C A Nienaber

University of Rostock, Rostock, Mecklenburg-Vorpommern, Germany

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Publications (304)909.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study is to report updated clinical and aortic remodeling results from the Study for the Treatment of complicated Type B Aortic Dissection using Endoluminal repair (STABLE) trial, a prospective, multicenter study evaluating safety and effectiveness of a pathology-specific endovascular system (proximal stent graft and distal bare metal stent) for the treatment of complicated type B aortic dissection. All 86 enrolled patients (mean age, 59 years; 73.3% men) were treated within 90 days of symptom onset (55 with acute dissections and 31 with nonacute dissections). Inclusion criteria were branch vessel obstruction/compromise, impending rupture as evidenced by periaortic effusion/hematoma, resistant hypertension, persistent pain/symptoms, or aortic growth ≥5 mm within 3 months (or transaortic diameter ≥40 mm). Remodeling of the dissected aorta, including thrombosis of the false lumen and changes in the true lumen, false lumen, and transaortic diameter, were assessed in patients with available computed tomographic imaging through 2 years. The 30-day mortality rate was 4.7% (4/86) in the overall patient group (5.5% in acute patients and 3.2% in non-acute patients). Freedom from all-cause mortality was 88.3% at 1 year and 84.7% at 2 years (no significant difference between acute and nonacute patients). From baseline to 2 years, the true lumen diameter increased significantly in the descending thoracic aorta and the more distal abdominal aorta, along with a decrease in the false lumen diameter in both aortic segments. A majority of patients had either a stable or shrinking transaortic diameter in the thoracic (80.3% at 1 year and 73.9% at 2 years) or abdominal aorta (79.1% at 1 year and 66.7% at 2 years). Transaortic growth (>5 mm) occurred predominantly in acute dissections. Consistently, a shorter time from symptom onset to treatment was found to predict transaortic growth in the abdominal aorta (P = .03). Endovascular repair of complicated type B aortic dissection with the use of a composite construct demonstrates favorable early clinical outcomes and aortic remodeling. However, patients treated in the acute setting may be prone to aortic growth and may require close observation. Follow-up through 5 years is ongoing.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2014; · 3.52 Impact Factor
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    ABSTRACT: Drug-eluting stents (DES) have substantially reduced target vessel revascularization (TVR) after percutaneous coronary interventions. Risk factors for clinical events need to be redefined with this treatment option. In the prospective DES.DE registry, baseline clinical and angiographic characteristics as well as in-hospital and follow-up events were recorded for all enrolled patients. Between October 2005 and May 2009, 21,774 patients receiving DES were enrolled at 98 DES.DE sites. The composite of death, myocardial infarction (MI) and stroke defined as major adverse cardiac and cerebrovascular events (MACCE) and TVR were predefined as primary endpoints. At 1-year follow-up rates for overall death, MI, stroke, MACCE, TVR and definite stent thrombosis were 2.7, 3.1, 1.4, 7.1, 11.5 and 0.6 %, respectively. Aside from well-known risk factors like age, diabetes mellitus and triple-vessel disease, stratification in patients with or without MACCE revealed atrial fibrillation, non-ST-segment elevation myocardial infarction, renal failure, impaired ejection fraction and peripheral vascular disease as strong predictors of MACCE at 1 year. Data collected in the DES.DE registry, reflecting the clinical practice in Germany, revealed favorable clinical outcomes after DES implantation in a real world setting but also identifying several high-risk populations.
    Clinical Research in Cardiology 01/2014; · 3.67 Impact Factor
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    ABSTRACT: Myocardial infarction in young individuals is a rare event that is seldom due to atherosclerotic coronary artery diseases, except in the setting of familial hyperlipidemias with accelerated atherosclerosis. Potential etiologies of myocardial injury in young patients are various, but non-coronary pathologies causing direct myocardial injury e.g. viral myocarditis, account for the majority of cases. Coronary artery diseases causing myocardial infarction in young patients represent a challenge to any treating physician; they mostly fall into the category of “coronary artery vasomotor disorders”. The coronary slow flow phenomena or as more recently called “cardiac syndrome Y” is a relatively poorly understood microvascular coronary artery disorder caused by increased microvascular coronary artery resistance to flow that may result in myocardial infarction at rest in young individuals, the diagnosis can be especially challenging. The unique characteristics of the CSFP/CSY prompted the call for a separate classification within coronary artery vasomotor disorders. In this review we discuss in brief non-atherosclerotic coronary artery disorders, highlighting key clinical features, then we move to an in depth review of the CSFP/CSY including its: Epidemiology, pathophysiology, diagnosis prognosis and management.
