130 results on '"Takkenberg JJM"'
Search Results
2. Standardized approach to extract candidate outcomes from literature for a standard outcome set:a case- and simulation study
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Veen, Km, Joseph, A., Sossi, F., Jaber, P. Blancarte, Lansac, E., Das-Gupta, E., Aktaa, S., Takkenberg, Jjm, Veen, Km, Joseph, A., Sossi, F., Jaber, P. Blancarte, Lansac, E., Das-Gupta, E., Aktaa, S., and Takkenberg, Jjm
- Abstract
Aims: Standard outcome sets enable the value-based evaluation of health care delivery. Whereas the attainment of expert opinion has been structured using methods such as the modified-Delphi process, standardized guidelines for extraction of candidate outcomes from literature are lacking. As such, we aimed to describe an approach to obtain a comprehensive list of candidate outcomes for potential inclusion in standard outcome sets. Methods: This study describes an iterative saturation approach, using randomly selected batches from a systematic literature search to develop a long list of candidate outcomes to evaluate healthcare. This approach can be preceded with an optional benchmark review of relevant registries and Clinical Practice Guidelines and data visualization techniques (e.g. as a WordCloud) to potentially decrease the number of iterations. The development of the International Consortium of Health Outcome Measures Heart valve disease set is used to illustrate the approach. Batch cutoff choices of the iterative saturation approach were validated using data of 1000 simulated cases. Results: Simulation showed that on average 98% (range 92–100%) saturation is reached using a 100-article batch initially, with 25 articles in the subsequent batches. On average 4.7 repeating rounds (range 1–9) of 25 new articles were necessary to achieve saturation if no outcomes are first identified from a benchmark review or a data visualization. Conclusion: In this paper a standardized approach is proposed to identify relevant candidate outcomes for a standard outcome set. This approach creates a balance between comprehensiveness and feasibility in conducting literature reviews for the identification of candidate outcomes.
- Published
- 2023
3. Pregnancy outcomes in women with a mitral valve prosthesis: A Systematic Review and Meta-Analysis
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CTC, Grashuis, Pepijn, Khargi, SDM, Veen, K, El Ousrouti, A, Bemelmans-Lalezari, Shirin, Cornette, JMJ, Roos-Hesselink, JW, Takkenberg, JJM, Mokhles, Mostafa, CTC, Grashuis, Pepijn, Khargi, SDM, Veen, K, El Ousrouti, A, Bemelmans-Lalezari, Shirin, Cornette, JMJ, Roos-Hesselink, JW, Takkenberg, JJM, and Mokhles, Mostafa
- Published
- 2023
4. Novel approach to extract candidate outcomes from literature for a standard outcome set: A case- and simulation study
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Veen, Kevin, primary, Joseph, A, additional, Sossi, F, additional, Jaber, P Blancarte, additional, Lansac, E, additional, Das-Gupta, Z, additional, Aktaa, S, additional, and Takkenberg, JJM, additional
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- 2023
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5. Moderated Posters session: pulmonary hypertension and other conditionsP516Echocardiographic findings predicting mortality in pulmonary arterial hypertension: a systematic review and meta-analysisP517Impairment of endothelial-mediated coronary flow reserve in patients with Anderson Fabry diseaseP518Comparative evaluation of various echocardiography-based methods for the estimation of pulmonary vascular resistance in pulmonary hypertensionP519Detection of early radiotherapy-induced changes in myocardial cyclic variation in breast cancer patients - an ultrasound tissue characterization studyP520Right ventricle adaptation changes resulting from endurance training in the group of junior cyclists - sex is an important determinantP521Impact of pulmonary hypertension on the impairment of right ventricular longitudinal function in patients with obstructive sleep apnea syndromeP522Improvement of echocardiographic (TTE) estimation of pulmonary vascular resistance (PVR) in comparison with right heart catheter measurementsP523Assessment of left ventricular function in breast cancer patients with adjuvant treatment (combined anthracyclines and trastuzumab): two years follow upP5243D regional right ventricular function in pulmonary hypertensionP525Simple echocardiographic parameters to assess right ventricular systolic function in patients with precapillary pulmonary hypertension: a comparison with cardiac magnetic resonance imaging
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Baggen, VJM, primary, Spinelli, L, primary, Venner, C, primary, Tuohinen, S, primary, Konopka, M, primary, Santoro, C, primary, Wahi, S, primary, Krstic, I, primary, Duchateau, N, primary, Handoko, M L, primary, Driessen, MMP, additional, Post, MC, additional, Van Dijk, AP, additional, Roos-Hesselink, JW, additional, Van Den Bosch, AE, additional, Takkenberg, JJM, additional, Sieswerda, GT, additional, Giudice, C A, additional, Castaldo, D, additional, Pisani, A, additional, Trimarco, B, additional, Huttin, O, additional, Mandry, D, additional, Voilliot, D, additional, Chabot, JF, additional, Marie, PY, additional, Juilliere, Y, additional, Chaouat, A, additional, Selton-Suty, C, additional, Skytta, T, additional, Virtanen, V, additional, Kellokumpu-Lehtinen, PL, additional, Raatikainen, P, additional, Burkhard-Jagodzinska, K, additional, Krol, W, additional, Zdanowicz, R, additional, Starczewski, M, additional, Aniol-Strzyzewska, K, additional, Jakubiak, A, additional, Sitkowski, D, additional, Dluzniewski, M, additional, Braksator, W, additional, Buonauro, A, additional, Bocchino, ML, additional, Esposito, R, additional, Canora, A, additional, Vaccaro, A, additional, Castaldo, S, additional, Sanduzzi Zamparelli, A, additional, Galderisi, M, additional, Chong, A, additional, Deljanin Ilic, M, additional, Vrbic, S, additional, Marinkovic, D, additional, Ilic, S, additional, Sermesant, M, additional, Gibelin, P, additional, Ferrari, E, additional, Moceri, P, additional, Di Pasqua, MC, additional, Spruijt, OA, additional, Oosterveer, FPT, additional, Marcus, JT, additional, Bogaard, HJ, additional, and Vonk Noordegraaf, A, additional
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- 2015
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6. The effect of pre-operative blood withdrawal, with or without sequestration, on allogeneic blood product requirements
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van der Wal, MT, primary, Boks, RH, additional, Wijers-Hille, MJ, additional, Hofland, J, additional, Takkenberg, JJM, additional, and Bogers, A JJC, additional
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- 2015
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7. Clinical outcome and blood transfusion after infant cardiac surgery with a routine use of conventional ultrafiltration
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Golab, HD, primary, Kissler, J, additional, de Jong, PL, additional, van de Woestijne, PC, additional, Takkenberg, JJM, additional, and Bogers, AJJC, additional
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- 2014
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8. Minimizing the perfusion system by integration of the components. Does it affect the hematocrit drop and transfused red blood cells? A retrospective audit
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Boks, RH, primary, van Pelt, C, additional, Takkenberg, JJM, additional, and Bogers, Ad JJC, additional
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- 2014
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9. Excessive pulmonary autograft dilatation causes important aortic regurgitation
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Hokken, RB, Takkenberg, JJM, van Herwerden, LA, Roelandt, JRTC, and Bogers, AJJC
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Aortic valve insufficiency -- Care and treatment ,Autografts -- Usage -- Analysis -- Physiological aspects ,Pulmonary artery -- Physiological aspects -- Usage -- Analysis ,Statistics -- Analysis -- Physiological aspects -- Usage ,Health ,Care and treatment ,Usage ,Physiological aspects ,Analysis - Abstract
Aortic root replacement with reimplantation of the coronary arteries using the pulmonary autograft (PAG) is an accepted operative technique to treat aortic valve disease in children and adults. However, the [...]
- Published
- 2003
10. Impact of endocarditis after the Ross procedure – Results of the German Dutch Ross Registry
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Charitos, EI, primary, Hanke, T, additional, Stierle, U, additional, Gorski, AW, additional, Hemmer, WB, additional, Botha, CA, additional, Franke, UFW, additional, Dodge-Khatami, A, additional, Lange, R, additional, Hoerer, J, additional, Moritz, A, additional, Ferrari-Kühne, K, additional, Hetzer, R, additional, Hübler, M, additional, Bogers, AJJC, additional, Takkenberg, JJM, additional, and Sievers, HH, additional
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- 2012
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11. Update on reinterventions after the Ross procedure – Results of the German-Dutch Ross Registry
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Charitos, EI, primary, Hanke, T, additional, Stierle, U, additional, Gorski, AW, additional, Hemmer, WB, additional, Botha, CA, additional, Franke, UFW, additional, Dodge-Khatami, A, additional, Lange, R, additional, Hoerer, J, additional, Moritz, A, additional, Ferrari-Kühne, K, additional, Hetzer, R, additional, Hübler, M, additional, Bogers, AJJC, additional, Takkenberg, JJM, additional, and Sievers, HH, additional
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- 2012
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12. After the Ross procedure the patients' survival is similar to that of the normal population: results from the German-Dutch Ross Registry in 1623 patients
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Charitos, EI, primary, Hanke, T, additional, Robinson, D, additional, Misfeld, M, additional, Bogers, AJJC, additional, Hemmer, W, additional, Bechtel, M, additional, Boehm, J, additional, Botha, C, additional, Lange, R, additional, Hörer, J, additional, Moritz, A, additional, Wahlers, T, additional, Franke, U, additional, Breuer, M, additional, Ferrari-Kuehne, K, additional, Hetzer, R, additional, Hübler, M, additional, Ziemer, G, additional, Takkenberg, JJM, additional, Gorski, A, additional, Stierle, U, additional, and Sievers, HH, additional
- Published
- 2010
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13. What happens to patients in the second decade after the Ross operation? Results from the German-Dutch Ross registry
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Misfeld, M, primary, Charitos, EI, additional, Richardt, D, additional, Robinson, D, additional, Borgers, AJJC, additional, Hemmer, W, additional, Franke, U, additional, Boehm, J, additional, Rein, J, additional, Botha, C, additional, Lange, R, additional, Hörer, J, additional, Moritz, A, additional, Wahlers, T, additional, Breuer, M, additional, Ferrari-Kuehne, K, additional, Hetzer, R, additional, Hübler, M, additional, Gorski, A, additional, Ziemer, G, additional, Takkenberg, JJM, additional, Hanke, T, additional, Sievers, HH, additional, and Stierle, U, additional
- Published
- 2010
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14. Major adverse cardiac events after the Ross operation in 1620 patients – current status of the German-Dutch Ross Registry with up to 20 years follow-up
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Hanke, T, primary, Stierle, U, additional, Charitos, EI, additional, Gorski, A, additional, Bogers, AJJC, additional, Bechtel, M, additional, Boehm, J, additional, Botha, C, additional, Lange, R, additional, Hörer, J, additional, Moritz, A, additional, Wahlers, T, additional, Franke, U, additional, Hemmer, W, additional, Ferrari-Kuehne, K, additional, Hetzer, R, additional, Hübler, M, additional, Ziemer, G, additional, Takkenberg, JJM, additional, Robinson, D, additional, Misfeld, M, additional, and Sievers, HH, additional
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- 2010
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15. First report of the Dutch-German Ross Registry – the pulmonary homograft in 1162 patients
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Hanke, T, primary, Takkenberg, JJM, additional, Rein, J, additional, Hemmer, W, additional, Botha, CA, additional, Stierle, U, additional, Lange, R, additional, Moritz, A, additional, Ziemer, G, additional, Hetzer, R, additional, Bogers, A, additional, and Sievers, HH, additional
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- 2008
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16. Clinical outcome and blood transfusion after infant cardiac surgery with a routine use of conventional ultrafiltration.
