Role of Interventional Repair in the Thoracic Aorta

Future Cardiology. Jul, 2007  |  Pubmed ID: 19804231

Endovascular treatment of chronic aneurysmatic diseases of the descending thoracic aorta has demonstrated encouraging peri-interventional mortality and morbidity and is accepted as a preferred strategy in experienced centers. The emergence of endovascular strategies for acute thoracic aortic pathologies is an even more exciting new territory for nonsurgical interventions considering the sobering results of open surgery. Although it is apparent that patients at high risk for open surgery will benefit from endovascular strategies, the exact role of stent-graft placement remains to be defined, as the community awaits solid long-term data and as devices and techniques continue to improve. While some indications and scenarios, such as acute type B dissection with associated malperfusion syndrome or imminent aortic rupture, have been shown to benefit from stent-graft treatment, others are less settled. The current paper discusses both the established and emerging indications, as well as technical and anatomical aspects of this fascinating therapeutic option.

Improvement of Objective GERD Parameters After Radiofrequency Energy Delivery: a European Study

Scandinavian Journal of Gastroenterology. Aug, 2007  |  Pubmed ID: 17613919

The Stretta procedure is an endoluminal radiofrequency energy delivery system for the treatment of gastroesophageal reflux disease (GERD). The purpose of this study was to present, for the first time, the Stretta treatment experience from European centers.

Stem Cell Use for Cardiac Diseases As of 2008

Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis. Jun, 2008  |  Pubmed ID: 18485824

Congestive heart failure and coronary artery disease are the leading causes of morbidity and mortality in the western society despite substantial therapeutic advances in the last half century. Only very recently have studies arisen that support possibility of regenerating tissue of damaged human organs including the heart. In this regard, there is growing preclinical and clinical evidence demonstrating the safety and efficacy of cell-based myocardial regeneration using a variety of cell lines. Different mechanisms have been proposed to explain the beneficial effects of cell-based therapy. The beneficial effects of cell therapy may involve multiple mechanisms. The encouraging results of early clinical cell therapy studies have not been sustained by subsequent robust studies for all cell types. These findings suggest that many unanswered questions need to be addressed before cell therapy becomes an acceptable adjunctive treatment for heart disease. Future setbacks are likely, but both clinicians and basic scientists will eventually introduce more potent cell-based strategies into the clinical arena.

Current Role of Endovascular Therapy in Marfan Patients with Previous Aortic Surgery

Vascular Health and Risk Management. 2008  |  Pubmed ID: 18629349

The Marfan syndrome is a heritable disorder of the connective tissue which affects the cardiovascular, ocular, and skeletal system. The cardiovascular manifestation with aortic root dilatation, aortic valve regurgitation, and aortic dissection has a prevalence of 60% to 90% and determines the premature death of these patients. Thirty-four percent of the patients with Marfan syndrome will have serious cardiovascular complications requiring surgery in the first 10 years after diagnosis. Before aortic surgery became available, the majority of the patients died by the age of 32 years. Introduction in the aortic surgery techniques caused an increase of the 10 year survival rate up to 97%. The purpose of this article is to give an overview about the feasibility and outcome of stent-graft placement in the descending thoracic aorta in Marfan patients with previous aortic surgery.

Stent-graft Repair in Acute and Chronic Diseases of the Thoracic Aorta

Revista Española De Cardiología. Oct, 2008  |  Pubmed ID: 18817683

Thoracic aortic endografting has demonstrated encouraging mid-term results and attracts growing acceptance as a valuable treatment option for chronic aneurysmal disease. The emerging role of endovascular strategies for management of acute thoracic aortic pathologies is even more exciting considering the sobering results of open repair. Although it is accepted that patients at high risk for open surgery will benefit from endovascular strategies, the exact role of stent-graft interventions remains to be defined as the medical community awaits solid long-term data and better devices. While some indications and scenarios such as acute type B dissection with associated malperfusion syndrome or imminent aortic rupture have shown to benefit from stent-graft treatment, other scenarios are less settled. The current paper discusses both the established and emerging indications, as well as technical and anatomical aspects of this fascinating therapeutic option.

