36 results on '"Menghesha, Hruy"'
Search Results
2. Stage I and II Small-Cell Lung Cancer-New Challenge for Surgery
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Doerr, Fabian, Stange, Sebastian, Michel, Maximilian, Schlachtenberger, Georg, Menghesha, Hruy, Wahlers, Thorsten, and Hekmat, Khosro
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Medical research ,Medicine, Experimental ,Lung cancer -- Care and treatment ,Surgery ,Health - Abstract
Purpose The recommended treatment for small-cell lung cancer (SCLC) currently is surgery in stage I disease. We wondered about stage II SCLC and present a meta-analysis on mean-survival of patients that underwent surgery for stage I and II compared to controls. Methods A systematic literature search was performed on December 01st 2021 in Medline, Embase and Cochrane Library. We considered studies published on the effect of surgery in SCLC since 2004 and assessed them using ROBINS-I. We preformed I.sup.2-tests, Q-statistics, DerSimonian-Laird tests and Egger-regression. The meta-analysis was conducted according to PRISMA. Results Out of 6826 records, seven studies with a total of 11,241 patients ('surgery group': 3911 patients; 'non-surgery group': 7330; treatment period: 1984-2015) were included. Heterogeneity between the studies was revealed in absence of any publication bias. Patient characteristics did not differ between the groups (p-value > 0.05). The mean-survival in an analysis of patients in stage I was 36.7 ± 10.8 months for the 'surgery group' and 20.3 ± 5.7 months for the 'non-surgery group' (p-value = 0.0084). A combined analysis of patients in stage I and II revealed a mean-survival of 32.0 ± 16.7 months for the 'surgery group' and 19.1 ± 6.1 months for the 'non-surgery group' (p-value = 0.0391). In a separate analysis of stage II, we were able to demonstrate a significant survival benefit after surgery (21.4 ± 3.6 versus 16.2 ± 3.9 months; p-value = 0.0493). Conclusion Our meta-analysis shows a significant survival benefit after surgery not only in the recommended stage I but also in stage II SCLC. Our data suggests that both stages should be considered for surgery of early SCLC., Author(s): Fabian Doerr [sup.1], Sebastian Stange [sup.2], Maximilian Michel [sup.3], Georg Schlachtenberger [sup.1], Hruy Menghesha [sup.1], Thorsten Wahlers [sup.1], Khosro Hekmat [sup.1], Matthias B. Heldwein [sup.1] Author Affiliations: (1) grid.411097.a, [...]
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- 2022
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3. Sublobar resection without staging and lymphadenectomy for ≤2 cm Non-Small Cell Lung Cancer is no adequate therapy
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Schlachtenberger, Georg, Doerr, Fabian, Menghesha, Hruy, Hagmeyer, Lars, Bennink, Gerardus, Gaisendrees, Christopher, Wahlers, Thorsten, Hekmat, Khosro, and Heldwein, Matthias B.
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- 2022
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4. Hemangiosis carcinomatosa as an independent risk factor for long-term survival in Non-Small Cell Lung Cancer patients
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Heldwein, Matthias, Menghesha, Hruy, Doerr, Fabian, Schlachtenberger, Georg, Günther, Aldisa, Polegenko, Evgenija, Amorin Estremadoyro, Andres, Quaas, Alexander, Bennink, Gerardus, Wahlers, Thorsten, and Hekmat, Khosro
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- 2022
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5. Different pulmonary adenocarcinoma growth patterns significantly affect survival
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Heldwein, Matthias B., Schlachtenberger, Georg, Doerr, Fabian, Menghesha, Hruy, Bennink, Gerardus, Schroeder, Karl-Moritz, Schaefer, Stephan C., Wahlers, Thorsten, and Hekmat, Khosro
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- 2022
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6. Der Stellenwert der Thymektomie ohne Thymom in der Therapie der Myasthenia gravis
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Menghesha, Hruy, Schroeter, Michael, Doerr, Fabian, Schlachtenberger, Georg, Heldwein, Matthias B., Chiapponi, Costanza, Wahlers, Thorsten, Bruns, Christiane, and Hekmat, Khosro
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- 2022
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7. LIONS PREY: A New Logistic Scoring System for the Prediction of Malignant Pulmonary Nodules
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Doerr, Fabian, primary, Giese, Annika, additional, Höpker, Katja, additional, Menghesha, Hruy, additional, Schlachtenberger, Georg, additional, Grapatsas, Konstantinos, additional, Baldes, Natalie, additional, Baldus, Christian J., additional, Hagmeyer, Lars, additional, Fallouh, Hazem, additional, Pinto dos Santos, Daniel, additional, Bender, Edward M., additional, Quaas, Alexander, additional, Heldwein, Matthias, additional, Wahlers, Thorsten, additional, Hautzel, Hubertus, additional, Darwiche, Kaid, additional, Taube, Christian, additional, Schuler, Martin, additional, Hekmat, Khosro, additional, and Bölükbas, Servet, additional
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- 2024
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8. Postoperative long-term survival of non-small cell lung cancer patients with skip-N2 metastases
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Schlachtenberger, Georg, Doerr, Fabian, Menghesha, Hruy, Heldwein, Matthias B., Hagmeyer, Lars, Michel, Maximilian, Schaefer, Stephan C., Wahlers, Thorsten, and Hekmat, Khosro
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- 2021
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9. Lymphangiosis carcinomatosa independently affects long-term survival of Non-Small Cell Lung Cancer patients
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Heldwein, Matthias B., Doerr, Fabian, Schlachtenberger, Georg, Menghesha, Hruy, Kuhn, Elmar W., Scheel, Andreas H., Michel, Maximilian, Wahlers, Thorsten, and Hekmat, Khosro
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- 2021
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10. Closing the RCT Gap—A Large Meta-Analysis on the Role of Surgery in Stage I–III Small Cell Lung Cancer Patients.
