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14. Long‐Term Survival of Mitroflow and Perimount Aortic Valve Replacements: A Valve Size‐Stratified Retrospective Observational Study.

Author

Krasniqi, Lytfi, Dahl, Jordi Sanchez, Jensen, Christian Greve, Mortensen, Poul Erik, Brandes, Axel, Gerke, Oke, Ravn, Emil Johannes, Poulsen, Viktor, Riber, Lars Peter Schødt, and Narayan, Pradeep

Subjects
AORTIC valve transplantation, BIOPROSTHETIC heart valves, CARDIAC arrest, AORTIC valve, OVERALL survival
Abstract

Objectives: The American College of Cardiology (ACC) guidelines recommend the same imaging frequency for all bioprosthetic valves, but some have demonstrated poor durability. We aimed to assess mortality differences between small (19–21 mm) and large (23–29 mm) in Mitroflow and Carpentier‐Edwards Perimount aortic valves. Methods: A retrospective observational study was conducted by all patients undergoing isolated surgical aortic valve replacement with Mitroflow or Perimount in Western Denmark between 1999 and 2014 and followed until January 2024. The primary endpoint was all‐cause mortality. Secondary endpoints were cardiovascular mortality and sudden cardiac death. A propensity score‐matched analysis was performed. Results: A total of 1150 patients were analyzed, with 496 (43%) receiving Mitroflow valves and 654 (57%) receiving Perimount valves. In the Mitroflow group, 108 (22%) had a valve size of 19–21 mm, and 388 (78%) in the size range of 23–29 mm. In the Perimount group, the distribution was 99 (15%) and 555 (85%), respectively. The compromised survival of Mitroflow valves was attributed to the valve type, regardless of the valve sizes. Larger Mitroflow valves exhibited the same compromised late mortality as smaller valves, 66.7% vs 61.5%, respectively (p = 0.95). The same pattern of mortality was observed in the matched population, with Perimount demonstrating significant lower risk of mortality. Conclusion: Mitroflow valves were associated with a poorer prognosis compared to Perimount valves. Additionally, larger Mitroflow valves were not associated with an improved prognosis compared to smaller valve sizes. EuroSCORE2 had a significant impact on patient survival. [ABSTRACT FROM AUTHOR]

Published
2024
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15. Incidence and assessment of delirium following open cardiac surgery: a systematic review and meta-analysis.

Author

Petersson, Nadja Buch, Hansen, Malene Haugaard, Hjelmborg, Jacob V B, Instenes, Irene, Christoffersen, Anne Sofie, Larsen, Katrine Lawaetz, Schmidt, Henrik, Riber, Lars Peter Schødt, Norekvål, Tone Merete, and Borregaard, Britt

Subjects
DIAGNOSIS of delirium, MEDICAL information storage & retrieval systems, PSYCHOLOGY of cardiac patients, DATA analysis, SURGERY, PATIENTS, CINAHL database, THORACIC surgery, META-analysis, DESCRIPTIVE statistics, SURGICAL complications, SYSTEMATIC reviews, MEDLINE, CORONARY artery bypass, DELIRIUM, MEDICAL databases, INFERENTIAL statistics, STATISTICS, CONFIDENCE intervals, CARDIAC surgery, PSYCHOLOGY information storage & retrieval systems, SENSITIVITY & specificity (Statistics)
Abstract

Aims This systematic review and meta-analysis sought (i) to provide an overview of the incidence of delirium following open cardiac surgery and (ii) to investigate how incidences of delirium are associated with different assessment tools. Methods and results A systematic search of studies investigating delirium following open cardiac surgery was conducted in Medline (Ovid), EMBASE, PsycINFO, CiNAHL, and the Cochrane Database. Only studies with patients diagnosed or screened with a validated tool were included. Studies published from 2005–2021 were included in the meta-analysis. Of 7126 individual studies retrieved, 106 met the inclusion criteria for the meta-analysis, hereof 31% of high quality. The weighted pooled incidence of delirium following open cardiac surgery across all studies was 23% (95% CI 20–26%), however we found a considerable heterogeneity (I 2 = 99%), which could not be explained by subgroups or further sensitivity analyses. The most commonly applied screening tool for delirium is CAM/CAM-ICU. The lowest estimates of delirium were found by applying the Delirium Observation Scale (incidence 14%, 95% CI 8–20%), and the highest estimates in studies using 'other' screening tools (Organic Brain Symptom Scale, Delirium Symptom Interview) with a pooled incidence of 43% (95% CI 19–66%), however, only two studies applied these. Conclusion Delirium following open cardiac surgery remains a complication with a high incidence of overall 23%, when applying a validated tool for screening or diagnosis. Nevertheless, this systematic review and meta-analyses highlight the significant inconsistency in current evidence regarding assessment tools and regimens. Registration Prospero CRD42020215519. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study

