Due to increasing life expectancy of patients with heart valve replacement and a limited durabili... more Due to increasing life expectancy of patients with heart valve replacement and a limited durability of heart valve bioprostheses, replacement of aortic valve prosthesis becomes necessary in a significant percentage of patients. However, reliable data on mortality and its risk factors in octogenarians after replacement of aortic bioprostheses are limited. 56 patients aged > or = 80 years who underwent cardiac reoperation of a bioprosthesis due to structural valve deterioration at the authors' heart center between 1991 and 2004 were analyzed retrospectively. To assess predictors of 30-day and 3-year survival, uni- and multivariate Cox regression analyses were performed. 30-day, 1-year, 3-year, and 5-year survival rates were 81.1%, 71.3%, 67.5%, and 50.8%, respectively. Patients with reoperation had an estimated median survival of 5.0 years. Patients who survived their in-hospital stay had a very similar life expectancy compared with the general German population. Postoperative complications such as low cardiac output syndrome and intestinal failure were the only independent predictors of 30-day and 3-year survival (p < 0.001). Postoperative New York Heart Association functional class improved markedly in the study cohort and the majority of survivors was able to live at home. As we cannot offer these patients an alternative effective medical therapy, octogenarians who need their aortic valve prosthesis to be replaced are left in a miserable condition with a poor prognosis, if surgery is denied. Therefore, considering that almost the same criteria are used for younger patients with the emphasis that surgery should not be delayed until they are highly symptomatic, reoperation of the aortic valve in this age group is justified. The data demonstrate that it is possible to achieve an acceptable outcome in octogenarians who are in need of a replacement of their aortic valve prosthesis. Early as well as mid-term survival are predominantly influenced by unexpected postoperative complications.
Despite enormous progress concerning material and design, patients with artificial heart valves s... more Despite enormous progress concerning material and design, patients with artificial heart valves still face a considerable risk of serious complications (e. g. hemorrhage, thromboemboli, redos) which sum up to 5-20% within the first 10 postoperative years depending on type and position of the implanted prosthetic valve. Nowadays technical defects of mechanical valves are negligible and relevant complications are most frequently the consequence of inappropriate oral anticoagulation therapy. To avoid these complications a strict control of both the anticoagulation therapy and the functional integrity of the prosthetic valve is mandatory. Therefore with the aim of risk minimization the patient should be enabled to cooperate by means of methods which are easy to handle in his everyday environment. We present a reliable method for early detection of prosthetic valve dysfunction which can be applied daily with minimal effort by the patient himself.
ABSTRACT Hintergrund:Aufgrund der gestiegenen Lebenserwartung von Patienten mit Herzklappenersatz... more ABSTRACT Hintergrund:Aufgrund der gestiegenen Lebenserwartung von Patienten mit Herzklappenersatz sowie einer begrenzten Haltbarkeit biologischer Klappenprothesen wird bei einem signifikanten Prozentsatz der Patienten eine Reoperation im Alter von ≥80 Jahren notwendig. Es liegen jedoch nur wenige Daten zur Letalität nach Ersatz einer biologischen Prothese vor. Patienten und Methodik:Deshalb wurde bei 56 Patienten im Alter von ≥80 Jahren, die im Zeitraum von 1991 bis 2004 aufgrund einer Klappendegeneration am Zentrum der Autoren reoperiert wurden, eine retrospektive Datenanalyse vorgenommen. Mittels uniund multivariater Cox-Regressionsanalysen wurden Einflussfaktoren auf die Überlebensrate untersucht. Ergebnisse:Die mittlere Überlebensdauer der Patienten betrug 5 Jahre. Die 30-Tage-, 1-Jahres-, 3-Jahres- und 5-Jahres-Überlebensraten lagen bei 81,1%, 71,3%, 67,5% und 50,8%. Lediglich das Low-Output-Syndrom und Darmischämien erwiesen sich als unabhängige Prädiktoren sowohl der 30-Tage-Letalität als auch der 3-Jahres-Mortalität. Postoperativ kam es zu einer deutlichen Verbesserung des NYHA-Stadiums, und die Mehrzahl der Überlebenden war in der Lage, eigenständig zu Hause zu leben. Schlussfolgerung:Die Daten zeigen, dass es möglich ist, akzeptable Ergebnisse bei ≥80-Jährigen nach Ersatz der Klappenprothese zu erzielen. Sowohl die frühe als auch die mittlere Mortalitätsrate sind vorwiegend von unerwarteten postoperativen Komplikationen beeinflusst. Somit