Ralf Zahn

BG Trauma Center Ludwigshafen, Ludwigshafen, Rheinland-Pfalz, Germany

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Publications (153)534.06 Total impact

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    ABSTRACT: Aims: Current guidelines recommend immediate multivessel percutaneous coronary intervention (PCI) in patients with cardiogenic shock, despite the lack of randomised trials. We sought to investigate the use and impact on outcome of multivessel PCI in current practice in cardiogenic shock in Germany. Methods and results: Between January 2008 and December 2011 a total of 735 consecutive patients with acute myocardial infarction, cardiogenic shock and multivessel coronary artery disease underwent immediate PCI in 41 hospitals in Germany. Of these, 173 (23.5%) patients were treated with immediate multivessel PCI. The acute success of PCI with respect to TIMI 3 flow did not differ between the groups (82.5% versus 79.6%). In-hospital mortality with multivessel PCI and culprit lesion PCI was 46.8% and 35.8%, respectively. In multivariate analysis multivessel PCI was associated with an increased mortality (odds ratio 1.5; 95% confidence interval 1.15-1.84). Conclusions: In current clinical practice in Germany multivessel PCI is used only in one quarter of patients with cardiogenic shock treated with primary PCI. We observed an adverse effect of immediate multivessel PCI. Therefore, a randomised trial is needed to determine the definitive role of multivessel PCI in cardiogenic shock.
    08/2014;
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    ABSTRACT: The German Aortic Valve Registry (GARY) seeks to provide information on a real-world, all-comers basis for patients undergoing aortic valve interventions. This registry comprises patients undergoing the complete spectrum of transcutaneous and conventional surgical aortic valve interventions. The aim of this study was to use the GARY registry to evaluate conventional and catheter-based aortic valve interventions in several risk groups.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 07/2014; · 2.40 Impact Factor
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    ABSTRACT: Residual aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) has been associated with increased mortality. Nevertheless, a considerable proportion of these patients survives and appears to tolerate AR. Identification of patients at higher risk of death may assist in tailoring therapy, but predictors of mortality in this subset of patients is largely unknown.
    Heart (British Cardiac Society) 06/2014; · 5.01 Impact Factor
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    ABSTRACT: The aim of this analysis is to examine the influence of gender differences on the outcome after transcatheter aortic valve implantation (TAVI) from a multicenter real-world registry in Germany (TAVI registry). The impact of gender differences on the clinical outcome after TAVI was examined in small studies with conflicting results. Consecutive patients (n = 1,432) undergoing TAVI in the period between January 2009 and June 2010 in Germany were evaluated. Differences in all-cause mortality were examined with Kaplan-Meier estimates and proportional hazards models. Women comprised 57.8 % of the cohort. The Edwards Sapien valve (18.5 %) and CoreValve (81.5 %) were used through the transfemoral (87.7 %), subclavian (3.0 %), transapical (8.6 %), or transaortic approach (0.7 %). At baseline, women had higher aortic gradients and were older. Men had more comorbidities: prior myocardial infarction, prior revascularization, prior coronary artery bypass surgery, peripheral arterial vascular disease and chronic obstructive pulmonary disease. Women had more periprocedural vascular complications in comparison to men (25.2 vs. 17.2 %, p < 0.001). There was no significant difference in mortality at 30-day follow-up (7.6 % for women vs. 8.6 % for men, p = 0.55). The adjusted HR for 1-year all-cause mortality favored women, HR 0.75 (95 % CI 0.57-0.98, p = 0.0346) with a mortality rate of 17.3 vs. 23.6 % for men. Female gender is associated with better 1-year survival after TAVI. These results suggest that TAVI could be the best treatment modality for elderly women with symptomatic severe aortic stenosis.