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Doerr, Fabian, Stange, Sebastian, Salamon, Sophie, Grapatsas, Konstantinos, Baldes, Natalie, Michel, Maximilian, Menghesha, Hruy, Schlachtenberger, Georg, Heldwein, Matthias B., Hagmeyer, Lars, Wolf, Jürgen, Roessner, Eric D., Wahlers, Thorsten, Schuler, Martin, Hekmat, Khosro, and Bölükbas, Servet
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TREATMENT of lung tumors ,META-analysis ,DESCRIPTIVE statistics ,SYSTEMATIC reviews ,LUNG tumors ,INFERENTIAL statistics ,SMALL cell carcinoma ,TUMOR classification ,SURVIVAL analysis (Biometry) ,REGRESSION analysis - Abstract
Simple Summary: Despite guidelines recommending surgery as part of treatment for stage I small cell lung cancer (SCLC), its application remains inconsistent, and its role in stages II and III is under debate. In absence of current randomized control trials this meta-analysis compared surgery to non-surgical treatment for stages I to III SCLC. After a systematic review, ten studies with a total of 95,323 patients were analyzed. The analysis found no significant differences in patient characteristics between the surgery and non-surgery groups. The 5-year survival rate for resected patients was significantly higher compared to non-surgically treated patients. This finding was valid also for patients in stages II and III. Surgery might significantly improve survival in SCLC patients and should be considered in treatment planning even in higher stages. Introduction: Despite clear guideline recommendations, surgery is not consistently carried out as part of multimodal therapy in stage I small cell lung cancer (SCLC) patients. The role of surgery in stages II and III is even more controversial. In the absence of current randomized control trials (RCT), we performed a meta-analysis comparing surgery versus non-surgical treatment in stage I to III SCLC patients. Methods: A systematic review of the literature was conducted on 1 July 2023, focusing on studies pertaining to the impact of surgery on small cell lung cancer (SCLC). These studies were evaluated using the ROBINS-I tool. Statistical analyses, including I² tests, Q-statistics, DerSimonian-Laird tests, and Egger regression, were performed to assess the data. In addition, 5-year survival rates were analyzed. The meta-analysis was conducted according to PRISMA standards. Results: Among the 6826 records identified, 10 original studies encompassing a collective cohort of 95,323 patients were incorporated into this meta-analysis. Heterogeneity was observed across the included studies, with no discernible indication of publication bias. Analysis of patient characteristics revealed no significant differences between the two groups (p-value > 0.05). The 5-year survival rates in a combined analysis of patients in stages I–III were 39.6 ± 15.3% for the 'surgery group' and 16.7 ± 12.7% for the 'non-surgery group' (p-value < 0.0001). SCLC patients in stages II and III treated outside the guideline with surgery had a significantly better 5-year survival compared to non-surgery controls (36.3 ± 20.2% vs. 20.2 ± 17.0%; p-value = 0.043). Conclusions: In the absence of current RCTs, this meta-analysis provides robust suggestions that surgery might significantly improve survival in all SCLC stages. Non-surgical therapy could lead to a shortening of life. The feasibility of surgery in non-metastatic SCLC should always be evaluated as part of a multimodal treatment. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Postoperative Tobacco Cessation Improves Quality of Life, Lung Function and Long-Term Survival in Non-Small-Cell Lung Cancer Patients
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Doerr, Fabian, primary, Leschczyk, Tobias, additional, Grapatsas, Konstantinos, additional, Menghesha, Hruy, additional, Baldes, Natalie, additional, Schlachtenberger, Georg, additional, Heldwein, Matthias B., additional, Michel, Maximilian, additional, Quaas, Alexander, additional, Hagmeyer, Lars, additional, Höpker, Katja, additional, Wahlers, Thorsten, additional, Darwiche, Kaid, additional, Taube, Christian, additional, Schuler, Martin, additional, Hekmat, Khosro, additional, and Bölükbas, Servet, additional
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- 2024
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12. Pneumonectomy for Primary Lung Tumors and Pulmonary Metastases: A Comprehensive Study of Postoperative Morbidity, Early Mortality, and Preoperative Clinical Prognostic Factors
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Grapatsas, Konstantinos, primary, Menghesha, Hruy, additional, Dörr, Fabian, additional, Baldes, Natalie, additional, Schuler, Martin, additional, Stuschke, Martin, additional, Darwiche, Kaid, additional, Taube, Christian, additional, and Bölükbas, Servet, additional
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- 2023
