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Dive into the research topics where Shahram Lotfi is active.

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Featured researches published by Shahram Lotfi.


Jacc-cardiovascular Interventions | 2012

Impact of a New Conduction Defect After Transcatheter Aortic Valve Implantation on Left Ventricular Function

Rainer Hoffmann; Ralf Herpertz; Sara Lotfipour; Ömer Aktug; Kathrin Brehmer; Walter Lehmacher; Rüdiger Autschbach; Nikolaus Marx; Shahram Lotfi

OBJECTIVES This study sought to evaluate the impact of new conduction defects after transcatheter aortic valve implantation (TAVI) on the evolution of left ventricular (LV) function during 1-year follow-up. BACKGROUND New left bundle branch block (LBBB) or need for permanent pacing due to atrioventricular (AV) block are frequent after TAVI. METHODS A total of 90 consecutive patients treated with TAVI and who had 12-month echocardiographic follow-up were included in the study. In 39 patients, a new conduction defect (new LBBB or need for permanent pacemaker activity.) persisted 1 month after TAVI. In 51 patients, no persistent new conduction defect was observed. Two-dimensional echocardiography using parasternal short-axis, apical 4-chamber, and apical 2-chamber views was performed before TAVI and at 1-year follow-up to determine LV volumes and ejection fraction based on Simpsons rule. Speckle-tracking echocardiography was applied using standard LV short-axis images to assess the effect of new conduction defects on time-to-peak radial strain of different LV segments as a parameter of LV dyssynchrony. RESULTS New conduction defects resulted in marked heterogeneity in time-to-peak strain between the 6 analyzed short-axis segments. During 1-year follow-up after TAVI, there was a significant increase in left ventricular ejection fraction (LVEF) in patients without new LBBB (53 ± 11% pre TAVI to 59 ± 10% at follow-up; p < 0.001), whereas there was no change in LVEF in patients with a new conduction defect (52 ± 11% pre TAVI to 51 ± 12% at follow-up, p = 0.740). Change in LV end-systolic volume was also significantly different between patient groups (-1.0 ± 14.2 vs. -11.2 ± 15.7 ml, p = 0.042). New conduction defect and LVEF at baseline were independent predictors of reduced LVEF at 12-month follow-up after TAVI. CONCLUSIONS LVEF improves after TAVI for treatment of severe aortic stenosis in patients without new conduction defects. In patients with a new conduction defect after TAVI, there is no improvement in LVEF at follow-up.


European Journal of Echocardiography | 2014

Regional left ventricular function after transapical vs. transfemoral transcatheter aortic valve implantation analysed by cardiac magnetic resonance feature tracking

Christian Meyer; Michael Frick; Shahram Lotfi; Ertunc Altiok; Ralf Koos; Annemarie Kirschfink; Michael Lehrke; Rüdiger Autschbach; Rainer Hoffmann

AIMS This study analysed the impact of transapical (TA) vs. transfemoral (TF) access site transcatheter aortic valve implantation (TAVI) on post-procedural regional left ventricular (LV) function using cardiac magnetic resonance (CMR) feature tracking (FT). METHODS AND RESULTS CMR was performed 3 months after TAVI on 44 consecutive patients with normal LV ejection fraction prior to TAVI. Twenty patients had TA-TAVI, and 24 had TF-TAVI. Standard cine imaging was performed in three standard cardiac long-axis views (two-, four- and three-chamber views). Myocardial peak systolic radial strain (PSRS) and peak systolic longitudinal strain (PSLS) were analysed based on CMR-FT considering 49 segments in each of the three views. There were no differences in PSRS and PSLS for the basal and mid-ventricular segments between TA- and TF-TAVI groups. In contrast, PSRS and PSLS of apical segments and apical cap were reduced in the TA- compared with the TF-TAVI group (PSRS: 15.7 ± 6.4 vs. 35.9 ± 15.7%, respectively, P < 0.001; PSLS: -8.9 ± 5.3 vs. -16.9 ± 4.3%, respectively, P < 0.001). Comparison of all non-apical segments vs. apical segments and apical cap demonstrated no difference in the TF group (PSRS: 34.6 ± 9.0 vs. 35.9 ± 15.7%; respectively, P = 0.702; PSLS: -17.8 ± 4.6 vs. -16.9 ± 4.3%; respectively, P = 0.802). After TA-TAVI, PSRS and PSLS of the apical segments were reduced compared with the non-apical segments (PSRS: 15.7 ± 6.4 vs. 33.5 ± 7.0%, respectively, P < 0.001; PSLS: -8.9 ± 5.3 vs. -15.5 ± 3.5%, respectively, P < 0.001). CONCLUSION Apical LV function abnormalities can be detected at 3-month follow-up in all TA-TAVI patients using CMR-FT. TA-TAVI results in significant impairment of apical LV function compared with TF-TAVI.


Eurointervention | 2016

Evaluation of aortic regurgitation after transcatheter aortic valve implantation: aortic root angiography in comparison to cardiac magnetic resonance.