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Golab, HD, Kissler, J, de Jong, PL, van de Woestijne, PC, Takkenberg, JJM, and Bogers, AJJC
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ANESTHESIA ,ANTICOAGULANTS ,AUDITING ,BLOOD transfusion ,BODY weight ,CHI-squared test ,COLLOIDS ,CORONARY artery bypass ,DEMOGRAPHY ,CARDIAC surgery ,HEMATOCRIT ,LENGTH of stay in hospitals ,INTENSIVE care units ,EVALUATION of medical care ,MEDICAL protocols ,MORTALITY ,PEDIATRICS ,PERFUSION ,POSTOPERATIVE care ,SURGICAL complications ,T-test (Statistics) ,ULTRAFILTRATION ,LOGISTIC regression analysis ,DATA analysis ,CONTROL groups ,RETROSPECTIVE studies ,BODY surface area ,DATA analysis software ,DESCRIPTIVE statistics ,OSMOTIC pressure ,MANN Whitney U Test - Abstract
The article discusses a study conducted to analyze the effect of conventional ultrafiltration on allogenic blood transfusion and clinical outcome in infants after cardiac surgery. Topics discussed include details of the method, subjects, results and conclusion of the study, which find no significant differences between the groups in relation to demographics or hematological and cardiopulmonary bypass data.
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- 2015
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17. Minimizing the perfusion system by integration of the components. Does it affect the hematocrit drop and transfused red blood cells? A retrospective audit.
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Boks, RH, van Pelt, C, Takkenberg, JJM, and Bogers, Ad JJC
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ACADEMIC medical centers ,ERYTHROCYTES ,ANALYSIS of variance ,AUDITING ,BLOOD transfusion ,CARDIOPULMONARY bypass ,STATISTICAL correlation ,HEMATOCRIT ,STATISTICS ,DATA analysis ,RETROSPECTIVE studies ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
The article discusses the retrospective audit to determine the affect on the drop of hematocrit (Hct) and amount of transfused red blood cells (RBCs) during cardiopulmonary bypass (CPB) in adult cardiac surgery patients from 2008-2011, with the use of integrated components to minimize CPB circuit. Findings discussed include usefulness and association of minimizing CPB circuit with use of integrated components with less drop of Hct values and possible reduction of transfused RBCs during CPB.
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- 2015
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18. Neuropsychologic dysfunction after CABG: standard cardiopulmonary bypass versus off-pump CABG
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Oudenaarde, I, primary, Takkenberg, JJM, additional, van der Velden, E, additional, Chalfont, L, additional, Wesnes, K, additional, and van Herwerden, LA, additional
- Published
- 2000
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19. Moderated Posters session: pulmonary hypertension and other conditions
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Baggen, VJM, Driessen, MMP, Post, MC, Van Dijk, AP, Roos-Hesselink, JW, Van Den Bosch, AE, Takkenberg, JJM, Sieswerda, GT, Spinelli, L, Giudice, C A, Castaldo, D, Pisani, A, Trimarco, B, Venner, C, Huttin, O, Mandry, D, Voilliot, D, Chabot, JF, Marie, PY, Juilliere, Y, Chaouat, A, Selton-Suty, C, Tuohinen, S, Skytta, T, Virtanen, V, Kellokumpu-Lehtinen, PL, Raatikainen, P, Konopka, M, Burkhard-Jagodzinska, K, Krol, W, Zdanowicz, R, Starczewski, M, Aniol-Strzyzewska, K, Jakubiak, A, Sitkowski, D, Dluzniewski, M, Braksator, W, Santoro, C, Buonauro, A, Bocchino, ML, Esposito, R, Canora, A, Vaccaro, A, Castaldo, S, Sanduzzi Zamparelli, A, Trimarco, B, Galderisi, M, Wahi, S, Chong, A, Krstic, I, Deljanin Ilic, M, Vrbic, S, Marinkovic, D, Ilic, S, Duchateau, N, Sermesant, M, Gibelin, P, Ferrari, E, Moceri, P, Handoko, M L, Di Pasqua, MC, Spruijt, OA, Oosterveer, FPT, Marcus, JT, Bogaard, HJ, and Vonk Noordegraaf, A
- Abstract
Purpose: Accurate prognostication is essential to guide clinical management in patients with pulmonary arterial hypertension (PAH). The goal of this study is to provide a comprehensive overview of the most thoroughly evaluated echocardiographic findings aiming to predict adverse outcome in PAH. Methods: MEDLINE and EMBASE electronic databases were systematically searched for longitudinal studies published by April 2015 that reported associations between echocardiographic findings and adverse clinical outcome in PAH. Studies were appraised using previously developed criteria for prognostic studies. Meta-analysis of echocardiographic findings investigated by ≥4 studies was performed using random effect models. In case of significant heterogeneity (I²>50% or Cochran’s Q p-value <0.10) additional sensitivity analyses were performed by excluding specific patient subgroups. Results: Thirty-seven papers investigating 6669 patients were included. Pooled hazard ratios and heterogeneity statistics are shown in the table. For TR severity and RV free wall LPSS no statistical heterogeneity was found, however the reported standard errors were generally larger. Sensitivity analyses did not change the overall results and conclusions for pericardial effusion, right atrial area and TAPSE. These results can be therefore regarded with a higher degree of certainty. Conclusions: This meta-analysis substantiates the clinical yield of specific echocardiographic findings in the prognostication of PAH patients in day-to-day practice. Especially, pericardial effusion, right atrial area and TAPSE are of prognostic value. Systematic review registration number: CRD42014009231.
Prognostic value of echo findings in PAH No. of studies Hazard ratio 95% CI p-value I², % Cochran's Q (p-value) Presence of pericardial effusion 16 1.70 1.44-1.99 <0.001 42 25.7 (0.041) Right atrial area, per 5 cm² increase 5 1.71 1.38-2.13 <0.001 55 8.9 (0.063) RV systolic pressure, per 10 mmHg increase 7 1.18 1.01-1.38 0.043 76 25.1 (<0.001) Tricuspid regurgitation severity 7 2.20 1.64-2.95 <0.001 39 9.8 (0.133) Right atrial pressure, >15 mmHg 6 2.45 1.56-3.85 <0.001 76 20.7 (<0.001) TAPSE, per 5 mm increase 7 0.58 0.46-0.75 <0.001 77 26.1 (<0.001) RV fractional area change, per 5% increase 5 0.81 0.69-0.96 0.039 60 10.1 (0.039) Tei index, per 0.1 unit increase 7 1.23 1.09-1.40 0.001 73 22.3 (0.001) RV free wall longitudinal peak systolic strain, per 5% increase 4 1.72 1.53-1.93 <0.001 0 3.0 (0.392) - Published
- 2015
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20. Sex-related differences in the clinical course of aortic root and ascending aortic aneurysms: the DisSEXion Study.
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Notenboom ML, de Keijzer AR, Veen KM, Gökalp A, Bogers AJJC, Heijmen RH, van Kimmenade RRJ, Geuzebroek GSC, Mokhles MM, Bekkers JA, Roos-Hesselink JW, and Takkenberg JJM
- Abstract
Background and Aims: To explore male-female differences in aneurysm growth and clinical outcomes in a two-centre retrospective Dutch cohort study of adult patients with ascending aortic aneurysm (AscAA)., Methods: Adult patients in whom imaging of an AscAA (root and/or ascending: ≥40 mm) was performed between 2007 and 2022 were included. Aneurysm growth was analysed using repeated measurements at the sinuses of Valsalva (SoV) and tubular ascending aorta. Male-female differences were explored in presentation, aneurysm characteristics, treatment strategy, survival, and clinical outcomes., Results: One thousand eight hundred and fifty-eight patients were included (31.6% female). Median age at diagnosis was 65.4 years (interquartile range: 53.4-71.7) for females and 59.0 years (interquartile range: 49.3-68.0) for males (P < .001). At diagnosis, females more often had tubular ascending aortic involvement (75.5% vs. 70.2%; P = .030) while males more often had SoV involvement (42.8% vs. 21.6%; P < .001). Maximum absolute aortic diameter, at any location, at diagnosis did not differ between females (45.0 mm) and males (46.5 mm; P = .388). In females, tubular ascending growth was faster (P < .001), whereas in males, SoV growth was faster (P = .005), corrected for covariates. Unadjusted 10-year survival was 72.5% [95% confidence interval (CI) 67.8%-77.6%] for females and 78.3% (95% CI 75.3%-81.3%) for males (P = .010). Twenty-three type A dissections occurred, with an incidence rate of 8.2/1000 patient-years (95% CI 4.4-14.1) in females and 2.4/1000 patient-years (95% CI 1.2-4.5) in males [incidence rate ratio females/males: 3.4 (95% CI 1.5-8.0; P = .004)]., Conclusions: In patients having entered a diagnostic programme, involvement of aortic segments and age- and segment-related growth patterns differ between women and men with AscAA, particularly at an older age. Unravelling of these intertwined observations will provide a deeper understanding of AscAA progression and outcome in women and men and can be used as an evidence base for patient-tailored clinical guideline development., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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21. Long-Term Health-Related Quality of Life following Acute Type A Aortic Dissection with a Focus on Male-Female Differences: A Cross Sectional Study.
