1,109 results on '"A. Haverich"'
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2. In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study
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Roberto Lorusso, Maria Elena De Piero, Silvia Mariani, Michele Di Mauro, Thierry Folliguet, Fabio Silvio Taccone, Luigi Camporota, Justyna Swol, Dominik Wiedemann, Mirko Belliato, Lars Mikael Broman, Alain Vuylsteke, Yigal Kassif, Anna Mara Scandroglio, Vito Fanelli, Philippe Gaudard, Stephane Ledot, Julian Barker, Udo Boeken, Sven Maier, Alexander Kersten, Bart Meyns, Matteo Pozzi, Finn M Pedersen, Peter Schellongowski, Kaan Kirali, Nicholas Barrett, Jordi Riera, Thomas Mueller, Jan Belohlavek, Valeria Lo Coco, Iwan C C Van der Horst, Bas C T Van Bussel, Ronny M Schnabel, Thijs Delnoij, Gil Bolotin, Luca Lorini, Martin O Schmiady, David Schibilsky, Mariusz Kowalewski, Luis F Pinto, Pedro E Silva, Igor Kornilov, Aaron Blandino Ortiz, Leen Vercaemst, Simon Finney, Peter P Roeleveld, Matteo Di Nardo, Felix Hennig, Marta Velia Antonini, Mark Davidson, Tim J Jones, Thomas Staudinger, Peter Mair, Juliane Kilo, Christoph Krapf, Kathrin Erbert, Andreas Peer, Nikolaos Bonaros, Florian Kotheletner, Niklas Krenner Mag, Liana Shestakova, Greet Hermans, Dieter Dauwe, Philippe Meersseman, Bernard Stockman, Leda Nobile, Olivier Lhereux, Alexandre Nrasseurs, Jacques Creuter, Daniel De Backer, Simone Giglioli, Gregoire Michiels, Pierre Foulon, Matthias Raes, Inez Rodrigus, Matthias Allegaert, Philippe Jorens, Gerd Debeucklare, Michael Piagnerelli, Patrick Biston, Harlinde Peperstraete, Komeel Vandewiele, Olivier Germay, Dimitri Vandeweghe, Sven Havrin, Marc Bourgeois, Marc-Gilbert Lagny, Genette Alois, Nathalie Lavios, Benoit Misset, Romain Courcelle, Philippe J Timmermans, Alaaddin Yilmaz, Michiel Vantomout, Jerone Lehaen, Ame Jassen, Herbert Guterman, Maarten Strauven, Piet Lormans, Bruno Verhamme, catherine Vandewaeter, Frederik Bonte, Dominique Vionne, Martin Balik, Jan Blàha, Michal Lips, Michal Othal, Filip Bursa, Radim Spacek, Steffen Christensen, Vibeke Jorgensen, Marc Sorensen, Soren A Madsen, Severin Puss, Aleksandr Beljantsev, gabriel Saiydoun, Antonio Fiore, Pascal Colson, Florian Bazalgette, Xavier Capdevila, Sebastien Kollen, Laurent Muller, Jean-Francois Obadia, Pierre-Yves Dubien, Lucrezia Ajrhourh, Pierre G Guinot, Jonathan Zarka, Patricia Besserve, Maximilian V Malfertheiner, Esther Dreier, Birgit Heinze, Payam Akhyari, Artur Lichtenberg, Hug Aubin, Alexander Assman, Diyar Saeed, Holger Thiele, Matthias Baumgaertel, Jan D Schmitto, Natanov Ruslan, Axel Haverich, Matthias Thielmann, Thorsten Brenner, Arjang Ruhpawar, Christoph Benk, Martin Czerny, Dawid L Staudacher, Fridhelm Beyersdorf, Johannes Kalbhenn, Philipp Henn, Aron-Frederik Popov, Torje Iuliu, Ralf Muellenbach, Christian Reyher, Caroline Rolfes, Gosta Lotz, Michael Sonntagbauer, Helen Winkels, Julia Fichte, Robert Stohr, Sebastian Kalverkamp, Christian Karagiannidis, Simone Schafer, Alexei Svetlitchny, Hans-Bernd Hopf, Dominik Jarczak, Heinirich Groesdonk, Magdalena Rommer, Jan Hirsch, Christian Kaehny, Dimitros Soufleris, Georgios Gavriilidis, Kostantinos Pontikis, Magdalini Kyriakopoulou, Anna Kyriakoudi, Serena O'Brien, Ian Conrick-Martin, Edmund Carton, Maged Makhoul, Josef Ben-Ari, Amir Hadash, Alexander Kogan, Reut Kassif Lerner, Anas Abu-Shakra, Moshe Matan, Ahmad Balawona, Erez Kachel, Roman Altshuler, Ori Galante, Lior Fuchs, Yaniv Almog, Yaron S Ishay, Yael Lichter, Amir Gal-oz, Uri Carmi, Asaph Nini, Arie Soroksky, Hagi Dekel, Ziv Rozman, Emad Tayem, Eduard Ilgiyaev, Yuval Hochman, daniel Miltau, Avigal Rapoport, Arieh Eden, Dmitry Kompanietz, Michael Yousif, Miri Golos, Lorenzo Grazioli, Davide Ghitti, Antonio Loforte, Daniela Di Luca, Massimo Baiocchi, Davide Pacini, Antioco Cappai, Paolo Meani, Michele Mondino, Claudio F Russo, Marco Ranucci, Dario Fina, Marco Cotza, Andrea Ballotta, Giovanni Landoni, Pasquale Nardelli, Eygeny V Fominski, Luca Brazzi, Giorgia Montrucchio, Gabriele Sales, Umberto Simonetti, Sergio Livigni, Daniela Silengo, Giulia Arena, Stefania S Sovatzis, Antonella Degani, Mariachiara Riccardi, Elisa Milanesi, Giuseppe Raffa, Gennaro Martucci, Antonio Arcadipane, Giovanna Panarello, Giovanni Chiarini, Sergio Cattaneo, Carmine Puglia, Stefano Benussi, Giuseppe Foti, Marco Giani, Michela Bombino, Maria Cristina Costa, Roberto Rona, Leonello Avalli, Abele Donati, Roberto Carozza, Francesco Gasparri, Andrea Carsetti, Marco Picichè, Anna Marinello, Vinicio Danzi, Anita Zanin, Ignazio Condello, Flavio Fiore, Marco Moscarelli, Giuseppe Nasso, Giuseppe Speziale, Luca Sandrelli, Andrea Montalto, Francesco Musumeci, Alessandro Circelli, Emanuele Russo, Vanni Agnoletti, Ruggero Rociola, Aldo D Milano, Emanuele Pilato, Giuseppe Comentale, Andrea Montisci, Francesco Alessandri, Antonella Tosi, Francesco Pugliese, Giovanni Giordano, Simone Carelli, Domenico L Grieco, Antonio M Dell'Anna, Massimo Antonelli, Enrico Ramoni, Josè Zulueta, Mauro Del Giglio, Sebastiano Petracca, Pietro Bertini, Fabio Guarracino, Luigi De Simone, Paolo M Angeletti, Francesco Forfori, Francesco Taraschi, Veronica N Quintiliani, Robertas Samalavicius, Agne Jankuviene, Nadezda Scupakova, Karolis Urbonas, Juozas Kapturauskas, Gro Soerensen, Piotr Suwalski, Luis Linhares Santos, Ana Marques, Marisa Miranda, Sonia Teixeira, Andrea Salgueiro, Filipe Pereira, Michail Ketskalo, Sergey Tsarenko, Alexandra Shilova, Ivan Afukov, Konstantin Popugaev, Sergei Minin, Daniil Shelukhin, Olga Malceva, Moroz Gleb, Alexander Skopets, Roman Kornelyuk, Alexandr Kulikov, Vadim Okhrimchuk, Alexandr Turchaninov, Maxim Petrushin, Anastasia Sheck, Akhmed Mekulov, Svetlana Ciryateva, Dmitry Urusov, Vojka Gorjup, Alenka Golicnik, Tomaz Goslar, Ricard Ferrer, Maria Martinez-Martinez, Eduard Argudo, Neiser Palmer, Raul De Pablo Sanchez, Lucas Juan Higuera, Lucas Arnau Blasco, Josè A Marquez, Fabrizio Sbraga, Mari Paz Fuset, Pablo Ruiz De Gopegui, Luis M Claraco, Josè A De Ayala, Maranta Peiro, Pilar Ricart, Sergio Martinez, Fernando Chavez, Marc Fabra, elena Sandoval, David Toapanta, Albert Carraminana, Adrian Tellez, Jeysson Ososio, Pablo Milan, Jorge Rodriguez, Garcia Andoni, Carola Gutierrez, Enrique Perez de la Sota, Andrea Eixeres-Esteve, Maria Teresa Garcia-Maellas, Judit Gutierrez-Gutierrez, Rafael Arboleda-Salazar, Patricia Santa Teresa, Alexis Jaspe, Alberto Garrido, Galo Castaneda, Sara Alcantara, Nuria Martinez, Marina Perez, Hector Villanueva, Anxela Vidal Gonzalez, Juan Paez, Arnoldo Santon, Cesar Perez, Marta Lopez, Maria Isabel Rubio Lopez, Antonio Gordillo, Jose Naranjo-Izurieta, Javier Munoz, Immaculada Alcalde, Fernando Onieva, Ricardo Gimeno Costa, Francisco Perez, Isabel Madrid, Monica Gordon, Carlos L Albacete Moreno, Daniel Perez, Nayara Lopez, Domingo Martinenz, Pablo Blanco-Schweizer, Cristina Diez, David Perez, Ana Prieto, Gloria Renedo, Elena Bustamante, Ramon Cicuendez, Rafael Citores, Victoria Boado, Katherine Garcia, Roberto Voces, Monica Domezain, Jose Maria Nunez Martinez, Raimundo Vicente, David Martin, Antonio Andreu, Vanesa Gomez Casal, Ignacio Chico, Eva Maria Menor, Sabela Vara, Jose Gamacho, Helen Perez-Chomon, Francisco Javier Gonzales, Irene Barrero, Luis Martin-Villen, Esperanza Fernandez, Maria Mendoza, Joaquin Navarro, Joaquin Colomina Climent, Alfredo Gonzales-Perez, Guillermo Muniz-Albaceita, Laura Amado, Raquel Rodriguez, Emilio Ruiz, Maria Eiras, Edgars Grins, Rosen Magnus, Mikael Kanetoft, Marcus Eidevald, Pia Watson, Paul R Vogt, Peter Steiger, Tobias Aigner, Alberto Weber, Jurg Grunefelder, Martin Kunz, Martin Grapow, Thierry Aymard, Diana Reser, Gianluca Agus, Jolanda Consiglio, Matthias Haenggi, Jenni Hansjoerg, Manuela Iten, Thomas Doeble, Urs Zenklusen, Xavier Bechtold, Giovanni Faedda, Manuel Iafrate, Amanda Rohjer, Layla Bergamaschi, Jos Maessen, Dinis Reis Miranda, H Endeman, D Gommers, C Meuwese, Jacinta Maas, MJ Van Gijlswijk, RN Van Berg, Dario Candura, Marcel Van der Linden, Merijin Kant, JJ Van der Heijden, Eric Scholten, Nicole Van Belle-van Haren, WK Lagrand, Alexander P Vlaar, Syste De Jong, Basar Cander, Murat Sargin, Murat Ugur, Mehmet A Kaygin, Kathleen Daly, Nicola Agnew, Laura Head, Laura Kelly, Gunawardena Anoma, Clare Russell, Verna Aquino, Ian Scott, Lucy Flemming, Stuart Gillon, Olivia Moore, Elton Gelandt, George Auzinger, Sameer Patel, Robert Loveridge, MUMC+: MA Cardiothoracale Chirurgie (3), CTC, RS: Carim - V04 Surgical intervention, University of Zurich, and Lorusso, Roberto
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Pulmonary and Respiratory Medicine ,2740 Pulmonary and Respiratory Medicine ,610 Medicine & health ,10023 Institute of Intensive Care Medicine - Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation.METHODS: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing.FINDINGS: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms.INTERPRETATION: Patient's age, timing of cannulation (FUNDING: None.
