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201. Randomized trial of ticagrelor vs. aspirin in patients after coronary artery bypass grafting: the TiCAB trial

Author

Schunkert, Heribert, primary, Boening, Andreas, additional, von Scheidt, Moritz, additional, Lanig, Clarissa, additional, Gusmini, Friederike, additional, de Waha, Antoinette, additional, Kuna, Constantin, additional, Fach, Andreas, additional, Grothusen, Christina, additional, Oberhoffer, Martin, additional, Knosalla, Christoph, additional, Walther, Thomas, additional, Danner, Bernhard C, additional, Misfeld, Martin, additional, Zeymer, Uwe, additional, Wimmer-Greinecker, Gerhard, additional, Siepe, Matthias, additional, Grubitzsch, Herko, additional, Joost, Alexander, additional, Schaefer, Andreas, additional, Conradi, Lenard, additional, Cremer, Jochen, additional, Hamm, Christian, additional, Lange, Rüdiger, additional, Radke, Peter W, additional, Schulz, Rainer, additional, Laufer, Günther, additional, Grieshaber, Philippe, additional, Pader, Philip, additional, Attmann, Tim, additional, Schmoeckel, Michael, additional, Meyer, Alexander, additional, Ziegelhöffer, Tibor, additional, Hambrecht, Rainer, additional, Kastrati, Adnan, additional, and Sandner, Sigrid E, additional

Published
2019
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203. Discriminatory power of scoring systems for outcome prediction in patients with extracorporeal membrane oxygenation following cardiovascular surgery†

Author

Schrutka, Lore, primary, Rohmann, Felix, additional, Binder, Christina, additional, Haberl, Thomas, additional, Dreyfuss, Ben, additional, Heinz, Gottfried, additional, Lang, Irene M, additional, Felli, Alessia, additional, Steinlechner, Barbara, additional, Niessner, Alexander, additional, Laufer, Günther, additional, Goliasch, Georg, additional, Wiedemann, Dominik, additional, and Distelmaier, Klaus, additional

Published
2019
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205. Syncope

Author

Goliasch, Georg, primary, Kammerlander, Andreas A., additional, Nitsche, Christian, additional, Dona, Carolina, additional, Schachner, Laurin, additional, Öztürk, Begüm, additional, Binder, Christina, additional, Duca, Franz, additional, Aschauer, Stefan, additional, Laufer, Günther, additional, Hengstenberg, Christian, additional, Bonderman, Diana, additional, and Mascherbauer, Julia, additional

Published
2019
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206. Operative outcome of patients at low, intermediate, high and ‘very high’ surgical risk undergoing isolated aortic valve replacement with sutureless and rapid deployment prostheses: results of the SURD-IR registry

Author

Santarpino, Giuseppe, primary, Berretta, Paolo, additional, Fischlein, Theodor, additional, Carrel, Thierry P, additional, Teoh, Kevin, additional, Misfeld, Martin, additional, Savini, Carlo, additional, Kappert, Utz, additional, Glauber, Mattia, additional, Villa, Emmanuel, additional, Meuris, Bart, additional, Mignosa, Carmelo, additional, Albertini, Alberto, additional, Martinelli, Gianluca, additional, Folliguet, Thierry A, additional, Shrestha, Malak, additional, Solinas, Marco, additional, Laufer, Günther, additional, Phan, Kevin, additional, Yan, Tristan, additional, and Di Eusanio, Marco, additional

Published
2019
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210. Left ventricular assist device driveline infections in three contemporary devices.

Author

Schlöglhofer, Thomas, Michalovics, Peter, Riebandt, Julia, Angleitner, Philipp, Stoiber, Martin, Laufer, Günther, Schima, Heinrich, Wiedemann, Dominik, Zimpfer, Daniel, and Moscato, Francesco

Subjects
HEART assist devices, PATIENT readmissions, HOSPITAL admission & discharge, C-reactive protein
Abstract

Driveline infections (DLI) are common adverse events in left ventricular assist devices (LVADs), leading to severe complications and readmissions. The study aims to characterize risk factors for DLI readmission 2 years postimplant. This single‐center study included 183 LVAD patients (43 HeartMate II [HMII], 29 HeartMate 3 [HM3], 111 HVAD) following hospital discharge between 2013 and 2017. Demographics, clinical parameters, and outcomes were retrospectively analyzed and 12.6% of patients were readmitted for DLI, 14.8% experienced DLI but were treated in the outpatient setting, and 72.7% had no DLI. Mean C‐reactive protein (CRP), leukocytes and fibrinogen were higher in patients with DLI readmission (P <.02) than in outpatient DLI and patients without DLI, as early as 60 days before readmission. Freedom from DLI readmission was comparable for HMII and HVAD (98% vs. 87%; HR, 4.52; 95% CI, 0.58‐35.02; P =.15) but significantly lower for HM3 (72%; HR, 10.82; 95% CI, 1.26‐92.68; P =.03). DLI (HR, 1.001; 95% CI, 0.999‐1.002; P =.16) or device type had no effect on mortality. DLI readmission remains a serious problem following LVAD implantation, where CRP, leukocytes, and fibrinogen might serve as risk factors already 60 days before. HM3 patients had a higher risk for DLI readmissions compared to HVAD or HMII, possibly because of device‐specific driveline differences. [ABSTRACT FROM AUTHOR]

Published
2021
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211. The impact of volume substitution on post-operative atrial fibrillation.

