Jürgen O Böhm

Universität zu Lübeck, Lübeck, Schleswig-Holstein, Germany

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Publications (27)97.82 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of the study is to report major cardiac and cerebrovascular events after the Ross procedure in the large adult and pediatric population of the German-Dutch Ross registry. These data could provide an additional basis for discussions among physicians and a source of information for patients. One thousand six hundred twenty patients (1420 adults; 1211 male; mean age, 39.2±16.2 years) underwent a Ross procedure between 1988 and 2008. Follow-up was performed on an annual basis (median, 6.2 years; 10 747 patient-years). Early and late mortality were 1.2% (n=19) and 3.6% (n=58; 0.54%/patient-year), respectively. Ninety-three patients underwent 99 reinterventions on the autograft (0.92%/patient-year); 78 reinterventions in 63 patients on the pulmonary conduit were performed (0.73%/patient-year). Freedom from autograft or pulmonary conduit reoperation was 98.2%, 95.1%, and 89% at 1, 5, and 10 years, respectively. Preoperative aortic regurgitation and the root replacement technique without surgical autograft reinforcement were associated with a greater hazard for autograft reoperation. Major internal or external bleeding occurred in 17 (0.15%/patient-year), and a total of 38 patients had composite end point of thrombosis, embolism, or bleeding (0.35%/patient-year). Late endocarditis with medical (n=16) or surgical treatment (n=29) was observed in 38 patients (0.38%/patient-year). Freedom from any valve-related event was 94.9% at 1 year, 90.7% at 5 years, and 82.5% at 10 years. Although longer follow-up of patients who undergo Ross operation is needed, the present series confirms that the autograft procedure is a valid option to treat aortic valve disease in selected patients. The nonreinforced full root technique and preoperative aortic regurgitation are predictors for autograft failure and warrant further consideration. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00708409.
    Circulation 09/2010; 122(11 Suppl):S216-23. · 15.20 Impact Factor
  • Thoracic and Cardiovascular Surgeon - THORAC CARDIOVASC SURG. 01/2010; 58.
  • Thoracic and Cardiovascular Surgeon - THORAC CARDIOVASC SURG. 01/2010; 58.
  • Thoracic and Cardiovascular Surgeon - THORAC CARDIOVASC SURG. 01/2010; 58.
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    ABSTRACT: Until today, no perfect valve substitute has been developed. Some essential requirements for a perfect valve substitute are proposed in Table 1. Regarding the aortic valve, the Ross procedure (pulmonary autograft operation) is closer to this ideal than any other substitute in many ways. For this reason, it was enthusiastically adopted by many surgeons after it became widely known in the late 1980s and was technically simplified by Stelzer and Elkins [27] (total root replacment, Fig. 1). In recent years, however, several groups report high reoperation rates and a worrysome tendency for the development of neoaortic regurgitation and/or ascending aortic aneurysms [7, 10, 16, 18, 20, 29]. A recent systematic review concluded that “durability limitations become apparent by the end of the first postoperative decade, in particular in younger patients” [28], and it was asked whether the ross procedure is a “Trojan horse” [15]. As a result of these newer data, many centers appear to have stopped performing the Ross procedure. Table 1.Proposed criteria of an ideal valve substitute Fig. 1.Schematic drawing of the Ross procedure. The diseased aortic valve is resected (1). Then, the autologous pulmonary root including the valve is harvested from the right ventricular outflow tract (RVOT) (2). The autologous pulmonary valve can be implanted into the aortic position using different techniques • Full root replacement: this technique was popularized by Stelzer and Elkins and is the technique most often used worldwide. The autologous pulmonary root is implanted in the aortic position (3). With this technique, reimplantation of the coronary arteries into the neoaortic root is necessary, but the geometry of the pulmonary root can be easily preserved in its new position • Subcoronary implantation: this is the technique originally described by Ross and still preferred by the Luebeck group. The autologous pulmonary valve is implanted into the aortic root in a subcoronary position (4) • Cylinder inclusion technique: this technique combines features from the other two techniques. It is technically the most demanding and is only rarely used (5) • To complete the operation, the defect in the RVOT needs to be reconstructed, usually by implantation of a pulmonary allograft root (6)
