25 results on '"Dominik Joskowiak"'
Search Results
2. Failure of Surgical Aortic Valve Prostheses: An Analysis of Heart Team Decisions and Postoperative Outcomes
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Philipp Schnackenburg, Shekhar Saha, Ahmad Ali, Konstanze Maria Horke, Joscha Buech, Christoph S. Mueller, Sebastian Sadoni, Martin Orban, Rainer Kaiser, Philipp Maximilian Doldi, Konstantinos Rizas, Steffen Massberg, Christian Hagl, and Dominik Joskowiak
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Failed SAVR ,ViV TAVR ,Redo SAVR ,Medicine - Abstract
Objectives: To analyze Heart Team decisions and outcomes following failure of surgical aortic valve replacement (SAVR) prostheses. Methods: Patients undergoing re-operations following index SAVR (Redo-SAVR) and those undergoing valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) following SAVR were included in this study. Patients who underwent index SAVR and/or Redo-SAVR for endocarditis were excluded. Data are presented as medians and 25th–75th percentiles, or absolute numbers and percentages. Outcomes were analyzed in accordance to the VARC-3 criteria. Results: Between 01/2015 and 03/2021, 53 patients underwent Redo-SAVR, 103 patients ViV-TAVR. Mean EuroSCORE II was 5.7% (3.5–8.5) in the Redo-SAVR group and 9.2% (5.4–13.6) in the ViV group. In the Redo-SAVR group, 12 patients received aortic root enlargement (22.6%). Length of hospital and ICU stay was longer in the Redo-SAVR group (p < 0.001; p < 0.001), PGmax and PGmean were lower in the Redo-SAVR group as compared to the ViV-TAVR group (18 mmHg (10–30) vs. 26 mmHg (19–38), p < 0.001) (9 mmHg (6–15) vs. 15 mmHg (9–21), p < 0.001). A higher rate of paravalvular leakage was seen in the ViV-TAVR group (p = 0.013). VARC-3 Early Safety were comparable between the two populations (p = 0.343). Survival at 1 year and 5 years was 82% and 36% in the ViV-TAVR cohort and 84% and 77% in the Redo-SAVR cohort. The variables were patient age (OR 1.061; [95% CI 1.020–1.104], p = 0.004), coronary heart disease (OR 2.648; [95% CI 1.160–6.048], p = 0.021), and chronic renal insufficiency (OR 2.711; [95% CI 1.160–6.048], p = 0.021) showed a significant correlation to ViV-TAVR. Conclusions: Heart Team decisions are crucial in the treatment of patients with degenerated aortic bioprostheses and lead to a low mortality in both treatment paths thanks to patient-specific therapy planning. ViV-TAVR offers a treatment for elderly or intermediate-risk profile patients with comparable short-term mortality. However, this therapy is associated with increased pressure gradients and a high prevalence of paravalvular leakage. Redo-SAVR enables the surgical treatment of concomitant cardiac pathologies and allows anticipation for later VIV-TAVR by implanting the largest possible valve prostheses.
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- 2024
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3. Aortic arch blood flow measurements as a predictor of successful ECMO weaning in cardiogenic shock
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Antonia Kellnar, Dominik Naumann, Clemens Scherer, Enzo Lüsebrink, Dominik Joskowiak, Sven Peterß, Christian Hagl, Steffen Massberg, Martin Orban, and Christopher Stremmel
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ECMO ,Cardiogenic shock ,Weaning ,Aortic arch ,Doppler ultrasound ,USCOM ,Science (General) ,Q1-390 ,Social sciences (General) ,H1-99 - Abstract
Objective: Acute cardiogenic shock is a life-threatening condition with mortality rates of up to 50%. If conventional therapy fails, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy has emerged to a promising alternative for temporary cardiac and respiratory support in specialized centers. However, it is only a bridge to recovery, final decision, heart transplantation or the permanent implantation of a left ventricular assist device. Therefore, the identification of the optimum weaning time point is challenging, and standardized weaning protocols are rare. Methods: In this explorative pilot study, we evaluated the potential benefit of blood flow measurements in the aortic arch using an ultrasonic cardiac output monitor (USCOM) for the primary endpoint of successful VA-ECMO weaning. 12 patients under VA-ECMO therapy for acute cardiogenic shock and a hemodynamic condition which qualified for a stepwise weaning process were included in this study. Main exclusion criterion was the presence of additional venting therapy for left ventricular unloading, e.g. Impella. Statistical comparisons were performed using the Mann-Whitney test and corrected for multiple testing by the Holm-Sidak method. Results: Peak velocity of flow in the aortic arch showed a positive correlation with weaning success independent of ECMO flow (weaning success vs. failure: 0.75 vs. 0.35 m/s (low ECMO support), p = 0.049), whereas we identified only a trend for mean pressure gradient, minute distance and stroke volume index. Conclusion: We hypothesize, that USCOM might provide an additive benefit to conventional strategies in its ability to predict successful VA-ECMO weaning and prevent pulmonary congestion. Larger upcoming trials are required to address this relevant topic and provide standardized treatment protocols for optimized weaning in the future.
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- 2024
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4. Mid-Term Outcome after Extracorporeal Life Support in Postcardiotomy Cardiogenic Shock: Recovery and Quality of Life
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Maja Hanuna, German Herz, Andre L. Stanzl, Yupeng Li, Christoph S. Mueller, Christine E. Kamla, Clemens Scherer, Dietmar Wassilowsky, Gerd Juchem, Martin Orban, Sven Peterss, Christian Hagl, and Dominik Joskowiak
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postcardiotomy cardiogenic shock ,extracorporeal life support ,cardiocirculatory failure ,mechanical circulatory support ,health-related quality of life ,Medicine - Abstract
Background: Extracorporeal life support (ECLS) therapy for refractory postcardiotomy cardiogenic shock (rPCS) is associated with high early mortality rates. This study aimed to identify negative predictors of mid-term survival and to assess health-related quality of life (HRQoL) and recovery of the survivors. Methods: Between 2017 and 2020, 142 consecutive patients received ECLS therapy following cardiac surgery. The median age was 66.0 [57.0–73.0] years, 67.6% were male and the median EuroSCORE II was 10.5% [4.2–21.3]. In 48 patients, HRQoL was examined using the 36-Item Short Form Survey (SF-36) and the modified Rankin-Scale (mRS) at a median follow-up time of 2.2 [1.9–3.2] years. Results: Estimated survival rates at 3, 12, 24 and 36 months were 47%, 46%, 43% and 43% (SE: 4%). Multivariable Cox Proportional Hazard regression analysis revealed preoperative EuroSCORE II (p = 0.013), impaired renal function (p = 0.010), cardiopulmonary bypass duration (p = 0.015) and pre-ECLS lactate levels (p = 0.004) as independent predictors of mid-term mortality. At the time of follow-up, 83.3% of the survivors were free of moderate to severe disability (mRS < 3). SF-36 analysis showed a physical component summary of 45.5 ± 10.2 and a mental component summary of 50.6 ± 12.5. Conclusions: Considering the disease to be treated, ECLS for rPCS is associated with acceptable mid-term survival, health-related quality of life and functional status. Preoperative EuroSCORE II, impaired renal function, cardiopulmonary bypass duration and lactate levels prior to ECLS implantation were identified as negative predictors and should be included in the decision-making process.