ist eine Reoperation der Aortenklappe selbst bei Patienten dieser Altersgruppe vertretbar. Background:Due to increasing life expectancy of patients with heart valve replacement and a limited durability of heart valve bioprostheses, replacement of aortic valve prosthesis becomes necessary in a significant percentage of patients. However, reliable data on mortality and its risk factors in octogenarians after replacement of aortic bioprostheses are limited. Patients and Methods:56 patients aged ≥ 80 years who underwent cardiac reoperation of a bioprosthesis due to structural valve deterioration at the authors’ heart center between 1991 and 2004 were analyzed retrospectively. To assess predictors of 30-day and 3-year survival, uni- and multivariate Cox regression analyses were performed. Results:30-day, 1-year, 3-year, and 5-year survival rates were 81.1%, 71.3%, 67.5%, and 50.8%, respectively. Patients with reoperation had an estimated median survival of 5.0 years. Patients who survived their in-hospital stay had a very similar life expectancy compared with the general German population. Postoperative complications such as low cardiac output syndrome and intestinal failure were the only independent predictors of 30-day and 3-year survival (p < 0.001). Postoperative New York Heart Association functional class improved markedly in the study cohort and the majority of survivors was able to live at home. As we cannot offer these patients an alternative effective medical therapy, octogenarians who need their aortic valve prosthesis to be replaced are left in a miserable condition with a poor prognosis, if surgery is denied. Therefore, considering that almost the same criteria are used for younger patients with the emphasis that surgery should not be delayed until they are highly symptomatic, reoperation of the aortic valve in this age group is justified. Conclusion:The data demonstrate that it is possible to achieve an acceptable outcome in octogenarians who are in need of a replacement of their aortic valve prosthesis. Early as well as mid-term survival are predominantly influenced by unexpected postoperative complications.
Despite enormous progress concerning material and design, patients with artificial heart valves s... more Despite enormous progress concerning material and design, patients with artificial heart valves still face a considerable risk of serious complications (e.g., hemorrhage, thromboemboli, redos) which sum up to 4.9-22.4% for the first 10 postoperative years depending on type and position of the implanted prosthetic valve. Nowadays, technical defects of mechanical valves are negligible and relevant complications are rather a consequence of long-term anticoagulation therapy. To avoid these complications, the authors consider a strict control of both the anticoagulation therapy and the functional integrity of the prosthetic valve to be inevitable. Therefore, with the aim of risk minimization the patient should be enabled to cooperate by means of methods which are easy to handle in his everyday environment. First multicentric results of a new method of early detection of valve dysfunction are presented.
Background and aim of the study: Depending on the individual risk profile of a patient, disturban... more Background and aim of the study: Depending on the individual risk profile of a patient, disturbances of the functional integrity of mechanical heart valve prostheses occur in up to 2.5% of patients each year. The early phase of prosthetic dysfunction (due to thrombus formation, tissue ingrowth or endocardi- tis) usually remains undiagnosed, as patients do not present with symptoms in
Transcatheter aortic valve implantation (TAVI) is used as an alternative to conventional surgery ... more Transcatheter aortic valve implantation (TAVI) is used as an alternative to conventional surgery in high-risk patients. The EuroSCORE quantifies the risk, and patients are selected for this procedure if their predicted mortality is high. The study aim was to evaluate the risk discrimination and calibration of the EuroSCORE, as well as the surgical judgment that is used when selecting the aortic valve replacement (AVR) approach. Between 2003 and 2006, a total of 2757 patients underwent isolated, open AVR. The EuroSCORE was compared to the observed in-hospital mortality. A survey among surgeons assessed the relevance of patient-specific factors towards the approach of TAVI versus open AVR. Survivors of AVR had a lower additive EuroSCORE than non-survivors (7.2 +/- 3.34 versus 12.0 +/- 3.34; p < 0.001). The EuroSCORE demonstrated reasonable risk stratification (c-statistic 0.843, p < 0.001). However, none of the 67 non-survivors was correctly predicted (Hosmer-Lemeshow test; p &l...
