61 results on '"Katharina Huenges"'
Search Results
2. Case report—CARMAT: the first experience with the Aeson bioprosthetic total artificial heart as a bridge to transplantation in a case of post-infarction ventricular septal rupture
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Katharina Huenges, Bernd Panholzer, Jochen Cremer, and Assad Haneya
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total artificial heart ,VSD ,myocardial infarction ,heart transplantation ,heart failure ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundPost-infarction ventricular septal defects remain one of the most feared complications after myocardial infarction with high mortality rates. In special cases, surgical or interventional treatment strategies are technically not feasible and do not always lead to a good outcome.Case presentationA 58-year-old male patient in cardiogenic shock with a very large ventricular septal (VSD) defect (4.9 cm × 5 cm) due to myocardial infarction was presented in our department. Acute stabilization was achieved using peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. Neither surgical nor interventional therapy was considered as a sufficient option due to the unsuitable anatomy of the VSD and the patient was listed for heart transplantation. After 2 weeks on ECMO, bleeding and infectious complications occurred. Due to organ shortage, urgent implantation of the bioprosthetic total artificial heart (TAH) Aeson device (CARMAT) remained the only useful strategy to achieve a mid- or long-term bridge to transplantation. After successful implantation and good recovery with the Aeson device, the patient was transplanted 4 weeks after implantation.ConclusionPost-infarction ventricular septal defects are highly challenging and are commonly associated with a poor prognosis. The implantation of the new Aeson TAH device is a promising therapeutic option, allowing a safe and long-term bridging to heart transplantation.
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- 2023
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3. Coronary Artery Bypass Grafting in Patients with Acute Myocardial Infarction and Cardiogenic Shock
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Christina Grothusen, Christine Friedrich, Ulysses Ulbricht, Jette Meinert, Tim Attmann, Katharina Huenges, Christoph Borzikowsky, Assad Haneya, Jan Schoettler, and Jochen Cremer
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cardiogenic shock ,acute myocardial infarction ,cabg ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objective: Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains associated with a high rate of mortality and disabling morbidity. Coronary artery bypass grafting (CABG) is seldom considered in this setting due to the fear of peri-operative complications. Here, we analysed the outcome of CS patients undergoing CABG within 48 hours after diagnosed with AMI. Methods: A single-center, retrospective data analysis was performed in 220 AMI patients with CS that underwent CABG within 48 hours between 01/2001 and 01/2018. Results: 141 patients were diagnosed with ST-elevation myocardial infarction (STEMI), 79 with non-STEMI (NSTEMI). Median age was 67 (60; 72) for STEMI, and 68 (60.8; 75.0) years for NSTEMI patients (p = 0.190). 52.5% of STEMI patients and 39.2% of NSTEMI patients had suffered from cardiac arrest (CA) pre-operatively (p = 0.049). Coronary 3-vessel disease was present in most patients (78.0% STEMI vs 83.5% NSTEMI; p = 0.381). Percutaneous coronary interventions (PCI) were performed in 32.6% STEMI and 27.8% NSTEMI patients (p = 0.543) prior to surgery. Time from diagnosis to surgery was shorter in STEMI patients (3.92 (2.67; 5.98) vs 7.50 (4.78; 16.74) hours; p < 0.001). A complete revascularization was achieved in 82.3% of STEMI and 73.4% of NSTEMI cases (p = 0.116). Post-operative low cardiac output occurred in 14.2% of STEMI vs 8.9% of NSTEMI patients (p = 0.289). The rate of cerebrovascular injury–including hypoxic brain damage was 12.1% for STEMI and 10.1% among NSTEMI patients. (p = 0.825). 30-day mortality was 32.6% after STEMI vs 31.6% in NSTEMI cases (p = 0.285). Conclusions: In contrast to the discouraging data concerning the role of PCI in AMI patients with CS and complex coronary artery disease, CABG may represent a treatment option worth considering.
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- 2022
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4. CSA-Induced PRES after Heart Transplantation—Report of Two Cases and Review
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Katharina Huenges, Philipp Kolat, Bernd Panholzer, and Assad Haneya
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heart transplantation ,immunusuppression ,rejection ,Surgery ,RD1-811 - Abstract
Background Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disease possibly associated with the use of calcineurin inhibitors (CNI) like cyclosporine A. Case Description The case of a patient who developed severe PRES under CNI therapy shortly after heart transplantation is presented here. Cerebral computed tomography led to the diagnose of PRES in our patient. New therapy strategy with a quadruple immunosuppressive protocol (cortisone, mycophenolate mofetil, low-dose CNI, and a mechanistic target of rapamycin inhibitor) was started. Conclusion Under the quadruple therapy, a neurologic recovery occurred. In PRES, the presented alternative therapy strategy may lead to improving neurological conditions and preserved transplant organ functions.
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- 2021
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5. Left Ventricular Assist Device Implantation with Concomitant Aortic Valve and Ascending Aortic Replacement
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Katharina Huenges, Bernd Panholzer, Jochen Cremer, and Assad Haneya
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Medicine - Abstract
Left ventricular assist device (LVAD) is nowadays a routine therapy for patients with advanced heart failure. We present the case of a 74-year-old male patient who was admitted to our center with terminal heart failure in dilated cardiomyopathy and ascending aortic aneurysm with aortic valve regurgitation. The LVAD implantation with simultaneous aortic valve and supracoronary ascending aortic replacement was successfully performed.
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- 2018
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6. Cardiac Graft from Donors with Extracorporeal Support—A Report of Two Cases
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Bernd Panholzer, Katharina Huenges, Jochen Cremer, and Assad Haneya
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extracorporeal support ,heart transplantation ,organ donors ,Surgery ,RD1-811 - Abstract
The persistent global shortage of organ donors is still a major limitation for transplantation. Experiences of heart transplantation from donors with extracorporeal support are rare. Here, we report from two cases of donors who were supported by extracorporeal membrane oxygenation due to acute circulatory failure. In both cases, the direct postoperative course was uneventful and free from major complications. The patients were discharged to a rehabilitation clinic. Our experience suggests that the use of heart organ from carefully selected donors with extracorporeal support is possible and may lead to an excellent outcome.
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- 2018
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7. Outcome of Stable Patients With Acute Myocardial Infarction and Coronary Artery Bypass Surgery Within 48 Hours: A Single‐Center, Retrospective Experience
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Christina Grothusen, Christine Friedrich, Johannes Loehr, Jette Meinert, Eva Ohnewald, Ulysses Ulbricht, Tim Attmann, Assad Haneya, Katharina Huenges, Sandra Freitag‐Wolf, Jan Schoettler, and Jochen Cremer
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coronary artery bypass ,myocardial infarction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundThe optimal timing of coronary artery bypass grafting (CABG) in clinically stable patients with acute myocardial infarction who are unsuitable for percutaneous coronary intervention is unclear. We report our experience with early CABG in these patients. Methods and ResultsBetween January 2001 and May 2015, 766 patients with ST‐segment–elevation myocardial infarction (STEMI, n=305) or non‐STEMI (NSTEMI, n=461) not including cardiogenic shock underwent CABG within 48 hours at our department. STEMI patients were younger than non‐STEMI patients (age 65 years [range: 58–72] versus 70 years [range: 62–75], P
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- 2017
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8. A Cardiac Graft from a Donor with Granulomatosis with Polyangiitis—A Case Report
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Katharina Huenges, Bernd Panholzer, Jochen Cremer, and Assad Haneya
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systemic ,transplantation ,heart ,heart failure ,Surgery ,RD1-811 - Abstract
Organ shortage unavoidably leads to shifting strategies in modern transplantation medicine. Experiences with specific comorbidities in terms of organ transplantation therefore have to be made. We report a case of a 51-year-old male patient with successful orthotopic heart transplantation from a donor with granulomatosis with polyangiitis. After a good recovery, the patient was discharged to rehabilitation 2 months after transplantation.
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- 2017
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9. Lung Transplantation in a Multidrug-Resistant Gram-Negative Acinetobacter Baumannii–Colonized Patient: A Case Report
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Katharina Huenges, Alexander Reinecke, Burkhard Bewig, Assad Haneya, and Jochen Cremer
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lung transplantation ,α-1-antitrypsin deficiency ,multidrug-resistant acinetobacter baumannii ,Surgery ,RD1-811 - Abstract
Abstract Colonization or infection with various pathogens is frequently found in patients listed for lung transplantation. We describe a case of a 50-year-old woman with α-1-antitrypsin deficiency, which was listed for double-lung transplantation, with multidrug-resistant gram-negative Acinetobacter baumannii (MRGN4-Ab) skin colonization. Transplantation was successfully performed. Colistin (Polymyxine E) was administered intravenously and through inhalation in the first month. MRGN4-Ab was still detectable in skin swabs without evidence of infection. After good recovery and clinical inapparence, the patient was discharged 2 months after transplantation.
