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J Van Der Heyden,
J Van Werkum,
C M Hackeng, J C Kelder,
N J Breet,
V H M Deneer,
R G A Ackerstaff,
S C Tromp,
J P P M De Vries,
J A Vos,
M J Suttorp,
E H A Elsenberg,
D Van Neerven,
W J Schonewille,
F Wolters,
J M Ten Berg
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ABSTRACT: AIM:The aim of this study was to compare the effects of 300 mg or 600 mg clopidogrel loading dose, prior to carotid artery stenting (CAS) on the number of transcranial Doppler (TCD)-detected microembolic signals (MES) and to investigate the relationship between the magnitude of platelet reactivity and MES. METHODS: In this prospective randomized, double-blind study, 35 consecutive asymptomatic patients (17.1% females), scheduled for CAS and cardiac surgery were included. The primary endpoint was the number of TCD-detected MES. The secondary endpoints were the absolute magnitude of on-treatment platelet reactivity and the adverse cerebral events. Negative binomial regression to find predictors for sum of single emboli, the student's t-test to assess the association between platelet function tests and randomized dose of 300 mg or 600 mg clopidogrel, and the R2 calculation for the assessment of the association between platelet function tests and embolic load, were used. RESULTS:No statistically significant difference in the number of TCD-detected MES, in the sum of all the single emboli or showers and platelet aggregation measurements between the two groups was observed (aggregometry: 21.7±18.3 versus 23±18%, P=0.8499 and 45.8±17.5 versus 46.5±14.5%, P=0.9003) (verifyNow P2Y12 assay: 231±93 PRU versus 222±86 PRU, P=0.7704). In one patient a transient ischemic attack occurred. CONCLUSION: A loading dose of 300 mg of clopidogrel in combination with aspirin is as effective as 600 mg of clopidogrel in achieving adequate platelet inhibition and preventing periprocedural events in asymptomatic patients undergoing CAS prior to cardiac surgery.
The Journal of cardiovascular surgery 11/2012; · 1.56 Impact Factor
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ABSTRACT: Previous studies have suggested that women do not accrue equal therapeutic benefit from antiplatelet medication as compared with men. The physiological mechanism and clinical implications behind this gender disparity have yet to be established.
On-treatment platelet reactivity was determined in 717 men and 234 women on dual antiplatelet therapy, undergoing elective coronary stent implantation. Platelet function testing was performed using arachidonic acid and adenosine diphosphate-induced light transmittance aggregometry (LTA) and the VerifyNow P2Y12 and Aspirin assays. Also the incidence of all-cause death, non-fatal acute myocardial infarction, stent thrombosis and ischaemic stroke was evaluated.
Women had higher baseline platelet counts than men. Women exhibited a higher magnitude of on-aspirin platelet reactivity using LTA, but not using the VerifyNow Aspirin assay. The magnitude of on-clopidogrel platelet reactivity was significantly higher in women as compared with men with both tests used. The cut-off value to identify patients at risk as well as the incidence of clinical endpoints was similar between women and men (16/234[6.8%] vs. 62/717[8.6%], p = 0.38).
Although the magnitude of platelet reactivity was higher in women, the absolute difference between genders was small and both the cut-off value to identify patients at risk and the incidence of the composite endpoint were similar between genders. Thus, it is unlikely that the difference in platelet reactivity accounts for a worse prognosis in women.
