11 research outputs found
The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): first annual reportâ€
The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was founded on 10 December 2009 with the initiative of Roland Hetzer (Deutsches Herzzentrum Berlin, Berlin, Germany) and Jan Gummert (Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany) with 15 other founding international members. It aims to promote scientific research to improve care of end-stage heart failure patients with ventricular assist device or a total artificial heart as long-term mechanical circulatory support. Likewise, the organization aims to provide and maintain a registry of device implantation data and long-term follow-up of patients with mechanical circulatory support. Hence, EUROMACS affiliated itself with Dendrite Clinical Systems Ltd to offer its members a software tool that allows input and analysis of patient clinical data on a daily basis. EUROMACS facilitates further scientific studies by offering research groups access to any available data wherein patients and centres are anonymized. Furthermore, EUROMACS aims to stimulate cooperation with clinical and research institutions and with peer associations involved to further its aims. EUROMACS is the only European-based Registry for Patients with Mechanical Circulatory Support with rapid increase in institutional and individual membership. Because of the expeditious data input, the European Association for Cardiothoracic Surgeons saw the need to optimize the data availability and the significance of the registry to improve care of patients with mechanical circulatory support and its potential contribution to scientific intents; hence, the beginning of their alliance in 2012. This first annual report is designed to provide an overview of EUROMACS' structure, its activities, a first data collection and an insight to its scientific contribution
Chirurgische Techniken und Ergebnisse nach Rekonstruktion von Mitralklappenfehlern bei Säuglingen und Kindern
These cumulative studies described our entire surgical experience with
congenital and acquired mitral valve anomalies in children with biventricular
hearts and concordant connections inclusive of atrioventricular septal
defects. These confirmed the diversity and severity of congenital MV
anomalies, which characteristically involved multiple components of the mitral
valve complex. In our institution, MV reconstruction is the surgical technique
of choice for any kind of mitral disease in childhood. We firmly believe that
repair allows continuous somatic and valve growth, and delays or eliminates
the need for future valve replacement and lifelong anticoagulation, and
obviating the known complications of valve replacement which frequently
requires subsequent reoperation to implant a larger prosthesis. It must be
assumed that the majority of, if not all, valves repaired during childhood,
will eventually have to be replaced at some time in life. The concept of
repair in childhood primarily aimed at growth of the patient to an age when,
if necessary, an adult size prosthesis can be implanted. Strong predictors for
poor overall survival and freedom from reoperation are age less than 3 months,
urgency of surgery, concomitant procedures.Die vorliegenden kumulativen Studien beschreiben unsere gesamte operative
Erfahrung mit angeborenen und erworbenen Mitralklappenfehlern bei Kindern mit
Zweikammer-Herzen und konkordanten Verbindungen mit Ausnahme von
atrioventriculären Septumdefekten. Diese Studien unterstreichen die
Vielfältigkeit und den Schweregrad von angeborenen Mitralklappenfehlern, die
typischerweise mehrere Teile des Mitralklappenapparats befallen. In unserer
Institution ist die Mitralklappenrekonstruktion die chirurgische Technik der
Wahl fĂĽr jede Art von Mitralklappenfehlern im Kindesalter. Wir sind davon
überzeugt, dass die Rekonstruktion das ungestörte Wachstum des gesamten
Körpers und der Klappe erlaubt und dass die Notwendigkeit eines späteren
Klappenersatzes in ein höheres Lebensalter verschoben werden kann. Damit
werden dem Kind die Nachteile einer Ersatzklappe, wie dauernde
Antikoagulation, mögliche erneute Operationen bei zu kleiner Klappe und andere
Probleme erspart. Dabei muss man jedoch annehmen, dass die Mehrzahl, wenn
nicht alle Klappen, die während der Kindheit rekonstruiert wurden, irgendwann
im Leben doch zu einem Klappenersatz fĂĽhren. Damit ist das Konzept der
Rekonstruktion im Kindesalter darauf abgestellt, dass der Patient mit der
Rekonstruktion ein Alter erreichen kann, wenn eine ausreichend groĂźe Prothese
implantiert werden kann, die auch fĂĽr ein Erwachsenenleben reicht. UngĂĽnstige
Prädiktoren für Überleben und Freiheit von Re-Operation sind Alter unter 3
Monaten, Dringlichkeit der Operation und Begleiteingriffe
State of the art in paediatric heart transplantation: the Berlin experience
Summary Enormous progress has been made in paediatric heart transplantation since the first unsuccessful effort by Kantrowitz in 1967. Early reports of children undergoing heart transplantation showed alarmingly high perioperative mortality rates of 25-60%, with the diagnosis of congenital heart disease (CHD) representing a particularly high-risk subset compared with cardiomyopathy. Many of these early failures were related to poor patient selection, suboptimal immunosuppression and technical problems. We learned a great deal from these earlier difficulties. Presently, with more refined techniques, better-defined patient selection criteria, excellent graft rejection monitoring and optimal immunosuppression, the ISHLT 2011 registry reported a 10-year survival rate of 60% for patients transplanted for end-stage CHD and >70% for those transplanted for cardiomyopathy. The technical dilemmas in complex CHD were overcome by surgical ingenuity and creativity, innovative solutions and careful surgical planning, adapting the complex recipient anatomy to the normal donor anatomy. The miniaturized Berlin Heart pulsatile ventricular assist devices in children as a bridge to transplantation have revolutionized treatment and become a significant contribution in heart-failure therapy. The intramyocardial electrogram and echocardiographic strain rate imaging have been employed as non-invasive techniques of rejection monitoring. Immunosuppressive drugs have a major impact on the development and progression of cardiac allograft vasculopathy, the main cause of cardiac allograft loss and a leading cause of mortality after the first year post-transplantation. The questions of whether a transplanted heart in a newborn grows to adult size along with the child and whether the dimensional cardiac growth allows adequate function over time have been largely answered in our previous investigations. As more transplanted children reach adulthood, concerns about their life expectancy when they have reached 10 years of life post-transplant are raised, particularly with respect to establishing partnerships and families, their ability to earn a living and the fulfilment of personal life perspectives. Some heart-transplanted patients require retransplantation to remain alive. The disparity between the demand for and supply of donor hearts makes retransplantation an ethical issue. We 'do not refuse' any patient who needs retransplantation. Mechanical circulatory support devices for long-term use are now largely available to accommodate such cases
Influence of size disparity of transplanted hearts on cardiac growth in infants and children
OBJECTIVE: We aimed to evaluate the influence of size disparity of the transplanted heart on cardiac growth in infant and child recipients by comparing donor body surface area (BSA) and cardiac dimensions during transplantation to the corresponding parameters of the recipient over a period of time.