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Meccanici F, Thijssen CGE, Gökalp AL, Bom AW, Geuzebroek GSC, Ter Woorst JF, van Kimmenade RRJ, Post MC, Takkenberg JJM, and Roos-Hesselink JW
- Abstract
Objectives : Acute type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency, of which the long-term impact on health-related quality of life (HRQoL) and male-female-specific insights remain inadequately clarified. Methods : Consecutive adult ATAAD patients who underwent surgery were retrospectively included between 2007 and 2017 in four referral centers in the Netherlands, and baseline data were collected. The 36-Item Short-Form (SF-36) Health Survey was sent to all survivors between 2019 and 2021 and compared to validated SF-36 scores of the Dutch general population stratified by age group and sex. Results : In total, 324/555 surviving patients returned the SF-36 questionnaire (response rate 58%), of which 40.0% were female; the median follow-up was 6.5 years (range: 1.7-13.9, IQR: 4.0-9.4) after surgery for ATAAD. In comparison to the general population, ATAAD patients scored significantly lower on 6/8 SF-36 subdomains and higher on bodily pain. Differences in HRQoL domains compared to the sex-matched data were largely comparable between sexes, apart from bodily pain. In the age-matched subgroups impaired HRQoL was most pronounced in younger patients aged 41-60 (5/8 impaired domains). Female ATAAD patients scored significantly worse on 5/8 SF-36 subdomains and the physical component summary (PCS) scores than male patients. Age at ATAAD, female sex, hypertension, COPD, and prior thoracic aortic aneurysm were associated with worse PCS scores. Conclusions : Long-term HRQoL was impaired in both male and female ATAAD patients when compared to the general population. Further studies on the nature of this impairment and on interventions to improve HRQoL after ATAAD are clearly warranted, with special attention to females and younger patients.
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- 2024
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22. Decision analysis in cardiac surgery: a scoping review and methodological primer.
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Vervoort D, Lee GS, Lia H, Afzal AM, Tam DY, Ouzounian M, Takkenberg JJM, Wijeysundera HC, and Fremes SE
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- Humans, Cost-Benefit Analysis, Heart, Decision Support Techniques, Cardiac Surgical Procedures
- Abstract
Objectives: Randomized controlled trials are the gold standard for evidence generation in medicine but are limited by their real-world generalizability, resource needs, shorter follow-up durations and inability to be conducted for all clinical questions. Decision analysis (DA) models may simulate trials and observational studies by using existing data and evidence- and expert-informed assumptions and extend analyses over longer time horizons, different study populations and specific scenarios, helping to translate population outcomes to patient-specific clinical and economic outcomes. Here, we present a scoping review and methodological primer on DA for cardiac surgery research., Methods: A scoping review was performed using the PubMed/MEDLINE, EMBASE and Web of Science databases for cardiac surgery DA studies published until December 2021. Articles were summarized descriptively to quantify trends and ascertain methodological consistency., Results: A total of 184 articles were identified, among which Markov models (N = 92, 50.0%) were the most commonly used models. The most common outcomes were costs (N = 107, 58.2%), quality-adjusted life-years (N = 96, 52.2%) and incremental cost-effectiveness ratios (N = 89, 48.4%). Most (N = 165, 89.7%) articles applied sensitivity analyses, most frequently in the form of deterministic sensitivity analyses (N = 128, 69.6%). Reporting of guidelines to inform the model development and/or reporting was present in 22.3% of articles., Conclusion: DA methods are increasing but remain limited and highly variable in cardiac surgery. A methodological primer is presented and may provide researchers with the foundation to start with or improve DA, as well as provide readers and reviewers with the fundamental concepts to review DA studies., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
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- 2024
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23. How microsimulation translates outcome estimates to patient lifetime event occurrence in the setting of heart valve disease.
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Notenboom ML, Rhellab R, Etnel JRG, Huygens SA, Hjortnaes J, Kluin J, Takkenberg JJM, and Veen KM
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- Humans, Computer Simulation, Clinical Decision-Making, Heart Valve Diseases epidemiology, Heart Valve Diseases surgery
- Abstract
Treatment decisions in healthcare often carry lifelong consequences that can be challenging to foresee. As such, tools that visualize and estimate outcome after different lifetime treatment strategies are lacking and urgently needed to support clinical decision-making in the setting of rapidly evolving healthcare systems, with increasingly numerous potential treatments. In this regard, microsimulation models may prove to be valuable additions to current risk-prediction models. Notable advantages of microsimulation encompass input from multiple data sources, the ability to move beyond time-to-first-event analysis, accounting for multiple types of events and generating projections of lifelong outcomes. This review aims to clarify the concept of microsimulation, also known as individualized state-transition models, and help clinicians better understand its potential in clinical decision-making. A practical example of a patient with heart valve disease is used to illustrate key components of microsimulation models, such as health states, transition probabilities, input parameters (e.g. evidence-based risks of events) and various aspects of mortality. Finally, this review focuses on future efforts needed in microsimulation to allow for increasing patient-tailoring of the models by extending the general structure with patient-specific prediction models and translating them to meaningful, user-friendly tools that may be used by both clinician and patient to support clinical decision-making., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2024
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24. Aortic Valve Embryology, Mechanobiology, and Second Messenger Pathways: Implications for Clinical Practice.
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Notenboom ML, Van Hoof L, Schuermans A, Takkenberg JJM, Rega FR, and Taverne YJHJ
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During the Renaissance, Leonardo Da Vinci was the first person to successfully detail the anatomy of the aortic root and its adjacent structures. Ever since, novel insights into morphology, function, and their interplay have accumulated, resulting in advanced knowledge on the complex functional characteristics of the aortic valve (AV) and root. This has shifted our vision from the AV as being a static structure towards that of a dynamic interconnected apparatus within the aortic root as a functional unit, exhibiting a complex interplay with adjacent structures via both humoral and mechanical stimuli. This paradigm shift has stimulated surgical treatment strategies of valvular disease that seek to recapitulate healthy AV function, whereby AV disease can no longer be seen as an isolated morphological pathology which needs to be replaced. As prostheses still cannot reproduce the complexity of human nature, treatment of diseased AVs, whether stenotic or insufficient, has tremendously evolved, with a similar shift towards treatments options that are more hemodynamically centered, such as the Ross procedure and valve-conserving surgery. Native AV and root components allow for an efficient Venturi effect over the valve to allow for optimal opening during the cardiac cycle, while also alleviating the left ventricle. Next to that, several receptors are present on native AV leaflets, enabling messenger pathways based on their interaction with blood and other shear-stress-related stimuli. Many of these physiological and hemodynamical processes are under-acknowledged but may hold important clues for innovative treatment strategies, or as potential novel targets for therapeutic agents that halt or reverse the process of valve degeneration. A structured overview of these pathways and their implications for cardiothoracic surgeons and cardiologists is lacking. As such, we provide an overview on embryology, hemodynamics, and messenger pathways of the healthy and diseased AV and its implications for clinical practice, by relating this knowledge to current treatment alternatives and clinical decision making.
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- 2024
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25. Male-Female Differences in Acute Type B Aortic Dissection.
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Meccanici F, Thijssen CGE, Heijmen RH, Geuzebroek GSC, Ter Woorst JF, Gökalp AL, de Bruin JL, Gratama DN, Bekkers JA, van Kimmenade RRJ, Poyck P, Peels K, Post MC, Mokhles MM, Takkenberg JJM, Roos-Hesselink JW, and Verhagen HJM
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- Humans, Male, Female, Retrospective Studies, Treatment Outcome, Acute Disease, Risk Factors, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation, Aortic Dissection epidemiology, Endovascular Procedures
- Abstract
Background: Acute type B aortic dissection is a cardiovascular emergency with considerable mortality and morbidity risk. Male-female differences have been observed in cardiovascular disease; however, literature on type B aortic dissection is scarce., Methods and Results: A retrospective cohort study was conducted including all consecutive patients with acute type B aortic dissection between 2007 and 2017 in 4 tertiary hospitals using patient files and questionnaires for late morbidity. In total, 384 patients were included with a follow-up of 6.1 (range, 0.02-14.8) years, of which 41% (n=156) were female. Women presented at an older age than men (67 [interquartile range (IQR), 57-73] versus 62 [IQR, 52-71]; P =0.015). Prior abdominal aortic aneurysm (6% versus 15%; P =0.009), distally extending dissections (71 versus 85%; P =0.001), and clinical malperfusion (18% versus 32%; P =0.002) were less frequently observed in women. Absolute maximal descending aortic diameters were smaller in women (36 [IQR: 33-40] mm versus 39 [IQR, 36-43] mm; P <0.001), while indexed for body surface area diameters were larger in women (20 [IQR, 18-23] mm/m
2 versus 19 [IQR, 17-21] mm/m2 ). No male-female differences were found in treatment choice; however, indications for invasive treatment were different ( P <0.001). Early mortality rate was 9.6% in women and 11.8% in men ( P =0.60). The 5-year survival was 83% (95% CI, 77-89) for women and 84% (95% CI, 79-89) for men ( P =0.90). No male-female differences were observed in late (re)interventions., Conclusions: No male-female differences were found in management, early or late death, and morbidity in patients presenting with acute type B aortic dissection, despite distinct clinical profiles at presentation. More details on the impact of age and type of intervention are warranted in future studies.- Published
- 2024
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26. Long-term surgical outcomes of congenital supravalvular aortic stenosis: a systematic review, meta-analysis and microsimulation study.