    Clinical Research in Cardiology 03/2014; · 3.67 Impact Factor
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    ABSTRACT: Patient outcome, quality of life as well as health care costs differ between patients with minor versus major stroke during carotid artery stenting. Evaluation of predictors for both subtypes of strokes is of paramount importance. We analyzed data from the prospective, web-based German carotid artery stenting (CAS) registry. All patients entered in this registry were included as of January 2011. During the periprocedural period (until patient discharge or transfer) 1.5 % of the patients (85/5,794) sustained a major and 1.3 % (75/5,784) a minor stroke (total periprocedural stroke rate 2.8 %). Mean age of all patients was 71 years, 72 % were male and 50 % had a symptomatic carotid stenosis. Regression analysis identified age (OR 1.44; 95 % CI 1.05-1.98), symptomatic stenosis (OR 3.17; 95 % CI 1.74-5.76) and procedural duration per 10 min (OR 1.22; 95 % CI 1.13-1.31) as independent predictors for major strokes. Age (OR 1.43; 95 % CI 1.03-1.98), diabetes (OR 1.75; 95 % CI 1.04-2.94), and procedural duration (OR 1.17; 95 % CI 1.08-1.27) predicted for minor strokes. The use of an embolic protection device significantly prevented both type of strokes (OR 0.31; 95 % CI 0.15-0.62 for major strokes; OR 0.40; 95 % CI 0.18-0.91 for minor strokes), female patients suffered less major strokes (OR 0.47; 95 % CI 0.24-0.92). Moreover, minor and major strokes were associated with death, contralateral embolism and a longer hospital stay more frequently. Patients with one or more risk factors for periprocedural stroke seem to require special attention in terms of optimal preprocedural assessment of the carotid stenosis and vascular anatomy, as well as adequate patient preparation. Identifying these risk factors may help in patient selection, encourage further refinement in carotid artery stenting technique and avoid procedural complications. The use of an embolic protection device system was associated with less periprocedural minor and major strokes.
    Clinical Research in Cardiology 01/2014; · 3.67 Impact Factor
  • Clinical Research in Cardiology 11/2013; · 3.67 Impact Factor
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    ABSTRACT: Patients with bicuspid aortic valves (BAVs) are considered a relative contraindication to transcatheter aortic valve implantation (TAVI). One of the main reasons is the presumed risk for residual aortic regurgitation (AR). However, case reports and small case series have suggested that TAVI can be successfully performed with acceptable clinical outcomes in high-risk patients with BAV. Within the large German TAVI Registry, we sought to evaluate TAVI in older high-risk patients with BAV. From January 2009 to June 2010, a total of 1,424 patients with severe aortic stenosis undergoing TAVI were prospectively enrolled into the German TAVI Registry. For the present analysis, patients with valve-in-valve procedures were excluded and those with BAV (n = 38, 3%) were compared with those with tricuspid aortic valve (TAV; n = 1357, 97%). Patient characteristics did not markedly differ and procedural success was very high in both groups. There was a higher rate of relevant AR (≥II) after TAVI among patients with BAV (25 vs 15%, p = 0.05), whereas pacemakers were more often implanted in patients with TAV (17% vs 35%, p = 0.02). Thirty-day mortality rate was similar in both cohorts (11% vs 11%). In a Cox proportional regression analysis, BAV was not associated with higher 1-year mortality rate (hazard ratio 0.64, 95% confidence interval 0.29 to 1.41). In selected patients with BAV, TAVI can be performed with a satisfactory clinical result. Although the risk for relevant AR seems to be greater among patients with BAV, 30-day and 1-year mortality rates were not elevated compared with patients with TAV.
    The American journal of cardiology 11/2013; · 3.58 Impact Factor
  • R Zahn
    Herz 09/2013; · 0.78 Impact Factor
  • EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2013; 9(5):654. · 3.17 Impact Factor
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    ABSTRACT: Aortic stenosis is a frequent valvular disease especially in elderly patients. Catheter-based valve implantation has emerged as a valuable treatment approach for these patients being either at very high risk for conventional surgery or even deemed inoperable. The German Aortic Valve Registry (GARY) provides data on conventional and catheter-based aortic procedures on an all-comers basis. A total of 13 860 consecutive patients undergoing repair for aortic valve disease [conventional surgery and transvascular (TV) or transapical (TA) catheter-based techniques] have been enrolled in this registry during 2011 and baseline, procedural, and outcome data have been acquired. The registry summarizes the results of 6523 conventional aortic valve replacements without (AVR) and 3464 with concomitant coronary bypass surgery (AVR + CABG) as well as 2695 TV AVI and 1181 TA interventions (TA AVI). Patients undergoing catheter-based techniques were significantly older and had higher risk profiles. The stroke rate was low in all groups with 1.3% (AVR), 1.9% (AVR + CABG), 1.7% (TV AVI), and 2.3% (TA AVI). The in-hospital mortality was 2.1% (AVR) and 4.5% (AVR + CABG) for patients undergoing conventional surgery, and 5.1% (TV AVI) and AVI 7.7% (TA AVI). The in-hospital outcome results of this registry show that conventional surgery yields excellent results in all risk groups and that catheter-based aortic valve replacements is an alternative to conventional surgery in high risk and elderly patients.
