| 1. |
- Braun, Oscar Ö., et al.
(författare)
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Continuous-flow LVADs in the Nordic countries : complications and mortality and its predictors
- 2019
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 53:1, s. 14-20
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study was to assess complications and mortality and its predictors, with continuous-flow left ventricular assist devices (CF-LVADs) in the Nordic Countries.Design: This was a retrospective, international, multicenter cohort study.Results: Between 1993 and 2013, 442 surgically implanted long-term mechanical assist devices were used among 8 centers in the Nordic countries. Of those, 238 were CF-LVADs (HVAD or HeartMate II) implanted in patients >18 years with complete data. Postoperative complications and survival were compared and Cox proportion hazard regression analysis was used to identify predictors of mortality. The overall Kaplan-Meier survival rate was 75% at 1 year, 69% at 2 years and 63% at 3 years. A planned strategy of destination therapy had poorer survival compared to a strategy of bridge to transplantation or decision (2-year survival of 41% vs. 76%, p < .001). The most common complications were non-driveline infections (excluding sepsis) (44%), driveline infection (27%), need for continuous renal replacement therapy (25%) and right heart failure (24%). In a multivariate model age and left ventricular diastolic dimension was left as independent risk factors for mortality with a hazard ratio of 1.35 (95% confidence interval (CI) [1.01-1.80], p = .046) per 10 years and 0.88 (95% CI [0.72-0.99], p = .044) per 5 mm, respectively.Conclusion: Outcome with CF LVAD in the Nordic countries was comparable to other cohorts. Higher age and destination therapy require particularly stringent selection.
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| 2. |
- Hellgren, Tina, et al.
(författare)
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Outcomes of aortic arch repair using the frozen elephant trunk technique
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To study outcomes of frozen elephant trunk (FET) repair of complex aortic arch disease. Methods: All patients who underwent FET repair of the aortic arch at a tertiary referral center during 2006-2020 were included in this retrospective single-center cohort study. Survival, complication and reintervention rate, and aortic remodelling were analyzed. Results: Fifty patients were included: 23 with complex thoracic aortic aneurysms (TAA), 19 with chronic aortic dissections (CAD) (16 Stanford type A, 3 type B) and 8 with acute aortic dissections (AAD) (7 Stanford type A, 1 type B). 30-day mortality was: TAA 22% (n=5), CAD 5% (n=1), AAD 37% (n=3). Rate of disabling stroke was: TAA 22% (n=5), CAD 5% (n=1), AAD 25% (n=2). Rate of permanent spinal cord injury was: TAA 9% (n=2), CAD 5% (n=1), AAD 0%. 5-year survival was: TAA 53%, CAD 83%, AAD 63%. 5-year reintervention-free survival was TAA 83% and CAD 36%. There were no aortic reinterventions in the AAD group. 13/19 (68%) of CAD patients underwent distal stent graft extension during follow-up, 3 of which were planned already prior to FET procedure. On last CT follow-up after median 32 (IQR 58) months, 78% of CAD had false lumen thrombosis along the stent graft and 11% in the abdominal aorta. 9/14 (64%) of patients with thoracic false lumen thrombosis had distal TEVAR extension after FET. In proximal descending aorta there was a mean 64% expansion (p<0.001) of true and 39% reduction (p 0.007) of false lumen diameter. There was a mean expansion of both true and false lumen in the abdominal aorta.Conclusions: Despite the advantages of the FET technique, repair of extensive aortic arch disease remains associated with considerable morbidity and mortality. Neurologic complications are a particular concern and further advancements to prevent these are necessary. FET repair of CAD, commonly followed by distal stent graft extension, induces favorable remodeling in the thoracic but not abdominal aorta.
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| 3. |
- Hellgren, Tina, et al.
(författare)
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Outcomes of aortic arch repair using the frozen elephant trunk technique : analysis of a Scandinavian center's results over 14 years
- 2023
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Ingår i: Journal of Cardiovascular Surgery. - : EDIZIONI MINERVA MEDICA. - 0021-9509 .- 1827-191X. ; 64:2, s. 215-223
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The frozen elephant trunk (FET) technique enables repair of aortic arch pathology, with possibility for endovascular treat-ment of distal thoracic aortic disease. We aimed to study outcomes of FET repair of complex aortic arch disease at a Scandinavian tertiary referral center. METHODS: All patients who underwent FET repair of the aortic arch 2006-2020 were included. Survival, complication and reintervention rate, and aortic remodeling were analyzed. RESULTS: Fifty patients were included: 23 complex thoracic aortic aneurysms involving the aortic arch (TAA), 19 with chronic aortic dis-sections (CAD) (16 Stanford type A, 3 type B) and 8 acute aortic dissections (AAD) (7 Stanford type A, 1 type B). Thirty-day mortality was: TAA=22% (N.=5), CAD=5% (N.=1), AAD=37% (N.=3). Rate of disabling stroke: TAA=22% (N.=5), CAD=5% (N.=1), AAD=25% (N.=2). Rate of permanent spinal cord injury: TAA=9% (N.=2), CAD=5% (N.=1), AAD=0%. 5-year survival: TAA=53%, CAD=83%, AAD=63%. 5-year reintervention-free survival was TAA=83% and CAD=36%. There were no reinterventions in the AAD group. 13/19 (68%) of CAD patients underwent distal stent graft extension during follow-up. On last CT follow-up (median 32 months), 78% of CAD had false lumen thrombosis along the stent graft and 11% in the abdominal aorta. In thoracic aorta there was a mean 64% expansion (P<0.001) of true and 39% reduction (P=0.007) of false lumen diameter. In abdominal aorta, both true and false lumen expanded. CONCLUSIONS: Despite the advantages of the FET technique, repair of extensive aortic arch disease remains associated with high rates of mortality and major neurologic complications. FET repair of CAD induces favorable remodeling in the thoracic aorta.
