Publications by authors named "Michael A Borger"

387 Publications

Spinal cord monitoring using collateral network near-infrared spectroscopy during extended aortic arch surgery with a frozen elephant trunk.

J Surg Case Rep 2021 May 8;2021(5):rjab174. Epub 2021 May 8.

University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.

The true incidence of spinal cord injury associated with modern hybrid extended arch/descending aortic procedures utilizing a frozen elephant trunk (fET) remains unclear, and it is estimated with ~5-8%. Prolonged distal arrest without sufficient hypothermic protection as well as extended coverage of segmental arteries have been suggested to cause this complication, previously uncommon in open arch surgery. Recently, extensive clinical and experimental research led to the implementation of a new method of collateral network near-infrared spectroscopy (cnNIRS) to non-invasively monitor spinal cord oxygenation in the setting of extensive thoracoabdominal aortic repair. To date, limited experience with this method during arch procedures exists. Based on recent experiments regarding the optimal cnNIRS optode placement, we used this method for the first time during an fET procedure to document mid-thoracic paraspinous oxygenation levels.
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http://dx.doi.org/10.1093/jscr/rjab174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8104940PMC
May 2021

Valve-sparing aortic root replacement can be done safely and effectively in acute type A aortic dissection.

J Thorac Cardiovasc Surg 2021 Apr 3. Epub 2021 Apr 3.

University Clinic of Cardiac Surgery, Leipzig Heart Centre, Leipzig, Germany. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2021.02.101DOI Listing
April 2021

Commentary: More insights into the resect versus respect debate: Will we ever have a winner?

J Thorac Cardiovasc Surg 2021 Mar 24. Epub 2021 Mar 24.

University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2021.03.068DOI Listing
March 2021

Minimally invasive ventricular assist device implantation.

J Thorac Dis 2021 Mar;13(3):2010-2017

Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.

Durable mechanical circulatory support (MCS) systems are established therapy option in patients with end-stage heart failure, with increasing importance during the last years due to donor organ shortage. Left ventricular assist devices (LVADs) are traditionally implanted through median sternotomy (MS). However, improvement in the pump designs during the last years led to evolvement of new surgical approaches that aim to reduce the invasiveness of the procedure. Numerous reports and studies have shown the viability and possible advantages of less-invasive approach compared to the sternotomy approach. The less invasive implant strategies for LVADs, while vague in definition, are characterized by minimizing surgical trauma and if possible, cardio-pulmonary bypass related complications. Usually it involves minimizing or completely avoiding sternal trauma, avoiding heart luxation while simultaneously leaving the major part of pericardium intact. There is no consensus between the centers regarding the ideal approach for LVAD implantation. Some centers, like our center, perform by default VAD implantation using less invasive approach in almost all patients and some centers use only sternotomy approach. The aim of this review article is to shed light on the currently available less invasive options of LVAD implantation, with particular focus on the centrifugal pumps, and their possible advantages compared to traditional sternotomy approach.
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http://dx.doi.org/10.21037/jtd-20-1492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024790PMC
March 2021

Effect of cerebrospinal fluid pressure elevation on spinal cord perfusion during aortic cross-clamping with distal aortic perfusion.

Eur J Cardiothorac Surg 2021 Apr 11. Epub 2021 Apr 11.

University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.

Objectives: Distal aortic perfusion (DaP) is a widely accepted protective adjunct facilitating early reinstitution of visceral perfusion during extended thoracic and thoraco-abdominal aortic repair. DaP has also been suggested to secure distal inflow to the paraspinal collateral network via the hypogastric arteries and thereby reduce the risk of spinal cord ischaemia. However, an increase in cerebrospinal fluid (CSF) pressure is frequently observed during thoracoabdominal aortic aneurysm repair. The aim of this study was to evaluate the effects of DaP on regional spinal cord blood flow (SCBF) during descending aortic cross-clamping and iatrogenic elevation of cerebrospinal fluid pressure.

Methods: Eight juvenile pigs underwent central cannulation for cardiopulmonary bypass according to our established experimental protocol followed by aortic cross-clamping of the descending thoracic and abdominal aorta-mimicking sequential aortic clamping-with the initiation of DaP. Thereafter, CSF pressure elevation was induced by the infusion of blood plasma until baseline CSF pressure was tripled. At each time-point, microspheres of different colours were injected allowing for regional SCBF analysis.

Results: DaP led to a pronounced hyperperfusion of the distal spinal cord [SCBF up to 480%, standard deviation (SD): 313%, compared to baseline]. However, DaP provided no or only limited additional flow to the upper and middle segments of the spinal cord (C1-Th7: 5% of baseline, SD: 5%; Th8-L2: 24%, SD: 39%), which was compensated by proximal flow only at C1-Th7 level. Furthermore, DaP could not counteract an experimental CSF pressure elevation, which led to a further decrease in regional SCBF most pronounced in the mid-thoracic spinal cord segment.

Conclusions: Protective DaP during thoraco-abdominal aortic repair may be associated with inadequate spinal protection particularly at the mid-thoracic spinal cord level ('watershed area') and result in the adverse effect of a potentially dangerous hyperperfusion of the distal spinal cord segments.
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http://dx.doi.org/10.1093/ejcts/ezab167DOI Listing
April 2021

Mid-term results after isolated tricuspid valve surgery in the presence of right ventricular leads.

J Cardiovasc Surg (Torino) 2021 Apr 8. Epub 2021 Apr 8.

University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.

Background: Patients with tricuspid valve (TV) disease and indication for TV surgery frequently have permanent pacemaker (PM) or defibrillator (AICD) leads, placed in the right ventricle (RV). The aim of this study was to analyse postoperative results and mid-term outcomes after isolated TV surgery (with no further concomitant cardiac procedures) in the presence of permanent RV leads.