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13. New Prognostic Score (Essen Score) to Predict Postoperative Morbidity after Resection of Lung Metastases
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Grapatsas, Konstantinos, primary, Dörr, Fabian, additional, Menghesha, Hruy, additional, Schuler, Martin, additional, Grünwald, Viktor, additional, Bauer, Sebastian, additional, Schmidt, Hartmut H. -J., additional, Lang, Stephan, additional, Kimmig, Rainer, additional, Kasper, Stefan, additional, Baldes, Natalie, additional, and Bölükbas, Servet, additional
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- 2023
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14. Do skip-N2 metastases significantly impact overall survival and disease-free interval in N2 non-small-cell lung cancer patients? A multicentre analysis
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Schlachtenberger, Georg, primary, Schallenberg, Simon, additional, Doerr, Fabian, additional, Menghesha, Hruy, additional, Gaisendrees, Christopher, additional, Amorin, Andres, additional, Grathwohl, Corinna, additional, Büttner, Reinhard, additional, Quaas, Alexander, additional, Horst, David, additional, Klauschen, Frederick, additional, Frost, Nikolaj, additional, Rueckert, Jens-C, additional, Neudecker, Jens, additional, Höpker, Katja, additional, Wahlers, Thorsten, additional, Hekmat, Khosro, additional, and Heldwein, Matthias B, additional
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- 2023
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15. A comparative study of four thoracic mortality scores
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Schlachtenberger, Georg, primary, Doerr, Fabian, additional, Menghesha, Hruy, additional, Amorin, Andres, additional, Gaisendrees, Christopher, additional, Miesen, Sebastian, additional, Seibel, Christian, additional, Wahlers, Thorsten, additional, Hekmat, Khosro, additional, and Heldwein, Matthias B., additional
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- 2023
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16. Prognostic impact of lymph node spreading pattern in N2 NSCLC patients
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Schlachtenberger, Georg, primary, Doerr, Fabian, additional, Menghesha, Hruy, additional, Amorin, Andres, additional, Hoepker, Katja, additional, Hagmeyer, Lars, additional, Wahlers, Thorsten, additional, Hekmat, Khosro, additional, and Heldwein, Matthias B., additional
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- 2023
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17. Der Stellenwert der Thymektomie ohne Thymom in der Therapie der Myasthenia gravis
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Menghesha, Hruy, Schroeter, Michael, Doerr, Fabian, Schlachtenberger, Georg, Heldwein, Matthias B., Chiapponi, Costanza, Wahlers, Thorsten, Bruns, Christiane, and Hekmat, Khosro
- Abstract
Der Stellenwert der Thymektomie in der Therapie der thymomfreien Myasthenia gravis blieb bis vor einiger Zeit umstritten. Die relativ geringe Inzidenz und Prävalenz der Erkrankung, die uneinheitliche Dokumentation in den verschiedenen Studien sowie die notwendige Langzeitbeobachtung zur Erfassung therapeutischer Effekte erschwerten das Generieren valider Daten. Die Veröffentlichung des MGTX-Trials 2016 im New England Journal of Medicinelieferte die ersten randomisiert-kontrollierten Daten, nach denen Patienten mit Acetylcholin-Rezeptor-Antikörper-positiver generalisierter Myasthenia gravis im Alter von 18 bis 65 Jahren von der chirurgischen Resektion des Thymus über eine mediane Sternotomie profitieren. Trotz fehlender Validierung des Vorteils der Thymektomie über minimal-invasive Techniken durch randomisiert-kontrollierte Studien scheinen diese das Outcome bestimmter Patientengruppen in ähnlicher Form positiv zu beeinflussen. So haben videoassistiert-thorakoskopische, roboterassistierte, subxiphoidale und transzervikale Zugangswege nicht nur ästhetische Vorteile, sondern zeigen in der Beeinflussung des Krankheitsverlaufs der Myasthenia gravis keine relevante Unterlegenheit gegenüber der medianen Sternotomie. Doch nicht nur der Nutzen und das ästhetische Ergebnis differieren, sondern auch die Erfolgsaussichten im Hinblick auf die Remission sind bei den Unterformen der Myasthenia gravis unterschiedlich. Die heterogene Gruppe der Myasthenien unterscheidet sich bezüglich des Auftretens von Autoantikörpern, der betroffenen Körperregionen und des Alters der Patienten bei Erstdiagnose. Schließlich ist die Thymektomie eine wirksame kausale Therapie der Myasthenia gravis.
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- 2024
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18. The impact of thymectomy in subgroups of Myasthenia gravis patients: a single center longitudinal observation.