    12/2009: pages 74-85;
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    ABSTRACT: Autograft reinforcement interventions (R) during the Ross procedure are intended to preserve autograft function and improve durability. The aim of this study is to evaluate this hypothesis. 1335 adult patients (mean age:43.5+/-12.0 years) underwent a Ross procedure (subcoronary, SC, n=637; root replacement, Root, n=698). 592 patients received R of the annulus, sinotubular junction, or both. Regular clinical and echocardiographic follow-up was performed (mean:6.09+/-3.97, range:0.01 to 19.2 years). Longitudinal assessment of autograft function with time was performed using multilevel modeling techniques. The Root without R (Root-R) group was associated with a 6x increased reoperation rate compared to Root with R (Root+R), SC with R (SC+R), and without R (SC-R; 12.9% versus 2.3% versus 2.5%.versus 2.6%, respectively; P<0.001). SC and Root groups had similar rate of aortic regurgitation (AR) development over time. Root+R patients had no progression of AR, whereas Root-R had 6 times higher AR development compared to Root+R. In SC, R had no remarkable effect on the annual AR progression. The SC technique was associated with lower rates of autograft dilatation at all levels of the aortic root compared to the Root techniques. R did not influence autograft dilatation rates in the Root group. For the time period of the study surgical autograft stabilization techniques preserve autograft function and result in significantly lower reoperation rates. The nonreinforced Root was associated with significant adverse outcome. Therefore, surgical stabilization of the autograft is advisable to preserve long-term autograft function, especially in the Root Ross procedure.
    Circulation 09/2009; 120(11 Suppl):S146-54. · 15.20 Impact Factor
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    ABSTRACT: Although the Ross operation requires double-valve replacement for aortic valve pathology, it is the only autologous, aortic valve replacement available. We report a single-unit's 11-year experience. Before August 2006, 467 patients (mean age, 41 +/- 15 years; 358 males) underwent a Ross operation. The right ventricular outflow tract was repaired with a cryopreserved pulmonary homograft. Follow-up was 94.4% complete. The 30-day mortality was 0.6%. The Kaplan-Meier survival estimate at 120 months was 94.4% +/- 2.9% (standard error [SE], 0.0146). Reoperation was due to autograft failure in 15 patients (7 repairs, 8 replacements), with a Kaplan-Meier freedom from autograft failure measured as reoperation or regurgitation exceeding grade II at 120 months of 94.2% +/- 2.8% (SE, 0.0142). Homograft replacement, mostly due to stenosis, occurred in 11 patients. Freedom from homograft dysfunction, defined as homograft reoperation or peak homograft gradient of 30 mm Hg or more, at 120 months was 79.3% +/- 7.3% (SE, 0.0372). Freedom from all autograft- and homograft-related reoperations at 120 months was 85.9% +/- 6.3% (SE, 0.0321). Autograft or homograft endocarditis occurred in 8 patients, and 1 patient had simultaneous endocarditis of both valves. Patient survival and freedom from prostheses-related events over 11 years still compares favorably with conventional heart valve prostheses. Mortality and morbidity remain low. Reoperation for autograft or homograft failure is higher than our previous reports, and endocarditis is also evident, 1.9% (9 of 467). Homograft dysfunction is higher in younger recipients.
    The Annals of thoracic surgery 03/2009; 87(2):514-20. · 3.45 Impact Factor
  • Thoracic and Cardiovascular Surgeon - THORAC CARDIOVASC SURG. 01/2009; 56.
