Heart and Diabetes Center North Rhine Westphalia

Bad Oeynhausen, Germany

Heart and Diabetes Center North Rhine Westphalia

Bad Oeynhausen, Germany
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Scheffers I.J.M.,Maastricht University | Kroon A.A.,Maastricht University | Schmidli J.,University of Bern | Jordan J.,Hannover Medical School | And 11 more authors.
Journal of the American College of Cardiology | Year: 2010

Objectives This study assessed the safety and efficacy of a novel implantable device therapy in resistant hypertension patients. Background Despite the availability of potent antihypertensive drugs, a substantial proportion of patients remain hypertensive. A new implantable device (Rheos system, CVRx, Inc., Minneapolis, Minnesota) that activates the carotid baroreflex may help these patients. Methods Forty-five subjects with systolic blood pressure ≥160 mm Hg or diastolic ≥90 mm Hg despite at least 3 antihypertensive drugs were enrolled in a prospective, nonrandomized feasibility study to assess whether Rheos therapy could safely lower blood pressure. Subjects were followed up for as long as 2 years. An external programmer was used to optimize and individualize efficacy. Results Baseline mean blood pressure was 179/105 mm Hg and heart rate was 80 beats/min, with a median of 5 antihypertensive drugs. After 3 months of device therapy, mean blood pressure was reduced by 21/12 mm Hg. This result was sustained in 17 subjects who completed 2 years of follow-up, with a mean reduction of 33/22 mm Hg. The device exhibited a favorable safety profile. Conclusions The Rheos device sustainably reduces blood pressure in resistant hypertensive subjects with multiple comorbidities receiving numerous medications. This unique therapy offers a safe individualized treatment option for these high-risk subjects. This novel approach holds promise for patients with resistant hypertension and is currently under evaluation in a prospective, placebo-controlled clinical trial. © 2010 American College of Cardiology Foundation.

Woehrle H.,Sleep and Ventilation Center Blaubeuren | Woehrle H.,ResMed | Oldenburg O.,Heart and Diabetes Center North Rhine Westphalia | Arzt M.,University of Regensburg | And 4 more authors.
BMC Cardiovascular Disorders | Year: 2014

Background: The objective of the SCHLA-HF registry is to investigate the prevalence of sleep-disordered breathing (SDB) in patients with chronic heart failure with reduced left ventricular systolic function (HF-REF) and to determine predictors of SDB in such patients.Methods: Cardiologists in private practices and in hospitals in Germany are asked to document patients with HF-REF into the prospective SCHLA-HF registry if they meet predefined inclusion and exclusion criteria. Screening was started in October 2007 and enrolment was completed at the end of May 2013. After enrolment in the registry, patients are screened for SDB. SDB screening is mainly undertaken using the validated 2-channel ApneaLink™ device (nasal flow and pulse oximetry; ResMed Ltd., Sydney, Australia). Patients with a significant number of apneas and hypopneas per hour recording time (AHI ≥15/h) and/or clinical symptoms suspicious of SDB will be referred to a cooperating sleep clinic for an attended in-lab polysomnography with certified scoring where the definite diagnosis and, if applicable, the differentiation between obstructive and central sleep apnea will be made. Suggested treatment will be documented.Discussion: Registries play an important role in facilitating advances in the understanding and management of cardiovascular disease. The SCHLA-HF registry will provide consistent data on a large group of patients with HF-REF that will help to answer questions on the prevalence, risk factors, gender differences and stability of SDB in these patients by cross-sectional analyses. Further insight into the development of SDB will be gained by extension of the registry to include longitudinal data. © 2014 Woehrle et al.; licensee BioMed Central Ltd.

Head S.J.,Erasmus Medical Center | Howell N.J.,University of Birmingham | Osnabrugge R.L.J.,Erasmus Medical Center | Bridgewater B.,University of Manchester | And 6 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2013