Methods: From January 2005 to January 2019 a total of 80 patients (mean age: 67.7±10.3 yrs; 56.3% male) with isolated TV disease and presence of at least one permanent RV lead in place were referred to our institution for isolated TV repair / replacement; patients with concomitant procedures were excluded for this analysis. All data were retrospectively analysed. The follow-up was 98% complete.

Results: Mean follow-up time was 4.3±3.9 years. Mean preoperative clinical NYHA status was 3.0±0.8, left ventricular ejection fraction 50.7±12.9%, mean pulmonary artery pressure 23.8±9.3mmHg, creatinine 125.7±57.5μmol/l, mean MELD-XI Score (Model of Endstage-Liver Disease excluding INR) was 14.6±5.0 μmol/l. Thirty-day mortality was 6.3% with a 5-years survival of 58.2±6.0%. Cox regression analysis revealed the MELD-XIScore as the only highly significant predictor for postoperative mortality (p=0.002).

Conclusions: In conclusion, Hepatorenal dysfunction-possibly indicating long lasting TV failure- could be a factor for limited postoperative survival in our patient cohort. This finding could unterline our hypothesis, that early TV surgery may achieve better postoperative survival, even in patients with TV disease caused by RV leads. Further investigations are needed.
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http://dx.doi.org/10.23736/S0021-9509.21.11803-8DOI Listing
April 2021

Proximal aortic aneurysms: correlation of maximum aortic diameter and aortic wall thickness.

Eur J Cardiothorac Surg 2021 Apr 5. Epub 2021 Apr 5.

University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.

Objectives: The goal of therapy of proximal aortic aneurysms is to prevent an aortic catastrophe, e.g. acute dissection or rupture. The decision to intervene is currently based on maximum aortic diameter complemented by known risk factors like bicuspid aortic valve, positive family history or rapid growth rate. When applying Laplace's law, wall tension is determined by pressure × radius divided by aortic wall thickness. Because current imaging modalities lack precision, wall thickness is currently neglected. The purpose of our study was therefore to correlate maximum aortic diameter with aortic wall thickness and known indices for adverse aortic events.

Methods: Aortic samples from 292 patients were collected during cardiac surgery, of whom 158 presented with a bicuspid aortic valve and 134, with a tricuspid aortic valve. Aortic specimens were obtained during the operation and stored in 4% formaldehyde. Histological staining and analysis were performed to determine the thickness of the aortic wall.

Results: Patients were 62 ± 13 years old at the time of the operation; 77% were men. The mean aortic dimensions were 44 mm, 41 mm and 51 mm at the aortic root, sinotubular junction and ascending aorta, respectively. Aortic valve stenosis was the most frequent (49%) valvular dysfunction, followed by aortic valve regurgitation (33%) and combined dysfunction (10%). The maximum aortic diameter at the ascending level did not correlate with the thickness of the media (R = 0.07) or the intima (R = 0.28) at the convex sample site. There was also no correlation of the ascending aortic diameter with age (R = -0.18) or body surface area (R = 0.07). The thickness of the intima (r = 0.31) and the media (R = 0.035) did not correlate with the Svensson index of aortic risk. Similarly, there was a low (R = 0.29) or absent (R = -0.04) correlation between the aortic size index and the intima or media thickness, respectively. There was a similar relationship of median thickness of the intima in the 4 aortic height index risk categories (P < 0.001).

Conclusions: Aortic diameter and conventional indices of aortic risk do not correlate with aortic wall thickness. Other indices may be required in order to identify patients at high risk for aortic complications.
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http://dx.doi.org/10.1093/ejcts/ezab147DOI Listing
April 2021

Postoperative outcome after reoperative isolated tricuspid valve surgery-is there a predictor for survival?

Eur J Cardiothorac Surg 2021 Mar 26. Epub 2021 Mar 26.

University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.

Objectives: Reoperative tricuspid valve (TV) surgery is considered high risk even in the absence of additional concomitant cardiac procedures. The purpose of this study was to evaluate preoperative clinical parameters as predictors for survival after isolated reoperative TV surgery.

Methods: From January 2005 to January 2019, 85 patients (mean age: 66.7 ± 10.3 years, 34 male) with severe isolated TV regurgitation and prior cardiac surgery were referred to our centre for elective or urgent TV repair/replacement; patients with endocarditis were excluded. We retrospectively analysed preoperative hepatorenal function [reflected by widely used clinical and laboratory parameters and the Model of End-stage-Liver Disease excluding International Normalized Ratio (MELD-XI) score] as a predictor for postoperative survival.

Results: At hospital admission, the patients' average preoperative New York Heart Association class was 2.9 ± 0.6, left ventricular ejection fraction 52.5 ± 10.6%, mean pulmonary artery pressure 24.7 ± 8.0 mmHg, creatinine 115.4 ± 66.6 μmol/l, bilirubin 20.0 ± 19.6 μmol/l and the mean MELD-XI score was 13.3 ± 4.0 μmol/l. The mean follow-up was 5.4 ± 4.2 years. Thirty-day mortality was 5%, 5-year survival was 60.6 ± 5.4% and 10-year survival was 42.9 ± 6.5%. The multivariable Cox regression analysis evaluated the MELD-XI score [hazard ratio (HR 1.144, confidence interval 95% 1.0-1.3, P = 0.005] and diabetes mellitus (HR 2.27, confidence interval 95% 1.0-5.0, P = 0.04) as significant predictors for excess mortality while age and mean pulmonary artery pressure did not reliably predict clinical outcome.

