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  • Beerbaum, Philipp  (8)
  • Bobylev, Dmitry  (8)
  • 2020-2024  (8)
  • 1
    Online Resource
    Online Resource
    Three-step preoperative sequential planning for pulmonary valve replacement in repaired tetralogy of Fallot using computed tomography
    Oxford University Press (OUP) ; 2021
    In:  European Journal of Cardio-Thoracic Surgery Vol. 59, No. 2 ( 2021-01-29), p. 333-340
    Details
    In: European Journal of Cardio-Thoracic Surgery, Oxford University Press (OUP), Vol. 59, No. 2 ( 2021-01-29), p. 333-340
    Abstract: OBJECTIVES Our goal was to compare results between a standard computed tomography (CT)-based strategy, the ‘three-step preoperative sequential planning’ (3-step PSP), for pulmonary valve replacement in repaired tetralogy of Fallot versus a conventional planning approach. METHODS We carried out a retrospective study with unmatched and matched groups. The 3-step PSP comprised the planning of mediastinal re-entry, cannulation for cardiopulmonary bypass (CPB) and the main procedure, using standard 3-dimensional videos. Operative times (skin incision to CPB, CPB time, end of CPB to skin closure and cross-clamp time) as well as postoperative length of stay and in-hospital mortality were compared. RESULTS Eighty-two patients (49% classical tetralogy of Fallot) underwent an operation (85% with pulmonary homograft) with 1.22% in-hospital mortality. The 3-step PSP (n = 14) and the conventional planning (n = 68) groups were compared. There were no statistically significant differences in the preoperative characteristics. Differences were observed in the total operative time (P = 0.009), skin incision to CPB (P = 0.034) and cross-clamp times (74 ± 33 vs 108 ± 47 min; P = 0.006), favouring the 3-step PSP group. Eight matched pairs were compared showing differences in the total operative time (263 ± 44 vs 360 ± 66 min; P = 0.008), CPB time (123 ± 34 vs 190 ± 43 min; P = 0.008) and postoperative length of stay (P = 0.031), favouring the 3-step PSP group. CONCLUSIONS In patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement, preoperative planning using a standard CT-based strategy, the 3-step PSP, is associated with shorter operative times and shorter postoperative length of stay.
    Type of Medium: Online Resource
    ISSN: 1010-7940 , 1873-734X
    URL: Article
    DOI: 10.1093/ejcts/ezaa346
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 1500330-9
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  • 2
    Online Resource
    Online Resource
    4D-flow cardiac magnetic resonance imaging after aortic root replacement with long-valved decellularized aortic homografts: comparison to valve-sparing aortic root replacement and healthy controls
    Oxford University Press (OUP) ; 2022
    In:  European Journal of Cardio-Thoracic Surgery Vol. 61, No. 6 ( 2022-05-27), p. 1307-1315
    Details
    In: European Journal of Cardio-Thoracic Surgery, Oxford University Press (OUP), Vol. 61, No. 6 ( 2022-05-27), p. 1307-1315
    Abstract: OBJECTIVES Long-valved decellularized aortic homografts (DAH) may be used in young patients to treat aortic valve disease associated with aortic root dilatation, thereby eliminating the need for prosthetic material and anticoagulation. METHODS Thirty-three male subjects in 3 equally sized cohorts were compared: patients following DAH implantation with a median age of 29 years [interquartile range (IQR) 27.5–37.5], patients post-valve-sparing aortic root replacement (VSARR), median 44 years (IQR 31.5–49) and healthy controls, median 33 years (IQR 28–40, P = 0.228). Time-resolved three-dimensional phase-contrast cardiac magnetic resonance imaging was performed to assess maximum blood flow velocity, pulse wave velocity, mechanical energy loss (EL), wall shear stress and flow patterns (vorticity, eccentricity, helicity) in 5 different planes of the aorta. RESULTS The mean time between surgery and cardiovascular magnetic resonance was 2.56 ± 2.0 years in DAH vs 2.67 ± 2.1 in VSARR, P = 0.500. No significant differences in maximum velocity and pulse wave velocity were found between healthy controls and DAH across all planes. Velocity in the proximal aorta was significantly higher in VSARR (182.91 ± 53.91 cm/s, P = 0.032) compared with healthy controls. EL was significantly higher in VSARR in the proximal aorta with 1.85 mW (IQR 1.39–2.95) compared with healthy controls, 1.06 mW (0.91–1.22, P = 0.016), as well as in the entire thoracic aorta. In contrast, there was no significant EL in DAH in the proximal, 1.27 m/W (0.92–1.53, P = 0.296), as well as in the thoracic aorta, 7.7 m/W (5.25–9.90, P = 0.114), compared with healthy controls. There were no significant differences in wall shear stress parameters for all 5 regions of the thoracic aorta between the 3 groups. DAH patients, however, showed more vorticity, helicity and eccentricity in the ascending aorta compared with healthy controls (P  & lt; 0.019). CONCLUSIONS Decellularized long aortic homografts exhibit near to normal haemodynamic parameters 2.5 years postoperatively compared with healthy controls and VSARR.