METHODS: A retrospective review of medical and echocardiographic records of 147 children (5.3 ± 4.0; median, 4.1; range, 1 month-15 years) who underwent orthotopic heart transplantation was done. The patients were divided into age groups as follows: less than 1 year (n = 23), 1 to 2 years (n = 26), more than 2 to 5 years (n = 18), more than 5 to 10 years (n = 27), and more than 10 to 15 years (n = 53). Donor/recipient BSA ratio was determined during transplantation. Cardiac dimensions were measured 30 days after transplantation and compared at 1 year, 2 to 5 years, and 5 to 10 years after transplantation.
RESULTS: There were no significant differences in the ventricular end-diastolic diameter, volumes, and mass among those with a donor/recipient BSA ratio of less than 0.80, 0.8 to 1.2, and more than 1.2 (PÂ =Â .80, .44, and .48, respectively). In all the cardiac dimensions and volumes measured, donor-recipient mismatch did not influence the continuous growth of the heart, as indicated by the measured parameters, in accordance with the recipients' increase in BSA over time. All calculated Z-scores at 1 year, 2 to 5 years, and 6 to 10 years after transplantation were normal when indexed to BSA.
CONCLUSIONS: This study demonstrates that despite size disparity of a transplanted heart, it undergoes normal growth in diastolic dimensions, volumes, and myocardial mass over time as appropriate for body growth after cardiac transplantation in infants and children
Surgical reconstruction techniques for mitral valve insufficiency from lesions with restricted leaflet motion in infants and children
The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): first annual reportâ€
The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was founded on 10 December 2009 with the initiative of Roland Hetzer (Deutsches Herzzentrum Berlin, Berlin, Germany) and Jan Gummert (Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany) with 15 other founding international members. It aims to promote scientific research to improve care of end-stage heart failure patients with ventricular assist device or a total artificial heart as long-term mechanical circulatory support. Likewise, the organization aims to provide and maintain a registry of device implantation data and long-term follow-up of patients with mechanical circulatory support. Hence, EUROMACS affiliated itself with Dendrite Clinical Systems Ltd to offer its members a software tool that allows input and analysis of patient clinical data on a daily basis. EUROMACS facilitates further scientific studies by offering research groups access to any available data wherein patients and centres are anonymized. Furthermore, EUROMACS aims to stimulate cooperation with clinical and research institutions and with peer associations involved to further its aims. EUROMACS is the only European-based Registry for Patients with Mechanical Circulatory Support with rapid increase in institutional and individual membership. Because of the expeditious data input, the European Association for Cardiothoracic Surgeons saw the need to optimize the data availability and the significance of the registry to improve care of patients with mechanical circulatory support and its potential contribution to scientific intents; hence, the beginning of their alliance in 2012. This first annual report is designed to provide an overview of EUROMACS' structure, its activities, a first data collection and an insight to its scientific contributions.status: publishe
The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): first annual report
The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was founded on 10 December 2009 with the initiative of Roland Hetzer (Deutsches Herzzentrum Berlin, Berlin, Germany) and Jan Gummert (Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany) with 15 other founding international members. It aims to promote scientific research to improve care of end-stage heart failure patients with ventricular assist device or a total artificial heart as long-term mechanical circulatory support. Likewise, the organization aims to provide and maintain a registry of device implantation data and long-term follow-up of patients with mechanical circulatory support. Hence, EUROMACS affiliated itself with Dendrite Clinical Systems Ltd to offer its members a software tool that allows input and analysis of patient clinical data on a daily basis. EUROMACS facilitates further scientific studies by offering research groups access to any available data wherein patients and centres are anonymized. Furthermore, EUROMACS aims to stimulate cooperation with clinical and research institutions and with peer associations involved to further its aims. EUROMACS is the only European-based Registry for Patients with Mechanical Circulatory Support with rapid increase in institutional and individual membership. Because of the expeditious data input, the European Association for Cardiothoracic Surgeons saw the need to optimize the data availability and the significance of the registry to improve care of patients with mechanical circulatory support and its potential contribution to scientific intents; hence, the beginning of their alliance in 2012. This first annual report is designed to provide an overview of EUROMACS' structure, its activities, a first data collection and an insight to its scientific contributions