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 09/2011; 19(11):451-7. · 1.44 Impact Factor
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ABSTRACT: Both heightened platelet reactivity and an occluded infarct related artery (IRA) on initial angiography and at the time of primary percutaneous coronary intervention (PCI) are associated with a worsened clinical outcome in patients with ST-elevation myocardial infarction (STEMI). However, the relationship between platelet reactivity and IRA patency has not yet been established. Consecutive STEMI-patients were enrolled in this study. Patients who had TIMI-flow (thrombolysis in myocardial infarction) 0 or 1 on initial angiography constituted the occluded IRA group and patients having TIMI-flow 2 or 3 comprised the IRA patent group. Platelet function measurements were performed using the PFA-100 COL/ADP cartridge and light transmittance aggregometry without agonist (spontaneous) and after stimulation with adenosine diphosphate (ADP) and arachidonic acid (AA). Ninety-nine patients were enrolled, of whom 49 presented with an occluded IRA. Multivariate analysis identified the following independent factors to be associated with an occluded IRA; short COL/ADP closure time (ORper quartile increase=0.60; 95% CI, 0.39-.93; p=0.02), the 20 μM ADP-induced light transmittance aggregometry (ORper quartile increase =1.77; 95% CI, 1.15-2.73; p=0.01) and leukocyte counts (odds ratio [OR]=1.21; 95% CI, 1.05-1.39; p = 0.008). In conclusion, heightened platelet reactivity and elevated leukocyte counts are associated with an occluded IRA upon presentation in STEMI-patients. These results emphasise the importance of potent antithrombotic therapy early after the onset of symptoms, to obtain early recanalisation of the IRA.
Thrombosis and Haemostasis 06/2011; 106(2):331-6. · 5.04 Impact Factor
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ABSTRACT: INTRODUCTION: Myocardial perfusion SPECT (MPS) is frequently used for cardiovascular risk stratification. The significance of MPS in patients with abnormal electrical ventricular activation is often questionable. This review assesses the value of MPS for risk stratification of patients with intrinsic left bundle branch block or that due to right ventricular apical pacing. METHODS: We reviewed the literature by a search of the MEDLINE database (January 1980 to September 2010). The terms prognosis or prognostic value were combined with SPECT and LBBB or pacing or pacemakers. MPS was categorised as low and high risk according to the original definitions. RESULTS: We identified 11 studies suitable for review. A low-risk MPS is associated with a low risk of cardiac events whereas high-risk MPS carries a 4.8-fold increased risk, 95% CI [3.2 - 7.2] (p < 0.0001). Despite secondary prevention and an improved medical and interventional care, these figures have hardly changed over time. CONCLUSION AND CLINICAL IMPLICATIONS: A low-risk MPS permits a policy of watchful waiting whereas a high-risk MPS requires further analysis and treatment. The persistent high cardiac death and acute myocardial infarction rate after a high-risk MPS suggest that the current management of these patients does not suffice and needs reconsideration.
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 06/2011; · 1.44 Impact Factor
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ABSTRACT: The objective of this study is to develop a simple risk score to predict 30-day mortality of aortic valve replacement (AVR).
In a development set of 673 consecutive patients who underwent AVR between 1990 and 1993, four independent predictors for 30-day mortality were identified: body mass index (BMI) ≥30, BMI <20, previous coronary artery bypass grafting (CABG) and recent myocardial infarction. Based on these predictors, a 30-day mortality risk score-the AVR score-was developed. The AVR score was validated on a validation set of 673 consecutive patients who underwent AVR almost two decennia later in the same hospital.
Thirty-day mortality in the development set was ≤2% in the absence of any predictor (class I, low risk), 2-5% in the solitary presence of BMI ≥30 (class II, mild risk), 5-15% in the solitary presence of previous CABG or recent myocardial infarction (class III, moderate risk), and >15% in the solitary presence of BMI <20, or any combination of BMI ≥30, previous CABG or recent myocardial infarction (class IV, high risk). The AVR score correctly predicted 30-day mortality in the validation set: observed 30-day mortality in the validation set was 2.3% in 487 class I patients, 4.4% in 137 class II patients, 13.3% in 30 class III patients and 15.8% in 19 class IV patients.
The AVR score is a simple risk score validated to predict 30-day mortality of AVR.