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| 4. |
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| 5. |
- Granfeldt, Hans, et al.
(författare)
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Experience with the Impella (R) recovery axial-flow system for acute heart failure at three cardiothoracic centers in Sweden
- 2009
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 43:4, s. 233-239
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. The Impella (R) recovery axial-flow system is a mechanical assist system for use in acute heart failure. This retrospective study reports the use of the device at three cardiothoracic units in Sweden. Design. Fifty patients (35 men, mean age 55.8 years, range 26 to 84 years) underwent implantation of 26 Impella (R) LP 2.5/5.0 (support-time 0.1 to 14 days), 16 Impella (R) LD (support-time 1 to 7 days) and 8 Impella (R) RD (support-time 0.1 to 8 days) between 2003 and 2007. Implantation was performed because of postcardiotomy heart failure (surgical group, n=33) or for various states of heart failure in cardiological patients (non-surgical group, n=17). The intention for the treatments was mainly to use the pump as a obridge-to-recoveryo. Results. Early mortality in the surgical and non-surgical groups was 45% and 23%, respectively. Complications included infection, 36% and right ventricular failure, 28%. Cardiac output and cardiac power output postoperatively were significantly higher among survivors than non-survivors. Conclusions. The Impella (R) recovery axial-flow system facilitates treatment in acute heart failure. Early intervention in patients with acute heart failure and optimized hemodynamics in the post-implantation period seem to be of importance for long-term survival. Insufficient early response to therapy should urge to consider further treatment options.
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| 6. |
- Hellgren, Laila, et al.
(författare)
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Biological versus mechanical prosthesis in 3279 patients from the Swedish in-patients register
- 2011
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 45:4, s. 223-228
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To compare valve-related morbidity among patients aged = 70 years, receiving either a mechanical or a biological prosthesis in a population-based setting. Design. In total, 3279 patients (21 644 patient-years) were followed up through the Swedish National In-Patients Register, which registers all hospital admissions. Death, thromboembolism, bleeding, endocarditis, valve thrombosis and reoperations were all captured. Results. Survival was lower among patients aged 5 years). Event-free survival was higher in younger patients with a mechanical prosthesis compared to bioprosthesis recipients (p < 0.001), but equal among older patients. Conclusions. Survival was comparable in older patients irrespective of prosthesis type. Bleeding was increased with a mechanical prosthesis, especially in the elderly. The risk of thromboembolism was higher in patients with a bioprosthesis.
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| 7. |
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| 8. |
- Hellgren, Laila, 1967-
(författare)
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Heart Valve Surgery : Preoperative Assessment and Clinical Outcome
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A more global analysis of the outcome of heart valve surgery is desirable to reflect the actual benefit for the patient. This thesis focuses on the preoperative assessment of the patient, and the outcome after surgery with regard to operative mortality, long-term survival, valve-related complications, and quality of life.Magnetic resonance imaging and echocardiography were comparable in assessing severe mitral regurgitation, but did not agree in measuring regurgitant fraction. Natriuretic peptides correlated well to regurgitant fraction on magnetic resonance imaging and to PISA and vena contracta on echocardiography.The risk of death, myocardial injury and postoperative heart failure after valve surgery has decreased over the last decade whereas the proportion older patients has increased.Survival is reduced after mitral valve replacement in patients with severe symptoms whereas patients with less symptoms have excellent survival. Older patients are more often severly symptomatic at the time of mitral valve surgery.Event-free survival is superior in patients with a mechanical prosthesis, but not influenced by valve type in older patients. A mechanical prosthesis is associated with a higher risk of bleeding < 5 years from surgery, especially in older patients; and a bioprosthesis is associated with a higher risk of thromboembolism > 5 years from surgery. Ageing with a mechanical prosthesis implied an increased risk for an adverse event, this was not true for bioprostheses.Quality of life after complicated heart valve surgery resulted in reduced physical health but equal mental health compared to uncomplicated controls.
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