jan Gummert, Bart Meyns, Cardiovascular Centre (CVC), Cardiothoracic Surgery, and Cardiology
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Adult ,Heart Failure ,Pulmonary and Respiratory Medicine ,Registry ,OUTCOMES ,SOCIETY ,Thoracic Surgery ,CUMULATIVE INCIDENCE ,General Medicine ,End-stage heart failure ,Thoracic Surgical Procedures ,EVENTS ,Treatment Outcome ,Mechanical circulatory support ,VENTRICULAR ASSIST DEVICE ,Humans ,Surgery ,Heart-Assist Devices ,Registries ,610 Medicine & health ,Cardiology and Cardiovascular Medicine - Abstract
OBJECTIVES In the third report of the European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery, outcomes of patients receiving mechanical circulatory support are reviewed in relation to implant era. METHODS Procedures in adult patients (January 2011-June 2020) were included. Patients from centres with 3 months). Risk factors for death were explored using univariable Cox regression with a stepwise time-varying hazard ratio (3 months). RESULTS In total, 4834 procedures in 4486 individual patients (72 hospitals) were included, with a median follow-up of 1.1 (interquartile range: 0.3-2.6) years. The annual number of implants (range: 346-600) did not significantly change (P = 0.41). Both Interagency Registry for Mechanically Assisted Circulatory Support class (classes 4-7: 23, 25 and 33%; P < 0.001) and in-hospital deaths (18.5, 17.2 and 11.2; P < 0.001) decreased significantly between eras. Overall, mortality, transplants and the probability of weaning were 55, 25 and 2% at 5 years after the implant, respectively. Major infections were mainly noted early after the implant occurred (AER(3 months): 0.45). Bilirubin and creatinine levels were significant risk factors in the early phase but not in the late phase after the implant. CONCLUSIONS In its 10 years of existence, EUROMACS has become a point of reference enabling benchmarking and outcome monitoring. Patient characteristics and outcomes changed between implant eras. In addition, both occurrence of outcomes and risk factor weights are time dependent. As a registry of the European Association for Cardio-Thoracic Surgery, the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) offers a robust repository of clinical data on long-term mechanical circulatory support (MCS) from a large international community., European Association for Cardio-Thoracic Surgery (EACTS), This work was funded and supported by European Association for Cardio-Thoracic Surgery (EACTS).
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- 2022
14. Normothermic Ex Situ Heart Perfusion With the Organ Care System for Cardiac Transplantation: A Meta-analysis
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Sanne J.J. Langmuur, Jorik H. Amesz, Kevin M. Veen, Ad J.J.C. Bogers, Olivier C. Manintveld, and Yannick J.H.J. Taverne
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Adult ,Perfusion ,Transplantation ,Brain Death ,Tissue and Organ Procurement ,Heart Transplantation ,Humans ,Heart ,Organ Preservation ,Tissue Donors - Abstract
Background. Heart transplantation (HTx) is, at present, the most effective therapy for end-stage heart failure patients; however, the number of patients on the waiting list is rising globally, further increasing the gap between demand and supply of donors for HTx. First studies using the Organ Care System (OCS) for normothermic machine perfusion show promising results yet are limited in sample size. This article presents a meta-analysis of heart donation either after brain death (OCS-DBD) or circulatory death (OCS-DCD) on using OCS versus static cold storage used for HTx. Methods. A systematic literature search was performed for articles discussing the use of normothermic ex situ heart perfusion in adult patients. Thirty-day survival outcomes were pooled, and odds ratios were calculated using random-effects models. Long-term survival was visualized with Kaplan-Meier curves, hazard ratios were calculated and pooled using fixed-effects models, and secondary outcomes were analyzed. Results. A total of 12 studies were included, with 741 patients undergoing HTx, of which 260 with the OCS (173 DBD and 87 DCD). No differences were found between the 3 groups for early and late survival outcomes or for secondary outcomes. Conclusions. OCS outcomes, for both DBD and DCD hearts, appeared similar as for static cold storage. Therefore, OCS is a safe and effective technique to enlarge the cardiac donor pool in both DBD and DCD, with additional benefits for long-distance transport and surgically complex procedures.
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- 2022
15. Relapsing low-flow alarms due to suboptimal alignment of the left ventricular assist device inflow cannula
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Casper F Zijderhand, Wiebe G Knol, Ricardo P J Budde, Cornelis W van der Heiden, Kevin M Veen, Jelena Sjatskig, Olivier C Manintveld, Alina A Constantinescu, Ozcan Birim, Jos A Bekkers, Ad J J C Bogers, Kadir Caliskan, Cardiothoracic Surgery, Radiology & Nuclear Medicine, and Cardiology
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Heart Failure ,Pulmonary and Respiratory Medicine ,Male ,Heart Ventricles ,General Medicine ,Middle Aged ,Quality of Life ,Cannula ,Humans ,Surgery ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,Tomography, X-Ray Computed ,Retrospective Studies - Abstract
OBJECTIVES This retrospective study investigated the correlation between the angular position of the left ventricular assist device (LVAD) inflow cannula and relapsing low-flow alarms. METHODS Medical charts were reviewed of all patients with HeartMate 3 LVAD support for relapsing low-flow alarms. A standardized protocol was created to measure the angular position with a contrast-enhanced computed tomography scan. Statistics were done using a gamma frailty model with a constant rate function. RESULTS For this analysis, 48 LVAD-supported patients were included. The majority of the patients were male (79%) with a median age of 57 years and a median follow-up of 30 months (interquartile range: 19–41). Low-flow alarm(s) were experienced in 30 (63%) patients. Angulation towards the septal–lateral plane showed a significant increase in low-flow alarms over time with a constant rate function of 0.031 increase in low-flow alarms per month of follow-up per increasing degree of angulation (P = 0.048). When dividing this group using an optimal cut-off point, a significant increase in low-flow alarms was observed when the septal–lateral angulation was 28° or more (P = 0.001). Anterior–posterior and maximal inflow cannula angulation did not show a significant difference. CONCLUSIONS This study showed an increasing number of low-flow alarms when the degrees of LVAD inflow cannula expand towards the septal–lateral plane. This emphasizes the importance of the LVAD inflow cannula angular position to prevent relapsing low-flow alarms with the risk of diminished quality of life and morbidity.
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- 2022
16. Left ventricular assist device-related infections and the risk of cerebrovascular accidents: a EUROMACS study
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Casper F Zijderhand, Christiaan F J Antonides, Kevin M Veen, Nelianne J Verkaik, Felix Schoenrath, Jan Gummert, Petr Nemec, Béla Merkely, Francesco Musumeci, Bart Meyns, Theo M M H de By, Ad J J C Bogers, Kadir Caliskan, Cardiothoracic Surgery, Cardiology, and Medical Microbiology & Infectious Diseases
- Subjects
Pulmonary and Respiratory Medicine ,Male ,Cardiac & Cardiovascular Systems ,Respiratory System ,COAGULATION ,Heart failure ,Left ventricular assist device ,EVENTS ,HEMORRHAGIC STROKE ,INFLAMMATION ,SUPPORT ,Humans ,Registries ,Retrospective Studies ,Heart Failure ,Thromboembolic events ,Science & Technology ,Anticoagulants ,General Medicine ,PREVALENCE ,Anti-Bacterial Agents ,EUROPEAN REGISTRY ,Stroke ,Cerebrovascular accidents ,Treatment Outcome ,ATRIAL-FIBRILLATION ,Cardiovascular System & Cardiology ,VON-WILLEBRAND SYNDROME ,SURVIVAL ,Surgery ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,Infection ,Life Sciences & Biomedicine - Abstract
OBJECTIVES In patients supported by a durable left ventricular assist device (LVAD), infections are a frequently reported adverse event with increased morbidity and mortality. The purpose of this study was to investigate the possible association between infections and thromboembolic events, most notable cerebrovascular accidents (CVAs), in LVAD patients. METHODS An analysis of the multicentre European Registry for Patients Assisted with Mechanical Circulatory Support was performed. Infections were categorized as VAD-specific infections, VAD-related infections and non-VAD-related infections. An extended Kaplan–Meier analysis for the risk of CVA with infection as a time-dependent covariate and a multivariable Cox proportional hazard model were performed. RESULTS For this analysis, 3282 patients with an LVAD were included with the majority of patients being male (83.1%). During follow-up, 1262 patients suffered from infection, and 457 patients had a CVA. Cox regression analysis with first infection as time-dependent covariate revealed a hazard ratio (HR) for CVA of 1.90 [95% confidence interval (CI): 1.55–2.33; P CONCLUSIONS Infection during LVAD support is associated with an increased risk of developing an ischaemic or haemorrhagic CVA, particularly in the setting of VAD-related or VAD-specific infections. This suggests the need of a stringent anticoagulation management and adequate antibiotic treatment during an infection in LVAD-supported patients.