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- 2024
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5. Suture-based vs. pure plug-based vascular closure devices for VA-ECMO decannulation–A retrospective observational study
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Clemens Scherer, Hans Theiss, Mario Istrefi, Leonhard Binzenhöfer, Danny Kupka, Thomas Stocker, Enzo Lüsebrink, Era Stambollxhiu, Ahmed Alemic, Tobias Petzold, Konstantin Stark, Simon Deseive, Daniel Braun, Dominik Joskowiak, Sven Peterss, Jörg Hausleiter, Christian Hagl, Steffen Massberg, and Martin Orban
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cardiogenic shock ,VA-ECMO ,ProGlide ,MANTA ,suture-based closure device ,plug-based closure device ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a valuable treatment option for patients in cardiogenic shock, but complications during decannulation may worsen the overall outcome. Therefore, the aim of this study was to compare the efficacy and safety of suture-based to pure plug-based vascular closure devices for VA-ECMO decannulation.MethodsIn this retrospective study, the procedural outcome of 33 patients with suture-based Perclose ProGlide closure devices was compared to 38 patients with MANTA plug-based closure devices.ResultsRate of technically correct placement of closure devices was 88% in the suture-based group and 97% in the plug-based group (p = 0.27). There was a significant reduction of severe bleeding events during VA-ECMO decannulation in plug-based versus suture-based systems (3% vs. 21%, p = 0.04). Ischemic complications occurred in 6% with suture-based and 5% with plug-based device (p = 1.00). Pseudoaneurysm formation was detected in 3% in both groups (p = 1.00). No switch to vascular surgery due to bleeding after decannulation was necessary in both groups.ConclusionBased on our retrospective analysis, we propose that plug-based vascular closure should be the preferred option for VA-ECMO decannulation. This hypothesis should be further tested in a randomized trial.
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- 2023
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6. Heparin-Induced Thrombocytopenia in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation
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Enzo Lüsebrink, Clemens Scherer, Leonhard Binzenhöfer, Sabine Hoffmann, Julia Höpler, Antonia Kellnar, Manuela Thienel, Dominik Joskowiak, Sven Peterß, Tobias Petzold, Simon Deseive, Ralph Hein, Stefan Brunner, Stefan Kääb, Daniel Braun, Hans Theiss, Jörg Hausleiter, Christian Hagl, Steffen Massberg, and Martin Orban
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VA-ECMO ,thrombocytopenia ,heparin-induced thrombocytopenia ,Medicine - Abstract
Background: Heparin-induced thrombocytopenia (HIT) is a serious, immune-mediated adverse drug reaction to unfractionated heparin (UFH) affecting also patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO). Although the association between VA-ECMO support and the development of thrombocytopenia has long been known and discussed, HIT as one underlying cause is still insufficiently understood. Therefore, the purpose of this study was to further investigate the epidemiology, mortality, diagnosis, and clinical management of HIT occurring in VA-ECMO patients treated with UFH. Methods: We conducted a retrospective single-center study including adult patients (≥18 years) with VA-ECMO support in the cardiac intensive care unit (ICU) of the University Hospital of Munich (LMU) between January 2013 and May 2022, excluding patients with a known history of HIT upon admission. Differences in baseline characteristics and clinical outcome between excluded HIT (positive anti-platelet factor 4 (PF4)/heparin antibody test but negative functional assay) and confirmed HIT (positive anti-PF4/heparin antibody test and positive functional assay) VA-ECMO patients as well as diagnosis and clinical management of HIT were analysed. Results: Among the 373 patients included, anti-PF4/heparin antibodies were detected in 53/373 (14.2%) patients. Functional HIT testing confirmed HIT in 13 cases (3.5%) and excluded HIT in 40 cases (10.7%), corresponding to a prevalence of confirmed HIT of 13/373 (3.5%) [1.6, 5.3] and a positive predictive value (PPV) of 24.5% for the antibody screening test. The platelet course including platelet recovery following argatroban initiation was similar between all groups. One-month mortality in patients with excluded HIT was 14/40 (35%) and 3-month mortality 17/40 (43%), compared to 5/13 (38%) (p > 0.999), and 6/13 (46%) (p > 0.999) in patients with confirmed HIT. Neurological outcome in both groups measured by the cerebral performance category of survivors on hospital discharge was similar, as well as adverse events during VA-ECMO therapy. Conclusions: With a prevalence of 3.5%, HIT is a non-frequent complication in patients on VA-ECMO and was not associated with a higher mortality rate. HIT was ultimately excluded by functional essay in 75% of VA-ECMO patients with clinical suspicion of HIT and positive anti-PF4/heparin antibody test. Argatroban seems to be an appropriate and safe therapeutic option for confirmed HIT-positive patients on VA-ECMO support.
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- 2023
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7. Hemoadsorption in the critically ill-Final results of the International CytoSorb Registry.