Detection of FMR1-gene in Takotsubo Cardiomyopathy: a New Piece in the Puzzle

International Journal of Cardiology. Nov, 2009  |  Pubmed ID: 19619908

Takotsubo cardiomyopathy (TTC) is a cardiac entity appreciated only recently mimicking acute myocardial infarction, often affects post-menopausal women and is triggered by preceding emotional or physical stress. Pathogenesis of TTC is unknown, recurrence of TTC in one individual and familial predisposition occurs. Expression profiling of cardiac genes in the acute phase of TTC are not enough analyzed and are a component of future research. We report for the first time on a female individual with TTC, who happened to be carrier of an FMR1 gene mutation, alleles of an intermediate size between 40-55 triplet premutations.

Clinical Outcomes After Sirolimus-eluting, Paclitaxel-eluting, and Bare Metal Stents (from the First Phase of the Prospective Multicenter German DES.DE Registry)

The American Journal of Cardiology. Nov, 2009  |  Pubmed ID: 19892051

The prospective multicenter German Drug-Eluting Stent (DES.DE) registry is an observational study to analyze and evaluate the therapeutic principle of the differential drug-eluting stents (sirolimus- and paclitaxel-eluting stents) and bare metal stents under real world conditions in the context of the German healthcare system. The baseline clinical and angiographic characteristics and follow-up events for 1 year were recorded for all enrolled patients. In addition, a health economics assessment was performed at 3, 6, 9, and 12 months after initial stent placement. The composite of death, myocardial infarction, and stroke, defined as major adverse cardiac and cerebrovascular events, and target vessel revascularization were used as the primary objectives. From October 2005 to October 2006, 6,384 patients were enrolled (sirolimus-eluting stents, n = 2,137; paclitaxel-eluting stents, n = 2,740; bare metal stents, n = 485) at 98 Deutsches Drug-Eluting Stent Register sites. With similar baseline clinical and descriptive morphology of coronary artery disease between both drug-eluting stent groups, no differences were present at 1 year of follow-up in the rates of overall mortality (3.8% vs 4.1%), target vessel revascularization (10.4% vs 10.4%), overall stent thrombosis (3.6% vs 3.8%), and major adverse cardiac and cerebrovascular events (8.1% vs 8.0%). Compared with the bare metal stent group, patients treated with drug-eluting stents had significantly lower rates of myocardial infarction (3.2% vs 6.0%; p <0.01), stroke (1.2% vs 2.7%; p <0.05), and target vessel revascularization (10.4% vs 14.9%; p <0.01) without any difference in the stent thrombosis rate (3.7% vs 4.3%; p = 0.57) or mortality rate (4.0% vs 5.2%; p = 0.21). In conclusion, the data generated from the German Drug-Eluting Stent registry revealed no differences between patients receiving a paclitaxel-eluting stent and sirolimus-eluting stent in a "real-world" setting with regard to the clinical outcomes at 1 year.

[Quadricuspid Aortic Valve As an Unusual Cause of Severe Aortic Regurgitation]

Medizinische Klinik (Munich, Germany : 1983). Nov, 2009  |  Pubmed ID: 19916078

Both, acute and chronic aortic insufficiency, can be caused by various conditions. While the acute form is often associated with an endocarditis, type A aortic dissection and trauma, one possible cause of chronic aortic insufficiency is a congenital malformation of the aortic valve. Among these malformations, the quadricuspid aortic valve is the most rare form. The diagnosis is often made by Doppler echocardiography, during cardiac surgery, or postmortem.

Effect of Antibiotic Treatment in Patients with Postimplantation Syndrome After Aortic Stent Placement

Revista Española De Cardiología. Dec, 2009  |  Pubmed ID: 20038402

Postimplantation syndrome that can develop after stent placement is characterized by fever, leukocytosis and an elevated C-reactive protein level or by coagulation disturbances, or by a combination of these features. It is a transient condition that frequently appears following endovascular treatment. At present, no data are available on the effect of antibiotics on postimplantation syndrome after placement of a thoracic endoprosthesis.

Clinical Outcomes in Diabetic and Non-diabetic Patients with Drug-eluting Stents: Results from the First Phase of the Prospective Multicenter German DES.DE Registry

Clinical Research in Cardiology : Official Journal of the German Cardiac Society. Jun, 2010  |  Pubmed ID: 20221833

Patients with diabetes mellitus (DM) undergoing coronary revascularization are at increased risk for adverse outcomes. Without sufficiently powered data from diabetic subgroup analyses and in absence of randomized controlled trials in diabetic patients with primary clinical outcomes controversy is ongoing over safety and efficacy of drug-eluting stents (DES) in diabetic patients.

