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Reiner Koerfer

Publications and source records attributed to Reiner Koerfer.

At least 37 records · Page 2Linked to original sources
PubMed2005

Heart transplantation in a 68-year-old patient with senile systemic amyloidosis.

Senile systemic amyloidosis (SSA) results from deposition, predominantly in the heart, of amyloid fibrils derived from wild-type transthyretin (T TR) molecules. Cardiac autopsies indicate that SSA progressively increases in subjects 80 years of age and older. However, only a few cases of patients with SSA and cardiac failure have been recognized by cardiac biopsies during life. Here, we report a case of heart transplantation in a 68-year-old male patient with SSA. After cardiopulmonary resuscitation in October 1998, he underwent complete evaluation. Myocardial biopsies revealed the presence of amyloid deposition. Immunohistochemical staining of the amyloid indicated T TR. Genomic DNA analysis of the T TR exons did not result in any identification of a mutation. In 2001, heart transplantation was performed because progressive heart failure occurred. At the 1-year follow-up, no amyloid deposits were found in the donor heart. At the 2-year follow-up, the patient's physical and mental health was excellent. We conclude that heart transplantation can be an effective treatment in progressive heart failure due to SSA.

Aged↗
PubMed2004

Operative outcome of simultaneous carotid and valvular surgery.

BACKGROUND: Operative outcome of simultaneous carotid endarterectomy and valvular surgery has not been clarified. We retrospectively reviewed short-term and long-term outcomes after carotid endarterectomy combined with valvular replacement. METHODS: Seventy-nine patients (50 men and 29 women. mean age, 68.9 +/- 6.9 years; range, 53.3 to 78.7 years) underwent carotid endarterectomy combined with valve replacement from February 1985 to April 2002. Indication of carotid endarterectomy was more than 75% carotid stenosis with or without ulceration. Thirteen patients had history of stroke. Endarterectomy was performed under mild hypothermia with cardiopulmonary bypass in all cases. Positions of replaced valves were aortic in 64 patients, mitral in 10, and mitral and aortic in 5 patients. RESULTS: There were 8 early deaths (10.1%). Early neurologic complications occurred in 8 patients (10.1%); two late events were observed. Double valve replacement was an independent risk factor for early death (p = 0.039; odds ratio = 25.6). For early stroke we found no statistically significant risk factor. Myocardial infarction (p = 0.022; odds ratio = 3.0) and age more than 70 years (p = 0.03; odds ratio = 2.5) were independent risk factors for premature death; we found no independent risk factor for late stroke. Permanent impairment or death as a stroke consequence was seen in 5 patients, 3 of them had ipsilateral strokes, 2 had contralateral strokes. CONCLUSIONS: Endarterectomy can be safely performed combined with aortic valve surgery. Concomitant mitral or double valve replacement cannot be judged reliably because of the small number of patients, but they might be a high risk.

Aged↗
PubMed2004

Clinical results with an ePTFE inflow conduit for mechanical circulatory support.

BACKGROUND: Neurologic complication is an adverse event associated with mechanical circulatory support. To decrease the incidence of embolic cerebrovascular accidents (CVA) during support with the Novacor left ventricular assist system (LVAS), an expanded polytetrafluoroethylene (ePTFE) inflow conduit has been developed and introduced clinically. METHODS: Using clinical data from Europe and Canada, we conducted a retrospective analysis of the incidence of embolic CVA with the ePTFE inflow conduit (n=88) in comparison with the previously used polyester inflow conduits (n=310, including Vascutek n=155 and Cooley n=155). We calculated freedom from embolic CVA, risk reduction for embolic CVA, and linearized rates of embolic CVA. RESULTS: A significant decrease in the incidence of embolic CVA was demonstrated with the ePTFE conduit (ePTFE 10% vs polyester 23%, p=0.002). Kaplan-Meier analysis of freedom from embolic CVA at 180 days after implantation was 86% for the ePTFE group vs 72% for the polyester group (log-rank test, 0.0185). We also found an associated risk reduction of 55% in CVA occurrence in the ePTFE group when compared with the Polyester group (hazard ratio, 0.445; 95% confidence limit, 0.222-0.890; p=0.0221). Linearized CVA rates also were decreased at all time intervals after implantation in the ePTFE group. CONCLUSIONS: Preliminary clinical results with the newly introduced ePTFE inflow conduit provide compelling evidence that the ePTFE conduit material significantly decreases thromboembolic complications during mechanical circulatory support with the Novacor LVAS.

Adolescent↗
PubMed2004

Tricuspid valve replacement: clinical long-term results for acquired isolated tricuspid valve regurgitation.