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Fatime Hawchar, Dana Tomescu, Karl Träger, Dominik Joskowiak, Klaus Kogelmann, Jens Soukup, Singrun Friesecke, David Jacob, Jan Gummert, Andreas Faltlhauser, Filippo Aucella, Martijn van Tellingen, Manu L N G Malbrain, Ralph Bogdanski, Günter Weiss, Andreas Herbrich, Stefan Utzolino, Axel Nierhaus, Andreas Baumann, Andreas Hartjes, Dietrich Henzler, Evgeny Grigoryev, Harald Fritz, Friedhelm Bach, Stefan Schröder, Andreas Weyland, Udo Gottschaldt, Matthias Menzel, Olivier Zachariae, Radovan Novak, Jernej Berden, Hendrik Haake, Michael Quintel, Stephan Kloesel, Andreas Kortgen, Stephanie Stecher, Patricia Torti, Frieder Nestler, Markus Nitsch, Detlef Olboeter, Philip Muck, Michael Findeisen, Diane Bitzinger, Jens Kraßler, Martin Benad, Martin Schott, Ulrike Schumacher, Zsolt Molnar, and Frank Martin Brunkhorst
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Medicine ,Science - Abstract
The aim of the current paper is to summarize the results of the International CytoSorb Registry. Data were collected on patients of the intensive care unit. The primary endpoint was actual in-hospital mortality compared to the mortality predicted by APACHE II score. The main secondary endpoints were SOFA scores, inflammatory biomarkers and overall evaluation of the general condition. 1434 patients were enrolled. Indications for hemoadsorption were sepsis/septic shock (N = 936); cardiac surgery perioperatively (N = 172); cardiac surgery postoperatively (N = 67) and "other" reasons (N = 259). APACHE-II-predicted mortality was 62.0±24.8%, whereas observed hospital mortality was 50.1%. Overall SOFA scores did not change but cardiovascular and pulmonary SOFA scores decreased by 0.4 [-0.5;-0.3] and -0.2 [-0.3;-0.2] points, respectively. Serum procalcitonin and C-reactive protein levels showed significant reduction: -15.4 [-19.6;-11.17] ng/mL; -17,52 [-70;44] mg/L, respectively. In the septic cohort PCT and IL-6 also showed significant reduction: -18.2 [-23.6;-12.8] ng/mL; -2.6 [-3.0;-2.2] pg/mL, respectively. Evaluation of the overall effect: minimal improvement (22%), much improvement (22%) and very much improvement (10%), no change observed (30%) and deterioration (4%). There was no significant difference in the primary outcome of mortality, but there were improvements in cardiovascular and pulmonary SOFA scores and a reduction in PCT, CRP and IL-6 levels. Trial registration: ClinicalTrials.gov Identifier: NCT02312024 (retrospectively registered).
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- 2022
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8. Mortality in Cardiogenic Shock Patients Is Predicted by Pao2/Fio2 (Horowitz Index) Measured on ICU After Venoarterial Extracorporeal Membrane Oxygenation Implantation
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Clemens Scherer, MD, Enzo Lüsebrink, MD, Dominik Joskowiak, MD, Vanessa Feuchtgruber, MDS, Tobias Petzold, MD, Jörg Hausleiter, MD, Sven Peterss, MD, Steffen Massberg, MD, Christian Hagl, MD, and Martin Orban, MD
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Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
OBJECTIVES:. Venoarterial extracorporeal membrane oxygenation treatment in patients with severe cardiogenic shock can cause or aggravate acute lung injury. In our retrospective analysis, we aimed at identifying markers for acute lung injury after arrival on ICU, which predict mortality of those patients. DESIGN:. Observational, monocentric, retrospective analysis. SETTING:. Cardiac ICU of Ludwig Maximilian University Hospital, Munich, Germany. PATIENTS:. Two-hundred eleven patients undergoing venoarterial extracorporeal membrane oxygenation treatment for severe cardiogenic shock were included into this analysis. Patients who died within 24 hours after venoarterial extracorporeal membrane oxygenation implantation were excluded. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. To determine lung injury, we investigated the influence of Pao2/Fio2 ratio (Horowitz index). The lowest Horowitz index was measured on ICU 6–12 hours after venoarterial extracorporeal membrane oxygenation implantation. An optimal cutoff value of less than 126 for Horowitz index to predict mortality was identified via receiver operating characteristic analysis (area under the curve, 0.62). Patients with Horowitz index less than 126 had a 30-day mortality rate of 67.5% compared to 37.5% with a Horowitz index greater than or equal to 126 (p < 0.001). Multivariate analysis identified Horowitz index less than 126 as an independent risk factor of ICU mortality (odds ratio, 3.6; 95% CI, 1.8–7.3; p < 0.001). CONCLUSIONS:. In this hypothesis-generating analysis, a Horowitz index less than 126 is associated with increased mortality in patients with cardiogenic shock and venoarterial extracorporeal membrane oxygenation, which may serve as a threshold for further therapeutic interventions.
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- 2021
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9. Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era
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Shekhar Saha, Ahmad Ali, Philipp Schnackenburg, Konstanze Maria Horke, Andreas Oberbach, Nadine Schlichting, Sebastian Sadoni, Konstantinos Rizas, Daniel Braun, Maximilian Luehr, Erik Bagaev, Christian Hagl, and Dominik Joskowiak
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infective endocarditis ,transcatheter aortic valve implantation ,prosthetic valve endocarditis ,Medicine - Abstract
Objectives: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. Methods: Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. Results: The median EuroSCORE II (52.1 (40.6–62.0) v/s 45.4 (32.6–58.1), p = 0.207) and STS-PROM (1.8 (1.6–2.1) v/s 1.9 (1.4–2.2), p = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020.Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group (p = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement (p = 0.081). Conclusions: Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort.
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- 2022
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10. Health-Related Quality of Life following Surgery for Native and Prosthetic Valve Infective Endocarditis
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Shekhar Saha, Ralitsa Mladenova, Caroline Radner, Konstanze Maria Horke, Joscha Buech, Philipp Schnackenburg, Ahmad Ali, Sven Peterss, Gerd Juchem, Maximilian Luehr, Christian Hagl, and Dominik Joskowiak
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infective endocarditis ,health-related quality of life ,valve replacement ,Medicine - Abstract
Objectives: The objective of this study was to compare the long-term outcomes and health-related quality of life (HRQOL) of patients following surgery for infective native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). Methods: We retrospectively identified 633 consecutive patients who had undergone surgery for infective endocarditis at our center between January 2005 and October 2018. The patients were interviewed, and the SF-36 survey was used to assess the HRQOL of survivors. Propensity score matching (2:1) was performed with data from a German reference population. Multivariable analysis incorporated binary logistic regression using a forward stepwise (conditional) model. Results: The median age of the cohort was 67 (55–74) years, and 75.6% were male. Operative mortality was 13.7% in the NVE group and 21.6% in the PVE group (p = 0.010). The overall survival at 1 year was 88.0% and was comparable between the groups. The physical health summary scores were 49 (40–55) for the NVE patients and 45 (37–52) for the PVE patients (p = 0.043). The median mental health summary scores were 52 (35–57) and 49 (41–56), respectively (p = 0.961). On comparison of the HRQOL to the reference population, the physical health summary scores were comparable. However, significant differences were observed with regard to the mental health summary scores (p = 0.005). Conclusions: Our study shows that there are significant differences in the various domains of HRQOL, not only between NVE and PVE patients, but also in comparison to healthy individuals. In addition to preoperative health status, it is important to consider the patient’s expectations regarding surgery. Further prospective studies are required.