    European Heart Journal 09/2013; · 14.10 Impact Factor
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    ABSTRACT: Aims: To evaluate: 1) the causes of emergency conversion from transcatheter aortic valve implantation (TAVI) to surgery, 2) procedural settings, and 3) short-term outcome of converted patients. Methods and results: The prospective German TAVI registry was used to identify patients who underwent bail-out surgery during TAVI. Additionally, standardised questionnaires were developed and used to assess more detailed periprocedural and postprocedural data. Emergency conversion from TAVI to open cardiac surgery was required in 24 of 1,975 patients (1.2%). Primary conversion causes were aorto-valvular complications (i.e., aortic annulus rupture, aortic perforation, or thoracic aortic dissection). This was followed by prosthesis embolisation, myocardial perforation, severe aortic regurgitation, and coronary obstructions. The mean time interval between abortions of TAVI to surgery was 19 minutes (SD±17 min, range 5-80 min). Four of 24 patients (16.7%) died during the initial surgery, seven of 24 (29.2%) within the first 72 hours and the 30-day mortality was 45.8%. The highest mortality was observed in patients with aortic perforation or dissection (4/5, 80%). Mortality rates for other entities were: prosthesis embolisation 40% (2/5), myocardial perforation 50% (2/4), annulus rupture 67% (2/3), severe aortic regurgitation 33% (1/3), and coronary impairment 0% (0/3). Conclusions: Emergency conversion from TAVI to surgery is a rare event carrying a mortality of around 45% after 30 days. Outcome of converted patients with prior injury of aortic, aorto-valvular, or myocardial tissue during TAVI was poor, whereas patients with severe aortic regurgitation and those with coronary complications had a more favourable outcome after 30 days. Collected procedural and outcome data demand on-site cardiac surgery as a prerequisite for TAVI and constant process optimisation efforts regarding such emergency scenarios.
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 08/2013; 9(4):446-51. · 3.17 Impact Factor
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    ABSTRACT: Little is known about angiographic and clinical differences in patients presenting with left circumflex artery (LCX)-related ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI). We sought to determine the clinical significance of ST elevations in patients with LCX-related myocardial infarction. Between 2005 and 2008 10,503 consecutive patients with acute STEMI and NSTEMI undergoing percutaneous coronary intervention (PCI) were prospectively enrolled into the Euro Heart Survey PCI-Registry. For the present analysis patients with LCX-related STEMI (n=1100, 54.7%) were compared to those with LCX-related NSTEMI (n=910, 45.3%). NSTEMI-patients were older, more often female and had a higher incidence of prior cardiac events. Patients with STEMI more frequently presented with shock (8.0 versus 3.9%, P<0.001) or had been resuscitated (8.5 versus 2.7%, P<0.0001). TIMI 0-1 before PCI was much more often found among those with STEMI (58.2 versus 25.1%, P<0.0001). In the univariate analysis there were no significant differences in hospital mortality (STEMI: 4.8%, NSTEMI: 3.5%, P=0.17), however after adjustment for age, female gender, diabetes and chronic renal failure hospital mortality was significantly higher in STEMI patients (odds ratio 1.71, 95%-CI 1.08-2.72, P<0.05). Over 50% of the patients with LCX-related myocardial infarction treated with PCI had ST elevations in the initial electrocardiogram. STEMIs were more often associated with total vessel occlusions or haemodynamic instability. In-hospital mortality was significantly higher in patients with LCX-related STEMI.