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- 2015
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10. Outcome after surgical embolectomy for acute pulmonary embolism
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Bernd Panholzer, Hanna Gravert, Christoph Borzikowsky, Katharina Huenges, Jan Schoettler, Felix Schoeneich, Tim Attmann, Assad Haneya, Derk Frank, Jochen Cremer, and Christina Grothusen
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Treatment Outcome ,Acute Disease ,Humans ,Thrombolytic Therapy ,General Medicine ,Embolectomy ,Middle Aged ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
Patients with pulmonary embolism (PE) and contraindications for or failed thrombolysis are at the highest risk for PE-related fatal events. These patients may benefit from surgical embolectomy, but data concerning this approach are still limited.The method used here was retrospective data analysis of 103 patients who underwent surgical embolectomy from 2002 to 2020 at our department.Mean age was 58.4 (±15.1) years. Fifty-eight (56.3%) patients had undergone recent surgery; the surgery was tumor associated in 32 (31.1%) cases. Thirty (29.1%) patients had to be resuscitated due to PE, and 13 (12.6%) patients underwent thrombolysis prior to pulmonary embolectomy. Fifteen (14.5%) patients were placed on extra corporeal membrane oxygenation (ECMO) peri-operatively. Five patients (4.9%) died intra-operatively. Neurological symptoms occurred in four patients (3.9%). Thirty-day mortality was 23.3% ( n = 24). Re-thoracotomy due to bleeding was necessary in 12 (11.6%) patients. This parameter was also identified as an independent risk factor for mortality.Surgical pulmonary embolectomy resulted in survival of the majority of patients with PE and contraindications for or failed thrombolysis. Given the excessive mortality when left untreated, an operative approach should become a routine part of discussions concerning alternative treatment options for these patients.
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- 2022
11. Mid- and Long-Term Surgical Outcomes Due to Infective Endocarditis in Elderly Patients: A Retrospective Cohort Study
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Jill Jussli-Melchers, Mohamed Ahmed Salem, Jan Schoettler, Christine Friedrich, Katharina Huenges, Gunnar Elke, Thomas Puehler, Jochen Cremer, and Assad Haneya
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General Medicine ,infective endocarditis ,cardiac surgery ,cardiopulmonary bypass ,elderly patients - Abstract
Background: Infective endocarditis (IE) is one of the true remaining dreaded situations in cardiovascular medicine. Current international guidelines do not include specific recommendations for treatment options of infective endocarditis (conventional vs. surgical) based on the patient’s age, functional status or comorbidities. Elderly patients have less invasive and often delayed surgeries compared to younger patients due to their shorter long-term survival probabilities. In the setting of IE, this might not be the right treatment, as surgery is the only curative option in up to 50% of all endocarditis patients. The aim of our study was to evaluate the mid- and long-term surgical outcomes due to infective endocarditis of patients aged ≥70 years. Methods: Between 2002 and 2020, a retrospective study with 137 patients aged 70 years and older and 276 patients aged below 70 years was conducted. Altogether, 413 consecutive patients who received surgery due to infective native or prosthetic valve endocarditis were assigned to either the elderly (E)-Group or the control (C)-Group. Primary endpoints were short- and long-term MACCEs (Major Adverse Cardiac and Cerebrovascular Events) as a composite of death or major adverse events, and secondary endpoints were intraoperative variables and postoperative course. Results: Preoperative risk factors differed significantly. Elderly patients had more arterial hypertension, atrial fibrillation, diabetes, chronic renal insufficiency and coronary heart disease. Fewer of them were in a state of emergency. Time from diagnosis to OR, antibiotic pretreatment, length of surgery and cardiopulmonary bypass time were significantly longer in the E-Group. Furthermore, 44.5% of patients in the E-Group had prosthesis endocarditis as opposed to 29.7% in the C-group. During postoperative follow-up, new onset of hemodialysis, duration of ventilation, delirium, reintubation and tracheotomy rates were significantly higher in the E-Group. There were significant differences in 7- and 30-day mortality. One- year survival was 62% for the E-Group and 79% for the C-Group. Five-year survival was 47% for the E-Group and 67% for the C-Group. Conclusions: This study demonstrates that surgery for infective endocarditis is a high-risk procedure, especially for elderly people. Nevertheless, as it is more or less the only concept to increase long-term survival, it should be offered generously to all patients who are still able to take care of themselves.
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- 2022
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12. Severe Pulmonary Bleeding after Assist Device Implantation: Incidence, Risk Factors and Prognostic Impact
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Bernd Panholzer, Kevin Pilarczyk, Katharina Huenges, Charlotte Aldinger, Christine Friedrich, Ulrike Nowak-Göttl, Jochen Cremer, and Assad Haneya
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LVAD ,heart failure ,bleeding ,hemoptysis ,pulmonary hemorrhage ,General Medicine - Abstract
Background: Continuous flow left ventricular assist devices (CF-LVAD) improve survival in patients with advanced heart failure but confer risk of bleeding complications. Whereas pathophysiology and risk factors for many bleeding complications are well investigated, the literature lacks reports about pulmonary bleeding. Therefore, it was the aim of the present study to assess incidence, risk factors, and clinical relevance of pulmonary bleeding episodes after LVAD implantation. Methods: We retrospectively analyzed our institutional database of 125 consecutive patients who underwent LVAD implantation between 2008 and 2017. Demographic and clinical variables related to bleeding were collected. The primary endpoint was incidence of severe pulmonary bleeding (SPB). Results: Nine out of 125 patients suffered from SPB during the postoperative course (7.2%) 11 days after surgery in the median. None of them had a known history of lung disease or bleeding disorder. History of prior myocardial infarction (0% vWD. 42.2%, p = 0.012) and ischemic cardiomyopathy (25.0% vs. 50.0%, p = 0.046) were less frequent in the SBP group. Concomitant aortic valve replacement was more common in the group with SPB (33.3% versus 7.0%, p = 0.034). Surgical (blood loss 9950 vs. 3800 mL, p = 0.012) as well as ear-nose-throat (ENT) bleedings (33% vs. 4.6%, p = 0.015) were observed more frequently in patients with SPB. SPB was associated with a complicated postoperative course with a higher incidence of acute kidney failure (100% versus 36.7%, p = 0.001) and delirium (44.4% versus 14.8%, p = 0.045); a higher need for red blood cell (26 packs versus 7, p < 0.001), fresh frozen plasma (18 units versus 6, p = 0.002), and platelet transfusion (8 pools versus 1, p = 0.001); longer ventilation time (1206 versus 171 h, p = 0.001); longer ICU-stay (58 versus 13 days, p = 0.002); and higher hospital mortality (66.7% vs. 29%, p = 0.029). Conclusion: SPB is a rare but serious complication after LVAD implantation and is significantly associated with higher morbidity and mortality. The pathophysiology and potential risk factors are unknown but may include coagulation disorders and frequent suctioning or empiric bronchoscopy causing airway irritation.
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- 2022
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13. Minimally Invasive Direct Coronary Artery Bypass in High-Risk Patients with Multivessel Disease
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Grischa Hoffmann, Christine Friedrich, Astrid-Mareike Vogt, Christina Grothusen, Rainer Petzina, Katharina Huenges, and J. Cremer
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,Revascularization ,Risk Factors ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Minimally invasive direct coronary artery bypass ,Coronary Artery Bypass ,Aged ,Aged, 80 and over ,business.industry ,Incidence (epidemiology) ,Incidence ,Perioperative ,Multivessel disease ,Guideline ,medicine.disease ,Surgery ,Stenosis ,medicine.anatomical_structure ,Treatment Outcome ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Background High-risk patients with multivessel disease (MVD) including a complex stenosis of the left anterior descending coronary may not be ideal candidates for guideline compliant therapy by coronary artery bypass grafting (CABG) regarding invasiveness and perioperative complications. However, they may benefit from minimally invasive direct coronary artery bypass (MIDCAB) grafting and hybrid revascularization (HCR). Methods A logistic European system for cardiac operative risk evaluation score (logES) >10% defined high risk. In high-risk patients with MVD undergoing MIDCAB or HCR, the incidence of major adverse cardiac and cerebrovascular events (MACCEs) after 30 days and during midterm follow-up was evaluated. Results Out of 1,250 patients undergoing MIDCAB at our institution between 1998 and 2015, 78 patients (logES: 18.5%; age, 76.7 ± 8.6 years) met the inclusion criteria. During the first 30 days, mortality and rate of MACCE were 9.0%; early mortality was two-fold overestimated by logES. Complete revascularization as scheduled was finally achieved in 64 patients (82.1%). Median follow-up time reached 3.4 (1.2–6.5) years with a median survival time of 4.7 years. Survival after 1, 3, and 5 years was 77, 62, and 48%. Conclusion In high-risk patients with MVD, MIDCAB is associated with acceptable early outcome which is better than predicted by logES. Taking the high-risk profile into consideration, midterm follow-up showed satisfying results, although scheduled HCR was not realized in a relevant proportion. In selected cases of MVD, MIDCAB presents an acceptable alternative for high-risk patients.