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- 2022
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11. Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View
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Philipp Maximilian Doldi, Lukas Stolz, Felix Escher, Julius Steffen, Jonas Gmeiner, Daniel Roden, Marie Linnemann, Kornelia Löw, Simon Deseive, Thomas J. Stocker, Martin Orban, Hans Theiss, Konstantinos Rizas, Adrian Curta, Sebastian Sadoni, Joscha Buech, Dominik Joskowiak, Sven Peterss, Christian Hagl, Steffen Massberg, Jörg Hausleiter, and Daniel Braun
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TAVR ,aortic stenosis ,TAVI ,permanent pacemaker implantation ,conduction disturbance ,self-expandable valves ,Medicine - Abstract
Despite the rapid increase in experience and technological improvement, the incidence of conduction disturbances in patients undergoing transcatheter aortic valve replacement (TAVR) with the self-expandable CoreValve Evolut valve remains high. Recently, a cusp-overlap view (COP) implantation technique has been proposed for TAVR with self-expandable valves offering an improved visualization during valve expansion compared to the three-cusp view (TCV). This study aims to systematically analyze procedural outcomes of TAVR patients treated with the CoreValve Evolut valve using a COP compared to TCV in a high-volume center. The primary endpoint was technical success according the 2021 VARC-3 criteria. A total of 122 consecutive patients (61 pts. TCV: April 2019 to November 2020; 61 pts. COP: December 2020 to October 2021) that underwent TAVR with the CoreValve Evolut prosthesis were included in this analysis. Although there was no difference in the primary endpoint technical success between TCV and COP patients (93.4% vs. 90.2%, OR 0.65, 95% CI 0.16, 2.4, p = 0.51), we observed a significantly lower risk for permanent pacemaker implantation (PPI) among COP patients (TCV: 27.9% vs. COP: 13.1%, OR 0.39, 95% CI 0.15, 0.97, p = 0.047). Implantation of the CoreValve Evolut prosthesis using the COP might help to reduce the rate of PPI following TAVR.
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- 2022
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12. Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism—The Risk of Intermediate Deterioration
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Alexey Dashkevich, Georg Bratkov, Yupeng Li, Dominik Joskowiak, Sven Peterss, Gerd Juchem, Christian Hagl, and Maximilian Luehr
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infective endocarditis (IE) ,cerebral embolism ,ischemic stroke ,hemorrhagic stroke ,mitral valve ,aortic valve ,Medicine - Abstract
Cerebral embolism due to infective endocarditis (IE) is associated with significant morbidity and mortality. The optimal time-interval between symptomatic stroke and cardiac surgery remains unclear. This study aimed to analyze the patients’ outcomes and define the potential risk factors with regard to surgical timing for IE patients with preoperative symptomatic cerebral embolism (CE). A total of 119 IE patients with CE were identified and analyzed with regard to operative timing: early (1–7 days), intermediate (8–21 days), and late (>22 days). The preoperative patient data, comorbidities and previous cardiac surgical procedures were analyzed to identify potential predictors and independent risk factors for in-hospital mortality using univariate and multivariate regression analysis. Actuarial survival was estimated by the Kaplan-Meier method. In-hospital mortality for the entire study cohort was 15.1% (n = 18), and in comparison, between groups was found to be highest in the intermediate surgical group (25.7%). Univariate analysis identified preoperative mechanical ventilation dependent respiratory insufficiency (p = 0.006), preoperative renal insufficiency (p = 0.019), age (p = 0.002), large vegetations (p = 0.018) as well as intermediate (p = 0.026), and late (p = 0.041) surgery as predictors of in-hospital mortality. The presence of large vegetations (>8 mm) (p = 0.019) and increased age (p = 0.037)—but not operative timing—were identified as independent risk factors for in-hospital mortality. In the presence of large vegetations (>8 mm), cardiac surgery should be performed early and independently from the entity of cerebral embolic stroke. Postponing surgery to achieve clinical stabilization and better postoperative outcomes of IE patients with CE is reasonable, however, worsening of the disease process with deterioration and resulting heart failure during the first 3 weeks after CE results in a significantly higher in-hospital mortality and inferior long-term survival.
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- 2021
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13. Severe Acute Kidney Injury in Cardiovascular Surgery: Thrombotic Microangiopathy as a Differential Diagnosis to Ischemia Reperfusion Injury. A Retrospective Study
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Melissa Grigorescu, Christine-Elena Kamla, Dietmar Wassilowsky, Dominik Joskowiak, Sven Peterss, Stephan Kemmner, Maximilian Pichlmaier, Christian Hagl, Michael Fischereder, and Ulf Schönermarck
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acute kidney injury ,cardiovascular surgery ,aortic aneurysm ,aortic replacement ,thrombotic microangiopathy ,atypical hemolytic uremic syndrome ,Medicine - Abstract
Background: Acute kidney injury (AKI) after cardiovascular surgery (CVS) infers high morbidity and mortality and may be caused by thrombotic microangiopathy (TMA). This study aimed to assess incidence, risk factors, kidney function, and mortality of patients with a postoperative TMA as possible cause of severe AKI following cardiovascular surgery. Methods: We analyzed retrospectively all patients admitted to the ICU after a cardiovascular procedure between 01/2018 and 03/2019 with severe AKI and need for renal replacement therapy (RRT). TMA was defined as post-surgery-AKI including need for RRT, hemolytic anemia, and thrombocytopenia. TMA patients were compared to patients with AKI requiring RRT without TMA. Results: Out of 893 patients, 69 (7.7%) needed RRT within one week after surgery due to severe AKI. Among those, 15 (21.7%) fulfilled TMA criteria. Aortic surgery suggested an increased risk for TMA (9/15 (60.0%) vs. 7/54 (31.5%), OR 3.26, CI 1.0013-10.64). Ten TMA patients required plasmapheresis and/or eculizumab, and five recovered spontaneously. Preoperative kidney function was significantly better in TMA patients than in controls (eGFR 92 vs. 60.5 mL/min, p = 0.004). However, postoperative TMA resulted in a more pronounced GFR loss (ΔeGFR −54 vs. −17 mL/min, p = 0.062). There were no deaths in the TMA group. Conclusion: Our findings suggest TMA as an important differential diagnosis of severe AKI following cardiovascular surgery, which may be triggered by aortic surgery. Therefore, early diagnosis and timely treatment of TMA could reduce kidney damage and improve mortality of AKI following cardiovascular surgery, which should be further investigated.