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- 2023
3. Open surgical replacement of the descending aorta: single-center experience
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Saad Rustum, Sebastian Lübeck, Erik Beckmann, Mathias Wilhelmi, Axel Haverich, and Malakh Lal Shrestha
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
4. In memoriam Hans Georg Borst
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Axel Haverich and Gerhard Walterbusch
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
5. Eight‐year outcomes of aortic valve replacement with the Carpentier‐Edwards PERIMOUNT Magna Ease valve
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Steven Tsui, Michael Rosenbloom, James Abel, Jeffrey Swanson, Axel Haverich, Joseph Zacharias, Gilbert Schorlemmer, Gideon Cohen, Michael Moulton, and Rüdiger Lange
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Adult ,Heart Valve Prosthesis Implantation ,Bioprosthesis ,Pulmonary and Respiratory Medicine ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Surgery ,Prospective Studies ,Prosthesis Design ,Cardiology and Cardiovascular Medicine ,Follow-Up Studies ,Retrospective Studies - Abstract
The Carpentier-Edwards PERIMOUNT Magna Ease valve is a third-generation bioprosthesis for aortic valve replacement (AVR). This is a postapproval study reporting on its 8-year outcomes.Adults undergoing AVR with the Magna Ease valve between October 2007 and December 2012 were enrolled for this prospective, nonrandomized, single-arm, and multicenter study. Assessments occurred preoperatively, at hospital discharge, 6 months, 1 year, and annually thereafter for up to 8 years. Outcomes included safety endpoints, hemodynamic performance, and New York Heart Association (NYHA) functional class.Of the 258 study patients, 67.5% were in NYHA Class I or II, and 32.5% were in NYHA Class III or IV at baseline. Concomitant procedures were performed in 44.2%. Total follow-up was 1597.6 patient-years, and median follow-up was 7 years (interquartile range: 5.5-8.0 years). Eight years following AVR, the functional class remained improved from baseline with 93.9% in NYHA Class I/II and 6.1% in NYHA Class III; 38 deaths had occurred, 8 of which were valve related; freedom from all-cause mortality was 80.7% (95% confidence intervals: 74.9, 86.4); freedom from valve-related mortality was 95.8% (92.8, 98.8); freedom from reintervention, explant, major bleeding events, and structural valve deterioration was 89.8% (85.1, 94.6), 94.8% (91.7, 97.9), 85.1% (80.0, 90.1), and 90.1% (84.7, 95.4), respectively; effective orifice area was 1.5 ± 0.5 cmThis study demonstrated satisfactory safety and sustained hemodynamic and functional improvements at 8 years following AVR with the Magna Ease valve.
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- 2022
6. Impact of Total Ischemic Time and Disease Severity Class on Graft Function after Bilateral Lung Transplantation
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Khalil Aburahma, Nunzio D de Manna, Dietmar Boethig, Maximilian Franz, Pavel Iablonskii, Emma L Heise, Dmitry Bobylev, Murat Avsar, Mark Greer, Nicolaus Schwerk, Wiebke Sommer, Tobias Welte, Axel Haverich, Gregor Warnecke, Christian Kuehn, Jawad Salman, and Fabio Ius
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Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Objectives Total ischemic time is considered a limiting factor in lung transplantation. In this retrospective study we investigate effects of ischemic time and disease burden on outcomes after bilateral lung transplantation. Methods 1,298 patients undergoing bilateral lung transplantation between January 2010 and May 2022 (Follow-up 100%, median 54 months) were included. Pre-transplant diseases ‘severity (recipient body mass index, recipient age, previous lung transplantation, Tacrolimus immunosuppression, preoperative recipient extracorporeal membrane oxygenation support, lung volume reduction) for graft failure was individually calculated and- as ischemic time- categorised. Vice-versa adjusted Cox models were calculated. Considering competing risks, we assessed cumulative incidences of airway obstructive complications and chronic lung allograft dysfunction with death as competing risk factors for primary graft dysfunction were assessed by binary logistic regression. Results Higher disease burden significantly accelerated chronic lung allograft dysfunction and death occurrence (p Conclusion The eventual graft survival disadvantage that results from an ischemic time between 7 and at least 11 hours is negligible in contrast to frequent recipients’ disease-based risk levels.
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- 2023
7. Frauen in der Herzchirurgie
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Jasmin S. Hanke, Gloria Färber, Andreas Beckmann, Claudia Schmidtke, Erik Klautzsch, Beniye Erman, Axel Haverich, Volkmar Falk, Andreas Böning, Torsten Doenst, Jan D. Schmitto, Jan Gummert, and Sabine Bleiziffer
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
8. Minimally Invasive Mitral Valve Surgery in the Elderly
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Maximilian Franz, Nunzio Davide De Manna, Saskia Schulz, Fabio Ius, Axel Haverich, Serghei Cebotari, Igor Tudorache, and Jawad Salman
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Background The minimally invasive mitral valve procedure warrants minimal surgical trauma and might influence the postoperative course positively, especially in old patients. In this retrospective study, we reviewed our experience in minimally invasive mitral valve surgery (miMVS) in patients aged ≥ 75 years. Methods In this retrospective cohort study, based on propensity score matching, we compared patients aged ≥75 years with patients aged Results Between January 2011 and February 2021, 761 patients underwent miMVS at our institution. After propensity score matching, a study group (≥75 years, n = 189) and a control group ( Conclusion miMVS results in satisfactory early postoperative outcomes in elderly patients.
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- 2023
9. Simultaneous Aortic and Pulmonary Valve Replacement in Repaired Congenital Heart Disease
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Dmitry Bobylev, Klea Hysko, Murat Avsar, Tomislav Cvitkovic, Elena Petena, Samir Sarikouch, Mechthild Westhoff Bleck, Georg Hansmann, Axel Haverich, and Alexander Horke
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Objectives Patients with congenital heart disease frequently require surgical or percutaneous interventional valve replacement after initial congenital heart defect (CHD) repair. In some of these patients, simultaneous replacement of both semilunar valves is necessary, resulting in increased procedural complexity, morbidity, and mortality. In this study, we analyze the outcomes of simultaneous aortic and pulmonary valve replacements following multiple surgical interventions for CHD. Methods This was a retrospective study of 24 patients who after initial repair of CHD underwent single-stage aortic and pulmonary valve replacement at our institution between 2003 and 2021. Results The mean age of the patients was 28 ± 13 years; the mean time since the last surgery was 15 ± 11 years. Decellularized valved homografts (DVHs) were used in nine patients, and mechanical valves were implanted in seven others. In eight patients, DVHs, biological, and mechanical valves were implanted in various combinations. The mean cardiopulmonary bypass time was 303 ± 104 minutes, and aortic cross-clamp time was 152 ± 73 minutes. Two patients died at 12 and 16 days postoperatively. At a maximum follow-up time of 17 years (mean 7 ± 5 years), 95% of the surviving patients were categorized as New York Heart Association heart failure class I. Conclusions Single-stage aortic and pulmonary valve replacement after initial repair of CHD remains challenging with substantial perioperative mortality (8.3%). Nevertheless, long-term survival and clinical status at the latest follow-up were excellent. The valve type had no relevant impact on the postoperative course. The selection of the valves for implantation should take into account operation-specific factors—in particular reoperability—as well as the patients' wishes.
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- 2023
10. Does donor–recipient age mismatch have an influence on outcome after lung transplantation? A single-centre experience
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Maximilian Franz, Khalil Aburahma, Murat Avsar, Dietmar Boethig, Mark Greer, Hani Alhadidi, Wiebke Sommer, Igor Tudorache, Gregor Warnecke, Axel Haverich, Fabio Ius, and Jawad Salman
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Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
OBJECTIVESLack of organ donors demands transplantation of older lung allografts for recipients between 0 and 50 years. So far, it has not yet been investigated whether donor–recipient age mismatch affects long-term outcome.METHODSRecords of patients aged between 0 and 50 years were retrospectively reviewed. Donor–recipient age mismatch was calculated subtracting recipient age from donor age. Multivariable Cox regression analyses was performed to assess donor–recipient age mismatch regarding the end points’ overall patient mortality, mortality conditioned to hospital discharge, biopsy-confirmed rejection and chronic lung allograft dysfunction. Furthermore, we performed competing risk analysis to analyse if age mismatch affects biopsy-confirmed rejection and CLAD while death being a competing risk.RESULTSBetween January 2010 and September 2021, out of 1363 patients who underwent lung transplantation at our institution, 409 patients fulfilled the eligibility criteria and were included. Age mismatch ranged between 0 and 56 years. Multivariable analysis revealed that donor–recipient age mismatch does not affect overall patient mortality (P = 0.19), biopsy-confirmed rejection (P = 0.68) and chronic lung allograft dysfunction (P = 0.42). There was no difference seen in CLAD (P = 0.166) and biopsy-confirmed rejection (P = 0.944) with the competing risk death (P = 0.765 and P = 0.851; respectively).CONCLUSIONSAge mismatch between recipients and donors of lung allografts does not affect long-term outcomes after lung transplantation.