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- 2021
14. Coronary Artery Bypass Grafting in Patients with Acute Myocardial Infarction and Cardiogenic Shock
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Jochen Cremer, Jan Schoettler, Assad Haneya, Christoph Borzikowsky, Katharina Huenges, Tim Attmann, Jette Meinert, Ulysses Ulbricht, Christine Friedrich, and Christina Grothusen
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
15. Hemocompatibility-Related Adverse Events in a Real-World Cohort Comparing Three Different LVADs, the HeartWare, HeartMate II, and HeartMate 3: A Multicenter Observational Study
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A. Rotaru, Klaus Matschke, A. H. Diab, Ruediger Autschbach, O. Allham, Assad Haneya, Heike Schnoering, Katharina Huenges, Bernd Panholzer, J. Cremer, and R. Zayat
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medicine.medical_specialty ,Heartmate ii ,business.industry ,Emergency medicine ,Cohort ,medicine ,Observational study ,business ,Adverse effect - Published
- 2021
16. Acute Kidney Injury in Patients with Severe ARDS Requiring Extracorporeal Membrane Oxygenation: Incidence, Prognostic Impact and Risk Factors
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Kevin Pilarczyk, Katharina Huenges, Burkhard Bewig, Lorenz Balke, Jochen Cremer, Assad Haneya, and Bernd Panholzer
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surgical procedures, operative ,acute respiratory distress syndrome ,extracorporeal membrane oxygenation ,acute kidney injury ,General Medicine - Abstract
(1) Background: Acute kidney injury (AKI) is a common but under-investigated complication in patients receiving extracorporeal membrane oxygenation (ECMO). We aimed to define the incidence and clinical course, as well as the predictors of AKI in adults receiving ECMO support. (2) Materials and Methods: This is a retrospective analysis of all patients undergoing veno-venous ECMO treatment in a tertiary care center between December 2008 and December 2017. The primary endpoint was the new occurrence of an AKI of stage 2 or 3 according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification after ECMO implantation. (3) Results: During the observation period, 103 patients underwent veno-venous ECMO implantation. In total, 59 patients (57.3%) met the primary endpoint with an AKI of stage 2 or 3 and 55 patients (53.4%) required renal replacement therapy. Patients with an AKI of 2 or 3 suffered from more bleeding and infectious complications. Whereas weaning failure from ECMO (30/59 (50.8%) vs. 15/44 (34.1%), p = 0.08) and 30-day mortality (35/59 (59.3%) vs. 17/44 (38.6%), p = 0.06) only tended to be higher in the group with an AKI of stage 2 or 3, long-term survival of up to five years was significantly lower in the group with an AKI of stage 2 or 3 (p = 0.015). High lactate, serum creatinine, and ECMO pump-speed levels, and low platelets, a low base excess, and a low hematocrit level before ECMO were independent predictors of moderate to severe AKI. Primary hypercapnic acidosis was more common in AKI non-survivors (12 (32.4%) vs. 0 (0.0%), p < 0.01). Accordingly, pCO2-levels prior to ECMO implantation tended to be higher in AKI non-survivors (76.12 ± 27.90 mmHg vs. 64.44 ± 44.31 mmHg, p = 0.08). In addition, the duration of mechanical ventilation prior to ECMO-implantation tended to be longer (91.14 ± 108.16 h vs. 75.90 ± 86.81 h, p = 0.078), while serum creatinine (180.92 ± 115.72 mmol/L vs. 124.95 ± 77.77 mmol/L, p = 0.03) and bicarbonate levels were significantly higher in non-survivors (28.22 ± 8.44 mmol/L vs. 23.36 ± 4.19 mmol/L, p = 0.04). (4) Conclusion: Two-thirds of adult patients receiving ECMO suffered from moderate to severe AKI, with a significantly increased morbidity and long-term mortality.
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- 2022
17. Prediction of Acute Kidney Injury by Cystatin C and [TIMP-2]*[IGFBP7] after Thoracic Aortic Surgery with Moderate Hypothermic Circulatory Arrest
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Kevin Pilarczyk, Bernd Panholzer, Katharina Huenges, Mohamed Salem, Toni Jacob, Jochen Cremer, and Assad Haneya
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General Medicine ,acute kidney injury ,hypothermic circulatory arrest ,thoracic aortic surgery ,biomarkers ,Cystatin ,cell cycle arrest markers - Abstract
(1) Background: Acute kidney injury (AKI) is a common complication following thoracic aortic surgery (TAS), with moderate hypothermic circulatory arrest (MHCA). However, prediction of AKI with classical tools remains uncertain. Therefore, it was the aim of the present study to evaluate the role of new biomarkers in patients after MHCA. (2) Methods: 101 consecutive patients were prospectively enrolled. Measurements of urinary [TIMP-2]*[IGFBP7] and Cystatin C in the blood were performed perioperatively. Primary endpoint was the occurrence of AKI stage 2 or 3 (KDIGO-classification) within 48 h after surgery (AKI group). (3) Results: Mean age of patients was 69.1 ± 10.9 years, 35 patients were female (34%), and 13 patients (13%) met the primary endpoint. Patients in the AKI group had a prolonged ICU-stay (6.9 ± 7.4 days vs. 2.5 ± 3.1 days, p < 0.001) as well as a higher 30-day-mortality (9/28 vs. 1/74, p < 0.001). Preoperative serum creatinine (169.73 ± 148.97 μmol/L vs. 89.74 ± 30.04 μmol/L, p = 0.027) as well as Cystatin C (2.41 ± 1.54 mg/L vs. 1.13 ± 0.35 mg/L, p = 0.029) were higher in these patients. [TIMP-2]*[IGFBP7] increased significantly four hours after surgery (0.6 ± 0.69 mg/L vs. 0.37 ± 0.56 mg/L, p = 0.03) in the AKI group. Preoperative Cystatin C (AUC 0.828, p < 0.001) and serum creatinine (AUC 0.686, p = 0.002) as well as [TIMP-2]*[IGFBP7] 4 h after surgery (AUC 0.724, p = 0.020) were able to predict postoperative AKI. The predictive capacity of Cystatin C was superior to serum creatinine (p = 0.0211) (4) Conclusion: Cystatin C represents a very sensitive and specific biomarker to predict AKI in patients undergoing thoracic surgery with MHCA even before surgery, whereas the predictive capacity of [TIMP-2]*[IGFBP7] is only moderate and inferior to that of serum creatinine.
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- 2022
18. Risk Factors for Mortality in Acute Aortic Dissection Type A: A Centre Experience Over 15 Years
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M. Salem, Christine Friedrich, Katharina Huenges, Jochen Cremer, A. Thiem, Thomas Puehler, and Assad Haneya
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Time Factors ,MEDLINE ,Risk Assessment ,Blood Vessel Prosthesis Implantation ,Postoperative Complications ,Hypothermia, Induced ,Risk Factors ,Germany ,Retrospective analysis ,Medicine ,Humans ,Aged ,Retrospective Studies ,Aortic dissection ,business.industry ,Mortality rate ,Age Factors ,Middle Aged ,medicine.disease ,Surgery ,Cardiac surgery ,Aortic Aneurysm ,Aortic Dissection ,Treatment Outcome ,Circulatory system ,Heart Arrest, Induced ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction Acute aortic dissection Type A (AADA) is still associated with a high mortality rate and frequent postoperative complications. This study was designed to evaluate the risk factors for mortality in AADA patients. Patients and Methods This retrospective analysis included 344 consecutive patients who underwent surgery for AADA in moderate hypothermic circulatory arrest (20–24°C nasopharyngeal) between 2001 and 2016. Results The 30-day mortality rate was 18%. Nonsurvivors were significantly older (65.7 ± 12.0 years vs. 62.0 ± 12.5 years; p = 0.034) with significantly higher Euro-score II [15.4% (6.6; 23.0) vs. 4.63% (2.78; 9.88); p Conclusion Our analysis suggested that the reason for mortality was multifactorial, especially age, previous cardiac surgery, CPR, transfusion, as well as postoperative AKI were considered risk factors for mortality.