BACKGROUND AND AIM OF THE STUDY: Acquired isolated tricuspid valve insufficiency (TVI) is a rare condition, and tricuspid valve replacement (TVR) is reserved for those patients in whom operative repair is not possible. The long-term follow up of patients who underwent isolated TVR at the authors' institution was analyzed. METHODS: All patients (n = 107) who underwent TVR between January 1985 and December 2002 were identified from a clinical database. Among 87 multiple valve replacements, 20 consecutive patients (12 females, eight males; mean age 52.4 years) were encountered who underwent TVR for acquired isolated TVI. Preoperative and perioperative data were recorded retrospectively. The patients and/or their physicians were contacted directly to determine long-term outcome; the follow up was 100% complete. RESULTS: The mean follow up period was 40.8 months (range: 1-211 months). The cause of TVI was endocarditis (n = 6) or trauma (n = 1); two patients suffered from hypertrophic non-obstructive cardiomyopathy, and one patient had endomyocardial fibrosis. TVI was related to constrictive pericarditis (n = 1) and to prior heart transplantation (n = 3). Seven patients were in NYHA functional classes I/II, and 13 were in classes III/IV. TVR was performed with either a mechanical valve (n = 15) or a bioprosthesis (n = 5). One patient (5%) died perioperatively, and five (25%) died during the follow up period. Two patients underwent a redo-operation during follow up, one due to prosthetic endocarditis, and one after thrombosis of a mechanical prosthesis. There was no structural deterioration of biological prostheses, and no bleeding due to anticoagulation with mechanical prostheses. Among the surviving patients, 13 were in NYHA class I, and one was in class II/III at the time of follow up. CONCLUSION: Isolated TVR for acquired TVI is rarely performed. Among the present patients, perioperative mortality and morbidity were lower than previously reported in the literature. The long-term outcome appeared to be largely dependent on the etiology of the regurgitation.

Adult↗
PubMed2003

Can progression of valvar aortic stenosis be predicted accurately?

BACKGROUND: It was the aim of the present study to elaborate criteria for the assessment of rapid hemodynamic progression of valvar aortic stenosis. These criteria are of special importance when cardiac surgery is indicated for other reasons but the established criteria for aortic valve replacement are not yet fulfilled. Such aspects of therapeutic planing were mostly disregarded in the past so that patients had to undergo cardiac reoperation within a few years. METHODS: Hemodynamic, echocardiographic, and clinical data of 169 men and 88 women with aortic stenosis, aged 55.2 +/- 15.7 years at their first and 63.4 +/- 15.6 years at their second cardiac catheterization, were analyzed. RESULTS: The progression rate of aortic valve obstruction was found to be dependent on the degree of valvar calcification ([VC] scoring 0 to III) and to be exponentially correlated with the aortic valve opening area (AVA) at initial catheterization. Neither age nor sex of the patient nor etiology of the valvar obstruction significantly influence the progression of aortic stenosis. If AVA decreases below 0.75 cm(2) with a present degree of VC = 0, or AVA of 0.8 with VC of I, AVA of 0.9 with VC of II, or AVA of 1.0 with VC of III, it is probable that aortic stenosis will have to be operated upon in the following years. CONCLUSIONS: The present data indicate that for clinical purposes and planning of valvar surgery the progression of asymptomatic aortic stenosis can be sufficiently predicted by the present aortic valve opening area and the degree of valvar calcification.

Adolescent↗
PubMed2003

Does the noise of mechanical heart valve prostheses affect quality of life as measured by the SF-36 questionnaire?

OBJECTIVE: The closure clicks of mechanical heart valve prostheses' leaflets are quite often clearly audible. The study describes the effects of subjective valve sound perception on the patients' quality of life and analyses factors that might contribute to valve noise-related discomfort. METHODS: We included 556 patients who received a mechanical valve prosthesis and participated in the study in our institution from 1994 to 1998. All compiled the standardised questionnaire Short-Form-36 Health Survey (SF-36) and indicated their subjective disturbance grade pre- and postoperatively, then every 6 months up to 2 years. A series of factors was scanned for correlation with unpleasant noise perception. RESULTS: Two years after the operation, only 5.8% classified their valve sounds as 'quite' or 'very much' disturbing. Age <60 years and being female were statistically significant factors for persisting unease caused by valve sounds. Without one of these factors, severe disturbance chance was 1.5%. As expected, quality of life improved after surgery. Patients disturbed seriously by valve noise showed significantly lower mean life quality values on each SF-36 scale. CONCLUSION: Patients (94.2%) with mechanical heart valve replacement have no persistent complaints about the valve noise. The grade of annoyance by valve noise is paralleled by lower average quality of life. Age under 60 years or being female increases the probability of severe disturbance due to mechanical valve sounds. It remains unclear whether the disturbing noise is reason or consequence of lower quality of life.

