Ina Wagner

Deutsches Herzzentrum München, München, Bavaria, Germany

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Publications (10)35.76 Total impact

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    ABSTRACT: Magnetic Resonance Imaging (MRI) and transthoracic echocardiography have been shown to be noninvasive highly sensitive diagnostic tools to identify changes in LV mass and volume. We therefore investigated the effects of mitral valve repair (MVR) on LV function parameters including ejection fraction (EF; %), indices of LV mass (LVMI; g/m2) and volume (LVEDVI, LVESVI; mL/m2) as detected by MRI and echocardiography. Eight consecutive patients (mean age 53.3 +/- 10.0 years) with severe mitral regurgitation (MR; grade III-IV), normal LV function and sinus rhythm were included in this prospective study. Cine MRI and transthoracic M-mode echocardiography were performed pre-operatively, as well as 6 months post-op, to identify changes in EF and in LV mass and volume. Data are given as mean +/- standard deviation. Post-op MR was grade 0-I in all patients. Early mortality and late mortality was 0%. EF by either method did not change significantly within the follow-up period. A significant improvement of indices of LV mass and volume was detected by Cine MRI and echocardiography within 6 months following surgery (LVMIMRI: pre-op: 76.3 +/- 20.1 vs. post-op: 66.5 +/- 14.3, p < 0.05; LVMIEcho: pre-op: 184.2 +/- 38.1 vs. post-op: 136.5 +/- 28.4, p < 0.05. LVEDVIMRI: pre-op: 119.3 +/- 26.0 vs. post-op: 75.4 +/- 13.1, p < 0.05; LVEDVIEcho: pre-op: 97.4 +/- 28.8 vs. post-op: 69.2 +/- 13.1, p < 0.05. LVESVIMRI: pre-op: 44.6 +/- 12.0 vs. post-op: 32.5 +/- 9.5, p < 0.05; LVESVIEcho: pre-op: 29.3 +/- 8.3 vs. post-op: 21.8 +/- 4.6, p < 0.05). MRI and echocardiography show a significant reduction of LV volume and mass 6 months after MVR. The data show that for routine follow-up transthoracic M-mode echocardiography provides reliable information for the identification of LV mass and volume regression in patients after MVR.
    Journal of Cardiac Surgery 01/2008; 23(2):126-32. · 1.35 Impact Factor
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    ABSTRACT: Aortic valve replacement in patients with a small aortic annulus is often associated with increased pressure gradients. For this reason, prostheses for completely supra-annular placement have been developed. To evaluate the potential benefit of this design, the present study compared the effectiveness of 1 intra-supra-annular bioprosthesis and 3 completely supra-annular bioprostheses in patients with an aortic annulus diameter of 23 mm or less. Between August 2000 and December 2004, each of 192 patients requiring aortic valve replacement with an intraoperatively measured aortic annulus diameter of 23 mm or less received one of the following bioprostheses: the stented bovine Sorin Soprano bioprosthesis (n = 28) (Sorin Group, Saluggia, Italy), the Carpentier-Edwards Perimount bioprosthesis (n = 50) (Edwards Lifesciences, Irvine, Calif), the Carpentier-Edwards Perimount Magna bioprosthesis (n = 70) (Edwards Lifesciences), or the stented porcine Medtronic Mosaic (n = 44) (Medtronic Inc, Minneapolis, Minn) bioprosthesis. After 6 months, hemodynamic data at rest and during exercise were obtained by echocardiography in 142 patients. The pericardial valves showed lower mean systolic pressure gradients, larger effective orifice areas and indices, and superior effective orifice fractions than did the porcine valve (P < .05) (Carpentier-Edwards Perimount: 10.9 +/- 3.6 mm Hg, 1.59 +/- 0.41 cm2, 0.9 +/- 0.25 cm2/m2, 41.9% +/- 9.6%; Carpentier-Edwards Perimount Magna 10.1 +/- 3.8 mm Hg, 1.64 +/- 0.38 cm2, 0.93 +/- 0.22 cm2/m2, 45.1% +/- 10.2%; Sorin Soprano 13.5 +/- 5.0 mm Hg, 1.64 +/- 0.32 cm2, 0.92 +/- 0.15 cm2/m2, 45.8% +/- 9.0%; vs Medtronic Mosaic 15.5 +/- 5.2 mm Hg, 1.31 +/- 0.42 cm2, 0.75 +/- 0.24 cm2/m2, 35.2% +/- 10.0%, respectively). The lowest mean systolic pressure gradients were found after the implantation of the Carpentier-Edwards Perimount Magna. Effective orifice areas, indices, and fractions of the pericardial valves did not show significant differences. In patients with small aortic roots, transvalvular gradients and effective orifice area showed a tendency to superior results in pericardial valves compared with the porcine bioprosthesis. However, the completely supra-annular design does not necessarily lead to superior hemodynamic results compared with the intra-supra-annular position.