Conclusions: Hepatorenal dysfunction was one main factor accounting for limited postoperative survival in our patient cohort. The MELD-XI score is easy to calculate and seems to reliably predict the perioperative risk in patients with prior cardiac surgery and indication for TV surgery.
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http://dx.doi.org/10.1093/ejcts/ezab134DOI Listing
March 2021

Utilization of in- and outpatient hospital care in Germany during the Covid-19 pandemic insights from the German-wide Helios hospital network.

PLoS One 2021 25;16(3):e0249251. Epub 2021 Mar 25.

Helios Health, Berlin, Germany.

Background: During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting.

Methods And Findings: Using claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the "protection" stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06-1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01-1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00-1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78-1.31], P<0.95).

Conclusions: There have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249251PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993839PMC
April 2021

Twenty-year outcomes of minimally invasive direct coronary artery bypass surgery: The Leipzig experience.

J Thorac Cardiovasc Surg 2021 Feb 17. Epub 2021 Feb 17.

Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany.

Objective: Minimally invasive direct coronary artery bypass (MIDCAB) surgery involving left anterior descending coronary artery grafting with the left internal thoracic artery through a left anterior small thoracotomy is being routinely performed in some specified centers for patients with isolated complex left anterior descending coronary artery disease, but very few reports regarding long-term outcomes exist in literature. Our study was aimed at assessing and analyzing the early and long-term outcomes of a large cohort of patients who underwent MIDCAB procedures and identifying the effects of changing trends in patient characteristics on early mortality.

Methods: A total of 2667 patients, who underwent MIDCAB procedures between 1996 and 2018, were divided into 3 groups on the basis of the year of surgery: group A, 1996-2003 (n = 1333); group B, 2004-2010 (n = 627) and group C, 2011-2018 (n = 707). Groupwise characteristics and early postoperative outcomes were compared. Long-term survival for all patients was analyzed and predictors for late mortality were identified using Cox proportional hazards methods.

Results: The mean age was 64.5 ± 10.9 years and 691 (25.9%) patients were female. Group C patients (log EuroSCORE I = 4.9 ± 6.9) were older with more cardiac risk factors and comorbidities than groups A (log EuroSCORE I = 3.1 ± 4.5) and B (log EuroSCORE I = 3.5 ± 4.7). Overall and groupwise in-hospital mortality was 0.9%, 1.0%, 0.6%, and 1.0% (P = .7), respectively. Overall 10-, 15-, and 20-year survival estimates for all patients were 77.7 ± 0.9%, 66.1 ± 1.2%, and 55.6 ± 1.6%, respectively.

Conclusions: MIDCAB can be safely performed with very good early and long-term outcomes. In-hospital mortality remained constant over the 22-year period of the study despite worsening demographic profile of patients.
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http://dx.doi.org/10.1016/j.jtcvs.2020.12.149DOI Listing
February 2021

Oral health-related quality of life in patients with heart failure and left ventricular assist devices-results of a cross-sectional study.

Clin Oral Investig 2021 Mar 22. Epub 2021 Mar 22.

Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr. 12, D 04103, Leipzig, Germany.

Objectives: The aim of this cross-sectional study was to compare oral health-related quality of life (OHRQoL) of patients with left ventricular assist device (LVAD) and heart failure (HF).

Material And Methods: Seventy-four patients with LVAD were recruited from University Department for Cardiac Surgery, Leipzig Heart Center, Germany. A group of 72 patients with HF was composed by matching (age, gender, smoking). The German short form of oral health impact profile (OHIP G14) was applied. Health-related quality of life (HRQoL) was measured by short form 36 survey (SF-36). Dental conditions (decayed-, missing- and filled-teeth [DMF-T]), remaining teeth and periodontal findings were assessed.

Statistics: t-test, Mann-Whitney U test, Kruskal-Wallis test, chi-square or Fisher test, linear regression.

Results: Age, gender, smoking, underlying disease, co-morbidities and oral findings were comparable between groups (p > 0.05). OHIP G14 sum score was 3.53 ± 6.82 (LVAD) and 2.92 ± 5.35 (HF; p = 0.70), respectively. The scales SF-36 physical functioning (p = 0.05) and SF-36 social functioning (p < 0.01) were worse in LVAD. In the LVAD group, the DMF-T and remaining teeth negatively correlated with OHIP G14 sum score (p < 0.01). In HF patients, positive correlations were found between OHIP G14 and D-T (p < 0.01) and remaining teeth (p = 0.04). Moreover, DMF-T (p = 0.03) and remaining molars/premolars (p = 0.02) were negatively correlated with SF-36 scales in HF.

Conclusions: Oral health and OHRQoL was comparable between LVAD and HF; thereby, OHRQoL reflected the clinical oral status.

Clinical Relevance: Dental care, with beginning in early stage of HF, should be fostered to preserve teeth and support quality of life before and after LVAD implantation.
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http://dx.doi.org/10.1007/s00784-021-03893-wDOI Listing
March 2021

Decreased exercise capacity in young athletes using self-adapted mouthguards.

Eur J Appl Physiol 2021 Mar 13. Epub 2021 Mar 13.

Institute of Sport Medicine and Prevention, University of Leipzig, Marschnerstraße 29a, 04109, Leipzig, Germany.

Purpose: There is evidence of both the preventive effects and poor acceptance of mouthguards. There are various effects on performance depending on the type of mouthguard model. Hemodynamic responses to wearing a mouthguard have not been described. The aim of this study was to investigate the effects of self-adapted mouthguards with breathing channels (SAMG).

