R Hetzer

Deutsches Herzzentrum Berlin, Berlín, Berlin, Germany

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Publications (761)1778.87 Total impact

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    ABSTRACT: OBJECTIVE: The EuroSCORE-II-model has recently been introduced and validated for accurate risk assessment in cardiac surgery. This study sought to investigate whether EuroSCORE-II is a more reliable tool for risk evaluation in transcatheter aortic valve implantation (TAVI) in comparison to older risk estimators. METHODS: Since 2008, 679 patients underwent transapical TAVI. The mean estimated risk for surgery was: EuroSCORE-II 16±16% (range 1-95%), logistic EuroSCORE 35±22% (2-97%), and The-Society-of-Thoracic-Surgeons-predicted-risk-of-mortality (STS-PROM) 14±12% (1-90%). Discrimination ability and calibration of these scores were investigated with receiver-operating-characteristic-curve, Hosmer-Lemeshow-test, and Brier score. According to allocation in quartiles of EuroSCORE-II, 4 equal subgroups were defined with low, intermediate, high, and very high surgical risk. RESULTS: The overall 30-day mortality rate was 4.7% (32/679) and 4.0% (26/642) in patients without cardiogenic shock. EuroSCORE-II showed a better discrimination (area-under-curve=0.669) compared to other scores but was not well calibrated. The analysis per EuroSCORE-II-quartiles showed a good prediction of 30-day-outcome for low risk patients (observed-to-expected mortality [O/E-ratio]=1.1), but a marked overestimation for intermediate (O/E-ratio=0.18), high (O/E-ratio=0.36) and very high (O/E-ratio=0.22) risk patients. The cumulative survival up to 5 years was dependent on EuroSCORE-II risk quartile (hazard ratio 1.54, 95%-confidence interval 1.35-1.77, p<0.001). CONCLUSIONS: There is no different outcome between TAVI and surgical valve replacement in patients with low risk profile (EuroSCORE-II ≤ 5%). For all patients with higher surgical risk, the outcome after TAVI is superior. Although EuroSCORE-II has not been developed from TAVI data, the score characterizes the patient’s comorbidities and provides most valuable additional information in TAVI risk assessment.
    XXVII congresso SICCH, Roma, Italia; 11/2014
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    ABSTRACT: Ventrikuläre Assistenzsysteme („ventricular assist device“, VAD) werden bei Kindern mit terminaler Herzinsuffizienz als Überbrückungstherapie zur Herztransplantation oder zur myokardialen Erholung seit über 20 Jahren eingesetzt. Bei Kindern unter 20 kgKG werden parakorporale Pumpen (Excor® Pediatric) in einer uni- oder biventrikulären Konfiguration implantiert. Für größere Kindern stehen implantierbare Pumpen, z. B. HeartWare HVAD®, zur Verfügung. Indikationen im Kindesalter sind Kardiomyopathie oder Myokarditis und angeborene Herzfehler (AHF). Die Wartezeiten bis zur Transplantation haben sich erheblich verlängert; Unterstützungszeiten von mehr als einem Jahr sind auch im Kindesalter keine Seltenheit mehr. Die Überlebensraten konnten durch zunehmende Erfahrung und technische Verbesserungen deutlich erhöht werden und betragen bei normalen anatomischen Verhältnissen etwa 80 %. Die Herzunterstützung von Kindern mit AHF geht mit einer schlechteren Prognose einher (Überlebensraten von etwa 50 %). Hauptkomplikationen während der Herzunterstützung sind thrombembolische Ereignisse, die in etwa 25 % der Fälle auftreten. Aktuelle Entwicklungstendenzen sind die Miniaturisierung der VAD, um die Lebensqualität der Kinder zu erhöhen, sowie technische Modifikationen, um das Risiko von thrombembolischen Ereignissen zu vermindern. Abstract Ventricular assist devices (VAD) in children with terminal heart failure have been used as a bridge to transplantation or myocardial recovery for more than 20 years. The Berlin Heart Excor® Pediatric VAD is approved for use either as univentricular or biventricular support for children with a body weight less than 20 kg. Larger children can be supported with implantable continuous flow devices, e.g. HeartWare HVAD. Indications for support are cardiomyopathy, myocarditis and terminal heart failure in patients with congenital heart diseases. Due to the shortage of donors support time on VADs has greatly increased often lasting longer than 1 year. Although increased experience and technical modifications over the last decade have substantially improved the outcome of patients on VAD support, much is still dependent on the etiology of the heart failure. The survival rate in children with normal anatomy is approximately 80 % compared to 50 % in children with congenital heart diseases. The main complications during VAD support which occur in nearly 25 % of children weighing less than 20 kg are thromboembolic events. Miniaturization of the device to improve the quality of life for children on support and minimizing the risk of thromboembolic events are current fields of intensive research.