    Reviews in Vascular Medicine. 01/2014;
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    ABSTRACT: BACKGROUND: Unprotected left main coronary artery (ULMCA) disease is considered an indication for surgical revascularization. However, refined percutaneous coronary intervention (PCI) technology and modern drug-eluting stents (DES) render the ULMCA a target for interventional treatment. METHODS AND RESULTS: Between October 2005 and September 2009, 374 patients receiving DES in ULMCA and 18,678 patients receiving DES in non-left main coronary arteries (nLMCA) with no previous coronary artery bypass graft surgery, were registered at 130 DES.DE sites. The composite of death, myocardial infarction (MI), and stroke defined as major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR) were defined as primary endpoints. Baseline clinical and descriptive morphology of coronary artery disease revealed more comorbidities and more complex anatomies in the ULMCA group. At 1-year follow-up, the ULMCA group suffered from higher rates of overall death (5.6 versus 2.3 %; p < 0.0001), stroke (2.0 versus 0.8 %; p < 0.05), MACCE (8.6 versus 4.9 %; p < 0.01); whereas rates for definite/probable stent thrombosis (2.4 versus 1.6 %; p = 0.29), TVR (14.2 versus 10.8 %; p = 0.06) and MI (1.3 versus 1.9 %; p = 0.44) were not statistically different. These results persisted even after adjustment for different baseline characteristics, except MACCE that was no longer statistically significant. CONCLUSION: Data collected in DES.DE revealed that ULMCA PCI with DES result in similar TVR rates as compared to PCI in nLMCA. Moreover, modern DES have not offset the higher comorbidity index and higher procedure-related complication rate with PCI of ULMCA lesions.
    Clinical Research in Cardiology 05/2013; · 3.67 Impact Factor
  • C A Nienaber, I Akin, S Kische, H Ince, T Chatterjee
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    ABSTRACT: Considering the demographic changes in our society and the proliferation of imaging-based improved diagnostics, both acute and chronic aortic diseases attract increasing attention and require dedicated care. Cardiac as well as vascular surgery used to represent the gold standards for therapeutic management of pathologies of the ascending aorta and the arch; however, the technological evolution of endoluminal strategies has had a serious impact on the treatment of the descending aorta, the aortic arch in combination with vascular debranching or bypass, and in selected cases even on managing pathologies of the ascending aorta. Although several case series and meta-analyses of published observations hint towards superiority of endografting in comparison to open surgical repair, the affected usually multimorbid patients with highly complex aortic disease should be subjected to an individual evaluation by a team of cardiologists, cardiac and vascular surgeons as well as imaging specialists; a dedicated individualized treatment concept in highly experienced centers of excellence is likely to provide the best results for such challenging patients.
    Der Internist 04/2013; · 0.33 Impact Factor
  • Christoph A Nienaber
    Journal of Endovascular Therapy 04/2013; 20(2):219-20. · 2.70 Impact Factor
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    ABSTRACT: An expert multidisciplinary panel in the treatment of type B aortic dissection reviewed available literature to develop treatment algorithms using a consensus method. Data from 63 studies published in 2006-2012 were retrieved for a total 1,548 patients treated medically 1,706 with open surgery and 3,457 with Thoracic Endovascular Repair (TEVAR). For acute (first 2 weeks) type B aortic dissection the pooled early mortality rate was 6.4% with medical treatment and increased to 10.2% with TEVAR and 17.5% with open surgery , mostly for complicated cases. Limited data for treatment of subacute (2-6 weeks after onset) type B aortic dissection showed an early mortality rate of 2.8% with TEVAR. In chronic (after 6 weeks) type B aortic dissection 5-year survival of 60-80% is expected with medical therapy since complications are likely. If interventional treatment was applied pooled early mortality rate was 6.6% with TEVAR and 8.0% with open surgery. Management for uncomplicated acute, subacute and chronic type B aortic dissection is by medical treatment with close imaging monitoring. Hemodynamic instability, organ malperfusion, increasing periaortic hematoma and hemorrhagic pleural effusion on imaging identify patients with complicated acute type B aortic dissection requiring urgent aortic repair. Recurrence of symptoms, aortic aneurysmal dilation (>55 mm) or a yearly increase >4mm after the acute phase are predictors of adverse outcome and need of delayed aortic repair ("complicated chronic aortic dissections") . The expert panel is aware that this consensus document provides proposal for strategies based on non-robust evidence for management of type B aortic dissection and that literature results are largely heterogeneous and should be interpreted cautiously.