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Menghesha, Hruy, Schroeter, Michael, Nelke, Christopher, Ruck, Tobias, Schlachtenberger, Georg, Welskop, Clara, Camo, Amina, Heldwein, Matthias, Bennink, Gerardus, Wahlers, Thorsten, Bölükbas, Servet, Doerr, Fabian, and Hekmat, Khosro
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MYASTHENIA gravis ,THYMECTOMY ,NEUROMUSCULAR diseases ,CHOLINERGIC receptors ,RECEPTOR antibodies ,IMMUNOSUPPRESSIVE agents - Abstract
Background: Myasthenia gravis (MG) is a rare neuromuscular disorder. Symptoms can range from ptosis only to life threatening myasthenic crisis. Thymectomy is recommended for anti-acetylcholine receptor-antibody positive patients with early-onset MG. Here, we investigated prognostic factors shaping therapeutic outcomes of thymectomy to improve patient stratification. Methods: We retrospectively collected single-center data from a specialized center for MG from all consecutive adult patients that underwent thymectomy from 01/2012 to 12/2020. We selected patients with thymoma-associated and non-thymomatous MG for further investigations. We analyzed the patient collective regarding perioperative parameters in relation to the surgical approach. Furthermore, we investigated the dynamics of the anti-acetylcholine receptor-antibody titers and concurrent immunosuppressive therapies, as well as the therapeutic outcomes in dependence of clinical classifications. Results: Of 137 patients 94 were included for further analysis. We used a minimally invasive approach in 73 patients, whereas 21 patients underwent sternotomy. A total of 45 patients were classified as early-onset MG (EOMG), 28 as late-onset MG (LOMG) and 21 as thymoma-associated MG (TAMG). The groups differed in terms of age at diagnosis (EOMG: 31.1 ± 12.2 years; LOMG: 59.8 ± 13.7 years; TAMG: 58.6 ± 16.7 years; p < 0.001). Patients with EOMG and TAMG were more often female than patients in the LOMG group (EOMG: 75.6%; LOMG: 42.9%; TAMG: 61.9%; p = 0.018). There were no significant differences in outcome scores (quantitative MG; MG activities of daily living; MG Quality of Live) with a median follow-up of 46 months. However, Complete Stable Remission was achieved significantly more frequently in the EOMG group than in the other two groups (p = 0.031). At the same time, symptoms seem to improve similarly in all three groups (p = 0.25). Conclusion: Our study confirms the benefit of thymectomy in the therapy of MG. Both, the concentration of acetylcholine receptor antibodies and the necessary dosage of cortisone therapy show a continuous regression after thymectomy in the overall cohort. Beyond EOMG, groups of LOMG and thymomatous MG responded to thymectomy as well, but therapy success was less pronounced and delayed compared to the EOMG subgroup. Thymectomy is a mainstay of MG therapy to be considered in all subgroups of MG patients investigated. [ABSTRACT FROM AUTHOR]
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- 2023
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19. Patients with Pulmonary Metastases from Head and Neck Cancer Benefit from Pulmonary Metastasectomy, A Systematic Review
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Schlachtenberger, Georg, primary, Doerr, Fabian, additional, Menghesha, Hruy, additional, Lauinger, Patrick, additional, Wolber, Philipp, additional, Sabashnikov, Anton, additional, Popov, Aron-Frederik, additional, Macherey-Meyer, Sascha, additional, Bennink, Gerardus, additional, Klussmann, Jens P., additional, Wahlers, Thorsten, additional, Hekmat, Khosro, additional, and Heldwein, Mathias B., additional
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- 2022
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20. The value of thymectomy in the treatment of non-thymomatous myasthenia gravis
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Menghesha, Hruy, Schroeter, Michael, Doerr, Fabian, Schlachtenberger, Georg, Heldwein, Matthias B., Chiapponi, Costanza, Wahlers, Thorsten, Bruns, Christiane, Hekmat, Khosro, Menghesha, Hruy, Schroeter, Michael, Doerr, Fabian, Schlachtenberger, Georg, Heldwein, Matthias B., Chiapponi, Costanza, Wahlers, Thorsten, Bruns, Christiane, and Hekmat, Khosro
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The value of thymectomy in the treatment of non-thymomatous myasthenia gravis has been controversially discussed. The relatively low incidence and prevalence of this disease, the inconsistent documentation in various studies and the necessity of a long-term follow-up to assess the therapeutic effects has made the generation of valid data difficult. The publication in 2016 of the MGTX trial in the New England Journal of Medicine delivered the first randomized controlled data in which patients aged 18-65 years with generalized myasthenia gravis and positive for acetylcholine receptor antibodies showed a significant benefit after surgical resection of the thymus via median sternotomy. Despite a lack of validation of the advantages of thymectomy by minimally invasive surgery from randomized controlled studies, this technique seems to positively influence the outcome of certain patient groups in a similar way. Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) using subxyphoidal and transcervical access routes showed not only esthetic advantages but also showed no relevant inferiority in the influence on clinical outcomes of myasthenia gravis compared to median sternotomy; however, not only the benefits and the esthetic results show differences but also the advantages in the various subtypes of myasthenia gravis show divergent prospects of success with respect to remission. The clinical spectrum of myasthenia is heterogeneous with respect to the occurrence of antibodies, the body region affected and the age of the patient at first diagnosis. Ultimately, thymectomy is an effective causal treatment of myasthenia gravis.
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- 2022
21. Patients with Pulmonary Metastases from Head and Neck Cancer Benefit from Pulmonary Metastasectomy, A Systematic Review
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Schlachtenberger, Georg, Doerr, Fabian, Menghesha, Hruy, Lauinger, Patrick, Wolber, Philipp, Sabashnikov, Anton, Popov, Aron-Frederik, Macherey-Meyer, Sascha, Bennink, Gerardus, Klussmann, Jens P., Wahlers, Thorsten, Hekmat, Khosro, Heldwein, Mathias B., Schlachtenberger, Georg, Doerr, Fabian, Menghesha, Hruy, Lauinger, Patrick, Wolber, Philipp, Sabashnikov, Anton, Popov, Aron-Frederik, Macherey-Meyer, Sascha, Bennink, Gerardus, Klussmann, Jens P., Wahlers, Thorsten, Hekmat, Khosro, and Heldwein, Mathias B.
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Background and Objectives: The incidence of distant metastases in patients with head and neck cancer (HNC) is approximately 10%. Pulmonary metastases are the most frequent distant location, with an incidence of 70-85%. The standard treatment options are chemo-, immuno- and radiotherapy. Despite a benefit for long-term survival for patients with isolated pulmonary metastases, pulmonary metastasectomy (PM) is not the treatment of choice. Furthermore, many otorhinolaryngologists are not sufficiently familiar with the concept of PM. This work reviews the recent studies of pulmonary metastatic HNC and the results after pulmonary metastasectomy. Materials and Methods: PubMed, Medline, Embase, and the Cochrane library were checked for the case series' of patients undergoing metastasectomy with pulmonary metastases published since 1 January 2000. Results: We included the data of 15 studies of patients undergoing PM. The 5-year survival rates varied from 21% to 59%, with median survival from 10 to 77 months after PM. We could not identify one specific prognostic factor for long-term survival after surgery. However, at least most studies stated that PM should be planned if a complete (R0) resection is possible. Conclusions: PM showed reliable results and is supposedly the treatment of choice for patients with isolated pulmonary metastases. Patients not suitable for surgery may benefit from other non-surgical therapy. Every HNC patient with pulmonary metastases should be discussed in the multidisciplinary tumor board to optimize the therapy and the outcome.
