Juergen Kammler

Mid‐term outcome after carotid artery stenting depends on presence of coronary artery disease

BACKGROUND. Longer‐term outcome of patients following carotid artery revascularization depends predominantly on cardiac events rather than neurological events. AIM. To assess the longer‐term outcomes of patients with known coronary artery morphology undergoing carotid artery stenting. METHOD. In a prospective observational study including 549 consecutive patients undergoing carotid artery stenting, a coronary angiography was performed in a single session unless a recent angiogram was available. Following the intervention, patients were followed prospectively to determine neurological events as well as major adverse coronary events (MACE) during long‐term follow‐up. RESULTS. Coronary artery disease was present in 378 patients including 92 patients without current significant stenosis. The MACE rate was 6.4% in patients without coronary artery disease compared to 28.3% in patients with coronary artery disease (P<0.00001). Cardiac and all‐cause mortality were statistically significantly higher in patients with a significant coronary stenosis than in patients without coronary artery disease (P<0.001 and P<0.01). Cardiac mortality and all‐cause mortality were 2.3% and 7.6% in patients without coronary artery disease (patient group I), 7.6% and 13.0% in patients with coronary artery disease but no current significant stenosis (patient group II), and 10.5% and 16.1% in patients with significant coronary stenosis (patient group III). Neurological events, however, were distributed equally among the three patient groups. CONCLUSIONS<1/emph>. In the longer term, outcomes in patients undergoing carotid artery stenting depend on concomitant coronary artery disease rather than neurological events, cardiac mortality and even all‐cause mortality depending on a significant coronary artery stenosis.

Leadless Cardiac Pacemaker Implantation After Lead Extraction in Patients With Severe Device Infection.

Conventional pacemaker therapy is limited by short‐ and long‐term complications, most notably device infection. Transcatheter pacing systems (TPS) may be beneficial in this kind of patients as they eliminate the need for a device pocket and leads and thus may reduce the risk of re‐infection.

Perioperative Use of β-Blockers in Cardiac and Noncardiac Surgery

CLINICAL QUESTION Are β-blockers associated with lower rates of mortality and morbidity after cardiac or noncardiac surgery? BOTTOM LINE In cardiac surgery, β-blockers are associated with a lower incidence of supraventricular tachycardias (SVTs) and ventricular arrhythmias. In noncardiac surgery, β-blockers are associated with a possible increase in mortality and strokes, a lower incidence of acute myocardial infarctions (AMIs) and SVTs, and an increase in bradycardia and hypotension. If tolerated, long-term β-blocker treatment should be continued perioperatively, whereas the decision to start a β-blocker should be individualized, weighing risks and benefits.

Clinical safety of an MRI conditional implantable cardioverter defibrillator system: A prospective Monocenter ICD‐Magnetic resonance Imaging feasibility study (MIMI)

The aim of this study was to evaluate the safety and efficacy of the Lumax 740® Implantable Cardioverter Defibrillator (ICD) system in patients undergoing a defined 1.5 Tesla (T) MRI.

Subcutaneous Double "Purse String Suture"-A Safe Method for Femoral Vein Access Site Closure after Leadless Pacemaker Implantation.

Leadless cardiac pacemaker (LCP) requires large‐caliber venous sheaths for device placement. Sheath sizes for these procedures vary from 18‐ to 23‐French (F). The most common complications are hematomas, pseudoaneurysms, and arteriovenous fistulas. Complete and secure closure of the venous access is an important step at the end of such a procedure.

Extraction of a trapped pacemaker lead in a pacemaker-dependent patient

A 47-year-old female with a dual chamber pacemaker was referred to our institution for transvenous lead removal because of suspected pocket infection. The history of this patient started in 2002 with a tricuspid valve endocarditis. Therefore, the patient had tricuspid valve repair that yielded a poor outcome. The patient received biological tricuspid valve in 2006. Due to postoperative total atrioventricular-block a DDDR device was implanted. The biological valve degenerated and thus was replaced by a mechanical one in 2014. During this valve implantation the atrial lead was removed and the ventricular lead was trapped by the mechanical valve between the native tricuspid valve annulus of the right ventricle and the outer ring of the mechanical valve. Three months after the last revision the patient developed signs of inflammation. The pocket was opened and a swab test proved positive for Staphylococcus epidermidis. After disinfection with iodine solution the pacemaker was placed under the pectoralis muscle. However, during the following 3 months the patient suffered from swelling over the pacemaker pocket and severe pain. In awareness of the previous history and the clinical symptoms we decided to implant a new pacemaker system on the left side and explant the infected system on the right side. <Learning objective: Pocket infections always require system explantation. Simultaneous explantation of an infected system and implantation of a new system within the same session is not recommended but was necessary in this case. Even complex lead extraction like this one can be successfully performed applying the appropriate tools (locking stylet, Evolution device, Cook Intravascular Inc., Leechburg, PA, USA).>.