Methods: In this randomized crossover study, 17 healthy, active subjects (age 25.12 ± 2.19 years) underwent body plethysmography and performed two incremental exertion tests wearing a (SAMG) and not wearing (CON) a mouthguard. Blood lactate, spirometrics, and thoracic impedance were measured during these maximum exercise tests.

Results: The mean values using a SAMG revealed significantly greater airway resistance compared to CON (0.53 ± 0.16 kPa·L vs. 0.35 ± 0.10 kPa·L, respectively; p = < 0.01). At maximum load, ventilation with SAMGv was less than CON (118.4 ± 28.17 L min vs. 128.2 ± 32.16 L min, respectively; p = < 0.01). At submaximal loads, blood lactate responses with SAMG were higher than CON (8.68 ± 2.20 mmol·L vs. 7.89 ± 1.65 mmol·L, respectively; p < 0.01). Maximum performance with a SAMG was 265.9 ± 59.9 W, and without a mouthguard was 272.9 ± 60.8 W (p < 0.01). Maximum stroke volume was higher using a SAMG than without using a mouthguard (138.4 ± 29.9 mL vs. 130.2 ± 21.2 mL, respectively; p < 0.01).

Conclusion: Use of a self-adapted mouthguard led to increased metabolic effort and a significant reduction in ventilation parameters. Unchanged oxygen uptake may be the result of cardiopulmonary compensation and increased breathing efforts, which slightly affects performance. These results and the obvious preventive effects of mouthguards support their use in sports.
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http://dx.doi.org/10.1007/s00421-021-04659-8DOI Listing
March 2021

Device-induced platelet dysfunction in patients after left ventricular assist device implantation.

J Thromb Haemost 2021 May 28;19(5):1331-1341. Epub 2021 Mar 28.

Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany.

Background: Non-surgical bleeding (NSB) is a major complication after left ventricular assist device (LVAD) implantation. It has been reported that non-physiological shear stress caused by LVADs could alter platelet receptor expression, which leads to bleeding disorders caused by coagulation dysfunctions.

Objectives: Because bleeding diathesis could be multifactorial, we focused on the combined characterization of platelet receptor expression patterns and oxidative stress to compare patients with NSB and patients without coagulation disorder in a monocentric, prospective study.

Methods: Blood samples were obtained from LVAD patients with NSB (bleeder group, n = 19) and without NSB (non-bleeder group, n = 20). The platelet receptors platelet endothelial cell adhesion molecule-1 (PECAM-1), glycoprotein (GP)Ibα, P-selectin, CD63, and GPIIb/IIIa, as well as the production of intraplatelet reactive oxygen species (ROS) were quantified by flow cytometry. Aggregation capacity was evaluated by aggregometry.

Results: The surface expression level of P-selectin and GPIbα on platelets was decreased in bleeders (P-selectin: 465 ± 72 U; GPIbα: 435 ± 41 U) compared to non-bleeders (P-selectin: 859 ± 115 U, P < .01; GPIbα: 570 ± 49 U, p = .04). Additionally, the mean fluorescence intensity of ADP-stimulated P-selectin and PECAM-1 expressing platelets were reduced in bleeders (P-selectin: 944 ± 84 U; PECAM-1: 6722 ± 419 U) compared to non-bleeders (P-selectin: 1269 ± 130 U, P = .04; PECAM-1: 8542 ± 665 U, P = .03). Bleeders showed a higher amount of ROS formation in platelets (88.0 ± 2.6%) than non-bleeders (81.5 ± 2.1%, P = .05).

Conclusions: These findings suggested that changes of three platelet receptors (GPIbα, P-selectin, and PECAM-1) and elevated oxidative stress may play a role in patients with bleeding complications following LVAD implantation. These results might help to explain the high incidence of spontaneous hemorrhage during LVAD support through an altered platelet function.
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http://dx.doi.org/10.1111/jth.15279DOI Listing
May 2021

Quantification of regurgitation in mitral valve prolapse with automated real time echocardiographic 3D proximal isovelocity surface area: multimodality consistency and role of eccentricity index.

Int J Cardiovasc Imaging 2021 Feb 22. Epub 2021 Feb 22.

University Department for Cardiac Surgery, HELIOS Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.

Three-dimensional transthoracic echocardiography (3D-TTE) provides a semi-automated proximal isovelocity surface area method (3D-PISA) to obtain quantitative parameters. Data assessing regurgitation severity in mitral valve prolapse (MVP) are scarce, so we assessed the 3D-PISA method compared with 2D-PISA and cardiovascular magnetic resonance (CMR) and the role of an eccentricity index. We evaluated the 3D-PISA method for assessing MR in 54 patients with MVP (57 ± 14 years; 42 men; 12 mild/mild-moderate; 12 moderate-severe; and 30 severe MR). Role of an asymmetric (i.e. eccentricity index ≥ 1.25) flow convergence region (FCR) and inter-modality consistency were then assessed. 3D-PISA derived regurgitant volume (RVol) showed a good correlation with 2D-PISA and CMR derived parameters (r = 0.86 and r = 0.81, respectively). The small mean differences with 2D-PISA derived RVol did not reach statistical significance in overall population (5.7 ± 23 ml, 95% CI - 0.6 to 12; p = 0.08) but differed in those with asymmetric 3D-FCR (n = 21; 2D-PISA: 72 ± 36 ml vs. 3D-PISA: 93 ± 47 ml; p = 0.001). RVol mean values were higher using PISA methods (CMR 57 ± 33 ml; 2D-PISA 73 ± 39 ml; and 3D-PISA 79 ± 45 ml) and an overestimation was observed when CMR was used as reference (2D-PISA vs. CMR: mean difference: 15.8 ml [95% CI 10-22, p < 0.001]; and 3D-PISA vs. CMR: 21.5 ml [95% CI 14-29, p < 0.001]). Intra- and inter-observer reliability was excellent (ICC 0.91-0.99), but with numerically lower coefficient of variation for 3D-PISA (8%-10% vs. 2D-PISA: 12%-16%). 3D-PISA method for assessing regurgitation in MVP may enable analogous evaluation compared to standard 2D-PISA, but with overestimation in case of asymmetric FCR or when CMR is used as reference method.
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http://dx.doi.org/10.1007/s10554-021-02179-2DOI Listing
February 2021

Magnetic resonance imaging in patients with postoperative spinal cord injury: 'one step at a time towards safer aortic repair'.