- Published
- 2020
19. Transcatheter mitral valve implantation: supra-annular and subvalvular fixation techniques
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Michael M. Morlock, Derk Frank, Klaas Loger, Katharina Huenges, Tim Attmann, Justus Groß, Saskia Pokorny, Jochen Cremer, and Georg Lutter
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Swine ,medicine.medical_treatment ,Ischemia ,Hemodynamics ,030204 cardiovascular system & hematology ,Prosthesis Design ,03 medical and health sciences ,Fixation (surgical) ,0302 clinical medicine ,Mitral valve ,medicine ,Animals ,cardiovascular diseases ,030212 general & internal medicine ,Heart Valve Prosthesis Implantation ,Ejection fraction ,business.industry ,Mitral Valve Insufficiency ,Treatment options ,Stent ,Equipment Design ,General Medicine ,medicine.disease ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Heart Valve Prosthesis ,cardiovascular system ,Mitral Valve ,Stents ,Cardiology and Cardiovascular Medicine ,Mitral valve regurgitation ,business ,Echocardiography, Transesophageal - Abstract
OBJECTIVES Transcatheter mitral valved stent implantation provides an off-pump treatment option for mitral valve regurgitation, especially for secondary mitral valve regurgitation. The aim of this study was to evaluate novel fixation strategies: direct fixation (SUPRA) and subvalvular fixation (sub-VALV) to successfully implement alternative fixation methods at the mitral annulus and to reduce radial stent and apical tether forces. METHODS Specific concepts were developed for the supra-annular hook-shaped fixation (SUPRA) and the subvalvular fixation (sub-VALV). These prototypes were compared with the sole apical tether fixation (AP) methods. Thirty-three pigs underwent mitral valved stent implantation accompanied by standardized transoesophageal echocardiographic and haemodynamic evaluation of heart function and the stent performance 1 h after implantation. Additionally, animals were followed up for 3 months. RESULTS Secure deployment and correct positioning with low transvalvular gradients were achieved in all cases with mitral valved stent implantation. Nevertheless, 2 pigs died due to rhythm disturbances during dissection and pre-transcatheter mitral valve implantation. Paravalvular leakages were trace or less in prototypes with supra-annular fixation and sole apical fixation. In contrast, moderate paravalvular leakages were observed in the sub-VALV group (P
- Published
- 2018
20. Sex-dependent Differences after Early Operative Myocardial Revascularization in Acute Myocardial Infarction
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Christine Friedrich, M. Ashbahs, Katharina Huenges, J. Meinert, J. Schoettler, E. Ohnewald, Assad Haneya, Tim Attmann, Christina Grothusen, and J. Cremer
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Myocardial revascularization ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Surgery ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2018
21. Is Total Arch Replacement Associated with an Increased Risk for 30-day Mortality after Surgery for Acute Type A Dissection
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M. Salem, Thomas Puehler, F. Schoeneich, Assad Haneya, Christine Friedrich, J. Cremer, Katharina Huenges, Bernd Panholzer, and J. Schoettler
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Dissection (medical) ,medicine.disease ,Surgery ,Increased risk ,30 day mortality ,Acute type ,Medicine ,Arch ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
22. Effect of Deep Hypothermia Circulatory Arrest on Neurological Outcomes in Patients Undergoing Replacement of Ascending Aorta: A Comparison between Young and Elderly Adults
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N. Psykalla, T Pühler, Assad Haneya, M. Salem, J. Schoettler, Christine Friedrich, F. Schoeneich, A. Salem, S. Düver, J. Cremer, Y. Erdal, Katharina Huenges, and Bernd Panholzer
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Pulmonary and Respiratory Medicine ,business.industry ,Hypothermia ,medicine.artery ,Anesthesia ,Circulatory system ,Ascending aorta ,medicine ,Surgery ,In patient ,Elderly adults ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
23. A new device for vein localization and effect of application of disinfectant spray on its efficiency
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Assad Haneya, Jan Dreyer, Katharina Huenges, and Jochen Cremer
- Subjects
medicine.medical_specialty ,Materials science ,mlx90614 ,disinfectant spray ,Disinfectant ,Biomedical Engineering ,vein finding ,Surgery ,temperature gradient ,arduino ,medicine.anatomical_structure ,infrared thermography ,medicine ,Medicine ,New device ,Vein ,Biomedical engineering - Abstract
A functional device was developed to immediately show the localization of veins by detecting a temperature increase on the skin directly above them. Our new idea, compared to other developments, is the comparison of temperatures between a small, ideally punctiform, skin area, and a larger circularly surrounding area. This is realized by two infrared temperature sensors, one with a small field of view, and the other one with a larger field of view. The position of the vein is indicated by two laser modules, which beams cross in one spot, when the device is held in a defined distance to the skin. If the device is held over a vein, the laser spot lightens up. The device was tested in ten study participants. Cooling of the skin by disinfectant spray prior to the measurements increases the temperature gradient and thereby improves the efficiency of the device. Temperature profiles of four skin areas of each study participant were measured before and one minute after application of disinfectant spray. After application of disinfectant spray, a temperature difference of more than 0.3 K between a measuring point above a vein and points 15 mm next to this could be found in 36 out of 40 measurements (90%), compared to 26 out of 40 (65%) before disinfection. The mean temperature gradient could be increased from 0.476 K to 1.03 K (p < 0.001).
- Published
- 2017
24. Transesophageal Echocardiography in Swine: Establishment of a Baseline
- Author
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Georg Lutter, Rouven Berndt, Katharina Huenges, Saskia Pokorny, and Jochen Cremer
- Subjects
Male ,medicine.medical_specialty ,Future studies ,Acoustics and Ultrasonics ,Swine ,Cardiovascular research ,Echocardiography, Three-Dimensional ,Biophysics ,Hemodynamics ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Imaging Tool ,Animal model ,Mitral valve ,Animals ,Medicine ,Radiology, Nuclear Medicine and imaging ,Ultrasonography, Interventional ,Heart Valve Prosthesis Implantation ,Radiological and Ultrasound Technology ,business.industry ,Large white ,medicine.anatomical_structure ,030228 respiratory system ,Heart Valve Prosthesis ,Reference values ,Models, Animal ,Mitral Valve ,Female ,Stents ,Radiology ,business ,human activities ,Echocardiography, Transesophageal - Abstract
The porcine model is a commonly used animal model in cardiovascular research. Along with new innovative operative techniques, choice of the optimal imaging technique is crucial. Transesophageal echocardiography (TEE) is a reliable imaging tool is highly important in a large number of experimental evaluations. But so far, TEE data for swine are limited, and few standard values have been established for the porcine model. The experience and baseline results for TEE in 45 swine are presented in this study. A full TEE examination was conducted in 45 German landrace or German large white swine, with an average body weight of 49 ± 3 kg, before experimental off-pump mitral valved stent implantation. Additionally hemodynamic measurements were evaluated. The valve implantation procedure was guided solely by real-time 3-D TEE. Baseline values of standard echocardiographic parameters are provided and, where appropriate, compared with human reference values. TEE proved to be an adequate imaging technique in this experimental porcine animal model. The baseline TEE and hemodynamic parameters established for the widely used porcine model can serve as a reference in future studies.
- Published
- 2017
25. Extracorporeal membrane oxygenation for acute respiratory distress syndrome in adults: an analysis of differences between survivors and non-survivors
- Author
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Katrin Meckelburg, Nils Haake, Kevin Pilarczyk, Michael von der Brelie, Jochen Cremer, Grischa Hoffmann, Assad Haneya, Katharina Huenges, and Bernd Panholzer
- Subjects
Adult ,Male ,ARDS ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Acute respiratory distress ,030204 cardiovascular system & hematology ,Cohort Studies ,Young Adult ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Radiology, Nuclear Medicine and imaging ,Intensive care medicine ,Aged ,Retrospective Studies ,Advanced and Specialized Nursing ,Respiratory Distress Syndrome ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Survival Analysis ,Pneumonia ,030228 respiratory system ,Acute Disease ,Female ,Cardiology and Cardiovascular Medicine ,business ,Safety Research - Abstract
Objectives: Over the last decade, extracorporeal membrane oxygenation (ECMO) has become a promising option for patients with severe acute respiratory distress syndrome (ARDS). In this single-center observational cohort study, data from a patient group with severe ARDS treated with ECMO was analyzed. Methods: Data from 46 patients [median age 54 years (18 to 72), male: 65.2%] were evaluated retrospectively between January 2009 and September 2015. Results: Diagnosis leading to ARDS was pneumonia in 63.1% of the patients. The median SOFA Score was 13 (10 to 19) and the median LIS was 3.5 (2.67 to 4). The median duration of ECMO support was 12 days (1 to 86). Twenty-eight patients (60.9%) were successfully weaned from ECMO and 22 patients survived (47.8%). Non-survivors needed significantly more frequent renal replacement therapy (37.5% vs. 18.2%; pConclusion: This report suggests that ECMO currently allows treatment of severe ARDS with presumed improved survival. The incidence rate of acute kidney injury and transfusion are associated with adverse outcomes.