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    ABSTRACT: We studied the efficacy of propafenone in preventing atrial tachyarrhythmias after cardiac surgery, and the possible relationships between CYP2D6 polymorphism and the efficacy, pharmacokinetics, and tolerability of propafenone. One hundred and sixty patients were randomized (double blind) to receive propafenone (n= 78) or placebo (n= 82) for 1 week after cardiac surgery. The patients who were assigned to the propafenone group received 1 mg/kg infused in 1 h, followed by a continuous infusion at a rate of 4 mg/kg/24 h until the following morning, and subsequently 450 mg/day orally until the sixth postoperative day. Thirty-seven patients completed the trial in the propafenone group and 45 in the placebo group. The frequency of occurrence of atrial tachyarrhythmia was lower in the propafenone group than in the placebo group (29.7% vs. 53.3%, P< 0.05; relative risk, 0.56). Plasma propafenone concentrations were markedly influenced by CYP2D6 genotype-derived phenotype.
    Clinical Pharmacology &#38 Therapeutics 07/2008; 84(1):104-10. · 6.85 Impact Factor
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    ABSTRACT: Autograft regurgitation and root dilatation after the Ross procedure is of major concern. We reviewed data from the German Ross Registry to document the development of autograft regurgitation and root dilatation with time and also to compare 2 different techniques of autograft implantation. Between 1990 and 2006 1014 patients (786 men, 228 women; mean age 41.2+/-15.3 years) underwent the Ross procedure using 2 different implantation techniques (subcoronary, n=521; root replacement, n=493). Clinical and serial echocardiographic follow up was performed preoperatively and thereafter annually (mean follow up 4.41+/-3.11 years, median 3.93 years, range 0 to 16.04 years; 5012 patient-years). For statistical analysis of serial echocardiograms, a hierarchical multilevel modeling technique was applied. Eight early and 28 late deaths were observed. Pulmonary autograft reoperations were required in 35 patients. Initial autograft regurgitation grade was 0.49 (root replacement 0.73, subcoronary 0.38) with an annual increase of grade 0.034 (root replacement 0.0259, subcoronary 0.0231). Annulus and sinus dimensions did not exhibit an essential increase over time in both techniques, whereas sinotubular junction diameter increased essentially by 0.5 mm per year in patients with root replacement. Patients with the subcoronary implantation technique showed nearly unchanged dimensions. Bicuspid aortic valve morphology did not have any consistent impact on root dimensions with time irrespective of the performed surgical technique. The present Ross series from the German Ross Registry showed favorable clinical and hemodynamic results. Development of autograft regurgitation for both techniques was small and the annual progression thereof is currently not substantial. Use of the subcoronary technique and aortic root interventions with stabilizing measures in root replacement patients seem to prevent autograft regurgitation and dilatation of the aortic root within the timeframe studied.
    Circulation 10/2007; 116(11 Suppl):I251-8. · 15.20 Impact Factor
  • W Hemmer, J O Böhm
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    ABSTRACT: The Cox-Maze procedure and less complex modifications have gained widespread use as a treatment modality for patients with concomitant atrial fibrillation. Hypothermic or hyperthermic energy sources play a significant role in rapidly creating linear lesions. Endocardial ablation is easy to perform and effective with different energy sources. Epicardial techniques may simplify the procedure by allowing surgery on a beating heart. But epicardial fat and the heat sink effect of the flowing endocardial blood are obstacles to effective ablation. New devices using bipolar (irrigated) radiofrequency, microwave or laser energy, cryoablation or focused ultrasound are in clinical or pre-clinical stages and permit lesions to be created on a beating heart without cardiopulmonary bypass. Minimally invasive or video-assisted surgical techniques and effective devices for epicardial ablation will enable the treatment of patients suffering from lone atrial fibrillation. To facilitate the comparison between different techniques and devices, guidelines for reporting clinical results are necessary.
    Herzschrittmachertherapie & Elektrophysiologie 07/2007; 18(2):92-100.
  • The Thoracic and Cardiovascular Surgeon 01/2007; 55. · 0.93 Impact Factor
  • Thoracic and Cardiovascular Surgeon - THORAC CARDIOVASC SURG. 01/2007; 55.