    International journal of cardiology 08/2013; · 6.18 Impact Factor
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    ABSTRACT: BACKGROUND: STROKE IS A RARE BUT SERIOUS COMPLICATION OF PERCUTANEOUS CORONARY INTERVENTIONS (PCIS). SO FAR, SCANT INFORMATION IS AVAILABLE ABOUT THE INCIDENCE AND OUTCOME OF PATIENTS DEVELOPING STROKE AFTER PCI FOR STABLE ANGINA OR ACUTE CORONARY SYNDROME (ACS) IN DAILY CLINICAL PRACTICE IN EUROPE TODAY.METHODS AND RESULTS: BETWEEN 2005 AND 2008, 46 888 PATIENTS UNDERGOING PCI WERE ENROLLED INTO THE PCI REGISTRY OF THE EURO HEART SURVEY PROGRAMME (176 CENTERS IN 33 EUROPEAN COUNTRIES) TO DOCUMENT PATIENTS CHARACTERISTICS, PCI DETAILS, AND HOSPITAL COMPLICATIONS IN DIFFERENT PCI INDICATIONS. STROKE WAS OBSERVED IN 0.4% OF THE PROCEDURES IN THE TOTAL POPULATION, IN 0.3% OF PCIS IN ELECTIVE PATIENTS, AND IN 0.6% IN PCIS PERFORMED FOR ACS. THE OVERALL IN-HOSPITAL MORTALITY WAS 19.2% FOR PATIENTS WHO DEVELOPED STROKE (ELECTIVE PCIS, 10.0%; PCI FOR ACS, 23.2%) COMPARED WITH 1.3% FOR THOSE WITHOUT STROKE (ELECTIVE PCIS, 0.2%; PCI FOR ACS, 2.3%). IN MULTIVARIATE ANALYSIS HEMODYNAMIC INSTABILITY, AGE 75 YEARS, HISTORY OF STROKE, AND CONGESTIVE HEART FAILURE WERE FOUND TO BE INDEPENDENT PREDICTORS FOR PERIPROCEDURAL STROKE IN ACS, WHEREAS ONLY PCI OF A BYPASS GRAFT AND RENAL FAILURE COULD BE IDENTIFIED AS INDEPENDENT PREDICTORS FOR STROKE IN ELECTIVE PATIENTS.CONCLUSIONS: Stroke as complication of PCI occurs rarely (0.4%) in clinical practice in Europe today. However, peri-interventional stroke is still associated with an exceedingly high in-hospital mortality rate. Most predictors for periprocedural stroke are not modifiable and cannot be diminished before PCI. Therefore, treatment of patients with stroke after PCI needs further research.
    Circulation Cardiovascular Interventions 07/2013; · 6.54 Impact Factor
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    ABSTRACT: BACKGROUND: Predictors of long-term mortality after discharge after acute myocardial infarction (AMI) are well characterized. However, these established risk factors are based on data almost exclusively derived from older studies without consistent use of revascularization therapy and adjunctive therapy with statins, platelet inhibitors, beta-blockers and ACE inhibitors/ARBs. We therefore sought to investigate predictors of 1-year mortality in survivors of AMI treated with contemporary guideline-adherent therapy. METHODS AND RESULTS: We performed a retrospective analysis of 3,782 patients surviving acute ST-elevation and non ST-elevation myocardial infarction who were enrolled in the prospective, randomized, double-blind, controlled OMEGA trial with 104 German centers. The primary objective of the OMEGA study was to determine the effect of highly purified omega-3 fatty acid ethyl esters-90 on the rate of sudden cardiac death in patients surviving AMI and receiving current guideline-adherent treatment within the 1-year of follow-up. 80.8 % of the patients received early revascularization therapy. At discharge, 94.2 % of the patients received beta-blocker, 90.4 % ACE inhibitor/angiotensin receptor blocker, 94.3 % statin, 95.4 % aspirin and 88.4 % clopidogrel. During the 1-year follow-up 139 patients (3.7 %) died. Multivariate logistic regression analysis revealed the following independent predictors of 1-year mortality in decreasing order of importance: ejection fraction <45 % [odds ratio (OR) 2.28, 95 % confidence interval (CI) 1.53-3.41], age ≥70 years (OR 2.17, 95 % CI 1.42-3.32), no acute revascularization (OR 2.02, 95 % CI 1.33-3.08), prior stroke/transient ischemic attack (OR 1.90, 95 % CI 1.09-3.30), peripheral arterial disease (OR 1.86, 95 % CI 1.12-3.10), heart rate >85/min (OR 1.82, 95 % CI 1.23-2.71), chronic obstructive lung disease (OR 1.77, 95 % CI 1.01-3.10) and HDL cholesterol <40 mg/dl (OR 1.75, 95 % CI 1.15-2.67). CONCLUSIONS: In patients surviving AMI and treated with contemporary guideline-adherent therapy, 1-year mortality was low. Nevertheless, traditional risk factors such as ejection fraction <45 %, older age, no acute revascularization and comorbidities were the strongest predictors of long-term mortality supporting the findings from previous studies.