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- 2022
17. The ideal location of the male nipple-areolar complex: A pinpointing algorithm
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M.-B. Bouman, S. E. Mokken, Margriet G. Mullender, F. W. Timmermans, Kevin M Veen, B. A.M. Jansen, T. C. van de Grift, M. H. de Heer, Adult Psychiatry, Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, APH - Methodology, Other Research, AMS - Rehabilitation & Development, AMS - Tissue Function & Regeneration, APH - Quality of Care, Psychiatry, APH - Mental Health, APH - Health Behaviors & Chronic Diseases, and Cardiothoracic Surgery
- Subjects
anthropometry ,Health (social science) ,business.industry ,Health Policy ,medicine.medical_treatment ,Linear model ,Medicine (miscellaneous) ,gender-affirming surgery ,Anthropometry ,Chest circumference ,chest wall ,Subset regression ,Gender Studies ,SDG 3 - Good Health and Well-being ,Medicine ,transgender persons ,Internal validation ,business ,nipples ,Subcutaneous Mastectomy ,Algorithm ,Mastectomy ,Male nipple - Abstract
Background: In the treatment of gender dysphoria, appropriate nipple-areola complex (NAC) positioning is essential for achieving a natural appearing male chest after subcutaneous mastectomy. An accurate predictive model for the ideal personalized position of the NAC is still lacking. The aim of this study is to determine the anthropometry of the male chest to create individualized guidelines for appropriate NAC positioning in the preoperative setting. Materials and methods: Cisgender male participants were recruited. Multiple chest measurements were manually recorded. Best subset regression using linear models was used to select predictors for the horizontal coordinate (nipple-nipple distance; NN) and vertical coordinate (sternal notch-nipple distance; SNN) of the NAC. Internal validation was assessed using bootstrapping. Furthermore, a cohort of transgender men who had received a mastectomy with replantation of nipples according to current practice was identified. Comparison testing between the algorithm and standard practice was performed to test the limitations of standard practice. Results: One hundred and fifty cis male participants were included (median age: 26, IQR: 22-34 years). Four predictors were found to predict NN (age, weight, chest circumference (CC), anterior-axillar fold to anterior-axillar fold (AUX-AUX)) and reads as follows: NN = 4.11 + 0.035*age + 0.041*weight + 0.093*CC + 0.140*AUX-AUX Two predictors were found to predict SNN (NN and weight), and reads as follows: SNN = 7.248 + 0.303*NN + 0.072*weight. Both models performed well (Bootstrapped R2: 0.63 (NN), 0.50 (SNN)) and outperformed previous models predicting NAC position. Ninety-six transgender men were eligible for evaluation of current practice and showed an average placement error of −0.9 cm for NN and +2.2 cm for SNN. Conclusion: The non-standardized approach of NAC repositioning results in a significant error of nipple placement. We suggest that the two predictive models for NN and SNN can be used to optimize NAC positioning on the masculinized chest wall. Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1884926.
- Published
- 2021
18. Clinical impact and 'natural' course of uncorrected tricuspid regurgitation after implantation of a left ventricular assist device: an analysis of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS)
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Ad J.J.C. Bogers, Theo M M H de By, Kadir Caliskan, Paul Mohacsi, Euromacs Investigators, M. Mostafa Mokhles, Ivan Netuka, Felix Schoenrath, Osama Ibrahim Ibrahim Soliman, Johanna J.M. Takkenberg, Lech Paluszkiewicz, Kevin M Veen, Cardiothoracic Surgery, and Cardiology
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Left ventricular assist device ,Tricuspid regurgitation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Tricuspid Valve Insufficiency ,Internal medicine ,medicine ,Humans ,Registries ,Eacts/118 ,Mortality ,Retrospective Studies ,Natural course ,Heart Failure ,Tricuspid valve ,AcademicSubjects/MED00920 ,business.industry ,Eacts/173 ,Hazard ratio ,Transplantation and Mechanical Circulatory Support ,General Medicine ,Middle Aged ,equipment and supplies ,medicine.disease ,Pulmonary hypertension ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Ventricular assist device ,Concomitant ,Circulatory system ,Cardiology ,Surgery ,Heart-Assist Devices ,Elevated right atrial pressure ,Cardiology and Cardiovascular Medicine ,business ,Eacts/125 - Abstract
OBJECTIVES Data on the impact and course of uncorrected tricuspid regurgitation (TR) during left ventricular assist device (LVAD) implantation are scarce and inconsistent. This study explores the clinical impact and natural course of uncorrected TR in patients after LVAD implantation. METHODS The European Registry for Patients with Mechanical Circulatory Support was used to identify adult patients with LVAD implants without concomitant tricuspid valve surgery. A mediation model was developed to assess the association of TR with 30-day mortality via other risk factors. Generalized mixed models were used to model the course of post-LVAD TR. Joint models were used to perform sensitivity analyses. RESULTS A total of 2496 procedures were included (median age: 56 years; men: 83%). TR was not directly associated with higher 30-day mortality, but mediation analyses suggested an indirect association via preoperative elevated right atrial pressure and creatinine (P = 0.035) and bilirubin (P = 0.027) levels. Post-LVAD TR was also associated with increased late mortality [hazard ratio 1.16 (1.06–1.3); P = 0.001]. On average, uncorrected TR diminished after LVAD implantation. The probability of having moderate-to-severe TR immediately after an implant in patients with none-to-mild TR pre-LVAD was 10%; in patients with moderate-to-severe TR pre-LVAD, it was 35% and continued to decrease in patients with moderate-to-severe TR pre-LVAD, regardless of pre-LVAD right ventricular failure or pulmonary hypertension. CONCLUSIONS Uncorrected TR pre-LVAD and post-LVAD is associated with increased early and late mortality. Nevertheless, on average, TR diminishes progressively without intervention after an LVAD implant. Therefore, these data suggest that patient selection for concomitant tricuspid valve surgery should not be based solely on TR grade.
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- 2021
19. Impact of Continuous Flow Left Ventricular Assist Device Therapy on Chronic Kidney Disease: A Longitudinal Multicenter Study
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Steven Hsu, Osama Ibrahim Ibrahim Soliman, Alina A. Constantinescu, Olivier C. Manintveld, Rahatullah Muslem, Marat Fudim, Stuart D. Russell, Brett Tomashitis, Dennis A. Hesselink, Kevin M Veen, Brian A. Houston, Jasper J. Brugts, Ad J.J.C. Bogers, Ryan J. Tedford, Kadir Caliskan, Yunus C. Yalcin, Cardiothoracic Surgery, Cardiology, and Internal Medicine
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Renal function ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Renal Insufficiency, Chronic ,Stage (cooking) ,Retrospective Studies ,Heart Failure ,Creatinine ,business.industry ,Middle Aged ,medicine.disease ,Treatment Outcome ,chemistry ,Multicenter study ,Ventricular assist device ,Cardiology ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease ,Destination therapy ,Cohort study - Abstract
Background: Many patients undergoing durable left ventricular assist device (LVAD) implantation suffer from chronic kidney disease (CKD). Therefore, we investigated the effect of LVAD support on CKD. Methods: A retrospective multicenter cohort study, including all patients undergoing LVAD (HeartMate II (n = 330), HeartMate 3 (n = 22) and HeartWare (n = 48) implantation. In total, 227 (56.8%) patients were implanted as bridge-to-transplantation; 154 (38.5%) as destination therapy; and 19 (4.7%) as bridge-to-decision. Serum creatinine measurements were collected over a 2-year follow-up period. Patients were stratified based on CKD stage. Results: Overall, 400 patients (mean age 53 ± 14 years, 75% male) were included: 186 (46.5%) patients had CKD stage 1 or 2; 93 (23.3%) had CKD stage 3a; 82 (20.5%) had CKD stage 3b; and 39 (9.8%) had CKD stage 4 or 5 prior to LVAD implantation. During a median follow-up of 179 days (IQR 28–627), 32,629 creatinine measurements were available. Improvement of kidney function was noticed in every preoperative CKD-stage group. Following this improvement, estimated glomerular filtration rates regressed to baseline values for all CKD stages. Patients showing early renal function improvement were younger and in worse preoperative condition. Moreover, survival rates were higher in patients showing early improvement (69% vs 56%, log-rank P = 0. 013). Conclusions: Renal function following LVAD implantation is characterized by improvement, steady state and subsequent deterioration. Patients who showed early renal function improvement were in worse preoperative condition, however, and had higher survival rates at 2 years of follow-up.