  • W. Hemmer, J. O. Böhm
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    ABSTRACT: Die Cox-Maze-Operation und ihre chirurgisch weniger komplexen Modifikationen sind heute zur Behandlung des Vorhofflimmerns begleitend zu anderen herzchirurgischen Eingriffen weitgehend anerkannt. Durch eine Ablation des Vorhofmyokards mit Kälte oder Hitze können rasch lineare Läsionen erzeugt werden. Das endokardiale Vorgehen unter Verwendung unterschiedlicher Energiequellen hat sich als technisch einfach und effektiv erwiesen. Mit epikardialen Techniken kann die Prozedur weiter vereinfacht und am schlagenden Herzen durchgeführt werden. Hindernisse für die Gewährleistung transmuraler Linien sind das epikardiale Fettgewebe und der kühlende oder erwärmende Effekt des subendokardialen Blutflusses. Neue Sondentechnologien unter Verwendung von bipolarer (gekühlter) Radiofrequenz-, Mikrowellen- oder Laserenergie, Cryoablation oder fokusiertem Ultraschall sind derzeit in vor- oder klinischer Erprobung. Damit sollten auch am schlagenden Herzen ohne Einsatz der Herzlungenmaschine transmurale Läsionen realisierbar sein. Mit diesen neuen Technologien und einem minimalinvasiven oder endoskopischen chirurgischen Vorgehen kann auch für Patienten mit „lone atrial fibrillation“ eine alternative Therapieform angeboten werden. Zur besseren Erfassung und zum wissenschaftlichen Vergleich der unterschiedlichen Techniken sind Empfehlungen zur einheitlichen Sammlung und Auswertung klinischer Daten notwendig. The Cox-Maze procedure and less complex modifications have gained widespread use as a treatment modality for patients with concomitant atrial fibrillation. Hypothermic or hyperthermic energy sources play a significant role in rapidly creating linear lesions. Endocardial ablation is easy to perform and effective with different energy sources. Epicardial techniques may simplify the procedure by allowing surgery on a beating heart. But epicardial fat and the heat sink effect of the flowing endocardial blood are obstacles to effective ablation. New devices using bipolar (irrigated) radiofrequency, microwave or laser energy, cryoablation or focused ultrasound are in clinical or pre-clinical stages and permit lesions to be created on a beating heart without cardiopulmonary bypass. Minimally invasive or video-assisted surgical techniques and effective devices for epicardial ablation will enable the treatment of patients suffering from lone atrial fibrillation. To facilitate the comparison between different techniques and devices, guidelines for reporting clinical results are necessary.
    Herzschrittmachertherapie & Elektrophysiologie 01/2007; 18(2):92-100.
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    ABSTRACT: The Ross operation is increasingly accepted as an alternative to conventional valve prostheses for children, adolescents, and young adults. We review patients younger than 20 years of age. Of 404 Ross operations done before November 2004, 60 were young patients with a median age of 12 years (range, 1 to 20 years). The pulmonary autograft technique universally was as a free root. A cryopreserved pulmonary homograft reconstructed the right ventricular outflow tract. Early postoperative complications were reentry for bleeding in 2 patients and one pacemaker insertion. No thromboembolic or hemorrhagic events occurred during the follow-up of 42 +/- 27 months. Two late deaths occurred, one from myocardial infarction after 3 months and another sudden death after 5 years, probably from critical pulmonary homograft stenosis. Echocardiographic follow-up revealed a median peak gradient of 6.3 +/- 3 mm Hg across the autograft. The median pulmonary homograft peak gradient of 19.1 +/- 13.7 mm Hg was increased to more than 30 mm Hg in 6 patients. Another 6 patients had moderate but clinically insignificant pulmonary homograft regurgitation. Altogether, 6 patients required reoperation for replacement of stenotic homografts. No autograft related reoperation occurred. Young patients with the Ross operation had good mid-term autograft function and no perioperative mortality. Factors that justify the choice of the Ross operation for young patients are the normal physiologic hemodynamics and growth of the autograft as well as freedom from anticoagulation. A 10% reoperation rate, elevated pulmonary homograft gradients, and the surgical complexity remain limiting factors.