Michael Frick; Christian Meyer; Annemarie Kirschfink; Ertunc Altiok; Michael Lehrke; Kathrin Brehmer; Shahram Lotfi; Rainer Hoffmann

AIMS Aortic regurgitation (AR) is common after transcatheter aortic valve implantation (TAVI). Intraprocedural assessment of AR relies on aortic root angiography. Cardiac magnetic resonance (CMR) phase-contrast mapping of the ascending aorta provides accurate AR quantification. This study evaluated the accuracy of AR grading by aortic root angiography after TAVI in comparison to CMR phase-contrast velocity mapping. METHODS AND RESULTS In 69 patients with TAVI for severe aortic stenosis, post-procedural AR was determined by aortic root angiography with visual assessment according to the Sellers classification and by CMR using phase-contrast velocity mapping for analysis of AR volume and fraction. Spearmans correlation coefficient showed a moderate correlation between angiographic analysis of AR grade and CMR-derived AR volume (r=0.41; p<0.01) as well as AR fraction (r=0.42; p<0.01). There was significant overlap between the angiographic Sellers classes compared to CMR-derived AR fractions. Aortic root angiography with cut-off Sellers grade ≥2 had a sensitivity of 71% and a specificity of 98% to detect AR graded as moderate to severe or severe as defined by CMR. CONCLUSIONS There is only a moderate correlation between aortic root angiography and CMR in the classification of AR severity after TAVI. Alternative imaging including multimodality imaging as well as haemodynamic analysis should therefore be considered for intraprocedural AR assessment and guidance of TAVI procedure in cases of uncertainty in AR grading.


Catheterization and Cardiovascular Interventions | 2013

Transcatheter aortic valve-in-valve implantation of a corevalve in a degenerated stenotic sapien heart valve prosthesis

Rainer Hoffmann; Helge Möllmann; Shahram Lotfi

Treatment options for re‐stenotic aortic valve prosthesis implanted by transcatheter technique have not been evaluated systematically. We describe the case of a 75‐year‐old dialysis patient who was treated by transcatheter aortic valve implantation 3.5 years ago and now presented with severe stenosis of the percutaneous heart valve. The patient was initially treated with a trans‐apical implantation of an Edwards Sapien 26 mm balloon expandable valve. The patient remained asymptomatic for 3 years when he presented with increasing shortness of breath and significant calcification of the valve prosthesis on transesophageal echocardiography. Valve‐in‐valve percutaneous heart valve implantation using a 26‐mm CoreValve prosthesis was performed under local anesthesia. The prosthesis was implanted without prior valvuloplasty. Pacing with a frequency of 140/min was applied during placement of the valve prosthesis. Positioning was done with great care using only fluoroscopic guidance with the aim to have the ventricular strut end of the CoreValve prosthesis 5 mm higher than the ventricular strut end of the Edwards Sapien prosthesis. After placement of the CoreValve prosthesis within the Edwards Sapien valve additional valvuloplasty with rapid pacing was performed in order to further expand the CoreValve prosthesis. The final result was associated with a remaining mean gradient of 5 mm Hg and no aortic regurgitation. In conclusion, implantation of a CoreValve prosthesis for treatment of a restenotic Edwards Sapien prosthesis is feasible and is associated with a good functional result.


Interactive Cardiovascular and Thoracic Surgery | 2018

The flutter-by effect: a comprehensive study of the fluttering cusps of the Perceval heart valve prosthesis

Ali Aljalloud; Mohamed Shoaib; Sandrine Egron; Jessica Arias; Lachmandath Tewarie; Heike Schnoering; Shahram Lotfi; Andreas Goetzenich; Nima Hatam; Desiree Pott; Zhaoyang Zhong; Ulrich Steinseifer; R. Zayat; R. Autschbach

OBJECTIVES Sutureless aortic valve prostheses are gaining popularity due to the substantial reduction in cross-clamp time. In this study, we report our observations on the cusp-fluttering phenomenon of the Perceval bioprosthesis (LivaNova, London, UK) using a combination of technical and medical perspectives. METHODS Between August 2014 and December 2016, a total of 108 patients (69% women) with a mean age of 78 years had aortic valve replacement using the Perceval bioprosthesis (34 combined procedures). All patients underwent transoesophageal echocardiography (TOE) intraoperatively. TOE was performed postoperatively to detect paravalvular leakage and to measure gradients, acceleration time, Doppler velocity indices (Vmax and LVOT/Vmax AV) and effective orifice area indices. In addition, a TOE examination was performed in 21 patients postoperatively. Data were collected retrospectively from our hospital database. RESULTS The retrospective evaluation of the intraoperative TOE examinations revealed consistent fluttering in all patients with the Perceval bioprosthesis. The echocardiographic postoperative measurements showed a mean effective orifice area index of 0.91 ± 0.12 cm2/m2. The overall mean pressure and peak pressure gradients were in a higher range (13.5 ± 5.1 mmHg and 25.5 ± 8.6 mmHg, respectively), whereas acceleration time (62.8 ± 16.4 ms) and Doppler velocity indices (0.43 ± 0.11) were within the normal range according to the American Society of Echocardiography or european association of echocardiography (EAE) guidelines. The 2-dimensional TOE in Motion Mode (M-Mode) that was performed in patients with elevated lactate dehydrogenase (LDH) levels revealed remarkable fluttering of the cusps of the Perceval bioprosthesis. CONCLUSIONS In our study cohort, we observed the fluttering phenomenon in all patients who received the Perceval bioprosthesis, which was correlated with elevated LDH levels and higher pressure gradients.