Author

Mørk, Sivagowry Rasalingam, Stengaard, Carsten, Linde, Louise, Møller, Jacob Eifer, Jensen, Lisette Okkels, Schmidt, Henrik, Riber, Lars Peter, Andreasen, Jo Bønding, Thomassen, Sisse Anette, Laugesen, Helle, Freeman, Phillip Michael, Christensen, Steffen, Greisen, Jacob Raben, Tang, Mariann, Møller-Sørensen, Peter Hasse, Holmvang, Lene, Gregers, Emilie, Kjaergaard, Jesper, Hassager, Christian, Eiskjær, Hans, and Terkelsen, Christian Juhl

Published
2021
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25. Pericardial delta like non‐canonical NOTCH ligand 1 (Dlk1) augments fibrosis in the heart through epithelial to mesenchymal transition

Author

Jensen, Charlotte Harken, primary, Johnsen, Rikke Helin, additional, Eskildsen, Tilde, additional, Baun, Christina, additional, Ellman, Ditte Gry, additional, Fang, Shu, additional, Bak, Sara Thornby, additional, Hvidsten, Svend, additional, Larsen, Lars Allan, additional, Rosager, Ann Mari, additional, Riber, Lars Peter, additional, Schneider, Mikael, additional, De Mey, Jo, additional, Thomassen, Mads, additional, Burton, Mark, additional, Uchida, Shizuka, additional, Laborda, Jorge, additional, and Andersen, Ditte Caroline, additional

Published
2024
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34. Selection of patients for mechanical circulatory support for refractory out-of-hospital cardiac arrest

Author

Linde, Louise, Mørk, Sivagowry Rasalingam, Gregers, Emilie, Andreasen, Jo Bønding, Lassen, Jens Flensted, Ravn, Hanne Berg, Schmidt, Henrik, Riber, Lars Peter, Thomassen, Sisse Anette, Laugesen, Helle, Eiskjær, Hans, Terkelsen, Christian Juhl, Christensen, Steffen, Tang, Mariann, Moeller-Soerensen, Hasse, Holmvang, Lene, Kjaergaard, Jesper, Hassager, Christian, Moller, Jacob Eifer, Linde, Louise, Mørk, Sivagowry Rasalingam, Gregers, Emilie, Andreasen, Jo Bønding, Lassen, Jens Flensted, Ravn, Hanne Berg, Schmidt, Henrik, Riber, Lars Peter, Thomassen, Sisse Anette, Laugesen, Helle, Eiskjær, Hans, Terkelsen, Christian Juhl, Christensen, Steffen, Tang, Mariann, Moeller-Soerensen, Hasse, Holmvang, Lene, Kjaergaard, Jesper, Hassager, Christian, and Moller, Jacob Eifer