Eur J Cardiothorac Surg 2021 Feb 13. Epub 2021 Feb 13.

University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.

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http://dx.doi.org/10.1093/ejcts/ezab062DOI Listing
February 2021

Chordal replacement: future surgical gold standard or first-line option as bridge to definitive therapy in primary mitral regurgitation?

Ann Cardiothorac Surg 2021 Jan;10(1):167-169

University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.

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http://dx.doi.org/10.21037/acs-2020-mv-22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867423PMC
January 2021

Experimental near-infrared spectroscopy-guided minimally invasive segmental artery occlusion.

Eur J Cardiothorac Surg 2021 Feb 4. Epub 2021 Feb 4.

University Department for Cardiac Surgery, Leipzig Heart Center, Saxony, Germany.

Objectives: Minimally invasive staged segmental artery (SA) coil- and plug embolization is a new method for paraplegia prevention associated with extensive aortic procedures. Near-infrared spectroscopy of the paraspinal collateral network (cnNIRS) has emerged as a non-invasive method for spinal cord monitoring. The aim of this study was to evaluate cnNIRS to guide minimally invasive SA occlusion.

Methods: In a chronic large animal experiment, 18 juvenile pigs underwent two-stage minimally invasive staged SA coil- and plug embolization for complete SA occlusion. Coil-embolization was performed either by SA main stem occlusion (characteristic of pig anatomy) or separately for the left- and right SA. Lumbar cnNIRS was recorded during and after the procedure. Neurological status was assessed up to 3 days after complete SA occlusion.

Results: Mean time from SA coil embolization to minimum cnNIRS values was 11 ± 5 min with an average decrease from 101 ± 2% to 78 ± 8% of baseline (difference: -23 ± 9, P < 0.001). Lumbar cnNIRS demonstrated significant differences between left and right when SAs were occluded separately in all cases (-7 ± 4%, 1 min after first SA occlusion; P = 0.001). Permanent paraplegia occurred in 2 (11%) and any kind of neurological deficit-temporary or permanent-in 7 animals (39%). Association between lumbar cnNIRS and neurological outcome after minimally invasive staged SA coil- and plug embolization suggests positive correlation (R = 0.5, P = 0.052).

Conclusions: Lumbar cnNIRS independently reacts to unilateral SA occlusion. cnNIRS-guided SA occlusion is feasible and may become a useful adjunct facilitating adequate and complete vessel occlusion.
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http://dx.doi.org/10.1093/ejcts/ezab005DOI Listing
February 2021

Hospitalization deficit of in- and outpatient cases with cardiovascular diseases and utilization of cardiological interventions during the COVID-19 pandemic: Insights from the German-wide helios hospital network.

Clin Cardiol 2021 Mar 26;44(3):392-400. Epub 2021 Jan 26.

Heart Center Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany.

Background: Treatment numbers of various cardiovascular diseases were reduced throughout the early phase of the ongoing COVID-19 pandemic. Aim of this study was to (a) expand previous study periods to examine the long-term course of hospital admission numbers, (b) provide data for in- and outpatient care pathways, and (c) illustrate changes of numbers of cardiovascular procedures.

Methods And Results: Administrative data of patients with ICD-10-encoded primary diagnoses of cardiovascular diseases (heart failure, cardiac arrhythmias, ischemic heart disease, valvular heart disease, hypertension, peripheral vascular disease) and in- or outpatient treatment between March, 13th 2020 and September, 10th 2020 were analyzed and compared with 2019 data. Numbers of cardiovascular procedures were calculated using OPS-codes. The cumulative hospital admission deficit (CumAD) was computed as the difference between expected and observed admissions for every week in 2020. In total, 80 hospitals contributed 294 361 patient cases to the database without relevant differences in baseline characteristics between the studied periods. There was a CumAD of -10% to -16% at the end of the study interval in 2020 for all disease groups driven to varying degrees by both reductions of in- and outpatient case numbers. The number of performed interventions was significantly reduced for all examined procedures (catheter ablations: -10%; cardiac electronic device implantations: -7%; percutaneous cardiovascular interventions: -9%; cardiovascular surgery: -15%).

Conclusions: This study provides data on the long-term development of cardiovascular patient care during the COVID-19 pandemic demonstrating a significant CumAD for several cardiovascular diseases and a concomitant performance deficit of cardiovascular interventions.
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http://dx.doi.org/10.1002/clc.23549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943897PMC
March 2021

Spinal cord protection in thoracoabdominal aortic aneurysm surgery: a multimodal approach.

J Cardiovasc Surg (Torino) 2021 Jan 26. Epub 2021 Jan 26.