Technique of Interventional Repair in Adult Aortic Coarctation

Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. Jun, 2010  |  Pubmed ID: 20223618

Surgical treatment of aortic coarctation has increased life expectancy and reduced mortality. Unfortunately, the average lifespan after repair remains only 35 to 50 years, and significant morbidity persists as a result of aneurysm formation, hypertension, accelerated coronary disease, and stroke. Follow-up studies have revealed restenosis rates of 30% and persistent hypertension at rest and during exercise, sometimes with compromised cardiac function. The less invasive nature of nonsurgical repair using transcatheter therapies has led to balloon angioplasty and, recently, stent implantation as an emerging concept for the treatment of aortic coarctation. This review focuses on advances in the management, current indication, and techniques of interventional repair in aortic coarctation.

Outcomes After Differential Use of Drug-eluting Stents in Diabetic Patients: 1-year Results from the DES.DE (Drug-Eluting Stent.DEutschland) Registry

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. Jul, 2010  |  Pubmed ID: 20578192

The prospective multicenter German DES.DE registry provides real world data to evaluate the therapeutic principle of two different drug-eluting stents (DES) [Sirolimus- (SES) and Paclitaxel-eluting stent (PES)] in the context of the German Health System.

Another Cause of Severe Aortic Regurgitation: Congenital Quadricuspid Aortic Valve

The Journal of Heart Valve Disease. May, 2010  |  Pubmed ID: 20583409

Thoracic Endovascular Stent-graft Therapy in Aortic Dissection

Current Opinion in Cardiology. Nov, 2010  |  Pubmed ID: 20802328

Aortic dissection is an uncommon but highly lethal condition with a mortality rate of 1-2% per hour within the first 24 h when the ascending aorta is affected and remains a surgical domain. For the treatment of type B aortic dissection, however, endovascular techniques became available recently and are increasingly popular. This review focuses on current indications and results of thoracic endovascular stent-graft therapy in aortic dissection.

Comparison of Outcomes in Patients with Insulin-dependent Versus Non-insulin Dependent Diabetes Mellitus Receiving Drug-eluting Stents (from the First Phase of the Prospective Multicenter German DES.DE Registry)

The American Journal of Cardiology. Nov, 2010  |  Pubmed ID: 21029813

Drug-eluting stents have been effective in randomized controlled trials, but their safety and efficacy in patients with insulin-dependent diabetes has not been well studied. Baseline clinical and angiographic characteristics and in-hospital and follow-up events were recorded for enrolled patients. From October 2005 and October 2006, 581 patients with insulin-dependent diabetes and 1,078 with non-insulin-dependent diabetes treated with sirolimus- and paclitaxel-eluting stents were enrolled at 98 sites. The composite of death, myocardial infarction, and stroke, defined as major adverse cardiac and cerebrovascular events, as well as target vessel revascularization was used as the primary end point. Multiple logistic regression analysis was used to adjust for confounding parameters. Baseline clinical characteristics were more severe in patients with insulin-dependent diabetes, whereas descriptive characteristics were not unique. At 1-year follow-up, the comparison between the 2 groups revealed significantly higher rates of overall death (7.4% vs 4.6%, p <0.05), target vessel revascularization (15.1% vs 10.4%, p <0.05), and overall stent thrombosis (6.5% vs 4.1%, p <0.05) for insulin-dependent patients, while rates of major adverse cardiac and cerebrovascular events were not significantly different (12.8% vs 9.9%, p = 0.09). These results persisted even after risk adjustment for heterogenous baseline characteristics of the 2 groups. In conclusion, the data generated from the German Drug-Eluting Stent (DES.DE) registry revealed that even with drug-eluting stents, the annual risk for death, target vessel revascularization, and thrombotic events remains higher in patients with insulin-dependent diabetes compared to those with non-insulin-dependent diabetes.

Another Cause of Severe Aortic Regurgitation: Congenital Quadricuspid Aortic Valve

The Journal of Heart Valve Disease. Sep, 2010  |  Pubmed ID: 21053752

Strategies for Subacute/chronic Type B Aortic Dissection: the Investigation Of Stent Grafts in Patients with Type B Aortic Dissection (INSTEAD) Trial 1-year Outcome

The Journal of Thoracic and Cardiovascular Surgery. Dec, 2010  |  Pubmed ID: 21092774

Endovascular stent grafting represents a novel concept for type B aortic dissection both in the acute and subacute/chronic setting, with an unknown effect on outcomes.