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Meccanici F, Notenboom ML, Meijssen J, Smit V, van de Woestijne PC, van den Bosch AE, Helbing WA, Bogers AJJC, Takkenberg JJM, and Roos-Hesselink JW
- Subjects
- Child, Adult, Humans, Child, Preschool, Reoperation, Constriction, Pathologic etiology, Treatment Outcome, Aortic Stenosis, Supravalvular surgery, Heart Valve Prosthesis Implantation adverse effects, Aortic Valve Stenosis
- Abstract
Objectives: Congenital supravalvular aortic stenosis (SVAS) is a rare form of congenital outflow tract obstruction and long-term outcomes are scarcely reported. This study aims to provide an overview of outcomes after surgical repair for congenital SVAS., Methods: A systematic review of published literature was conducted, including observational studies reporting long-term clinical outcome (>2 years) after SVAS repair in children or adults considering >20 patients. Early risks, late event rates and time-to-event data were pooled and entered into a microsimulation model to estimate 30-year outcomes. Life expectancy was compared to the age-, sex- and origin-matched general population., Results: Twenty-three publications were included, encompassing a total of 1472 patients (13 125 patient-years; pooled mean follow-up: 9.0 (6.2) years; median follow-up: 6.3 years). Pooled mean age at surgical repair was 4.7 (5.8) years and the most commonly used surgical technique was the single-patch repair (43.6%). Pooled early mortality was 4.2% (95% confidence interval: 3.2-5.5%) and late mortality was 0.61% (95% CI: 0.45-0.83) per patient-year. Based on microsimulation, over a 30-year time horizon, it was estimated that an average patient with SVAS repair (mean age: 4.7 years) had an observed life expectancy that was 90.7% (95% credible interval: 90.0-91.6%) of expected life expectancy in the matched general population. The microsimulation-based 30-year risk of myocardial infarction was 8.1% (95% credible interval: 7.3-9.9%) and reintervention 31.3% (95% credible interval: 29.6-33.4%), of which 27.2% (95% credible interval: 25.8-29.1) due to repair dysfunction., Conclusions: After surgical repair for SVAS, 30-year survival is lower than the matched-general-population survival and the lifetime risk of reintervention is considerable. Therefore, lifelong monitoring of the cardiovascular system and in particular residual stenosis and coronary obstruction is recommended., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
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- 2024
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27. Surgical Heritage: You Had to Be There, Ross: The Comeback Kid.
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Yacoub MH, Notenboom ML, Melina G, and Takkenberg JJM
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- Child, Humans, Aged, Autografts surgery, Transplantation, Autologous, Reoperation, Aortic Valve surgery, Treatment Outcome, Heart Valve Prosthesis Implantation, Pulmonary Valve surgery, Aortic Valve Insufficiency surgery, Aortic Valve Stenosis surgery
- Abstract
Half a century after the first pulmonary autograft operation (Ross operation), performed in 1967 by Donald Ross in central London, there is a very strong conviction that the Ross operation is the best available valve substitute today, not only for children, but also for younger and older adults. The Ross operation has stimulated a lot of science to do with tissue-engineering and biology of heart valves, which is a promising avenue for the future. For one of us (M.Y.), it has certainly been a privilege to be associated with the comeback of the Ross operation., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2024
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28. Long-Term Clinical and Echocardiographic Outcomes Following the Ross Procedure: A Post Hoc Analysis of a Randomized Clinical Trial.
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Notenboom ML, Melina G, Veen KM, De Robertis F, Coppola G, De Siena P, Navarra EM, Gaer J, Ibrahim MEK, El-Hamamsy I, Takkenberg JJM, and Yacoub MH
- Subjects
- Adult, Humans, Male, Young Adult, Middle Aged, Aged, Female, Aortic Valve diagnostic imaging, Aortic Valve surgery, Aortic Valve physiopathology, Treatment Outcome, Retrospective Studies, Echocardiography, Patient Reported Outcome Measures, Aortic Valve Stenosis surgery, Heart Valve Prosthesis Implantation methods, Aortic Valve Disease surgery, Endocarditis surgery
- Abstract
Importance: The Ross procedure as treatment for adults with aortic valve disease (AVD) has been the subject of renewed interest., Objective: To evaluate the long-term clinical and echocardiographic outcomes following the Ross procedure for the treatment of adults with AVD., Design, Setting, and Participants: This post hoc analysis of a randomized clinical trial included adult patients (age <69 years) who underwent a Ross procedure for the treatment of AVD, including those with active endocarditis, rheumatic AVD, decreased ejection fraction, and previous cardiac surgery. The trial, conducted from September 1, 1994, to May 31, 2001, compared homograft root replacement with the Ross procedure at a single center. Data after 2010 were collected retrospectively in November and December 2022., Exposure: Ross procedure., Main Outcomes and Measures: The primary end point was long-term survival among patients who underwent the Ross procedure compared with that in the age-, country of origin- and sex-matched general population. Secondary end points were freedom from any reintervention, autograft reintervention, or homograft reintervention and time-related valve function, autograft diameter, and functional status., Results: This study included 108 adults (92 [85%] male) with a median age of 38 years (range, 19-66 years). Median duration of clinical follow-up was 24.1 years (IQR, 22.6-26.1 years; 2488 patient-years), with 98% follow-up completeness. Of these patients, 9 (8%) had active endocarditis and 45 (42%) underwent reoperations. The main hemodynamic lesion was stenosis in 30 (28%) and regurgitation in 49 (45%). There was 1 perioperative death (0.9%). Twenty-five year survival was 83.0% (95% CI, 75.5%-91.2%), representing a relative survival of 99.1% (95% CI, 91.8%-100%) compared with the general population (83.7%). At 25 years, freedom from any reintervention was 71.1% (95% CI, 61.6%-82.0%); from autograft reintervention, 80.3% (95% CI, 71.9%-89.6%); and from homograft reintervention, 86.3% (95% CI, 79.0%-94.3%). Thirty-day mortality after the first Ross-related reintervention was 0% and after all Ross-related reinterventions was 3.8% (n = 1); 10-year survival after reoperation was 96.2% (95% CI, 89.0%-100%)., Conclusions and Relevance: This study found that the Ross procedure provided excellent survival into the third decade postoperatively that was comparable to that in the general population. Long-term freedom from reintervention demonstrated that the Ross procedure may be a durable substitute into late adulthood, showing a delayed but progressive functional decline., Trial Registration: isrctn.org Identifier: ISRCTN03530985.
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- 2024
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29. Male-female differences in contemporary elective ascending aortic surgery: insights from the Netherlands Heart Registration.
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Gökalp AL, Thijssen CGE, Bekkers JA, Roos-Hesselink JW, Bogers AJJC, Geuzebroek GSC, Houterman S, Takkenberg JJM, and Mokhles MM
- Abstract
Background: Scientific research regarding male-female differences in ascending aortic surgery is scarce. The objective of this study was to identify male-female differences in presentation, treatment and peri-operative outcome in elective ascending aortic surgery., Methods: Elective ascending aortic surgery procedures that took place in the Netherlands between 01/01/2013-31/12/2017 were identified from the Netherlands Heart Registration. Male-female differences in presentation, treatment characteristics, and in-hospital mortality and morbidity were explored., Results: The study population consisted of 887 females (31%) and 1,972 males (69%). Females were older (median age 67 versus 62 years, P<0.001), more often had chronic lung disease (12.3% versus 9.1%, P=0.011), New York Heart Association (NYHA) class III-IV (21.5% versus 15.5%, P=0.003), and less often a history of percutaneous coronary intervention (PCI) (3.2% versus 5.0%, P=0.033). Isolated supracoronary aortic replacement was performed in 47.7% of females versus 30.6% of males (P<0.001), and ascending aorta with root replacement in 40.6% of females versus 56.7% of males (P<0.001). Females more often underwent concomitant interventions of the aortic arch (33.1% versus 20.2%, P<0.001) and the mitral valve (8.2% versus 5.2%, P=0.002), and less often concomitant coronary artery bypass grafting (CABG) (14.4% versus 19.1%, P=0.002). Overall, in-hospital mortality was significantly higher in females (5.1% versus 2.7%, P=0.003). In multivariable regression analysis, being female was an independent risk factor for in-hospital mortality [odds ratio (OR) 1.55, 95% confidence interval (CI): 1.02-2.37]., Conclusions: This nation-wide cohort shows clear differences between females and males in patient presentation, procedural characteristics, in-hospital outcomes, and risk factors for in-hospital mortality in elective ascending aortic surgery. Further exploration of these differences, and of modifiable within-male and within-female risk factors, may offer great opportunities in improving treatment and thereby outcomes for both males and females., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2023 Annals of Cardiothoracic Surgery. All rights reserved.)
- Published
- 2023
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30. Male-female differences in thoracic aortic diameters at presentation of acute type A aortic dissection.