Objectives: Continuous monitoring of surgical outcomes through benchmarking and the identification of best practices has become increasingly important. A structured approach to data collection, coupled with validation, analysis and reporting, is a powerful tool in these endeavours. However, inconsistencies in standards and practices have made comparisons within and between European countries cumbersome. The European Association for Cardio-Thoracic Surgery (EACTS) has established a large international database with the goals of (i) working with other organizations towards universal data collection and creating a European-wide repository of information on the practice of cardio-thoracic surgery, and (ii) disseminating that information in scientific, peer-reviewed articles. We report on the process of data collection, as well as on an overview of the data in the database. Methods: The EACTS Database Committee met for the first time in Monaco, September 2002, to establish the ground rules for the process of setting upthe database. Subsequently, data have been collected and merged by Dendrite Clinical Systems Ltd. Results: As of December 2008, the database included 1 074 168 patient records from 366 hospitals located in 29 countries. The latest submission from the years 2006-08 included 404 721 records. The largest contributors were the UK (32.0%), Germany (20.9%) and Belgium (7.3%). Isolated coronary bypass surgery was the most frequently performed operation; the proportion of surgical workload that comprised isolated coronary artery bypass grafting varied from country to country: 30% in Spain and almost 70% in Denmark. Isolated valve procedures constituted 12% of all procedures in Norway and 32% in Spain. Baseline demographics showed an increase in the mean age and the percentage of patients that were female over time. Remarkably, the mortality rates for all procedures declined over the period analysed, to 2.2% (95% confidence interval [CI] 2.2-2.3%) for isolated coronary bypass, 3.4% (95% CI 3.3-3.5%) for isolated valve and 6.2% (95% CI 6.0-6.5%) for bypass + valve procedures. Conclusion: The EACTS database has proven to be an important step forward in providing opportunities for monitoring cardiac surgical care across Europe. As the database continues to expand, it will facilitate research projects, establish benchmarking standards and identify potential areas for quality improvements. © The Author 2013. Published by Oxford University Presson behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Furukawa N.,Heart and Diabetes Center North Rhine Westphalia | Hansky B.,Heart and Diabetes Center North Rhine Westphalia | Niedermeyer J.,Krankenhaus Bad Oeynhausen | Gummert J.,Heart and Diabetes Center North Rhine Westphalia | Renner A.,Heart and Diabetes Center North Rhine Westphalia
Journal of Cardiothoracic Surgery | Year: 2011

Solitary fibrous tumor of the pleura is a rare mesenchymal tumor, representing less than 5% of all neoplasms associated with the pleura. A 57-year-old man had general malaise without chest symptoms for 1 month. A chest roentgenogram and computed tomography showed a giant mass in the left thorax. Although the tumor compressed the descending aorta and other mediastinal structures strongly, thereby shifting them to the right side, the patient had no symptoms except malaise. The tumor was successfully resected via two separate thoracotomies. The tumor was measured (20 cm × 19 cm × 15 cm) and weighed (2150 g). The tumor was histologically and immunohistochemically diagnosed as benign. Although SFT is benign, a long follow-up period is essential as even patients with complete resection are at risk of recurrence many years after surgery. © 2011 Furukawa et al; licensee BioMed Central Ltd.

Mokhles M.M.,Erasmus Medical Center | Kortke H.,Heart and Diabetes Center North Rhine Westphalia | Stierle U.,University of Lübeck | Wagner O.,Heart and Diabetes Center North Rhine Westphalia | And 5 more authors.
Circulation | Year: 2011

Background-: It is suggested that in young adults the Ross procedure results in better late patient survival compared with mechanical prosthesis implantation. We performed a propensity score-matched study that assessed late survival in young adult patients after a Ross procedure versus that after mechanical aortic valve replacement with optimal self-management anticoagulation therapy. Methods and results-: We selected 918 Ross patients and 406 mechanical valve patients 18 to 60 years of age without dissection, aneurysm, or mitral valve replacement who survived an elective procedure (1994 to 2008). With the use of propensity score matching, late survival was compared between the 2 groups. Two hundred fifty-three patients with a mechanical valve (mean follow-up, 6.3 years) could be propensity matched to a Ross patient (mean follow-up, 5.1 years). Mean age of the matched cohort was 47.3 years in the Ross procedure group and 48.0 years in the mechanical valve group (P≤0.17); the ratio of male to female patients was 3.2 in the Ross procedure group and 2.7 in the mechanical valve group (P≤0.46). Linearized all-cause mortality rate was 0.53% per patient-year in the Ross procedure group compared with 0.30% per patient-year in the mechanical valve group (matched hazard ratio, 1.86; 95% confidence interval, 0.58 to 5.91; P≤0.32). Late survival was comparable to that of the general German population. Conclusions-: In comparable patients, there is no late survival difference in the first postoperative decade between the Ross procedure and mechanical aortic valve implantation with optimal anticoagulation self-management. Survival in these selected young adult patients closely resembles that of the general population, possibly as a result of highly specialized anticoagulation self-management, better timing of surgery, and improved patient selection in recent years. Copyright © 2011 American Heart Association. All rights reserved.

Weile J.,Heart and Diabetes Center North Rhine Westphalia | Seibold E.,University of Federal Defense Munich | Knabbe C.,Robert Bosch GmbH | Kaufmann M.,Heart and Diabetes Center North Rhine Westphalia | And 2 more authors.
Emerging Infectious Diseases | Year: 2013

We describe a case of human tularemia caused by Francisella tularensis subsp. holarctica in a stem cell transplant recipient with chronic graft-versus-host disease who was receiving levofloxacin prophylaxis. The infection was characterized by pneumonia with septic complications. The patient was successfully treated with doxycycline.