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- 2023
11. Surgical management of large tracheoesophageal fistula in infants after button battery ingestion
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Murat Avsar, Tobias Goecke, Oliver Keil, Harald Koeditz, Nicolaus Schwerk, Joachim F Kuebler, Alexander Horke, Gregor Warnecke, Axel Haverich, Benno Ure, and Patrick Zardo
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Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
OBJECTIVESIn recent years, an increase in severe and even fatal outcomes related to oesophageal or airway button battery (BB) ingestion by infants and small children has been reported. Extensive tissue necrosis caused by lodged BB can lead to major complications, including tracheoesophageal fistula (TEF). In these instances, best treatment remains controversial. While small defects may warrant a conservative approach, surgery often remains inevitable in highly complex cases with large TEF. We present a series of small children that underwent successful surgical management by a multidisciplinary team in our institution.METHODSThis is a retrospective analysis of n = 4 patients RESULTSSurgical repair under extracorporeal membrane oxygenation (ECMO) support was feasible in n = 4 patients by reconstructing the trachea with decellularized aortic homografts that were buttressed with pedicled latissimus dorsi muscle flaps. While direct oesophageal repair was feasible in 1 patient, 3 required esophagogastrostomy and secondary repair. The procedure was completed successfully in all 4 children with no mortality and acceptable morbidity.CONCLUSIONSTracheo-oesophageal repair after BB ingestion remains challenging and is associated with major morbidity. Bioprosthetic materials in conjunction with the interposition of vascularized tissue flaps between trachea and oesophagus appear to be a valid approach to manage severe cases.
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- 2023
12. Does valve size impact hemodynamic, left ventricular mass regression, and prosthetic valve deterioration with a sutureless aortic valve?
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Gabriel S. Aldea, Christopher R. Burke, Theodor Fischlein, David A. Heimansohn, Axel Haverich, Rakesh M. Suri, and Niv Ad
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
13. Outcomes in patients with cardiac amyloidosis undergoing heart transplantation: the Eurotransplant experience
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Martin J. Kraus, Jacqueline M. Smits, Anna L. Meyer, Agita Strelniece, Arne van Kins, Udo Boeken, Alexander Reinecke, Zdenek Provaznik, Oliver Van Caenegem, Arnaud Ancion, Michael Berchtold-Herz, Johan J.A. Van Cleemput, Axel Haverich, Guenther Laufer, Jan Gummert, Matthias Karck, Gregor Warnecke, Philip W. Raake, Norbert Frey, and Michael M. Kreusser
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Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,ddc:610 ,Cardiology and Cardiovascular Medicine - Published
- 2023
14. Features and risk factors of early intraluminal thrombus formation within the frozen elephant trunk stent graft
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Andreas Martens, Erik Beckmann, Tim Kaufeld, Morsi Arar, Ruslan Natanov, Felix Fleissner, Wilhelm Korte, Heike Krueger, Dietmar Boethig, Axel Haverich, and Malakh Shrestha
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
15. Indications and outcome after lung transplantation in children under 12 years of age: A 16-year single center experience
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Thomas Jack, Christian Kuehn, Mark Greer, Pavel Iablonskii, Murat Avsar, Axel Haverich, Dietmar Boethig, Joerg Optenhoefel, H. Koeditz, Katharina Floethmann, Georg Hansmann, Gregor Warnecke, C. Mueller, Dmitry Bobylev, A. Niehaus, K. Aburahma, Fabio Ius, Maximilian Franz, Wiebke Sommer, Nicolaus Schwerk, Alexander Horke, Jawad Salman, Julia Carlens, I. Tudorache, and Gesine Hansen
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Primary Graft Dysfunction ,Single Center ,law.invention ,Young Adult ,Extracorporeal Membrane Oxygenation ,law ,Germany ,medicine ,Cardiopulmonary bypass ,Humans ,Lung transplantation ,Hospital Mortality ,Child ,Aged ,Retrospective Studies ,Postoperative Care ,Transplantation ,Lung ,business.industry ,Graft Survival ,Interstitial lung disease ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Surgery ,Survival Rate ,Treatment Outcome ,medicine.anatomical_structure ,Female ,Graft survival ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Forecasting ,Lung Transplantation - Abstract
OBJECTIVE Paediatric lung transplantation poses unique management challenges. Experience regarding indications and outcome is scarce, especially in younger children. The primary aim of this study was to investigate outcome after first lung transplantation in children
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- 2022
16. 4D-flow cardiac magnetic resonance imaging after aortic root replacement with long-valved decellularized aortic homografts: comparison to valve-sparing aortic root replacement and healthy controls
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Tomislav Cvitkovic, Dmitry Bobylev, Alexander Horke, Murat Avsar, Philipp Beerbaum, Andreas Martens, Dietmar Böthig, Elena Petenà, Marcel Gutberlet, Frerk Hinnerk Beyer, Frank Wacker, Serghei Cebotari, Axel Haverich, Jens Vogel-Claussen, Samir Sarikouch, and Christoph Czerner
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Hemodynamics ,General Medicine ,Pulse Wave Analysis ,Allografts ,Magnetic Resonance Imaging ,Aortic Valve ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,Aorta ,Blood Flow Velocity - Abstract
OBJECTIVES Long-valved decellularized aortic homografts (DAH) may be used in young patients to treat aortic valve disease associated with aortic root dilatation, thereby eliminating the need for prosthetic material and anticoagulation. METHODS Thirty-three male subjects in 3 equally sized cohorts were compared: patients following DAH implantation with a median age of 29 years [interquartile range (IQR) 27.5–37.5], patients post-valve-sparing aortic root replacement (VSARR), median 44 years (IQR 31.5–49) and healthy controls, median 33 years (IQR 28–40, P = 0.228). Time-resolved three-dimensional phase-contrast cardiac magnetic resonance imaging was performed to assess maximum blood flow velocity, pulse wave velocity, mechanical energy loss (EL), wall shear stress and flow patterns (vorticity, eccentricity, helicity) in 5 different planes of the aorta. RESULTS The mean time between surgery and cardiovascular magnetic resonance was 2.56 ± 2.0 years in DAH vs 2.67 ± 2.1 in VSARR, P = 0.500. No significant differences in maximum velocity and pulse wave velocity were found between healthy controls and DAH across all planes. Velocity in the proximal aorta was significantly higher in VSARR (182.91 ± 53.91 cm/s, P = 0.032) compared with healthy controls. EL was significantly higher in VSARR in the proximal aorta with 1.85 mW (IQR 1.39–2.95) compared with healthy controls, 1.06 mW (0.91–1.22, P = 0.016), as well as in the entire thoracic aorta. In contrast, there was no significant EL in DAH in the proximal, 1.27 m/W (0.92–1.53, P = 0.296), as well as in the thoracic aorta, 7.7 m/W (5.25–9.90, P = 0.114), compared with healthy controls. There were no significant differences in wall shear stress parameters for all 5 regions of the thoracic aorta between the 3 groups. DAH patients, however, showed more vorticity, helicity and eccentricity in the ascending aorta compared with healthy controls (P CONCLUSIONS Decellularized long aortic homografts exhibit near to normal haemodynamic parameters 2.5 years postoperatively compared with healthy controls and VSARR.
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- 2022
17. Mid-term Outcome of the Edge-To-Edge Mitral Valve Repair Via Aortic Outflow Tract in High-Risk Patients
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Jasmin S. Hanke, Günes Dogan, Serghei Cebotari, Jan D. Schmitto, Christina Feldmann, Anamika Chatterjee, Leonhard Wert, Issam Ismail, and Axel Haverich
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Interquartile range ,Mitral valve ,medicine ,Humans ,cardiovascular diseases ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Mitral valve repair ,Mitral regurgitation ,business.industry ,Mitral Valve Insufficiency ,EuroSCORE ,Atrial fibrillation ,General Medicine ,medicine.disease ,New York Heart Association Functional Classification ,Surgery ,Stroke ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,cardiovascular system ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
The edge-to-edge mitral valve repair technique, invented by Alfieri and colleagues, introduced valve repair as a treatment option for patients with complex diseases where standard annuloplasty and related repair techniques are insufficient, due to annular calcification and patient frailty. We retrospectively evaluated the results of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) in high-risk patients who were undergoing aortic valve replacement. From February, 2012 to December, 2017, 43 patients underwent transaortic edge-to-edge mitral valve repair with concomitant aortic valve replacement at a single institution. Preoperative and postoperative echocardiograms were compared. Home telephone follow up was conducted and postoperative morbidity was examined, including the need for reoperation, stroke and cardiac arrhythmia. 30-day and long-term survival rates were also determined. Mitral regurgitation (MR) was graded semi-quantitatively as 0 (trace and/or none), mild (1), moderate (2) or moderate to severe (3-4). The patients were 74 ± 7.8 years old. 65% of the patients were male. Mean cardiopulmonary bypass time was 115 ± 37 minutes and mean cross-clamp time was 71 ± 23 minutes. There was a significant improvement in preoperative vs postoperative median MR grade (2 (IQR 2-3) vs 0 (IQR 0-1); P = 0.05). Follow-up transthoracic echocardiograms in 29 patients obtained at a median of 9 months' (range 3 - 19 months') and in 16 patients at a median of 34 months' postoperatively (range 21 - 53 months') showed mild (1 (IQR 1-2)) grade of mitral regurgitation. 30-day survival was 98%. Long term survival at 12 and 24 months' were 88% and 81% respectively. Mitral valve reoperation was conducted in 1 patient (2%), who was suffering of endocarditis. Stroke occurred in 2 patients (7%). Cardiac arrhythmia was observed in 15 patients (35%). 8 patients (19%) suffered from atrial fibrillation and 7 patients (16%) displayed atrioventricular blockage. 10 patients (23%) could be treated conservatively and 5 patients (12%) needed implantation of a pacemaker. Transaortic edge-to-edge mitral valve repair can be safely performed during aortic valve replacement in high-risk patients and improves even long-term MR grade. Postoperative cardiac arrhythmia occurs frequently. 66% of them could be treated successfully by conservative procedures.