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- 2022
22. Pulmonary metastasectomy for metastatic head and neck cancer prolongs survival significantly compared to non-surgical therapy
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Schlachtenberger, Georg, Doerr, Fabian, Menghesha, Hruy, Heldwein, Matthias B., Lauinger, Patrick, Wolber, Philipp, Klussmann, Jens Peter, Wahlers, Thorsten, Hekmat, Khosro, Schlachtenberger, Georg, Doerr, Fabian, Menghesha, Hruy, Heldwein, Matthias B., Lauinger, Patrick, Wolber, Philipp, Klussmann, Jens Peter, Wahlers, Thorsten, and Hekmat, Khosro
- Abstract
OBJECTIVES Pulmonary metastasectomy (PM) is an established procedure for selected patients with metastatic head and neck cancer (HNC). Non-surgical therapy in the form of chemo- and immunotherapy and checkpoint inhibitors and radiation therapy are also treatment options. There are no randomized controlled trials comparing PM with non-surgical therapy. Here, we retrospectively compare the long-term survival of patients, undergoing PM with patients receiving non-surgical therapy. METHODS All HNC patients with pulmonary metastases were included, if the primary HNC was treated curatively and distant metastases, apart from the lungs were excluded. The pulmonary metastases were confirmed by biopsy as metastases of the HNC primary tumour in the non-surgical therapy group. To further clarify that PM prolonged survival, a propensity score-matched analysis was performed. RESULTS Between January 2010 and December 2020, 62 HNC patients with isolated pulmonary metastases were included in our analysis. Thirty-three underwent PM and 29 received non-surgical therapy. Histology, tumour stage and localization of the primary HNC did not differ between groups. The number of metastases, age and ASA classification did also not differ between the groups. Patients undergoing PM showed significantly better 1- (n = 31; 93.5% vs n = 19; 65.5%; P = 0.006), 3- (n = 17; 72.2% vs n = 9; 30.4%; P = 0.004) and 5-year (n = 10; 53.4% vs n = 4; 20.0%; P = 0.001) survival rates, compared to patients receiving non-surgical therapy. CONCLUSIONS Patients with pulmonary metastatic HNC undergoing PM had a significantly better overall survival compared to patients receiving non-surgical therapy. Therefore, selected patients should undergo PM to improve survival.
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- 2022
23. Neoadjuvant chemoimmunotherapy as a potential therapeutic option in NSCLC UICC stage IIIA with multilevel N2 disease
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Menghesha, Hruy, Doerr, Fabian, Schlachtenberger, Georg, Estremadoyro, Andres Amorin, Toepelt, Karin, Wahlers, Thorsten, Hekmat, Khosro, Heldwein, Matthias, Menghesha, Hruy, Doerr, Fabian, Schlachtenberger, Georg, Estremadoyro, Andres Amorin, Toepelt, Karin, Wahlers, Thorsten, Hekmat, Khosro, and Heldwein, Matthias
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Lung Cancer is still one of the leading causes for cancer related death worldwide. The determina-tion of an adequate therapeutic approach requests a precise staging, which contains computed to-mography (CT) of the thorax, positron emission tomography computed tomography (PET-CT), cerebral magnetic resonance imaging (cMRI) and pulmonary function testing as well as the pa-tient's opinion. In UICC stages I and II, if there is functional operability and technical resectabil-ity, the treatment of choice is primary surgery followed by adjuvant therapy depending on lymph node status, while patients in the metastatic stage IV, or with locally advanced, nonresectable dis-ease are more likely to receive definitive chemoradiation therapy. The UICC Stage III (8th edi-tion) combines a heterogeneous group of patients that remains the focus of discussion regarding the optimal therapeutic regimen, which ranges from primary surgical care to a neoadjuvant ther-apeutic approach, to definitive conservative treatment. Since March 2020, we have been treating a patient on an interdisciplinary basis who initially had a UICC stage IIIA multilevel N-2 pul-monary adenocarcinoma and finally underwent successful surgery after a very good response to neoadjuvant chemoimmunotherapy. Our latest follow-up showed no evidence of recurrence. Sim-ilar to current ongoing studies our case shows, that neoadjuvant immunotherapy is a reasonable alternative to conventional neoadjuvant chemotherapy.
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- 2022
24. Sublobar resection without staging and lymphadenectomy for=2 cm Non-Small Cell Lung Cancer is no adequate therapy
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Schlachtenberger, Georg, Doerr, Fabian, Menghesha, Hruy, Hagmeyer, Lars, Bennink, Gerardus, Gaisendrees, Christopher, Wahlers, Thorsten, Hekmat, Khosro, Heldwein, Matthias B., Schlachtenberger, Georg, Doerr, Fabian, Menghesha, Hruy, Hagmeyer, Lars, Bennink, Gerardus, Gaisendrees, Christopher, Wahlers, Thorsten, Hekmat, Khosro, and Heldwein, Matthias B.