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Meccanici F, Bom AW, Knol WG, Gökalp AL, Thijssen CGE, Bekkers JA, Geuzebroek GSC, Mokhles MM, van Kimmenade RRJ, Budde RPJ, Takkenberg JJM, and Roos-Hesselink JW
- Abstract
Background: Acute type A aortic dissection (ATAAD) is a highly lethal event, associated with aortic dilatation. It is not well known if patient height, weight or sex impact the thoracic aortic diameter (TAA) at ATAAD. The study aim was to identify male-female differences in TAA at ATAAD presentation., Methods: This retrospective cross-sectional study analysed all adult patients who presented with ATAAD between 2007 and 2017 in two tertiary care centres and underwent contrast enhanced computed tomography (CTA) before surgery. Absolute aortic diameters were measured at the sinus of Valsalva (SoV), ascending (AA) and descending thoracic aorta (DA) using double oblique reconstruction, and indexed for body surface area (ASI) and height (AHI). Z-scores were calculated using the Campens formula., Results: In total, 59 % (181/308) of ATAAD patients had CT-scans eligible for measurements, with 82 female and 99 male patients. Females were significantly older than males (65.5 ± 12.4 years versus 60.3 ± 2.3, p = 0.024). Female patients had larger absolute AA diameters than male patients (51.0 mm [47.0-57.0] versus 49.0 mm [45.0-53.0], p = 0.023), and larger ASI and AHI at all three levels. Z-scores for the SoV and AA were significantly higher for female patients (2.99 ± 1.66 versus 1.34 ± 1.77, p < 0.001 and 5.27 [4.38-6.26] versus 4.06 [3.14-5.02], p < 0.001). After adjustment for important clinical factors, female sex remained associated with greater maximal TAA (p = 0.019)., Conclusion: Female ATAAD patients had larger absolute ascending aortic diameters than males, implying a distinct timing in disease presentation or selection bias. Translational studies on the aortic wall and studies on growth patterns should further elucidate these sex differences., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier B.V.)
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- 2023
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31. Reply to letter to the editor: "Novel biomarkers associated with thoracic aortic disease".
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Thijssen CGE, Dekker S, Bons LR, Geenen LW, Gökalp AL, Takkenberg JJM, Mokhles MM, Bekkers JA, Boersma E, Bouwens E, van Kimmenade RRJ, and Roos-Hesselink JW
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- Humans, Biomarkers, Aorta, Aortic Diseases
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- 2023
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32. Paediatric aortic valve replacement: a meta-analysis and microsimulation study.
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Notenboom ML, Schuermans A, Etnel JRG, Veen KM, van de Woestijne PC, Rega FR, Helbing WA, Bogers AJJC, and Takkenberg JJM
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- Humans, Child, Adolescent, Aortic Valve surgery, Retrospective Studies, Prospective Studies, Treatment Outcome, Heart Valve Prosthesis Implantation methods, Heart Valve Prosthesis
- Abstract
Aims: To support decision-making in children undergoing aortic valve replacement (AVR), by providing a comprehensive overview of published outcomes after paediatric AVR, and microsimulation-based age-specific estimates of outcome with different valve substitutes., Methods and Results: A systematic review of published literature reporting clinical outcome after paediatric AVR (mean age <18 years) published between 1/1/1990 and 11/08/2021 was conducted. Publications reporting outcome after paediatric Ross procedure, mechanical AVR (mAVR), homograft AVR (hAVR), and/or bioprosthetic AVR were considered for inclusion. Early risks (<30d), late event rates (>30d) and time-to-event data were pooled and entered into a microsimulation model. Sixty-eight studies, of which one prospective and 67 retrospective cohort studies, were included, encompassing a total of 5259 patients (37 435 patient-years; median follow-up: 5.9 years; range 1-21 years). Pooled mean age for the Ross procedure, mAVR, and hAVR was 9.2 ± 5.6, 13.0 ± 3.4, and 8.4 ± 5.4 years, respectively. Pooled early mortality for the Ross procedure, mAVR, and hAVR was 3.7% (95% CI, 3.0%-4.7%), 7.0% (5.1%-9.6%), and 10.6% (6.6%-17.0%), respectively, and late mortality rate was 0.5%/year (0.4%-0.7%/year), 1.0%/year (0.6%-1.5%/year), and 1.4%/year (0.8%-2.5%/year), respectively. Microsimulation-based mean life-expectancy in the first 20 years was 18.9 years (18.6-19.1 years) after Ross (relative life-expectancy: 94.8%) and 17.0 years (16.5-17.6 years) after mAVR (relative life-expectancy: 86.3%). Microsimulation-based 20-year risk of aortic valve reintervention was 42.0% (95% CI: 39.6%-44.6%) after Ross and 17.8% (95% CI: 17.0%-19.4%) after mAVR., Conclusion: Results of paediatric AVR are currently suboptimal with substantial mortality especially in the very young with considerable reintervention hazards for all valve substitutes, but the Ross procedure provides a survival benefit over mAVR. Pros and cons of substitutes should be carefully weighed during paediatric valve selection., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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33. Aortic valve repair in neonates, infants and children: a systematic review, meta-analysis and microsimulation study.
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Notenboom ML, Rhellab R, Etnel JRG, van den Bogerd N, Veen KM, Taverne YJHJ, Helbing WA, van de Woestijne PC, Bogers AJJC, and Takkenberg JJM
- Subjects
- Infant, Newborn, Humans, Child, Infant, Adolescent, Aortic Valve surgery, Constriction, Pathologic, Treatment Outcome, Retrospective Studies, Reoperation, Heart Valve Prosthesis Implantation, Heart Valve Prosthesis, Aortic Valve Stenosis
- Abstract
Objectives: To support clinical decision-making in children with aortic valve disease, by compiling the available evidence on outcome after paediatric aortic valve repair (AVr)., Methods: A systematic review of literature reporting clinical outcome after paediatric AVr (mean age at surgery <18 years) published between 1 January 1990 and 23 December 2021 was conducted. Early event risks, late event rates and time-to-event data were pooled. A microsimulation model was employed to simulate the lives of individual children, infants and neonates following AVr., Results: Forty-one publications were included, encompassing 2 623 patients with 17 217 patient-years of follow-up (median follow-up: 7.3 years; range: 1.0-14.4 years). Pooled mean age during repair for aortic stenosis in children (<18 years), infants (<1 year) or neonates (<30 days) was 5.2 ± 3.9 years, 35 ± 137 days and 11 ± 6 days, respectively. Pooled early mortality after stenosis repair in children, infants and neonates, respectively, was 3.5% (95% confidence interval: 1.9-6.5%), 7.4% (4.2-13.0%) and 10.7% (6.8-16.9%). Pooled late reintervention rate after stenosis repair in children, infants and neonates, respectively, was 3.31%/year (1.66-6.63%/year), 6.84%/year (3.95-11.83%/year) and 6.32%/year (3.04-13.15%/year); endocarditis 0.07%/year (0.03-0.21%/year), 0.23%/year (0.07-0.71%/year) and 0.49%/year (0.18-1.29%/year); and valve thrombosis 0.05%/year (0.01-0.26%/year), 0.15%/year (0.04-0.53%/year) and 0.19%/year (0.05-0.77%/year). Microsimulation-based mean life expectancy in the first 20 years for children, infants and neonates with aortic stenosis, respectively, was 18.4 years (95% credible interval: 18.1-18.7 years; relative survival compared to the matched general population: 92.2%), 16.8 years (16.5-17.0 years; relative survival: 84.2%) and 15.9 years (14.8-17.0 years; relative survival: 80.1%). Microsimulation-based 20-year risk of reintervention in children, infants and neonates, respectively, was 75.2% (72.9-77.2%), 53.8% (51.9-55.7%) and 50.8% (47.0-57.6%)., Conclusions: Long-term outcomes after paediatric AVr for stenosis are satisfactory and dependent on age at surgery. Despite a high hazard of reintervention for valve dysfunction and slightly impaired survival relative to the general population, AVr is associated with low valve-related event occurrences and should be considered in children with aortic valve disease., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
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- 2023
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34. Long Term Health Related Quality of Life After Acute Type B Aortic Dissection: a Cross Sectional Survey Study.
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Meccanici F, Thijssen CGE, Gökalp AL, Bom AW, de Bruin JL, Bekkers JA, van Kimmenade RRJ, Geuzebroek GSC, Poyck P, Woorst JJT, Peels K, Sjatskig J, Heijmen RH, Post MC, Mokhles MM, Verhagen HJM, Takkenberg JJM, and Roos-Hesselink JW
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- Humans, Male, Female, Cross-Sectional Studies, Retrospective Studies, Surveys and Questionnaires, Quality of Life, Aortic Dissection surgery
- Abstract
Objective: Acute type B aortic dissection (ATBD) is a rare yet serious cardiovascular event that potentially has an impact on health related quality of life (HRQoL). However, long term follow up data on this topic are scarce. This study aimed to review the long term HRQoL among patients treated for ATBD., Methods: In this multicentre, cross sectional survey study, consecutive treated patients with ATBD between 2007 and 2017 in four referral centres in the Netherlands were retrospectively included and baseline data were collected. Between 2019 and 2021 the 36 Item Short Form Survey (SF-36) was sent to all surviving patients (n = 263) and was compared with validated SF-36 scores in the Dutch general population stratified by age and sex., Results: In total, 144 of 263 surviving patients completed the SF-36 (response rate 55%). Median (IQR) age was 68 (61, 76) years at completion of the questionnaire, and 40% (n = 58) were female. Initial treatment was medical in 55% (n = 79), endovascular in 41% (n = 59), and surgical in 4% (n = 6) of ATBD patients. Median follow up time was 6.1 (range 1.7-13.9; IQR 4.0, 9.0) years. Compared with the general population, patients scored significantly worse on six of eight SF-36 subdomains, particularly physical domains. Apart from bodily pain, there were no substantial differences in HRQoL between male and female ATBD patients. Compared with sex matched normative data, females scored significantly worse on five of eight subdomains, whereas males scored significantly lower on six subdomains. Younger patients aged 41-60 years seemed more severely impaired in HRQoL compared with the age matched general population. Treatment strategy did not influence HRQoL outcomes. Follow up time was associated with better Physical and Mental Component Summary scores., Conclusion: Long term HRQoL was impaired in ATBD patients compared with the Dutch general population, especially regarding physical status. This warrants more attention for HRQoL during clinical follow up. Rehabilitation programmes including exercise and physical support might improve HRQoL and increase patients' health understanding., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)
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- 2023
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35. A left-shift in the diameter for prophylactic aneurysmectomy: The right decision for all?