    Journal of the American College of Cardiology 03/2013; · 14.09 Impact Factor
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    ABSTRACT: OBJECTIVES: To summarize our single Institution experience with staged total percutaneous management of aorto-mitral pathology. BACKGROUND: Percutaneous treatment of aortic valve stenosis (AVS) and mitral valve regurgitation (MVR) has been recently proposed for patients at high surgical risk. METHODS: Data concerning consecutive patients undergoing percutaneous transcatheter AV implantation (TAVI) followed by MV repair with MitraClip® were prospectively collected and analyzed. RESULTS: From January 2010 to February 2012 a total of 254 patients were referred to undergo TAVI in our Institution. Seventeen (6.7%) had preoperative severe MVR that remained unchanged after TAVI. Due to exacerbation of symptoms twelve patients were subsequently submitted to MV repair with the MitraClip® device. Mean age was 79 years (72-86 years), median Ambler score was 30.1 (17.2-42.6) and EuroSCORE 22.3 (10.2-48.6). Procedural success rate was 100%. Postprocedural hospitalization was 7.1 ± 2.7 and 4.6 ± 0.9 days after TAVI and MV repair, respectively. Six months follow-up echocardiography confirms improvement in LV-EF (37.2 ± 9.9 vs. 43.5 ± 10.7, p < 0.0001). No patient presents MVR exceeding grade I(+) or prosthetic aortic insufficiency > I grade and all patients experienced an improvement in functional status. CONCLUSIONS: Percutaneous treatment of AVS and MVR is feasible and safe. A tailored approach should be considered to treat firstly the AVS and subsequently the MVR when severe MV dysfunction and symptoms persist. Short-term durability of this combined percutaneous approach seems encouraging and justifies the economical burden to treat patients that have no other option. © 2013 Wiley-Liss, Inc.
    Catheterization and Cardiovascular Interventions 01/2013; · 2.51 Impact Factor
  • Christoph A Nienaber
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    ABSTRACT: The classic entity of life-threatening aortic dissection represents one pathology of a spectrum of acute conditions coined the acute aortic syndrome comprising dissection, intramural haematoma, penetrating atherosclerotic ulcer, and contained aortic rupture of any cause. The common denominator is disruption of the aortic media layers associated with severe pain and a variety of other symptoms. Any clinical suspicion of acute aortic syndrome should prompt immediate action and confirmatory non-invasive imaging; with respect to sensitivity and specificity for acute aortic pathology modern contrast-enhanced CT technology, MR imaging and ultrasound techniques have similar diagnostic accuracy near 100%. Since the prognosis of most patients with acute aortic dissection is related to undelayed diagnosis and (often surgical) treatment swift diagnostic imaging should be the primary goal in the work-up of any patient with suspected acute aortic syndrome; transfer and in-hospital logistics and local expertise for the differential use of various imaging modalities should be constantly improved.