- Published
- 2022
18. Total Aortic Arch Replacements With a 4 Branched Frozen Elephant Trunk (FET) Graft in Acute Aortic Dissection (DeBakey type I)
- Author
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Malakh Shrestha, Erik Beckmann, Tim Kaufeld, Axel Haverich, and Andreas Martens
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
19. (906) Impact of Donor Quality on Recipient Outcomes in Lung Transplantation: 12-Year Single-Center Experience Using the Eurotransplant Lung Donor Score
- Author
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K. Floethmann, K. Aburahma, N.D. de Manna, M. Franz, P. Yablonski, A. Saipbaev, M. Greer, M. Avsar, D. Bobylev, N. Schwerk, W. Sommer, G. Warnecke, T. Welte, A. Haverich, C. Kuehn, J. Salman, and F. Ius
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
20. (1264) Recipients of Extended Criteria Ex Situ Preserved Lungs Display Higher Plasma Levels of Cytokines and Endothelial Markers after Lung Transplantation Without Higher PGD Scores
- Author
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J.F. Kuehne, K. Beushausen, J. Keil, B. Wiegmann, F. Ius, L. Chacon, C. Kuehn, M. Avsar, A. Haverich, G. Loor, G. Warnecke, and C.S. Falk
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
21. Surgical treatment of non-cystic fibrosis bronchiectasis in Central Europe
- Author
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Axel Haverich, Patrick Zardo, Tomoyuki Nakagiri, Alaa Selman, Hayan Merhej, Norman Zinne, and Tobias Goecke
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung ,Bronchiectasis ,business.industry ,medicine.medical_treatment ,Non cystic fibrosis bronchiectasis ,Perioperative ,medicine.disease ,Surgery ,Chest tube ,medicine.anatomical_structure ,medicine ,Original Article ,Myocardial infarction ,Surgical treatment ,business ,Aspergilloma - Abstract
Background Bronchiectasis is a mostly irreversible bronchial dilatation induced by the destruction of elastic and muscular fibers of the bronchial wall. Surgical treatment is usually reserved for focal disease, and whenever complications, like hemoptysis or secondary aspergilloma, arise. In this study, we report our experience and outcomes in surgical bronchiectasis management between 2016 and 2020. Methods We retrospectively searched our database for patients admitted for surgical treatment of bronchiectasis between 2016 and 2020. All records were screened for pre-surgical management. Age, gender, distribution of bronchiectatic lesions, type of surgery, perioperative complications, chest tube duration, length of hospital stay as well as 30-day-mortality were recorded, and a brief follow-up was made. Results A total of n=34 patients underwent pulmonary resection with bronchiectasis. Mean age on admission was 56.2±15.1 years and n=21 patients (62%) were female. In n=23 cases the right lung was affected, in n=9 cases the left side and in two cases both lungs. Indications for surgery included persistent major alterations after conservative therapy (n=9), massive hemoptysis (n=4), and full-blown "destroyed lobe" (n=7). All patients received anatomical lung resection (n=21 lobectomies, n=2 bilobectomies and n=11 segmentectomies), either by uniportal video assisted thoracoscopic surgery (n=28) or by lateral thoracotomy (n=6). Average length of hospital stay was 7.9±6.3 days; one patient died on POD 7 due to myocardial infarction. Conclusions In spite of a decreasing number of patients with bronchiectasis referred to surgery due to improvements in preventing and managing the disease, pulmonary resection still plays a significant role in treating this pathology in Central Europe. Surgery remains a viable approach for localized forms of bronchiectasis, and the only option in treating acute deterioration and complications like massive hemoptysis.
- Published
- 2021
22. Preoperative pericardial hematoma in patients with acute type A aortic dissection (AAAD): Do we need an adjusted treatment?
- Author
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Tim Kaufeld, Erik Beckmann, Linda Rudolph, Heike Krüger, Ruslan Natanov, Morsi Arar, Wilhelm Korte, Tobias Schilling, Axel Haverich, Andreas Martens, and Malakh Shrestha
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Objective An acute type A aortic dissection (AAAD) is a critical emergency and remains one of the most challenging diseases in cardiothoracic surgery. The existence of a pericardial hematoma caused by an aortic rupture can dramatically reduce the chances of survival (Jerzewski and Kulik in J Card Surg 29(4):529–530, 2014; Mehta et al. in Circulation 105(2):200–206, 2002; Gilon et al. in Am J Cardiol 103(7):1029–1031, 2009; Isselbacher et al. in Circulation 90(5):2375–2378, 1994). We assessed the surgical outcome of a high-risk group of patients with AAAD and a pericardial hematoma. Methods In this study we included 430 Patients (67% male; median age: 64 years) who received surgical treatment between January 2000 and January 2018 at our facility for acute aortic dissection DeBakey type I. We divided the cohort in two groups: Group A consisted of high-risk patients with a pericardial hematoma (n = 162) and Group B of patients without pericardial hematoma (n = 268). Results Patients with a preoperative pericardial hematoma had a significantly higher requirement for preoperative mechanical resuscitation (A: 21%; B: 1.5%; P: P: P: 0.034). Limited aortic arch repair (proximal aortic arch replacement) was preferred in the high-risk group (A: 51.9%; B: 40.3%; P: 0.020). However, survival time was generally reduced in these patients (A: 7.5 y; B: 9.9 y). Conclusion AAAD patients with preoperative pericardial hematoma present themselves in potentially lethal conditions, with a significantly higher rate of visceral malperfusion. Despite the existence of this risk factor, a limited arch repair was favored. We have proven that cardiac compression is associated with preoperative intubation and mechanical resuscitation. Patients with pericardial hematoma must be further evaluated for preoperative pericardial drainage. In the event of long transfer times to an aortic center a slow drainage should be discussed to prevent early mortality.
- Published
- 2022
23. Discussion
- Author
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Axel Haverich
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
24. 5-Year results from the prospective European multi-centre study on decellularized homografts for pulmonary valve replacement ESPOIR Trial and ESPOIR Registry data
- Author
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Dmitry Bobylev, Alexander Horke, Dietmar Boethig, Mark Hazekamp, Bart Meyns, Filip Rega, Hitendu Dave, Martin Schmiady, Anatol Ciubotaru, Eduard Cheptanaru, Vladimiro Vida, Massimo Padalino, Victor Tsang, Ramadan Jashari, Günther Laufer, Martin Andreas, Alexandra Andreeva, Igor Tudorache, Serghei Cebotari, Axel Haverich, and Samir Sarikouch
- Subjects
Pulmonary and Respiratory Medicine ,Cardiac & Cardiovascular Systems ,Adolescent ,Respiratory System ,Humans ,Tissue engineering ,Prospective Studies ,Registries ,Decellularization ,Aged ,Heart Valve Prosthesis Implantation ,Pulmonary Valve ,Science & Technology ,ALLOGRAFTS ,Heart valve disease ,General Medicine ,Allografts ,Treatment Outcome ,Heart Valve Prosthesis ,Aortic Valve ,Cardiovascular System & Cardiology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,Life Sciences & Biomedicine ,Follow-Up Studies - Abstract
OBJECTIVES Early results from the prospective ESPOIR Trial have indicated excellent results for pulmonary valve replacement using decellularized pulmonary homografts (DPH). METHODS A 5-year analysis of ESPOIR Trial patients was performed to provide an insight into the midterm DPH performance. ESPOIR Trial and Registry patients were matched with cryopreserved homografts (CH) patients considering patient age, type of heart defect and previous procedures to present the overall experience with DPH. RESULTS A total of 121 patients (59 female) were prospectively enrolled (8/2014–12/2016), median age 16.5 years (interquartile range 11.2–29.8), and median DPH diameter 24 mm. One death (73 year-old) occurred during a median follow-up of 5.9 years (5.4–6.4), in addition to 2 perioperative deaths resulting in an overall mortality rate of 2.5%. One case of endocarditis in 637 patient-years was noticed, resulting in an incidence of 0.15% per patient-year. At 5 years, the mean peak gradient was 19.9 mmHg (9.9), mean regurgitation 0.9 (0.6, grade 0–3) and freedom from explantation/any reintervention 97.5% (1.5). The combined DPH cohort, n = 319, comprising both Trial and Registry data, showed significantly better freedom from explantation for DPH 95.5% (standard deviation 1.7) than CH 83.0% (2.8) (P CONCLUSIONS The 5-year data of the prospective ESPOIR Trial show excellent performance for DPH and low rates of adverse events. ESPOIR Registry data up to 15 years, including a matched comparison with CH, demonstrated statistically significant better freedom from explantation.
- Published
- 2022
25. Pediatric urgent heart transplantation with age or weight mismatched donors: Reducing waiting time by enlarging donor criteria
- Author
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Axel Haverich, Elena Petená, Alexander Horke, Valery Tsimashok, Dmitry Bobylev, Harald Köditz, Philipp Beerbaum, Gregor Warnecke, Murat Avsar, Tomislav Cvitkovic, Dietmar Böthig, and Fabio Ius
- Subjects
Adult ,Pulmonary and Respiratory Medicine ,Waiting time ,medicine.medical_specialty ,Waiting Lists ,medicine.medical_treatment ,Cardiac allograft vasculopathy ,Waiting list mortality ,law.invention ,Cohort Studies ,law ,Humans ,Medicine ,Child ,Retrospective Studies ,Heart transplantation ,business.industry ,Intensive care unit ,Tissue Donors ,Surgery ,Transplantation ,Child, Preschool ,Cohort ,Heart Transplantation ,Pediatric heart transplantation ,Cardiology and Cardiovascular Medicine ,business - Abstract
Despite considerable progress in heart transplantation, pediatric waiting list mortality is still high, and often patients do not have enough time to wait. We hypothesized that extending the donor criteria regarding age and weight mismatch does not significantly affect the early follow-up.We retrospectively analyzed our pediatric heart transplantation patients operated on from 2014 to 2020 for high (3.0) or low (0.6) donor-recipient weight ratio (DRWR) or chronological age mismatches (donor organ5 years older than recipient age). This patient cohort constituted "mismatched heart transplantations" (mHTX). We compared mHTX preoperative status, postoperative course, 1-year survival, and early clinical follow-up to standard pediatric heart transplantations (sHTX).We performed 20 pediatric heart transplantations-10 mHTX and 10 sHTX. The minimum DRWR was 0.44, the maximum was 5.60, and the maximum age mismatch was 42.6 years. Median days in the intensive care unit (p = .436) and time-to-first-rejection episode (p = .925) were comparable. Nine patients in each group were alive after 1 year, two patients were operated within 1 year of follow-up. One mHTX patient developed cardiac allograft vasculopathy after 15 months and died 648 days after transplantation (p = .237). All other patients were alive at the end of follow-up and in good clinical conditions (median follow-up for mHTX was 732.5 days, 1149.5 days for sHTX).Postoperative course and early follow-up after mHTX were comparable to sHTX. In urgent clinical situations, extended donor criteria may be considered an additional option for pediatric heart transplantation.