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 06/2011; 19(6):273-8. · 1.44 Impact Factor
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ABSTRACT: The TRITON-TIMI 38 study has identified three subgroups of patients with a higher risk of bleeding during treatment with the thienopyridine prasugrel: patients with a history of stroke or transient ischaemic attack (TIA), patients ≥75 years and patients with a body weight <60 kg. However, the underlying pathobiology leading to this increased bleeding risk remains to be elucidated. The higher bleeding rate may be due to a stronger prasugrel-induced inhibition of platelet aggregation in these subgroups. The aim of the present study was to determine whether on-treatment platelet reactivity is lower in these risk subgroups as compared with other patients in a large cohort on the thienopyridine clopidogrel undergoing elective coronary stenting.
A total of 1069 consecutive patients were enrolled. On-clopidogrel platelet reactivity was measured in parallel by light transmittance aggregometry, the VerifyNow® P2Y12 assay and the PFA-100 collagen/ADP cartridge.
Fourteen patients (1.5%) had a prior history of stroke or TIA, 138 patients (14.5%) were older than 75 years and 30 patients (3.2%) had a body weight <60 kg. Age ≥ 75 years and a history of stroke were independent predictors of a higher on-treatment platelet reactivity. In contrast, a body weight <60 kg was significantly associated with a lower on-treatment platelet reactivity.
In two high-risk subgroups for bleeding, patients ≥ 75 years and patients with previous stroke, on-clopidogrel platelet reactivity is increased. In contrast, in patients with a low body weight, on-clopidogrel platelet reactivity is decreased, suggesting that a stronger response to a thienopyridine might only lead to more bleeds in patients with low body weight.
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 06/2011; 19(6):279-84. · 1.44 Impact Factor
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ABSTRACT: We retrospectively evaluated our results with the Shelhigh biological conduit model NR-2000C (Shelhigh, Inc, Milburn, NJ).
From November 1998 through December 2007, 175 patients with a mean age of 71.1 ± 7.4 years underwent aortic root replacement with a Shelhigh biological conduit. Indication for surgery was aneurysmal disease of the aorta in 120 (68.6%) patients, aortic valve endocarditis in 20 (11.4%), acute type A aortic dissection in 11 (6.3%), and other in 24 (13.7%) patients.
Overall hospital mortality was 13.7% (n = 24; 95% confidence limits, 9.0%-19.7%). Cause of death was cardiac failure in 12 patients, central neurologic damage in 5 patients, pulmonary in 3 patients, gastrointestinal ischemia in 2 patients, and aorta-related in 2 patients. Mean follow-up was 3.1 years (range 0.2-9.9 years). In total, 50 (33.1%) late deaths occurred; of these 7 were valve-related. The overall survival at 1 and 5 years is 77.6% ± 3.2% and 54.6% ± 4.6% respectively. Six (4.0%) patients required reoperation, either for endocarditis of the bioconduit (n = 5) or for false aneurysm (n = 1). Endocarditis of the bioconduit was reported in 11 (7.3%) patients, of whom 6 were treated nonoperatively and 5 required reoperation.
Midterm results of the implantation of the Shelhigh biological valved conduit are worrisome. The relatively high incidence of endocarditis of the Shelhigh BioConduit has forced us to look for other alternatives.
The Journal of thoracic and cardiovascular surgery 05/2011; 141(5):1157-62. · 3.41 Impact Factor
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A A C M Heestermans,
J W van Werkum,
B Zwart,
J A van der Heyden, J C Kelder,
N J Breet,
A W J van't Hof,
J-H E Dambrink,
J J Koolen,
B R G Brueren,
F Zijlstra,
J M ten Berg
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ABSTRACT: Early coronary stent thrombosis occurs most frequent after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
To identify the specific predictors of, respectively, acute and subacute stent thrombosis in patients after primary PCI for STEMI.
Consecutive STEMI patients with angiographically confirmed early stent thrombosis were enrolled and compared in a 2 : 1 ratio with a matched control group. Clinical outcome was collected up to 1 year.