    Clinical Research in Cardiology 06/2013; · 3.67 Impact Factor
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    ABSTRACT: Objective: We compare clinical outcomes among unselected patients undergoing PCI with drug-eluting stents (DES) stratified in categories of treating hospital PCI volume. Background: Previous observational evidence suggests an inverse relation between hospital percutaneous coronary intervention (PCI) volume and patients' outcomes. However, there are no mid-term outcomes data with the use of drug-eluting stents (DES). Methods: We used data from DES.DE (German Drug-Eluting Stent) registry to compare in-hospital and 1-year outcomes among unselected patients. Primary endpoints at one year follow-up were the rate of major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR). Results: Between 2005 and 2006, 2,075 patients were treated in group I hospitals (<1,000 PCIs/year), 1,624 in group II hospitals (1,000-1,500 PCIs/year) and 1,790 in group III hospitals (>1,500 PCIs/year). Compared with group II and group III, group I allocation was associated with higher rates of overall hospital mortality (1.1% versus 0.2% versus 0.2%; p<0.0001) and severe bleeding (1.0% versus 0.4% versus 0.5%; p<0.05); similarly, poorer outcomes with respect to MACCE (7.2% versus 6.5% versus 4.7%; p<0.01), stent thrombosis (5.2% versus 5.0% versus 3.0%; p<0.01) and non-fatal stroke (1.5% versus 0.9% versus 0.7%; p<0.05) were documented in group I. Conversely, TVR rates were highest in group II (10.2% versus 14.2% versus 11.7%; p<0.01); these differences persisted after risk adjustment for heterogeneous baseline characteristics. Conclusions: In the era of modern coronary intervention technological advances such as DES have not offset the inverse relation between procedural volume and both in-hospital and 1-year outcomes after PCI. © 2013 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 05/2013; · 2.51 Impact Factor
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    ABSTRACT: Purpose : To report a "real-world" multicenter experience in the use of thoracic endovascular aortic repair (TEVAR) for diseases of the descending thoracic aorta. Methods : A prospective, multicenter, German TEVAR Registry was established in October 2008 and enrolled 191 patients (134 men; mean age 64.5±13.2 years) from 7 hospitals up to March 2011. Stent-graft implantation was performed for Stanford type B aortic dissection (104, 55.3%), true thoracic aortic aneurysm (91, 48.7%), intramural hematoma (20, 10.7%), penetrating aortic ulcer (16, 8.6%), and traumatic aortic rupture (6, 3.2%). Results : Per patient, a mean of 1.2±0.7 stent-grafts were implanted. Technical success was 92.1% (164/178); 15 (8.5%) endoleaks (types I-III) were reported. Intervention duration was a mean 107±122 minutes. During the hospital stay, stroke occurred in 3.9% of patients (7/180) and paraplegia in 1.7% (3/180). Reintervention was performed in 3.3% (6/180). The mortality was 5.5% (10/181) in-hospital and 5.6% at 30 days. The mean follow-up was 24.5±27.7 months. The Kaplan-Meier estimates of 1-year reintervention and death rates were 7.2% and 11.4%, respectively. Conclusion : In this real-world TEVAR registry for acute or chronic descending aortic diseases, technical success was high and the short-term complication rate was acceptable. However, the high reintervention rate observed in the present study mandates thorough clinical and imaging follow-up after an initially successful procedure.