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Notenboom ML, Bekkers JA, and Takkenberg JJM
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- Humans, Postoperative Complications, Heart Ventricles, Heart Aneurysm
- Published
- 2023
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36. Exercise in patients with repaired tetralogy of Fallot: a systematic review and meta-analysis.
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Schuermans A, Boerma M, Sansoni GA, Van den Eynde J, Takkenberg JJM, Helbing WA, Geva T, Moons P, Van De Bruaene A, and Budts W
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- Adult, Child, Humans, Adolescent, Young Adult, Prospective Studies, Exercise, Exercise Therapy adverse effects, Tetralogy of Fallot surgery, Cardiac Rehabilitation methods
- Abstract
Objective: Children and adults with repaired tetralogy of Fallot (rTOF) have an impaired exercise capacity, a less active lifestyle and an increased long-term risk of adverse outcomes compared with healthy peers. This study aimed to summarise the current evidence for the effectiveness and safety of exercise training interventions in patients with rTOF., Methods: PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus and reference lists of relevant articles were searched for prospective studies published by November 2021. Random-effects meta-analysis and descriptive synthesis were performed to assess the effectiveness and safety of exercise training in patients with rTOF., Results: Of the 9677 citations identified, 12 articles were included that reported on 10 unique studies and covered 208 patients with rTOF (range of mean/median age: 7.4-43.3 years). All studies implemented 2 to 7 aerobic or respiratory training sessions per week with durations ranging from 6 to 26 weeks. Meta-analysis of the included randomised controlled trials showed that exercise training was associated with a significant improvement in peak VO
2 (pooled mean difference: +3.1 mL/min/kg; 95% CI: 0.76 to 5.36 mL/min/kg, p=0.019). Cardiac imaging studies revealed no subclinical adverse remodelling after the exercise interventions. No serious adverse events including arrhythmias were reported in these studies., Conclusion: Current evidence suggests that exercise training can improve exercise capacity in patients with rTOF with a low risk for adverse events. Exercise prescription may be a safe and effective tool to help improving outcomes in patients with rTOF., Prospero Registration Number: CRD42021292809., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2023
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37. The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant.
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Veen KM, Papageorgiou G, Zijderhand CF, Mokhles MM, Brugts JJ, Manintveld OC, Constantinescu AA, Bekkers JA, Takkenberg JJM, Bogers AJJC, and Caliskan K
- Subjects
- Male, Adult, Humans, Middle Aged, Echocardiography, Retrospective Studies, Treatment Outcome, Tricuspid Valve Insufficiency diagnostic imaging, Heart Transplantation, Ventricular Dysfunction, Left
- Abstract
In this study, we aim to elucidate the clinical impact and long-term course of tricuspid regurgitation (TR), taking into account its dynamic nature, after biatrial orthotopic heart transplant (OHT). All consecutive adult patients undergoing biatrial OHT (1984-2017) with an available follow-up echocardiogram were included. Mixed-models were used to model the evolution of TR. The mixed-model was inserted into a Cox model in order to address the association of the dynamic TR with mortality. In total, 572 patients were included (median age: 50 years, males: 74.9%). Approximately 32% of patients had moderate-to-severe TR immediately after surgery. However, this declined to 11% on 5 years and 9% on 10 years after surgery, adjusted for survival bias. Pre-implant mechanical support was associated with less TR during follow-up, whereas concurrent LV dysfunction was significantly associated with more TR during follow-up. Survival at 1, 5, 10, 20 years was 97% ± 1%, 88% ± 1%, 66% ± 2% and 23% ± 2%, respectively. The presence of moderate-to-severe TR during follow-up was associated with higher mortality (HR: 1.07, 95% CI (1.02-1.12), p = 0.006). The course of TR was positively correlated with the course of creatinine (R = 0.45). TR during follow-up is significantly associated with higher mortality and worse renal function. Nevertheless, probability of TR is the highest immediately after OHT and decreases thereafter. Therefore, it may be reasonable to refrain from surgical intervention for TR during earlier phase after OHT., (© 2023. Higher Education Press.)
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- 2023
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38. Circulating biomarkers associated with aortic diameter in male and female patients with thoracic aortic disease: a cross-sectional study.
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Meccanici F, Thijssen CGE, Dekker S, Bons LR, Gökalp AL, de Rijke YB, Takkenberg JJM, Mokhles MM, Bekkers JA, Boersma E, Bouwens E, van der Bosch AE, van Kimmenade RRL, and Roos-Hesselink JW
- Subjects
- Adult, Humans, Female, Male, Middle Aged, Cross-Sectional Studies, Ambulatory Care Facilities, Biomarkers, Carrier Proteins, Glycoproteins, Extracellular Matrix Proteins, Aorta, Aortic Diseases diagnostic imaging
- Abstract
Objective: As thoracic aortic disease (TAD) is generally asymptomatic, biomarkers are needed to provide insight into early progression. We aimed to examine the association between circulating blood biomarkers and the maximal thoracic aortic diameter (TADmax)., Methods: In this cross-sectional study, consecutive adult patients with a thoracic aortic diameter ≥40 mm and/or genetically proven hereditary TAD (HTAD) visiting our specialised outpatient clinic between 2017 and 2020 were prospectively included. Venous blood sampling and CT angiography and/or transthoracic echocardiography of the aorta were performed. Linear regression analyses were performed and estimates were presented as mean difference in TADmax in mm per doubling of standardised biomarker level., Results: In total, 158 patients were included (median age 61 (50.3-68.8) years, 37.3% female). HTAD diagnosis was confirmed in 36 of 158 (22.7%) patients. TADmax was 43.9±5.2 mm in men vs 41.9±5.1 in women (p=0.030). In unadjusted analysis, significant associations with TADmax were found for interleukin-6 (1.15 (95% CI 0.33 to 1.96), p=0.006), growth differentiation factor-15 (1.01 (95% CI 0.18 to 1.84), p=0.018), microfibrillar-associated protein 4 (MFAP4) (-0.88 (95% CI -1.71 to 0.05), p=0.039) and triiodothyronine (T3) (-2.00 (95%CI -3.01 to 0.99), p<0.001). The association of MFAP4 with TADmax was stronger in women (p for interaction=0.020) and for homocysteine, an inverse association with TADmax was observed when compared with men (p for interaction=0.008). When adjusted for age, sex, hyperlipidaemia and HTAD, total cholesterol (1.10 (95% CI 0.27 to 1.93), p=0.010) and T3 (-1.20 (95% CI -2.14 to 0.25), p=0.014) were significantly associated with TADmax., Conclusions: Circulating biomarkers indicative of inflammation, lipid metabolism and thyroid function might be associated with TAD severity. Possible distinct biomarker patterns for men and women warrant further investigation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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39. Male-Female Differences in Ascending Aortic Aneurysm Surgery: 25-Year Single Center Results.
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Voigt KR, Gökalp AL, Papageorgiou G, Bogers AJJC, Takkenberg JJM, Mokhles MM, and Bekkers JA
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- Humans, Male, Female, Retrospective Studies, Treatment Outcome, Aorta surgery, Risk Factors, Aneurysm, Ascending Aorta, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm surgery
- Abstract
The aim of this study was to improve insight into male-female differences in patients undergoing ascending aortic aneurysm surgery. Consecutive patients that underwent ascending aortic aneurysm surgery between January 1991-December 2016 were retrospectively analyzed. Patient and procedural characteristics, 30-day mortality, and survival were compared between male and female patients. Multivariable Cox-regression analysis was performed to explore differences in factors associated with long-term mortality. Of 631 included patients, 36% were female patients. They were older (66 (55.9-72.9) vs 56 (44.1-67.3) years, p < 0.001), had a higher logistic EuroSCORE (12 (8-17) vs 8 (5-12), p < 0.001), and underwent concomitant arch surgery more often (74% vs 54%, p < 0.001). Aortic diameter (5.5 (5.0.6.5) vs 5.5 (5.0-6.0) cm, p = 0.025) and Aortic Size Index (3.15 (2.80-3.65) vs 2.70 (2.42-3.00) cm/m
2 , p < 0.001) were larger in female patients. Early mortality was 0.9% in female patients and 2.0% in male patients (p = 0.51). Adjusted 15-year survival was comparable between male and female patients. Multivariable Cox-regression did not identify an independent association between female sex and mortality. In males a larger aortic diameter (HR1.38 per centimeter increase, 95%-CI 1.03-1.85, p = 0.003) was an independent factor associated with mortality, and in female patients a larger BSA (HR0.08 per 1kg/m2 increase, 95%-CI 0.01-0.49, p = 0.007) was an independent risk-reducing factor. Female patients presented at older age and with more advanced disease. Increased awareness for ascending aortic pathology and timely referral may result in better preoperative profiles in female patients. This may improve outcomes after ascending aortic aneurysm surgery., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)- Published
- 2023
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40. Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome.