Furukawa N.,Heart and Diabetes Center North Rhine Westphalia
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery | Year: 2015

ABSTRACT: An 81-year-old man with high-grade aortic valve stenosis and status post–coronary artery bypass grafting and supracoronary replacement of the ascending aorta was referred for transcatheter aortic valve implantation. He was in New York Heart Association class III and had dyspnea. After appropriate screening, we implanted a 29-mm SAPIEN XT valve (Edwards Lifesciences, Irvine, CA USA) through a transapical approach because of severe peripheral arterial occlusive disease. Postinterventional aortography revealed correct positioning and function of the valve and free coronary ostia but contrast extravasation in the vicinity of the interposed vascular prosthesis, resulting in severe luminal narrowing. We chose to manage the stenosis with an endovascular stent. After stenting, extravascular compression was markedly reduced, and the pressure gradient disappeared. The patient was discharged home on the 20th postoperative day. Three months later, computed tomography depicted correct positioning of both grafts. The patient’s general health is good, and he is now in New York Heart Association class II. This case illustrates a complication of transcatheter aortic valve implantation specific for patients with an ascending aortic graft. Although stenting may be a good solution, as depicted by this case, self-expanding transcatheter aortic valves should be preferred in patients with ascending aortic grafts to avoid the described complication. ©2015 by the International Society for Minimally Invasive Cardiothoracic Surgery.

Furukawa N.,Heart and Diabetes Center North Rhine Westphalia | Aboud A.,Heart and Diabetes Center North Rhine Westphalia | Hakim-Meibodi K.,Heart and Diabetes Center North Rhine Westphalia | Gummert J.,Heart and Diabetes Center North Rhine Westphalia
Annals of Thoracic Surgery | Year: 2011

An isolated cleft of the mitral valve leaflet is rare cause of mitral regurgitation in adults. We report a successful minimally invasive mitral valve repair for severe mitral regurgitation caused by an isolated cleft of the anterior mitral leaflet. During the operation, we found a large cleft measuring 5 x 8 mm in the center of the anterior mitral leaflet. We closed the cleft directly and performed annuloplasty with a 30-mm Carpenter-Edwards Physio Ring (Edwards Lifesciences, Irvine, CA). The mitral valve is very well visualized with the video-assisted minimally invasive approach through the right chest. © 2011 The Society of Thoracic Surgeons.

Furukawa N.,Heart and Diabetes Center North Rhine Westphalia | Hakim-Meibodi K.,Heart and Diabetes Center North Rhine Westphalia | Gummert J.,Heart and Diabetes Center North Rhine Westphalia
Thoracic and Cardiovascular Surgeon | Year: 2011

Isolated tricuspid regurgitation with rupture of the chordae tendinae caused by blunt trauma is uncommon. We present a 20-year-old man who was asymptomatic for four months after a traffic accident, but then developed severe tricuspid regurgitation, caused by rupture of the chordae tendinae. We performed minimally invasive tricuspid valve repair with chordal reconstruction and annuloplasty. We discuss the optimal treatment of traumatic valve insufficiency in a young patient and review the literature. © Georg Thieme Verlag KG Stuttgart · New York.

Furukawa N.,Heart and Diabetes Center North Rhine Westphalia | Gummert J.,Heart and Diabetes Center North Rhine Westphalia | Borgermann J.,Heart and Diabetes Center North Rhine Westphalia
Journal of Cardiothoracic Surgery | Year: 2012

Primary cardiac tumors are rare with an incidence ranging from 0.001% to 0.03% in autopsy series. The prognosis of cardiac sarcomas remains poor because it proliferates rapidly and distant metastases are often found at diagnosis. A 47-year-old male complained of persistent cough. The chest roentgenogram was normal. Subsequent computed tomography revealed a mass in the right atrium. Echocardiography and magnetic resonance imaging confirmed also a right atrial mass (34 x 35 mm) infiltrating the atrial septum. The tumor was completely resected en bloc, including the anterior and lateral right atrial walls, the left atrial dome, and a large segment of the superior vena cava, and reconstructed the atria and superior vena cava with bovine pericardium. The tumor was histologically and immunohistochemically diagnosed as undifferentiated pleomorphic sarcoma. This type of cardiac sarcoma is very rare and usually found in the left atrium. Twenty-seven months after surgery, the patient is doing well without metastasis or local tumor recurrence. © 2012 Furukawa et al.; licensee BioMed Central Ltd.

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