- Published
- 2020
20. Outcomes after Tricuspid Valve Replacement for Carcinoid Heart Disease: A Multicenter Study*
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Sabrina Siregar, Ronald Meijer, Johanna J.M. Takkenberg, Einar A. Hart, Steven A. J. Chamuleau, Ad J.J.C. Bogers, Jerry Braun, M. Mostafa Mokhles, Wouter W. de Herder, Wim Jan van Boven, Kevin M Veen, Peter L. de Jong, Titus van den Heuvel, Frederiek de Heer, Cardiothoracic Surgery, and Internal Medicine
- Subjects
medicine.medical_specialty ,Multicenter study ,business.industry ,medicine.medical_treatment ,Tricuspid valve replacement ,medicine ,Carcinoid Heart Disease ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Prosthesis ,Surgery - Abstract
Background This study evaluates clinical and echocardiographic outcomes in patients who underwent tricuspid valve replacement (TVR) for carcinoid heart disease (CaHD) stratified to prosthesis type (biological vs mechanical). Methods All patients undergoing TVR for CaHD between 1991 and 2017 were analyzed retrospectively in four tertiary centers. Cox-proportional hazard models were used to analyze survival data and mixed-models for repeated measurements of echo and laboratory data. Results In total, 49 patients (median age: 59 [51–66], 45% male) underwent biological (n = 20, 41%) or mechanical (n = 29, 59%) TVR. Three (6%) patients died in-hospital and 3-year actuarial survival was 73.3 ± 8.7% (biological) and 56.1 ± 10.0% (mechanical) (P = 0.69). During a median follow-up of 17 months, two patients with a biological prosthesis required reoperation for structural valve deterioration, while one patient with mechanical prostheses had a reoperation due to valve thrombosis. No significant differences in bleeding, thrombosis, thromboembolism and heart failure admissions were noted between prosthesis types. Postoperative valve regurgitation increased more in patients with a biological prosthesis (p = 0.022). Maximum tricuspid inflow gradient was higher in patients with biological prostheses (p = 0.02); however, course over time was comparable between prosthesis types (p = 0.136). Conclusion Tricuspid valve surgery for CaHD can be performed with acceptable hospital mortality risk. This data shows no apparent benefit of biological valves over mechanical prosthesis or vice versa. Valve choice should be made in a multi-disciplinary team taking into account expected lifespan, planned treatment for the carcinoid syndrome and neuroendocrine tumor and patient preferences.
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- 2020
21. Echocardiographic and clinical outcome after mitral valve plasty with a minimal access or conventional sternotomy approach
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Lotte E. de Groot-de Laat, Marcel L. Geleijnse, Kevin M Veen, Wouter J. van Leeuwen, Jackie S. McGhie, Ad J.J.C. Bogers, Frans B S Oei, Cardiology, and Cardiothoracic Surgery
- Subjects
Male ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Tricuspid Valve Insufficiency ,Predictive Value of Tests ,Internal medicine ,Mitral valve annuloplasty ,Mitral valve ,medicine ,Humans ,cardiovascular diseases ,Ventricular remodeling ,Aged ,Heart Valve Prosthesis Implantation ,Mitral regurgitation ,Tricuspid valve ,Ventricular Remodeling ,business.industry ,Mitral valve replacement ,Mitral Valve Insufficiency ,Atrial Remodeling ,Recovery of Function ,General Medicine ,Middle Aged ,medicine.disease ,Sternotomy ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Echocardiography ,Concomitant ,Cardiology ,Mitral Valve ,Atrial Function, Left ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND: The aim of this study is to evaluate the effects of minimal access mitral valve surgery (MAMVS) versus conventional surgery with or without concomitant tricuspid valve plasty (TVP) in consecutive patients with mitral regurgitation (MR) on clinical and echocardiographic outcome. METHODS: One-hundred-and-twenty patients operated for MR (91 conventional and 29 MAMVS) were followed by echocardiography and quality of life assessment before and 6 months after surgery. RESULTS: Patients in the MAMVS group were younger, more often in NYHA functional class I-II and had lower NT-proBNP levels. Only four patients (all in the conventional group) underwent mitral valve replacement. There were no significant differences in complications between MAMVS and conventional surgery. At 6 months, comparable MR reduction and left ventricular remodeling data were seen, left atrial remodeling was most prominent in the MAMVS group, 71 [55-90] to 43 [35-58] versus 69 [53-89] to 49 [41-70] mL/m2 in the conventional group (P
- Published
- 2020
22. Long-Term Outcome of Implantable Cardioverter-Defibrillators Therapy in Noncompaction Cardiomyopathy Compared with Dilated and Hypertrophic Cardiomyopathy
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Emrah Kaya, Martijn Otten, Dominic A.M.J. Theuns, Kevin M. Veen, Sing-Chien Yap, Arend Schinkel, Alina Constantinescu, Michelle Michels, Olivier C. Manintveld, Tamas Szili-Torok, and Kadir Caliskan
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- 2022
23. VAD related infections and the risk of pump thrombosis and thromboembolic events: a EUROMACS study
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B Merkely, T M M H de By, Bart Meyns, Christiaan F J Antonides, P. Nemec, Ad J.J.C. Bogers, Jan Gummert, Felix Schoenrath, Kadir Caliskan, C. Zijderhand, Kevin M Veen, and Francesco Musumeci
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medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,Pump thrombosis ,business - Abstract
Background In patients supported by a ventricular assist device (VAD) major infections are a frequently reported adverse event with increased morbidity and mortality. Purpose The purpose of this study was to investigate the possible association between infections and cerebrovascular accidents (CVAs) in VAD patients. Methods An analysis of the European Registry for Patients Assisted with Mechanical Circulatory Support (EUROMACS) was performed identifying all patients aged ≥18 years with a LVAD or BiVAD implantation. Infections were categorized as VAD-specific infections, VAD-related infections and, non-VAD infections. An extended Kaplan-Meier analysis for the risk of CVA and mortality with infection as a time-dependent covariate was performed. Furthermore, a multivariable Cox proportional hazard model was performed including 24 variables. Results For this analysis 3784 patients were included, with 45 patients being supported by a BiVAD and 3739 by an LVAD. The majority of patients were male (83.2%) and 60.5% had an INTERMACS patient profile 2 or 3. During follow-up, 3108 major infections were identified in 1385 (36.6%) of the patients, while 673 CVAs were identified in 545 (14.4%) of the patients. Extended Kaplan-Meier analysis with first infection as time-dependent covariate revealed a hazard ratio (HR) for CVA of 1.95 (95% CI: 1.57–2.36; p Conclusion Both VAD-related and VAD-specific infections are associated with a significantly increased risk of CVA with increased risk of mortality. Funding Acknowledgement Type of funding sources: None. KM freedom of CVA and infection
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- 2021
24. Initial clinical experience with minimally invasive surgical aortic valve replacement
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Djamila Abjigitova, Kevin M Veen, M. Mostafa Mokhles, Jos A. Bekkers, Ad J.J.C. Bogers, Frans B S Oei, and Cardiothoracic Surgery
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Male ,Aortic valve ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Humans ,Minimally Invasive Surgical Procedures ,Medicine ,Myocardial infarction ,Propensity Score ,Aged ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Mechanical ventilation ,business.industry ,General Medicine ,Perioperative ,Middle Aged ,medicine.disease ,Sternotomy ,Mediastinitis ,Surgery ,Cardiac surgery ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Aortic Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Packed red blood cells ,Follow-Up Studies - Abstract
BaCKground: The ministernotomy approach is increasingly used in aortic valve surgery. however, the advantages are still a matter of discussion. The aim of this study was to compare the postoperative outcome in patients undergoing elective aortic valve operation, either through mini-sternotomy or conventional sternotomy. MeThods: We included 317 patients who were treated for their aortic valve, 63 patients underwent a minimally invasive aortic valve replacement (mini-avr) and 254 patients underwent a full-sternotomy avr. Patients with endocarditis, those who underwent previous cardiac surgery and those who required a concomitant procedure were excluded from the analysis. The method of matching weights according to propensity score was used to adjust for differences between the two treatment groups, and outcomes were compared. RESULTS: The mediastinal drainage was significantly lower at 6, 24 hours and total after mini-AVR procedure than after full-sternotomy AVR (median: 373 vs. 499 ml, P
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- 2021
25. Reconstructive surgery for Ebstein anomaly: three decades of experience
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Jolien W. Roos-Hesselink, Bas R Rebel, Johanna J.M. Takkenberg, Kevin M Veen, M. Mostafa Mokhles, Ad J.J.C. Bogers, Cardiothoracic Surgery, Cardiology, and Pediatrics