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- 2020
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14. Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation
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Enzo Lüsebrink, Christopher Stremmel, Konstantin Stark, Dominik Joskowiak, Thomas Czermak, Frank Born, Danny Kupka, Clemens Scherer, Mathias Orban, Tobias Petzold, Patrick von Samson-Himmelstjerna, Stefan Kääb, Christian Hagl, Steffen Massberg, Sven Peterss, and Martin Orban
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venoarterial extracorporeal membrane oxygenation ,weaning ,weaning strategy ,weaning timing ,predictors of successful weaning ,Medicine - Abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary cardiac and respiratory support and has emerged as an established salvage intervention for patients with hemodynamic compromise or shock. It is thereby used as a bridge to recovery, bridge to permanent ventricular assist devices, bridge to transplantation, or bridge to decision. However, weaning from VA-ECMO differs between centers, and information about standardized weaning protocols are rare. Given the high mortality of patients undergoing VA-ECMO treatment, it is all the more important to answer the many questions still remaining unresolved in this field Standardized algorithms are recommended to optimize the weaning process and determine whether the VA-ECMO can be safely removed. Successful weaning as a multifactorial process requires sufficient recovery of myocardial and end-organ function. The patient should be considered hemodynamically stable, although left ventricular function often remains impaired during and after weaning. Echocardiographic and invasive hemodynamic monitoring seem to be indispensable when evaluating biventricular recovery and in determining whether the VA-ECMO can be weaned successfully or not, whereas cardiac biomarkers may not be useful in stratifying those who will recover. This review summarizes the strategies of weaning of VA-ECMO and discusses predictors of successful and poor weaning outcome.
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- 2020
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15. Infektiöse Endokarditis
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Shekhar Saha, Philipp Schnackenburg, Sebastian Sadoni, Dominik Joskowiak, and Christian Hagl
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
16. Dual ProGlide versus ProGlide and FemoSeal for vascular access haemostasis after transcatheter aortic valve implantation
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Jonas M.D. Gmeiner, Marie Linnemann, Julius Steffen, Clemens Scherer, Martin Orban, Hans Theiss, Julinda Mehilli, Sebastian Sadoni, Sven Peterß, Dominik Joskowiak, Christian Hagl, Nikolaos Tsilimparis, Adrian Curta, Stefan Maurus, Philipp M. Doldi, Kornelia Löw, Magda Haum, Daniel Roden, Jörg Hausleiter, Steffen Massberg, Konstantinos Rizas, Simon Deseive, and Daniel Braun
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Transcatheter Aortic Valve Replacement ,Femoral Artery ,Hemostasis ,Treatment Outcome ,Hemostatic Techniques ,Aortic Valve ,Humans ,Aortic Valve Stenosis ,Cardiology and Cardiovascular Medicine ,Vascular Closure Devices ,Retrospective Studies - Abstract
Large-bore arteriotomy for transcatheter aortic valve implantation (TAVI) requires percutaneous vascular closure devices, but real-world data comparing different closure strategies are limited.We sought to compare a dual ProGlide strategy vs a combination of one ProGlide and one FemoSeal for vascular closure after TAVI.We retrospectively analysed 874 propensity score-matched patients undergoing TAVI at the Munich University Hospital from August 2018 to October 2020. From August 2018 to August 2019, a dual ProGlide strategy was used for vascular closure. From October 2019 to October 2020, a combination of one ProGlide and one FemoSeal was used. The primary endpoint was defined as access-related major vascular complications or bleeding ≥Type 2 according to Valve Academic Research Consortium 3 criteria.Patients in the dual ProGlide group (n=437) had a higher incidence of the primary endpoint than patients treated with one ProGlide and one FemoSeal (n=437; 11.4% vs 3.0%; p0.001). Furthermore, they had a higher rate of closure device failure (2.7% vs 0.9%; p=0.044) and more often required unplanned surgery or endovascular treatment (3.9% vs 0.9%; p=0.004). The incidence of death did not differ significantly between groups (3.4% vs 1.6%; p=0.08).A combined ProGlide and FemoSeal strategy might have the potential to reduce access-related vascular complications following TAVI.
- Published
- 2022
17. Venting during venoarterial extracorporeal membrane oxygenation
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Enzo Lüsebrink, Leonhard Binzenhöfer, Antonia Kellnar, Christoph Müller, Clemens Scherer, Benedikt Schrage, Dominik Joskowiak, Tobias Petzold, Daniel Braun, Stefan Brunner, Sven Peterss, Jörg Hausleiter, Sebastian Zimmer, Frank Born, Dirk Westermann, Holger Thiele, Andreas Schäfer, Christian Hagl, Steffen Massberg, and Martin Orban
- Subjects
General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Cardiogenic shock and cardiac arrest contribute pre-dominantly to mortality in acute cardiovascular care. Here, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as an established therapeutic option for patients suffering from these life-threatening entities. VA-ECMO provides temporary circulatory support until causative treatments are effective and enables recovery or serves as a bridging strategy to surgical ventricular assist devices, heart transplantation or decision-making. However, in-hospital mortality rate in this treatment population is still around 60%. In the recently published ARREST trial, VA-ECMO treatment lowered mortality rate in patients with ongoing cardiac arrest due to therapy refractory ventricular fibrillation compared to standard advanced cardiac life support in selected patients. Whether VA-ECMO can reduce mortality compared to standard of care in cardiogenic shock has to be evaluated in the ongoing prospective randomized