Improved Mobilization of the CD34(+) and CD133(+) Bone Marrow-derived Circulating Progenitor Cells by Freshly Isolated Intracoronary Bone Marrow Cell Transplantation in Patients with Ischemic Heart Disease

Stem Cells and Development. Sep, 2011  |  Pubmed ID: 21190450

Cell therapy is a promising novel option for treatment of cardiovascular disease. Because the role of bone marrow-derived circulating progenitor cells (BM-CPCs) after cell therapy is less clear, we analyzed in this randomized, controlled study the influence of intracoronary autologous freshly isolated bone marrow cell transplantation (BMC-Tx) by using a point-of-care system on cardiac function and on the mobilization of BM-CPCs in patients with ischemic heart disease (IHD). Fifty-six patients with IHD were randomized to either receive freshly isolated BMC-Tx or a control group that did not receive cell therapy. Peripheral blood concentrations of CD34/45(+) and CD133/45(+) CPCs were measured by flow cytometry pre-, immediately post-, and at 3, 6, and 12 months postprocedure in both groups. Global ejection fraction and the size of infarct area were determined by left ventriculography. We observed in patients with IHD after intracoronary transplantation of autologous freshly isolated BMCs-Tx at 3 and 12 months follow-up a significant reduction of the size of infarct area and increase of global ejection fraction as well as infarct wall movement velocity. The mobilization of CD34/45(+) and CD133/45(+) BM-CPCs significantly increased at 3, 6, and 12 months after cell therapy when compared with baseline in patients with IHD, although no significant changes were observed between pre- and immediately postintracoronary cell therapy administration. In the control group without cell therapy, there was no significant difference of CD34/45(+) and CD133/45(+) BM-CPCs mobilization between pre- and at 3, 6, and 12 months postcoronary angiography. Intracoronary transplantation of autologous freshly isolated BMCs by using a point-of-care system in patients with IHD may enhance and prolong the mobilization of CD34/45(+) and CD133/45(+) BM-CPCs in peripheral blood and this might increase the regenerative potency in IHD.

Improvement of Cardiac Function by Intracoronary Freshly Isolated Bone Marrow Cells Transplantation in Patients with Acute Myocardial Infarction

Circulation Journal : Official Journal of the Japanese Circulation Society. 2011  |  Pubmed ID: 21266786

We analyzed in the present study the influence of intracoronary autologous freshly isolated bone marrow cells transplantation (BMCs-Tx) on cardiac function in patients with acute myocardial infarction (AMI).

Comparison Between On-label Versus Off-label Use of Drug-eluting Coronary Stents in Clinical Practice: Results from the German DES.DE-Registry

Clinical Research in Cardiology : Official Journal of the German Cardiac Society. Aug, 2011  |  Pubmed ID: 21416192

Observational studies from the USA have demonstrated that off-label use of drug-eluting stents (DES) is common. Data on off-label use in Western Europe are limited.

Assessment of Resting Electrocardiogram, P Wave Dispersion and Duration in Different Genders Applying for Registration to the School of Physical Education and Sports - Results of a Single Centre Turkish Trial with 2093 Healthy Subjects

Cardiology in the Young. Oct, 2011  |  Pubmed ID: 21554825

The 12-lead electrocardiogram shows a broad range of abnormal patterns in trained athletes. The primary end point of this study was to investigate P wave dispersion, and P wave durations and related factors in different genders applying for registration to the School of Physical Education and Sports.

Clinical Outcome of Percutaneous Treatment of In-stent Restenosis with Drug-eluting Stents: Results from the First Phase of the Prospective Multicentre German DES.DE Registry

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. Jun, 2011  |  Pubmed ID: 21646062

Treatment of in-stent restenosis (ISR) was historically considered the Achilles heel of percutaneous coronary intervention (PCI) and has been associated with worse clinical outcome than PCI of de novo lesions. However, comparative data on ISR and de novo lesions using drug-eluting stents (DES) are scarce. Therefore, we aimed to assess the impact of ISR on procedural and long-term outcome in patients treated with DES.