- Published
- 2021
26. Chirurgische Beiträge zur kardialen Stammzelltherapie
- Author
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Axel Haverich and Sebastian V. Rojas
- Subjects
Pulmonary and Respiratory Medicine ,Gynecology ,medicine.medical_specialty ,business.industry ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Die hohe Inzidenz der Herzinsuffizienz bedeutet eine besonders grose Herausforderung fur die kardiovaskulare Medizin. Eine vielversprechende Quelle fur kardioregenerative Ansatze stellt die Stammzelltherapie dar, allerdings wurde trotz zahlreicher experimenteller Studien noch kein therapeutischer Durchbruch erreicht. Neben der Auswahl des richtigen Zelltyps stehen technische Details wie Methoden zur Zellapplikation im Fokus der Wissenschaft. Erstellung einer Ubersicht der bisherigen Forschungsergebnisse im Bereich der myokardialen Stammzelltherapie mit besonderem Fokus auf die chirurgische Applikation sowie Strategien zur Verbesserung von Zellretention und Biodistribution. Literaturrecherche uber MEDLINE und PubMed, Analyse der vorliegenden Publikationen und Diskussion der Ergebnisse in Bezug auf das Wirkungspotenzial der myokardialen Stammzelltherapie. Ubersicht der Arbeiten, die kumulativ mit dem Ernst-Derra-Preis 2021 ausgezeichnet wurden. Unter Verwendung von Fluoreszenzpartikeln als Zellsurrogat zeigte sich, dass kurz nach intrakardialer Injektion mehr als die Halfte der Partikel das Injektionsgebiet verlassen hatten, sofern diese in wassriger Losung appliziert wurden. Im zellularen Modell bestatigte sich dies; zudem wurde gezeigt, dass es zu einer Kumulation von Stammzellen in beiden Lungenflugeln kommt. Unter Verwendung einer Fibrinogenbiomatrix konnte hingegen sowohl die kardiale Retention als auch die Biodistribution der Stammzellen verbessert werden. Chirurgische Applikationstechniken zur Stammzelltherapie sind ein sehr wichtiger Einflussfaktor bezuglich der Wirksamkeit und Beurteilung der kardialen Stammzelltherapie.
- Published
- 2021
27. Valve-sparing aortic root replacement in adult patients with congenital heart disease
- Author
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Harald Bertram, Axel Haverich, Philipp Beerbaum, Tomislav Cvitkovic, Murat Avsar, Alexander Horke, Samir Sarikouch, Dietmar Boethig, Mechthild Westhoff-Bleck, and Dmitry Bobylev
- Subjects
Adult ,Heart Defects, Congenital ,Pulmonary and Respiratory Medicine ,Valve-sparing aortic root replacement ,medicine.medical_specialty ,Aortic Valve Insufficiency ,Coarctation of the aorta ,030204 cardiovascular system & hematology ,Congenital ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pulmonary Valve Replacement ,medicine ,Humans ,Aorta ,Aortic valve regurgitation ,Tetralogy of Fallot ,business.industry ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Great arteries ,Ventricle ,Aortic Valve ,Replantation ,Cardiology and Cardiovascular Medicine ,Pulmonary atresia ,business - Abstract
OBJECTIVES Aortic root dilatation is frequently observed in patients with congenital heart defects (CHD), but has received little attention in terms of developing a best practice approach for treatment. In this study, we analysed our experience with aortic valve-sparing root replacement in patients following previous operations to repair CHD. METHODS In this study, we included 7 patients with a history of previous surgery for CHD who underwent aortic valve-sparing operations. The underlying initial defects were tetralogy of Fallot (n = 3), transposition of great arteries (n = 2), coarctation of the aorta (n = 1), and pulmonary atresia with ventricle septum defect (n = 1). The patients’ age ranged from 20 to 40 years (mean age 31 ± 6 years). RESULTS David reimplantation was performed in 6 patients and a Yacoub remodelling procedure was performed in 1 patient. Four patients underwent simultaneous pulmonary valve replacement. The mean interval between the corrective procedure for CHD and the aortic valve-sparing surgery was 26 ± 3 years. There was no operative or late mortality. The patient with transposition of great arteries following an arterial switch operation was re-operated 25 months after the valve-sparing procedure due to severe aortic regurgitation. In all other patients, the aortic valve regurgitation was mild or negligible at the latest follow-up (mean 8.7 years, range 2.1–15.1 years). CONCLUSIONS Valve-sparing aortic root replacement resulted in good aortic valve function during the first decade of observation in 6 of 7 patients. This approach can offer a viable alternative to root replacement with mechanical or biological prostheses in selected patients following CHD repair.
- Published
- 2021
28. (908) Does Donor-Recipient Sex Mismatch Have an Influence on Long Term Outcomes after Lung Transplantation? An Experience of a High Volume Center
- Author
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M. Franz, K. Aburahma, M. Avsar, D. Bobylev, W. Sommer, M. Greer, I. Tudorache, T. Welte, A. Haverich, G. Warnecke, C. Kuehn, F. Ius, and J. Salman
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
29. (882) Nine-Year Results of an IgA-And IgM-Enriched Human Immunoglobulin-Based Therapy for Early Detectable Anti-HLA Donor Specific Antibodies after Lung Transplantation
- Author
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K. Aburahma, M. Franz, P. Yablonski, N.D. de Manna, A. Saipbaev, M. Avsar, N. Schwerk, W. Sommer, M. Greer, C. Falk, T. Welte, A. Haverich, C. Kuehn, G. Warnecke, J. Salman, and F. Ius
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
30. (101) Nine-Year Experience with Treatment of Early Detectable Donor Specific Anti-HLA Antibodies in Pediatric Lung Transplant Recipients
- Author
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M. Franz, K. Aburahma, P. Yablonski, J. Carlens, A. Saipbaev, C. Mueller, W. Sommer, C. Kuehn, A. Haverich, G. Warnecke, M. Avsar, N. Schwerk, J. Salman, D. Bobylev, and F. Ius
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
31. (348) Longitudinal Dynamics of SARS-CoV-2 Spike-Specific Antibody Responses in Patients on Waiting List and after Lung Transplantation
- Author
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M. Hübner, J. Sauer, L. Ruhl, J. Kühne, K. Beushausen, J. Keil, M. Schael, F. Ius, T. Welte, A. Haverich, J. Gottlieb, M. Greer, and C. Falk
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
32. (402) 12-Year Experience with Postoperatively Extended Intraoperative Extracorporeal Membrane Oxygenation in Lung Transplantation for Patients with Severe Pulmonary Arterial Hypertension
- Author
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M. Franz, K. Aburahma, M. Avsar, D. Bobylev, W. Sommer, M. Greer, I. Tudorache, T. Welte, A. Haverich, G. Warnecke, C. Kuehn, F. Ius, and J. Salman
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
33. (120) Heart Preservation with the Organ Care System in Extended Criteria Donor Hearts: A Single Center Experience
- Author
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M. Franz, P. Yablonski, M. Arar, A. Haverich, G. Warnecke, A. Niehaus, M. Avsar, J. Salman, and F. Ius
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
34. (410) Perioperative Desensitization Changes the Plasma Cytokine Milieu in Lung Transplant Patients with Preformed Donor Specific Antibodies
- Author
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E. Heise, E. Chichelnitskiy, M. Franz, K. Aburahma, P. Iablonski, D. Bobylev, A. Saipbaev, N. Schwerk, W. Sommer, M. Greer, M. Avsar, B. Wiegmann, A. Knöfel, J. Kühne, G. Warnecke, A. Haverich, C. Kühn, J. Salman, C. Falk, and F. Ius
- Subjects
Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
35. Vascular procedures in patients with left ventricular assist devices: single-center experience
- Author
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Axel Haverich, Jan D. Schmitto, Julia Neuser, Mathias Wilhelmi, Saad Rustum, Thomas Aper, and Jasmin S. Hanke
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,LVAD ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Stroke ,business.industry ,Bleeding ,Thrombosis ,Perioperative ,Vascular surgery ,equipment and supplies ,medicine.disease ,Cardiac surgery ,Surgery ,030228 respiratory system ,Cardiothoracic surgery ,Ventricular assist device ,Heart failure ,Original Article ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective A growing number of patients suffering from heart failure is living with a left ventricular assist device (LVAD) and is in the need for non-cardiac surgery. Vascular procedures due to ischemia, bleeding, or other device-related complications may be required and pose a challenge to the caregivers in terms of monitoring and management of these patients. Therefore, we reviewed our experience with LVAD patients undergoing vascular surgery. Methods From January 2010 until March 2017, a total of 54 vascular procedures were performed on 41 LVAD patients at our institution. Patient records were reviewed retrospectively in terms of incidence of LVAD-related complications, including thrombosis, stroke, bleeding, wound healing, and survival associated with vascular surgery. The type of surgery was recorded, as well as various clinical demographic variables. Results Vascular procedures were performed in 35 men (85.4%) and 6 women (14.6%) with LVADs. There were no perioperative strokes, device thromboses, or device malfunctions. Thirty-day mortality overall was 26.8% (eleven patients), with most patients dying within 30 days after LVAD implantation due to multi-organ failure. In 25 procedures (46.3%), a blood transfusion was necessary. Conclusion Patients on LVAD support are a complex cohort with a high risk for perioperative complications. In a setting where device function and anticoagulation are monitored closely, vascular surgery in these patients is feasible with an acceptable perioperative risk.