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Mastrobuoni S, Govers PJ, Veen KM, Jahanyar J, van Saane S, Segreto A, Zanella L, de Kerchove L, Takkenberg JJM, and Arabkhani B
- Abstract
Background: Current guidelines recommend valve-sparing aortic root replacement (VSRR) procedures over valve replacement for the treatment of root aneurysm. The reimplantation technique seems to be the most widely used valve-sparing technique, with excellent outcomes in mostly single-center studies. The aim of this systematic review and meta-analysis is to present a comprehensive overview of clinical outcomes after VSRR with the reimplantation technique, and potential differences for bicuspid aortic valve (BAV) phenotype., Methods: We conducted a systematic literature search of papers reporting outcomes after VSRR that were published since 2010. Studies solely reporting on acute aortic syndromes or congenital patients were excluded. Baseline characteristics were summarized using sample size weighting. Late outcomes were pooled using inverse variance weighting. Pooled Kaplan-Meier (KM) curves for time-to-event outcomes were generated. Further, a microsimulation model was developed to estimate life expectancy and risks of valve-related morbidity after surgery., Results: Forty-four studies, with 7,878 patients, matched the inclusion criteria and were included for analysis. Mean age at operation was 50 years and almost 80% of patients were male. Pooled early mortality was 1.6% and the most common perioperative complication was chest re-exploration for bleeding (5.4%). Mean follow-up was 4.8±2.8 years. Linearized occurrence rates for aortic valve (AV) related complications such as endocarditis and stroke were below 0.3% patient-year. Overall survival was 99% and 89% at 1- and 10-year respectively. Freedom from reoperation was 99% and 91% after 1 and 10 years, respectively, with no difference between tricuspid and BAVs., Conclusions: This systematic review and meta-analysis shows excellent short- and long-term results of valve-sparing root replacement with the reimplantation technique in terms of survival, freedom from reoperation, and valve related complications with no difference between tricuspid and BAVs., Competing Interests: Conflicts of Interest: The authors declare no conflicts of interest., (2023 Annals of Cardiothoracic Surgery. All rights reserved.)
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- 2023
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41. Formal consensus study on surgery to replace the aortic valve in adults aged 18-60 years.
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Stoica S, Beard C, Takkenberg JJM, Mokhles MM, Turner M, Pepper J, Hopewell-Kelly N, Benedetto U, Nashef SAM, El-Hamamsy I, Skillington P, Glauber M, De Paulis R, Tseng E, Meuris B, Sitges M, Delgado V, Krane M, Kostolny M, and Pufulete M
- Subjects
- Humans, Adult, Aortic Valve surgery, Autografts surgery, Treatment Outcome, Transplantation, Autologous, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Objective: There is uncertainty about surgical procedures for adult patients aged 18-60 years undergoing aortic valve replacement (AVR). Options include conventional AVR (mechanical, mAVR; tissue, tAVR), the pulmonary autograft (Ross) and aortic valve neocuspidisation (Ozaki). Transcatheter treatment may be an option for selected patients. We used formal consensus methodology to make recommendations about the suitability of each procedure., Methods: A working group, supported by a patient advisory group, developed a list of clinical scenarios across seven domains (anatomy, presentation, cardiac/non-cardiac comorbidities, concurrent treatments, lifestyle, preferences). A consensus group of 12 clinicians rated the appropriateness of each surgical procedure for each scenario on a 9-point Likert scale on two separate occasions (before and after a 1-day meeting)., Results: There was a consensus that each procedure was appropriate (A) or inappropriate (I) for all clinical scenarios as follows: mAVR: total 76% (57% A, 19% I); tAVR: total 68% (68% A, 0% I); Ross: total 66% (39% A, 27% I); Ozaki: total 31% (3% A, 28% I). The remainder of percentages to 100% reflects the degree of uncertainty. There was a consensus that transcatheter aortic valve implantation is appropriate for 5 of 68 (7%) of all clinical scenarios (including frailty, prohibitive surgical risk and very limited life span)., Conclusions: Evidence-based expert opinion emerging from a formal consensus process indicates that besides conventional AVR options, there is a high degree of certainty about the suitability of the Ross procedure in patients aged 18-60 years. Future clinical guidelines should include the option of the Ross procedure in aortic prosthetic valve selection., Competing Interests: Competing interests: SS received speaker honoraria from Admedus. VD is a member of Heart’s editorial board., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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42. Pregnancy outcomes in women with a mitral valve prosthesis: A systematic review and meta-analysis.
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Grashuis P, Khargi SDM, Veen K, El Osrouti A, Bemelmans-Lalezari S, Cornette JMJ, Roos-Hesselink JW, Takkenberg JJM, and Mokhles MM
- Abstract
Objectives: To evaluate the ongoing debate concerning the choice of valve prosthesis for women requiring mitral valve replacement (MVR) and who wish to conceive. Bioprostheses are associated with risk of early structural valve deterioration. Mechanical prostheses require lifelong anticoagulation and carry maternal and fetal risks. Also, the optimal anticoagulation regimen during pregnancy after MVR remains unclear., Methods: A systematic review and meta-analysis was conducted of studies reporting on pregnancy after MVR. Valve- and anticoagulation-related maternal and fetal risks during pregnancy and 30 days' postpartum were analyzed., Results: Fifteen studies reporting 722 pregnancies were included. In total, 87.2% of pregnant women had a mechanical prosthesis and 12.5% a bioprosthesis. Maternal mortality risk was 1.33% (95% confidence interval [CI], 0.69-2.56), any hemorrhage risk 6.90% (95% CI, 3.70-12.88). Valve thrombosis risk was 4.71% (95% CI, 3.06-7.26) in patients with mechanical prostheses. 3.23% (95% CI, 1.34-7.75) of the patients with bioprostheses experienced early structural valve deterioration. Of these, the mortality was 40%. Pregnancy loss risk was 29.29% (95% CI, 19.74-43.47) with mechanical prostheses versus 13.50% (95% CI, 4.31-42.30) for bioprostheses. Switching to heparin during the first trimester demonstrated a bleeding risk of 7.78% (95% CI, 3.71-16.31) versus 4.08% (95% CI, 1.17-14.28) for women on oral anticoagulants throughout pregnancy and a valve thrombosis risk of 6.99% (95% CI, 2.08-23.51) versus 2.89% (95% CI, 1.40-5.94). Administration of anticoagulant dosages greater than 5 mg resulted in a risk of fetal adverse events of 74.24% (95% CI, 56.11-98.23) versus 8.85% (95% CI, 2.70-28.99) in ≤5 mg., Conclusions: A bioprosthesis seems the best option for women of childbearing age who are interested in future pregnancy after MVR. If mechanical valve replacement is preferred, the favorable anticoagulation regimen is continuous low-dose oral anticoagulants. Shared decision-making remains priority when choosing a prosthetic valve for young women., (© 2023 The Author(s).)
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- 2023
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43. Novel biomarkers associated with thoracic aortic disease.
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Thijssen CGE, Dekker S, Bons LR, Geenen LW, Gökalp AL, Takkenberg JJM, Mokhles MM, Bekkers JA, Boersma E, Bouwens E, van Kimmenade RRJ, and Roos-Hesselink JW
- Subjects
- Female, Humans, Middle Aged, Aged, Male, Matrix Metalloproteinase 3 metabolism, Insulin-Like Growth Factor Binding Protein 2, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic metabolism, Biomarkers metabolism, Aortic Aneurysm, Thoracic diagnosis, Aortic Aneurysm, Thoracic genetics, Aortic Diseases, Aortic Dissection diagnosis
- Abstract
Background: Biomarkers might help to improve diagnosis, surveillance and risk stratification of thoracic aortic disease (TAD). We explored the association between a broad spectrum of cardiovascular biomarkers with clinical characteristics and thoracic aortic diameter in TAD patients., Methods: Venous blood-samples were obtained in 158 clinically stable TAD patients visiting our outpatient clinic (2017-2020). TAD was defined as a thoracic aortic diameter ≥ 40 mm, or genetic confirmation (hereditary TAD). The cardiovascular panel III of the Olink multiplex platform was used for batch analysis of 92 proteins. A comparison was made between biomarker levels in patients with and without previous aortic dissection and/or surgery, and with and without hereditary TAD. Linear regression analyses were applied to identify (relative, normalized) biomarker concentrations associated with the absolute thoracic aortic diameter (AD
max ), and thoracic aortic diameter indexed for body surface area (IDmax )., Results: Median age of study patients was 61.0 (IQR 50.3-68.8) years, 37.3% females. Mean ADmax and IDmax were 43.3 ± 5.4 mm and 21.3 ± 3.3 mm/m2 . After multivariable adjustment, Matrix Metalloproteinase-3 (MMP-3) and Insulin-like growth factor binding protein 2 (IGFBP-2) showed a significant positive association with ADmax and IDmax , respectively. Patients with previous aortic surgery/dissection had higher N-terminal-pro hormone BNP (NTproBNP) (median 3.67 [IQR 3.01-3.99] vs 2.84 [2.32-3.26], p ≤0.001). Patients with hereditary TAD had higher Trem-like transcript protein 2 (TLT-2) (median 4.64 [IQR 4.45-4.84]) than those with non-heriditary TAD (4.40 [4.17-4.64]; p = 0.00042)., Conclusions: Among a broad range of biomarkers, MMP-3 and IGFBP-2 were associated with disease severity in TAD patients. The pathophysiological pathways uncovered by these biomarkers, and their potential clinical use warrants further research., Competing Interests: Declaration of Competing Interest Authors Carlijn Thijssen, Silvy Dekker, Lidia Bons, Laurie Geenen, Arjen Gökalp, Johanna Takkenberg, Mostafa Mokhles, Jos Bekkers, Elke Bouwens, Eric Boersma, Roland van Kimmenade and Jolien Roos-Hesselink declare that they have no conflict of interest., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)- Published
- 2023
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44. Elective Ascending Aortic Aneurysm Surgery in the Elderly.