Author

Schnaubelt, Sebastian, Pilz, Arnold, Koller, Lorenz, Kazem, Niema, Hofer, Felix, Fleck, Tatjana, Laufer, Günther, Steinlechner, Barbara, Niessner, Alexander, and Sulzgruber, Patrick

Subjects
ATRIAL fibrillation, INDIVIDUALIZED medicine, CORONARY artery bypass, WATER-electrolyte balance (Physiology), CORONARY artery surgery
Abstract

Background: Post-operative atrial fibrillation (POAF) represents a common complication after cardiac valve or coronary artery bypass surgery. While strain of atrial tissue is known to induce atrial fibrillating impulses, less attention has been paid to potentially strain-promoting values during the peri- and post-operative period. This study aimed to determine the association of peri- and post-operative volume substitution with markers of cardiac strain and subsequently the impact on POAF development and promotion. Results: A total of 123 (45.4%) individuals were found to develop POAF. Fluid balance within the first 24 hours after surgery was significantly higher in patients developing POAF as compared to non-POAF individuals (+1129.6 mL [POAF] vs +544.9 mL [non-POAF], P = .044). Post-operative fluid balance showed a direct and significant correlation with post-operative N-terminal pro-brain natriuretic peptide (NT-ProBNP) values (r = .287; P = .002). Of note, the amount of substituted volume significantly proved to be a strong and independent predictor for POAF with an adjusted odds ratio per one litre of 1.44 (95% CI: 1.09-1.31; P = .009). In addition, we observed that low pre-operative haemoglobin levels at admission were associated with a higher need of intraoperative transfusions and volume-demand. Conclusion: Substitution of larger transfusion volumes presents a strong and independent predictor for the development of POAF. Via the observed distinct association with NT-proBNP values, it can reasonably be assumed that post-operative atrial fibrillating impulses are triggered via increased global cardiac strain. Optimized preoperative management of pre-existing anaemia should be considered prior surgical intervention in terms of a personalized patient care. [ABSTRACT FROM AUTHOR]

Published
2021
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212. Outcomes of a Rapid Deployment Aortic Valve Versus Its Conventional Counterpart: A Propensity-Matched Analysis

Author

Wahlers, Thorsten C W, Andreas, Martin, Rahmanian, Parwis, Candolfi, Pascal, Zemanova, Barbora, Giot, Christophe, Ferrari, Enrico, Laufer, Günther, Wahlers, Thorsten C W, Andreas, Martin, Rahmanian, Parwis, Candolfi, Pascal, Zemanova, Barbora, Giot, Christophe, Ferrari, Enrico, and Laufer, Günther

Abstract

OBJECTIVE The aim of this study was to compare outcomes after rapid-deployment aortic valve replacement (RDAVR) and conventional aortic valve replacement (AVR) from two studies. METHODS Patients who underwent RDAVR (INTUITY valve) in the prospective, 5-year, single-arm multicenter TRITON study, or conventional AVR (Perimount Magna Ease valve) in the prospective Perimount Magna Ease postmarket study, were propensity score matched and compared for procedural, hemodynamic, safety, and clinical outcomes. RESULTS Matched RDAVR (n = 106) and conventional AVR (n = 106) patients had similar baseline characteristics (mean ± SD age, 72.8 ± 7.6 vs 72.5 ± 7.4 years; male 59.4% vs 61.3%) and procedures (concomitant procedures: 41.5% vs 50.9%). Mean ± SD aortic cross-clamp time was significantly shorter in RDAVR than AVR patients (51.8 ± 20.9 vs 73.9 ± 33.2 minutes; P < 0.001), as was mean cardiopulmonary bypass time (82.8 ± 34.2 vs 102.4 ± 41.7 minutes; P < 0.001). At 1 year, RDAVR patients showed significantly lower mean ± SD and peak aortic valve gradients (9.0 ± 3.4 and 17.0 ± 6.2 mm Hg, respectively) than conventional AVR patients (13.4 ± 5.5 and 24.2 ± 10.8 mm Hg, respectively; all P < 0.001). Patient-prosthesis mismatch was significantly less common with RDAVR than with AVR [overall: 16/66 (24.2%) vs 46/76 (60.5%); P = 0.007; severe: 2/66 (3.0%) vs 13/76 (17.1%)]. There were no significant differences between the RDAVR and AVR groups regarding 30-day safety endpoints. Survival rates in the RDAVR and conventional AVR groups were, respectively, 99.1% and 100.0% at 30 days, 97.1% and 95.1% at 1 year, and 93.3% and 94.1% at 3 years (P = nonsignificant). CONCLUSIONS In this retrospective study with matched populations, the RDAVR with the INTUITY valve system provided superior procedural and hemodynamic outcomes than a standard bioprosthesis without compromising safety.

Published
2018

213. One-year outcomes after rapid-deployment aortic valve replacement

Author

Young, Christopher, Laufer, Günther, Kocher, Alfred, Solinas, Marco, Alamanni, Francesco, Polvani, Gianluca, Podesser, Bruno K, Aramendi, Jose Ignacio, Arribas, Jose, Bouchot, Olivier, Livi, Ugolino, Massetti, Massimo, Terp, Kim, Giot, Christophe, Glauber, Mattia, Massetti, Massimo (ORCID:0000-0002-7100-8478), Young, Christopher, Laufer, Günther, Kocher, Alfred, Solinas, Marco, Alamanni, Francesco, Polvani, Gianluca, Podesser, Bruno K, Aramendi, Jose Ignacio, Arribas, Jose, Bouchot, Olivier, Livi, Ugolino, Massetti, Massimo, Terp, Kim, Giot, Christophe, Glauber, Mattia, and Massetti, Massimo (ORCID:0000-0002-7100-8478)