- Published
- 2017
26. Short- and Long-Term Outcome of Patients with Acute Myocardial Infarction and Coronary Artery Bypass Surgery within 48 Hours
- Author
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Christine Friedrich, J. Meinert, J. Schoettler, Tim Attmann, J. Cremer, E. Ohnewald, U. Ulbricht, Assad Haneya, Katharina Huenges, Christina Grothusen, and J. Loehr
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine.disease ,Term (time) ,Surgery ,Coronary artery bypass surgery ,Internal medicine ,Cardiology ,Medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
27. Severe Calcification of the Ascending Aorta Detected Incidentally in Patients Undergoing Coronary Artery Bypass Grafting
- Author
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Assad Haneya, Grischa Hoffmann, J. Cremer, M. Salem, F. Schoeneich, Katharina Huenges, Bernd Panholzer, J Schöttler, and B. Mohammad
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Bypass grafting ,business.industry ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Internal medicine ,medicine.artery ,Ascending aorta ,medicine ,Cardiology ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Calcification ,Artery - Published
- 2017
28. Severe Pulmonary Bleeding after Assist Device Implantation: A Case Series
- Author
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Philipp Kolat, Christina Grothusen, Assad Haneya, A.M. Eide, Grischa Hoffmann, J. Cremer, Katharina Huenges, and Bernd Panholzer
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Series (stratigraphy) ,business.industry ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
29. Mid-Term Outcome of Total Arterial Myocardial Revascularization in Patients Older than 70 Years
- Author
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J Schöttler, Katharina Huenges, A. Kowalski, Bernd Panholzer, Christina Grothusen, Jill Jussli-Melchers, F Schöneich, Assad Haneya, and J. Cremer
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Myocardial revascularization ,business.industry ,Medicine ,Surgery ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Outcome (game theory) ,Term (time) - Published
- 2017
30. Development of a new catheter prototype for laser thrombolysis under guidance of optical coherence tomography (OCT): validation of feasibility and efficacy in a preclinical model
- Author
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Matthias Lutz, Georg Lutter, Lars Hummitzsch, Alexander Schlaefer, Rouven Berndt, Justus Groß, Christoph Otte, Assad Haneya, Katharina Heß, Katharina Huenges, Bernd Panholzer, Jochen Cremer, and Rene Rusch
- Subjects
medicine.medical_specialty ,Catheters ,Mechanical Thrombolysis ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Models, Biological ,01 natural sciences ,law.invention ,010309 optics ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Optical coherence tomography ,law ,0103 physical sciences ,medicine ,Humans ,Thrombus ,Reproducibility ,Laser ablation ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Thrombosis ,Hematology ,Thrombolysis ,medicine.disease ,Laser ,Catheter ,Treatment Outcome ,Tissue Plasminogen Activator ,Laser Therapy ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence - Abstract
In this feasibility study, a novel catheter prototype for laser thrombolysis under the guidance of optical coherence tomography (OCT) was designed and evaluated in a preclinical model. Human arteries and veins were integrated into a physiological flow model and occluded with thrombi made from the Chandler Loop. There were four experimental groups: placebo, 20 mg alteplase, laser, 20 mg alteplase + laser. The extent of thrombolysis was analyzed by weighing, OCT imaging and relative thrombus size. In the alteplase group, thrombus size decreased to 0.250 ± 0.036 g (p < 0.0001) and 14.495 ± 0.526 mm2 (p < 0.0001) at 60 min. The relative thrombus size decreased to 73.6 ± 4.1% at 60 min (p < 0.0001). In the laser group, thrombus size decreased significantly to 0.145 ± 0.028 g (p < 0.0001) and 11.559 ± 1.034 mm2 (p < 0.0001). In the alteplase + laser group, thrombus size decreased significantly (0.051 ± 0.026 g; p < 0.0001; 9.622 ± 0.582 mm2; p < 0.0001; 47.4 ± 6.1%; p < 0.0001) in contrast to sole alteplase and laser application. The reproducibility and accuracy of the OCT imaging was high (SD
- Published
- 2017
31. Interventionelle Mitralklappen: der Blick in die Glaskugel
- Author
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Derk Frank, Katharina Huenges, Saskia Pokorny, and Georg Lutter
- Published
- 2016
32. Iatrogenic Catheter-Induced Acute Aortic Dissection Type A after Coronary Angiography—A Retrospective Consecutive Case Series
- Author
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Miriam Freundt, Azizolah Rahimi-Barfeh, Jochen Cremer, Jochen Renner, F. Schoeneich, Philipp J. Schäfer, Jan Dreyer, Assad Haneya, Christina Grothusen, Katharina Huenges, Bernd Panholzer, and J Schöttler
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Coronary angiography ,Cardiac Catheterization ,medicine.medical_specialty ,Time Factors ,Myocardial ischemia ,Iatrogenic Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Cardiac Catheters ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Germany ,medicine.artery ,Internal medicine ,Ascending aorta ,medicine ,Humans ,Aorta ,Severe complication ,Aged ,Retrospective Studies ,Aged, 80 and over ,Aortic dissection ,business.industry ,fungi ,Hemodynamics ,Consecutive case series ,Middle Aged ,Vascular System Injuries ,medicine.disease ,Aortic Aneurysm ,Surgery ,Aortic Dissection ,Catheter ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Acute Disease ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Background Acute aortic dissection type A (AADA) is one of the most life-threatening situations and surgical demanding procedures even today. Usually AADA develops spontaneously, but it can be related also to interventional procedures. Methods We analyzed the data of 14 patients surgically treated in our institution with catheter-induced AADA (ciAADA) during coronary angiography between January 2004 and December 2014. Data were compared with overall AADA patients in this time period (n = 288). Results Nine of the 14 patients were female. Subjects were significantly older compared to the AADA patients (69 ± 11 vs. 62 ± 11; p = 0.021). At admission, ciAADA patients were more often hemodynamically instable and mechanically ventilated. Twelve patients underwent replacement of the ascending aorta and two patients received a modified Bentall operation. Cardiopulmonary bypass time (210 ± 92 vs. 172 ± 51 min) and cross-clamp time (122 ± 63 vs. 92 ± 40 min) were significantly longer due to additional coronary artery bypass grafts in 71.4 versus 3.1% due to myocardial ischemia. Operative mortality (7.1 vs. 2.1%, p = 0.29) and 30-day mortality (50.0 vs. 10.7%, p Conclusion Coronary angiography–induced AADA is a rare but severe complication. Due to additional myocardial ischemia and preoperative hemodynamic instability, patients with ciAADA have adverse outcome compared to overall AADA patients.
- Published
- 2016
33. Sex-Specific Outcome after Ascending Aortic Surgery in Moderate Hypothermic Circulatory Arrest
- Author
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Mohamed Salem, Thomas Puehler, Katharina Huenges, Bernd Panholzer, Christine Friedrich, Assad Haneya, Jochen Cremer, and Miriam Freundt
- Subjects
Pulmonary and Respiratory Medicine ,Male ,Blood transfusion ,Time Factors ,medicine.medical_treatment ,Risk Assessment ,law.invention ,Aortic aneurysm ,Blood Vessel Prosthesis Implantation ,Postoperative Complications ,Sex Factors ,law ,Hypothermia, Induced ,Risk Factors ,medicine.artery ,Ascending aorta ,Cardiopulmonary bypass ,medicine ,Humans ,Elective surgery ,Vascular Calcification ,Aged ,Retrospective Studies ,Aorta ,business.industry ,Retrospective cohort study ,Perioperative ,Health Status Disparities ,Middle Aged ,medicine.disease ,Aortic Aneurysm ,Treatment Outcome ,Anesthesia ,Heart Arrest, Induced ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Historically, female patients had worse outcome undergoing heart surgery. No recent data exist on gender-specific outcome after moderate hypothermic circulatory arrest (MHCA). The aim of this large retrospective analysis was to investigate gender disparity in patients undergoing elective surgery of ascending aorta in MHCA at 24°C. Methods We conducted a retrospective review of 905 (33.3% female) cases of elective heart surgery in MHCA for ascending aortic aneurysm (90.9%) or severely calcified aorta (12.5%) between 2001 and 2015. Furthermore, 299 female and 299 male patients matched by propensity score were compared. Patients with dissection of the aorta were excluded. Results Women were older (68.4 ± 9.9 vs. 65.8 ± 11.6 years; p = 0.002), had higher logistic EuroSCORE I (18.4 [11.7; 29.2] vs. 12.3% [7.4; 22.6]; p Conclusion This study supports the hypothesis that female gender is not associated with increased short-term mortality or perioperative adverse events in elective aortic surgery in MHCA.
- Published
- 2019
34. Severe Calcification of the Ascending Aorta Detected Incidentally in Patients Undergoing Cardiac Surgery
- Author
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M. Salem, Assad Hanyea, Baland Mohammad, Christine Friedrich, Jochen Cremer, Katharina Huenges, and Bernd Panholzer
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Aortic Diseases ,030204 cardiovascular system & hematology ,Severity of Illness Index ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,medicine.artery ,Severity of illness ,Ascending aorta ,Medicine ,Humans ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Adverse effect ,Vascular Calcification ,Aged ,Retrospective Studies ,Aged, 80 and over ,Incidental Findings ,business.industry ,Extracorporeal circulation ,Retrospective cohort study ,Surgery ,Cardiac surgery ,Treatment Outcome ,Circulatory system ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Incidentally discovered severe calcified ascending aorta (CAA) is a major challenge faced by surgeons during cardiac surgery. The aim of this study was to evaluate the outcome in patients undergoing cardiac surgery in this condition with the additional replacement of the CAA. Methods A retrospective study on a cohort of 74 patients (28.4% females; mean age: 73 ± 7 years) underwent cardiac surgery and initial replacement of an incidentally discovered CAA using moderate hypothermic circulatory arrest. A control group was matched according to age, gender, and procedure. Results No significant differences were noted with regard to preoperative risk factors. Due to the additional replacement of CAA, the extracorporeal circulation and cross-clamping time were significantly longer in the study group (p Conclusion Our study showed that the initial replacement of incidental CAA in patients undergoing cardiac surgery was not associated with increased risks for neurologic adverse events and mortality.