Of 5842 STEMI patients treated with primary PCI, 201 (3.5%) presented with a definite early stent thrombosis. Of these, 97 (1.7%) had acute stent thromboses and 104 (1.8%) had subacute stent thromboses. Postprocedurally discovered dissection, undersizing and smaller stent diameter were the strongest predictors for acute stent thrombosis. No glycoprotein IIb/IIIa therapy and the use of drug-eluting stents were also associated with acute stent thrombosis. Lack of clopidogrel therapy in the first 30 days after the index PCI was the strongest predictor for subacute stent thrombosis. Mortality rates at 1-year follow-up were lower for acute stent thrombosis than for subacute stent thrombosis (8.3% vs. 13.2%, P = 0.294). The incidence of definite recurrent stent thrombosis at 1-year follow up was significantly lower after a first definite acute stent thrombosis than after a first definite subacute stent thrombosis (6.4% vs. 19.3%, P = 0.007 at 1 year).
The specific risk factors for, respectively, acute and subacute stent thrombosis after primary PCI vary greatly. Mortality rates are high for both categories of stent thrombosis. However, recurrent stent thrombosis occurs more frequently after subacute stent thrombosis.
Journal of Thrombosis and Haemostasis 11/2010; 8(11):2385-93. · 5.73 Impact Factor
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Journal of Thrombosis and Haemostasis 10/2010; 8(10):2326-8. · 5.73 Impact Factor
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ABSTRACT: High on-aspirin platelet reactivity (HAPR) is associated with atherothrombotic events following percutaneous coronary intervention (PCI). The aim of the present study was to identify the platelet function test sensitive for platelet cyclooxygenase-1 inhibition that best predicts atherothrombotic events.
Nine hundred and fifty-one consecutive patients on dual antiplatelet therapy undergoing elective PCI were enrolled. On-aspirin platelet reactivity was measured in parallel by arachidonic acid (AA)-induced light transmittance aggregometry (AA-induced LTA), the VerifyNow® Aspirin Assay (VerifyNow® Aspirin Assay), the arachidonic acid prestimulated IMPACT-R (IMPACT-R AA) and the PFA-100 collagen/epinephrine cartridge (PFA COL/EPI). Cut-offs for HAPR were established by receiver-operator characteristic curve analysis. At 1-year follow-up, the composite of all-cause death, non-fatal acute myocardial infarction, stent thrombosis and ischemic stroke occurred more frequently in patients with HAPR when assessed by LTA [10.1% vs. 6.0%, P=0.020 (n=925)] and VerifyNow(®) [13.3% vs. 5.9%, P=0.015 (n=422)]. The VerifyNow(®) ASA assay (AUC=0.78) and, to a lesser extent, AA-induced LTA (AUC=0.73) added significantly to a model consisting of clinical and procedural risk factors in predicting atherothrombotic events. In contrast, the IMPACT-R (n=791) and the PFA Collagen/Epinephrine (n=719) were unable to discriminate between patients with and without primary endpoint at 1-year follow-up. None of the platelet function tests was able to identify patients at risk for bleeding.
AA-induced LTA and the VerifyNow(®) ASA test were able to identify aspirin-treated patients undergoing PCI with stenting at risk for atherothrombotic events. The VerifyNow(®) Aspirin Assay had the highest predictive accuracy. None of the tests was able to identify patients at higher risk of bleeding.