Abstract

OBJECTIVE: The goals of rapid-deployment aortic valve replacement include facilitation of minimally invasive surgery and reduced aortic crossclamp time. We report the short-term outcomes of a series of 493 patients undergoing rapid-deployment aortic valve replacement with the EDWARDS INTUITY valve system (Edwards Lifesciences, LLC, Irvine, Calif). METHODS: Assessing Standard oF Care and Clinical Outcomes UsiNg the EDWARDS INTUITY VAlve SysTem in a European multI-center, Active, pOst-market surveillaNce Study was a prospective, multicenter (n = 26) European registry designed to evaluate the safety and performance of the valve system. During rapid-deployment aortic valve replacement, device technical success and crossclamp time were assessed. Procedural outcomes, hemodynamic performance, and various adverse events and clinical outcomes were evaluated up to 2 years. RESULTS: Between 2012 and 2014, 493 of 517 enrolled patients successfully received implants with the study valve (95.4% technical success). Mean crossclamp times for 163 full sternotomies, 128 mini-upper sternotomies, and 36 right anterior thoracotomies isolated aortic valve replacements were 47.3, 52.0, and 73.3 minutes, respectively. Mean follow-up was 1.8 years, with 870 total patient-years of follow-up. Mean effective orifice area increased from 0.72 (baseline) to 1.88 cm2, and mean pressure gradient decreased from 47.6 to 9.6 mm Hg (1 year). Mean effective orifice area index increased (0.39-1.01 cm2/m2), and 28 of 287 patients (9.8%) exhibited severe prosthesis-patient mismatch at 1 year. After 1 year, 68.1% and 21.7% of patients were in New York Heart Association class I and II, respectively. Freedom from death, major bleeding, major perivalvular leak, reoperation, and device explant at 1 year were 0.935, 0.939, 0.976, 0.975, and 0.983, respectively. CONCLUSIONS:These results demonstrate commendable safety and performance of the test valve system over the short term in a broad European settin

Published
2018

215. Every like is not the same

Author

Sarikouch, Samir, Haverich, Axel, Pepper, John, Pomar, Jose L, Hazekamp, Mark, Padalino, Massimo, Stellin, Giovanni, Meyns, Bart, Laufer, Günther, Andreas, Martin, Hübler, Michael, Schmiady, Martin, Ciubotaru, Anatol, Horke, Alexander, Cebotari, Serghei, Tudorache, Igor, ARISE-Trial-Investigators, and University of Zurich

Subjects
Pulmonary and Respiratory Medicine, 2740 Pulmonary and Respiratory Medicine, 610 Medicine & health, Surgery, Cardiology and Cardiovascular Medicine, 2705 Cardiology and Cardiovascular Medicine, 10020 Clinic for Cardiac Surgery, 2746 Surgery
Published
2017

216. Recommendations for extracorporeal membrane oxygenation (ECMO) in COVID-19 patients: Consensus paper of the Medical University of Vienna.

Author

Wiedemann, Dominik, Bernardi, Martin H., Distelmaier, Klaus, Goliasch, Georg, Hengstenberg, Christian, Hermann, Alexander, Holzer, Michael, Hoetzenecker, Konrad, Klepetko, Walter, Lang, György, Lassnigg, Andrea, Laufer, Günther, Magnet, Ingrid A. M., Markstaller, Klaus, Röggla, Martin, Rössler, Bernhard, Schellongowski, Peter, Simon, Paul, Tschernko, Edda, and Ullrich, Roman

Abstract

Summary: The pandemic from the SARS-CoV‑2 virus is currently challenging healthcare systems all over the world. Maintaining appropriate staffing and resources in healthcare facilities is essential to guarantee a safe working environment for healthcare personnel and safe patient care. Extracorporeal membrane oxygenation (ECMO) represents a valuable therapeutic option in patients with severe heart or lung failure. Although only a limited proportion of COVID-19 patients develop respiratory or circulatory failure that is refractory to conventional treatment, it is of utmost importance to clearly define criteria for the use of ECMO in this steadily growing patient population. The ECMO working group of the Medical University of Vienna has established the following recommendations for ECMO support in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Published
2020
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217. Empfehlungen für ECMO bei COVID-19-Patienten: Consensus Paper zur Extrakorporalen Membranoxygenierung der Medizinischen Universität Wien.

Author

Wiedemann, Dominik, Bernardi, Martin H., Distelmaier, Klaus, Goliasch, Georg, Hengstenberg, Christian, Hermann, Alexander, Holzer, Michael, Hoetzenecker, Konrad, Klepetko, Walter, Lang, György, Lassnigg, Andrea, Laufer, Günther, Magnet, Ingrid A. M., Markstaller, Klaus, Röggla, Martin, Rössler, Bernhard, Schellongowski, Peter, Simon, Paul, Tschernko, Edda, and Ullrich, Roman

Abstract

Copyright of Wiener Klinisches Magazin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2020
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219. Ticagrelor monotherapy versus aspirin in patients undergoing multiple arterial or single arterial coronary artery bypass grafting: insights from the TiCAB trial.

Author

Sandner, Sigrid E, Schunkert, Heribert, Kastrati, Adnan, Wiedemann, Dominik, Misfeld, Martin, Böning, Andreas, Tebbe, Ulrich, Nowak, Bernd, Stritzke, Jan, Laufer, Günther, Scheidt, Moritz von, and Investigators, for the TiCAB

Subjects
CORONARY artery bypass, ASPIRIN, ARTERIAL grafts, MYOCARDIAL infarction, CEREBRAL revascularization, TICAGRELOR
Abstract

Open in new tab Download slide Open in new tab Download slide OBJECTIVES We evaluated the effect of ticagrelor monotherapy on outcomes after multiple arterial grafting (MAG) or single arterial grafting (SAG) in coronary artery bypass grafting (CABG). METHODS In a post hoc , non-randomized analysis of the TiCAB (Ticagrelor in CABG; ClinicalTrials.gov NCT01755520) trial, we compared event rates for ticagrelor versus aspirin in patients undergoing MAG and SAG. Primary outcome was the composite of cardiovascular death, non-fatal myocardial infarction (MI), stroke or repeat revascularization 1 year after CABG. Secondary outcomes included individual components of the primary end point, all-cause death and bleeding. RESULTS Among 1753 patients, 998 patients underwent MAG and 755 patients underwent SAG. There was no significant difference in the 1-year primary composite outcome for ticagrelor versus aspirin with MAG [7.2% vs 7.9%; hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.57–1.43; P  = 0.66] or SAG (12.3% vs 8.6%; HR 1.47, 95% CI 0.93–2.31; P  = 0.10). Event rates for cardiovascular death, MI, stroke, repeat revascularization and all-cause death were similar for both treatment groups with MAG and SAG. No significant difference in major bleeding was observed for ticagrelor versus aspirin with MAG (2.6% vs 2.7%; HR 0.95, 95% CI 0.44–2.05; P  = 0.90) or SAG (5.8% vs 4.0%; HR 1.49, 95% CI 0.77–2.89; P  = 0.24). CONCLUSIONS In patients undergoing either MAG or SAG in the TiCAB trial, ticagrelor monotherapy compared with aspirin did not affect the rate of cardiovascular death, non-fatal MI, stroke or repeat revascularization, or the rate of bleeding, at 1 year after CABG. [ABSTRACT FROM AUTHOR]