- Published
- 2019
35. Transapical Mitral Valve Implantation—Macroscopic and Histologic Findings after Up to 8 Weeks Follow-up
- Author
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Klaas Loger, J. Cremer, Georg Lutter, Katharina Huenges, L. Bax, and Saskia Pokorny
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Mitral valve ,medicine ,business ,Surgery - Published
- 2019
36. Over Ten Years of Experience with a Modified Right Atrial Anastomosis in Orthotopic Heart Transplantation: Follow-up and Comparison with the Biatrial and Bicaval Technique
- Author
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Jochen Cremer, Christine Friedrich, Azizolah Rahimi-Barfeh, Assad Haneya, Ole Jacob Broch, Katharina Fritzsche, Jochen Renner, Alexander Reinecke, Katharina Huenges, and Bernd Panholzer
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Vena Cava, Superior ,medicine.medical_treatment ,Operative Time ,Vena Cava, Inferior ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Anastomosis ,Right atrial ,law.invention ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,law ,Internal medicine ,medicine ,Cardiopulmonary bypass ,Humans ,Heart Atria ,Aged ,Retrospective Studies ,Heart Failure ,Heart transplantation ,Cardiopulmonary Bypass ,business.industry ,Anastomosis, Surgical ,Retrospective cohort study ,Recovery of Function ,Middle Aged ,medicine.disease ,Surgery ,Transplantation ,Treatment Outcome ,030228 respiratory system ,Heart failure ,Cardiology ,Heart Transplantation ,Female ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background In 1997, a modified right atrial anastomosis (cavoatrial technique) for orthotopic heart transplantation (oHTx) was first developed in our institution. The purpose of this study is to report our long-term experience with this technique compared with biatrial and bicaval technique. Methods Retrospectively, 202 consecutive oHTx between 1997 and 2013 were analyzed. The applied transplantation techniques were biatrial (n = 108), bicaval (n = 22), and cavoatrial (n = 72). Results Demographic data were similar in all groups. The cardiopulmonary bypass and cross-clamp time were significantly shorter in the biatrial group. Follow-up echocardiographic examination showed excellent results in all groups with no relevant differences. After 1 year, occurrence of severe tricuspid regurgitation (biatrial 1.9% vs bicaval 0.0% vs cavoatrial 1.4%) was low in all groups. Rate of permanent pacemaker implantations was also low (12.0% vs 5.0% vs 11.1%). There were no significant differences in survival between the groups. Conclusion The cavoatrial technique can be a safe and simple alternative for heart transplantation. Easy handling and similar reduced postoperative complications encourage the use of this technique.
- Published
- 2016
37. Impact of Gender on Outcome in Octogenarians after Coronary Artery Bypass Grafting
- Author
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F. Schoeneich, Assad Haneya, Grischa Hoffmann, Christine Friedrich, Rouven Berndt, Jochen Cremer, Jill Jussli-Melchers, Katharina Huenges, and Bernd Panholzer
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Coronary Artery Disease ,Kaplan-Meier Estimate ,Anastomosis ,Risk Assessment ,law.invention ,Coronary artery disease ,Postoperative Complications ,Sex Factors ,Risk Factors ,law ,Germany ,Internal medicine ,Cardiopulmonary bypass ,Humans ,Medicine ,Coronary Artery Bypass ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Patient Selection ,Extracorporeal circulation ,Age Factors ,Retrospective cohort study ,EuroSCORE ,medicine.disease ,Surgery ,Cardiac surgery ,Treatment Outcome ,Cohort ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Increasing life expectancy makes cardiac surgery in octogenarians not very uncommon. In this study, the impact of gender on outcome of octogenarians after coronary artery bypass grafting (CABG) was assessed. Materials and Methods We retrospectively studied 485 octogenarians (176 females: mean age 82.4 ± 2.2 years vs. 306 males: mean age 82.2 ± 2.4 years) who underwent isolated CABG using extracorporeal circulation between January 2005 and December 2012. Results No significant differences were noted between both gender groups with regard to preoperative risk factors. At baseline, the groups differed significantly with respect to mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) (women: 22.3 ± 17.4% vs. men: 17.5 ± 13.3%; p Conclusion Outcome of octogenarians after CABG resulted in acceptable mortality. Female gender was not associated with increased risks for morbidity and mortality after surgery. Satisfactory outcomes encourage the offering of surgery in octogenarians.
- Published
- 2016
38. The Mesenteric-Caval Fistula: First Results of a New Technique in a Transperitoneal Reconstruction of the Caval Vein by Fulminant Thrombosis of the Inferior Vena Cava Based on Homozygous Antithrombin III-Deficiency
- Author
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Katharina Huenges, Bernd Panholzer, Rene Rusch, Andreas Bayer, Jochen Cremer, Rouven Berndt, Justus Gross, Rainer Petzina, and Leonie Aschauer
- Subjects
medicine.medical_specialty ,Fistula ,030204 cardiovascular system & hematology ,Inferior vena cava ,03 medical and health sciences ,0302 clinical medicine ,Occlusion ,medicine ,cardiovascular diseases ,030212 general & internal medicine ,Vein ,business.industry ,Antithrombin ,Antithrombin III deficiency ,medicine.disease ,Thrombosis ,Surgery ,body regions ,Stenosis ,medicine.anatomical_structure ,medicine.vein ,cardiovascular system ,Radiology ,business ,circulatory and respiratory physiology ,medicine.drug - Abstract
Recurrent thrombotic occlusions are one major problem in patients with thrombosis of the inferior vena cava. Due to this, we report a new surgical strategy for the construction of aorto-caval (mesenteric-caval) fistula in a patient with homozygous Antithrombin III (ATIII)-Deficiency. The patient survived postoperatively and only surgical complications grade I and II (Clavien-Dindo classification) were reported after short-term and one year follow-up. After one year, the CT-angiography did not show any caval thrombosis or stenosis and no restriction or occlusion of the fistula. Thus, the mesenteric-caval fistula could be safely performed and resulted in a satisfactory patency.
- Published
- 2016
39. Mid- and Long-Term Outcomes of Total Arterial Myocardial Revascularization in Patients Aged 70 Years and Older: A Single-Center Experience
- Author
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Christine Friedrich, Katharina Huenges, Assad Haneya, Bernd Panholzer, Ole Jacob Broch, Jill Jussli-Melchers, and J. Cremer
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Myocardial revascularization ,Time Factors ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Anastomosis ,Revascularization ,Single Center ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Germany ,medicine ,Long term outcomes ,Humans ,In patient ,Saphenous Vein ,030212 general & internal medicine ,Coronary Artery Bypass ,Mammary Arteries ,Aged ,Retrospective Studies ,business.industry ,Age Factors ,Retrospective cohort study ,Progression-Free Survival ,Surgery ,medicine.anatomical_structure ,Radial Artery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Background Patients receiving arterial grafts have superior late survival after coronary artery bypass graft (CABG) surgery. The aim of our study was to evaluate the mid- and long-term results of total arterial (TA) revascularization in the elderly. Methods Between January 2005 and December 2012, a retrospective study on age-, gender-, and EuroSCORE-matched patients aged 70 years and older was performed. Altogether, 356 patients who received isolated CABG were assigned to either TA group or control (CON) group. Results No significant differences were noted in regard to preoperative risk factors. The number of distal anastomoses was significantly higher in the CON group (3.6 ± 0.6 vs. 2.9 ± 0.8; p Conclusion This study suggests that TA revascularization is an effective procedure. Lower rates of late cardiac events encourage the use of this concept for the elderly.