Prosthetic heart valve dysfunction impacts on morbidity and quality of life. Although the diagnos... more Prosthetic heart valve dysfunction impacts on morbidity and quality of life. Although the diagnosis can be made by imaging studies, clinical symptoms commonly precede the diagnostic work-up. The ThromboCheck device analyzes the sound frequency spectra of valve motion, and alterations due to valve dysfunction are observed before overt clinical symptoms develop. The study aim was to determine if the ThromboCheck can be used to monitor the prosthetic valve function of patients at home. Between 2003 and 2007, a total of 541 prosthetic heart valve recipients was prospectively enrolled into a double-blind, multi-center study. ThromboCheck devices were used to evaluate the sound frequency phenomena of valve motion. If the sound frequency spectra deviated from baseline, alarm signals were returned to the medical center via telephone, and these prompted evaluation by fluoroscopy and echocardiography. The clinical follow up included questionnaires at regular intervals. The cumulative observat...
Due to increasing life expectancy of patients with heart valve replacement and a limited durabili... more Due to increasing life expectancy of patients with heart valve replacement and a limited durability of heart valve bioprostheses, replacement of aortic valve prosthesis becomes necessary in a significant percentage of patients. However, reliable data on mortality and its risk factors in octogenarians after replacement of aortic bioprostheses are limited. 56 patients aged > or = 80 years who underwent cardiac reoperation of a bioprosthesis due to structural valve deterioration at the authors' heart center between 1991 and 2004 were analyzed retrospectively. To assess predictors of 30-day and 3-year survival, uni- and multivariate Cox regression analyses were performed. 30-day, 1-year, 3-year, and 5-year survival rates were 81.1%, 71.3%, 67.5%, and 50.8%, respectively. Patients with reoperation had an estimated median survival of 5.0 years. Patients who survived their in-hospital stay had a very similar life expectancy compared with the general German population. Postoperative ...
Depending on the individual risk profile of a patient, disturbances of the functional integrity o... more Depending on the individual risk profile of a patient, disturbances of the functional integrity of mechanical heart valve prostheses occur in up to 2.5% of patients each year. The early phase of prosthetic dysfunction (due to thrombus formation, tissue ingrowth or endocarditis) usually remains undiagnosed, as patients do not present with symptoms in this situation, and imaging techniques (echocardiography, fluoroscopy) demonstrate normal occluder motion. The delay between the onset of prosthetic valve dysfunction and its clinical manifestation may result in complications (e.g. thromboembolism) or extended therapeutic options (e.g. reoperation rather than more intensive anticoagulation). A total of 291 patients with mechanical heart valves was allocated to four different sub-groups, and each measured their valve sounds regularly with the 'ThromboCheck' device. Depending on the subgroup, the signals were compared with different reference signals. Patients in whom a suspicious ...
The study aim was to investigate whether: (i) by detection of changing acoustic sound phenomena, ... more The study aim was to investigate whether: (i) by detection of changing acoustic sound phenomena, minimal changes in prosthetic valve function may be detected earlier than with echocardiography, invasive diagnosis or clinically; (ii) patients can record and pass on signals with a high level of reproducibility from any location via the Internet; and (iii) clinical data evaluation permits conclusions to be drawn on changes in the functional state of a prosthetic replacement valve. Simulation studies were carried out using a mock circulation device. Aortic valve replacement (AVR) using extracorporeal circulation was performed in pigs, valve function was artificially disturbed, and valve sounds were recorded. Patients were equipped with briefcase-like devices to record their valve sounds after AVR and to transfer them via the Internet. Simulation studies produced a typical sound spectrum for each tested valve that remained constant under variable conditions. Experiments in animals proved...