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Pulmonary and Respiratory Medicine ,Reconstructive surgery ,medicine.medical_specialty ,Tricuspid valve ,business.industry ,Mean age ,General Medicine ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,New york heart association ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,EBSTEIN ANOMALY ,Cohort ,Medicine ,In patient ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVESSince 1988, our centre employs vertical plication repair with deattachment and reattachment of the tricuspid valve for Ebstein anomaly. This study describes the characteristics and long-term outcomes of our single-centre cohort.METHODSData from all patients operated on between 1988 and 2016 were retrospectively collected. Kaplan–Meier analyses were done for survival data and mixed models were used to analyse longitudinally collected clinical and echocardiography data.RESULTSThirty-six patients (mean age: 25.4 ± 15.9 years, 36% male) were operated on using the Carpentier–Chauvaud 21 (58%) or Cone repair 15 (42%). One patient (3%) died in hospital. Two late deaths were observed, yielding a survival of 97 ± 3% at 25 years. Reoperation was performed in 6 patients after a mean follow-up of 14.1 ± 10.3 years, resulting in a freedom of reoperation of 80 ± 8% at 25 years. During follow-up, predicted probability of being in New York Heart Association III/IV did not exceed 10%. Modelling longitudinal evolution of tricuspid regurgitation showed no major changes over time. Additionally, a rigid ring repair was associated with a higher probability of tricuspid regurgitation, especially after the first years after the operation. A full Cone repair was associated with less progression of tricuspid regurgitation over time.CONCLUSIONSRepair of Ebstein abnomaly is associated with low mortality and morbidity, acceptable reoperation rate and excellent valve function over time, especially in patients with completed Cone repair. Therefore, we conclude that in our centre, repair of Ebstein abnomaly is a durable technique to treat patients.
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- 2019
26. The Development and Clinical Impact of Aortic Regurgitation Following Left Ventricular Assist Device Surgery: An Analysis of the IMACS Database
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Yunus C. Yalcin, Ozcan Birim, Jesse F. Veenis, Kevin M Veen, Jasper J. Brugts, Ad J.J.C. Bogers, Kadir Caliskan, Cardiothoracic Surgery, and Cardiology
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Regurgitation (circulation) ,Lower risk ,medicine.disease ,Surgery ,Aortic valve replacement ,Ventricular assist device ,Concomitant ,Relative risk ,medicine ,Lung transplantation ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose We aimed to investigate the determinants and clinical impact of dynamic moderate-to-severe (mod-sev) aortic regurgitation (AR) on the long-term outcomes following LVAD implantation. Methods The international multicenter registry data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry was used. All adult LVAD patients, implanted between January 2013 until September 2017, with at least 1 echocardiogram available following implantation were included. Longitudinal evolution of AR was modeled using logistic mixed effect models. Joint modelling was used to link the dynamic longitudinal evolution of AR to a relative risk model for morality (Cox). Outcomes are presented by hazard ratios and two simulated Kaplan Meier curves presenting two identical patients. Results In total, 12.810 patients (median age 58 [48-66], 78.5% male) were included, with 36.343 echocardiograms available. Following LVAD implantation, mod-sev AR was observed in 1.660 (12.9%) patients on 2.660 different echocardiograms. The strongest predictors for the development of mod-sev AR included mild AR at baseline and prolonged LVAD support. Moreover, concomitant aortic valve replacement, opposed to repair surgery, was associated with a substantial lower risk for the development of mod-sev AR. Both the presence of mod-sev AR, as the pace of the probability of AR was changing (slope), were significantly associated with increased mortality. Survival following the development significant AR is heavily impacted, as displayed in Figure 1. Conclusion The development of significant AR occurs approximately in 1 in 8 patients following LVAD implantation. Subsequent mortality seems largely dictated by the pace of the development of mod-sev AR, with a faster development of AR being associated with less favorable outcomes.
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- 2021
27. Sufficient Methods for Monitoring Aortic Insufficiency
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Kevin M Veen, Yunus C. Yalcin, M. Mostafa Mokhles, Cardiothoracic Surgery, and Cardiology
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine ,MEDLINE ,Surgery ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2021
28. Prognostic Value of Tricuspid Valve Regurgitation in Patients With Pulmonary Arterial Hypertension and CTEPH: A Longitudinal Study
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Karin A. Boomars, Annemien E. van den Bosch, Johanna J.M. Takkenberg, Kevin M Veen, Paul M. Hendriks, and Thomas Koudstaal
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History ,medicine.medical_specialty ,Longitudinal study ,Polymers and Plastics ,business.industry ,Proportional hazards model ,medicine.medical_treatment ,Hazard ratio ,Industrial and Manufacturing Engineering ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,medicine ,Cardiology ,Clinical endpoint ,Lung transplantation ,Business and International Management ,Tricuspid Valve Regurgitation ,business ,Prospective cohort study - Abstract
Aims: The prognostic value of functional tricuspid valve regurgitation (TR) in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (CTEPH) remains undetermined. This study aims to quantify the prognostic role of TR during follow-up in relation to right ventricle (RV) dysfunction on clinical outcomes. Methods and Results: Patients from our prospective cohort study with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension were included. The primary endpoint was a composite of death or lung transplantation. The longitudinal evolution of TR and RV dysfunction were modelled with generalized mixed-effect models, which were inserted in a cox model under the joint-modelling framework in order to investigate the association of TR and RV dysfunction with the endpoint. In total, 120 patients were included (median age:59, females:62%), with a mean follow-up of 3.2±2.1 years. 31 patients reached the endpoint (2 transplant, 29 mortality). On average the probability of moderate-to-severe TR decreased during follow-up, whereas the probability of moderate-to-severe RV dysfunction remained stable over time. The cumulative effect of moderate-to-severe TR (hazard ratio: 1.01 95%CI[1.00-1.01],P
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- 2021
29. Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review
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Johanna J.M. Takkenberg, Siew Yen Ho, Azeem Latib, Frans B S Oei, Kevin M Veen, Mohamed Abdel-Wahab, Osama Ibrahim Ibrahim Soliman, Jeroen J. Bax, Khalil Fattouch, Ad J.J.C. Bogers, Thomas Modine, Johan Bosmans, Rodrigo Modolo, Nicolas M. Van Mieghem, Kadir Caliskan, Philip Lurz, Mohammad Abdelghani, Chun Chin Chang, Rebecca T. Hahn, Patrick W. Serruys, Maurizio Taramasso, Cardiology, and Cardiothoracic Surgery
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Risk ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Context (language use) ,Heart failure ,Regurgitation (circulation) ,Tricuspid regurgitation ,030204 cardiovascular system & hematology ,Cardiac Valve Annuloplasty ,Imaging ,03 medical and health sciences ,0302 clinical medicine ,Tricuspid Valve Insufficiency ,Valve replacement ,Tricuspid valve ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Outcome ,Heart Valve Prosthesis Implantation ,Mitral regurgitation ,business.industry ,Guideline ,medicine.disease ,Treatment ,medicine.anatomical_structure ,Treatment Outcome ,Mitral Valve ,Human medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Tricuspid regurgitation (TR) is a frequent and complex problem, commonly combined with left-sided heart disease, such as mitral regurgitation. Significant TR is associated with increased mortality if left untreated or recurrent after therapy. Tricuspid regurgitation was historically often disregarded and remained undertreated. Surgery is currently the only Class I Guideline recommended therapy for TR, in the form of annuloplasty, leaflet repair, or valve replacement. As growing experience of transcatheter therapy in structural heart disease, many dedicated transcatheter tricuspid repair or replacement devices, which mimic well-established surgical techniques, are currently under development. Nevertheless, many aspects of TR are little understood, including the disease process, surgical or interventional risk stratification, and predictors of successful therapy. The optimal treatment timing and the choice of proper surgical or interventional technique for significant TR remain to be elucidated. In this context, we aim to highlight the current evidence, underline major controversial issues in this field and present a future roadmap for TR therapy.