Published
2020
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224. Duration of extracorporeal membrane oxygenation support and survival in cardiovascular surgery patients

Author

Distelmaier, Klaus, primary, Wiedemann, Dominik, additional, Binder, Christina, additional, Haberl, Thomas, additional, Zimpfer, Daniel, additional, Heinz, Gottfried, additional, Koinig, Herbert, additional, Felli, Alessia, additional, Steinlechner, Barbara, additional, Niessner, Alexander, additional, Laufer, Günther, additional, Lang, Irene M., additional, and Goliasch, Georg, additional

Published
2018
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226. One-year outcomes after rapid-deployment aortic valve replacement

Author

Young, Christopher, primary, Laufer, Günther, additional, Kocher, Alfred, additional, Solinas, Marco, additional, Alamanni, Francesco, additional, Polvani, Gianluca, additional, Podesser, Bruno K., additional, Aramendi, Jose Ignacio, additional, Arribas, Jose, additional, Bouchot, Olivier, additional, Livi, Ugolino, additional, Massetti, Massimo, additional, Terp, Kim, additional, Giot, Christophe, additional, and Glauber, Mattia, additional

Published
2018
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230. Reply to Napp et al.

Author

Angleitner, Philipp, primary, Röggla, Martin, additional, Laufer, Günther, additional, and Wiedemann, Dominik, additional

Published
2017
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231. Impact of Right Ventricular Performance in Patients Undergoing Extracorporeal Membrane Oxygenation Following Cardiac Surgery

Author

Bartko, Philipp E., primary, Wiedemann, Dominik, additional, Schrutka, Lore, additional, Binder, Christina, additional, Santos‐Gallego, Carlos G., additional, Zuckermann, Andreas, additional, Steinlechner, Barbara, additional, Koinig, Herbert, additional, Heinz, Gottfried, additional, Niessner, Alexander, additional, Zimpfer, Daniel, additional, Laufer, Günther, additional, Lang, Irene M., additional, Distelmaier, Klaus, additional, and Goliasch, Georg, additional

Published
2017
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232. Every like is not the same

Author

Sarikouch, Samir, primary, Haverich, Axel, additional, Pepper, John, additional, Pomar, Jose L., additional, Hazekamp, Mark, additional, Padalino, Massimo, additional, Stellin, Giovanni, additional, Meyns, Bart, additional, Laufer, Günther, additional, Andreas, Martin, additional, Hübler, Michael, additional, Schmiady, Martin, additional, Ciubotaru, Anatol, additional, Horke, Alexander, additional, Cebotari, Serghei, additional, and Tudorache, Igor, additional

Published
2017
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233. Adverse events while awaiting myocardial revascularization: a systematic review and meta-analysis

Author

Head, Stuart J., primary, da Costa, Bruno R., additional, Beumer, Berend, additional, Stefanini, Giulio G., additional, Alfonso, Fernando, additional, Clemmensen, Peter M., additional, Collet, Jean-Philippe, additional, Cremer, Jochen, additional, Falk, Volkmar, additional, Filippatos, Gerasimos, additional, Hamm, Christian, additional, Kappetein, A. Pieter, additional, Kastrati, Adnan, additional, Knuuti, Juhani, additional, Kolh, Philippe, additional, Landmesser, Ulf, additional, Laufer, Günther, additional, Neumann, Franz-Josef, additional, Richter, Dimitrios J., additional, Schauerte, Patrick, additional, Taggart, David P., additional, Torracca, Lucia, additional, Valgimigli, Marco, additional, Wijns, William, additional, Witkowski, Adam, additional, Windecker, Stephan, additional, Jüni, Peter, additional, and Sousa-Uva, Miguel, additional

Published
2017
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234. Long-term outcomes of a rapid deployment aortic valve: data up to 5 years†

Author

Laufer, Günther, primary, Haverich, Axel, additional, Andreas, Martin, additional, Mohr, Friedrich W., additional, Walther, Thomas, additional, Shrestha, Malakh, additional, Rahmanian, Parwis, additional, Holzhey, David, additional, Roth, Matthias, additional, Schmitz, Christoph, additional, Schramm, René, additional, Giot, Christophe, additional, and Wahlers, Thorsten C.W., additional

Published
2017
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236. The megaaortic syndrome: Progression of ascending aortic aneurysm or a disease of distinct origin?