- Published
- 2021
36. Intraoperative Extracorporeal Circulatory Support in Lung Transplantation for Pulmonary Fibrosis
- Author
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Hani Alhadidi, Axel Haverich, Christian Kuehn, Reza Poyanmehr, K. Aburahma, Murat Avsar, Jawad Salman, Beeke-Alina Bernhard, Thierry Siemeni, Igor Tudorache, Wiebke Sommer, Gregor Warnecke, and Fabio Ius
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Pulmonary Fibrosis ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Extracorporeal ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Risk Factors ,Pulmonary fibrosis ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Lung transplantation ,Risk factor ,Retrospective Studies ,Intraoperative Care ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Surgery ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,030228 respiratory system ,Vascular resistance ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Lung Transplantation - Abstract
Venous-arterial extracorporeal membrane oxygenation (ECMO) is an established technique for intraoperative cardiopulmonary support in patients undergoing lung transplantation. Patients with pulmonary fibrosis have a higher risk to require it. The aim of this study was to identify risk factors for the need of intraoperative ECMO use.Records of patients undergoing lung transplantation for pulmonary fibrosis at our institution between January 2010 and May 2018 were retrospectively reviewed. Univariate logistic regression analysis was used for statistical identification of risk factors.There were 105 patients (34%) who required intraoperative ECMO support (ECMO+ group), and 203 (66%) did not (ECMO- group). Preoperative proof of pulmonary hypertension was identified as a risk factor for intraoperative ECMO support (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.2-6.5; P.01). Revealed mean pulmonary arterial pressure values exceeding 50 mm Hg and pulmonary vascular resistance values exceeding 9.4 Wood units were identified as risk factors for the need of intraoperative ECMO use with a prediction probability of 70%. Increased recipient body surface area (OR, 0.2; 95% CI, 0.1-0.5; P.01) emerged as a protective factor against intraoperative ECMO (Hosmer-Lemeshow statistic, P = .71) as well as higher cardiac output (OR, 0.7; 95% CI, 0.6-0.9; P.01). The postoperative course was more complicated in the ECMO+ group, whereas survival at 5 years did not differ among groups (70% vs 69%, P = .79).Pulmonary hypertension with elevated pulmonary vascular resistance values predicts the need of intraoperative ECMO in patients receiving lung transplantation for pulmonary fibrosis. Although the postoperative course was more complicated in the ECMO+ group, long-term survival did not differ significantly.
- Published
- 2021
37. Commentary: Total aortic arch replacement and the frozen elephant trunk: Out with the old, in with the new?
- Author
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Erik Beckmann and Axel Haverich
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Elephant trunks ,business.industry ,Aortic arch replacement ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2022
38. Single-center experience with thoracoabdominal aortic replacement in patients with Marfan syndrome
- Author
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Saad Rustum, Osama Zahlout, Andreas Martens, Tim Kaufeld, Heike Krüger, Linda Rudolph, Axel Haverich, Malakh Shrestha, and Erik Beckmann
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Patients with Marfan syndrome are usually not suitable for endovascular repair of the thoracoabdominal aorta. This study was designed to analyze our center's experience with open surgical thoracoabdominal aortic replacement in Marfan patients.This was a retrospective study with prospective follow-up. Between January 1995 and September 2021, a total of 648 patients underwent thoracoabdominal aortic replacement at our center. Of these, 60 had Marfan syndrome and were included in this study.The mean age was 39.5 ± 10.7 years, and 36 (60%) were male. Ten (17%) had aortic aneurysm, 4 (7%) acute/subacute dissection, and 46 (77%) chronic dissection. Patients presented with the following extent of aortic disease according to the Crawford classification: I-17 (28%), II-18 (30%), III-22 (37%), IV-2 (3%), and V-1 (2%). The mean cardiopulmonary bypass time was 173.9 ± 84.7 minutes. Four (7%) patients required stent graft extraction. Postoperatively, 5 (8%) patients required rethoracotomy and 6 (10%) tracheostomy. One (1.7%) patient had permanent paraplegia and 2 (3%) permanent paraparesis. Two (3%) patients had stroke. One (1.7%) patient was discharged with dialysis. The 30-day mortality was 3% (n = 2). Median follow-up time was 21.5 (range, 9.4-33.6) years. The 1-, 5-, and 10-year survival rate was 87%, 80%, and 68%, respectively. There were 16 aortic reinterventions in 9 patients during follow-up.Thoracoabdominal aortic replacement remains a complex procedure but can be done extremely safely in Marfan patients. Perioperative mortality rates are very low, and the long-term outcomes are enduring. Because endovascular aortic repair is not recommended for patients with connective tissue disease, open surgery remains an important cornerstone of therapy.
- Published
- 2022
39. Valve-sparing aortic root replacement using a straight tube graft (David I procedure)
- Author
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Malakh, Shrestha, Dietmar, Boethig, Heike, Krüger, Tim, Kaufeld, Andreas, Martens, Axel, Haverich, and Erik, Beckmann
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
We present our 25-year experience with valve-sparing aortic root replacement using a straight tube graft (David-I).From 1993 to 2019, 677 patients (median age, 56.0 years; range, 42-65) underwent the David-I procedure with a straight tube graft. A total of 24 different surgeons performed these operations. Marfan syndrome was present in 111 patients (16.4%), and bicuspid aortic valve was present in 71 patients (10.5%). Aortic root aneurysm was present in 544 patients (80.4%), and acute dissection was present in 133 patients (19.6%).Ministernotomy was used in 57 patients (8.4%). Additional cusp plasty was performed in 84 patients (12.4%). Concomitant procedures were coronary artery bypass grafting (n = 122, 18.0%), mitral valve surgery (n = 34, 5%), proximal arch replacement (n = 125, 18.4%), subtotal arch replacement (n = 43, 6.4%), and total arch replacement (n = 102, 15.1%). Overall in-hospital mortality was 4.0% (n = 27), and perioperative stroke occurred in 26 patients (3.8%). Postoperative echocardiography showed aortic insufficiency less than I° in 600 of 623 (96.3%). The 1-, 5-, 10-, 15-, and 20-year survivals were 97%, 92%, 79%, 68%, and 50%, respectively. The rates for freedom from aortic valve-related reoperation at 1, 5, 10, 15, and 20 years were 97%, 92%, 87%, 84%, and 80%, respectively. Multivariate Cox regression analysis identified age (odds ratio, 0.974; 95% confidence interval, 0.957-0.992; P = .004), senior surgeon (odds ratio, 0.546; 95% confidence interval, 0.305-0.979; P = .042), and residual postoperative aortic insufficiency (odds ratio, 4.864; 95% confidence interval, 1.124-21.052; P = .034) as independent risk factors for aortic valve-related reoperation.The aortic valve-sparing David-I procedure can be performed with very low perioperative morbidity and mortality. The short- and long-term results are excellent. The straight tube graft does not lead to increased leaflet erosion. This procedure is reproducible by multiple surgeons.
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- 2022
40. Five-year outcomes of patients supported with HeartMate 3: a single-centre experience
- Author
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Johann Bauersachs, Tong Li, Jens Garbade, Ivan Netuka, Daniel Zimpfer, Silvia Mariani, Axel Haverich, Silvana Marasco, Friedhelm Beyersdorf, Michiel Morshuis, Christoph Bara, Vivek Rao, Jasmin S. Hanke, Thomas Krabatsch, Yuriy Pya, Guenes Dogan, and Jan D. Schmitto
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Clinical endpoint ,Humans ,Medicine ,Prospective Studies ,Prospective cohort study ,Heart Failure ,Heart transplantation ,business.industry ,Surrogate endpoint ,General Medicine ,medicine.disease ,Haemolysis ,Surgery ,Clinical trial ,Treatment Outcome ,030228 respiratory system ,Heart failure ,Ventricular assist device ,Quality of Life ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES The HeartMate 3 left ventricular assist device was first implanted in 2014 and received the Conformité Européenne mark in 2015. Since then, several trials demonstrated its high haemocompatibility associated with good survival and low adverse events rates. Herein, we report our institutional experience with patients supported with HeartMate 3 for 5 years. METHODS This prospective cohort study included patients receiving a HeartMate 3 implantation in 2014 as part of the HeartMate 3 Conformité Européenne Mark clinical trial. Patients had follow-up visits every 3 months while on left ventricular assist device support, and all patients completed the 5-year follow-up. The primary end point was survival at 5 years. Secondary end points included adverse events, health status and quality of life. RESULTS Eight patients (men: 75%) aged 59 years (min–max: 52–66 years) were enrolled. At 5 years, survival was 100%. Patients remained on support for a median time of 1825 days (min–max: 101–1825 days); 2 patients successfully received cardiac transplants. No right heart failure, haemolysis, pump thrombosis, pump malfunction or neurological events occurred in any patients. A driveline infection was observed in 6 patients (0.25 events/patient-year). Compared to baseline, a significant improvement in quality of life and in New York Heart Association functional class was noted after the implant and for the whole follow-up time. A slight decline in kidney function and in the 6-min walk test results occurred after 3 years. CONCLUSIONS This study reports the longest single-centre follow-up of the HeartMate 3, showing excellent haemocompatibility over time with high survival and low complication rates at 5 years.