studies EURO-SHOCK (NCT03813134) and ECLS-SHOCK (NCT03637205). As an innate drawback of VA-ECMO treatment, the retrograde aortic flow could lead to an elevation of left ventricular (LV) afterload, increase in LV filling pressure, mitral regurgitation, and elevated left atrial pressure. This may compromise myocardial function and recovery, pulmonary hemodynamics—possibly with concomitant pulmonary congestion and even lung failure—and contribute to poor outcomes in a relevant proportion of treated patients. To overcome these detrimental effects, a multitude of venting strategies are currently engaged for both preventive and emergent unloading. This review aims to provide a comprehensive and structured synopsis of existing venting modalities and their specific hemodynamic characteristics. We discuss in detail the available data on outcome categories and complication rates related to the respective venting option. Graphical abstract
- Published
- 2022
18. Four decades of experience of prosthetic valve endocarditis reflect a high variety of diverse pathogens
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Andreas Oberbach, Nadine Schlichting, Christian Hagl, Stefanie Lehmann, Yvonne Kullnick, Maik Friedrich, Ulrike Köhl, Friedemann Horn, Vivek Kumbhari, Bettina Löffler, Frank Schmidt, Dominik Joskowiak, Frank Born, Shekhar Saha, Erik Bagaev, and Publica
- Subjects
Microbial diversity ,Virulence ,Physiology ,Physiology (medical) ,Prosthetic valve endocarditis ,Cardiology and Cardiovascular Medicine ,Blood culture ,Molecular diagnostic - Abstract
Prosthetic valve endocarditis (PVE) remains a serious condition with a high mortality rate. Precise identification of the PVE-associated pathogen/s and their virulence is essential for successful therapy and patient survival. The commonly described PVE-associated pathogens are staphylococci, streptococci, and enterococci, with Staphylococcus aureus being the most frequently diagnosed species. Furthermore, multi-drug resistance pathogens are increasing in prevalence and continue to pose new challenges mandating a personalized approach. Blood cultures in combination with echocardiography are the most common methods to diagnose PVE, often being the only indication, it exists. In many cases, the diagnostic strategy recommended in the clinical guidelines does not identify the precise microbial agent, and frequently, false-negative blood cultures are reported. Despite the fact that blood culture findings are not always a good indicator of the actual PVE agent in the valve tissue, only a minority of re-operated prostheses are subjected to microbiological diagnostic evaluation. In this review, we focus on the diversity and the complete spectrum of PVE-associated bacterial, fungal, and viral pathogens in blood and prosthetic heart valve, their possible virulence potential, and their challenges in making a microbial diagnosis. We are curious to understand if the unacceptable high mortality of PVE is associated with the high number of negative microbial findings in connection with a possible PVE. Herein, we discuss the possibilities and limits of the diagnostic methods conventionally used and make recommendations for enhanced pathogen identification. We also show possible virulence factors of the most common PVE-associated pathogens and their clinical effects. Based on blood culture, molecular biological diagnostics, and specific valve examination, better derivations for the antibiotic therapy as well as possible preventive intervention can be established in the future.
- Published
- 2022
19. Cytokine Hemoadsorption During Cardiac Surgery Versus Standard Surgical Care for Infective Endocarditis (REMOVE): Results From a Multicenter Randomized Controlled Trial
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Mahmoud Diab, Thomas Lehmann, Wolfgang Bothe, Payam Akhyari, Stephanie Platzer, Daniel Wendt, Antje-Christin Deppe, Justus Strauch, Stefan Hagel, Albrecht Günther, Gloria Faerber, Christoph Sponholz, Marcus Franz, André Scherag, Ilia Velichkov, Miriam Silaschi, Jens Fassl, Britt Hofmann, Sven Lehmann, Rene Schramm, Georg Fritz, Gabor Szabo, Thorsten Wahlers, Klaus Matschke, Artur Lichtenberg, Mathias W. Pletz, Jan F. Gummert, Friedhelm Beyersdorf, Christian Hagl, Michael A. Borger, Michael Bauer, Frank M. Brunkhorst, Torsten Doenst, Jan F Gummert, Isabella Schiller, Marcus Winter, Cornelia Eichhorn, Aicko Helbig, Florian Rißner, Kubanychbek Abdyvasiev, Alexandros Moschovas, Sebastian Freiburger, Rauf Safarov, Steffen Bargenda, Hristo Kirov, Markus Richter, Tim Sandhaus, Natig Zeynalov, Mirko Kaluza, Denis Bösemann, Swen Boog, Romanus Ostermann, P. Christian Schulze, Ali Hamadanchi, Rita Musleh, Otto W. Witte, Petra Bloos, Katrin Schwope, Steffi Kolanos, Karina Knuhr-Kohlberg, Anja Haucke, Katja Lehmann-Pohl, Carolyn Weber, Amila Cizmic, Corinna Grathwohl, Dirk Sindhu, Markus Schaschek, Axel Baier, Sebastian Schaub, Uwe Großkurth, Eranya Sone Herré, Andrey Vlasov, Dimitry Podanev, Tobias Plettenberg, Thomas Mühlbauer, Irawati Tunggal, Madlen Eichler, Jasmina Cosic, Vera Wolf, Petra Krause, Stephanie Krischer, Matthias Thielmann, Ingo Wiese, Tobias Hillmer, Jörg von Manstein, Markus Deus, Dusko Ljesic, Daniel Roloff, Tim Alabowicz Wolfgang Ristau, Gina Spangel, Johannes Kroll, Fatos Ballazhi, Stoyan Kondov, Matthias Siepe, Bartosz Rylski, Johannes Scheumann, Matthias D’Inka, Matthias Eschenhagen, Yasir Al-Hamami, Nils Bauer, Martin Thoma, Albena Rambach, Christian Ziemann, Gustavo Fernandez Baca Garcia, Julia Morlock, Christoph Benk, Alina Klink, Christoph Maltes, Gabriele Lechner, Veronika Blümel, Ulrike Heizmann, Priscilla Kotzjan, Peter Haldenwang, Mahmoud Elghannam, Dritan Useini, Dirk Buchwald, Bärbel Buchwald, Thomas Schröter, Christian Binner, Philipp Hartung, David Holzhey, Martin Misfeld, Christian Etz, Piroze Davierwala, Sergey Leontyev, Bettina Pfannmüller, Jens Garbade, Konstantin von Aspern, Diyar Saeed, Muhammed Aydin, Jonathan Herzfeld, Stefan Feder, Philipp Kiefer, Anna Meyer, Joerg Seeburger, Philipp Münch, Jörg Prehl, René Ginther, Josephine Koch, Salome Hecht, Hannes Winkler, Berit Fritzsche, Johann Winata, Julia Schmidt, Jakob Labus, Isabell Frei, Volker Schmidt, Katrin Plötze, Susanne Schal, Moritz Immohr, Yukiharu Sugimura, Anne Gietmann, Andreas Simm, Florian Höpfner, Markus Stiller, Kathrin Ludwig, Sven Helms, Jakub Sunavsky, Julia Götte, Markus Rudloff, Andrea Schönbrodt, Swetlana Fink, Ina-Maria Albrecht, Alice Huguette Minko Nnanga, Carola Schneider, Heike Schilling, Tanja Maier, Ralf-Uwe Kühnel, Stelios Ioannou, Anna-Maria Necaev, Torsten Müller, Ralph Bienek, Hendrik Treede, Zaki Kohistani, Touraj Ahmadpour, Sonja Friese, Andreas Oberbach, Maximilian Luehr, Dominik Joskowiak, and Joscha Büch