Author

Baranyi, Ulrike, primary, Stern, Christian, additional, Winter, Birgitta, additional, Türkcan, Adrian, additional, Scharinger, Bernhard, additional, Stelzmüller, Marie-Elisabeth, additional, Aschacher, Thomas, additional, Andreas, Martin, additional, Ehrlich, Marek, additional, Laufer, Günther, additional, Bernhard, David, additional, and Messner, Barbara, additional

Published
2017
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237. Dietary Silicon Deficiency Does Not Exacerbate Diet-Induced Fatty Lesions in Female ApoE Knockout Mice

Author

Jugdaohsingh, Ravin, Kessler, Katharina, Messner, Barbara, Stoiber, Martin, Pedro, Liliana D, Schima, Heinrich, Laufer, Günther, Powell, Jonathan J, Bernhard, David, Jugdaohsingh, Ravin [0000-0001-8074-2992], Powell, Jonathan [0000-0003-2738-1715], and Apollo - University of Cambridge Repository

Subjects
inorganic chemicals, monomethylsilanetriol, Silicon, aorta silicon content, apoE knockout mice, Diet, High-Fat, complex mixtures, elastic structure and morphology, Mice, Apolipoproteins E, Animals, aortic lesions, dietary silicon, Aorta, Triglycerides, Mice, Knockout, collagen and elastin contents, Body Weight, Cholesterol, HDL, technology, industry, and agriculture, tensile strength and elasticity, Cholesterol, LDL, equipment and supplies, Atherosclerosis, Plaque, Atherosclerotic, Diet, Mice, Inbred C57BL, stomatognathic diseases, Disease Models, Animal, nutrition, serum lipids, Dietary Supplements, Female, Endothelium, Vascular
Abstract

BACKGROUND: Dietary silicon has been positively linked with vascular health and protection against atherosclerotic plaque formation, but the mechanism of action is unclear. OBJECTIVES: We investigated the effect of dietary silicon on 1) serum and aorta silicon concentrations, 2) the development of aortic lesions and serum lipid concentrations, and 3) the structural and biomechanic properties of the aorta. METHODS: Two studies, of the same design, were conducted to address the above objectives. Female mice, lacking the apolipoprotein E (apoE) gene, and therefore susceptible to atherosclerosis, were separated into 3 groups of 10-15 mice, each exposed to a high-fat diet (21% wt milk fat and 1.5% wt cholesterol) but with differing concentrations of dietary silicon, namely: silicon-deprived (-Si

Published
2015

238. Syncope: The Underestimated Threat in Severe Aortic Stenosis.

Author

Goliasch, Georg, Kammerlander, Andreas A., Nitsche, Christian, Dona, Carolina, Schachner, Laurin, Öztürk, Begüm, Binder, Christina, Duca, Franz, Aschauer, Stefan, Laufer, Günther, Hengstenberg, Christian, Bonderman, Diana, and Mascherbauer, Julia

Abstract

Abstract Objectives Decision making in severe aortic stenosis (AS) requires a comprehensive pre-operative evaluation of the risk-to-benefit ratio. The aim of this study was to assess whether certain pre-operative symptoms are associated with outcome after surgical aortic valve replacement (SAVR). Background The cardinal symptoms of AS indicating a need for intervention are angina, symptoms of heart failure, and syncope. Nevertheless, it remains unknown whether the presence of these more advanced symptoms conveys an increased risk after SAVR and whether the detection of early symptoms in patients with asymptomatic AS should be emphasized more in routine clinical practice. Methods A total of 625 patients with isolated severe AS undergoing elective SAVR were prospectively enrolled in this long-term observational study. Results Patients experiencing syncope had significantly smaller left ventricular diameters (p = 0.02), left atrial diameters (p = 0.043), right ventricular diameters (p = 0.04), and right atrial diameters (p = 0.001), smaller aortic valve areas (p = 0.048), and lower indexed stroke volumes (p = 0.043) compared with patients without syncope. Syncope conveyed an increased risk for mortality after SAVR that persisted after multivariate adjustment for a bootstrap-selected confounder model, with an adjusted hazard ratio of 2.27 (95% confidence interval: 1.04 to 4.95; p = 0.04) for 1-year short-term mortality and an adjusted hazard ratio of 2.11 (95% confidence interval: 1.39 to 3.21; p < 0.001) for 10-year long-term mortality. In contrast, pre-operative dyspnea, angina, and reduced left ventricular function were not significantly associated with outcomes. Conclusions This long-term observational study in a large contemporary cohort of patients with AS for the first time demonstrates that syncope represents an underestimated threat in aortic stenosis, associated with poor prognosis after SAVR. Importantly, other primary indications for SAVR (i.e., dyspnea, angina, and decreased left ventricular function) were associated with significantly better post-operative outcomes than syncope. Patients experiencing syncope displayed a specific pathophysiologic phenotype characterized by a smaller aortic valve area, smaller cardiac cavities, and lower stroke volumes. Graphical abstract [ABSTRACT FROM AUTHOR]

Published
2019
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240. Five-year results from a prospective, single-arm European trial on decellularized allografts for aortic valve replacement—the ARISE Study and ARISE Registry Data.

Author

Horke, Alexander, Tudorache, Igor, Laufer, Günther, Andreas, Martin, Pomar, Jose Luis, Pereda, Daniel, Quintana, Eduard, Sitges, Marta, Meyns, Bart, Rega, Filip, Hazekamp, Mark, Cesnjevar, Robert, Schmiady, Martin Oliver, Pepper, John, Rosendahl, Ulrich, Lichtenberg, Artur, Stadnik, Dmytro, Jashari, Ramadan, Boethig, Dietmar, and Bobylev, Dmitry

Subjects
*AORTIC valve transplantation, *VENTRICULAR arrhythmia, *HOMOGRAFTS, *RENAL replacement therapy, *CARDIOPULMONARY bypass, *AORTIC valve diseases
Abstract