Impaired Mobilization of CD133(+) Bone Marrow-derived Circulating Progenitor Cells with an Increased Number of Diseased Coronary Arteries in Ischemic Heart Disease Patients with Diabetes

Circulation Journal : Official Journal of the Japanese Circulation Society. 2011  |  Pubmed ID: 21828932

The influence of the number of diseased coronary arteries on the mobilization of CD133/45(+) bone marrow-derived circulating progenitor cells (BM-CPCs) in peripheral blood (PB) in patients with ischemic heart disease (IHD) was analyzed.

Very Late Coronary Aneurysm Formation with Subsequent Stent Thrombosis Secondary to Drug-eluting Stent

Chinese Medical Journal. Oct, 2011  |  Pubmed ID: 22088549

Drug-eluting stents have changed the practice in interventional cardiology. With the widespread use of these stents important safety concerns regarding stent thrombosis and formation of coronary artery aneurysm have been expressed. While the majority of attention was focused on stent thrombosis, the formation of coronary aneurysm was only described in anecdotal reports. We report on a patient who suffered from very late stent thrombosis in association with coronary artery aneurysm formation secondary to drug-eluting stent but not to bare-metal stent.

Relation Between the Frequency of CD34⁺ Bone Marrow Derived Circulating Progenitor Cells and the Number of Diseased Coronary Arteries in Patients with Myocardial Ischemia and Diabetes

Cardiovascular Diabetology. 2011  |  Pubmed ID: 22118372

Bone marrow-derived circulating progenitor cells (BM-CPCs) in patients with coronary heart disease are impaired with respect to number and mobilization. However, it is unknown whether the mobilization of BM-CPCs depends on the number of diseased coronary arteries. Therefore, in our study, we analysed the correlation between the diseased coronary arteries and the frequency of CD34/45+ BM-CPCs in peripheral blood (PB) in patients with ischemic heart disease (IHD).

In-Hospital Outcome of Patients with Severe Mitral Valve Regurgitation Classified As Inoperable and Treated with the MitraClip(®) Device

Journal of Interventional Cardiology. Dec, 2011  |  Pubmed ID: 22188385

Background: To evaluate the short-term outcome of patients predominantly at high risk treated with the MitraClip® device for severe mitral valve regurgitation (MR) using one or more clips. Methods: We prospectively analyzed patients with highly symptomatic MR classified as inoperable (logistic EuroSCORE 24.16 ± 13.64%; STS-score 29.9 ± 14.5%) but subject to mitral valve repair with MitraClip® between May 2010 and January 2011. Thirty-three consecutive patients (57.6% male; age 77.8 ± 6.7 years) were enrolled and treated with either 1 (n = 7; 21.2%), 2 (n = 20; 60.6%), 3 (n = 4; 12.1%), or 4 (n = 2, 6.1%) clips. Grading of MR was performed by two-dimensional transesophageal echocardiography (2D-TEE) prior to TEE-guided clipping and before discharge. Results: MR was classified as functional in 23 (69.7%) and organic in 10 (30.3%) of the patients with MR-grade ≥ 3+ in 32 (97%) and = 4 in 1 patients (3%) before repair. Reduction in MR grade to grade ≤1+ was achieved in 81.7% and to 2 in 12.1% (P = 0.00072). Invasive pulmonary artery systolic pressure (PAPsyst) and pulmonary capillary wedge pressure (PCWP) v-wave decreased from 59.2 ± 18.6 to 46.9 ± 15.3 mmHg (P = 0.00014) and 21.2 ± 6.7 to 8.0 ± 3.3 mmHg (P = 0.0093), respectively, as measured immediately after clipping. Functional NYHA class improved from mean 3 (range 3 [90.9%] to 4 [9.1%]) to 2 in 84.9% (P = 0.00081) as obtained at discharge. Conclusions: Mitral valve repair with MitraClip® using multiple clips is appropriate and safe in unselected patients resulting in reduced MR with positive impact on short-term functional capacity. (J Interven Cardiol 2011;**:1-10).

Real-world Experience of Drug-eluting Stents in Saphenous Vein Grafts Compared to Native Coronary Arteries: Results from the Prospective Multicenter German DES.DE Registry

Clinical Research in Cardiology : Official Journal of the German Cardiac Society. Mar, 2012  |  Pubmed ID: 22080410

Bypass-graft intervention was associated with worse outcomes in the bare-metal stent era. Without sufficiently powered data from subgroup analyses, and in absence of randomized controlled trials targeting clinical endpoints, controversy is ongoing over safety and efficacy of drug-eluting stents (DES) in saphenous vein graft (SVG) lesions.