Abstract

Objective: To describe characteristics of patients admitted with refractory cardiac arrest for possible extracorporeal cardiopulmonary resuscitation (ECPR) and gain insight into the reasons for refraining from treatment in some. Methods: Nationwide retrospective cohort study involving all tertiary centres providing ECPR in Denmark. Consecutive patients admitted with ongoing chest compression for evaluation for ECPR treatment were enrolled. Presenting characteristics, duration of no-flow and low-flow time, end-tidal carbon dioxide (ETCO2), lactate and pH, and recording of reasons for refraining from ECPR documented by the treating team were recorded. Outcomes were survival to intensive care unit admission and survival to hospital discharge. Results: Of 579 patients admitted with refractory cardiac arrest for possible ECPR, 221 patients (38%) proceeded to ECPR and 358 patients (62%) were not considered candidates. Median prehospital low-flow time was 70 min (IQR 56 to 85) in ECPR patients and 62 min (48 to 81) in no-ECPR patients, p<0.001. Intra-arrest transport was more than 50 km in 92 (42%) ECPR patients and 135 in no-ECPR patients (38%), p=0.25. The leading causes for not initiating ECPR stated by the treating team were duration of low-flow time in 39%, severe metabolic derangement in 35%, and in 31% low ETCO2. The prevailing combination of contributing factors were non-shockable rhythm, low ETCO2, and metabolic derangement or prehospital low-flow time combined with low ETCO2. Survival to discharge was only achieved in six patients (1.7%) in the no-ECPR group. Conclusions: In this large nationwide study of patients admitted for possible ECPR, two-thirds of patients were not treated with ECPR. The most frequent reasons to abstain from ECPR were long duration of prehospital low-flow time, metabolic derangement and low ETCO2.

Published
2023

37. Selection of patients for mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study

Author

Linde, Louise, Mørk, Sivagowry Rasalingam, Gregers, Emilie, Andreasen, Jo Bønding, Lassen, Jens Flensted, Ravn, Hanne Berg, Schmidt, Henrik, Riber, Lars Peter, Laugesen, Helle, Terkelsen, Christian Juhl, Møller-Sørensen, Peter Hasse, Holmvang, L., Kjaergaard, Jesper, Hassager, Christian, and Møller, Jacob Eifer

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a potential salvage therapy for selected patients with refractory out-of-hospital cardiac arrest (OHCA). Purpose The objective of this study was to describe the characteristics of potential ECPR patients. Methods This retrospective, observational cohort study included 579 patients admitted with refractory OHCA for possible ECPR at all tertiary cardiac arrest centers in Denmark between 2015 and 2020. Presenting characteristics, reasons for refraining from ECPR, and survival to hospital discharge were recorded. Results After initial evaluation, 221 patients (38%) proceeded to ECPR, and 358 (62%) were considered futile. Median prehospital low-flow time was 70 minutes [interquartile range 56–85] in ECPR patients and 62 minutes [48–81] in no-ECPR patients, p Conclusions In this large nationwide study of patients admitted for possible ECPR, 62% were not treated with ECPR. The most frequent reasons to abstain from ECPR were duration of prehospital low flow time, metabolic derangement, and low ETCO2. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

Published
2022
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38. Extracorporeal cardiopulmonary resuscitation: a national study on the association between survival and biomarkers of hypoperfusion, inflammation, and organ failure

Author

Gregers, Emilie, Mørk, Sivagowry Rasalingam, Linde, Louise, Andreasen, Jo Bønding, Smerup, Morten Holdgaard, Kjaergaard, Jesper, Møller-Sørensen, Peter Hasse, Holmvang, Lene, Christensen, Steffen, Terkelsen, Christian Juhl, Møller, Jacob Eifer, Lassen, Jens Flensted, Riber, Lars Peter, Laugesen, Helle, and Søholm, Helle

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR). Purpose We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR. Methods This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011–2020). Biomarkers at admission and consecutively two days after ECPR initiation were retrieved. Odds ratio (OR) of 90-day survival were assessed by logistic regression analyses. Cut-off values were calculated from area under the curve (AUC) via the Youden index. Results Fifty-six patients (25%) survived to hospital discharge, all were still alive after 90-days and 91% had a favorable neurological status at discharge. Factors independently associated with 90-day survival were: male sex, shockable presenting rhythm, low flow time, platelets, pH, lactate, C-reactive protein, lactate dehydrogenase (LDH), alkaline phosphatase (ALP), and creatine kinase MB (CK-MB) level. Comparing the ability of standard predictive variables (age, sex, shockable presenting rhythm, witnessed arrest, and low flow time) and selected biomarkers (from multivariate analyses) in predicting 90-day survival, biomarkers day 2 after OHCA were significantly better than standard variables (AUC 0.79 vs. 0.56, p=0.01). Conclusion Biomarkers of hypoperfusion (low lactate and high pH), inflammation (high platelets and CRP), and organ failure (low LDH, ALP, and CK-MB) were independently associated with 90-day survival. Biomarkers on day 2 after OHCA (d-dimer, ALP, and CK-MB) were more predictive of 90-day survival than standard predictive variables. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Odense University Hospital's and Rigshospitalet's Common Research Foundation