- Published
- 2018
40. Unilateral pulmonary oedema after minimally invasive mitral valve surgery: a single-centre experience
- Author
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Jochen Renner, Ole Jacob Broch, Jochen Cremer, F. Schoeneich, Johannes Hensler, Christoph Borzikowsky, Katharina Huenges, Bernd Panholzer, Assad Haneya, and Ulf Lorenzen
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Pulmonary Edema ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Risk Factors ,Internal medicine ,medicine ,Minimally invasive cardiac surgery ,Extracorporeal membrane oxygenation ,Humans ,Minimally Invasive Surgical Procedures ,Hospital Mortality ,Retrospective Studies ,business.industry ,Retrospective cohort study ,General Medicine ,Odds ratio ,Length of Stay ,Middle Aged ,medicine.disease ,Intensive care unit ,Pulmonary hypertension ,Confidence interval ,Surgery ,030228 respiratory system ,Cardiology ,Mitral Valve ,Radiography, Thoracic ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Objectives Unilateral pulmonary oedema (UPE) is a rare but potentially life-threatening complication that has been described after minimally invasive mitral valve surgery (MICS). Over the last 8 years, we have witnessed, in our institution, several cases of severe UPE requiring immediate postoperative extracorporeal life support after MICS. Reviewing the available literature, data regarding this complication after MICS are rare. Consequently, we decided to retrospectively analyse patients scheduled for MICS in our institution. Methods After approval by our institutional review board, 256 MICS patients were analysed. As a primary end-point, we defined a newly developed UPE, radiographically evident within the first 24 h postoperatively. Secondary end-points were length of stay in the intensive care unit, length of stay in the hospital and in-hospital mortality. Chest radiographs were analysed by an independent consultant of radiology. Results Fifty-one (19.9%) patients showed increased right-sided pulmonary vascular congestion in the 1st postoperative chest radiography performed in the intensive care unit. Five (1.95%) patients immediately required extracorporeal life support after admission to the intensive care unit. Cardiopulmonary bypass time was significantly longer in the UPE group [UPE vs non-UPE 213 (49) vs 196 (43) min; P = 0.013]. More patients with UPE showed a preoperative increase of C-reactive protein >0.4265 mg/dl (P = 0.05). Logistic regression analysis identified a preoperative increase in C-reactive protein >0.4265 mg/dl as well as a prolonged cardiopulmonary bypass time (odds ratio 1.009, 95% confidence level 1.002-1.016; P = 0.014) independent risk factors, significantly associated with the development of UPE (odds ratio 2.583, 95% confidence interval 1.275-5.233; P = 0.008), a prolonged cardiopulmonary bypass time (odds ratio 1.009, 95% confidence interval 1.002-1.016; P = 0.014). The presence of pulmonary hypertension (odds ratio 0.273, 95% confidence interval 0.08-0.84; P = 0.02) seemed to be a protective factor regarding the genesis of UPE. Conclusions In accordance with the rarely available literature regarding UPE after MICS, our analysis led us to hypothesize the possibility of an inflammatory disposition for UPE. The role of pulmonary hypertension remains unclear in our patient population. Clinical trials number NCT02655094.
- Published
- 2017
41. Off-Pump Tricuspid Valved Stent Implantation: Real-Time Three-Dimensional Transesophageal Echocardiography for Guidance and Assessment
- Author
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Derk Frank, Katharina Huenges, Justus Gro, Jan-Paul Gundlach, Saskia Pokorny, Jochen Cremer, and Georg Lutter
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Swine ,medicine.medical_treatment ,Coronary Artery Bypass, Off-Pump ,Imaging, Three-Dimensional ,Internal medicine ,medicine ,Stent implantation ,Animals ,cardiovascular diseases ,Ultrasonography, Interventional ,Heart Valve Prosthesis Implantation ,Tricuspid valve ,business.industry ,Stent ,General Medicine ,medicine.anatomical_structure ,Models, Animal ,Cardiology ,Stents ,Surgery ,Tricuspid Valve ,business ,Cardiology and Cardiovascular Medicine ,human activities ,Echocardiography, Transesophageal - Abstract
In this case report, the value of real-time three-dimensional transesophageal echocardiography (TEE) for guidance and assessment of orthotopic tricuspid valved stent implantation in the beating heart is assessed in four pigs. A full two-dimensional TEE evaluation of standardized parameters was conducted. Three-dimensional TEE provided dependable imaging of anatomical structures of the right side of the heart, the delivery system, and the valved stent, allowing easier orientation and more accurate views for the surgical team. Although visualization of the tricuspid valve in the porcine model is challenging, it contributed highly to the successful implantation of the tricuspid valved stent.
- Published
- 2014
42. Transapical mitral valved stent implantation: comparison between circular and D-shaped design
- Author
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Huangdong Dai, Jochen Cremer, Georg Lutter, Saskia Pokorny, Martin Marczynski-Bühlow, Katharina Huenges, Telse Bähr, and Michael M. Morlock
- Subjects
Beating heart ,Time Factors ,Swine ,medicine.medical_treatment ,Hemodynamics ,Materials testing ,Prosthesis Design ,Mitral valve ,Materials Testing ,medicine ,Animals ,Prosthesis design ,Stent implantation ,cardiovascular diseases ,Heart Valve Prosthesis Implantation ,Prosthetic valve ,business.industry ,Stent ,medicine.anatomical_structure ,Heart Valve Prosthesis ,Models, Animal ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Echocardiography, Transesophageal - Abstract
AIMS In this study two designs of a self-expanding valved stent were compared after off-pump implantation into the mitral valve to identify the superior one. METHODS AND RESULTS Two designs of a mitral valved stent were tested. The first design is composed of a circular atrial element connected to a tube-shaped ventricular element. In the second design, the atrial element is D-shaped to achieve better anatomical alignment. Prior to in vivo testing, the area with the highest risk of PVL was identified in a hydrostatic in vitro set-up. Subsequently, eight pigs received stents (circular, n=5; D-shaped, n=3) via apical access in the beating heart. Positioning and haemodynamics were evaluated by TEE and invasive pressure measurement pre-implantation, after 1 hr, and at two and four weeks. In vitro testing showed less PVL in the anteromedial region in D-shaped design stents (p
- Published
- 2014
43. Accuracy of Cardiac Output by Nine Different Pulse Contour Algorithms in Cardiac Surgery Patients: A Comparison with Transpulmonary Thermodilution
- Author
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Sarah Masing, Jochen Renner, Markus Steinfath, Assad Haneya, Berthold Bein, Katharina Huenges, Matthias Gruenewald, and Ole Jacob Broch
- Subjects
Male ,Cardiac output ,medicine.medical_specialty ,Article Subject ,genetic structures ,Thermodilution ,lcsh:Medicine ,Hemodynamics ,Coronary surgery ,Pulmonary Artery ,Pulse Wave Analysis ,Sensitivity and Specificity ,General Biochemistry, Genetics and Molecular Biology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,law ,Monitoring, Intraoperative ,Cardiopulmonary bypass ,Medicine ,Humans ,Poor correlation ,Diagnosis, Computer-Assisted ,Cardiac Output ,Coronary Artery Bypass ,General Immunology and Microbiology ,business.industry ,Pulse (signal processing) ,lcsh:R ,Ultrasound ,Reproducibility of Results ,030208 emergency & critical care medicine ,Blood Pressure Determination ,General Medicine ,Middle Aged ,Cardiac surgery ,Female ,business ,Algorithm ,Algorithms ,Research Article - Abstract
Objective. Today, there exist several different pulse contour algorithms for calculation of cardiac output (CO). The aim of the present study was to compare the accuracy of nine different pulse contour algorithms with transpulmonary thermodilution before and after cardiopulmonary bypass (CPB). Methods. Thirty patients scheduled for elective coronary surgery were studied before and after CPB. A passive leg raising maneuver was also performed. Measurements included CO obtained by transpulmonary thermodilution (COTPTD) and by nine pulse contour algorithms (COX1–9). Calibration of pulse contour algorithms was performed by esophageal Doppler ultrasound after induction of anesthesia and 15 min after CPB. Correlations, Bland-Altman analysis, four-quadrant, and polar analysis were also calculated. Results. There was only a poor correlation between COTPTD and COX1–9 during passive leg raising and in the period before and after CPB. Percentage error exceeded the required 30% limit. Four-quadrant and polar analysis revealed poor trending ability for most algorithms before and after CPB. The Liljestrand-Zander algorithm revealed the best reliability. Conclusions. Estimation of CO by nine different pulse contour algorithms revealed poor accuracy compared with transpulmonary thermodilution. Furthermore, the less-invasive algorithms showed an insufficient capability for trending hemodynamic changes before and after CPB. The Liljestrand-Zander algorithm demonstrated the highest reliability. This trial is registered with NCT02438228 (ClinicalTrials.gov).
- Published
- 2016
44. Cardiac Graft from Donors with Extracorporeal Support—A Report of Two Cases
- Author
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Assad Haneya, Jochen Cremer, Katharina Huenges, and Bernd Panholzer
- Subjects
Heart transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,lcsh:Surgery ,Case Report: Cardiac ,Economic shortage ,lcsh:RD1-811 ,030230 surgery ,heart transplantation ,organ donors ,extracorporeal support ,Extracorporeal ,Surgery ,Transplantation ,03 medical and health sciences ,0302 clinical medicine ,Rehabilitation clinic ,Extracorporeal membrane oxygenation ,Medicine ,030211 gastroenterology & hepatology ,Major complication ,Acute circulatory failure ,business - Abstract
The persistent global shortage of organ donors is still a major limitation for transplantation. Experiences of heart transplantation from donors with extracorporeal support are rare. Here, we report from two cases of donors who were supported by extracorporeal membrane oxygenation due to acute circulatory failure. In both cases, the direct postoperative course was uneventful and free from major complications. The patients were discharged to a rehabilitation clinic. Our experience suggests that the use of heart organ from carefully selected donors with extracorporeal support is possible and may lead to an excellent outcome.