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Treatment Outcome ,Endocarditis ,Physiology (medical) ,Multiple Organ Failure ,Medizin ,Cytokines ,Humans ,Endocarditis, Bacterial ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine - Abstract
Background: Cardiac surgery often represents the only treatment option in patients with infective endocarditis (IE). However, IE surgery may lead to a sudden release of inflammatory mediators, which is associated with postoperative organ dysfunction. We investigated the effect of hemoadsorption during IE surgery on postoperative organ dysfunction. Methods: This multicenter, randomized, nonblinded, controlled trial assigned patients undergoing cardiac surgery for IE to hemoadsorption (integration of CytoSorb to cardiopulmonary bypass) or control. The primary outcome (change in sequential organ failure assessment score [ΔSOFA]) was defined as the difference between the mean total postoperative SOFA score, calculated maximally to the 9th postoperative day, and the basal SOFA score. The analysis was by modified intention to treat. A predefined intergroup comparison was performed using a linear mixed model for ΔSOFA including surgeon and baseline SOFA score as fixed effect covariates and with the surgical center as random effect. The SOFA score assesses dysfunction in 6 organ systems, each scored from 0 to 4. Higher scores indicate worsening dysfunction. Secondary outcomes were 30-day mortality, duration of mechanical ventilation, and vasopressor and renal replacement therapy. Cytokines were measured in the first 50 patients. Results: Between January 17, 2018, and January 31, 2020, a total of 288 patients were randomly assigned to hemoadsorption (n=142) or control (n=146). Four patients in the hemoadsorption and 2 in the control group were excluded because they did not undergo surgery. The primary outcome, ΔSOFA, did not differ between the hemoadsorption and the control group (1.79±3.75 and 1.93±3.53, respectively; 95% CI, –1.30 to 0.83; P =0.6766). Mortality at 30 days (21% hemoadsorption versus 22% control; P =0.782), duration of mechanical ventilation, and vasopressor and renal replacement therapy did not differ between groups. Levels of interleukin-1β and interleukin-18 at the end of integration of hemoadsorption to cardiopulmonary bypass were significantly lower in the hemoadsorption than in the control group. Conclusions: This randomized trial failed to demonstrate a reduction in postoperative organ dysfunction through intraoperative hemoadsorption in patients undergoing cardiac surgery for IE. Although hemoadsorption reduced plasma cytokines at the end of cardiopulmonary bypass, there was no difference in any of the clinically relevant outcome measures. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03266302.
- Published
- 2022
20. Surgery for infective endocarditis following low-intermediate risk transcatheter aortic valve replacement—a multicentre experience
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Shekhar Saha, Dominik Joskowiak, Mateo Marin-Cuartas, Mahmoud Diab, Benedikt M Schwaiger, Rodrigo Sandoval-Boburg, Aron-Frederik Popov, Carolyn Weber, Sam Varghese, Andreas Martens, Serghei Cebotari, Maximilian Scherner, Walter Eichinger, David Holzhey, Daniel-Sebastian Dohle, Thorsten Wahlers, Torsten Doenst, Martin Misfeld, Julinda Mehilli, Steffen Massberg, and Christian Hagl
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Endocarditis ,Aortic Valve Stenosis ,Endocarditis, Bacterial ,General Medicine ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Risk Factors ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,Aged ,Retrospective Studies - Abstract
OBJECTIVES With the expansion of transcatheter aortic valve replacement (TAVR) into intermediate and low risk, the number of TAVR procedures is bound to rise and along with it the number of cases of infective endocarditis following TAVR (TIE). The aim of this study was to review a multicentre experience of patients undergoing surgical intervention for TIE and to analyse the underlying indications and operative results. METHODS We retrospectively identified and analysed 69 patients who underwent cardiac surgery due to TIE at 9 cardiac surgical departments across Germany. The primary outcome was operative mortality, 6-month and 1-year survival. RESULTS Median age was 78 years (72–81) and 48(69.6%) were male. The median time to surgical aortic valve replacement was 14 months (5–24) after TAVR, with 32 patients (46.4%) being diagnosed with early TIE. Cardiac reoperations were performed in 17% of patients and 33% underwent concomitant mitral valve surgery. The main causative organisms were: Enterococcus faecalis (31.9%), coagulase-negative Staphylococcus spp. (26.1%), Methicillin-sensitive Staphylococcus aureus (15.9%) and viridians group streptococci (14.5%). Extracorporeal life support was required in 2 patients (2.9%) for a median duration of 3 days. Postoperative adverse cerebrovascular events were observed in 13 patients (18.9%). Postoperatively, 9 patients (13.0%) required a pacemaker and 33 patients (47.8%) needed temporary renal replacement therapy. Survival to discharge was 88.4% and survival at 6 months and 1 year was found to be 68% and 53%, respectively. CONCLUSIONS Our results suggest that TIE can be treated according to the guidelines for prosthetic valve endocarditis, namely with early surgery. Surgery for TIE is associated with acceptable morbidity and mortality rates. Surgery should be discussed liberally as a treatment option in patients with TIE by the ‘endocarditis team’ in referral centres.