Adolescent↗
PubMed2003

Successful heart-lung transplantation in a patient with kyphoscoliosis.

The association is well established between congenital heart disease and spinal deformities such as scoliosis or kyphosis, but data are not available for risks and the outcome of heart surgery in patients with spinal deformities. We report a case of successful orthotopic heart lung transplantation in a patient with complex congenital heart disease and severe chest deformity who had undergone previous spinal fusion surgery for progressive right convex thoracic kyphoscoliosis.

Adolescent↗
PubMed2003

Hemodynamic performance of the Medtronic ADVANTAGE prosthetic heart valve in the aortic position: echocardiographic evaluation at one year.

BACKGROUND AND AIM OF THE STUDY: The study aim was to investigate the echocardiographic Doppler-derived hemodynamic results at one-year follow up at a single center for patients receiving the Medtronic ADVANTAGE aortic prosthetic heart valve. This study was part of a multi-center, prospective clinical evaluation of the ADVANTAGE bileaflet mechanical heart valve. METHODS: Echocardiographic data were obtained one year postoperatively from 40 patients who underwent aortic valve replacement between November 1999 and March 2000. Data collected were in accordance with the Food and Drug Administration guidelines for clinical trials. RESULTS: The in-vivo mean pressure gradients for valves implanted in the aortic position ranged from 11.2 mmHg for size 21 valves to 6.1 mmHg for size 29 valves, and the corresponding in-vivo effective orifice area ranged from 1.5 to 3.6 cm2. CONCLUSION: Early results of the study showed hemodynamic performance of the ADVANTAGE aortic valve to be comparable with that of other bileaflet valves in current clinical use.

Adult↗
PubMed2003

Results of staged reconstruction for hypoplasia of the left heart: an experience of 12 years from one institution.

BACKGROUND: We reviewed our 12-year experience with staged reconstruction for hypoplasia of the left heart, examining the results of each surgical step and the impact of the year of the Norwood operation on survival. We compared survival of patients with hypoplasia of the left heart subsequent to completion of the Fontan circulation to survival of patients with a dominant left ventricle undergoing a Fontan procedure. PATIENTS: Between 1989 and 2001, we performed a first stage procedure in 89 patients. Their median age was 9 days, with a range from 2 to 140 days, and the median weight was 3.4 kg, with a range from 2.4 to 5.4 kg. RESULTS: Survival at 1, 4, and 10 years was 55%, 49%, and 49%, respectively. We experienced 23 early deaths (26%), and 12 deaths between the stages of the Norwood cascade. Of our patients, 42 underwent the second stage, and 30 the third stage. Prior to the first stage, symptoms of necrotising enterocolitis, and of obstructed pulmonary venous return, influenced survival significantly. The latter was eliminated as risk factor when surgery was performed within the first week of life. During the later part of our experience, survival at the first stage operation improved significantly, with survival at 3 years increasing from 42% to 75% for the patients at standard-risk (p = 0.017), and from 17% to 42% for those deemed to be at high-risk (p = 0.1). No deaths occurred in 23 patients older than 3 years of age, all of whom had proceeded through the third stage. After completion of the Fontan circulation, the survival of the patients with hypoplasia of the left heart at 4 years was comparable to the survival of patients undergoing the Fontan procedure with a dominant left ventricle (88% versus 90%, p = 0.8). CONCLUSIONS: Early and intermediate survival has improved significantly over the period of 12 years. Late death has been uncommon, and none of our patients are listed for cardiac transplantation.

Cardiac Surgical Procedures↗
PubMed2002

Coronary vein balloon angioplasty for left ventricular pacemaker lead implantation.

OBJECTIVES: Retrospective analysis of five cases of coronary vein balloon angioplasty performed to allow insertion of left ventricular pacing leads. BACKGROUND: Coronary vein stenoses or an insufficient vessel caliber can preclude transvenous placement of coronary vein leads. METHODS: We compared our total patient population (n = 218), in whom we implanted coronary vein leads, to those five patients who required coronary vein angioplasty to allow lead placement. Standard over-the-wire coronary artery balloon angioplasty catheters were used to dilate the vessel to 2.5 mm (n = 3) or 3.5 mm (n = 2). RESULTS: Transvenous lead placement succeeds in >99% of patients. Four cases of target vein stenoses and one case of a vein of insufficient caliber were successfully treated by balloon angioplasty. There were no complications. CONCLUSIONS: Coronary vein angioplasty is an effective and safe technique to permit transvenous left ventricular pacing lead insertion in cases of target vein stenoses or insufficient target vein caliber.