Journal of Thrombosis and Haemostasis 10/2010; 8(10):2140-8. · 5.73 Impact Factor
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Thrombosis and Haemostasis 09/2010; 105(1):197-9. · 5.04 Impact Factor
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ABSTRACT: Background. Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is associated with a poor survival.Objectives. To evaluate the long-term response to a dual endothelin receptor antagonist in patients with inoperable CTEPH.Methods. All consecutive 18 patients (mean age 63+/-14 years) treated with bosentan for symptomatic inoperable CTEPH were included. Efficacy was evaluated by the log value of serum levels of N-terminal-pro brain natriuretic peptide (log NTpro BNP), New York Heart Association functional class (NYHA), and the six-minute walk test (6-MWT). All follow-up data (median 31 months) were compared with baseline and divided into: short-term (<12 months), mid-term (between 12 and 24 months), and long-term follow-up (>24 months).Results. At baseline, 15 patients were in NYHA class III and three in NYHA class IV, mean log NT-pro BNP level was 7.2+/-1.4 log pg/ml, and mean 6-MWT distance was 404+/-125 m. During short-term follow-up (n=18), the NYHA class improved (p=0.001), 6-MWT distance increased by 33 m (p=0.03), and log NT-pro BNP decreased to 6.9+/-1.4 log pg/ml (p=0.007). During mid-term follow-up (n=17), the NYHA class improved (p<0.001), the mean 6-MWT distance increased by 41 m (p=0.01), and log NT-pro BNP was 6.9+/-1.4 log pg/ml (p=0.31). During late followup (n=14) the NYHA class was still improved (p=0.03), the 6-MWT distance decreased by 9 m (p=0.73), and log NT-pro BNP was 7.1+/-1.5 log pg/ml (p=0.91). The overall four year survival rate was 88%.Conclusion: Bosentan seems to be effective during long-term treatment in patients with inoperable CTEPH. (Neth Heart J 2009;17:329-33.).
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 09/2009; 17(9):329-33. · 1.44 Impact Factor
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ABSTRACT: Migraine with aura (MA) is associated with cardiac right-to-left shunt. We prospectively studied the association between pulmonary arteriovenous malformations (PAVMs) and MA in hereditary haemorrhagic telangiectasia (HHT). All 220 consecutive HHT patients who underwent high-resolution chest computed tomography for PAVM screening were included prospectively. Prior to screening, a structured validated headache questionnaire was completed by 196 patients (57% female; mean+/-sd age 44.6+/-15.2 yrs). Two neurologists diagnosed migraine according to the International Headache Society Criteria. A PAVM was present in 70 (36%) patients. The prevalence of MA was 24% in the presence of a PAVM compared with 6% in the absence of a PAVM (OR 4.6, 95% CI 1.84-11.2; p = 0.001), and MA was an independent predictor for the presence of PAVM using multivariate analysis (OR 3.6, 95% CI 1.21-10.5; p = 0.02). A PAVM was present in 68% of the patients with MA compared with 32% in the non-migraine controls (OR 4.6, 95% CI 1.84-11.2; p = 0.001), and a PAVM was an independent predictor for MA using multivariate analysis (OR 3.0, 95% CI 1.00-9.20; p = 0.05). In conclusion, PAVMs are associated with MA in HHT patients.
European Respiratory Journal 04/2009; 34(4):882-7. · 5.89 Impact Factor
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ABSTRACT: In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI, few data exist on the magnitude of platelet activation, aggregation and dosing of glycoprotein (GP) IIb/IIIa receptor inhibitors.
Sixty STEMI patients were randomised to abciximab, to high-dose tirofiban or to no additional GP IIb/IIIa inhibitor treatment. Platelet activation (P-selectin expression) was measured using flow cytometry and the level of inhibition of platelet aggregation was assessed using the Plateletworks assay. Additionally, the PFA-100 with the collagen/adenosine-diphosphate cartridge (CADP) was used to compare the levels of platelet inhibition. All measurements were performed at baseline (T(0)), immediately after (T(1)), 30 minutes (T(2)), 60 minutes (T(3)) and 120 minutes (T(4)) after primary PCI.
The level of platelet activation in both GP IIb/IIIa receptor inhibitor treated groups was significantly lower compared with the control group at all time points after primary PCI (p=0.04). Also the administration of the currently recommended dose of abciximab resulted in significantly lower levels of inhibition of aggregation compared with high-dose tirofiban (p<0.0001). In addition, the CADP closure times were significantly prolonged in both GP IIb/IIIa inhibitor treated groups compared with the control group at time points T(1) (p=0.006) and T(4) (p<0.0001).
