Laborde F.,Institute Mutualiste Montsouris |
Fischlein T.,Paracelsus Medical University |
Hakim-Meibodi K.,Klinik |
Misfeld M.,University of Leipzig |
And 48 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2016
OBJECTIVES: The aim of the Cavalier trial was to evaluate the safety and performance of the Perceval sutureless aortic valve in patients undergoing aortic valve replacement (AVR). We report the 30-day clinical and haemodynamic outcomes from the largest study cohort with a sutureless valve. METHODS: FromFebruary 2010 to September 2013, 658 consecutive patients (mean age 77.8 years; 64.4% females; mean logistic EuroSCORE 10.2%) underwent AVR in 25 European Centres. Isolated AVRs were performed in 451 (68.5%) patients with a less invasive approach in 219 (33.3%) cases. Of the total, 40.0% were octogenarians. Congenital bicuspid aortic valve was considered an exclusion criterion. RESULTS: Implantation was successful in 628 patients (95.4%). In isolated AVR through sternotomy, the mean cross-clamp time and the cardiopulmonary bypass (CPB) time were 32.6 and 53.7 min, and with the less invasive approach 38.8 and 64.5 min, respectively. The 30-day overall and valve-related mortality rates were 3.7 and 0.5%, respectively. Valve explants, stroke and endocarditis occurred in 0.6, 2.1 and in 0.1% of cases, respectively. Preoperative mean and peak pressure gradients decreased from 44.8 and 73.24 mmHg to 10.24 and 19.27 mmHg at discharge, respectively. The mean effective orifice area improved from 0.72 to 1.46 cm2. CONCLUSIONS: The current 30-day results show that the Perceval valve is safe (favourable haemodynamic effect and low complication rate), and can be implanted with a fast and reproducible technique after a short learning period. Short cross-clamp and CPB times were achieved in both isolated and combined procedures. The Perceval valve represents a promising alternative to biological AVR, especially with a less invasive approach and in older patients. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Van Gelder I.C.,University of Groningen |
Van Gelder I.C.,Interuniversity Cardiology Institute Netherlands |
Haegeli L.M.,Universitatsspital Zurich |
Brandes A.,University of Southern Denmark |
And 12 more authors.
Europace | Year: 2011
Atrial fibrillation (AF) is the most common sustained arrhythmia and an important source for mortality and morbidity on a population level. Despite the clear association between AF and death, stroke, and other cardiovascular events, there is no evidence that rhythm control treatment improves outcome in AF patients. The poor outcome of rhythm control relates to the severity of the atrial substrate for AF not only due to the underlying atrial remodelling process but also due to the poor efficacy and adverse events of the currently available ion-channel antiarrhythmic drugs and ablation techniques. Data suggest, however, an association between sinus rhythm maintenance and improved survival. Hypothetically, sinus rhythm may also lead to a lower risk of stroke and heart failure. The presence of AF, thus, seems one of the modifiable factors associated with death and cardiovascular morbidity in AF patients. Patients with a short history of AF and the underlying heart disease have not been studied before. It is fair to assume that abolishment of AF in these patients is more successful and possibly also safer, which could translate into a prognostic benefit of early rhythm control therapy. Several trials are now investigating whether aggressive early rhythm control therapy can reduce cardiovascular morbidity and mortality and increase maintenance of sinus rhythm. In the present paper we describe the background of these studies and provide some information on their design. © The Author 2011.
Reynolds C.,Universitatsklinikum Hamburg Eppendorf |
Schofer N.,Universitares Herzzentrum Hamburg GmbH |
Zengin E.,Universitares Herzzentrum Hamburg GmbH |
Lohse A.W.,Universitatsklinikum Hamburg Eppendorf |
And 2 more authors.
Internist | Year: 2016
We report a case of an extracutaneus involvement of pyoderma gangrenosum. The patient initially presented with multiple sterile abscesses of the skin, heart, prostate, and kidney. Extracutaneus involvement in pyoderma gangrenosum is very rare. Confirmation of the diagnosis was only possible after exclusion of other relevant differential diagnoses. Continuous search for microbes proved negative and after an empiric therapeutic attempt with prednisolone, the patient improved quickly. However, each time we reduced the steroids even in combination with methotrexate or with azathioprine the patient relapsed. Only after therapy with the tumor necrosis factor-α-inhibitor infliximab was permanent remission achieved. © 2016, Springer-Verlag Berlin Heidelberg.
PubMed | Universitatsklinikum Hamburg Eppendorf, Universitares Herzzentrum Hamburg GmbH and Gastroenterologie und Interventionelle Endoskopie
Type: Case Reports | Journal: Der Internist | Year: 2016
We report a case of an extracutaneous involvement of pyoderma gangrenosum. The patient initially presented with multiple sterile abscesses of the skin, heart, prostate, and kidney. Extracutaneous involvement in pyoderma gangrenosum is very rare. Confirmation of the diagnosis was only possible after exclusion of other relevant differential diagnoses. Continuous search for microbes proved negative and after an empiric therapeutic attempt with prednisolone, the patient improved quickly. However, each time we reduced the steroids even in combination with methotrexate or with azathioprine the patient relapsed. Only after therapy with the tumor necrosis factor--inhibitor infliximab was permanent remission achieved.
Kruska P.,Abt. fur Anasthesiologie und Operative Intensivmedizin |
Spies C.,Charité - Medical University of Berlin |
Debus E.S.,Universitares Herzzentrum Hamburg GmbH |
Schwenk W.,Abt. fur Allgemein und Visceralchirurgie |
And 2 more authors.