    Type of Medium: Online Resource
    ISSN: 1010-7940 , 1873-734X
    URL: Article
    DOI: 10.1093/ejcts/ezac016
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 3
    Online Resource
    Online Resource
    Idiopathic Aneurysm of the Aortic Arch in an Infant
    Georg Thieme Verlag KG ; 2022
    In:  The Thoracic and Cardiovascular Surgeon Reports Vol. 11, No. 01 ( 2022-01), p. e54-e57
    Details
    In: The Thoracic and Cardiovascular Surgeon Reports, Georg Thieme Verlag KG, Vol. 11, No. 01 ( 2022-01), p. e54-e57
    Abstract: Congenital aortic aneurysms are rare disorders, usually associated with genetic aortic syndromes. Here, we describe the case of an idiopathic aortic arch aneurysm which had been diagnosed prenatally by fetal echocardiography. The diagnosis was confirmed after birth in the neonatal period and successful surgical resection of the aneurysm was performed at the age of 3 months. The idiopathic etiology of the aneurysm, its localization, and the early surgical resection render this case very unusual.
    Type of Medium: Online Resource
    ISSN: 2194-7635 , 2194-7643
    URL: Article
    DOI: 10.1055/s-0042-1750426
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
    detail.hit.zdb_id: 2706759-2
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  • 4
    Online Resource
    Online Resource
    Pediatric urgent heart transplantation with age or weight mismatched donors: Reducing waiting time by enlarging donor criteria
    Hindawi Limited ; 2021
    In:  Journal of Cardiac Surgery Vol. 36, No. 12 ( 2021-12), p. 4551-4557
    Details
    In: Journal of Cardiac Surgery, Hindawi Limited, Vol. 36, No. 12 ( 2021-12), p. 4551-4557
    Type of Medium: Online Resource
    ISSN: 0886-0440 , 1540-8191
    URL: Issue
    URL: Article
    DOI: 10.1111/jocs.v36.12
    DOI: 10.1111/jocs.16041
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2021
    detail.hit.zdb_id: 2108425-7
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  • 5
    Online Resource
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    Valve-sparing aortic root replacement in adult patients with congenital heart disease
    Oxford University Press (OUP) ; 2021
    In:  Interactive CardioVascular and Thoracic Surgery Vol. 33, No. 6 ( 2021-11-22), p. 959-965
    Details
    In: Interactive CardioVascular and Thoracic Surgery, Oxford University Press (OUP), Vol. 33, No. 6 ( 2021-11-22), p. 959-965
    Abstract: Aortic root dilatation is frequently observed in patients with congenital heart defects (CHD), but has received little attention in terms of developing a best practice approach for treatment. In this study, we analysed our experience with aortic valve-sparing root replacement in patients following previous operations to repair CHD. METHODS In this study, we included 7 patients with a history of previous surgery for CHD who underwent aortic valve-sparing operations. The underlying initial defects were tetralogy of Fallot (n = 3), transposition of great arteries (n = 2), coarctation of the aorta (n = 1), and pulmonary atresia with ventricle septum defect (n = 1). The patients’ age ranged from 20 to 40 years (mean age 31 ± 6 years). RESULTS David reimplantation was performed in 6 patients and a Yacoub remodelling procedure was performed in 1 patient. Four patients underwent simultaneous pulmonary valve replacement. The mean interval between the corrective procedure for CHD and the aortic valve-sparing surgery was 26 ± 3 years. There was no operative or late mortality. The patient with transposition of great arteries following an arterial switch operation was re-operated 25 months after the valve-sparing procedure due to severe aortic regurgitation. In all other patients, the aortic valve regurgitation was mild or negligible at the latest follow-up (mean 8.7 years, range 2.1–15.1 years). CONCLUSIONS Valve-sparing aortic root replacement resulted in good aortic valve function during the first decade of observation in 6 of 7 patients. This approach can offer a viable alternative to root replacement with mechanical or biological prostheses in selected patients following CHD repair.