University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany -

Spinal cord injury is one major complication of open and endovascular thoracic and thoracacoabdominal aortic aneurysm repair. Despite numerous neuroprotective adjuncts, the incidence of SCI remains high. This review article discusses established and novel adjuncts for spinal cord protection, including priming and preconditioning of the paraspinal collateral network, intraoperative systemic hypothermia, distal aortic perfusion, motor- and somatosensory evoked potentials and non-invasive cnNIRS monitoring as well as peri- and postoperative drainage of cerebrospinal fluid. Regardless of the positive influence of many of these strategies on neurologic outcome, to date no strategy assures definitive preservation of spinal cord integrity during and after aortic aneurysm repair.
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http://dx.doi.org/10.23736/S0021-9509.21.11783-5DOI Listing
January 2021

The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies.

Innovations (Phila) 2021 Jan-Feb;16(1):3-16. Epub 2021 Jan 25.

12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.

Objective: There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons.

Methods: Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year.

Results: Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios.

Conclusions: In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient's aortic valve disease.
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http://dx.doi.org/10.1177/1556984520978316DOI Listing
January 2021

Less-invasive ventricular assist device implantation: A multicenter study.

J Thorac Cardiovasc Surg 2020 Dec 23. Epub 2020 Dec 23.

Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany; Cardiac Surgery, Düsseldorf University Hospital, Dusseldorf, Germany. Electronic address:

Background: Left ventricular assist device has been shown to be a safe and effective treatment option for patients with end-stage heart failure. However, there is limited evidence showing the effect of the implantation approach on postoperative morbidities and mortality. We aimed to compare left ventricular assist device implantation using conventional sternotomy versus less-invasive surgery including hemi-sternotomy and the minithoracotomy approach.

Methods: Between January 2014 and December 2018, 342 consecutive patients underwent left ventricular assist device implantation at 2 high-volume centers. Patient characteristics were prospectively collected. The propensity score method was used to create 2 groups in a 1:1 fashion. A competing risk regression model was used to evaluate time to death adjusting for competing risk of heart transplantation.

Results: The unmatched cohort included 241 patients who underwent left ventricular assist device implantation with the conventional sternotomy technique and 101 patients who underwent left ventricular assist device implantation with the less-invasive surgery technique. Propensity matching produced 2 groups each including 73 patients. In the matched groups, reexploration rate for bleeding was necessary in 17.9% (12/67) in the conventional sternotomy group compared with 4.1% (3/73) the less-invasive surgery group (P = .018). Intensive care unit stay for the less-invasive surgery group was significantly lower than for the sternotomy group (10.5 [interquartile range, 2-25.75] days vs 4 [interquartile range, 2-9.25] days, P = .008), as was hospital length of stay (37 [interquartile range, 27-61] days vs 25.5 [interquartile range, 21-42] days, P = .007). Mortality cumulative incidence for conventional surgery was 24% (95% confidence interval, 14.3-34.8) at 1 year and 26% (95% confidence interval, 15.9-37.4) at 2 years for patients without heart transplantation. Mortality cumulative incidence for less-invasive surgery was 22.5% (95% confidence interval, 12.8-33.8) at 1 year and 25.2% (95% confidence interval, 14.5-37.4) at 2 years for patients without heart transplantation. There was no difference in cumulative mortality incidence when adjusting for competing risk of heart transplantation (subdistribution hazard, 0.904, 95% confidence interval, 0.45-1.80, P = .77).

Conclusions: The less-invasive surgery approach is a safe technique for left ventricular assist device implantation. Less-invasive surgery was associated with a significant reduction in the postoperative bleeding complications and duration of hospital stay, with no significant difference in mortality incidence.
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http://dx.doi.org/10.1016/j.jtcvs.2020.12.043DOI Listing
December 2020

Discussion.

Authors:
Michael A Borger

J Thorac Cardiovasc Surg 2021 Mar 18;161(3):931-932. Epub 2021 Jan 18.

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http://dx.doi.org/10.1016/j.jtcvs.2020.11.175DOI Listing
March 2021

Resection of a tumor with thymic-like differentiation and reconstruction of the innominate artery.

Ann Thorac Surg 2021 Jan 11. Epub 2021 Jan 11.

Department of General- and Visceral Surgery, Helios Clinic Schkeuditz, Schkeuditz, Germany.

Carcinomas showing thymic-like differentiation (CASTLE-tumors) are a very rare entity requiring an individualized therapeutic plan. Herein we present a case of reconstruction of the innominate artery following radical resection of the tumor in which a custom-made cerebral shunt was used for continuous cerebral perfusion.
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http://dx.doi.org/10.1016/j.athoracsur.2020.12.037DOI Listing
January 2021

Ischemic spinal cord injury - experimental evidence and evolution of protective measures.

Ann Thorac Surg 2021 Jan 9. Epub 2021 Jan 9.

University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany. Electronic address:

Background: Paraplegia remains one of the most devastating complications of descending and thoracoabdominal aortic repair. The aim of this review is to outline the current state of art in the rapidly developing field of spinal cord injury (SCI) research.

Methods: A review of PubMed and Web of Science databases was performed using the following terms and their combinations: spinal cord, injury, ischemia, ischemia-reperfusion, ischemic spinal cord injury, paraplegia, paraparesis. Articles published before July 2019 were screened and included if considered relevant.

Results: The review focuses on the topic of SCI and the developments concerning methods of monitoring, diagnostics and prevention of SCI.

Conclusions: Translation of novel technologies from bench to bedside and into everyday clinical practice is challenging, however each of the developing areas hold great promise in SCI prevention.
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http://dx.doi.org/10.1016/j.athoracsur.2020.12.028DOI Listing
January 2021

30-Day perioperative mortality following venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock in patients with normal preoperative ejection fraction.

Interact Cardiovasc Thorac Surg 2021 May;32(5):817-824

Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, Leipzig, Germany.