Open in new tab Download slide OBJECTIVES Decellularized aortic homografts (DAH) were introduced as a new option for aortic valve replacement for young patients. METHODS A prospective, EU-funded, single-arm, multicentre study in 8 centres evaluating non-cryopreserved DAH for aortic valve replacement. RESULTS A total of 144 patients (99 male) were prospectively enrolled in the ARISE Trial between October 2015 and October 2018 with a median age of 30.4 years [interquartile range (IQR) 15.9–55.1]; 45% had undergone previous cardiac operations, with 19% having 2 or more previous procedures. The mean implanted DAH diameter was 22.6 mm (standard deviation 2.4). The median operation duration was 312 min (IQR 234–417), the median cardiopulmonary bypass time was 154 min (IQR 118–212) and the median cross-clamp time 121 min (IQR 93–150). No postoperative bypass grafting or renal replacement therapy were required. Two early deaths occurred, 1 due to a LCA thrombus on day 3 and 1 due ventricular arrhythmia 5 h postoperation. There were 3 late deaths, 1 death due to endocarditis 4 months postoperatively and 2 unrelated deaths after 5 and 7 years due to cancer and Morbus Wegener resulting in a total mortality of 3.47%. After a median follow-up of 5.9 years [IQR 5.1–6.4, mean 5.5 years. (standard deviation 1.3) max. 7.6 years], the primary efficacy end-points peak gradient with median 11.0 mmHg (IQR 7.8–17.6) and regurgitation of median 0.5 (IQR 0–0.5) of grade 0–3 were excellent. At 5 years, freedom from death/reoperation/endocarditis/bleeding/thromboembolism were 97.9%/93.5%/96.4%/99.2%/99.3%, respectively. CONCLUSIONS The 5-year results of the prospective multicentre ARISE trial continue to show DAH to be safe for aortic valve replacement with excellent haemodynamics. [ABSTRACT FROM AUTHOR]

Published
2024
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241. Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis

Author

Windecker, Stephan, Stortecky, Stefan, Stefanini, Giulio G, Da Costa, Bruno R, Dacosta, Bruno R, Rutjes, Anne Wilhelmina, Di Nisio, Marcello, Silletta, MARIA GIUSEPPINA, Siletta, Maria G, Maione, Ausilia, Alfonso, Fernando, Clemmensen, Peter M, Collet, Jean-philippe, Cremer, Jochen, Falk, Volkmar, Filippatos, Gerasimos, Hamm, Christian, Head, Stuart, Kappetein, Arie Pieter, Kastrati, Adnan, Knuuti, Juhani, Landmesser, Ulf, Laufer, Günther, Neumann, Franz-joseph, Richter, Dimitri, Schauerte, Patrick, Sousa Uva, Miguel, Taggart, David P, Torracca, Lucia, Valgimigli, Marco, Wijns, William, Witkowski, Adam, Kolh, Philippe, Jüni, Peter, Juni, Peter, Cardiothoracic Surgery, and Cardiology

Subjects
Bare-metal stent, Treatment Outcome ACUTE MYOCARDIAL-INFARCTION, medicine.medical_specialty, BALLOON ANGIOPLASTY, medicine.medical_treatment, 610 Medicine & health, Coronary Artery Disease, Humans, Myocardial Revascularization, Survival Rate, BYPASS GRAFT-SURGERY, BARE-METAL STENTS, RANDOMIZED-TRIALS, ELUTING STENTS, THERAPY, INTERVENTION, IMPLANTATION, HETEROGENEITY, Revascularization, Coronary artery disease, 360 Social problems & social services, Angioplasty, Internal medicine, medicine, Zotarolimus, Myocardial infarction, ta3126, Everolimus, business.industry, Stent, General Medicine, medicine.disease, Surgery, Treatment Outcome, Cardiology, business, medicine.drug
Abstract

OBJECTIVE To investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease. DESIGN Bayesian network meta-analyses to combine direct within trial comparisons between treatments with indirect evidence from other trials while maintaining randomisation. ELIGIBILITY CRITERIA FOR SELECTING STUDIES A strategy of initial medical treatment compared with revascularisation by coronary artery bypass grafting or Food and Drug Administration approved techniques for percutaneous revascularization: balloon angioplasty, bare metal stent, early generation paclitaxel eluting stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent, and new generation everolimus eluting stent, and zotarolimus eluting (Resolute) stent among patients with stable coronary artery disease. DATA SOURCES Medline and Embase from 1980 to 2013 for randomised trials comparing medical treatment with revascularisation. MAIN OUTCOME MEASURE All cause mortality. RESULTS 100 trials in 93 553 patients with 262 090 patient years of follow-up were included. Coronary artery bypass grafting was associated with a survival benefit (rate ratio 0.80, 95% credibility interval 0.70 to 0.91) compared with medical treatment. New generation drug eluting stents (everolimus: 0.75, 0.59 to 0.96; zotarolimus (Resolute): 0.65, 0.42 to 1.00) but not balloon angioplasty (0.85, 0.68 to 1.04), bare metal stents (0.92, 0.79 to 1.05), or early generation drug eluting stents (paclitaxel: 0.92, 0.75 to 1.12; sirolimus: 0.91, 0.75 to 1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10) were associated with improved survival compared with medical treatment. Coronary artery bypass grafting reduced the risk of myocardial infarction compared with medical treatment (0.79, 0.63 to 0.99), and everolimus eluting stents showed a trend towards a reduced risk of myocardial infarction (0.75, 0.55 to 1.01). The risk of subsequent revascularisation was noticeably reduced by coronary artery bypass grafting (0.16, 0.13 to 0.20) followed by new generation drug eluting stents (zotarolimus (Resolute): 0.26, 0.17 to 0.40; everolimus: 0.27, 0.21 to 0.35), early generation drug eluting stents (zotarolimus (Endeavor): 0.37, 0.28 to 0.50; sirolimus: 0.29, 0.24 to 0.36; paclitaxel: 0.44, 0.35 to 0.54), and bare metal stents (0.69, 0.59 to 0.81) compared with medical treatment. CONCLUSION Among patients with stable coronary artery disease, coronary artery bypass grafting reduces the risk of death, myocardial infarction, and subsequent revascularisation compared with medical treatment. All stent based coronary revascularisation technologies reduce the need for revascularisation to a variable degree. Our results provide evidence for improved survival with new generation drug eluting stents but no other percutaneous revascularisation technology compared with medical treatment.