    The Annals of thoracic surgery 10/2006; 82(3):940-7. · 3.45 Impact Factor
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    ABSTRACT: Return of left ventricular mass to normal is considered to be a favorable result of aortic valve replacement. The Ross procedure provides near normal hemodynamics and thus allows studies of left ventricular (LV) reverse remodeling. LV mass regression may be influenced by surgical technique (subcoronary [SC] versus root replacement [RR]). Data from the German Ross Registry were analyzed. A total of 646 patients (mean age: 43.6+/-12.7 years, range: 16 to 71 years; SC technique n=295, RR technique n=351) underwent a Ross procedure in 7 participating centers from 1990 to 2004. The patients underwent preoperative and postoperative echocardiographic evaluations. Mean follow-up time was 3.5+/-2.5 years (range 0.12 to 13.7 years). Follow-up completeness was 97%. The LV mass index (LVMI) decreased significantly during follow-up in both groups (SC: 209+/-53 preoperatively to 154+/-48 at 1-year follow-up, [P<0.01 versus preoperative values] to 149+/-51 g/m2 at 2-year follow-up, [P=NS 1-year versus 2-year follow-up] versus RR: from 195+/-56 preoperatively to 144+/-51 at 1-year follow-up [P<0.01 versus preoperative values] to 140+/-49 g/m2 [P=NS 1-year versus 2-year follow-up]). LVMI regression remained stagnant 1 year after the Ross procedure in most patients in both groups. On the basis of multivariate analysis, predictors for incomplete LVMI regression after the autograft procedure were high preoperative LVMI, smoking, and uncontrolled diastolic hypertension. At mid-term echocardiographic follow-up, patients of both groups had favorable autograft hemodynamics. Risk factors for incomplete postoperative LVMI regression in our study were smoking and persistent diastolic hypertension. This emphasizes the importance of cessation of smoking and treatment of arterial hypertension, even in younger patients, after corrected aortic valve disease.
    Circulation 09/2005; 112(9 Suppl):I415-22. · 15.20 Impact Factor
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    ABSTRACT: We present an early series to determine the technical feasibility of simultaneous aortic valve and complete ascending aortic replacement using a longer stentless aortic xenograft, harvested with an extended root. The stentless xenograft valved conduits commercially available are too short for complete ascending aorta replacement, and usually a prosthetic tube graft is required distally. To avoid this extra prosthetic conduit distally a number of stentless aortic xenografts with extended conduit were obtained from a supplier (Medtronic Inc). They were inserted in 6 elderly patients (67.8 +/- 7.1 years) who all required aortic valve and ascending aorta replacements owing to pathologic dilation. In all cases an extra prosthetic conduit was avoided, and the length of the available biological conduit comfortably allowed total ascending aortic replacement without tension. The advantages therefore were one less suture line, cost saving regarding the prosthetic conduit, shorter cross-clamping time, and possibly shorter time spent on hemostasis.