    The Journal of thoracic and cardiovascular surgery 05/2007; 133(5):1234-41. · 3.41 Impact Factor
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    ABSTRACT: The purpose of this clinical study was to obtain further evidence of the underlying mechanism causing the echocardiographically detected phenomenon of single beat regurgitation in a new bileaflet heart valve. As part of a prospective multicenter trial at our institution, 63 patients received the Advantage bileaflet mechanical heart valve (Medtronic, Minneapolis, Minnesota) in aortic position. During routine follow-up performed at discharge and annually after the operation, intermittent moderate transvalvular regurgitation was detected by echocardiography in 5 patients. Fluoroscopy of leaflet motion (n = 4), invasive blood pressure measurements in the ascending aorta (n = 3) and digital phonocardiography (n = 5) was obtained in the patients showing an intermittent regurgitation during echocardiography. Valve thrombosis, sutures, or pannus ingrowth impairing valve closure was not detected. Fluoroscopy of leaflet motion showed intermittent incomplete closure of either one of the two leaflets in the same prosthesis. This could be correlated with a distinct diastolic blood pressure drop in the same cardiac cycle. Digital phonocardiography showed pathologic closure sounds in those cycles in which echocardiographically the intermittent regurgitation was observed. Some patients with the Medtronic Advantage prosthesis in the aortic position show an intermittent inability of complete valve closure that leads to a single beat transvalvular regurgitation. As thrombotic or other material that might cause a disturbance of leaflet motion could not be detected, and the patients seem not to be exposed to any risk except for some chronic regurgitant volume, we decided not to replace the prostheses.
    The Annals of thoracic surgery 09/2006; 82(2):537-41. · 3.45 Impact Factor
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    ABSTRACT: Background. The purpose of this clinical study was to obtain further evidence of the underlying mechanism causing the echocardiographically detected phenomenon of single beat regurgitation in a new bileaflet heart valve. As part of a prospective multicenter trial at our institu- tion, 63 patients received the Advantage bileaflet me- chanical heart valve (Medtronic, Minneapolis, Minne- sota) in aortic position. During routine follow-up performed at discharge and annually after the operation, intermittent moderate transvalvular regurgitation was detected by echocardiography in 5 patients. Methods. Fluoroscopy of leaflet motion (n 4), inva- sive blood pressure measurements in the ascending aorta (n 3) and digital phonocardiography (n 5) was obtained in the patients showing an intermittent regur- gitation during echocardiography. Results. Valve thrombosis, sutures, or pannus in- growth impairing valve closure was not detected. Fluo- roscopy of leaflet motion showed intermittent incom- plete closure of either one of the two leaflets in the same prosthesis. This could be correlated with a distinct dia- stolic blood pressure drop in the same cardiac cycle. Digital phonocardiography showed pathologic closure sounds in those cycles in which echocardiographically the intermittent regurgitation was observed. Conclusions. Some patients with the Medtronic Advan- tage prosthesis in the aortic position show an intermit- tent inability of complete valve closure that leads to a single beat transvalvular regurgitation. As thrombotic or other material that might cause a disturbance of leaflet motion could not be detected, and the patients seem not to be exposed to any risk except for some chronic regur- gitant volume, we decided not to replace the prostheses. ileaflet mechanical valves exhibit some minor regur- gitation at the pivotal points. The pivotal region is designed to allow washing jets to reduce the risk of thrombus formation. This regurgitation is seen during color Doppler flow imaging as two small jets not exceed- ing the left ventricular outflow tract, homogeneous in color, reflecting its low momentum. The current report deals with five cases where we observed an intermittent, trivial to moderate, single beat transvalvular regurgita- tion which is clearly different from the expected trivial regurgitation. To obtain further evidence of the underly- ing mechanism causing this phenomenon, we performed additional testing.