Aged↗
PubMed2002

Bovine valved venous xenografts for RVOT reconstruction: results after 71 implantations.

BACKGROUND: Pediatric right ventricular outflow tract (RVOT) reconstruction with homo- or porcine xenografts is problematic because of limited availability, lack of material for reconstruction, early degeneration, and tissue ingrowth. Contegra, a bovine jugular vein graft, might be an interesting alternative to overcome these problems. PATIENTS AND METHODS: Within a Federal Drug Administration controlled study, we implanted 71 Contegra pulmonary valved conduits from May 1999 to September 2001 in 71 patients (male/female 33/38) in the age range 2 days-17.4 years, median 1.2 years. Twenty five were primary repairs, 22 had previous graft implantations, and 24 had other repairs/palliations. Preoperative diagnoses: truncus arteriosus communis (19 patients), tetralogy of Fallot (32), double outlet right ventricle (13), transposition of the great arteries (5), and two rare complex malformations. The size of implanted Contegra conduits ranged from 12 to 22 mm. Echocardiography was performed at 1 and 3 months, and then every 3 months postoperatively. Follow-up time was 27 months (maximal), 80 years in total. Results were compared with our 52 homograft- and 30 Tissuemed porcine xenograft recipients. RESULTS: Contegra enables the surgeon to perform all anastomoses without additional material. Its tissue is very apt for suturing and its insufficiencies are common, but without clinical significance or tendency to increase. We saw no sign of conduit or valve degeneration during the whole follow-up up to 27 months. There were no device related adverse events. Redos: five for peripheral pulmonary arteries, two residual ventricular septum defect (VSD) closures. There were six deaths (five early, one late). The maximal transvalvular gradients of 25-42 mmHg were measured in seven patients; these gradients did not increase further during the follow-up. Six patients with completely intact Contegra conduits developed pressure gradients of more than 70 mmHg immediately distal from the conduit. At 27 months, Contegra grafts were advantageous compared to homografts with respect to survival and freedom from explantation. Right ventricle to left ventricle (RV/LV) ratio development and freedom from explantation/redo were equal for Contegra conduits and homografts. Porcine Tissuemed xenografts were significantly inferior. CONCLUSION: The Contegra conduit offers unique tailoring and suturing options for primary and redo RVOT reconstruction. At 27 months, its durability seems at least equivalent to homografts and is superior to porcine Tissuemed xenografts.

Adolescent↗
PubMed2002

Experience in heart transplantation after dynamic cardiomyoplasty.

We report a case undergoing heart transplantation due to gradual progression of heart failure four years and one month after dynamic cardiomyoplasty. This case reports a 61-year-old man who received drug therapy after being diagnosed as having idiopathic dilated cardiomyopathy, but his heart failure progressed to New York Heart Association (NYHA) class III-IV, and heart transplantation was thought to be indicated. However, dynamic cardiomyoplasty was performed because this patient rejected heart transplantation. An implantable cardioverter/defibrillator (ICD) was implanted for postoperative ventricular arrhythmia. After that, his symptoms rapidly improved, but his heart failure gradually worsened two years after surgery and heart transplantation was performed four years and one month after dynamic cardiomyoplasty. Since transplantation he has had an uneventful postoperative course without rejection or complications.

Cardiomyoplasty↗
PubMedDate not supplied

Acute fulminant myocarditis in children and adolescents: the role of mechanical circulatory assist.

We report children and adolescents in fulminant myocarditis undergoing prolonged circulatory support with different assist devices. Between 1994 and 2004, seven children and adolescents (aged 7-18 years, mean age 13.5 years) were treated with VADs (5 Thoratec, 1 Medos, 1 Novacor) for circulatory support. Three patients underwent left ventricular support; biventricular support was necessary in four patients. Four patients (three left VADs, one bi-VAD) could be successfully bridged to heart transplantation after a mean support time of 163 days (56-258 days). One 7-year-old girl (Medos-BVAD) died after a support time of 11 days because of irreversible multiorgan failure. One 18-year-old patient was successfully weaned from Thoratec BVAD after 66 days with complete recovery of left ventricular function. As good markers, atrial and brain natriuretic peptides were found which reached normal values after recovery of myocardial function. A 15-year-old girl is still on the device. In children or adolescents with irreversible shock in fulminant myocarditis with an anticipated mortality of 100%, both successful bridging to heart transplantation and successful bridging to recovery are possible. Young patients with fulminant myocarditis should be rapidly transferred to a clinic with a mechanical circulatory support program to offer this life-saving option.

Acute Disease↗