:

Objectives: Assessment of early outcomes in patients with normal preoperative left ventricular ejection fraction (LVEF) in whom venoarterial extracorporeal membrane oxygenation (VA-ECMO) was implanted for postcardiotomy cardiogenic shock (PCCS) during the first postoperative 48 h.

Methods: Retrospective single-centre analysis in adult patients with normal LVEF, who received VA-ECMO support for PCCS from May 1998 to May 2018. The primary outcome was 30-day perioperative mortality during the index hospitalization.

Results: A total of 62 125 adult patients underwent cardiac surgery at our institution during the study period. Among them, 173 patients (0.3%) with normal preoperative LVEF required VA-ECMO for PCCS. Among them, 71 (41.1%) patients presented PCCS due to coronary malperfusion and in 102 (58.9%) patients, no evident cause was found for PCCS. Median duration of VA-ECMO support was 5 days (interquartile range 2-8 days). A total of 135 (78.0%) patients presented VA-ECMO-related complications and the overall 30-day perioperative mortality was 57.8%. Independent predictors of mortality were: lactate level just before VA-ECMO implantation [odds ratio (OR) 1.27; P < 0.001], major bleeding during VA-ECMO (OR 3.76; P = 0.001), prolonged cardiopulmonary bypass time (OR 1.01; P < 0.001) and female gender (OR 4.87; P < 0.001).

Conclusions: Mortality rates of VA-ECMO in PCCS patients are high, even in those with preoperative normal LVEF. Coronary problems are an important cause of PCCS; however, the aetiology remains unknown in the vast majority of the cases. The implantation of VA-ECMO before development of tissue hypoperfusion and the control of VA-ECMO-associated complications are the most important prognostic factors in PCCS patients. Lactate levels may help guide timing of VA-ECMO implantation and define the extent of therapeutic effort.
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http://dx.doi.org/10.1093/icvts/ivaa323DOI Listing
May 2021

Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Minithoracotomy for All Comers With Aortic Valve Disease.

Innovations (Phila) 2021 Mar-Apr;16(2):169-174. Epub 2020 Dec 23.

40628 Division of Cardiac Surgery, University Clinic of Cardiac Surgery, Leipzig Heart Centre, Leipzig, Germany.

Objective: Right anterior minithoracotomy is a promising technique for aortic valve replacement and has shown excellent results in terms of mortality and morbidity. Against this background, we analyzed our institutional experience in this technique during the last 3 years.

Methods: Between April 2017 and March 2019, 513 consecutive all comers with aortic valve disease underwent video-assisted minimally invasive aortic valve replacement through a 3-cm skin incision as right anterior minithoracotomy at our institution. A camera and automatic fastener technology were used for the valve implantation in all patients. Clinical data were prospectively entered into our institutional database.

Results: Cardiopulmonary bypass time accounted for 68 ± 24 min and the myocardial ischemic time 38 ± 12 minutes. Thirty-day mortality and overall mortality was 0.4% (2 patients) and 1.4% (7 patients), respectively. Postoperative cerebrovascular events were noted in 8 patients (1.5%). Intensive care stay and hospital stay were 2 ± 2 and 9 ± 7 days, respectively. Pacemaker implantation, injury of the right internal mammary artery, and conversion to full sternotomy were noted in 7 patients (1.4%), 3 patients (0.6%), and 1 patient (0.2%), respectively. Paravalvular leak need to intervention was noted in 2 patients (0.4%). Rethoracotomy rate was 2% (11 patients). Transient postoperative dialysis was necessary for 14 patients (3%).

Conclusions: Video-assisted minimally invasive aortic valve replacement through the right anterior minithoracotomy is a safe approach and yields excellent outcomes in high-volume centers. The use of a camera and automatic fastener technology facilitates this procedure.
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http://dx.doi.org/10.1177/1556984520977212DOI Listing
December 2020

Management of aortic root in type A dissection: Bentall approach.

J Card Surg 2021 May 20;36(5):1779-1785. Epub 2020 Dec 20.

Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany.

Background: We analyzed the results of the modified Bentall procedure in a high-risk group of patients presenting with acute type A aortic dissection (ATAAD).

Methods: ATAAD patients undergoing a modified Bentall between 1996 and 2018 (n = 314) were analyzed. Mechanical composite conduits were used in 45%, and biological ones using either a bioprosthesis implanted into an aortic graft (33%) or xeno-/homograft root conduits (22%) in the rest. Preoperative malperfusion was present in 34% of patients and cardiopulmonary resuscitation required in 9%.

Results: Concomitant arch procedures consisted of hemiarch in 56% and total arch/elephant trunk in 34%, while concomitant coronary artery surgery was required in 20%. The average cross-clamp and cardiopulmonary bypass times were 126 ± 43 and 210 ± 76 min, respectively, while the average circulatory arrest times were 29 ± 17 min. A total of 69 patients (22%) suffered permanent neurologic deficit, while myocardial infarction occurred in 18 cases (6%) and low cardiac output syndrome in 47 (15%). The in-hospital mortality rate was 17% due to intractable low cardiac output syndrome (n = 29), major brain injury (n = 16), multiorgan failure (n = 6), and sepsis (n = 2). The independent predictors of in-hospital mortality were critical preoperative state (odds ratio [OR], 5.6; p < .001), coronary malperfusion (OR, 3.6; p = .002), coronary artery disease (OR, 2.6; p = .033), and prior cerebrovascular accident (OR, 5.6; p = .002).

Conclusions: The modified Bentall operation, along with necessary concomitant procedures, can be performed with good early results in high-risk ATAAD patients presenting.
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http://dx.doi.org/10.1111/jocs.15271DOI Listing
May 2021

Transition From Temporary to Durable Circulatory Support Systems.