    Journal of Endovascular Therapy 05/2013; 20(3):265-72. · 2.70 Impact Factor
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    ABSTRACT: The wearable cardioverter-defibrillator (WCD) is indicated in patients who are considered to be at temporarily high risk for sudden cardiac death (SCD), when an implantable defibrillator is not yet clearly indicated.We report the case of a 41-year-old patient with a newly diagnosed severely reduced left ventricular (LV) function for suspected myocarditis and repeated nonsustained ventricular tachycardia (VT). This patient was supplied with a WCD who came back to the hospital 4 weeks after discharge with an electrical storm and adequate discharge of the WCD. After application of amiodarone, no further arrhythmias were detected during intrahospital course.For further risk stratification, we performed a magnetic field imaging (MFI), that was reported to be useful in risk assessment of SCD in patients with ischemic cardiomyopathy. This measurement showed a normal result, but we decided to give an implantable cardioverter-defibrillator (ICD) to the patient. During a follow-up of 1 year, no further arrhythmias occurred.With this case, we report the efficacy of a WCD, which is a novel tool in patients at temporarily high risk of SCD and we report a novel method of risk stratification in patients with a high risk of SCD.
    Herzschrittmachertherapie & Elektrophysiologie 05/2013;
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    ABSTRACT: Transcatheter aortic valve implantation (TAVI) is already an accepted option to treat elderly patients with severe symptomatic aortic stenosis who are inoperable or at high surgical risk. However, short- and long-term mortality after TAVI remains an important issue, raising the need to further improve the technology of TAVI as well as to identify patients who will not benefit from TAVI. A total of 1,391 patients treated with TAVI at 27 hospitals were included in the German Transcatheter Aortic Valve Interventions - Registry. One-year follow-up data were available for 1,318 patients (94.8%), with a mean follow-up period of 12.9 ± 4.5 months. One-year mortality was 19.9%. Survivors and nonsurvivors showed multiple differences in patient characteristics, indications for interventions, preintervention and interventional characteristics, and postintervention events. A higher logistic European System for Cardiac Operative Risk Evaluation score was associated with higher 1-year mortality (p <0.0001). Cox proportional-hazards analysis revealed the following independent predictors of mortality: among preintervention findings: previous mitral insufficiency ≥II° (p = 0.0005), low-gradient aortic stenosis (p = 0.0008), previous decompensation (p = 0.0061), previous myocardial infarction (p = 0.0138), renal failure (p = 0.0180), previous New York Heart Association class IV (p = 0.0254), and female gender (p = 0.0346); among procedural factors: intraprocedural conversion to surgery (p = 0.0009), peri-intervention stroke (p = 0.0003), and residual aortic insufficiency ≥II° (p = 0.0022); and among postprocedural events: postintervention myocardial infarction (p = 0.0009) and postintervention pulmonary embolism (p = 0.0025). In conclusion, 1-year mortality after TAVI was 19.9% in this series. Patient characteristics and procedural as well as postintervention factors associated with mortality were identified, which may allow better patient selection and better care for these critically ill patients.