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- 2020
30. Biatrial Versus Bicaval Orthotopic Heart Transplantation: A Systematic Review and Meta-Analysis
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Olivier C. Manintveld, C. Zijderhand, Johanna J.M. Takkenberg, Alina A. Constantinescu, Jasper J. Brugts, M. Mostafa Mokhles, Kevin M Veen, Ad J.J.C. Bogers, Kadir Caliskan, Tamar Schoonen, Jos A. Bekkers, Cardiothoracic Surgery, Cardiology, and Department of Business-Society Management
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,genetic structures ,Heart disease ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Rate ratio ,Global Health ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Heart transplantation ,Heart Failure ,Mitral regurgitation ,business.industry ,Hazard ratio ,Odds ratio ,medicine.disease ,eye diseases ,Confidence interval ,Survival Rate ,030228 respiratory system ,Meta-analysis ,Cardiology ,Heart Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Orthotopic heart transplantation (OHT) is the gold standard treatment in end-stage heart disease. Controversy remains whether bicaval OHT is superior to biatrial OHT in both early and late outcomes. This study aimed to provide an overview of the early and late outcomes in patients who underwent a bicaval or biatrial OHT. Methods: A systematic literature search was performed for articles published before December 2017. Studies comparing adult patients undergoing biatrial OHT and bicaval OHT were included. Early outcomes were pooled in odds ratios and late outcomes were pooled in rate ratios. Late survival was visualized by a pooled Kaplan-Meier curve. Results: A total of 36 publications were included in the meta-analysis, counting 3555 patients undergoing biatrial OHT and 3208 patients undergoing bicaval OHT. Early outcomes in mortality, tricuspid regurgitation, mitral regurgitation, and permanent pacemaker implantation differed significantly in favor of the bicaval OHT patients. Long-term survival was significantly better in patients undergoing bicaval vs biatrial OHT (hazard ratio, 1.32; 95% confidence interval, 1.1-1.6; P = .008). Also, late tricuspid regurgitation was less frequently seen in the bicaval OHT patients (rate ratio, 2.14; 95% CI, 1.17-3.94; P = .014). Conclusions. This systematic review with meta-analysis shows that bicaval OHT results in more favorable early and late outcomes for patients undergoing a bicaval OHT compared with a biatrial OHT. Therefore, bicaval OHT should be considered as preferable technique for OHT.
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- 2020
31. Outcomes after surgery for functional tricuspid regurgitation: a systematic review and meta-analysis
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Johanna J.M. Takkenberg, Moniba Rasheed, M. Mostafa Mokhles, Kevin M Veen, Folkert J. ten Cate, Thijs J M Quanjel, Ad J.J.C. Bogers, Frans B S Oei, Simone A. Huygens, Jonathan R.G. Etnel, Cardiothoracic Surgery, and Cardiology
- Subjects
medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Functional tricuspid regurgitation ,Mitral valve ,medicine ,Humans ,Ventricular Function ,Heart Valve Prosthesis Implantation ,Tricuspid valve ,business.industry ,Health Policy ,Mortality rate ,Mean age ,After discharge ,Tricuspid Valve Insufficiency ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Pooled variance ,030228 respiratory system ,Heart Valve Prosthesis ,Meta-analysis ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims This study aims to provide a contemporary overview of outcomes after tricuspid valve (TV) surgery for functional tricuspid regurgitation (TR). Methods and results The literature was systematically searched for papers published between January 2005 and December 2017 reporting on clinical/echocardiographic outcomes after TV surgery for functional TR. A random effects meta-analysis was conducted for outcome variables, and late outcomes are visualized by pooled Kaplan–Meier curves. Subgroup analyses were performed for studies with a within-study comparison of suture vs. ring repair and flexible vs. rigid ring repair. Eighty-seven publications were included, encompassing 13 184 patients (mean age: 62.1 ± 11.8 years, 55% females). A mitral valve procedure was performed in 92% of patients. Pooled mean follow-up was 4.0 ± 2.8 years. Pooled early mortality was 3.9% (95% CI: 3.2–4.6), and late mortality rate was 2.7%/year (95% CI: 2.0–3.5), of which approximately half was cardiac-related 1.2%/year (95% CI: 0.8–1.9). Pooled risk of early moderate-to-severe TR at discharge was 9.4% (95% CI: 7.0–12.1). Late moderate-to-severe TR rate after discharge was 1.9%/year (95% CI: 1.0–3.5). Late reintervention rate was 0.3%/year (95% CI: 0.2–0.4). Mortality and overall (early and late) TR rate were comparable between suture vs. ring annuloplasty (14 studies), whereas overall TR rate was higher after flexible ring vs. rigid ring annuloplasty (6 studies) (7.5%/year vs. 3.9%/year, P = 0.002). Conclusion This study shows that patients undergoing surgery for functional tricuspid regurgitation (FTR) have an acceptable early and late mortality. However, TR remains prevalent after surgery. The results of this study can be used to inform patients and clinicians about the expected outcome after surgery for FTR and can results serve as a benchmark for the performance of emerging transcatheter TV interventions.
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- 2020
32. VAD-Related and Specific Infections are Significantly Associated with an Increased Risk of Cerebrovascular Accidents in Patients Supported by a Ventricular Assist Device: An EUROMACS Analysis
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Francesco Musumeci, F. Schönrath, T. de By, Jan Gummert, Kevin M Veen, Ad J.J.C. Bogers, Béla Merkely, Kadir Caliskan, Christiaan F J Antonides, Bart Meyns, P. Nemec, Cardiothoracic Surgery, and Cardiology
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,Proportional hazards model ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Increased risk ,Ventricular assist device ,Internal medicine ,Covariate ,medicine ,Patient profile ,Surgery ,In patient ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,Adverse effect ,business - Abstract
Purpose In patients supported by a ventricular assist device (VAD) major infections are a frequently reported adverse event with increased morbidity and mortality. The purpose of this study was to investigate the possible association of infections and cerebrovascular accidents (CVAs). Methods An analysis of the European Registry for Patients Assisted with Mechanical Circulatory Support (EUROMACS) was performed identifying all patients aged ≥18 years with a LVAD or BiVAD implantation. Infections were categorized as VAD-specific infections, VAD-related infections and non-VAD infections. An extended Kaplan-Meier analysis for the risk of CVA and mortality with infection as a time-dependent covariate was performed. Furthermore, a multivariable cox proportional hazard model was performed including 24 variables. Results For this analysis 3784 patients were included, with 45 patients being supported by a BiVAD and 3739 by an LVAD. The majority of patients were male (83.2%) and 60.5% had an INTERMACS patient profile 2 or 3. During follow-up, 3108 major infections were identified in 1385 (36.6%) of the patients, while 673 CVAs were identified in 545 (14.4%) of the patients. Extended Kaplan-Meier analysis with first infection as time-dependent covariate revealed a hazard ratio for CVA of 1.95 (95% CI: 1.57-2.36; p Conclusion Both VAD-related and VAD-specific infections are associated with significant increased risk of CVA, but non-VAD infections are not.