Optimal management of patients with coronary artery disease and concomitant aortic valve stenosis... more Optimal management of patients with coronary artery disease and concomitant aortic valve stenosis remains a subject of controversy. In this retrospective study, an attempt was made to identify criteria indicating rapid progression of aortic valve stenosis in patients with coronary artery disease. Between 1990 and 1999, 47 patients underwent aortic valve replacement (AVR) after previous coronary artery bypass grafting (CABG) at the authors' institution. The postoperative data, including cardiac catheterization films, were reviewed. Aortic valve disease, mainly aortic stenosis, showed a rapid rate of progression. During a mean interval between CABG and AVR of 5.9 +/- 2.9 years, the mean peak-to-peak pressure gradient across the aortic valve rose from 16.1 +/- 13.8 to 61.4 +/- 23.9 mmHg in patients where presence of calcification and impaired aortic valve motion was found (66.0% of patients had calcified aortic valves; 72.3% had impaired valve motion) at the time of CABG; whereas i...
We reviewed the reports of 27 patients who had an aortic valve replacement after previous coronar... more We reviewed the reports of 27 patients who had an aortic valve replacement after previous coronary artery bypass grafting. The aortic valve disease -- mainly aortic stenosis -- showed a rapid rate of progression. In the time interval between coronary artery bypass grafting and aortic valve replacement of 4.6+/-2.2 years the peak-to-peak pressure gradient of the aortic valve rose from 20.2+/-14.3 to 63.0+/-22.7 mmHg. As there is a great interest to identify the patients with a high risk of a rapid progression because of a high mortality of an aortic valve replacement as the second cardiac operation following a coronary artery bypass grafting we also reviewed the cardiac catheterisation films and found a high incidence of calcification and impaired aortic valve motion (81.5% of the patients had already calcified aortic valves and 81.5% had a impaired valve motion) at the time of coronary artery bypass grafting. We concluded that if a patient has to be operated for coronary artery disease an aortic valve replacement should be considered not only according to hemodynamic criteria but also when the aortic valve is calcified or its leaflets&#39; motion is impaired.
Due to increasing life expectancy of patients with heart valve replacement and a limited durabili... more Due to increasing life expectancy of patients with heart valve replacement and a limited durability of heart valve bioprostheses, replacement of aortic valve prosthesis becomes necessary in a significant percentage of patients. However, reliable data on mortality and its risk factors in octogenarians after replacement of aortic bioprostheses are limited. 56 patients aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 80 years who underwent cardiac reoperation of a bioprosthesis due to structural valve deterioration at the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; heart center between 1991 and 2004 were analyzed retrospectively. To assess predictors of 30-day and 3-year survival, uni- and multivariate Cox regression analyses were performed. 30-day, 1-year, 3-year, and 5-year survival rates were 81.1%, 71.3%, 67.5%, and 50.8%, respectively. Patients with reoperation had an estimated median survival of 5.0 years. Patients who survived their in-hospital stay had a very similar life expectancy compared with the general German population. Postoperative complications such as low cardiac output syndrome and intestinal failure were the only independent predictors of 30-day and 3-year survival (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Postoperative New York Heart Association functional class improved markedly in the study cohort and the majority of survivors was able to live at home. As we cannot offer these patients an alternative effective medical therapy, octogenarians who need their aortic valve prosthesis to be replaced are left in a miserable condition with a poor prognosis, if surgery is denied. Therefore, considering that almost the same criteria are used for younger patients with the emphasis that surgery should not be delayed until they are highly symptomatic, reoperation of the aortic valve in this age group is justified. The data demonstrate that it is possible to achieve an acceptable outcome in octogenarians who are in need of a replacement of their aortic valve prosthesis. Early as well as mid-term survival are predominantly influenced by unexpected postoperative complications.