The administration of high-dose tirofiban resulted in a significantly higher inhibition of platelet aggregation compared with the currently recommended dose of abciximab. Large clinical trials are needed to assess whether this laboratory superiority of high-dose tirofiban translates into higher clinical efficacy. (Neth Heart J 2007;15:375-81.).
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 11/2007; 15(11):375-81. · 1.44 Impact Factor
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ABSTRACT: To determine the optimal patient position for subclavian-vein catheterisation.
Descriptive.
The anteroposterior diameter of the right and left subclavian vein was measured using B-mode ultrasound in 26 healthy volunteers lying in 4 different positions: horizontally with or without a rolled towel between the should blades, or in the Trendelenburg position with or without a rolled towel.
The mean diameter of the subclavian vein was 10.7 mm. There was a statistically significant association between the diameter of the vein and the position of the volunteer, the use of the rolled towel, and the side of the body. The least favourable results were obtained on the left side when the patient was lying horizontally with a rolled towel (8.65 mm). The most favourable results were obtained on the right side when the patient was in the Trendelenburg position without a rolled towel (12.05 mm).
For successful catheterisation of the subclavian vein, the patient should be placed in the Trendelenburg position without a rolled towel between the shoulder blades, and the puncture should be preferably on the right side.
Nederlands tijdschrift voor geneeskunde 02/2007; 151(4):243-7.
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ABSTRACT: To assess the short- and long-term results following the unmodified maze procedure in patients with medication-refractory or nearly refractory atrial fibrillation.
Retrospective.
We retrospectively collected and analysed preoperatively in-hospital and follow-up data from patients with atrial fibrillation with or without structural heart disease who underwent the unmodified maze procedure in the St. Antonius hospital, Nieuwegein, the Netherlands.
In the 11-year period 1993-2004, 203 patients underwent the procedure: 139 underwent the maze procedure only and 64 underwent combined surgery for concomitant atrial fibrillation and structural heart disease. There were no in-hospital deaths. During a mean follow-up period of 4 years, 2 ofthe 203 patients died from cardiac causes; both had undergone combined surgery. With a mean follow-up period of 4 years, the rate of atrial fibrillation-free survival was 90% in patients with lone atrial fibrillation and 70% in patients with concomitant atrial fibrillation. For patients who had no recurrent atrial fibrillation 1 year after surgery, the risk of recurrence after 4 years was small (odds ratio: 9.56). Risk factors for recurrence included a large left atrium and a long duration of atrial fibrillation (more than 5 years).
The maze procedure was a successful surgical intervention for patients with atrial fibrillation, both in the short and long term. This procedure can be considered when medication and electrical cardioversion are ineffective.
Nederlands tijdschrift voor geneeskunde 11/2006; 150(42):2314-9.
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ABSTRACT: The internal mammary artery (IMA) is the conduit of choice in coronary revascularization because of its long-term patency. We analyzed the effect of left internal mammary artery (LIMA) harvesting on sternal perfusion. Diameters and velocity parameters of the nonmobilized right internal mammary artery (RIMA) were noninvasively analyzed with duplex ultrasound in 41 patients with LIMA myocardial revascularization pre- (2.6 +/- 5 days) and postoperatively (4.9 +/- 3.9 months). Data of 41 patients were analyzed; 38 patients underwent all examinations with adequate supraclavicular signals. The proximal RIMA diameter and all velocity parameters increased significantly at follow-up (3.1 +/- 0.6 vs. 3.2 +/- 0.5 mm, p = 0.03; diastolic peak velocity [DPV] 15 +/- 7 vs. 27 +/- 9 cm/sec, p < 0.0001; systolic peak velocity [SPV] 90 +/- 24 vs. 105 +/- 29 cm/sec, p < 0.02). This was more pronounced for the diastolic parameters and for all parameters in the proximal part of the RIMA than in the distal part (DPV 11.9 +/- 10.1 vs. 9.5 +/- 10.2 cm/sec, p = NS; SPV 14.9 +/- 33.9 vs. 7.4 +/- 26.0 cm/sec, p = NS). With longer time intervals of follow-up the increase in all diastolic velocity parameters became less pronounced. As demonstrated in the RIMA velocity parameters, patients with skeletonized LIMA grafts (n = 4) had significantly more flow, suggesting hyperemic flow, than patients with pedicled LIMA grafts (n = 34). Only in diastolic velocity integral (DVI) and systolic/diastolic velocity ratio (SDVRA) were there significant differences between diabetics (n = 9) and nondiabetics (n = 29) and only in DVI between female, (n = 8) and male (n = 30) patients. This study indicates that duplex ultrasound is a useful tool for noninvasive RIMA follow-up in LIMA myocardial revascularization.