- Abstract
Objective: Sublobar resection is frequently performed for Non-Small Cell Lung Cancer (NSCLC) patients with <= 2 cm nodules. Frequently, both proper staging and radical lymphadenectomy are omitted in these operations. Therefore, we decided to evaluate the number of lymph node metastases and the number of postoperative nodal upstaging in patients undergoing pulmonary resection due to NSCLC with tumors <= 2 cm at our institution. Methods: Nodal upstaging, lymphangiosis-(L1), and hemangiosis carcinomatosa (V1) were analyzed. pN0 patients were compared to patients with postoperative nodal upstaging. One-, three, and five-year survival rates were measured. Survival was also assessed by the Kaplan-Meier method. Results: 747 patients underwent surgery for NSCLC at our institution between 2012 and 2020. We retrospectively reviewed data of 236 NSCLC patients with <= 2 cm tumors. The mean tumor size was 1.4 cm +/- 0.39 in our cohort. Of our patients, 14% showed a cT1a tumor, and 86% of patients cT1b. 24.0 +/- 12.3 lymph nodes were dissected and analyzed per patient, and 0.7 +/- 2.0 of those were affected. Of our patients, 16.1% showed L1 affection, and 7.6% a V1 affection. Lymph node involvement was diagnosed in 11(4.7%) patients preoperatively. 39(16.5%) patients were upstaged due to lymph node involvement postoperatively (p < 0.001). Upstaged patients showed significantly worse 3-(upstaged: 60.6% vs. pN0: 83.2%; p = 0.01) and 5-year (upstages: 38% vs. pN0 71.5%; p = 0.02) survival rates. Conclusion: 16.5% of patients with <= 2 cm NSCLC were nodal upstaged postoperatively. These results underline that lymphadenectomy and proper staging are crucial for NSCLC patients irrespective of the tumor size and the surgical approach.
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- 2022
25. Pulmonary metastasectomy for metastatic head and neck cancer prolongs survival significantly compared to non-surgical therapy
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Schlachtenberger, Georg, primary, Doerr, Fabian, additional, Menghesha, Hruy, additional, Heldwein, Matthias B, additional, Lauinger, Patrick, additional, Wolber, Philipp, additional, Klussmann, Jens Peter, additional, Wahlers, Thorsten, additional, and Hekmat, Khosro, additional
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- 2022
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26. Sublobar Resection Without Staging and Diagnostic for Tumors <2 cm is no Adequate Therapy for Non-Small Cell Lung Cancer Patients
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Heldwein, Matthias B., primary, Schlachtenberger, Georg, additional, Doerr, Fabian, additional, Menghesha, Hruy, additional, Hagmeyer, Lars, additional, Bennink, Gerardus, additional, Gaisendrees, Christopher, additional, Wahlers, Thorsten, additional, and Hekmat, Khosro, additional
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- 2022
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27. Neoadjuvant chemoimmunotherapy as a potential therapeutic option in NSCLC UICC stage IIIA with multilevel N2 disease
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Menghesha, Hruy, primary, Doerr, Fabian, additional, Schlachtenberger, Georg, additional, Estremadoyro, Andres Amorin, additional, Töpelt, Karin, additional, Wahlers, Thorsten, additional, Hekmat, Khosro, additional, and Heldwein, Matthias, additional
- Published
- 2022
- Full Text
- View/download PDF
28. Der Stellenwert der Thymektomie ohne Thymom in der Therapie der Myasthenia gravis
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Menghesha, Hruy, primary, Schroeter, Michael, additional, Doerr, Fabian, additional, Schlachtenberger, Georg, additional, Heldwein, Matthias B., additional, Chiapponi, Costanza, additional, Wahlers, Thorsten, additional, Bruns, Christiane, additional, and Hekmat, Khosro, additional
- Published
- 2021
- Full Text
- View/download PDF
29. Perigraft reaction and incorporation of porcine and bovine pericardial patches
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Schlachtenberger, Georg, Doerr, Fabian, Brezina, Annamaria, Menghesha, Hruy, Heldwein, Matthias B., Bennink, Gerardus, Menger, Michael D., Moussavian, Mohammed, Hekmat, Khosro, Wahlers, Thorsten, Schlachtenberger, Georg, Doerr, Fabian, Brezina, Annamaria, Menghesha, Hruy, Heldwein, Matthias B., Bennink, Gerardus, Menger, Michael D., Moussavian, Mohammed, Hekmat, Khosro, and Wahlers, Thorsten
- Abstract
OBJECTIVES: Bovine and porcine pericardial patches are frequently used in cardiothoracic and vascular surgery. There are no guidelines recommending the usage of these patches for particular surgical approaches. However, these 2 materials supposedly possess different properties. The clinical advantage of porcine compared with bovine patches remains controversial. In this experimental study, we analysed the incorporation and vascularization of bovine and porcine pericardial patches during the initial phase after implantation. METHODS: Bovine and porcine pericardial patches were implanted into the dorsal skinfold chamber of C57BL/6 mice (n = 8 per group) to study vascularization and inflammation at the implantation site using repetitive intravital fluorescence microscopy over a 14-day period. At the end of the in vivo experiments, CD-31-positive cells were determined to evaluate the vascularization by immunohistochemistry. Furthermore, cell proliferation and apoptosis were analysed immunohistochemically. RESULTS: Implanted bovine patches exhibited an enhanced vascularization, as indicated by a significantly higher number of CD-31-positive cells and micro-vessels (23.2 +/- 4.3 vs 16.5 +/- 5.8 mm(-2); P=0.001). Furthermore, bovine patches showed a slightly but not significantly higher functional capillary density. Both patches induced a moderate leukocytic inflammatory host tissue response, and neither bovine nor porcine patches significantly affected apoptosis and cell proliferation at the implantation site. CONCLUSIONS: Bovine and porcine pericardial patches are similarly suitable for surgery. Bovine patches exhibited an improved vascularization during the first 14 days after implantation. This may result in a quicker and improved incorporation into the surrounding tissue compared with porcine pericardial patches.