    The Journal of thoracic and cardiovascular surgery 04/2006; 131(3):730-1. · 3.41 Impact Factor
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    ABSTRACT: The study aim was to evaluate the clinical and hemodynamic performance of the Sorin Soprano bioprosthesis in the aortic position. Rest and stress echocardiography were performed at six months after surgery in 57 patients who underwent aortic valve replacement with the stented Soprano bioprosthesis. The exercise protocol included workloads of 25, 50, 75 and 100 W, each of 2 min duration. Thirty-day mortality was 1.8% (n = 1). Due to malperfusion of the coronary arteries, two Soprano prostheses had to be replaced by a different prosthesis, and one patient received coronary artery bypass grafts. One patient developed bacterial endocarditis of his prosthesis at seven months postoperatively and died as a result of a fulminant sepsis. There were no other prosthesis-related adverse events. Mean pressure gradients (MPG) ranged from 7.8 to 15.9 mmHg, effective orifice areas (EOA) from 1.25 to 2.98 cm2, EOA index (EOAI) from 0.79 to 1.43 cm2/m2, and EOA fraction from 34 to 45%. Stress echocardiography showed no significant increase in MPG up to 50 W, and MPGs did not exceed 35 mmHg at 75 and 100 W. Initial hemodynamic results showed low MPGs during rest and exercise. The EOAI was large due to completely supra-annular placement of the Soprano valve. The difficulty of complete supraannular placement is that the prosthesis is positioned relatively high, especially in narrow aortic roots, and this may handicap coronary artery perfusion. Patient selection with suitable aortic root anatomy is crucial to achieve the benefit of completely supra-annular implantation without coronary ostium deterioration.
    The Journal of heart valve disease 12/2005; 14(6):822-7. · 1.07 Impact Factor
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    ABSTRACT: Stentless valves are considered to exhibit better hemodynamics after aortic valve replacement (AVR) compared to stented valves. However, a new generation of stented bioprostheses for completely supra-annular implantation has been designed to optimize the ratio of the effective orifice area (EOA) of the prosthesis and aortic annulus area. The study aim was to determine whether a stentless valve implanted in the subcoronary technique renders larger orifice areas and lower transvalvular pressure gradients at rest and exercise compared to a completely supra-annular stented device. Twenty patients underwent AVR for aortic stenosis with the St. Jude Medical (SJM) Toronto Root stentless porcine bioprosthesis, using a subcoronary implantation technique. Through the authors' institutional database, 20 additional patients were identified who had undergone AVR with the Medtronic Mosaic stented completely supra-annular porcine bioprosthesis. The patient groups were not matched for labeled valve size, but for annulus diameter measured intraoperatively using Hegar's dilators. Hemodynamic performance was assessed by transthoracic echocardiography at discharge (early) and by rest and stress echocardiography at six months postoperatively (mid-term). Transvalvular mean pressure gradients (MPG) at rest were significantly lower in the stentless group, but cardiac output was similar in both groups. Stress echocardiography also revealed significantly lower gradients at 25 W and 50 W exercise in the stentless group. The EOA index (EOAI), grouped by annulus diameter, tended to be larger in the stentless group and showed no severe patient-prosthesis mismatch (PPM; EOAI <0.65 cm2/m2) which, in contrast, occurred in three patients (15%) in the stented group (p = 0.072). In summary, the SJM Toronto Root porcine stentless bioprosthesis in the subcoronary position showed lower MPGs and larger EOAs at rest and during exercise compared to the Medtronic Mosaic porcine stented bioprosthesis. Therefore, physically active patients in particular may benefit from use of the stentless valve. Because of its larger EOA, a stentless valve should be implanted if severe PPM is expected.
    The Journal of heart valve disease 11/2005; 14(6):814-21; discussion 821. · 1.07 Impact Factor
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    ABSTRACT: The aim of the study was to evaluate rest and exercise performance and left ventricular mass regression of the Medtronic Advantage (Medtronic, Inc, Minneapolis, MN) prosthesis in the aortic position at 1 year at a single center as part of a multicenter, prospective clinical trial. Between May 2002 and June 2003, 63 consecutive patients underwent aortic valve replacement with a Medtronic Advantage prosthesis (84.1% male; mean age, 56.0 +/- 9.7 years; ejection fraction, 56.5 +/- 15.8%). Valve lesions were stenosis (n = 20), mixed (n = 34), and insufficiency (n = 9). Concomitant procedures were performed in 34.9%. Follow-up was 100% complete. Echocardiographic data were obtained early postoperatively and at 1 year, combined with stress echocardiography by treadmill. Mean pressure gradients, stroke volume, and left ventricular mass were determined by echocardiography. Data are presented as mean +/- standard deviation. Operative mortality was 0%. Valve-related complications were observed in 2 patients (endocarditis, n = 1; thromboembolic event, n = 1). There was no case of antithromboembolic hemorrhage, prosthesis-related explant, or reoperation. One patient showed moderate paravalvular regurgitation. Mean pressure gradients 1 year postoperatively ranged from 6.3 to 11.0 mm Hg across all valve sizes. Left ventricular mass regression at 1 year was 18.4% across all valve sizes (p < 0.001). No severe patient-prosthesis mismatch (effective orifice area index < or = 0.65 cm2/m2) could be observed. After 1 year, the Medtronic Advantage valve shows comparable transvalvular mean pressure gradients across the valve sizes used during rest and exercise. This is accompanied by a significant left ventricular mass regression, an important indicator for long-term survival.