Gefasschirurgie | Year: 2010
The fast-track concept, a multidisciplinary approach to improve perioperative outcomes, has now been established in numerous surgical disciplines. Its application in vascular surgery has also been successfully demonstrated. The positive effects of fast-track rehabilitation can be achieved only by the cooperation of all professionals involved. Besides the surgeon, the anaesthesiologist plays a key role in perioperative management in fasttrack programmes through his or her direct influence on substantial aspects of the fasttrack concept. In this review, the authors describe therapeutic approaches of the anaesthesiologist using a fast-track concept in vascular surgery. © 2010 Springer-Verlag.
Wild P.S.,Johannes Gutenberg University Mainz |
Zeller T.,Universitares Herzzentrum Hamburg GmbH |
Beutel M.,Universitatsmedizin Mainz |
Blettner M.,Universitatsmedizin Mainz |
And 5 more authors.
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2012
The Gutenberg Health Study is a population-based, prospective, single-center cohort study that started in 2007 at the University Medical Center Mainz. The project focuses on cardiovascular diseases, cancer, eye diseases, metabolic diseases, diseases of the immune system and mental diseases. The study aims at improving the individual risk prediction for diseases. Therefore, lifestyle, psychosocial factors, environment, laboratory parameters as well as the extent of the subclinical disease are investigated. A comprehensive biobank enables biomolecular examinations including a systems biological approach. During the baseline visit 15,000 individuals aged 35-74 years were invited to a 5 h examination program in the study center. This will be followed by a computer-assisted telephone interview with a standardized interview and assessment of endpoints after 2.5 years. After 5 years a detailed follow-up examination comparable to the visit at study inclusion will be performed in the study center. Further follow-up visits of the cohort are envisaged. © Springer-Verlag 2012.
Consensus of the German cardiac society and the German society for thoracic and cardiovascular surgery on treatment of Mitral valve insufficiency [Konsensus der Deutschen Gesellschaft für Kardiologie - Herz- und Kreislaufforschung - und der Deutschen Gesellschaft für Thorax-, Herz- und Gefäßchirurgie zur Behandlung der Mitralklappeninsuffizienz]
Nickenig G.,Universitatsklinikum Bonn |
Mohr F.W.,University of Leipzig |
Kelm M.,Universitatsklinikum Dusseldorf |
Kuck K.-H.,II. Medizinische Abteilung |
And 6 more authors.
Kardiologe | Year: 2013
Mitral valve regurgitation is one of the most important and frequent valve diseases in the western hemisphere. Primary mitral valve regurgitation is due to pathological alterations of the valve structure itself, whereas secondary mitral valve regurgitation is due to pathology of the left ventricle which ultimately leads to deterioration of mitral valve functioning and mitral regurgitation. The diagnostic pathway requires various cardiovascular examinations. Central diagnostic tool resembles echocardiography which provides besides visual impressions semi quantitative and quantitative parameters. Treatment options in patients with mitral valve regurgitation are based on interdisciplinary discussion between cardiologists and heart surgeons in the heart team. Besides the conservative treatment including medical and device heart failure therapy, surgical and interventional procedures are to be discussed in order to reduce mitral valve regurgitation. The decision making is greatly influenced by the nature of mitral valve regurgitation and by the concomitant comorbidities. © 2013 Springer-Verlag Berlin Heidelberg.
Behrendt C.-A.,Universitares Herzzentrum Hamburg GmbH |
Tsilimparis N.,Universitares Herzzentrum Hamburg GmbH |
Diener H.,Universitares Herzzentrum Hamburg GmbH |
Larena-Avellaneda A.,Universitares Herzzentrum Hamburg GmbH |
And 2 more authors.
Gefässchirurgie | Year: 2014
Increasing economic aspects of the healthcare system, forthcoming legislative amendments and an inhomogeneous patient population call for advanced methods of quality improvement and research in vascular medicine. More than 12 established international registry projects have proven the importance of clinical registries as a complementary method for randomized clinical trials (RCT). In the USA the restenosis rate after carotid endarterectomy (CEA) could also be decreased due to the results of register data. In the United Kingdom the mortality rate of elective surgery in 8380 patients with abdominal aortic aneurysms (AAA) has been reduced from 7,5 % to 2.4 % from 2008 to 2012 by the use of register data. Unlike in many other countries, Germany currently has no common population-based registry for vascular treatments. The prospective registry for AAA currently only records a small proportion of treatments. The mandatory data collection and analysis of approximately 33,000 CEAs by the AQUA Institute is an important part of quality insurance but has limitations because of the limited validity. An interdisciplinary common vascular registry for Germany, GermanVasc, allows a better and more accurate description of the actual medical care situation. With GermanVasc it will be possible to answer some of the key questions in vascular medicine in Germany. © 2014 Springer-Verlag Berlin Heidelberg.
Kolbel T.,Universitares Herzzentrum Hamburg GmbH |
Wipper S.,Universitares Herzzentrum Hamburg GmbH |
Diener H.,Universitares Herzzentrum Hamburg GmbH |
Debus E.S.,Universitares Herzzentrum Hamburg GmbH
Chirurg | Year: 2011
Arteriosclerosis is the most common cause of chronic mesenteric ischemia, which is characterized by postprandial pain, unintentional weight loss and food avoidance. The use of endovascular techniques for revascularization of chronic stenoses and occlusions of the mesenteric arteries has rapidly increased over the last 10 years. The results of endovascular therapy have shown less morbidity and mortality compared to open surgical procedures, such as bypass and thrombendarterectomy. Early publications have reported higher rates of restenosis, symptomatic recurrence and reinterventions but recent case series show comparable patency rates. This article reviews visceral arterial anatomy and anomalies and endovascular techniques for the revascularization of mesenteric arteries. © 2011 Springer-Verlag.