Published
2014

242. Cardioprotection: A Review of Current Practice in Global Ischemia and Future Translational Perspective

Author

Habertheuer, Andreas, Kocher, Alfred, Laufer, Günther, Andreas, Martin, Szeto, Wilson Y., Petzelbauer, Peter, Ehrlich, Marek, and Wiedemann, Dominik

Subjects
Article Subject
Abstract

The idea of protecting the heart from ischemic insult during heart surgery to allow elective cardiac arrest is as old as the idea of cardiac surgery itself. The current gold standard in clinical routine is a high potassium regimen added either to crystalloid or blood cardioplegic solutions inducing depolarized arrest. Ongoing patient demographic changes with increasingly older, comorbidly ill patients and increasing case complexity with increasingly structurally abnormal hearts as morphological correlate paired with evolutions in pediatric cardiac surgery allowing more complex procedures than ever before redefine requirements for cardioprotection. Many, in part adversarial, regimens to protect the myocardium from ischemic insults have entered clinical routine; however, functional recovery of the heart is still often impaired due to perfusion injury. Myocardial reperfusion damage is a key determinant of postoperative organ functional recovery, morbidity, and mortality in adult and pediatric patients. There is a discrepancy between what current protective strategies are capable of and what they are expected to do in a rapidly changing cardiac surgery community. An increased understanding of the molecular players of ischemia reperfusion injury offers potential seeds for new cardioprotective regimens and may further displace boundaries of what is technically feasible.

Published
2014
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243. Acute Aortic Dissection Type A : Age-related Management and Outcomes Reported in the German Registry for Acute Aortic Dissection Type A (GERAADA) of Over 2000 Patients

Author

Rylski, Bartosz, Hoffmann, Isabell, Beyersdorf, Friedhelm, Suedkamp, Michael, Siepe, Matthias, Nitsch, Brigitte, Blettner, Maria, Borger, Michael Andrew, Weigang, Ernst, Mohr, Friedrich Wilhelm, Moritz, Anton, Karck, Matthias, Beyer, Michael, Schlensak, Christian, Hagl, Christian, Reichenspurner, Hermann, Vahl, Christian-Friedrich, Harringer, Wolfgang, Dapunt, Otto, Carrel, Thierry, Diegeler, Anno, Jakob, Heinz G., Laufer, Günther, Liebold, Andreas, Warnecke, Henning, Matschke, Klaus, Sievers, Hans-Hinrich, Welz, Armin, Walther, Thomas, Fischlein, Theodor, Leyh, Rainer, Däbritz, Sabine, Schäfers, Hans-Joachim, Peivandi, Ali Asghar, Martens, Sven, Massoudy-Touiserkan, Parwis, Rieß, Friedrich-Christian, Gummert, Jan, Cremer, Jochen, Autschbach, Rüdiger, Ennker, Jürgen, Posival, Herbert, Markewitz, Andreas, Schütz, Albert, Wimmer-Greinecker, Gerhard, Steinhoff, Gustav, Dahm, Manfred, Franke, Ulrich, Dörge, Hilmar, Vetter, Herbert, Doenst, Torsten, Kuntze, Thomas, Wahlers, Thorsten, Hausmann, Harald, Haverich, Axel, Doll, Nicolas, Silber, Rolf-Edgar, and Hammel, Dieter

Subjects
Adult, Male, medicine.medical_specialty, Medizin, law.invention, Young Adult, Aortic aneurysm, Sex Factors, Aneurysm, Randomized controlled trial, law, Germany, medicine, Humans, Prospective Studies, Registries, Young adult, Prospective cohort study, Aged, Aortic dissection, Aortic Aneurysm, Thoracic, business.industry, fungi, Age Factors, Middle Aged, Prognosis, medicine.disease, Surgery, Survival Rate, Aortic Dissection, Cardiothoracic surgery, Austria, Female, Morbidity, business, Vascular Surgical Procedures, Switzerland, Aortic Aneurysm, Abdominal, Follow-Up Studies, Abdominal surgery
Abstract

To determine the association between age and clinical presentation, management and surgical outcomes in a large contemporary, prospective cohort of patients with acute aortic dissection type A (AADA).AADA is one of the most life-threatening cardiovascular diseases, and delayed surgery or overly conservative management can result in sudden death.The perioperative and intraoperative conditions of 2137 patients prospectively reported to the multicenter German Registry for Acute Aortic Dissection Type A were analyzed.Of all patients with AADA, 640 (30%) were 70 years or older and 160 patients (7%) were younger than 40 years. The probability of aortic dissection extension to the supra-aortic vessels and abdominal aorta decreased with age (P0.0001 and P = 0.0017, respectively). In 1447 patients (69%), the aortic root was preserved and supracoronary replacement of the ascending aorta was done. The probability of this procedure increased with age (P0.0001). The incidence of new postoperative neurological disorders was not influenced by age. The lowest probability of 30-day mortality was noted in the youngest patients (11%-14% for patients aged between 20 and 40 years) and rose progressively with age, peaking at 25% in octogenarians.This study reflects current results after surgical treatment of AADA in relation to patient age. Current survival rates are acceptable, even in very elderly patients. The contemporary surgical mortality rate among young patients is lower than that previously reported in the literature. The postoperative stroke incidence does not increase with age.

Published
2014

245. Leoligin, the major lignan from Edelweiss, inhibits 3-hydroxy-3-methyl-glutaryl-CoA reductase and reduces cholesterol levels in ApoE −/− mice

Author

Scharinger, Bernhard, primary, Messner, Barbara, additional, Türkcan, Adrian, additional, Schuster, Daniela, additional, Vuorinen, Anna, additional, Pitterl, Florian, additional, Heinz, Katharina, additional, Arnhard, Kathrin, additional, Laufer, Günther, additional, Grimm, Michael, additional, Stuppner, Hermann, additional, Oberacher, Herbert, additional, Eller, Philipp, additional, Ritsch, Andreas, additional, and Bernhard, David, additional

Published
2016
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246. A randomized, parallel group, double-blind study of ticagrelor compared with aspirin for prevention of vascular events in patients undergoing coronary artery bypass graft operation: Rationale and design of the Ticagrelor in CABG (TiCAB) trial

