In isolated mitral valve regurgitation general consensus on surgery is to favor repair over replacement excluding rheumatic etiology or endocarditis. If concomitant aortic valve replacement is ...performed however, clinical evidence is more ambiguous and no explicit guidelines exist on the choice of mitral valve treatment. Both, double valve replacement (DVR) and aortic valve replacement in combination with concomitant mitral valve repair (AVR + MVP) have been proven to be feasible procedures. In our single-center, retrospective, observational cohort study, we compared the outcome of these two surgical techniques focusing on mortality and morbidity.
89 patients underwent DVR (n = 41) or AVR + MVP (n = 48) in our institution between 2009 and 2018. Follow-up data was collected using electronic patient records, by contacting treating physicians and by telephone interviews. We used the Kaplan-Meier method to analyze mortality during follow-up and Cox regression to investigate potential predictors of mortality.
During a median follow-up duration of 4.5 IQR 2.9 to 6.1 years, there was no significant difference in mortality between both cohorts. Thirty days mortality was 6.3% in the DVR and 7% in the AVR + MVP cohort. Overall mortality amounted to 17% for DVR and 23% for AVR + MVP. DVR was the preferred procedure for valve disease of rheumatic etiology and for endocarditis, while in degenerative valves AVR + MVP was predominant. More biological valves were used in the AVR + MVP cohort (p < 0.001) and more mechanical valves were implanted in the DVR cohort. The rate of rehospitalization, deterioration of left ventricular ejection fraction and postoperative complications were equally distributed among the two cohorts.
Our data analysis showed that both DVR and AVR + MVP are safe and feasible options for double valve surgery. Based on our findings we could not prove superiority of one surgical technique over the other. Choosing the appropriate procedure for the patient should be influenced by valve etiology, patients' comorbidities and the surgeons' experience.
This was a retrospectively registered trial, registered on April 1st 2018, ClinicalTrials.gov Identifier: NCT03667274.
Metallic magnetic calorimeters (MMCs) are particle detectors that combine ultra-high energy resolution with a predictable and smooth response based on the physics of paramagnetism. For best energy ...resolution, MMCs are read out with dc SQUID preamplifiers. Since the ac Josephson effect also makes dc SQUIDs broadband RF sources in the 1–100 GHz range, the SQUID can potentially excite RF modes of the MMC sensor, with negative consequences. The importance of this possibility is magnified in direct-coupled MMCs, where the MMC sensor is part of the SQUID loop to maximize performance. For these reasons, the RF behavior of MMC sensors must be investigated. In this report, we present the results of exploratory RF simulations of MMC sensor modes and damping, and we assess three approaches to damp the parallel-meander direct-coupled MMC without excessive noise increase.
Please cite this paper as: Moertl M, Friedrich S, Kraschl J, Wadsack C, Lang U, Schlembach D. Haemodynamic effects of carbetocin and oxytocin given asintravenous bolus on women undergoing caesarean ...delivery: a randomised trial. BJOG 2011;118:1349–1356.
Objective This study compares the maternal heart rate effects of carbetocin and oxytocin during elective caesarean delivery.
Design Double blind randomised single centre study (1:1).
Setting University hospital providing intrapartum care.
Population Fifty‐six women undergoing elective caesarean section after spinal anaesthesia.
Methods Haemodynamic parameters were measured non‐invasively using the Task Force® Monitor 3040i system. Measurements were taken for 500 seconds upon administration of a slow intravenous bolus of the clinically recommended doses of 100 μg of carbetocin or 5 IU of oxytocin to prevent postpartum haemorrhage (PPH).
Main outcome measure Effect on maternal heart rate (HR).
Results Statistically indistinguishable haemodynamic effects were seen for both drugs, with a maximal effect at about 30–40 seconds: HR increased 17.98 ± 2.53 bpm for oxytocin and 14.20 ± 2.45 bpm for carbetocin. Systolic blood pressure (sBP) decreased (−26.80 ± 2.82 mmHg for oxytocin versus −22.98 ± 2.75 mmHg for carbetocin). Following the maximal effect, women treated with carbetocin recovered slowly to baseline values asymptotically (HR and BP), whereas women treated with oxytocin displayed a slight rebound bradycardia at 200 seconds (−6.8 ± 1.92 bpm). Patients under both treatments showed a similar profile of side effects without any indication of unexpected adverse effects.
Conclusion Both oxytocins have comparable haemodynamic effects and are uterotonic drugs with an acceptable safety profile for prophylactic use. Minimal differences in the recovery phase beyond 70 seconds are in keeping with the fact that carbetocin has an extended half‐life compared with oxytocin.
Aim of this study was to evaluate the outcomes of endocarditis patients undergoing valve surgery with the Cytosorb
hemoadsorption (HA) device during cardiopulmonary bypass.
From 2009 until 2019, 241 ...patients had undergone valve surgery due to endocarditis at the Department of Cardiac Surgery, University Hospital of Basel. We compared patients who received HA during surgery (
= 41) versus patients without HA (
= 200), after applying inverse probability of treatment weighting.
In-hospital mortality, major adverse cardiac and cerebrovascular events and postoperative renal failure were similar in both groups. Demand for norepinephrine (88.4 vs. 52.8%;
= 0.001), milrinone (42.2 vs. 17.2%;
= 0.046), red blood cell concentrates (65.2 vs. 30.6%;
= 0.003), and platelets (HA vs. Control: 36.7 vs. 9.8%;
= 0.013) were higher in the HA group. In addition, a higher incidence of reoperation for bleeding (34.0 vs. 7.7 %;
= 0.011), and a prolonged length of in-hospital stay (15.2 (11.8 to 19.6) vs. 9.0 (7.1 to 11.3) days;
= 0.017) were observed in the HA group.
No benefits of HA-therapy were observed in patients with infective endocarditis undergoing valve surgery.
COVID‐19 and immune checkpoint inhibitors Ahmed, M.S.; Brehme, H.; Friedrich, S. ...
JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology,
20/May , Letnik:
35, Številka:
5
Journal Article
The diagnostic performance of T-wave amplitudes for the detection of myocardial infarction is largely unknown. We aimed to address this knowledge gap.
T-wave amplitudes were automatically measured in ...12-lead ECGs of patients presenting with acute chest discomfort to the emergency department within a prospective diagnostic multicenter study. The final diagnosis was centrally adjudicated by 2 independent cardiologists. Patients with left ventricular hypertrophy, complete left bundle branch block, or paced ventricular depolarization were excluded. The performance for lead-specific 95th-percentile thresholds were reported as likelihood ratios (lr), specificity, and sensitivity.
Myocardial infarction was the final diagnosis in 445 (18%) of 2457 patients. In most leads, T-wave amplitudes tended to be greater in patients without myocardial infarction than those with myocardial infarction, and T-wave amplitude exceeding the 95th percentile had positive and negative lr close to 1 or with confidence intervals (CIs) crossing 1. The exceptions were leads III, aVR, and V1, which had positive lrs of 3.8 (95% CI, 2.7 to 5.3), 4.3 (95% CI, 3.1 to 6.0) and 2.0 (95% CI, 1.4 to 2.9), respectively. These leads normally have inverted T waves, so T-wave amplitude exceeding the 95th percentile reflects upright rather than increased-amplitude hyperacute T waves.
Hyperacute T waves, when defined as increased T-wave amplitude exceeding the 95th percentile, did not provide useful information in diagnosing myocardial infarction in this sample.
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