    European heart journal cardiovascular Imaging. 10/2012;
  • K Rotter, K Kroll, C A Nienaber, B Ismer
    Biomedizinische Technik/Biomedical Engineering 09/2012; · 1.16 Impact Factor
  • Biomedizinische Technik/Biomedical Engineering 08/2012; · 1.16 Impact Factor
  • Source
    International journal of cardiology 07/2012; · 6.18 Impact Factor
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    ABSTRACT: OBJECTIVE: Available data on clinical outcomes of hybrid aortic arch repair are limited, especially for patients with aortic dissection. The objective of this review was to provide pooled analysis of periprocedural mortality and neurologic outcomes in hybrid procedures involving the aortic arch for dissection and other aortic diseases. METHODS: Studies involving hybrid aortic arch procedures (2002-2011) were systematically searched and reviewed. End points were periprocedural mortality, stroke, and spinal cord ischemia. RESULTS: A total of 50 studies including 1886 patients were included. Perioperative mortality ranged from 1.6% to 25.0% with a pooled event ratio of 10.8% (95% confidence intervals [CI], 9.3-12.5). Perioperative stroke, regardless of severity, ranged from 0.8% to 25.0% (pooled ratio 6.9%; 95% CI, 5.7%-8.4), and spinal cord ischemia, including permanent and transitory events, ranged from 1.0% to 25.0% (pooled ratio, 6.8%; 95% CI, 5.6-8.2). Neurologic but no mortality risk was affected by timing and center volume with decreased rates in more recent and higher volume studies. In dissected aorta, perioperative mortality rate was 9.8% (95% CI, 7.7-12.4), stroke 4.3% (95% CI, 3.0-6.3), and spinal cord ischemia 5.8% (95% CI, 4.2-7.9). Perioperative mortality was higher in diseases that extended to the ascending aorta (15.1% vs 7.6%; odds ratio, 2.8; 95% CI, 1.17-6.7; P = .021), whereas there were no significant differences in the neurologic risks of stroke or spinal cord ischemia. CONCLUSIONS: Hybrid repair of the aortic arch carries not negligible risks of perioperative mortality and neurologic morbidity. Risk of neurologic complications has decreased with timing and center volume and may be limited in dissection repairs. However, contemporary information on aortic hybrid arch procedures is mainly provided by small case series or retrospective studies with wide range of results.
    The Journal of thoracic and cardiovascular surgery 07/2012; · 3.41 Impact Factor
  • 07/2012: pages 317-365; , ISBN: 978-2-913628-57-1.
  • L Paranskaya, G D Ancona, C A Nienaber, H Ince
    Clinical Research in Cardiology 06/2012; · 3.67 Impact Factor
  • Source
    Christoph A Nienaber
    Journal of the American Heart Association. 06/2012; 1(3):e001404.
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    ABSTRACT: Das Marfan-Syndrom ist eine autosomal-dominant vererbte Bindegewebserkrankung mit Beteiligung des skelettalen, okulären und kardiovaskulären Systems. Die Erkrankung wird durch Mutationen im FBN1-Gen verursacht, das für das Glykoprotein Fibrillin, eine elementare Strukturkomponente der elastischen Fasern kodiert. Die Diagnose des Marfan-Syndroms basiert auf zwei Säulen, erstens der klinischen Evaluierung der Patienten, zweitens dem direkten Mutationsnachweis im FBN1-Gen. Inter- und intrafamiliäre Unterschiede im klinischen Erscheinungsbild erschweren die phänotypische Diagnostik. In dieser Arbeit wird die indirekte Genotypanalyse, in welcher die Segregation von allelischen DNA-Polymorphismen verfolgt wird, als ein zusätzliches Verfahren für die Diagnose vorgestellt. Mittels indirekter Genotypdiagnostik und in Kombination mit den klinischen Untersuchungsbefunden kann die Diagnose oder der Ausschluss des Marfan-Syndroms noch sicherer gestellt werden, insbesondere bei klinischen Grenzfällen. Marfan syndrome (MFS) is an autosomal dominant disorder of connective tissue characterized by skeletal, ocular and cardiovascular manifestations. The disease is caused by mutations in the FBN1 gene, encoding fibrillin, an important component of elastic fibers. Diagnosis of Marfan syndrome is currently based on detailed clinical examination and/or mutation analysis in the fibrillin gene. Clinical expression varies widely both among and within families, rendering clinical diagnosis extremely difficult. In this study, we performed segregation analysis of allelic DNA polymorphisms to support diagnosis of Marfan syndrome. This type of genotype analysis is a useful, additional diagnostic tool for families with Marfan syndrome and provides incremental information of diagnosis or exclusion of Marfan syndrome based on clinical findings. Schlüsselwörter–Marfan-Syndrom–Fibrillin 1-Gen–klinische Variabilität–indirekte GenotypdiagnostikKey words Marfan syndrome–fibrillin-1 gene–clinical variability–haplotype segregation analysis
    Zeitschrift für Kardiologie 04/2012; 89(10):939-948. · 0.97 Impact Factor