- Published
- 2021
30. Perigraft reaction and incorporation of porcine and bovine pericardial patches
- Author
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Schlachtenberger, Georg, primary, Doerr, Fabian, additional, Brezina, Annamaria, additional, Menghesha, Hruy, additional, Heldwein, Matthias B, additional, Bennink, Gerardus, additional, Menger, Michael D, additional, Moussavian, Mohammed, additional, Hekmat, Khosro, additional, and Wahlers, Thorsten, additional
- Published
- 2020
- Full Text
- View/download PDF
31. Rapid Deployment Aortic Valve Replacement: Excellent Results and Increased Effective Orifice Areas
- Author
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Rahmanian, Parwis B., Kaya, Suereyya, Eghbalzadeh, Kaveh, Menghesha, Hruy, Madershahian, Navid, Wahlers, Thorsten, Rahmanian, Parwis B., Kaya, Suereyya, Eghbalzadeh, Kaveh, Menghesha, Hruy, Madershahian, Navid, and Wahlers, Thorsten
- Abstract
Background. The aim of this study was to evaluate the effects of rapid deployment aortic valve replacement (RDAVR) on surgical outcome and hemodynamics compared with standard aortic valve replacement (AVR). Methods. One hundred sixty- three RDAVR patients (isolated, n = 67; combined with coronary artery bypass graft surgery [CABG], n = 96) were compared with a propensity matched control group (n = 163). Primary endpoints included association between valve type and procedure times, prosthesis size, transvalvular gradient, and indexed effective orifice area. Secondary endpoints were postoperative mortality and morbidity. Results. Aortic cross-clamp and cardiopulmonary bypass times in the RDAVR group were 55 +/- 23 and 88 +/- 38 minutes, respectively, compared with 77 +/- 22 and 105 +/- 38 minutes in the control group (p < 0.001). In the subgroup of patients undergoing isolated RDAVR (n = 67 of 163), the aortic cross-clamp and cardiopulmonary bypass times were 38 +/- 13 and 66 +/- 22 minutes, respectively, compared with 55 +/- 14 and 81 +/- 18 minutes in the control group (n = 67 of 163; p < 0.001). The RDAVR patients received larger prostheses (23.3 +/- 1.8 mm) compared with standard AVR (22.8 +/- 1.5 mm; p = 0.002). Mean transvalvular gradients and indexed effective orifice areas were 9 +/- 5 mm Hg and 1.11 +/- 0.11, respectively, in the RDVAR group compared with 13 +/- 5 mm Hg and 0.95 +/- 0.08 in the control group (p < 0.001). Hospital mortality was similar in both groups (1.8%, n = 3 of 163; p = 1.000). Postoperative pacemaker rates were 3.5% (n = 3 of 67) for isolated RDAVR versus 3.0% (n = 2 of 67; p = 0.649) for isolated AVR and 12.5% (n = 12 of 96) for RDAVR/CABG versus 4.2% (n = 4 of 96; p = 0.032) for AVR/CABG. Conclusions. RDAVR facilitates reduced aortic crossclamp and cardiopulmonary bypass times compared with standard AVR, particularly in patients undergoing concomitant procedures, allowing the use of larger prostheses and resulting in lower transvalvula
- Published
- 2018
32. Determination of risk factors for pacemaker requirement following rapid-deployment aortic valve replacement
- Author
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Rahmanian, Parwis B., Eghbalzadeh, Kaveh, Kaya, Suereyya, Menghesha, Hruy, Gerfer, Stephen, Liakopoulos, Oliver J., Choi, Yeong-Hong, Wahlers, Thorsten, Rahmanian, Parwis B., Eghbalzadeh, Kaveh, Kaya, Suereyya, Menghesha, Hruy, Gerfer, Stephen, Liakopoulos, Oliver J., Choi, Yeong-Hong, and Wahlers, Thorsten
- Abstract
OBJECTIVES: Rapid-deployment aortic valve replacement (RD-AVR) potentially reduces procedure times providing excellent haemodynamic results compared to standard tissue aortic valve replacement. However, concerns have been raised regarding higher rates of postoperative pacemaker (PPM) requirement compared to standard aortic valve replacement. In this study, we sought to determine the PPM rate and its potential risk factors in RD-AVR patients. METHODS: Between 2011 and 2017, 193 patients underwent RD-AVR. The main outcome investigated was PPM. Other outcome parameters included hospital mortality, major morbidity, length of stay and discharge condition. Predictors of PPM were determined using multivariable regression models. RESULTS: Isolated RD-AVR was performed in 72 (37%) patients and 121 (63%) patients underwent combined RD-AVR [coronary artery bypass grafting (n = 110), mitral repair (n = 6) and others (n = 5)]. Aortic cross-clamp and cardiopulmonary bypass times were 57.1 +/- 25.1 min and 90.0 +/- 40.1 min in the overall RD-AVR population and 39.4 +/- 13.5 min and 67.6 +/- 24.5 min, respectively, in isolated RD-AVR procedures. PPM occurred in 20 (10.4%) patients. Multivariable analysis revealed bypass grafting of the circumflex artery [odds ratio = 2.8] and preoperative right branch bundle block (odds ratio = 11.7) as independent predictors for PPM. CONCLUSIONS: RD-AVR is a safe and simple procedure resulting in favourable short aortic cross-clamp and cardiopulmonary bypass times and considerable low gradients in postoperative echocardiography. PPM following isolated RD-AVR remains in the range of standard aortic valve replacement However, patients undergoing concomitant coronary artery bypass grafting, particularly of the circumflex artery, face a 3-fold increased risk for PPM implantation enhanced if right branch bundle block is present Follow-up examination is necessary to determine whether these patients remain pacer dependent during long-term follow-up.