In‐stent Restenosis in Bare Metal Stents Versus Sirolimus‐eluting Stents After Primary Coronary Intervention for Acute Myocardial Infarction and Subsequent Transcoronary Transplantation of Autologous Stem Cells

Following stenting for acute myocardial infarction, transcoronary transplantation of granulocyte‐colony stimulating factor (G‐CSF) mobilized autologous stem cells (ASC) has been shown to result in an increased in‐stent restenosis rate of bare metal stents (BMS).

Characterization of Von Willebrand Factor Multimer Structure in Patients With Severe Aortic Stenosis

Acquired von Willebrand syndrome (AVWS) associated with severe aortic stenosis (AS) has been frequently subclassified into a subtype 2A based on the deficiency of high-molecular-weight (HMW) multimers as it is seen in inherited von Willebrand disease (VWD) type 2A. However, the multimeric phenotype of VWD type 2A does not only include an HMW deficiency but also a decrease in intermediate-molecular-weight (IMW) multimers and an abnormal inner triplet band pattern. These additional characteristics have not been evaluated in AVWS associated with severe AS. Therefore, we recruited N = 31 consecutive patients with severe AS and performed a high-resolution Western blot with densitometrical band quantification to characterize the von Willebrand factor (VWF) multimeric structure and reevaluate the AVWS subtype classification. Study patients showed an isolated HMW VWF multimer deficiency without additional abnormalities of the IMW portions and the inner triplet structure in 65%. In conclusion, the multimeric pattern of AVWS associated with severe AS does neither resemble that seen in AVWS type 2A nor that seen in inherited VWD type 2A. Therefore, a subclassification into a type 2A should not be used.

Gold-coated pacemaker implantation for a patient with type IV allergy to titanium

A 65-year-old man was scheduled for pacemaker implantation for symptomatic sick-sinus-syndrome (SSS). He suffered from multiple drug-allergies and allergies to several metals like quicksilver and titanium. Gold-coated pacemaker generators and polyurethane leads are effective in avoiding allergic reactions to pacing system components. Therefore, we decided to implant a custom-made gold-coated DDDR-pacemaker generator and polyurethane leads.

Economic assessment of traditional surgical intervention versus use of a new innovative radiofrequency based surgical system in device replacements

Introduction Intra-operative complications like mechanical damages to the leads, infections and hematomas during generator replacements of implantable pacemakers and defibrillators contribute to additional costs for hospitals. The aim of this study was to evaluate operation room use, costs and budget impact of generator replacements using either a traditional surgical intervention (TSI) with scissors, scalpel and electrocautery vs. a new radiofrequency energy based surgical system, called PEAK PlasmaBladeTM (PPB). Materials and methods We conducted a retrospective analysis of a population including 508 patients with TSI and 254 patients with PPB who underwent generator replacement at the Kepler University Hospital in Linz or the St. Josef Hospital in Braunau, Austria. The economic analysis included costs of resources used for intra-operative complications (lead damages) and of procedure time for TSI vs. PPB. Results Proportion of males, mean age and type of generator replaced were similar between the two groups. Lead damages occurred significantly more frequent with TSI than with PPB (5.3% and 0.4%; p< 0.001) and the procedure time was significantly longer with TSI than with PPB (47.9±24.9 and 34.1±18.1 minutes; p<0.001). Shorter procedure time and a lower rate of lead damages with PPB resulted in per patient cost savings of €81. Based on estimated 2,700 patients annually undergoing generator replacement in Austria, the use of PPB may translate into cost savings of €219,600 and 621 saved operating facility hours. Conclusion PPB has the potential to minimize the risk of lead damage with more efficient utilization of the operating room. Along with cost savings and improved quality of care, hospitals may use the saved operating room hours to increase the number of daily surgeries.