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    ABSTRACT: In-hospital outcome of acute type B dissection (ABAD) is strongly related to preoperative aortic conditions. In order to clarify the influence of the clinical presentation on the outcome, we analyzed the patients of the International Registry of Acute Aortic Dissection (IRAD). All patients affected by complicated ABAD, enrolled in the IRAD from 1996-2004, were included. Complications were defined as the presence of shock, periaortic hematoma, spinal cord ischemia, preoperative mesenteric ischemia/infarction, acute renal failure, limb ischemia, recurrent pain, refractory pain or refractory hypertension (group I). All other patients were categorized as uncomplicated (group II). A comprehensive analysis was performed of all clinical variables in relation to in-hospital outcome. The overall in-hospital mortality among 550 patients was 12.4%. Mortality in group I (250 patients) was 20.0 %, compared to 6.1% in group II (300 patients) (P<0.001). Univariate predictors of ABAD complications were Marfan syndrome, abrupt onset of pain, migrating pain, any focal neurological deficits, need for higher number of diagnostic examinations and use of magnetic resonance and/or aortogram, abdominal vessels involvement at aortogram, larger descending aortic diameter, especially >6 cm, pleural effusion, and widened mediastinum on chest X-ray. Univariate predictors of a non complicated status were normal chest X-ray and medical management. In group I, in-hospital mortality following surgical and endovascular intervention were 28.6% and 10.1% (P=0.006), respectively. Independent predictors of overall in-hospital mortality included age >70 years, female gender, ECG showing ischemia, preoperative acute renal failure, preoperative limb ischemia, periaortic hematoma, and surgical management. The only independent variable protective for mortality was magnetic resonance as diagnostic test. ABAD is a heterogeneous disease that produces dissimilar clinical subsets, each of which can have specific clinical signs, management and in-hospital results. In IRAD ABAD uncomplicated patients, medical therapy was associated with best hospital outcome, while endovascular interventions were associated with better results than surgery when invasive treatments were required. Although selection bias may be possible, and irrespective of treatments, knowledge of significant risk factors for mortality may contribute to a better management and a more defined risk-assessment in patients affected by ABAD.
    The Journal of cardiovascular surgery 04/2012; 53(2):161-8. · 1.51 Impact Factor
  • Clinical Research in Cardiology 03/2012; 101(10):847-9. · 3.67 Impact Factor
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    ABSTRACT: Left ventricular hypertrophy, dehydration, sepsis, vasodilatation, excessive sympathetic stimulation, pericardial tamponade and surgical treatment of the atrioventricular valve are known causes of left ventricular outflow tract (LVOT) obstruction. We report the rare case of a patient who developed dynamic LVOT obstruction as a complication of acute pulmonary embolism.
    Der Internist 03/2012; 53(6):751-5. · 0.33 Impact Factor

Publication Stats

4k Citations
909.31 Total Impact Points

Institutions

  • 2003–2014
    • University of Rostock
      • Abteilung Kardiologie
      Rostock, Mecklenburg-Vorpommern, Germany
  • 1987–2012
    • Universität Hamburg
      • • Department of Human Genetics
      • • II. Department of Internal Medicine
      • • University Heart Center
      • • Department of Cardiovascular Surgery
      • • Department of Nuclear Medicine
      • • Paediatric Cardiology / Paediatric Cardiac Surgery
      Hamburg, Hamburg, Germany
  • 2011
    • Erasmus Universiteit Rotterdam
      Rotterdam, South Holland, Netherlands
    • Isar Heart Center
      Münchenbernsdorf, Thuringia, Germany
    • Asklepios Klinik St. Georg
      Hamburg, Hamburg, Germany
  • 2010
    • University of Münster
      • Clinic for Vascular Surgery
      Münster, North Rhine-Westphalia, Germany
  • 2009
    • Klinik Hirslanden
      Zürich, Zurich, Switzerland
    • University of Colorado
      • Division of General Internal Medicine
      Denver, CO, United States
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany
  • 2006
    • Erasmus MC
      • Department of Cardiology
      Rotterdam, South Holland, Netherlands
  • 1988–2001
    • University Medical Center Hamburg - Eppendorf
      • Department of Nuclear Medicine
      Hamburg, Hamburg, Germany
  • 1999
    • University of Bologna
      • Institute of Cardiology
      Bologna, Emilia-Romagna, Italy
  • 1993
    • Children's Hospital Los Angeles
      Los Angeles, California, United States
  • 1991–1992
    • University of California, Los Angeles
      • Department of Medicine
      Los Angeles, CA, United States
    • University of Southern California
      • Department of Medicine
      Los Angeles, CA, United States