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- 2020
33. A clinician’s guide for developing a prediction model: a case study using real?world data of patients with castration?resistant prostate cancer
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Paul J.M. Kil, Carin A. Uyl-de Groot, Johanna J.M. Takkenberg, Hans M. Westgeest, Kevin M Veen, M. Mostafa Mokhles, Isabel B. de Angst, Winald R. Gerritsen, Malou C.P. Kuppen, Cardiothoracic Surgery, and Health Technology Assessment (HTA)
- Subjects
Male ,Cancer Research ,Review – Clinical Oncology ,Computer science ,Clinical Decision-Making ,Machine learning ,computer.software_genre ,01 natural sciences ,010104 statistics & probability ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Lasso (statistics) ,SDG 3 - Good Health and Well-being ,medicine ,Humans ,030212 general & internal medicine ,Registries ,0101 mathematics ,Castration-resistant prostate cancer ,Netherlands ,Proportional Hazards Models ,Retrospective Studies ,Models, Statistical ,Proportional hazards model ,business.industry ,General Medicine ,Missing data ,medicine.disease ,Decision Support Systems, Clinical ,Regression ,Prostatic Neoplasms, Castration-Resistant ,Specification ,Oncology ,Prediction modeling ,Cox proportional hazard model ,Urological cancers Radboud Institute for Health Sciences [Radboudumc 15] ,Regression Analysis ,Artificial intelligence ,business ,computer ,Statistician ,Coding (social sciences) ,Decision-making - Abstract
Purpose With the increasing interest in treatment decision-making based on risk prediction models, it is essential for clinicians to understand the steps in developing and interpreting such models. Methods A retrospective registry of 20 Dutch hospitals with data on patients treated for castration-resistant prostate cancer was used to guide clinicians through the steps of developing a prediction model. The model of choice was the Cox proportional hazard model. Results Using the exemplary dataset several essential steps in prediction modelling are discussed including: coding of predictors, missing values, interaction, model specification and performance. An advanced method for appropriate selection of main effects, e.g. Least Absolute Shrinkage and Selection Operator (LASSO) regression, is described. Furthermore, the assumptions of Cox proportional hazard model are discussed, and how to handle violations of the proportional hazard assumption using time-varying coefficients. Conclusion This study provides a comprehensive detailed guide to bridge the gap between the statistician and clinician, based on a large dataset of real-world patients treated for castration-resistant prostate cancer.
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- 2020
34. The Clinical Impact and Long-Term Outcome of Tricuspid Regurgitation in Patients with Orthotopic Heart Transplantation
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Ad J.J.C. Bogers, Kadir Caliskan, Olivier C. Manintveld, Jos A. Bekkers, M. Mostafa Mokhles, A. Constantinescu, Johanna J.M. Takkenberg, Jasper J. Brugts, C. Zijderhand, Kevin M Veen, and Grigorios Papageorgiou
- Subjects
Pulmonary and Respiratory Medicine ,Heart transplantation ,Transplantation ,medicine.medical_specialty ,Creatinine ,Medical treatment ,business.industry ,Proportional hazards model ,medicine.medical_treatment ,Regurgitation (circulation) ,chemistry.chemical_compound ,chemistry ,Internal medicine ,Lv dysfunction ,Overall survival ,Cardiology ,Medicine ,Surgery ,In patient ,Cardiology and Cardiovascular Medicine ,business - Abstract
PURPOSE: Tricuspid regurgitation (TR) is common in patients with orthotopic heart transplantation (HTX). Nevertheless, the clinical impact and the long-term outcome of TR remains controversial. In this study we aim to elucidate the clinical impact and long-term outcome of TR, taking into account its dynamic nature. METHODS: All consecutive adults patients undergoing biatrial HTX in our tertiary center with a follow-up echocardiogram were included in this study. Mixed-models were used to model the evolution of TR over time. Thereafter, the mixed-model was inserted into a Cox model, under the joint-model framework, in order to address the association of the dynamic TR with mortality. RESULTS: In total, 572 patients were included (median age: 50 years, males: 74.9%). Approximately 33% of patients had moderate-to-severe TR immediately after surgery. However, this declined to approximately 15% after 5 years and 10% after 10 years of surgery (Fig 1). Predictors of TR were: a higher operation urgency, higher donor age, no pre-implant mechanical assist device, and concurrent post-HTX LV dysfunction. Overall survival at 1, 5, 10, 20 years was 97±1%, 88±1%, 66±2% and 23±2%, respectively. The presence of moderate-to-severe TR during follow-up was associated with higher mortality (HR: 1.08, 95%CI[1.03-1.14], p
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- 2020
35. Tricuspid valve replacement: an appraisal of 45 years of experience
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Thijs J M Quanjel, Kevin M Veen, Ad J.J.C. Bogers, Johanna J.M. Takkenberg, M. Mostafa Mokhles, and Cardiothoracic Surgery
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Pulmonary and Respiratory Medicine ,Tricuspid Valve Disorder ,Adult ,Male ,Reoperation ,medicine.medical_specialty ,Adolescent ,Heart Valve Diseases ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Carcinoid Heart Disease ,Humans ,Cumulative incidence ,Child ,Aged ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Tricuspid valve ,Proportional hazards model ,business.industry ,Hazard ratio ,Central venous pressure ,Middle Aged ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Child, Preschool ,Replantation ,Etiology ,Cardiology ,Surgery ,Female ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Forecasting - Abstract
OBJECTIVES This study provides an overview of the change over a 45-year time period in the characteristics and outcome of patients with tricuspid valve disease undergoing surgical tricuspid valve replacement (TVR). METHODS The characteristics and outcomes of all consecutive TVRs from November 1972 to November 2017 at Erasmus MC were collected retrospectively. A logistic regression analysis was conducted to identify the significant predictors of 30-day mortality. Multivariable Cox regression analysis was used to identify the potential risk factors of patient outcome and the effect of time on these factors. RESULTS Ninety-eight patients with tricuspid valve dysfunction underwent 114 consecutive TVRs at a mean age of 50.1 ± 17.2 years (68.5% female). Aetiology changed over time from predominantly functional regurgitation (42.9% in 1972-1985) to predominantly carcinoid heart disease (47.7% in 2001-2017). Early mortality declined significantly from 35% in 1972–1985 to 6.7% in 2001–2017 (P < 0.001). Over time, the hazard ratio of late mortality decreased for higher New York Heart Association class, lower preoperative haemoglobin, and high central venous pressure and increased for the presence of preoperative leg oedema, higher creatinine and alkaline phosphatase. The late survival was 43.8% ± 5.89% at 10 years and was comparable among eras (P = 0.44). The cumulative incidence of reoperation at 10 years was 14.1% (2.3–26.0) in biological valves and 4.9% (0.1–10.3) in mechanical valves (P = 0.25). CONCLUSIONS Patient characteristics, potential risk factors and patient outcome changed considerably over time in patients undergoing TVR. Notably, there was a shift in aetiology, completely altering the patient population and their characteristics.
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- 2019
36. Outcomes after tricuspid valve surgery concomitant with left ventricular assist device implantation in the EUROMACS registry: a propensity score matched analysis
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Ad J.J.C. Bogers, Theo M M H de By, Kadir Caliskan, Antonio Loforte, Johanna J.M. Takkenberg, Lech Paluszkiewicz, Ivan Netuka, Felix Schoenrath, Paul Mohacsi, Osama Ibrahim Ibrahim Soliman, Kevin M Veen, M. Mostafa Mokhles, Jan Gummert, Yuriy Pya, Cardiothoracic Surgery, and Cardiology
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,Patient Readmission ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Tricuspid Valve Insufficiency ,law ,medicine ,Humans ,Cumulative incidence ,Registries ,Propensity Score ,education ,Retrospective Studies ,Heart Failure ,Heart Valve Prosthesis Implantation ,education.field_of_study ,Tricuspid valve ,business.industry ,General Medicine ,Length of Stay ,Middle Aged ,Intensive care unit ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Ventricular assist device ,Concomitant ,Propensity score matching ,Female ,Heart-Assist Devices ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES Tricuspid regurgitation (TR) is common in patients receiving a left ventricular assist device (LVAD). Controversy exists as to whether concomitant tricuspid valve surgery (TVS) is beneficial in currently treated patients. Therefore, our goal was to investigate the effect of TVS concomitant with a LVAD implant. METHODS The European Registry for Patients with Mechanical Circulatory Support was used to identify adult patients. Matched patients with and without concomitant TVS were compared using a propensity score matching strategy. RESULTS In total, 3323 patients underwent LVAD implantation of which 299 (9%) had TVS. After matching, 258 patients without TVS were matched to 258 patients with TVS. In the matched population, hospital deaths, days on inotropic support, temporary right ventricular assist device implants and hospital stay were comparable, whereas stay in the intensive care unit was higher in the TVS cohort (11 vs 15 days; P = 0.026). Late deaths (P = 0.17), cumulative incidence of unexpected hospital readmission (P = 0.15) and right heart failure (P = 0.55) were comparable between patients with and without concomitant TVS. In the matched population, probability of moderate-to-severe TR immediately after surgery was lower in patients with concomitant TVS compared to patients without TVS (33% vs 70%; P = 0.001). Nevertheless, the probability of moderate-to-severe TR decreased more quickly in patients without TVS (P = 0.030), resulting in comparable probabilities of moderate-to-severe TR within 1.5 years of follow-up. CONCLUSIONS In matched patients, TVS concomitant with LVAD implant does not seem to be associated with better clinical outcomes. Concomitant TVS reduced TR significantly early after LVAD implant; however, differences in probability of TR disappeared during the follow-up period.