Despite enormous progress concerning material and design, patients with artificial heart valves s... more Despite enormous progress concerning material and design, patients with artificial heart valves still face a considerable risk of serious complications (e. g. hemorrhage, thromboemboli, redos) which sum up to 5-20% within the first 10 postoperative years depending on type and position of the implanted prosthetic valve. Nowadays technical defects of mechanical valves are negligible and relevant complications are most frequently the consequence of inappropriate oral anticoagulation therapy. To avoid these complications a strict control of both the anticoagulation therapy and the functional integrity of the prosthetic valve is mandatory. Therefore with the aim of risk minimization the patient should be enabled to cooperate by means of methods which are easy to handle in his everyday environment. We present a reliable method for early detection of prosthetic valve dysfunction which can be applied daily with minimal effort by the patient himself.
ABSTRACT Hintergrund:Aufgrund der gestiegenen Lebenserwartung von Patienten mit Herzklappenersatz... more ABSTRACT Hintergrund:Aufgrund der gestiegenen Lebenserwartung von Patienten mit Herzklappenersatz sowie einer begrenzten Haltbarkeit biologischer Klappenprothesen wird bei einem signifikanten Prozentsatz der Patienten eine Reoperation im Alter von ≥80 Jahren notwendig. Es liegen jedoch nur wenige Daten zur Letalität nach Ersatz einer biologischen Prothese vor. Patienten und Methodik:Deshalb wurde bei 56 Patienten im Alter von ≥80 Jahren, die im Zeitraum von 1991 bis 2004 aufgrund einer Klappendegeneration am Zentrum der Autoren reoperiert wurden, eine retrospektive Datenanalyse vorgenommen. Mittels uniund multivariater Cox-Regressionsanalysen wurden Einflussfaktoren auf die Überlebensrate untersucht. Ergebnisse:Die mittlere Überlebensdauer der Patienten betrug 5 Jahre. Die 30-Tage-, 1-Jahres-, 3-Jahres- und 5-Jahres-Überlebensraten lagen bei 81,1%, 71,3%, 67,5% und 50,8%. Lediglich das Low-Output-Syndrom und Darmischämien erwiesen sich als unabhängige Prädiktoren sowohl der 30-Tage-Letalität als auch der 3-Jahres-Mortalität. Postoperativ kam es zu einer deutlichen Verbesserung des NYHA-Stadiums, und die Mehrzahl der Überlebenden war in der Lage, eigenständig zu Hause zu leben. Schlussfolgerung:Die Daten zeigen, dass es möglich ist, akzeptable Ergebnisse bei ≥80-Jährigen nach Ersatz der Klappenprothese zu erzielen. Sowohl die frühe als auch die mittlere Mortalitätsrate sind vorwiegend von unerwarteten postoperativen Komplikationen beeinflusst. Somit ist eine Reoperation der Aortenklappe selbst bei Patienten dieser Altersgruppe vertretbar. Background:Due to increasing life expectancy of patients with heart valve replacement and a limited durability of heart valve bioprostheses, replacement of aortic valve prosthesis becomes necessary in a significant percentage of patients. However, reliable data on mortality and its risk factors in octogenarians after replacement of aortic bioprostheses are limited. Patients and Methods:56 patients aged ≥ 80 years who underwent cardiac reoperation of a bioprosthesis due to structural valve deterioration at the authors’ heart center between 1991 and 2004 were analyzed retrospectively. To assess predictors of 30-day and 3-year survival, uni- and multivariate Cox regression analyses were performed. Results:30-day, 1-year, 3-year, and 5-year survival rates were 81.1%, 71.3%, 67.5%, and 50.8%, respectively. Patients with reoperation had an estimated median survival of 5.0 years. Patients who survived their in-hospital stay had a very similar life expectancy compared with the general German population. Postoperative complications such as low cardiac output syndrome and intestinal failure were the only independent predictors of 30-day and 3-year survival (p &lt; 0.001). Postoperative New York Heart Association functional class improved markedly in the study cohort and the majority of survivors was able to live at home. As we cannot offer these patients an alternative effective medical therapy, octogenarians who need their aortic valve prosthesis to be replaced are left in a miserable condition with a poor prognosis, if surgery is denied. Therefore, considering that almost the same criteria are used for younger patients with the emphasis that surgery should not be delayed until they are highly symptomatic, reoperation of the aortic valve in this age group is justified. Conclusion:The data demonstrate that it is possible to achieve an acceptable outcome in octogenarians who are in need of a replacement of their aortic valve prosthesis. Early as well as mid-term survival are predominantly influenced by unexpected postoperative complications.