    Zeitschrift für Herz- Thorax- und Gefäßchirurgie 08/2014; 28(4):277-282.
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    ABSTRACT: Die rechtsventrikuläre (RV-)Funktion ist seit Anbeginn die Achillesferse der Therapie mit einem linksventrikulären Unterstützungssystem („left ventricular assist device“, LVAD). Das postoperative RV-Versagen vorherzusagen, gestaltet sich schwierig. Das Heranziehen mehrerer Faktoren ist notwendig. Beispielsweise ist das Verhältnis „right ventricular end-diastolic dimension“ (RVEDD) zu „left ventricular end-diastolic dimension“ (LVEDD) ein geeigneter präoperativer prädiktiver Parameter. Dies gilt allerdings nur in der Zusammenschau der Befunde. Ist es bereits zu einem kardiogenen Schock mit Multiorganversagen gekommen, ist die alleinige Unterstützung des Organismus mithilfe eines LVAD nicht ausreichend. Die Implantation eines „biventricular assist device“ (BVAD) oder eines venoarteriellen Extrakorporalen-Membranoxygenierung(ECMO)-Systems wird notwendig. Sollte es nach durchgeführter LVAD-Implantation nicht zu einer zügigen Stabilisierung auf der Intensivstation kommen, muss eine RV-Dysfunktion ausgeschlossen werden. Ist die RV-Dysfunktion bedeutsam, sollte frühzeitig eine Right-ventricular-assist-device(RVAD)-Implantation in Erwägung gezogen werden, bevor die Folgen von Stauung und Minderperfusion manifest werden. Eine sekundäre Implantation auf der Intensivstation ist mit einer schlechteren Prognose verbunden. Inwieweit eine Trikuspidalklappen(TK)-Insuffizienz zum Zeitpunkt der LVAD-Implantation chirurgisch korrigiert werden sollte, ist Gegenstand aktueller Forschung und Diskussion. Abstract Right ventricular function is from the outset the Achilles heel of left ventricular assist device (LVAD) therapy. Predicting right ventricular failure can be difficult and consideration of various factors is necessary including the right ventricular end-diastolic dimension (RVEDD) LVEDD ratio which seems to be a suitable preoperative predictive parameter in conjunction with the clinical symptoms. If the patient is in cardiogenic shock with imminent multiorgan failure the implantation of a LVAD alone will not be sufficient to assist the whole organism. The implantation of a biventricular assist device (BVAD) or veno-arterial extracorporeal membrane oxygenation (ECMO) is needed. Should there be any delay in the recovery of the patient after LVAD implantation right ventricular dysfunction must be excluded. If the RV dysfunction is clinically significant the implantation of an RVAD should be taken into consideration before the sequelae of venous congestion and impaired perfusion evolve. A secondary implantation in an intensive care unit (ICU) has a worse prognosis. To which degree a secondary tricuspid insufficiency should be corrected at the time of LVAD implantation is matter of debate and research.
    Zeitschrift für Herz- Thorax- und Gefäßchirurgie 06/2014; 28(3):205-215.
  • The Thoracic and Cardiovascular Surgeon 02/2014; 62(S 01). · 1.08 Impact Factor
  • The Thoracic and Cardiovascular Surgeon 02/2014; 62(S 01). · 1.08 Impact Factor
  • The Thoracic and Cardiovascular Surgeon 02/2014; 62(S 01). · 1.08 Impact Factor
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    ABSTRACT: With increasing enthusiasm in minimally invasive surgery, several approaches and access are being performed with great precision. In this report, we illustrate and describe a minimal invasive approach to mitral valve surgery with optimal access under direct vision, the indications and patient selection, the surgical techniques, its advantages over the other approaches, and its simplicity and reproducibility.
    Heart, lung and vessels. 01/2014; 6(3):152-6.