    The Annals of thoracic surgery 01/2005; 78(6):2150-2; discussion 2153. · 3.45 Impact Factor
  • The Annals of thoracic surgery 08/2004; 78(1):384. · 3.45 Impact Factor
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    ABSTRACT: The Ross operation as aortic valve replacement has undergone technical evolution. Originally described as a subcoronary implant, the full-root replacement technique is now more common worldwide. It remains unclear which of the two techniques has the better results. Hence, the hemodynamic performances of the two implantation methods, as applied by two experienced centers, were compared as part of the German Ross Registry. In total, 132 (Group 1, root replacement, mean age 40 +/- 14 years) and 249 (Group 2, subcoronary implant, mean age 48 +/- 14 years) consecutively operated patients were compared clinically and echocardiographically. Data were analyzed focusing on pulmonary autograft and homograft function at mid-term (2.78 +/- 1.89 versus 2.26 +/- 2.11 years). Echocardiography revealed autograft peak systolic gradients of 5.0 +/- 2.7 mmHg for Group 1 and 6.7 +/- 3.7 mmHg for Group 2 (p < 0.05), and an indexed effective orifice area (EOA) of 1.98 +/- 0.57 cm2/m2 and 1.64 +/- 0.43 cm2/m2 (p < 0.05), respectively. Homograft peak systolic gradients were 15.6 +/- 9.0 mmHg and 11.7 +/- 6.8 mmHg for Groups 1 and 2 (p < 0.05) respectively, and the indexed EOA with regard to the homograft was 1.08 +/- 0.49 cm2/m2 and 1.26 +/- 0.50 cm2/m2 (p < 0.05). Autograft insufficiency grade > I was present in 1.5% (2/132) of Group 1 and 2.8% (7/249) of Group 2 patients. Pulmonary insufficiency grade > I was 17.4% (23/132) for Group 1 and 4.8% (12/249) for Group 2 (p < 0.05). Although both groups enjoyed excellent hemodynamics in the mid-term, the root replacement technique had the advantage of larger annulus diameters and greater aortic EOA. Clinically relevant autograft regurgitation in both groups was gratifyingly rare, and seemed to be independent of surgical technique. Long-term durability of the more demanding subcoronary technique versus the problems of larger dimensions of the sinus of Valsalva and sinotubular junction in the free-root technique, remains to be proven. Apparent differences in pulmonary homograft hemodynamics can most likely be explained by surgical differences, younger patients in Group 1, and by homograft variation.
    The Journal of heart valve disease 04/2004; 13(2):174-80; discussion 180-1. · 1.07 Impact Factor
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    ABSTRACT: The Ross operation has an established position in young patients. We address the question of whether any age group profits most from the Ross operation, and we compare the results in various ages. From February 1995 to August 2001 we performed 250 Ross operations. Group 1 consisted of 46 patients, ages 2 to 25 years (median age, 15 years). Group 2 consisted of 123 patients, ages 26 to 49 years (median age, 39 years). Group 3 consisted of 81 patients, ages 50 to 67 years (median age, 55 years). Echocardiography was performed perioperatively, at 2 to 6 months, and then yearly. Mean follow-up for the three groups was 32, 31, and 28 months, respectively (p = 0.36). One patient from group 2 died after 25 months caused by suppurative pneumonia and 3 patients from group 3 died (1 from suspected acute thoracic aorta dissection at 40 months, 1 from ventricular fibrillation after 25 months, and 1 from an undiagnosed sudden death at 5 months). Autograft replacement was necessary for 3 patients from group 2 and 1 from group 3. Autograft repair was necessary for 1 patient from group 2, and pulmonary homograft reoperation was necessary for 1 patient from group 1. All other autografts currently have physiologic gradients and clinically insignificant regurgitation. Median peak gradient across the right ventricular outflow tract was 23.6 +/- 18 mm Hg for group 1, 14.6 +/- 8 mm Hg for group 2, and 11.5 +/- 7 mm Hg, which was significantly lower for group 3 patients (p < 0.001). Eleven patients are under close follow-up for right ventricular outflow tract gradients > or = 40 mm Hg; eight of these patients are from group 1, 3 are from group 2, and there are none from group 3. Although the Ross operation provides excellent results in all age groups, the problem of right ventricular outflow tract stenosis has not been seen in patients older than 50 years, which implies that it offers superior results for aortic valve disease in middle aged and older patients.
    The Annals of Thoracic Surgery 03/2003; 75(3):796-801; discussion 802. · 3.45 Impact Factor

Publication Stats

163 Citations
97.82 Total Impact Points

Institutions

  • 2007–2009
    • Universität zu Lübeck
      • Department of Cardiac and Thoracic Vascular Surgery
      Lübeck, Schleswig-Holstein, Germany
  • 1997–2009
    • Sana Herzchirurgie, Stuttgart
      Stuttgart, Baden-Württemberg, Germany
  • 2005
    • University Medical Center Schleswig-Holstein
      Kiel, Schleswig-Holstein, Germany