    Type of Medium: Online Resource
    ISSN: 1569-9285
    URL: Article
    DOI: 10.1093/icvts/ivab189
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2096257-5
    detail.hit.zdb_id: 3167862-2
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  • 6
    Online Resource
    Online Resource
    Pulmonary valve prostheses: patient’s lifetime procedure load and durability. Evaluation of the German National Register for Congenital Heart Defects
    Oxford University Press (OUP) ; 2022
    In:  Interactive CardioVascular and Thoracic Surgery Vol. 34, No. 2 ( 2022-01-18), p. 297-306
    Details
    In: Interactive CardioVascular and Thoracic Surgery, Oxford University Press (OUP), Vol. 34, No. 2 ( 2022-01-18), p. 297-306
    Abstract: We evaluated 4384 procedures performed between 1957 and 2018, collected in the National Register for Congenital Heart Defects, conducted on 997 patients with 1823 pulmonary valve replacements (PVRs), including 226 implanted via catheter [transcatheter valve (TCV)]. Main study targets are as follows: TCV benefit, valve type durability, decade-wise treatment changes and procedure frequencies over the lifetime of a PVR patient. METHODS We studied TCV impact on surgical valve replacement (via Kaplan–Meier); pulmonary valve type-specific performance (Kaplan–Meier and Cox regressions with age group as stratification or ordinary variable); procedure interval changes over the decades (Kaplan–Meier); procedure load, i.e. frequency of any procedure/surgical PVR/interventional or surgical PVR by patient age (multistate analyses). RESULTS TCV performance was equivalent to surgical PVRs and extended durability significantly. Homografts were most durable; Contegras lasted comparably less in older; and Hancock devices lasted less in younger patients. Matrix P-valves showed poorer performance. Age group stratification improves the precision of valve-specific explantation hazard estimations. The current median interval between procedures is 2.6 years; it became significantly shorter in most age groups below 40 years. At 30 years, 80% of patients had undergone ≥3 procedures, 20% ≥3 surgical PVRs and 42% ≥3 surgical or interventional PVRs. CONCLUSIONS TCVs doubled freedom from explantation of conventional valves. Homografts’ age group-specific explantation hazard ratio was lowest; Matrix P’s hazard ratio was highest. Age-stratified Cox regressions improve the precision of prosthesis durability evaluations. The median time between procedures for PVR patients shortened significantly to 2.6 years. At 30 years, 42% had ≥3 PVRs.