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- 2019
37. Tricuspid Valve Disease: Surgical Outcome
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Kevin M Veen, Jonathan R.G. Etnel, and Johanna J.M. Takkenberg
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congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Tricuspid valve ,business.industry ,Tricuspid valve replacement ,030204 cardiovascular system & hematology ,medicine.disease ,Tricuspid valve disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,Functional tricuspid regurgitation ,Internal medicine ,Ebstein's anomaly ,cardiovascular system ,medicine ,Cardiology ,Endocarditis ,In patient ,cardiovascular diseases ,TRICUSPID VALVE REPAIR ,business - Abstract
Outcomes after tricuspid valve surgery were initially extremely poor but have improved over time thanks to innovations in diagnostics, guidelines for treatment, emerging surgical experience and technical advances. This chapter provides a contemporary overview of patient and procedural characteristics of tricuspid valve repair and replacement and early and late outcomes in different settings, such as functional tricuspid regurgitation, rheumatic, congenital, carcinoid tricuspid valve disease, iatrogenic tricuspid valve damage, and finally endocarditis of the tricuspid valve. For this purpose a systematic literature review and meta-analysis was conducted including 132 studies published after 2005 and reporting on outcome after tricuspid valve surgery. This thorough review of reported experience with tricuspid valve repair and replacement reveals a strong variation in patient presentation and outcome among the various indications and highlights that tricuspid valve replacement is still associated with high early and late mortality. Innovations in the treatment of tricuspid valve disease are direly needed to improve outcome in this complicated patient population.
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- 2018
38. Left ventricular assist device implantation with and without concomitant tricuspid valve surgery: a systematic review and meta-analysis
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Ad J.J.C. Bogers, Kadir Caliskan, Marit E A Kolff, Dagmar Dousma, Olivier C. Manintveld, Johanna J.M. Takkenberg, Osama Ibrahim Ibrahim Soliman, Ozcan Birim, Kevin M Veen, Rahatullah Muslem, Cardiothoracic Surgery, and Cardiology
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,030212 general & internal medicine ,Heart Failure ,Heart Valve Prosthesis Implantation ,Tricuspid valve ,business.industry ,Central venous pressure ,General Medicine ,equipment and supplies ,medicine.disease ,Tricuspid Valve Insufficiency ,Surgery ,Right Ventricular Assist Device ,Treatment Outcome ,medicine.anatomical_structure ,Ventricular assist device ,Relative risk ,Concomitant ,Heart-Assist Devices ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives Moderate-to-severe tricuspid regurgitation is common in end-stage heart disease and is associated with an impaired survival after left ventricular assist device (LVAD) surgery. Controversy remains whether concomitant tricuspid valve surgery (TVS) during LVAD implantation is beneficial. We aimed to provide a contemporary overview of outcomes in patients who underwent LVAD surgery with or without concomitant TVS. Methods A systematic literature search was performed for articles published between January 2005 and March 2017. Studies comparing patients undergoing isolated LVAD implantation and LVAD + TVS were included. Early outcomes were pooled in risk ratios using random effects models, and late survival was visualized by a pooled Kaplan-Meier curve. Results Eight publications were included in the meta-analysis, including 562 undergoing isolated LVAD implantation and 303 patients with LVAD + TVS. Patients undergoing LVAD + TVS had a higher tricuspid regurgitation grade, central venous pressure and bilirubin levels at baseline and were more often female. We found no significant differences in early mortality and late mortality, early right ventricular failure and late right ventricular failure, acute kidney failure, early right ventricular assist device implantation or length of hospital stay. Cardiopulmonary bypass time was longer in patients undergoing additional TVS [mean difference +35 min 95% confidence interval (16-55), P = 0.001]. Conclusions Adding TVS during LVAD implantation is not associated with worse outcome. Adding TVS, nevertheless, may be beneficial, as baseline characteristics of patients undergoing LVAD + TVS were suggestive of a more progressive underlying disease, but with comparable short-term outcome and long-term outcome with patients undergoing isolated LVAD.
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- 2018
39. Contrast-enhancement influences skeletal muscle density, but not skeletal muscle mass, measurements on computed tomography
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Jan N. M. IJzermans, Henk J.W. Schippers, François E.J.A. Willemsen, Wiro J. Niessen, Stef Levolger, Jeroen L.A. van Vugt, Ron W. F. de Bruin, Kevin M Veen, Marcel Koek, Robert R. J. Coebergh van den Braak, Surgery, Medical Informatics, and Radiology & Nuclear Medicine
- Subjects
Male ,0301 basic medicine ,Contrast enhancement ,Contrast Media ,Computed tomography ,Critical Care and Intensive Care Medicine ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Clinical significance ,Muscle, Skeletal ,Third lumbar vertebra ,030109 nutrition & dietetics ,Nutrition and Dietetics ,medicine.diagnostic_test ,Portal Vein ,business.industry ,Body Weight ,Skeletal muscle ,Arteries ,Anatomy ,Gold standard (test) ,medicine.disease ,Skeletal muscle mass ,Body Height ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Sarcopenia ,Female ,Tomography, X-Ray Computed ,business ,Nuclear medicine - Abstract
Summary Background & aims Low skeletal muscle mass and density have recently been discovered as prognostic and predictive parameters to guide interventions in various populations, including cancer patients. The gold standard for body composition analysis in cancer patients is computed tomography (CT). To date, the effect of contrast-enhancement on muscle composition measurements has not been established. The aim of this study was to determine the effect of contrast-enhancement on skeletal muscle mass and density measurements on four-phase CT studies. Design In this observational study, two observers measured cross-sectional skeletal muscle area corrected for patients' height (skeletal muscle index [SMI]) and density (SMD) at the level of the third lumbar vertebra on 50 randomly selected CT examinations with unenhanced, arterial, and portal-venous phases. The levels of agreement between enhancement phases for SMI and SMD were calculated using intra-class correlation coefficients (ICCs). Results Mean SMI was 42.5 (±9.9) cm2/m2 on the unenhanced phase, compared with 42.8 (±9.9) and 43.6 (±9.9) cm2/m2 for the arterial and portal-venous phase, respectively (both p Conclusions Statistically significant differences in SMI were observed between different enhancement phases. However, further work is needed to assess the clinical relevance of these small differences. Contrast-enhancement strongly influenced SMD values. Studies using this measure should therefore use the portal-venous phase of contrast-enhanced CT examinations.
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- 2018
40. A Surgeon’s View on Echocardiographic Imaging of the Tricuspid Valve
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Folkert J. ten Cate, Kevin M Veen, and Frans B S Oei
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congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Tricuspid valve ,business.industry ,Two dimensional echocardiography ,Regurgitation (circulation) ,Cardiac surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Internal medicine ,cardiovascular system ,medicine ,Tricuspid annulus ,Cardiology ,cardiovascular diseases ,Radiology ,business ,Cardiac imaging - Abstract
Echocardiography has evolved into an important diagnostic tool in cardiac imaging and is frequently used in preparing for cardiac surgery. In this chapter we will discuss a surgeon’s view on imaging of the tricuspid valve. Generally, cardiac surgeons focus on four different aspects of echocardiography when preparing for tricuspid valve surgery: the size of the tricuspid annulus; the severity of tricuspid regurgitation, the morphology of valve leaflets and the degree of tethering of the tricuspid valve. In this chapter we discuss each of these four aspect separately. The emphasis is based on two dimensional echocardiography used in three clinical cases outlining the advantages and disadvantages of this contemporary technique.