- Published
- 2021
41. Is total aortic arch replacement with the frozen elephant trunk procedure reasonable in elderly patients?
- Author
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Andreas Martens, Erik Beckmann, Axel Haverich, Tim Kaufeld, Heike Krueger, Malakh Shrestha, and Ruslan Natanov
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Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Elephant trunks ,medicine.medical_treatment ,Aorta, Thoracic ,Blood Vessel Prosthesis Implantation ,medicine.artery ,medicine ,Humans ,Stroke ,Dialysis ,Aged ,Retrospective Studies ,Aortic Aneurysm, Thoracic ,business.industry ,General Medicine ,Odds ratio ,Perioperative ,medicine.disease ,Confidence interval ,Surgery ,Log-rank test ,Aortic Dissection ,Treatment Outcome ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES Total aortic arch replacement is an invasive procedure with significant risks for complications. These risks are even higher in older, multimorbid patients. The current trends in demographic changes in western countries with an ageing population will aggravate this issue. In this study, we present our experience with total aortic arch replacement using the frozen elephant trunk (FET) technique in septuagenarians. We compared the results of septuagenarians with those of younger patients and analysed if there was an improvement in outcome over time. METHODS Between August 2001 and March 2020, 225 patients underwent non-urgent FET procedure at our institution. There were 75 patients aged ≥70 years (mean age 74 ± 4) who were assigned to group A, and 150 patients aged RESULTS The rate for temporary dialysis was significantly higher in group A than in group B (29% vs 13%, P = 0.003), although the majority recovered kidney function. Rates for re-exploration for bleeding and stroke were comparable in both groups. In-hospital mortality was significantly higher in group A than in group B (24% vs 13%, P = 0.037). Logistic regression analysis showed that age >70 years was an independent statistically significant risk factor for in-hospital mortality (odds ratio = 2.513, 95% confidence interval = 1.197–5.278, P-value = 0.015). Follow-up was complete for 100% of patients and comprised a total of 1073 patient-years with a mean follow-up time of 4.8 ± 4.5 years. The 1- and 5-year survival rates were 68% and 49% in group A, and 85% and 71% in group B, respectively (log rank, P Discussion Total aortic arch replacement using the FET technique has a significantly higher risk for perioperative morbidity and mortality in septuagenarians than in younger patients. Long-term survival is significantly impaired in older patients. We recommend thorough patient selection of those who require total aortic arch replacement, and optimization of perioperative management to improve outcomes.
- Published
- 2021
42. Implantation of two HeartMate 3s in the setting of a Total Artificial Heart
- Author
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Jasmin S. Hanke, Axel Haverich, Jan D. Schmitto, and Günes Dogan
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Mortality rate ,030204 cardiovascular system & hematology ,medicine.disease ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Biventricular heart failure ,law ,Artificial heart ,Internal medicine ,Heart failure ,medicine ,Cardiology ,Surgery ,Bridge to transplantation ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
Irreversible, end-stage biventricular heart failure is associated with mortality rates of up to 100%. Despite the increasing application of ventricular assist devices (VADs), many centers lack experience with total artificial heart (TAH) implantation techniques. We present a surgical technique consisting of the implantation of 2 HeartMate 3 VADs in the setting of a TAH as a bridge to transplantation strategy.
- Published
- 2021
43. Residual immune response towards decellularized homografts may be highly individual
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Dmitry Bobylev, Axel Haverich, Johannes Ebken, Andres Hilfiker, Tobias Goecke, Murat Avsar, Samir Sarikouch, Nils Mester, Dietmar Böthig, Ramadan Jashari, Alexander Horke, Serghei Cebotari, Isabel Smart, Robert Ramm, and Igor Tudorache
- Subjects
Heart Defects, Congenital ,Male ,Pulmonary and Respiratory Medicine ,Arbitrary unit ,Dot blot ,030204 cardiovascular system & hematology ,Andrology ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,ABO blood group system ,medicine.artery ,Translational Research ,medicine ,Humans ,Transplantation, Homologous ,Heart valve replacement ,Decellularization ,Pulmonary Valve ,Aorta ,Lung ,biology ,AcademicSubjects/MED00920 ,business.industry ,Immunogenicity ,Immunity ,General Medicine ,Allografts ,medicine.anatomical_structure ,030228 respiratory system ,Homograft ,Aortic Valve ,biology.protein ,Eacts/106 ,Female ,Surgery ,Eacts/108 ,Antibody ,Cardiology and Cardiovascular Medicine ,business ,Eacts/125 ,Eacts/103 - Abstract
OBJECTIVES Decellularized homograft valves (DHVs) have shown promising clinical results, particularly in the treatment of congenital heart disease. However, DHV appears to elicit an immune response in a subset of young patients, indicated by early valve degeneration. As the decellularization process is quality controlled for each DHV, we hypothesized that there may be residual immunogenicity within the extracellular matrix of DHV. METHODS A semi-quantitative dot blot analysis was established to screen for preformed recipient antibodies using secondary anti-human antibodies. Fifteen DHV samples (7 aortic, 8 pulmonary) were solubilized and exposed to serum from 20 healthy controls. RESULTS The sera from young controls (n = 10, 18–25 years) showed significantly stronger binding of preformed antibodies than sera from older individuals (n = 10, 48–73 years). The difference between the means of arbitrary units was 15.1 ± 6.5 (P = 0.0315). There was high intraindividual variance in the mean amounts of arbitrary units of antibody binding with some healthy controls showing >10 times higher antibody binding towards 2 different DHV. The amount of preformed antibodies bound to DHVs was higher in aortic than in pulmonary DHVs. The mean number of antibody binding (in arbitrary units) was 17.2 ± 4.5 in aortic and 14.5 ± 4.7 in pulmonary DHV (P = 0.27). The amount of preformed antibodies bound to pulmonary DHVs was statistically significantly higher in the sera of healthy males (n = 10) than in the sera of healthy females (n = 10). The mean number of arbitrary units was 17.2 ± 4.2 in male and 11.7 ± 5.3 in female sera (P = 0.036). Antibody binding to aortic DHV was also higher in males, but not significant (18.8 ± 5.0 vs 15.6 ± 4.0). Blood group (ABO) incompatibility between the serum from controls and DHV showed no impact on antibody binding, and there was no age-related impact among DHV donors. CONCLUSIONS Residual immunogenicity of decellularized homografts appears to exist despite almost complete cell removal. The established dot blot method allows a semi-quantitative assessment of the individual immune response towards extracellular DHV components and potentially the possibility of preoperative homograft matching.
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- 2020
44. Three-step preoperative sequential planning for pulmonary valve replacement in repaired tetralogy of Fallot using computed tomography
- Author
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Dietmar Boethig, Axel Haverich, Paulo Ernando Ferraz Cavalcanti, Samir Sarikouch, Tomislav Cvitkovic, Philipp Beerbaum, Catarina Cavalcanti, Ricardo Felipe de Albuquerque Lins, Ricardo de Carvalho Lima, Dmitry Bobylev, Alexander Horke, and Michel Pompeu Barros de Oliveira Sá
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Eacts/140 ,Computed tomography ,030204 cardiovascular system & hematology ,Surgical planning ,Preoperative care ,law.invention ,03 medical and health sciences ,Congenital ,0302 clinical medicine ,law ,Pulmonary Valve Replacement ,Cardiopulmonary bypass ,medicine ,Eacts/139 ,Tetralogy of Fallot ,medicine.diagnostic_test ,Eacts/132 ,business.industry ,AcademicSubjects/MED00920 ,Retrospective cohort study ,General Medicine ,medicine.disease ,Surgery ,030228 respiratory system ,Pulmonary valve replacement ,Three-step preoperative sequential planning ,Planning approach ,Eacts/129 ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES Our goal was to compare results between a standard computed tomography (CT)-based strategy, the ‘three-step preoperative sequential planning’ (3-step PSP), for pulmonary valve replacement in repaired tetralogy of Fallot versus a conventional planning approach. METHODS We carried out a retrospective study with unmatched and matched groups. The 3-step PSP comprised the planning of mediastinal re-entry, cannulation for cardiopulmonary bypass (CPB) and the main procedure, using standard 3-dimensional videos. Operative times (skin incision to CPB, CPB time, end of CPB to skin closure and cross-clamp time) as well as postoperative length of stay and in-hospital mortality were compared. RESULTS Eighty-two patients (49% classical tetralogy of Fallot) underwent an operation (85% with pulmonary homograft) with 1.22% in-hospital mortality. The 3-step PSP (n = 14) and the conventional planning (n = 68) groups were compared. There were no statistically significant differences in the preoperative characteristics. Differences were observed in the total operative time (P = 0.009), skin incision to CPB (P = 0.034) and cross-clamp times (74 ± 33 vs 108 ± 47 min; P = 0.006), favouring the 3-step PSP group. Eight matched pairs were compared showing differences in the total operative time (263 ± 44 vs 360 ± 66 min; P = 0.008), CPB time (123 ± 34 vs 190 ± 43 min; P = 0.008) and postoperative length of stay (P = 0.031), favouring the 3-step PSP group. CONCLUSIONS In patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement, preoperative planning using a standard CT-based strategy, the 3-step PSP, is associated with shorter operative times and shorter postoperative length of stay., Repeat sternotomy in heart surgery poses a major risk for undesired outcomes.
- Published
- 2020
45. Is aortic valve-sparing root reimplantation (David-I) justified in cardiac redo surgery?
- Author
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Erik Beckmann, Tim Kaufeld, Andreas Martens, Linda Rudolph, Heike Krüger, Ruslan Natanov, Axel Haverich, and Malakh Lal Shrestha
- Subjects
Heart Valve Prosthesis Implantation ,Reoperation ,Pulmonary and Respiratory Medicine ,Postoperative Complications ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Replantation ,Humans ,Surgery ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
OBJECTIVES Aortic valve-sparing root reimplantation (AVSRR) is a complex procedure, which offers the benefit of preserving the native aortic valve. Cardiac redo surgery is complex and time-consuming, and it is not known if David procedure is safe or beneficial in this context. METHODS Between 1993 and 2019, we performed a total of 544 elective AVSRR operations at our centre. Patients were assigned to either group A (n = 30, redo) or group B (n = 514, first-time sternotomy). RESULTS Aortic cross-clamp time was higher in the redo group (173[62] vs 125[31], P < 0.001). Cardiopulmonary bypass time was higher in the redo group as well (250[78] vs 179[51], P < 0.001). There were significantly more concomitant total arch replacements in the redo group (43.3% vs 5.8%, P < 0.001) using the ‘beating heart’ technique (20.0% vs 1.9%, P < 0.001). In-hospital mortality was comparable in both groups (3.3% vs 1.8%, P = 0.44). The rates for perioperative complications in terms of permanent neurological deficit and rethoracotomy were comparable between the 2 groups, too. Follow-up was complete for 99.6% of all patients and comprised a total of 584 patient-years. The 1-, 5-, 10- and 15-year survival rates were 90%, 81%, 60% and 55%, in group A (redo) and 96%, 90%, 78% and 67% in group B (native, P = 0.16), respectively. The rates for freedom from valve-related reoperation at 1, 5, 10 and 15 years after initial surgery were 96%, 92%, 92% and 92% in group A (redo) and 97%, 92%, 87% and 84% in group B (native, P = 0.52), respectively. CONCLUSIONS Despite significantly more concomitant total arch replacements in the redo group, early mortality was comparable in both groups. We conclude that AVSRR can be performed in redo cardiac surgery without compromising the early postoperative outcome. Careful patient assessment and selection are mandatory when evaluating patients with a history of previous cardiac surgery for David procedure.