  • The Thoracic and Cardiovascular Surgeon 10/2013; 61(S 02). · 1.08 Impact Factor
  • B. Zipfel, R. Hetzer
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    ABSTRACT: Für die endovaskuläre Versorgung thorakaler Aortenerkrankungen ist es in mehr als einem Drittel der Fälle notwendig, die Stent-Prothesen im Aortenbogen zu verankern, um einen sicheren Sitz und die Abdichtung zu erreichen. Dabei ist der Verschluss von supraaortalen Gefäßen unvermeidlich. „Debranching“ bezeichnet die chirurgische Umsetzung von supraaortalen Arterien zum Zweck der Verlängerung der Landezone von Stent-Prothesen. Nach der Ausdehnung des Verschlusses von supraaortalen Gefäßen werden folgende Operationen praktiziert: extrathorakal Karotis-Subklavia-Bypass, Subklavia-Karotis-Transposition und Karotis-Karotis-Subklavia-Bypass sowie intrathorakal Doppeltransposition von Aa. carotis und subclavia und das komplette Debranching aller 3 supraaortalen Arterien auf die Aorta ascendens. Die Operationen werden in den wesentlichen Details beschrieben sowie technische Besonderheiten der Implantation von Stent-Prothesen im Aortenbogen in Verbindung mit Debranching-Operationen ausgeführt. Die antegrade Implantationstechnik nach Freilegen der Aorta ascendens kann Probleme der retrograden transfemoralen Implantation umgehen, benötigt aber speziell konstruierte Stent-Prothesen. Abstract Endovascular repair of thoracic aortic disease requires implantation of stent grafts in the aortic arch to ensure secure anchoring and sealing in more than one third of cases. Occlusion of supra-aortic arteries is thus unavoidable. Debranching refers to the surgical transposition of supra-aortic arteries to safely extend the landing zone for stent grafts. After extending the occluded supra-aortic arteries the following surgical procedures are performed: extrathoracic carotid-subclavian bypass, subclavian-carotid transposition and carotid-carotid-subclavian bypass and intrathoracic double transposition of left subclavian and carotid arteries and complete debranching of all three supra-aortic arteries to the ascending aorta. The most important details of these surgical procedures as well as the special technical aspects of the implantation of stent grafts in the aortic arch in combination with debranching surgery are described. If the ascending aorta is exposed, antegrade implantation of the stent graft can avoid problems associated with the retrograde transfemoral route but this requires custom-made devices.
    Zeitschrift für Herz- Thorax- und Gefäßchirurgie 10/2013; 27(5):308-314.
  • Interactive Cardiovascular and Thoracic Surgery 09/2013; 17(suppl 2):S135-S135. · 1.11 Impact Factor
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    ABSTRACT: Today, heart transplantation (HTX) is a routine therapy for end-stage heart failure. However, the number of patients on the waiting list always exceeds the number of available donor hearts, leading to increasing use of older donors. Coronary atherosclerosis (CAS) prevalence already amounts to 20% in a healthy, 20 to 25-year-old population. The European donor pool is 10 to 15 years older, bearing considerable risk for inadvertently transmitted CAS in about 7% of transplanted hearts. Little is known about how inadvertently transmitted CAS develops after HTX. This study was performed in older, 40 to 65-year-old donor hearts to study CAS development after HTX.Methods and MaterialsBetween January 2001 and December 2009 1479 donors were registered in the German DSO-NO region (German Foundation for Organ TX North East); 549 were heart donors and 328 were 40 to 65 years old (mean 49.5) and fulfilled HTX criteria. Coronary catheterization was performed in 42 (21.9%, mean age 49) before and after HTX. CAS progression or reduction was studied.ResultsBefore HTX, 26 (62%) hearts were CAS free and 16 (38%) were not. CAS frequency was not age dependent (p = 0.03). After HTX, 14 (53.85%) out of 26 healthy hearts developed CAS. In the group of 16 hearts with CAS, 2 (12.5%) showed CAS aggravation, 5 (31.25%) improvement and 9 (56.25%) no change [Figure 1].Conclusions Inadvertently transmitted donor heart CAS is known to worsen HTX outcome but little is known about its development in the recipient. We showed that CAS aggravation or improvement is observable even in a small population. Why CAS development is so variable needs to be answered on the basis of a larger number of donor hearts studied before and after HTX.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S157-S158. · 5.61 Impact Factor