Despite enormous progress concerning material and design, patients with artificial heart valves s... more Despite enormous progress concerning material and design, patients with artificial heart valves still face a considerable risk of serious complications (e.g., hemorrhage, thromboemboli, redos) which sum up to 4.9-22.4% for the first 10 postoperative years depending on type and position of the implanted prosthetic valve. Nowadays, technical defects of mechanical valves are negligible and relevant complications are rather a consequence of long-term anticoagulation therapy. To avoid these complications, the authors consider a strict control of both the anticoagulation therapy and the functional integrity of the prosthetic valve to be inevitable. Therefore, with the aim of risk minimization the patient should be enabled to cooperate by means of methods which are easy to handle in his everyday environment. First multicentric results of a new method of early detection of valve dysfunction are presented.
Background and aim of the study: Depending on the individual risk profile of a patient, disturban... more Background and aim of the study: Depending on the individual risk profile of a patient, disturbances of the functional integrity of mechanical heart valve prostheses occur in up to 2.5% of patients each year. The early phase of prosthetic dysfunction (due to thrombus formation, tissue ingrowth or endocardi- tis) usually remains undiagnosed, as patients do not present with symptoms in
Transcatheter aortic valve implantation (TAVI) is used as an alternative to conventional surgery ... more Transcatheter aortic valve implantation (TAVI) is used as an alternative to conventional surgery in high-risk patients. The EuroSCORE quantifies the risk, and patients are selected for this procedure if their predicted mortality is high. The study aim was to evaluate the risk discrimination and calibration of the EuroSCORE, as well as the surgical judgment that is used when selecting the aortic valve replacement (AVR) approach. Between 2003 and 2006, a total of 2757 patients underwent isolated, open AVR. The EuroSCORE was compared to the observed in-hospital mortality. A survey among surgeons assessed the relevance of patient-specific factors towards the approach of TAVI versus open AVR. Survivors of AVR had a lower additive EuroSCORE than non-survivors (7.2 +/- 3.34 versus 12.0 +/- 3.34; p < 0.001). The EuroSCORE demonstrated reasonable risk stratification (c-statistic 0.843, p < 0.001). However, none of the 67 non-survivors was correctly predicted (Hosmer-Lemeshow test; p &l...
Prosthetic heart valve dysfunction impacts on morbidity and quality of life. Although the diagnos... more Prosthetic heart valve dysfunction impacts on morbidity and quality of life. Although the diagnosis can be made by imaging studies, clinical symptoms commonly precede the diagnostic work-up. The ThromboCheck device analyzes the sound frequency spectra of valve motion, and alterations due to valve dysfunction are observed before overt clinical symptoms develop. The study aim was to determine if the ThromboCheck can be used to monitor the prosthetic valve function of patients at home. Between 2003 and 2007, a total of 541 prosthetic heart valve recipients was prospectively enrolled into a double-blind, multi-center study. ThromboCheck devices were used to evaluate the sound frequency phenomena of valve motion. If the sound frequency spectra deviated from baseline, alarm signals were returned to the medical center via telephone, and these prompted evaluation by fluoroscopy and echocardiography. The clinical follow up included questionnaires at regular intervals. The cumulative observat...
Due to increasing life expectancy of patients with heart valve replacement and a limited durabili... more Due to increasing life expectancy of patients with heart valve replacement and a limited durability of heart valve bioprostheses, replacement of aortic valve prosthesis becomes necessary in a significant percentage of patients. However, reliable data on mortality and its risk factors in octogenarians after replacement of aortic bioprostheses are limited. 56 patients aged > or = 80 years who underwent cardiac reoperation of a bioprosthesis due to structural valve deterioration at the authors' heart center between 1991 and 2004 were analyzed retrospectively. To assess predictors of 30-day and 3-year survival, uni- and multivariate Cox regression analyses were performed. 30-day, 1-year, 3-year, and 5-year survival rates were 81.1%, 71.3%, 67.5%, and 50.8%, respectively. Patients with reoperation had an estimated median survival of 5.0 years. Patients who survived their in-hospital stay had a very similar life expectancy compared with the general German population. Postoperative ...