J Am Coll Cardiol 2020 12;76(25):2956-2964

Department of Cardiovascular and Thoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany.

Background: The decision to implant durable mechanical circulatory systems (MCSs) in patients on extracorporeal life support (ECLS) is challenging due to expected poor outcomes in these patients.

Objectives: The aim of this study was to identify outcome predictors that may facilitate future patient selection and decision making.

Methods: The Durable MCS after ECLS registry is a multicenter retrospective study that gathered data on consecutive patients who underwent MCS implantation after ECLS between January 2010 and August 2018 in 11 high-volume European centers. Several perioperative parameters were collected. The primary endpoint was survival at 1 year after durable MCS implantation.

Results: A total of 531 durable MCSs after ECLS were implanted during this period. The average patient age was 53 ± 12 years old. ECLS cannulation was peripheral in 87% of patients and 33% of the patients had history of cardiopulmonary resuscitation before ECLS implantation. The 30-day, 1-year, and 3-year actuarial survival rates were 77%, 53%, and 43%, respectively. The following predictors for 1-year outcome have been observed: age, female sex, lactate value, Model of End-Stage Liver Disease XI score, history of atrial fibrillation, redo surgery, and body mass index >30 kg/m. On the basis of this data, a risk score and an app to estimate 1-year mortality was created.

Conclusions: The outcome in patients receiving durable MCS after ECLS remains limited, yet preoperative factors may allow differentiating futile patients from those with significant survival benefit.
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http://dx.doi.org/10.1016/j.jacc.2020.10.036DOI Listing
December 2020

Benefit of Self-Managed Anticoagulation in Patients with Left Ventricular Assist Device.

Thorac Cardiovasc Surg 2020 Dec 1. Epub 2020 Dec 1.

Department of Cardiac Surgery, University Hospital, Heidelberg, Germany.

Background:  The exact monitoring of the therapeutic-range international normalized ratio (INR) after left ventricular assist device (LVAD) implantation is an important aim to reduce the risk of thrombosis or bleeding complications. Service providers offer a telemedical anticoagulation service (CS).

Methods:  We compared LVAD patients using the CS ( = 15) to those who received regular medical care (RMC;  = 15) to investigate if telemedicine supervision increased the INR-specific time in the therapeutic range (TTR) during anticoagulation. All patients received self-management training for phenprocoumon medication according to their INR value. INR values were documented for 12 months. A survey (scale: 1 = not satisfied and 10 = very satisfied) was used to determine patient's satisfaction and psychological well-being.

Results:  A total of 1,798 INR measurements were analyzed. The TTR was higher in patients undergoing RMC (78.1 ± 14.3%) compared with that in patients using the CS (58.3 ± 28.0%,  = 0.03). The patient's satisfaction with the coagulation setting at the beginning of the study (RMC: 6.7 ± 3.1, CS: 7.2 ± 3.0,  = 0.74) and psychological wellbeing (RMC: 6.5 ± 1.9, CS: 6.5 ± 2.7,  = 0.97) were comparable between both groups.

Conclusion:  We found that INR self-management is superior regarding the efficiency of post-LVAD anticoagulation therapy when compared with telemedical (CS)-based INR management in a small study cohort. Intensive training by experienced staff was able to replace CS.
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http://dx.doi.org/10.1055/s-0040-1719153DOI Listing
December 2020

Assessment of long-term outcomes: aortic valve reimplantation versus aortic valve and root replacement with biological valved conduit in aortic root aneurysm with tricuspid valve.

Eur J Cardiothorac Surg 2021 Apr;59(3):658-665

Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.

Objectives: We compared the long-term outcomes between aortic valve reimplantation [David V (DV)] and aortic valve and root replacement with biological valved conduit [Bentall-De Bono (BD)] for the patients with aortic root aneurysm with tricuspid valve.

Methods: Among 876 patients who underwent aortic root replacement in our institution between 2005 and 2018, 371 patients who underwent DV (n = 199) or BD (n = 172) for aortic root aneurysm with tricuspid valve were retrospectively reviewed. Exclusion criteria included aortic stenosis, infective endocarditis, previous prosthetic aortic valve, bicuspid aortic valve, aortic dissection and mechanical Bentall procedure. Propensity score matching was performed based on the patient characteristics, matching 90 patients in each group. The primary end point was all-cause mortality. Secondary end points were reoperation for any cause and specifically for aortic valve-related cause.

Results: After propensity score matching, DV and BD groups each had 1 in-hospital mortality (1.1%). Survival at 10 years was 95.3% [95% confidence interval (CI) 85.8-98.5] in DV and 98.6% (95% CI 90.8-99.8) in BD (P = 0.345). The cumulative incidences of reoperation at 10 years in DV versus BD were 3.9% (95% CI 0.7-11.8) vs 18.1% (95% CI 6.9-33.4) for any cause (P = 0.046) and 1.9% (95% CI 0.1-8.8) vs 15.9% (95% CI 5.5-31.4) for aortic valve-related causes (P = 0.032). The reasons for valve-related reoperation were aortic insufficiency (3/5 in DV vs 5/10 in BD), aortic stenosis (0/5 vs 2/10) and infective endocarditis (2/5 vs 3/10).

Conclusions: Both DV and BD procedures for patients with aortic root aneurysm with tricuspid valve resulted in excellent 10-year survival. All-cause and aortic valve-related reoperations were significantly less frequent with valve-sparing root replacement, suggesting an advantage of DV over biological BD.
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http://dx.doi.org/10.1093/ejcts/ezaa389DOI Listing
April 2021