- Published
- 2018
33. Determination of risk factors for pacemaker requirement following rapid-deployment aortic valve replacement†
- Author
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Rahmanian, Parwis B, primary, Eghbalzadeh, Kaveh, additional, Kaya, Süreyya, additional, Menghesha, Hruy, additional, Gerfer, Stephen, additional, Liakopoulos, Oliver J, additional, Choi, Yeong-Hong, additional, and Wahlers, Thorsten, additional
- Published
- 2018
- Full Text
- View/download PDF
34. Rapid Deployment Aortic Valve Replacement: Excellent Results and Increased Effective Orifice Areas
- Author
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Rahmanian, Parwis B., primary, Kaya, Süreyya, additional, Eghbalzadeh, Kaveh, additional, Menghesha, Hruy, additional, Madershahian, Navid, additional, and Wahlers, Thorsten, additional
- Published
- 2018
- Full Text
- View/download PDF
35. [The value of thymectomy in the treatment of non-thymomatous myasthenia gravis].
- Author
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Menghesha H, Schroeter M, Doerr F, Schlachtenberger G, Heldwein MB, Chiapponi C, Wahlers T, Bruns C, and Hekmat K
- Subjects
- Humans, Randomized Controlled Trials as Topic, Retrospective Studies, Sternotomy, Thoracic Surgery, Video-Assisted, Treatment Outcome, Myasthenia Gravis surgery, Thymectomy
- Abstract
The value of thymectomy in the treatment of non-thymomatous myasthenia gravis has been controversially discussed. The relatively low incidence and prevalence of this disease, the inconsistent documentation in various studies and the necessity of a long-term follow-up to assess the therapeutic effects has made the generation of valid data difficult. The publication in 2016 of the MGTX trial in the New England Journal of Medicine delivered the first randomized controlled data in which patients aged 18-65 years with generalized myasthenia gravis and positive for acetylcholine receptor antibodies showed a significant benefit after surgical resection of the thymus via median sternotomy. Despite a lack of validation of the advantages of thymectomy by minimally invasive surgery from randomized controlled studies, this technique seems to positively influence the outcome of certain patient groups in a similar way. Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) using subxyphoidal and transcervical access routes showed not only esthetic advantages but also showed no relevant inferiority in the influence on clinical outcomes of myasthenia gravis compared to median sternotomy; however, not only the benefits and the esthetic results show differences but also the advantages in the various subtypes of myasthenia gravis show divergent prospects of success with respect to remission. The clinical spectrum of myasthenia is heterogeneous with respect to the occurrence of antibodies, the body region affected and the age of the patient at first diagnosis. Ultimately, thymectomy is an effective causal treatment of myasthenia gravis., (© 2021. The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
36. Perigraft reaction and incorporation of porcine and bovine pericardial patches.
- Author
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Schlachtenberger G, Doerr F, Brezina A, Menghesha H, Heldwein MB, Bennink G, Menger MD, Moussavian M, Hekmat K, and Wahlers T
- Subjects
- Animals, Apoptosis, Cattle, Cell Proliferation, Heart, Inflammation, Mice, Mice, Inbred C57BL, Prostheses and Implants, Swine, Cardiac Surgical Procedures
- Abstract
Objectives: Bovine and porcine pericardial patches are frequently used in cardiothoracic and vascular surgery. There are no guidelines recommending the usage of these patches for particular surgical approaches. However, these 2 materials supposedly possess different properties. The clinical advantage of porcine compared with bovine patches remains controversial. In this experimental study, we analysed the incorporation and vascularization of bovine and porcine pericardial patches during the initial phase after implantation., Methods: Bovine and porcine pericardial patches were implanted into the dorsal skinfold chamber of C57BL/6 mice (n = 8 per group) to study vascularization and inflammation at the implantation site using repetitive intravital fluorescence microscopy over a 14-day period. At the end of the in vivo experiments, CD-31-positive cells were determined to evaluate the vascularization by immunohistochemistry. Furthermore, cell proliferation and apoptosis were analysed immunohistochemically., Results: Implanted bovine patches exhibited an enhanced vascularization, as indicated by a significantly higher number of CD-31-positive cells and micro-vessels (23.2 ± 4.3 vs 16.5 ± 5.8 mm-2; P = 0.001). Furthermore, bovine patches showed a slightly but not significantly higher functional capillary density. Both patches induced a moderate leukocytic inflammatory host tissue response, and neither bovine nor porcine patches significantly affected apoptosis and cell proliferation at the implantation site., Conclusions: Bovine and porcine pericardial patches are similarly suitable for surgery. Bovine patches exhibited an improved vascularization during the first 14 days after implantation. This may result in a quicker and improved incorporation into the surrounding tissue compared with porcine pericardial patches., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
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