Annals of Vascular Surgery 03/2004; 18(2):207-11. · 1.03 Impact Factor
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ABSTRACT: To prospectively document the incidence, location, risk factors for and clinical consequences of restenosis after carotid artery angioplasty and stenting (CAS).
Serial duplex and neurological examinations were performed in 217 patients one day (n = 216), 3 (n = 189), 12 (n = 129) and 24 (n = 48) months, after CAS. The relationship between patient, lesion and procedure variables and restenosis was determined at 12 months.
The prevalence of restenosis > or = 50% was 14, 16, 18, and 21%, respectively, and was only significantly related with loss of proximal stent apposition (odds ratio 3.4, 95% confidence interval: 1.0-11.7, p < 0.05). Four restenoses were symptomatic.
Restenosis after CAS is common, unpredictable but infrequently symptomatic.
European Journal of Vascular and Endovascular Surgery 08/2003; 26(2):141-4. · 2.99 Impact Factor
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ABSTRACT: Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining the Maze III procedure with mitral valve surgery.
Thirty-five patients with AF and a mean age of 64 years undergoing mitral valve surgery were prospectively randomized according to a 2.5:1 ratio to surgery with (n=25), or without (n=10) maze III and followed for at least 1 year.
At discharge and after 12 months freedom from AF was 56% and 92%, respectively, in the maze group, and 0% and 20%, respectively, in patients without maze (group differences at discharge p=0.002, after 12 months p=0.0007). Sinus node incompetence was seen in 1 of 25 maze patients requiring pacing. No in-hospital or late death occurred; stroke was observed in 1 patient (without maze). Quality of life markedly improved after surgery, but did not differ between patients with or without maze surgery.
This first prospective randomized study shows that combining maze III with mitral valve surgery resulted in a significantly better elimination of preoperative AF than mitral valve surgery alone. As the quality of life did not differ between patients with, or without maze surgery, additional maze surgery is primarily recommended in patients in whom anticoagulation therapy can be avoided after surgery, specifically in patients with scheduled mitral valve plasty.
The Journal of cardiovascular surgery 02/2003; 44(1):9-18. · 1.56 Impact Factor
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ABSTRACT: Little information is available about short-term and none about long-term follow-up of cardiac rhythm after percutaneous mitral balloon valvotomy (PTMV).
We studied the long-term course of the supraventricular rhythm in 137 consecutive patients with severe mitral stenosis, who underwent PTMV. The rhythm before PTMV was sinus rhythm (SR) in 55% and chronic AF in 45% of patients. The mean follow-up time was 3.7+/-2.5 years (n=126). In patients with SR before PTMV, SR persisted in 91% of patients at the end of follow-up. In patients with chronic AF before PTMV, 84% of these patients were still in chronic AF at the end of follow-up, spontaneous conversion to SR did not occur. In 12 of 14 patients (85%), selected for cardioversion, SR was achieved, by DC cardioversion (n=11) or by drugs alone (n=1). After 2 years this outcome persisted, but after 4 years only 38% remained in SR.
Pre-procedural SR will persist following PTMV. However in patients with chronic AF PTMV is not associated with reversion to SR, suggesting that measures should be undertaken to restore sinus rhythm.
Europace 02/2003; 5(1):47-53. · 1.98 Impact Factor