- Published
- 2018
45. Left Ventricular Assist Device Implantation with Concomitant Aortic Valve and Ascending Aortic Replacement
- Author
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Assad Haneya, Katharina Huenges, Bernd Panholzer, and Jochen Cremer
- Subjects
Aortic valve ,medicine.medical_specialty ,medicine.medical_treatment ,lcsh:Medicine ,Case Report ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Internal medicine ,medicine ,Aortic valve regurgitation ,business.industry ,lcsh:R ,Dilated cardiomyopathy ,General Medicine ,equipment and supplies ,medicine.disease ,medicine.anatomical_structure ,Male patient ,030220 oncology & carcinogenesis ,Ventricular assist device ,Concomitant ,Heart failure ,cardiovascular system ,Cardiology ,business - Abstract
Left ventricular assist device (LVAD) is nowadays a routine therapy for patients with advanced heart failure. We present the case of a 74-year-old male patient who was admitted to our center with terminal heart failure in dilated cardiomyopathy and ascending aortic aneurysm with aortic valve regurgitation. The LVAD implantation with simultaneous aortic valve and supracoronary ascending aortic replacement was successfully performed.
- Published
- 2018
46. Ventricular assist device implantation in a young patient with non-compaction cardiomyopathy and hereditary spherocytosis
- Author
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Katharina Huenges, Bernd Panholzer, Jochen Cremer, and Assad Haneya
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Hereditary elliptocytosis ,Cardiomyopathy ,Spherocytosis, Hereditary ,030204 cardiovascular system & hematology ,Hereditary spherocytosis ,Prosthesis Implantation ,03 medical and health sciences ,Elliptocytosis ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Heart Failure ,Heart transplantation ,business.industry ,General Medicine ,medicine.disease ,Transplantation ,030228 respiratory system ,Heart failure ,Ventricular assist device ,Cardiology ,Female ,Surgery ,Heart-Assist Devices ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business - Abstract
A case of a 15-year-old female patient with acute heart failure due to non-compaction cardiomyopathy and hereditary anaemia (hereditary spherocytic elliptocytosis) requiring ventricular assist device implantation as a bridge to transplantation is presented. The possible effects of mechanical stress on erythrocytes potentially induced by mechanical circulatory support remains unclear, but it may lead to haemolytic crisis in patients suffering from hereditary anaemia. In our case, ventricular assist device therapy was feasible, and haematological complications did not occur within 6 weeks of bridging our patient to heart transplantation.
- Published
- 2017
47. Coronary artery bypass surgery within 48 hours after cardiac arrest due to acute myocardial infarction
- Author
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Tim Attmann, Christine Friedrich, Jette Meinert, Jan-Thorsten Graesner, Assad Haneya, Christina Grothusen, Jochen Cremer, Jan Schoettler, Derk Frank, Eva Ohnewald, Ulysses Ulbricht, and Katharina Huenges
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Revascularization ,Preoperative care ,Coronary artery disease ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,Postoperative Complications ,Internal medicine ,Medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Coronary Artery Bypass ,Stroke ,Aged ,Retrospective Studies ,business.industry ,Mortality rate ,General Medicine ,Middle Aged ,medicine.disease ,Heart Arrest ,Treatment Outcome ,Ventricular fibrillation ,Cardiology ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives Cardiac arrest (CA) in patients with acute myocardial infarction is associated with a poor prognosis. Due to the additional trauma, risk of stroke and lack of data, coronary artery bypass grafting (CABG) is a controversial revascularization strategy for patients who cannot be treated percutaneously. Against this background, we investigated the outcome of patients from our department with acute myocardial infarction undergoing CABG after CA. Methods Between January 2001 and January 2015, 129 patients with preoperative CA due to acute myocardial infarction underwent CABG at our institution within 48 h after the CA had occurred. Predictors of in-hospital and long-term mortality were analysed. Neurological outcome according to cerebral performance category scale was investigated. Results Sixty CA (47%) events occurred out-of-hospital. Ventricular fibrillation was the major underlying arrhythmia ( n = 92, 71%). The mean age was 65 ± 10 years. Eighty-four patients (65%) were diagnosed with ST-elevation myocardial infarction and 108 patients (84%) had 3-vessel coronary artery disease. Forty-three cases (33%) underwent percutaneous transluminal angioplasty. The median time to CABG was 4 (range 0.2-4) h. Complete revascularization was achieved in 106 patients (83%). The stroke rate was 9% ( n = 11) and hypoxic brain damage occurred in 16 patients (12%). Nine subjects (7%) needed extracorporeal life support. Four intraoperative deaths (3%) occurred; the 30-day mortality rate was 23% ( n = 30); the mortality rate during follow-up was 30% ( n = 27). A total of 79% ( n = 70) of patients discharged alive showed good neurological outcome according to the cerebral performance category scale. Conclusions Despite the reluctance to expose patients with CA to early CABG, our data indicate that the operative strategy may not be as unfavourable as suspected.
- Published
- 2016
48. Off-pump Transfemoral Pulmonary Polycarbonate Urethane Valved Stent Implantation in Sheep: One-, Three- and Six- Month Follow-up
- Author
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A. Topal, Georg Lutter, Jan Hinnerk Hansen, Katharina Huenges, Tim Attmann, Rouven Berndt, J. Cremer, and Anja Metzner
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Polycarbonate urethane ,medicine ,Stent implantation ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Month follow up - Published
- 2016
49. Off-pump mitral valved stent implantation: comparison of apical and subannular fixation techniques
- Author
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Katharina Huenges, Jochen Cremer, Georg Lutter, Gunther Fischer, Yannik Schadow, Michael M. Morlock, Saskia Pokorny, and Jan Hinerk Hansen
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Cardiac Catheterization ,Swine ,medicine.medical_treatment ,Conventional surgery ,Hemodynamics ,030204 cardiovascular system & hematology ,Prosthesis Design ,03 medical and health sciences ,0302 clinical medicine ,Mitral valve ,Internal medicine ,medicine ,Stent implantation ,Animals ,030212 general & internal medicine ,Pulmonary wedge pressure ,Fixation (histology) ,Heart Valve Prosthesis Implantation ,Mitral regurgitation ,business.industry ,Suture Techniques ,Stent ,Mitral Valve Insufficiency ,General Medicine ,Disease Models, Animal ,medicine.anatomical_structure ,Cardiology ,Feasibility Studies ,Mitral Valve ,Surgery ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
OBJECTIVES A large cohort of patients suffering from severe mitral regurgitation does not meet the indications for conventional surgery and would greatly benefit from a transcatheter approach in the beating heart. Consequently, off-pump transcatheter mitral valve procedures have been the focus of recent research. The aim of this study was the in vivo evaluation and comparison of subannular versus apical fixation of mitral valved stents to show the feasibility of subannular anchorage. METHODS Twenty-two pigs received a self-expanding valved stent in the mitral position in an off-pump procedure. The first design (design AP: n = 12) was anchored apically and served as the control group. The second design (design SA: n = 10) included additional sub-annular fixation elements. Echocardiographic and haemodynamic evaluations were conducted before and 1 h after stent implantation. RESULTS Haemodynamic stability was achieved, and the capillary wedge pressure was within a normal range (AP: 11 ± 4 mmHg, SA: 9 ± 4 mmHg). Paravalvular leakages were trace or less in 19 of 20 cases. The mean gradients across the valved stent increased (P ≤ 0.014) but remained within a physiological range in both groups (AP: 1.2 ± 0.6 mmHg, SA: 2.6 ± 2.0 mmHg). The longitudinal heart function remained within a physiological normal range (AP: 0.95 ± 0.1 cm, SA: 0.95 ± 0.1 cm) but was reduced in group SA. The ejection fraction decreased after stent implantation (AP: 52 ± 10%, SA: 48 ± 4%). The mean survival time was higher in group AP compared with group SA. CONCLUSIONS The proof-of-principle for the subannular fixation was shown with haemodynamic stability, low gradients and physiological longitudinal function. A decreased ejection fraction, survival time and fractures identify potential areas for improvement. With regard to the long-term outcome, the group with subannular fixation did not reach the results of the group with apical fixation in this study.
- Published
- 2015
50. A Cardiac Graft from a Donor with Granulomatosis with Polyangiitis—A Case Report
- Author
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Jochen Cremer, Katharina Huenges, Assad Haneya, and Bernd Panholzer
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,lcsh:Surgery ,030232 urology & nephrology ,heart failure ,Economic shortage ,heart ,030204 cardiovascular system & hematology ,Organ transplantation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Intensive care medicine ,Heart transplantation ,Rehabilitation ,business.industry ,Case Report: Cardiac ,lcsh:RD1-811 ,systemic ,medicine.disease ,Surgery ,Transplantation ,surgical procedures, operative ,Male patient ,Heart failure ,Granulomatosis with polyangiitis ,business ,transplantation - Abstract
Organ shortage unavoidably leads to shifting strategies in modern transplantation medicine. Experiences with specific comorbidities in terms of organ transplantation therefore have to be made. We report a case of a 51-year-old male patient with successful orthotopic heart transplantation from a donor with granulomatosis with polyangiitis. After a good recovery, the patient was discharged to rehabilitation 2 months after transplantation.
- Published
- 2016
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