    Type of Medium: Online Resource
    ISSN: 1569-9285
    URL: Article
    DOI: 10.1093/icvts/ivab233
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2096257-5
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  • 7
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    Paediatric aortic valve replacement using decellularized allografts: a multi-Centre update following 143 implantations and 5-year mean follow-up
    Oxford University Press (OUP) ; 2024
    In:  European Journal of Cardio-Thoracic Surgery
    Details
    In: European Journal of Cardio-Thoracic Surgery, Oxford University Press (OUP)
    Abstract: Decellularized aortic homografts (DAH) were introduced in 2008 as a further option for paediatric aortic valve replacement (AVR). METHODS Prospective, multicentre follow-up of all paediatric patients receiving DAH for AVR in 8 European centres. RESULTS 143 DAH were implanted between 2/2008 and 2/2023 in 137 children (106 male, 74%) with a median age of 10.8 years (IQR 6.6–14.6). 84 (59%) had undergone previous cardiac operations, 24 (17%) had undergone previous AVR. The median implanted DAH diameter was 21 mm (IQR 19–23). The median operation duration was 348 min (227–439) with a median CPB time of 212 min (171–257) and a median cross-clamp time of 135 min (113–164). After a median follow-up of 5.3 yrs. (3.3–7.2, max. 15.2 yrs.) the primary efficacy end-points peak gradient (median 14 mmHg, 9–28) and regurgitation (median 0.5, IQR 0–1, grade 0–3,) showed good results but an increase over time. Freedom from death/explantation/endocarditis/bleeding/thromboembolism at 5 years were 97.8 ± 1.2/88.7 ± 3.3/99.1 ± 0.9/100 and 99.2 ± 0.8% respectively. Freedom from death/explantation/endocarditis/bleeding/thromboembolism at 10 years were 96.3 ± 1.9/67.1 ± 8.0/93.6 ± 3.9/98.6 ± 1.4 and 86.9 ± 11.6% respectively. In total, 11 DAH were explanted. Five were replaced by mechanical AVR and DAH were implanted in 6 patients with no re-do mortality. The calculated expected adverse events were lower for DAH compared to cryopreserved homograft patients (mean age 8.4 yrs.), and in the same range as for Ross patients (9.2 yrs) and mechanical AVR (13.0 yrs.). CONCLUSIONS This large-scale prospective analysis demonstrates excellent mid-term survival using DAH with adverse event rates comparable to paediatric Ross procedures.
    Type of Medium: Online Resource
    ISSN: 1873-734X
    URL: Article
    DOI: 10.1093/ejcts/ezae112
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2024
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  • 8
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    Online Resource
    Paediatric aortic valve replacement using decellularized allografts
    Oxford University Press (OUP) ; 2020
    In:  European Journal of Cardio-Thoracic Surgery Vol. 58, No. 4 ( 2020-10-01), p. 817-824
    Details
    In: European Journal of Cardio-Thoracic Surgery, Oxford University Press (OUP), Vol. 58, No. 4 ( 2020-10-01), p. 817-824
    Abstract: OBJECTIVES Options for paediatric aortic valve replacement (AVR) are limited if valve repair is not feasible. Results of paediatric Ross procedures are inferior to adult Ross results, and mechanical AVR imposes constant anticoagulation with the inherent risks. METHODS The study design was a prospective, multicentre follow-up of all paediatric patients receiving decellularized aortic homografts (DAHs) for AVR in 8 European centres. RESULTS A total of 106 children (77 boys) were operated (mean age 10.1 ± 4.8 years, DAH diameter 20.5 ± 3.8 mm). A total of 60 (57%) had undergone previous surgical interventions: 34 with 1, 15 with 2 and 11 with ≥3. There was one early death in a 12-year-old girl, who underwent her fourth aortic valve operation, due to intracerebral haemorrhage on extracorporeal membrane oxygenation after coronary reimplantation problems following 3-sinus reconstruction 1 year earlier. One 2-year-old patient died due to sepsis 2 months postoperatively with no evidence for endocarditis. In addition, a single pacemaker implantation was necessary and a 2.5-year-old girl underwent successful HTx due to chronic myocardial failure despite an intact DAH. After a mean follow-up of 3.30 ± 2.45 years, primary efficacy end points mean peak gradient (18.1 ± 20.9 mmHg) and regurgitation (mean 0.61 ± 0.63, grade 0–3) were very good. Freedom from death/explantation/endocarditis/bleeding/stroke at 5 years was 97.8 ± 1.6/85.0 ± 7.4/100/100/100% respectively. Calculated expected adverse events were lower for DAH compared to cryopreserved homograft patients (mean age 8.9 years), lower than in Ross patients (9.4 years) and in the same range as mechanical AVR (12.8 years). CONCLUSIONS Even though the overall number of paediatric DAH patients and the follow-up time span are still limited, our data suggest that DAHs may present a promising additional option for paediatric AVR.
    Type of Medium: Online Resource
    ISSN: 1010-7940 , 1873-734X
    URL: Article
    DOI: 10.1093/ejcts/ezaa119
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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