- Published
- 2022
21. Erratum zu: Infektiöse Endokarditis
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Shekhar Saha, Philipp Schnackenburg, Sebastian Sadoni, Dominik Joskowiak, and Christian Hagl
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
22. Hemoadsorption in the critically ill-Final results of the International CytoSorb Registry
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Fatime Hawchar, Dana Tomescu, Karl Träger, Dominik Joskowiak, Klaus Kogelmann, Jens Soukup, Singrun Friesecke, David Jacob, Jan Gummert, Andreas Faltlhauser, Filippo Aucella, Martijn van Tellingen, Manu L. N. G. Malbrain, Ralph Bogdanski, Günter Weiss, Andreas Herbrich, Stefan Utzolino, Axel Nierhaus, Andreas Baumann, Andreas Hartjes, Dietrich Henzler, Evgeny Grigoryev, Harald Fritz, Friedhelm Bach, Stefan Schröder, Andreas Weyland, Udo Gottschaldt, Matthias Menzel, Olivier Zachariae, Radovan Novak, Jernej Berden, Hendrik Haake, Michael Quintel, Stephan Kloesel, Andreas Kortgen, Stephanie Stecher, Patricia Torti, Frieder Nestler, Markus Nitsch, Detlef Olboeter, Philip Muck, Michael Findeisen, Diane Bitzinger, Jens Kraßler, Martin Benad, Martin Schott, Ulrike Schumacher, Zsolt Molnar, and Frank Martin Brunkhorst
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Multidisciplinary ,C-Reactive Protein ,ROC Curve ,Interleukin-6 ,Critical Illness ,Sepsis ,Humans ,Registries ,Prognosis ,Procalcitonin ,Shock, Septic ,Biomarkers - Abstract
The aim of the current paper is to summarize the results of the International CytoSorb Registry. Data were collected on patients of the intensive care unit. The primary endpoint was actual in-hospital mortality compared to the mortality predicted by APACHE II score. The main secondary endpoints were SOFA scores, inflammatory biomarkers and overall evaluation of the general condition. 1434 patients were enrolled. Indications for hemoadsorption were sepsis/septic shock (N = 936); cardiac surgery perioperatively (N = 172); cardiac surgery postoperatively (N = 67) and “other” reasons (N = 259). APACHE-II-predicted mortality was 62.0±24.8%, whereas observed hospital mortality was 50.1%. Overall SOFA scores did not change but cardiovascular and pulmonary SOFA scores decreased by 0.4 [-0.5;-0.3] and -0.2 [-0.3;-0.2] points, respectively. Serum procalcitonin and C-reactive protein levels showed significant reduction: -15.4 [-19.6;-11.17] ng/mL; -17,52 [-70;44] mg/L, respectively. In the septic cohort PCT and IL-6 also showed significant reduction: -18.2 [-23.6;-12.8] ng/mL; -2.6 [-3.0;-2.2] pg/mL, respectively. Evaluation of the overall effect: minimal improvement (22%), much improvement (22%) and very much improvement (10%), no change observed (30%) and deterioration (4%). There was no significant difference in the primary outcome of mortality, but there were improvements in cardiovascular and pulmonary SOFA scores and a reduction in PCT, CRP and IL-6 levels. Trial registration: ClinicalTrials.gov Identifier: NCT02312024 (retrospectively registered).
- Published
- 2021
23. Wearable cardioverter defibrillator multicentre experience in a large cardiac surgery cohort at transient risk of sudden cardiac death
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Christian Kuehn, Stefan Ruemke, Philipp Rellecke, Artur Lichtenberg, Dominik Joskowiak, Christian Hagl, Mohamed Hassan, Rainer G Leyh, Stefan Erler, Jens Garbade, Sandra Eifert, Philippe Grieshaber, Andreas Boening, Torsten Doenst, Ilia Velichkov, Tomas Madej, Michael Knaut, Andreas Hain, and Heiko Burger
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Pulmonary and Respiratory Medicine ,Male ,Stroke Volume ,General Medicine ,Ventricular Function, Left ,Defibrillators, Implantable ,Wearable Electronic Devices ,Death, Sudden, Cardiac ,Humans ,Surgery ,Female ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,Aged ,Retrospective Studies - Abstract
OBJECTIVESThe wearable cardioverter defibrillator (WCD) is an established, safe, effective solution, protecting patients at risk of sudden cardiac death. We specifically investigated WCD use in cardiac surgery patients since data for this patient group are rare.METHODSRetrospective data analysis in 10 German cardiac surgery centres was performed. Cardiac surgery patients with left ventricular ejection fraction (LVEF) ≤35% or after implantable cardioverter defibrillator (ICD) explantation who received WCD between 2010 and 2020 were assessed using LifeVest Network data.RESULTSA total of 1168 patients with a median age of 66 years [interquartile range (IQR) 57–73] were enrolled; 87% were male. Clinical indications included coronary artery bypass grafting (43%), valve surgery (16%), combined coronary artery bypass graft/valve surgery (15%), ICD explantation (24%) and miscellaneous (2%). The median wear time of WCD was 23.4 h/day (IQR 21.7–23.8). A total of 106 patients (9.1%) exhibited ventricular tachycardia. A total of 93.2% of episodes occurred within the first 3 months. Eighteen patients (1.5%) received 26 adequate shocks. The inadequate shock rate was low (8 patients, 0.7%). LVEF improved from a median of 28% (IQR 22–32%) before WCD prescription to 35% (IQR 28–42%) during follow-up. Excluding ICD explant patients, 37% of patients received an ICD.CONCLUSIONSThe risk of sudden cardiac death is substantial within the first 3 months after cardiac surgery. Patients were protected effectively by WCD. Due to significant LVEF improvement, the majority did not require ICD implantation after WCD use. Compliance was high despite sternotomy. This multicentre experience confirms existing data regarding effectiveness, safety and compliance. Therefore, WCD should be considered in cardiac surgery patients with severely reduced LVEF.
- Published
- 2021
24. [Transapical aortic valve implantation--indications, risks and limitations]
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U, Kappert, Dominik, Joskowiak, S M, Tugtekin, and K, Matschke
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Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Male ,Cardiac Catheterization ,Time Factors ,Patient Selection ,Calcinosis ,Aortic Valve Stenosis ,Risk Assessment ,Treatment Outcome ,Risk Factors ,Germany ,Humans ,Female ,Hospital Mortality ,Aged - Abstract
Calcified aortic stenosis is the predominant valve disease in the western world. Currently, surgical aortic valve replacement is the gold standard procedure for symptomatic severe aortic stenosis that can be performed with low morbidity and mortality. The prevalence of aortic stenosis increases with age, and the incidence of several comorbidities also unavoidably elevates the risk of surgical treatment. Therefore, the most adequate and gentle treatment is needed especially for this population. Since the first transcatheter aortic valve implantation (TAVI) was performed in 2002, the main implanting routes are the transfemoral, retrograde access through the common femoral artery, and the antegrade, transapical approach via anterolateral minithoracotomy. Meanwhile, TAVI has become an alternative treatment for patients who are not suitable candidates for surgical therapy in some centers.The initial clinical results are promising and have confirmed the feasibility of this technique. Due to the restricted long-term data, conventional aortic valve replacement still remains the standard for the treatment of aortic stenosis. Selection of the suitable therapy approach (surgical replacement, transfemoral or transapical aortic valve implantation) must consider each patient's specific risk profile and individual indication. Prospective, randomized trials will be necessary to assess the individual survival benefit of TAVI for various risk populations and to extend the indication.
- Published
- 2012
25. Reply
- Author
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Dominik Joskowiak
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2012
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