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Potapov E.V.,From the Deutsches Herzzentrum Berlin | Kaufmann F.,From the Deutsches Herzzentrum Berlin | Stepanenko A.,From the Deutsches Herzzentrum Berlin | Hening E.,From the Deutsches Herzzentrum Berlin | And 6 more authors.
ASAIO Journal | Year: 2012

Implantable continuous flow pumps are a routine treatment for end-stage heart failure. The waiting time for heart transplantation is increasing, and more and more patients receive the pump for permanent support. We retrospectively analyzed our database of patients supported with the HeartMate II left ventricular assist device to identify instances of cable damage. Between May 9, 2006 and May 9, 2012, 161 patients were supported with the HeartMate II. There were 187 cumulative years of HeartMate II support. The documented cable damage occurred in 12 patients (7.5%), requiring pump exchange in five patients after a mean time of 706 days on support. There was no perioperative mortality. The damage occurred typically at the "weak" place-the feedthrough of the driveline to the pump body. In some cases, the device alarm history and x-ray may allow diagnosis before pump stop occurs. However, since the most recent changes in the design of the connection and modifications made in the implantation technique, no instance of cable damage has been registered. Copyright © 2012 by the American Society for Artificial Internal.


PubMed | From the Deutsches Herzzentrum Berlin
Type: Journal Article | Journal: Innovations (Philadelphia, Pa.) | Year: 2012

We report on simultaneous off-pump coronary artery bypass grafting to the left anterior descending artery, modified transapical aortic valve implantation, and stenting of the circumflex and right coronary arteries in an 84-year-old patient. The poly-morbid patient with a logistic EuroSCORE of 85% experienced recent myocardial infarction; the left ventricular ejection fraction was reduced to 20%. Postoperative recovery was fast and short. The strategy described is the next logical step in broadening the indication for transcatheter aortic valve interventions.


PubMed | From the Deutsches Herzzentrum Berlin
Type: Journal Article | Journal: Innovations (Philadelphia, Pa.) | Year: 2016

In this report, we assess the outcome of transcatheter aortic valve implantation (TAVI) in nonagenarians at our institution during a 6-year period.Between April 2008 and July 2014, 40 patients with a mean SD age of 91.8 2.3 years (range, 90-98 years) underwent TAVI. Thirty-three patients (82.5%) received transapical TAVI, and seven patients (17.5%) received transfemoral TAVI. Baseline characteristics were as follows: mean SD EuroSCORE II, 23.9 14.21; mean SD Society of Thoracic Surgeons mortality score, 24.2 11.4; mean SD SYNTAX score, 7.6 9.3; mean SD NYHA class, 3.5 0.5; mean SD transvalvular gradient, 46.8 17.8 mm Hg; mean SD aortic valve area, 0.7 0.2 cm.Intraoperative mortality was 2.5% and 30-day all-cause mortality was 10%. The actuarial survival rates at 1 and 5 years were 58.6% and 30.4%, respectively. Seven patients (17.5%) underwent simultaneous elective TAVI and percutaneous coronary intervention. Three patients (7.5%) were operated on with the use of cardiopulmonary bypass. No conversion to open surgery occurred. In transesophageal echocardiography assessment, no moderate or severe prosthetic aortic valve regurgitation was observed. Four patients (10%) had postoperative acute renal failure stage 3 and needed new dialysis (P = 0.125). Three patients (7.5%) had a disabling stroke. Periprocedural myocardial infarction occurred in one patient (2.5%). Seven patients (17.5%) needed postoperative pacemaker implantation. Male sex and renal insufficiency were found to be predictors of mortality in univariable analysis.Transcatheter aortic valve implantation can be performed in nonagenarians despite very high preoperative risk scores and substantial multimorbidity, with acceptable outcomes.

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