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- 2018
41. Impact of Left Ventricular Assist Device Placement on Chronic Kidney Diseases: A Multicenter Longitudinal Study
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R.J. Tedford, Steven Hsu, A. Constantinescu, Yunus C. Yalcin, Jasper J. Brugts, Olivier C. Manintveld, Ahmet Kilic, Kevin M Veen, B. Houston, B. Tomashitis, Rahatullah Muslem, Ad J.J.C. Bogers, Kadir Caliskan, and Y. Al Najam
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Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,Creatinine ,Longitudinal study ,business.industry ,Urology ,Renal function ,urologic and male genital diseases ,medicine.disease ,female genital diseases and pregnancy complications ,chemistry.chemical_compound ,chemistry ,Epidemiology ,medicine ,Ventricular Assist Device Placement ,Surgery ,Stage (cooking) ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease ,Cohort study - Abstract
Methods A retrospective multi-center cohort study was conducted, including all patients undergoing LVAD implantation. The Chronic Kidney Disease Epidemiology collaboration equation was used to determine the estimated glomerular filtration rate . Creatinine measurements were collected over a 2-year follow-up period. Patients stratification was based on their pre-operative CKD stage. Results Overall, 400 patients (mean age 52±14 years, 77% male) were included: 186 (47%) patients in CKD stage 1 & 2, 93 (23%) in CKD stage 3a, 82 (20%) in CKD stage 3b, and 39 (10%) patients were CKD stage 4 & 5. During a median follow-up of 458 days [141-1001], 46162 measurements of creatinine were available. Initial improvement of kidney function is noticed in every preoperative CKD stage group (P Conclusion Initial improvement of kidney function is noticed in all preoperative CKD stages. However, this improvement is of transient nature and the survival remains impaired in patients with diminished preoperative renal function.
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- 2019
42. Course and Clinical Impact of Tricuspid Regurgitation after LVAD Implantation: An Analysis of the EUROMACS Registry
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Johanna J.M. Takkenberg, Osama Ibrahim Ibrahim Soliman, Paul Mohacsi, Felix Schoenrath, Ad J.J.C. Bogers, Kadir Caliskan, T. de By, Lech Paluszkiewicz, M. Mostafa Mokhles, and Kevin M Veen
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,Tricuspid valve ,Adult patients ,Ventricular function ,business.industry ,medicine.medical_treatment ,Regurgitation (circulation) ,equipment and supplies ,medicine.anatomical_structure ,Ventricular assist device ,Internal medicine ,Concomitant ,Circulatory system ,Cardiology ,medicine ,Surgery ,Implant ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose This study explores the course of uncorrected tricuspid regurgitation (TR) after left ventricular assist device (LVAD) implantation and the clinical impact of pre-LVAD TR on 30-day and late mortality. Methods The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was used to identify adult patients undergoing LVAD implant with TR, but without concomitant tricuspid valve surgery. Multivariable regression models were used to assess the impact of TR on both early and late mortality. It was hypothesized that TR was associated with early mortality via well-known risk factors. Therefore, mediation analysis was conducted using structural equation models. Generalized mixed-models were used to model post-LVAD TR course over time. Results In total 2496 procedures were included. A higher pre-LVAD TR grade was associated with worse pre-LVAD right ventricular function (RVF) (OR 2,96 95%CI[2,18-4,01], p Conclusion Pre-LVAD TR is positively correlated with worse pre-LVAD RVF, and is associated with worse outcome. TR can decrease without intervention after LVAD implant. Therefore, patient selection for concomitant tricuspid valve surgery should not solely be based on TR grade.
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- 2019
43. Long-Term Outcome of Patients after Successful LVAD Explant: A EUROMACS Study
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Kadir Caliskan, Christiaan F J Antonides, David Schibilsky, Mustafa Özbaran, T. de By, Ivan Netuka, Bart Meyns, Kevin M Veen, Jan Gummert, Rahatullah Muslem, and Felix Schoenrath
- Subjects
Pulmonary and Respiratory Medicine ,Heart transplantation ,Transplantation ,Aspirin ,medicine.medical_specialty ,Myocarditis ,Ejection fraction ,business.industry ,medicine.medical_treatment ,Warfarin ,Dilated cardiomyopathy ,medicine.disease ,Heart failure ,Ventricular assist device ,Internal medicine ,medicine ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Purpose In patients supported by a left ventricular assist device (LVAD) myocardial recovery resulting in explant occurs in approximately 1-2%. However, the long-term outcome of these patients is unknown. We studied the clinical management and long-term outcomes in patients after LVAD explant. Methods An analysis of the European Registry for Patients Assisted with Mechanical Circulatory Support (EUROMACS) was performed identifying patients > 18 years old with successful LVAD explant. Baseline characteristics were retrieved and follow-up (FU) of patients after explant was collected. A Kaplan-Meier analysis was performed for the event-free survival (EFS), events being LVAD reimplantation or heart transplantation. Results A total of 49 (1.4%) patients with successful LVAD explant were identified in EUROMACS. FU was acquired of 28 (57%) of the patients: median age 43y (range 18-64), 23 (82%) males, median LVEF was 18% (IQR 13-23%) at the time of LVAD implantation, 60.7% were INTERMACS class 1 or 2. Etiologies of heart failure (HF) were: dilated cardiomyopathy (DCMP) due to myocarditis (9), idiopathic DCMP (6), ischemic (3) or others (10). Devices implanted: 14 HeartMate II (50%), 11 HeartWare VAD (39%), 2 HeartMate 3 (7%), 1 unknown, with a mean duration of support of 13.5 months (range 1 - 42). Mean FU after explant was 27 months (±23). Use of HF medication was: ACE inhibitor 71%, β-blockers 85% and loop diuretics 50%. New York Heart Association (NYHA) class is I to II in 82% and III in 11% of these patients. Aspirin was used by 43% of the patients, 39% used warfarin, with 29% using neither of them. The inflow cannula was in situ in 3 (11%) patients, while no cerebrovascular accident was seen. EFS was 92.9% after 4 years. One patient required reimplantation after 32 days, and 1 died of sepsis 10 months after LVAD explant. Conclusion This EUROMACS FU study is, to our knowledge the first in the literature, and shows that long-term EFS after LVAD explant is excellent, with the majority of the patients having only mild to moderate HF symptoms.
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- 2019
44. Outcomes of Concomitant Tricuspid Valve Surgery During Left Ventricular Assist Device Implantation: An Analysis of the EUROMACS Registry
- Author
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Paul Mohacsi, Ivan Netuka, Osama Ibrahim Ibrahim Soliman, M.M.H. Theo, Mustafa Özbaran, Jan Gummert, Kevin M Veen, Johanna J.M. Takkenberg, Ad J.J.C. Bogers, Kadir Caliskan, M. Mostafa Mokhles, Lech Paluszkiewicz, and Felix Schoenrath
- Subjects
medicine.medical_specialty ,Tricuspid valve ,medicine.anatomical_structure ,business.industry ,Ventricular assist device ,medicine.medical_treatment ,Concomitant ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Published
- 2019
45. Prognostic value of tricuspid valve regurgitation in patients with pulmonary arterial hypertension and CTEPH: A longitudinal study
- Author
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Kevin M. Veen, Thomas Koudstaal, Paul M. Hendriks, Johanna JM Takkenberg, Karin A. Boomars, and Annemien E. van den Bosch
- Subjects
Pulmonary arterial hypertension ,Chronic thromboembolic pulmonary hypertension ,Tricuspid valve regurgitation ,Prognosis ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Aims: The prognostic value of functional tricuspid valve regurgitation (TR) in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (CTEPH) remains undetermined. This study primarily aims to quantify the prognostic role of TR in relation to right ventricle (RV) dysfunction on clinical outcomes and secondarily the evolution of TR and RV dysfunction over time. Methods: Adult PAH or CTEPH patients diagnosed by right heart catheterization were included. Exclusion criteria were prevalent patients and age
- Published
- 2024
- Full Text
- View/download PDF
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