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    ABSTRACT: During recent years, mechanical circulatory support (MCS) devices have been increasingly used for long-term support. The Syncardia/CardioWest total artificial heart (TAH) has been implanted in over 1075 patients worldwide as a bridge to transplant. We reviewed data of patients supported more than one year to assess its safety and feasibility as destination therapy device.Methods and Materials47 patients from 10 centers worldwide have been included in this retrospective study. Clinical data have been collected on survival, infections, thromboembolic and hemorrhagic events, device failure, antithrombotic therapy regimen and outcome.ResultsThe median age was 49 years old, the median support time was 554 days (range 365 – 1373 days). The primary diagnosis was dilatative cardiomiopathy in 23 pts, Ischemic in 15 and other in 9. After at least one year of support patients have been successfully transplanted in 72% of cases, 24% died on device and 4 % are still supported. 4 patients (8%) had a device failure report but only for two patients it was the leading cause of death. Major complications were as follows: sistemic infections (19%; 3% leading death), drive line infections (20%, 0% leading death), ischemic (15%, 6% leading death) and hemorrhagic (23%, 6% leading death) events. Moreover antithrombotic regimen, hospital discharge, post operative rehabilitation period, drugs therapy and follow up management have been carefully investigated among our population of patience.Conclusions Cardiowest (t-TAH) has shown to be a reliable and effective device in replacing the entire heart. Device failure occurred rarely and only in two cases was the leading cause of death. The Syncardia TAH has emerged as a robust form of mechanical circulatory support for biventricular failure patients even in a setting of long term support. The dilemma of destination therapy is more ethical issue up to now considering the major impact in the quality of life of these patients.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S118. · 5.61 Impact Factor
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    ABSTRACT: Left ventricular assist devices (LVADs) provide better quality of life than biventricular devices, but it is a challenge to evaluate RV function and to predict its time-course during LV support. RV failure after LVAD insertion is related to preoperative RV geometry and tricuspid regurgitation (TR), both highly load sensitive. We assessed the impact of load depedency in RV performance to improve future decision making.Methods and MaterialsIn patients with LVAD implantation after 1/2006, RV anatomic and functional parameters plus pulmonary hemodynamic data were prospectively collected by echocardiography and heart catheterization before LVAD implantation in order to test their relationship with postoperative RV function and patient outcome.ResultsAfter LVAD implantation 45 of 475 evaluated patients showed RV worsening which necessitated mechanical support also for the RV. There were significant differences in preoperative RV short/long axis (S/L) and long axis/length-area (L/Area) ratios, tricuspid annulus systolic velocity (TAPSm), RV peak systolic longitudinal strain rate (PSLSr), pressure gradient between RV and right atrium (ΔPRV-RA), TR velocity-time integral (VTITR) and pulmonary arterial pressure (PAP) between the two patient groups (p<0.05). Highest predictive values (up to 92%) for postoperative RV failure were found for S/L ≥0.6, TAPSm <8cm/s and PSSr <0.7/s in patients with maximum ΔPRV-RA < 35mmHg and in those with systolic PAP<50mmHg. S/L <0.6, TAPSm ≥8cm/s and PSSr ≥0.7 in patients with maximum ΔPRV-RA ≥35mmHg showed high predictive values (≥ 90%) for post-operative freedom from RV failure.ConclusionsRV geometry and velocity of contraction before LVAD implantation become more predictive for postoperative RV function if preoperative RV pressure-load and TR are also considered. S/L or L/Area ratio, TAPSm and PSSr, in connection with either maximum ΔPRV-RA or VTITR can improve decision making before VAD implantation.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S286. · 5.61 Impact Factor
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    ABSTRACT: Major components of the myocardial extracellular matrix are collagen type I and type III. Furthermore, collagen type IV is located in the basement membranes. Continuous structural remodeling of the collagenous matrix results in an excessive accumulation of collagen fibrils and therefore in pathologic myocardial fibrosis. Functional consequences are related to an increase in myocardial stiffness. The phenomenon of collagen turnover in heart transplant recipients has not yet been studied. The aim of the study was to evaluate collagen type III and IV in endomyocardial biopsy specimens (EMB) after heart transplantation (HTx) and to analyze the prognostic value of immunohistochemistry staining compared to the Sirius-red staining of fibrosis used routinely.Methods and MaterialsIn total, 274 EMB of 77 patients who underwent HTx between 