Catheterization and Cardiovascular Interventions | 2013

Transcatheter aortic valve-in-valve implantation of a corevalve in a degenerated stenotic sapien heart valve prosthesis: TAVI Vs. Medical Therapy

Rainer Hoffmann; Helge Möllmann; Shahram Lotfi

Treatment options for re‐stenotic aortic valve prosthesis implanted by transcatheter technique have not been evaluated systematically. We describe the case of a 75‐year‐old dialysis patient who was treated by transcatheter aortic valve implantation 3.5 years ago and now presented with severe stenosis of the percutaneous heart valve. The patient was initially treated with a trans‐apical implantation of an Edwards Sapien 26 mm balloon expandable valve. The patient remained asymptomatic for 3 years when he presented with increasing shortness of breath and significant calcification of the valve prosthesis on transesophageal echocardiography. Valve‐in‐valve percutaneous heart valve implantation using a 26‐mm CoreValve prosthesis was performed under local anesthesia. The prosthesis was implanted without prior valvuloplasty. Pacing with a frequency of 140/min was applied during placement of the valve prosthesis. Positioning was done with great care using only fluoroscopic guidance with the aim to have the ventricular strut end of the CoreValve prosthesis 5 mm higher than the ventricular strut end of the Edwards Sapien prosthesis. After placement of the CoreValve prosthesis within the Edwards Sapien valve additional valvuloplasty with rapid pacing was performed in order to further expand the CoreValve prosthesis. The final result was associated with a remaining mean gradient of 5 mm Hg and no aortic regurgitation. In conclusion, implantation of a CoreValve prosthesis for treatment of a restenotic Edwards Sapien prosthesis is feasible and is associated with a good functional result.


Thoracic and Cardiovascular Surgeon | 2008

Prognostic significance of the lymph node involvement around the main bronchus. The intermediate group really early N2 disease

W Schreiner; Shahram Lotfi; Guido Dohmen; Jan Spillner; R. Autschbach; H. Sirbu

Introduction: N1 and N2 diseases represent heterogeneous patient groups with variable survivals. Some studies showed prognostic differences between intralobar and extralobar (hilar and interlobar) N1 disease. The prognosis of the extralobar N1 disease was similar to the single station N2 disease. Some authors designated metastases around the main bronchus as an intermediate group. The aim of our study was to investigate the prognostic significance of intermediate group in comparison to the single station N2 disease and to skipping metastasis in relation to tumor characteristics. Methods: From 1990 to 2007, a total of 850 patients underwent surgical resection for NSCLC: 252 (30%) had either N1 or N2 disease. We retrospectively evaluated 231 (95.8%) hospital survivors who underwent complete resection with mediastinal lymph node dissection on our institution. Results: The 5-year survival of patients with N1 and N2 diseases was 45% vs. 37%. Survival rate did not significantly differ between intralobar vs. extralobar N1 disease or intermediate group (46%, 43% and 43%). According to N2 disease metastases in subcarinal stations and the aortic-pulmonary window showed significantly better survival than in paratracheal stations (36% and 55% vs. 24%, p=0.002). The survival associated with skipping metastasis was significantly better on the left side (50% vs. 35%, p=0.003). Adenocarcinomas were located more on the right side (19% vs. 8%, p=0.003) resulting in extended lymph node involvement. Conclusion: The clinical significance of the intermediate group remains unclear. Their prognostic influence depends on type and extent of lymph node involvement, tumor histology and location.


European Radiology | 2013

Impact of aortic valve calcification severity and impaired left ventricular function on 3-year results of patients undergoing transcatheter aortic valve replacement

Ralf Koos; Sebastian Reinartz; Andreas H. Mahnken; Ralf Herpertz; Shahram Lotfi; Rüdiger Autschbach; Nikolaus Marx; Rainer Hoffmann


Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery | 2014

Midterm outcomes after transcatheter aortic valve implantation.

Shahram Lotfi; Guido Dohmen; Andreas Götzenich; M Haushofer; Jan Spillner; Rüdiger Autschbach; Rainer Hoffmann


Journal of the American College of Cardiology | 2013

The Impact of Concomitant Percutaneous Coronary Intervention in High-Risk Patients with Aortic Stenosis and Coronary Artery Disease on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation

Ömer Aktug; Ralf Herpertz; Kathrin Brehmer; Rüdiger Autschbach; Nikolaus Marx; Shahram Lotfi; Rainer Hoffmann

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Ralf Koos

RWTH Aachen University

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