- Published
- 2022
46. Immunoreaction to xenogenic tissue in cardiac surgery: alpha-Gal and beyond
- Author
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Antonio M Calafiore, Axel Haverich, Mario Gaudino, Michele Di Mauro, Khalil Fattouch, Sotirios Prapas, Peter Zilla, CTC, and RS: Carim - V04 Surgical intervention
- Subjects
Pulmonary and Respiratory Medicine ,BABOONS ,Bioprosthesis ,HEART-VALVE ,BIOPROSTHESES ,Transplantation, Heterologous ,General Medicine ,Alpha-Gal ,EPITOPE ,Bioprosthetic heart valves ,Heart Valve Prosthesis ,IMMUNE-RESPONSE ,Humans ,Surgery ,Xenotransplantation ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine - Published
- 2022
47. Frozen elephant trunk in acute aortic type a dissection: risk analysis of concomitant root replacement
- Author
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Erik Beckmann, Andreas Martens, Tim Kaufeld, Ruslan Natanov, Heike Krueger, Linda Rudolph, Axel Haverich, and Malakh Shrestha
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Aortic Aneurysm, Thoracic ,Aorta, Thoracic ,General Medicine ,Middle Aged ,Risk Assessment ,Blood Vessel Prosthesis ,Aortic Dissection ,Blood Vessel Prosthesis Implantation ,Postoperative Complications ,Treatment Outcome ,Humans ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
OBJECTIVES To analyse whether full root replacement increases perioperative risks in patients who undergo frozen elephant trunk for acute aortic dissection. METHODS Between March 2013 and December 2019, 115 patients underwent emergency frozen elephant trunk for acute dissection. Patients without root replacement were assigned to group A, while patients with concomitant full root replacement to group B. RESULTS Mean age was 50.8 (12.5) years and 85 (73.9%) patients were male. Preoperative malperfusion was present in 49 (42.6%) patients. In group B, 27 (41.5%) patients received composite root replacement and 38 (33.0%) aortic valve-sparing David procedure. Cardiopulmonary-bypass and cross-clamp times were 252.5 (208.5–293.0) and 96.0 (40.5–148.0) min in group A, and 310.0 (274.0–346.5) and 121.0 (89.0–182.0) in group B (P < 0.001). Continuous myocardial perfusion was used in 40 (80.0%) patients of group A and 59 (90.8%) of group B (P = 0.098). Disabling stroke was present in 10 (20.0%) patients in group A and 12 (18.5%) in group B (P = 0.835). Thirty-day mortality was 12.0% (n = 6) in group A and 9.2% (n = 6) in group B (P = 0.630). The 1- and 5-year survival rates were 80% and 62% in group A, and 81% and 79% in group B. Logistic regression analysis identified age (odds ratio = 1.117, 95% confidence interval = 1.004–1.242, P = 0.041), cardiopulmonary-bypass time (odds ratio = 1.012, 95% confidence interval = 1.001–1.022, P = 0.029) and abdominal malperfusion (odds ratio = 17.394, 95% confidence interval = 2.030–149.013, P = 0.009) to be associated with 30-day mortality. CONCLUSIONS Full root replacement does not increase the perioperative risk in patients who undergo frozen elephant trunk for acute dissection. Careful patient selection is important for such complex procedures. Continuous myocardial perfusion can help reducing the risk for intraoperative complications during such complex operations.
- Published
- 2022
48. Long-term outcomes after intraoperative extracorporeal membrane oxygenation during lung transplantation
- Author
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Joerg Optenhoefel, Murat Avsar, Mark Greer, Jawad Salman, Nicolaus Schwerk, Gregor Warnecke, Wiebke Sommer, Marius M. Hoeper, Dietmar Boethig, Christian Kuehn, Helge Draeger, K. Aburahma, Jens Gottlieb, Olaf Wiesner, Axel Haverich, Reza Poyanmehr, Dmitry Bobylev, Fabio Ius, Thierry Siemeni, Tobias Welte, and Igor Tudorache
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Graft function ,law.invention ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,law ,Cardiopulmonary bypass ,Long term outcomes ,medicine ,Hospital discharge ,Extracorporeal membrane oxygenation ,Humans ,Lung transplantation ,Retrospective Studies ,Transplantation ,Intraoperative Care ,Lung ,business.industry ,Middle Aged ,Surgical risk ,Surgery ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,030228 respiratory system ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Lung Transplantation - Abstract
Over the past decade, extracorporeal membrane oxygenation (ECMO) has replaced cardiopulmonary bypass (CPB) for cardiopulmonary support during lung transplantation at our institution. In this study, we present our experience using intraoperative ECMO in isolated lung transplantation and evaluate its impact on long-term graft function and survival.All patients undergoing isolated lung transplantation with or without ECMO support between January 2010 and June 2019 were evaluated. Patients transplanted using CPB were excluded. Peri-operative and follow-up results from our database and patient charts were analyzed. Follow-up continued until September 1, 2019 (median, 3.34 years).In total, 311 of 1,161 lung transplant recipients (27%) received intraoperative ECMO, with 24 (2%) patients further requiring CPB. None of the remaining 826 (71%) patients required intraoperative cardiopulmonary support. ECMO patients exhibited higher pre-transplant surgical risk profiles and endured more complicated early post-operative courses than those without ECMO (in-hospital mortality, 10.9% vs 2.3%; p0.001). Inevitably, this resulted in poorer overall graft survival among ECMO recipients (p = 0.0025). However, correcting for patients surviving to hospital discharge, no difference in survival between groups was observed (5-year survival, 71% vs 72%; p = 0.56). Similarly, freedom from chronic lung allograft dysfunction, biopsy-confirmed cellular rejection, or need for pulsed-steroid therapy did not differ between the groups (p = 0.99, p = 0.78, and p = 0.93, respectively).Compared with patients not requiring cardiopulmonary support, ECMO recipients endured a more complicated peri-operative and early post-operative course. However, among those surviving to hospital discharge, no differences in long-term complications or outcomes were observed.
- Published
- 2020
49. Aortic valve-sparing root replacement in patients with bicuspid aortic valve: long-term outcome with the David I procedure over 20 years
- Author
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Malakh Shrestha, Tim Kaufeld, Erik Beckmann, Wilhelm Korte, Andreas Martens, Alissa Stettinger, H. Krüger, and Axel Haverich
- Subjects
Pulmonary and Respiratory Medicine ,Aortic valve ,Aorta ,medicine.medical_specialty ,business.industry ,Treatment options ,Mean age ,General Medicine ,030204 cardiovascular system & hematology ,After discharge ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Bicuspid aortic valve ,030228 respiratory system ,medicine.artery ,cardiovascular system ,medicine ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Perioperative stroke - Abstract
OBJECTIVES Aortic valve-sparing root replacement is an excellent treatment option for patients with intact tricuspid aortic valves. However, the durability in patients with bicuspid aortic valves is still a matter of debate. The aim of this study was to analyse the short- and long-term outcomes in patients with bicuspid aortic valves. METHODS Between July 1993 and October 2015, a total of 582 patients underwent the David I procedure, 50 of whom had a bicuspid aortic valve. In these patients, the mean age was 46 ± 13 years, and 80% (n = 40) were men. Follow-up was complete for 100% of patients and comprised a total of 552 patient-years with a mean follow-up time of 11 ± 5.2 years. RESULTS In addition to the David procedure, cusp plication was performed in 34% (n = 17) of patients and commissure repair in 8% (n = 4) of patients. There were no in-hospital deaths, and 1 patient (2%) had a perioperative stroke. The 1-, 5-, 10- and 20-year survival rates of patients after discharge were 98%, 94%, 88% and 84%, respectively. The rates for freedom from valve-related reoperation at 1, 5, 10 and 20 years after initial surgery were 98%, 88%, 79% and 74%, respectively. Long-term freedom from reoperation was comparable to that of patients with tricuspid aortic valves (P = 0.2). CONCLUSIONS The David procedure has excellent short-term results in patients with a bicuspid aortic valve. In this study, the long-term durability of reimplanted bicuspid aortic valves was comparable to that of tricuspid valves. However, careful patient selection might have contributed to this, and further studies might be needed to definitely clarify this issue.
- Published
- 2020
50. Six‐year experience with treatment of early donor‐specific anti‐HLA antibodies in pediatric lung transplantation using a human immunoglobulin‐based protocol
- Author
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Wiebke Sommer, Christian Kühn, Michael Hallensleben, Dmitry Bobylev, Thierry Siemeni, Dietmar Böthig, Nicolaus Schwerk, Andreas Tecklenburg, Reza Poyanmehr, Julia Carlens, Jawad Salman, Igor Tudorache, Christine S. Falk, Murielle Verboom, Murat Avsar, Axel Haverich, Rainer Blasczyk, Gregor Warnecke, Carsten Müller, Gesine Hansen, C. Erdfelder, Lale Bayir, and Fabio Ius
- Subjects
Graft Rejection ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Gastroenterology ,Antibodies ,03 medical and health sciences ,0302 clinical medicine ,HLA Antigens ,Interquartile range ,hemic and lymphatic diseases ,030225 pediatrics ,Internal medicine ,Humans ,Medicine ,Lung transplantation ,Child ,Lung ,biology ,business.industry ,Graft Survival ,Immunoglobulins, Intravenous ,Tissue Donors ,Transplantation ,medicine.anatomical_structure ,030228 respiratory system ,Concomitant ,Pediatrics, Perinatology and Child Health ,biology.protein ,Female ,Rituximab ,Plasmapheresis ,Antibody ,business ,Lung Transplantation ,medicine.drug - Abstract
OBJECTIVES Experience with the treatment of early donor-specific anti-HLA antibodies (eDSA) after lung transplantation in children is very limited. At our institution, we have treated patients with eDSA since 2013 with successive infusions of intravenous human immunoglobulins (IVIG), combined in some cases with a single dose of Rituximab and plasmapheresis (therapeutic plasma exchange [tPE]) or immunoabsorption. The aim of this study was to present the 6-year results of IVIG-based therapy in pediatric lung recipients. METHODS Records of pediatric (
- Published
- 2020
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