2003 and 2006 (66 men, mean age at HTx 49 years) were evaluated on the date of HTx=FU0, and 4 weeks=FU1, 1 year=FU2, 3 years=FU3 and 5 years=FU4 post-HTX. Computer-based histomorphometrical analyses were compared. The rates of collagen III and IV and myocardial fibrosis were measured in an area of 1mm2 for each EMB.ResultsThe rate of collagen III increased continuously, while fibrosis demonstrated a fluctuating course (FU0: 13.0 vs 8.59%, FU1: 11.94 vs 7.87%, FU2: 12.0 vs 8.47%, FU3: 12.19 vs 6.95%, FU4: 16.17 vs 7.9%, p<0.01). Consequently the proportion of collagen III in relation to fibrosis increased from 1.52 (FU1) to 2.05 at long-term post-HTX (FU4 vs. FU0: 1.51, FU2: 1.42, FU3: 1.75). In comparison to collagen III the rate of collagen IV rose more clearly (FU0: 12.24%, FU1: 12.3%, FU2: 14.26%, FU3: 19.76%, FU4: 22.27%). A higher rate of collagen III (>20%) was associated with more fibrosis (10-19.9%, FU2: p=0.02, FU4: p<0.02).Conclusions The rate of collagen III and IV increases significantly more than the rate of fibrosis in the long term post-HTx. The consequences of the collagenous remodeling for the contractile functionality of the myocardium of HTx recipients remain unclear and need to be evaluated.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S263. · 5.61 Impact Factor
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    ABSTRACT: Timely recognition of the need for transplantation (Tx) due to pulmonary arterial hypertension (PAH) and finding predictors of Tx-free outcome are increasingly challenging with Tx waiting time prolongation. Right ventricular failure (RVF) is associated with worse prognosis in PAH, but the prognostic value of parameters for RV evaluation and the impact of RVF on Tx-free survival are barely known. We assessed the predictability of RVF in PAH and the predictive value of RV dysfunction for Tx-free survival.Methods and MaterialsAll consecutive Tx candidates with PAH (except PAH due to congenital shunts) without RVF at their first evaluation (2006-2010) were included in the study. At selection, after exercise testing and NT-proBNP measurement, patients underwent echocardiography with tissue Doppler and strain imaging. Examinations were repeated at each follow-up. Collected data were tested for ability to predict time course of RV function and Tx-free patient survival.ResultsOf 64 studied patients, 22 developed RVF. The 5-year Tx-free survival with and without RV worsening was 89% and 30%, respectively (p<0.001). Comparing the initial data from patients with and without subsequent RV worsening we found no differences in RV size, RVEF, pulmonary arterial pressure, right atrial size or tricuspid annulus systolic excursion. However, those with subsequent RV worsening had initially higher NT-proBNP and lower RV ΔP/Δt, and strain analysis revealed higher RV systolic dyssynchrony, lower systolic afterload-corrected strain rate and higher diastolic early/late strain rate (SrE/SrA) ratio (p<0.01). At certain cut-off values, ΔP/Δt and SrE/SrA showed the highest predictive values for ≥2 year freedom from RVF (86.7 and 84.8%, respectively) and Tx-free survival (84.2 and 83.8%, respectively).Conclusions In PAH patients referred for Tx, RV ΔP/Δt and certain strain parameters can predict the time course of RV function and Tx-free survival. Our results suggest that these parameters can improve Tx listing decisions.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S77-S78. · 5.61 Impact Factor
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    ABSTRACT: Cardiac allograft vasculopathy (CAV) is the main cause of graft failure in heart transplant (HTx) recipients. Coronary angiography remains the principal tool for CAV in most institutions. However, coronary angiography might miss CAV. Optical coherence tomography (OCT) might be used for visualisation of coronary pahtology in HTx recipients.Methods and MaterialsOCT is using near infrared light capturing micrometer resolution with three-dimensional imaging. OCT was used with the 5 Fr. Guiding catheter over a 0.014inch guide wire in the left and right coronary artery. OCT was used with a blood free pullback (20 mm/sec) with 100 frames per second, where axial resolution was 15 μm. Angiographic and histological assessment of coronary vascular status was performed.ResultsWe report our initial experience (n=7) with intracoronary OCT in pediatric HTx-recipients. Median age was 7.8 (4.6 – 10.9) years; median posttransplant time was 6.9 (4.5-10.2) years. OCT was performed in all patients without complications. We could detect intimal thickening (see figure), medial hypertrophy and overall luminal changes several patients, whereas all lesions were not detectable by angiography. These lesions still have to be analyzed for clinical relevance.Conclusions It is possible to perform OCT in pediatric Htx recipients above 15kg of BW. OCT delivers impressive and promising insight into the coronary arteries besides angiography and with an improved resolution, if compared to intravascular ultrasound (IVUS). Vascular pathology hidden for angiographic detection might be illuminated with this method and its clinical relevance needs to be studied.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S192-S193. · 5.61 Impact Factor