    The American journal of cardiology 04/2013; · 3.58 Impact Factor
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    ABSTRACT: AIMS: The purpose of this study was to evaluate whether there are differences in use and outcome of implantable cardioverter defibrillator (ICD) therapy with or without cardiac resynchronization therapy (CRT) between patients with underlying coronary artery disease (CAD) and non-ischemic dilated cardiomyopathy (DCM). METHODS: A total of 2,263 consecutive patients from 44 German centers who underwent new ICD or CRT implantation between March 2007 and April 2010 were enrolled in the German DEVICE registry. Patients were followed for at least 1 year. RESULTS: Of 1,621 patients who received an ICD, 1,202 (74.2 %) had CAD and 419 (25.8 %) suffered from DCM. Patients who received CRT (n = 642) had CAD in 52.2 % and DCM in 47.8 %. The vast majority received CRT with ICD backup (CRT-D, 95 %). In both ICD and CRT groups, CAD patients were older and more often male. LV ejection fraction in ICD patients with CAD was significantly higher than in DCM patients. Heart failure classification and history of atrial fibrillation were similar in CAD and DCM in CRT patients. There was no significant difference in mortality and first ICD shock delivery between CAD and DCM after 1 year of follow-up. Heart failure symptoms showed significant improvement in CRT patients irrespective of the underlying disease. CONCLUSION: ICD and CRT patients in the DEVICE registry showed similar short-term outcome irrespective of their underlying disease etiology. Except older age and preponderance of males, clinical characteristics, device selection and outcome of ICD or CRT patients in the German DEVICE registry are comparable with patients from randomized trials.
    Clinical Research in Cardiology 03/2013; · 3.67 Impact Factor
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    ABSTRACT: Objectives: To determine predictors of permanent pacemaker (PPM) implantation up to 30 days after transcatheter aortic valve implantation (TAVI) in a prospective multicenter registry. Background: Conduction disorders requiring PPM implantation are one of the most common complications seen after TAVI. Knowledge about possible predictors may help to decrease the rate of PPM implantations. Methods In total, 1.347 consecutive patients who underwent TAVI in 22 centers were prospectively enrolled in the German Transcatheter Aortic Valve Interventions Registry. Both Medtronic CoreValve™ and Edwards Sapien™ valves were implanted. Patients with pre-procedurally implanted PPM or implantable cardioverter defibrillator were excluded from the analysis (n=199). Regression analysis of baseline and procedure characteristics of the remaining 1.147 patients was performed. Results: Procedural success was achieved in 97.4 % of the cases. The rate for PPM after TAVI was 33.7 %. The absence of prior valve surgery, the use of Medtronic CoreValve™ prosthesis and the presence of a porcelain aorta were identified as independent predictors for PPM after TAVI. Mortality at 30 days did not differ between patients with or without PPM necessity (6.0 % vs. 8.1 % respectively; HR 0.72; CI (0.45-1.16); p= 0.17). Conclusions: PPM is a common post-procedure requirement after TAVI. The absence of prior valve surgery, the implantation of Medtronic CoreValve™ prosthesis and the presence of a porcelain aorta were independently associated with PPM after TAVI. © 2013 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 03/2013; · 2.51 Impact Factor

Publication Stats

1k Citations
534.06 Total Impact Points

Institutions

  • 2002–2014
    • BG Trauma Center Ludwigshafen
      Ludwigshafen, Rheinland-Pfalz, Germany
  • 2013
    • Städtisches Klinikum Solingen Gmbh
      Solingen, North Rhine-Westphalia, Germany
    • University of Ludwigshafen on the Rhine
      Ludwigshafen, Rheinland-Pfalz, Germany
  • 2012
    • Universitätsklinikum Erlangen
      Erlangen, Bavaria, Germany
    • Klinikum Worms
      Worms, Rheinland-Pfalz, Germany
  • 2011–2012
    • Universität Heidelberg
      Heidelburg, Baden-Württemberg, Germany
  • 2002–2012
    • Klinikum Ludwigshafen
      • Medizinische Klinik A
      Ludwigshafen, Rheinland-Pfalz, Germany
  • 2010
    • Klinikum Darmstadt
      Darmstadt, Hesse, Germany
    • Johannes Gutenberg-Universität Mainz
      Mayence, Rheinland-Pfalz, Germany
  • 2009
    • Agatharied Hospital
      Hausham, Bavaria, Germany
    • Klinikum Lippe
      Detmold, North Rhine-Westphalia, Germany
    • Duke University Medical Center
      • Duke Clinical Research Institute
      Durham, NC, United States
  • 2006–2008
    • Klinikum Nürnberg
      Nuremberg, Bavaria, Germany
  • 2007
    • Institut für Herzinfarktforschung
      Mayence, Rheinland-Pfalz, Germany
    • North Carolina Clinical Research
      Raleigh, North Carolina, United States