    The Annals of thoracic surgery 10/2005; 80(4):1319-26. · 3.45 Impact Factor
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    ABSTRACT: Complete supraannular placement and smaller stent design allow the implantation of a Perimount Magna bioprosthesis with a larger inner diameter than that of a standard Perimount. This study compares the hemodynamic performance and the incidence of patient-prosthesis mismatch (PPM) of both prostheses. 128 patients underwent aortic valve replacement, receiving either a Magna (n = 57) or a standard (n = 71) prosthesis. Inner aortic annulus diameter was measured intraoperatively by a hegar dilator to match echocardiographically obtained results to the annulus diameter instead of matching them to labelled valve size. The Magna was significantly superior with respect to mean pressure gradient and effective orifice area in patients with an annulus diameter of 22-23 mm. In patients with an annulus diameter < 22 mm or > 23 mm, there was a non-significant trend towards superior hemodynamics in the Magna group. Severe PPM (effective orifice area index < or = 0.65 cm (2)/m (2)) was present in 11.1% (Magna) vs. 42.1% (Standard) of patients with an annulus diameter < 22 mm; in 0% (Magna) vs. 13.8% (Standard) with an annulus diameter of 22-23 mm; no PPM was seen in patients with annulus diameter > 23 mm in both groups. The Perimount Magna had a significantly reduced incidence of patient-prosthesis mismatch and superior hemodynamics compared to the standard Perimount.
    The Thoracic and Cardiovascular Surgeon 08/2005; 53(4):226-30. · 0.93 Impact Factor
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    ABSTRACT: The present study evaluates complete supra-annular bioprostheses in patients with an aortic annulus of 18 to 23 mm in diameter. Aortic valve replacement in patients with small aortic annulus using stented bioprostheses is often associated with unsatisfactory hemodynamic results and high incidence of patient-prosthesis mismatch. Between February 2000 and January 2004, 156 patients with aortic valve disease and an aortic annulus of 18 to 23 mm in diameter received the stented bovine Soprano (Sorin Biomedica Cardio, Saluggia, Italy) (n = 18), Perimount (Edwards Lifesciences, Irvine, California) (n = 52), Perimount Magna (Edwards Lifesciences) (n = 42), or the stented porcine Mosaic (Medtronic Inc., Minneapolis, Minnesota) (n = 44) bioprostheses. Intraoperatively, the surgeon measured the aortic annulus diameter by inserting a hegar dilator. Thus, postoperative hemodynamic results could be referred to the patient's aortic annulus diameter instead of referring the results to the labeled valve size. This allows for objective comparisons between different valve types. There was no significant difference in hemodynamic results between the different valve types in patients with an aortic annulus 18 to 20 mm. In patients with an annulus 21 to 23 mm, the Magna was significantly superior to the other investigated devices in mean pressure gradient, effective orifice area, and incidence of patient-prosthesis mismatch. There was no significant difference between the complete supra-annular bioprostheses Mosaic and Soprano and the intra-supra-annular Perimount valve. In patients with an aortic annulus of 18 to 20 mm in diameter, hemodynamic performance is independent of the implanted stented valve type and the annular position. Root enlargement or stentless valves may be beneficial alternatives. Patients with annulus diameter 21 to 23 mm benefit from the Magna in complete supra-annular position leading to superior hemodynamic results.
    Journal of the American College of Cardiology 07/2005; 45(12):2054-60. · 14.09 Impact Factor
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    ABSTRACT: This prospective randomized study compares a porcine with a bovine bioprosthesis in the aortic position with regard to hemodynamic performance during exercise. Between August of 2000 and December of 2002, 136 patients underwent aortic valve replacement with the porcine Medtronic Mosaic (n = 66) or the bovine Carpentier-Edwards Perimount (n = 70) bioprosthesis. Transthoracic echocardiography was performed to assess hemodynamic and dimensional data preoperatively and 10 months postoperatively; the latter follow-up included stress echocardiography with treadmill exercise. At rest and during exercise (25 and 50 W), there was a significant difference in mean pressure gradient between the bovine and the porcine valves with labeled sizes 21 and 23, with superiority of the Perimount prosthesis. There was no difference in effective orifice area and incidence of patient-prosthesis mismatch among all sizes. The left ventricular mass index decreased significantly within 10 months postoperatively in the size 23 bovine group and the size 25 porcine group. Our data show a significant superiority of pressure gradients for the bovine bioprosthesis, especially with small valve sizes, when compared with the porcine device, which is more distinctive during exercise.
    Journal of Thoracic and Cardiovascular Surgery 06/2005; 129(5):1056-63. · 3.53 Impact Factor