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    ABSTRACT: Objectives CD133pos cells are currently evaluated for use in cardiac cell therapy. We hypothesized that they exert their beneficial effects in a paracrine manner and investigated this in a cell culture ischaemia model. Furthermore, we checked whether purified CD133pos cells perform better than non-fractionated mononuclear cells (MNC). Methods CD133pos cells were isolated from bone marrow MNC and conditioned medium was prepared from CD133pos and non-fractionated MNC. HL-1 cardiomyocytes were subjected to simulated ischaemia in the respective conditioned media or in control medium. After treatment, total remaining cells, apoptotic cells and nuclear shrinking were quantified using an automated imaging system. Furthermore, metabolic activity and phosphorylation of kinases Akt, Erk1/2, GSK3b and transcription factor Stat3 were investigated. Results After simulated ischaemia, the rate of detached dead cells was lowest in CD133pos conditioned medium (26 ± 6%) and highest in control medium (36 ± 6%). In CD133pos conditioned medium, the fraction of non-apoptotic cells was most enhanced and nuclear shrinking as a consequence of apoptosis was reduced. Cell viability was also highest in CD133pos conditioned medium (109.4 ± 8.8% in relation to control). In both conditioned media, phosphorylation of Akt, Erk1/2, and GSK3b was lower than in control medium. Stat3 phosphorylation was sustained on the level of control. Conclusions Factors released from purified CD133pos bone marrow cells exhibit more pronounced protective effects on HL-1 cardiomyocytes under simulated ischaemia than from non-fractionated MNC. These effects are not associated with the phosphorylation of cell survival promoting kinases Akt, Erk1/2, GSK3b and transcription factor Stat3. Although the molecular mechanism of cardioprotection by CD133pos cells requires further investigation, our results reinforce the advantage of enriching CD133pos cells for cardiac cell therapy. Conflict of interest and funding No conflict of interest declared. This work was supported by the German Ministry of Education and Research [BMBF FKZ 0312138A].
    Interactive cardiovascular and thoracic surgery; 02/2013
  • The Thoracic and Cardiovascular Surgeon 01/2013; 61(S 01). · 1.08 Impact Factor
  • The Thoracic and Cardiovascular Surgeon 01/2013; 61(S 01). · 1.08 Impact Factor
  • E Delmo Walter, R Hetzer
    The Thoracic and Cardiovascular Surgeon 01/2013; 61(S 01). · 1.08 Impact Factor

Publication Stats

4k Citations
1,778.87 Total Impact Points

Institutions

  • 1987–2014
    • Deutsches Herzzentrum Berlin
      • • Cardiothoracic and Vascular Surgery
      • • Department of Congenital Heart Disease / Pediatric Cardiology
      Berlín, Berlin, Germany
  • 2013
    • Fortis Hospital
      Mohali, Punjab, India
  • 2012
    • Università Vita-Salute San Raffaele
      Milano, Lombardy, Italy
  • 1987–2010
    • Berlin Heart
      Berlín, Berlin, Germany
  • 2007
    • Vivantes Klinikum im Friedrichshain
      Berlín, Berlin, Germany
    • Ghent University
      Gand, Flanders, Belgium
  • 1995–2005
    • Humboldt-Universität zu Berlin
      • Department of Biology
      Berlín, Berlin, Germany
  • 2004
    • Council for Chemical Research
      Concord, California, United States
  • 2003
    • Universität Regensburg
      Ratisbon, Bavaria, Germany
  • 2002
    • University of California, Los Angeles
      • Division of Cardiothoracic Surgery
      Los Angeles, CA, United States
    • Instituto de Cardiología y Cirugía Cardiovascular
      La Habana, Ciudad de La Habana, Cuba
  • 1992–2002
    • Deutsches Herzzentrum München
      München, Bavaria, Germany
  • 2001
    • Policlinico San Matteo Pavia Fondazione IRCCS
      Ticinum, Lombardy, Italy
  • 1996–2001
    • Charité Universitätsmedizin Berlin
      • Institute of Medical Immunology
      Berlín, Berlin, Germany
  • 2000
    • Goethe-Universität Frankfurt am Main
      Frankfurt, Hesse, Germany
  • 1998
    • Ludwig-Maximilians-University of Munich
      München, Bavaria, Germany
  • 1997
    • Max-Delbrück-Centrum für Molekulare Medizin
      Berlín, Berlin, Germany
  • 1994–1996
    • Freie Universität Berlin
      Berlín, Berlin, Germany
    • Herz- und Gefäß-Klinik
      Neustadt, Bavaria, Germany
  • 1978–1981
    • Hannover Medical School
      Hanover, Lower Saxony, Germany