Published
2022
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40. Extracorporeal cardiopulmonary resuscitation: a national study on the association between favourable neurological status and biomarkers of hypoperfusion, inflammation, and organ injury

Author

Gregers, Emilie, primary, Mørk, Sivagowry Rasalingam, additional, Linde, Louise, additional, Andreasen, Jo Bønding, additional, Smerup, Morten, additional, Kjærgaard, Jesper, additional, Møller-Sørensen, Peter Hasse, additional, Holmvang, Lene, additional, Christensen, Steffen, additional, Terkelsen, Christian Juhl, additional, Tang, Mariann, additional, Møller, Jacob Eifer, additional, Lassen, Jens Flensted, additional, Schmidt, Henrik, additional, Riber, Lars Peter, additional, Winther-Jensen, Matilde, additional, Thomassen, Sisse, additional, Laugesen, Helle, additional, Hassager, Christian, additional, and Søholm, Helle, additional

Published
2022
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41. Selection of patients for mechanical circulatory support for refractory out-of-hospital cardiac arrest

Author

Linde, Louise, primary, Mørk, Sivagowry Rasalingam, additional, Gregers, Emilie, additional, Andreasen, Jo Bønding, additional, Lassen, Jens Flensted, additional, Ravn, Hanne Berg, additional, Schmidt, Henrik, additional, Riber, Lars Peter, additional, Thomassen, Sisse Anette, additional, Laugesen, Helle, additional, Eiskjær, Hans, additional, Terkelsen, Christian Juhl, additional, Christensen, Steffen, additional, Tang, Mariann, additional, Moeller-Soerensen, Hasse, additional, Holmvang, Lene, additional, Kjaergaard, Jesper, additional, Hassager, Christian, additional, and Moller, Jacob Eifer, additional

Published
2022
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45. Extracorporeal cardiopulmonary resuscitation:a national study on the association between favourable neurological status and biomarkers of hypoperfusion, inflammation, and organ injury

Author

Gregers, Emilie, Mørk, Sivagowry Rasalingam, Linde, Louise, Andreasen, Jo Bønding, Smerup, Morten, Kjærgaard, Jesper, Møller-Sørensen, Peter Hasse, Holmvang, Lene, Christensen, Steffen, Terkelsen, Christian Juhl, Tang, Mariann, Møller, Jacob Eifer, Lassen, Jens Flensted, Schmidt, Henrik, Riber, Lars Peter, Winther-Jensen, Matilde, Thomassen, Sisse, Laugesen, Helle, Hassager, Christian, Søholm, Helle, Gregers, Emilie, Mørk, Sivagowry Rasalingam, Linde, Louise, Andreasen, Jo Bønding, Smerup, Morten, Kjærgaard, Jesper, Møller-Sørensen, Peter Hasse, Holmvang, Lene, Christensen, Steffen, Terkelsen, Christian Juhl, Tang, Mariann, Møller, Jacob Eifer, Lassen, Jens Flensted, Schmidt, Henrik, Riber, Lars Peter, Winther-Jensen, Matilde, Thomassen, Sisse, Laugesen, Helle, Hassager, Christian, and Søholm, Helle

Abstract

Aims In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischaemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR. Methods and results This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011-2020). Biomarkers the first days after ECPR-initiation were assessed. Odds ratio of favourable neurological status (Cerebral Performance Category 1-2) at hospital discharge was estimated by logistic regression analyses. Cut-off values were calculated using the Youden's index. Fifty-six patients (25%) survived to hospital discharge, 51 (91%) with a favourable neurological status. Factors independently associated with favourable neurological status were low flow time = 12.8 x 10(9)/L, admission lactate

Published
2022

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