Author

de Waha, Antoinette, primary, Sandner, Sigrid, additional, von Scheidt, Moritz, additional, Boening, Andreas, additional, Koch-Buettner, Katharina, additional, Hammel, Dieter, additional, Hambrecht, Rainer, additional, Danner, Bernhard C., additional, Schöndube, Friedrich A., additional, Goerlach, Gerold, additional, Fischlein, Theodor, additional, Schmoeckel, Michael, additional, Oberhoffer, Martin, additional, Schulz, Rainer, additional, Walther, Thomas, additional, Ziegelhöffer, Tibor, additional, Knosalla, Christoph, additional, Schönrath, Felix, additional, Beyersdorf, Friedhelm, additional, Siepe, Matthias, additional, Attmann, Tim, additional, Misfeld, Martin, additional, Mohr, Friedrich-Wilhelm, additional, Sievers, Hans-Hinrich, additional, Joost, Alexander, additional, Putman, Leon M., additional, Laufer, Günther, additional, Hamm, Christian, additional, Zeymer, Uwe, additional, Kastrati, Adnan, additional, Radke, Peter W., additional, Lange, Rüdiger, additional, Cremer, Jochen, additional, and Schunkert, Heribert, additional

Published
2016
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247. Early outcomes after isolated aortic valve replacement with rapid deployment aortic valve

Author

Wahlers, Thorsten C.W., primary, Haverich, Axel, additional, Borger, Michael A., additional, Shrestha, Malakh, additional, Kocher, Alfred A., additional, Walther, Thomas, additional, Roth, Matthias, additional, Misfeld, Martin, additional, Mohr, Friedrich W., additional, Kempfert, Joerg, additional, Dohmen, Pascal M., additional, Schmitz, Christoph, additional, Rahmanian, Parwis, additional, Wiedemann, Dominik, additional, Duhay, Francis G., additional, and Laufer, Günther, additional

Published
2016
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250. Guía de práctica clínica de la ESC sobre revascularización miocárdica, 2014

Author

Windecker, Stephan, Kolh, Philippe, Alfonso, Fernando, Collet, Jean Philippe, Cremer, Jochen, Falk, Volkmar, Filippatos, Gerasimos, Hamm, Christian, Head, Stuart J., Jüni, Peter, Kappetein, A. Pieter, Kastrati, Adnan, Knuuti, Juhani, Landmesser, Ulf, Laufer, Günther, Neumann, Franz Josef, Richter, Dimitrios J., Schauerte, Patrick, Uva, Miguel Sousa, Stefanini, Giulio G., Taggart, David Paul, Torracca, Lucia, Valgimigli, Marco, Wijns, William, Witkowski, Adam, Zamorano, José Luis, Achenbach, Stephan, Baumgartner, Helmut, Bax, Jeroen J., Bueno, Héctor, Dean, Veronica, Deaton, Christi, Erol, Çetin, Fagard, Robert, Ferrari, Roberto, Hasdai, David, Hoes, Arno W., Kirchhof, Paulus, Lancellotti, Patrizio, Linhart, Ales, Nihoyannopoulos, Petros, Piepoli, Massimo F., Ponikowski, Piotr, Sirnes, Per Anton, Tamargo, Juan Luis, Tendera, Michal, Torbicki, Adam, Pepper, John, Anyanwu, Anelechi, Badimon, Lina, Bauersachs, Johann, Baumbach, Andreas, Beygui, Farzin, Bonaros, Nikolaos, De Carlo, Marco, Dobrev, Dobromir, Dunning, Joel, Eeckhout, Eric, Gielen, Stephan, Luckraz, Heyman, Mahrholdt, Heiko, Montalescot, Gilles, Paparella, Domenico, Rastan, Ardawan J., Sanmartín, Marcelo, Sergeant, Paul, Silber, Sigmund, Ten Berg, Jurrien, Thiele, Holger, Van Geuns, Robert Jan, Wagner, Hans Otto, Wassmann, Sven, Wendler, Olaf, Windecker, Stephan, Kolh, Philippe, Alfonso, Fernando, Collet, Jean Philippe, Cremer, Jochen, Falk, Volkmar, Filippatos, Gerasimos, Hamm, Christian, Head, Stuart J., Jüni, Peter, Kappetein, A. Pieter, Kastrati, Adnan, Knuuti, Juhani, Landmesser, Ulf, Laufer, Günther, Neumann, Franz Josef, Richter, Dimitrios J., Schauerte, Patrick, Uva, Miguel Sousa, Stefanini, Giulio G., Taggart, David Paul, Torracca, Lucia, Valgimigli, Marco, Wijns, William, Witkowski, Adam, Zamorano, José Luis, Achenbach, Stephan, Baumgartner, Helmut, Bax, Jeroen J., Bueno, Héctor, Dean, Veronica, Deaton, Christi, Erol, Çetin, Fagard, Robert, Ferrari, Roberto, Hasdai, David, Hoes, Arno W., Kirchhof, Paulus, Lancellotti, Patrizio, Linhart, Ales, Nihoyannopoulos, Petros, Piepoli, Massimo F., Ponikowski, Piotr, Sirnes, Per Anton, Tamargo, Juan Luis, Tendera, Michal, Torbicki, Adam, Pepper, John, Anyanwu, Anelechi, Badimon, Lina, Bauersachs, Johann, Baumbach, Andreas, Beygui, Farzin, Bonaros, Nikolaos, De Carlo, Marco, Dobrev, Dobromir, Dunning, Joel, Eeckhout, Eric, Gielen, Stephan, Luckraz, Heyman, Mahrholdt, Heiko, Montalescot, Gilles, Paparella, Domenico, Rastan, Ardawan J., Sanmartín, Marcelo, Sergeant, Paul, Silber, Sigmund, Ten Berg, Jurrien, Thiele, Holger, Van Geuns, Robert Jan, Wagner, Hans Otto, Wassmann, Sven, and Wendler, Olaf

Published
2015

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