Depending on the individual risk profile of a patient, disturbances of the functional integrity o... more Depending on the individual risk profile of a patient, disturbances of the functional integrity of mechanical heart valve prostheses occur in up to 2.5% of patients each year. The early phase of prosthetic dysfunction (due to thrombus formation, tissue ingrowth or endocarditis) usually remains undiagnosed, as patients do not present with symptoms in this situation, and imaging techniques (echocardiography, fluoroscopy) demonstrate normal occluder motion. The delay between the onset of prosthetic valve dysfunction and its clinical manifestation may result in complications (e.g. thromboembolism) or extended therapeutic options (e.g. reoperation rather than more intensive anticoagulation). A total of 291 patients with mechanical heart valves was allocated to four different sub-groups, and each measured their valve sounds regularly with the 'ThromboCheck' device. Depending on the subgroup, the signals were compared with different reference signals. Patients in whom a suspicious ...
The study aim was to investigate whether: (i) by detection of changing acoustic sound phenomena, ... more The study aim was to investigate whether: (i) by detection of changing acoustic sound phenomena, minimal changes in prosthetic valve function may be detected earlier than with echocardiography, invasive diagnosis or clinically; (ii) patients can record and pass on signals with a high level of reproducibility from any location via the Internet; and (iii) clinical data evaluation permits conclusions to be drawn on changes in the functional state of a prosthetic replacement valve. Simulation studies were carried out using a mock circulation device. Aortic valve replacement (AVR) using extracorporeal circulation was performed in pigs, valve function was artificially disturbed, and valve sounds were recorded. Patients were equipped with briefcase-like devices to record their valve sounds after AVR and to transfer them via the Internet. Simulation studies produced a typical sound spectrum for each tested valve that remained constant under variable conditions. Experiments in animals proved...
Optimal management of patients with coronary artery disease and concomitant aortic valve stenosis... more Optimal management of patients with coronary artery disease and concomitant aortic valve stenosis remains a subject of controversy. In this retrospective study, an attempt was made to identify criteria indicating rapid progression of aortic valve stenosis in patients with coronary artery disease. Between 1990 and 1999, 47 patients underwent aortic valve replacement (AVR) after previous coronary artery bypass grafting (CABG) at the authors' institution. The postoperative data, including cardiac catheterization films, were reviewed. Aortic valve disease, mainly aortic stenosis, showed a rapid rate of progression. During a mean interval between CABG and AVR of 5.9 +/- 2.9 years, the mean peak-to-peak pressure gradient across the aortic valve rose from 16.1 +/- 13.8 to 61.4 +/- 23.9 mmHg in patients where presence of calcification and impaired aortic valve motion was found (66.0% of patients had calcified aortic valves; 72.3% had impaired valve motion) at the time of CABG; whereas i...
We reviewed the reports of 27 patients who had an aortic valve replacement after previous coronar... more We reviewed the reports of 27 patients who had an aortic valve replacement after previous coronary artery bypass grafting. The aortic valve disease -- mainly aortic stenosis -- showed a rapid rate of progression. In the time interval between coronary artery bypass grafting and aortic valve replacement of 4.6+/-2.2 years the peak-to-peak pressure gradient of the aortic valve rose from 20.2+/-14.3 to 63.0+/-22.7 mmHg. As there is a great interest to identify the patients with a high risk of a rapid progression because of a high mortality of an aortic valve replacement as the second cardiac operation following a coronary artery bypass grafting we also reviewed the cardiac catheterisation films and found a high incidence of calcification and impaired aortic valve motion (81.5% of the patients had already calcified aortic valves and 81.5% had a impaired valve motion) at the time of coronary artery bypass grafting. We concluded that if a patient has to be operated for coronary artery disease an aortic valve replacement should be considered not only according to hemodynamic criteria but also when the aortic valve is calcified or its leaflets&#39; motion is impaired.
Uploads
Papers by Thomas Eitz