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Memis F, Thijssen CGE, Gökalp AL, Notenboom ML, Meccanici F, Mokhles MM, van Kimmenade RRJ, Veen KM, Geuzebroek GSC, Sjatskig J, Ter Woorst FJ, Bekkers JA, Takkenberg JJM, and Roos-Hesselink JW
- Abstract
Background: No clear guidelines exist for performing preventive surgery for ascending aortic (AA) aneurysm in elderly patients. This study aims to provide insights by: (1) evaluating patient and procedural characteristics and (2) comparing early outcomes and long-term mortality after surgery between elderly and non-elderly patients., Methods: A multicenter retrospective observational cohort-study was performed. Data was collected on patients who underwent elective AA surgery in three institutions (2006-2017). Clinical presentation, outcomes, and mortality were compared between elderly (≥70 years) and non-elderly patients., Results: In total, 724 non-elderly and 231 elderly patients were operated upon. Elderly patients had larger aortic diameters (57.0 mm (IQR 53-63) vs. 53.0 mm (IQR 49-58), p < 0.001) and more cardiovascular risk factors at the time of surgery than non-elderly patients. Elderly females had significantly larger aortic diameters than elderly males (59.5 mm (55-65) vs. 56.0 mm (51-60), p < 0.001). Short-term mortality was comparable between elderly and non-elderly patients (3.0% vs. 1.5%, p = 0.16). Five-year survival was 93.9% in non-elderly patients and 81.4% in elderly patients ( p < 0.001), which are both lower than that of the age-matched general Dutch population., Conclusion: This study showed that in elderly patients, a higher threshold exists to undergo surgery, especially in elderly females. Despite these differences, short-term outcomes were comparable between 'relatively healthy' elderly and non-elderly patients.
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- 2023
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45. Prevalence and development of aortic dilation and dissection in women with Turner syndrome: a systematic review and meta-analysis.
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Meccanici F, de Bruijn JWC, Dommisse JS, Takkenberg JJM, van den Bosch AE, and Roos-Hesselink JW
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- Adult, Child, Humans, Female, Adolescent, Prevalence, Dilatation, Aortic Valve, Turner Syndrome complications, Turner Syndrome epidemiology, Aortic Diseases, Aortic Dissection epidemiology, Aortic Dissection etiology
- Abstract
Objectives: Women with Turner syndrome (TS) have an increased risk of aortic disease, reducing life-expectancy. This study aimed to systematically review the prevalence of thoracic aortic dilatation, aortic dimensions and growth, and the incidence of aortic dissection., Methods: A systematic literature search was conducted up to July 2022. Observational studies with an adult TS population were included, and studies including children aged <15 years old or specific TS populations were excluded., Results: In total 21 studies were included. The pooled prevalence of ascending aortic dilatation was 23% (95% CI 19-26) at a mean pooled age of 29 years (95% CI 26-32), while the incidence of aortic dissection was 164 per 100.000 patient-years (95% CI 95-284). Three reporting studies showed aortic growth over time to be limited. Risk factors for aortic dilation or dissection were older age, bicuspid aortic valve, aortic coarctation, and hypertension., Conclusion: In adult TS women, ascending aortic dilatation is common and the hazard of aortic dissection increased compared to the general population, whereas aortic growth is limited. Conventional risk markers do not explain all aortic dissection cases; therefore, new imaging parameters and blood biomarkers are needed to improve prediction, allowing for patient-tailored follow-up and surgical decision-making.
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- 2023
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46. Outcomes after right ventricular outflow tract reconstruction with valve substitutes: A systematic review and meta-analysis.
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Wang X, Bakhuis W, Veen KM, Bogers AJJC, Etnel JRG, van Der Ven CCEM, Roos-Hesselink JW, Andrinopoulou ER, and Takkenberg JJM
- Abstract
Introduction: This study aims to provide an overview of outcomes after right ventricular outflow tract (RVOT) reconstruction using different valve substitutes in different age groups for different indications., Methods: The literature was systematically searched for articles published between January 2000 and June 2021 reporting on clinical and/or echocardiographic outcomes after RVOT reconstruction with valve substitutes. A random-effects meta-analysis was conducted for outcomes, and time-related outcomes were visualized by pooled Kaplan-Meier curves. Subgroup analyses were performed according to etiology, implanted valve substitute and patient age., Results: Two hundred and seventeen articles were included, comprising 37,078 patients (age: 22.86 ± 11.29 years; 31.6% female) and 240,581 patient-years of follow-up. Aortic valve disease (Ross procedure, 46.6%) and Tetralogy of Fallot (TOF, 27.0%) were the two main underlying etiologies. Homograft and xenograft accounted for 83.7 and 32.6% of the overall valve substitutes, respectively. The early mortality, late mortality, reintervention and endocarditis rates were 3.36% (2.91-3.88), 0.72%/y (95% CI: 0.62-0.82), 2.62%/y (95% CI: 2.28-3.00), and 0.38%/y (95%CI: 0.31-0.47) for all patients. The early mortality for TOF and truncus arteriosus (TA) were 1.95% (1.31-2.90) and 10.67% (7.79-14.61). Pooled late mortality and reintervention rate were 0.59%/y (0.39-0.89), 1.41%/y (0.87-2.27), and 1.20%/y (0.74-1.94), 10.15%/y (7.42-13.90) for TOF and TA, respectively. Endocarditis rate was 0.21%/y (95% CI: 0.16-0.27) for a homograft substitute and 0.80%/y (95%CI: 0.60-1.09) for a xenograft substitute. Reintervention rate for infants, children and adults was 8.80%/y (95% CI: 6.49-11.95), 4.75%/y (95% CI: 3.67-6.14), and 0.72%/y (95% CI: 0.36-1.42), respectively., Conclusion: This study shows RVOT reconstruction with valve substitutes can be performed with acceptable mortality and morbidity rates for most patients. Reinterventions after RVOT reconstruction with valve substitutes are inevitable for most patients in their life-time, emphasizing the necessity of life-long follow-up and multidisciplinary care. Follow-up protocols should be tailored to individual patients because patients with different etiologies, ages, and implanted valve substitutes have different rates of mortality and morbidity., Systematic Review Registration: [www.crd.york.ac.uk/prospero], identifier [CRD42021271622]., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wang, Bakhuis, Veen, Bogers, Etnel, van Der Ven, Roos-Hesselink, Andrinopoulou and Takkenberg.)
- Published
- 2022
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47. Statistical primer: an introduction to the application of linear mixed-effects models in cardiothoracic surgery outcomes research-a case study using homograft pulmonary valve replacement data.
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Wang X, Andrinopoulou ER, Veen KM, Bogers AJJC, and Takkenberg JJM
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- Allografts, Humans, Linear Models, Outcome Assessment, Health Care, Retrospective Studies, Pulmonary Valve transplantation
- Abstract
Objectives: The emergence of big cardio-thoracic surgery datasets that include not only short-term and long-term discrete outcomes but also repeated measurements over time offers the opportunity to apply more advanced modelling of outcomes. This article presents a detailed introduction to developing and interpreting linear mixed-effects models for repeated measurements in the setting of cardiothoracic surgery outcomes research., Methods: A retrospective dataset containing serial echocardiographic measurements in patients undergoing surgical pulmonary valve replacement from 1986 to 2017 in Erasmus MC was used to illustrate the steps of developing a linear mixed-effects model for clinician researchers., Results: Essential aspects of constructing the model are illustrated with the dataset including theories of linear mixed-effects models, missing values, collinearity, interaction, nonlinearity, model specification, results interpretation and assumptions evaluation. A comparison between linear regression models and linear mixed-effects models is done to elaborate on the strengths of linear mixed-effects models. An R script is provided for the implementation of the linear mixed-effects model., Conclusions: Linear mixed-effects models can provide evolutional details of repeated measurements and give more valid estimates compared to linear regression models in the setting of cardio-thoracic surgery outcomes research., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
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- 2022
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48. Cerebral protection in aortic arch surgery: systematic review and meta-analysis.
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Abjigitova D, Veen KM, van Tussenbroek G, Mokhles MM, Bekkers JA, Takkenberg JJM, and Bogers AJJC
- Subjects
- Aorta, Thoracic, Cerebrovascular Circulation, Circulatory Arrest, Deep Hypothermia Induced, Humans, Perfusion, Retrospective Studies, Treatment Outcome, Aortic Diseases, Stroke
- Abstract
Consensus regarding optimal cerebral protection strategy in aortic arch surgery is lacking. We therefore performed a systematic review and meta-analysis to assess outcome differences between unilateral antegrade cerebral perfusion (ACP), bilateral ACP, retrograde cerebral perfusion (RCP) and deep hypothermic circulatory arrest (DHCA). A systematic literature search was performed in Embase, Medline, Web of Science, Cochrane and Google Scholar for all papers published till February 2021 reporting on early clinical outcome after aortic arch surgery utilizing either unilateral, bilateral ACP, RCP or DHCA. The primary outcome was operative mortality. Other key secondary endpoints were occurrence of postoperative disabling stroke, paraplegia, renal and respiratory failure. Pooled outcome risks were estimated using random-effects models. A total of 222 studies were included with a total of 43 720 patients. Pooled postoperative mortality in unilateral ACP group was 6.6% [95% confidence interval (CI) 5.3-8.1%], 9.1% (95% CI 7.9-10.4%), 7.8% (95% CI 5.6-10.7%), 9.2% (95% CI 6.7-12.7%) in bilateral ACP, RCP and DHCA groups, respectively. The incidence of postoperative disabling stroke was 4.8% (95% CI 3.8-6.1%) in the unilateral ACP group, 7.3% (95% CI 6.2-8.5%) in bilateral ACP, 6.4% (95% CI 4.4-9.1%) in RCP and 6.3% (95% CI 4.4-9.1%) in DHCA subgroups. The present meta-analysis summarizes the clinical outcomes of different cerebral protection techniques that have been used in clinical practice over the last decades. These outcomes may be used in advanced microsimulation model. These findings need to be placed in the context of the underlying aortic disease, the extent of the aortic disease and other comorbidities. Prospero registration number: CRD42021246372 METC: MEC-2019-0825., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
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- 2022
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49. Erratum to 'Male-female differences in acute thoracic aortic dissection: a systematic review and meta-analysis'.
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Meccanici F, Gökalp AL, Thijssen CGE, Mokhles MM, Bekkers JA, van Kimmenade R, Verhagen HJ, Roos-Hesselink JW, and Takkenberg JJM
- Published
- 2022
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50. Diversity Challenges and Opportunities for Randomized Controlled Trials in Cardiothoracic Surgery.
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Takkenberg JJM
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- Humans, Randomized Controlled Trials as Topic, Specialties, Surgical, Thoracic Surgery
- Published
- 2022
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