| 1. |
- Appel, Carl-Fredrik, et al.
(författare)
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Transcatheter versus surgical treatment for aortic stenosis : Patient selection and early outcome
- 2012
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa Healthcare. - 1401-7431 .- 1651-2006. ; 46:5, s. 301-307
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To describe short-term clinical and echocardiography outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). To explore patient selection criteria for treatment with TAVI. Design. TAVI patients (n = 45) were matched to SAVR patients (n = 45) with respect to age within +/- 10 years, sex and systolic left ventricular function. Results. TAVI patients were older, 82 +/- 8 versus 78 +/- 5 years (p = 0.005) and they had higher logEuroSCORE, 16 +/- 11% versus 8 +/- 4% (p andlt; 0.001). There were no significant differences in 30 days mortality, stroke and myocardial infarction. TAVI patients received less erythrocyte (53% vs. 78%, p = 0.03) and thrombocyte (7% vs. 27%, p = 0.02) transfusions. Postoperative atrial fibrillation was less common (18% vs. 60%, p andlt; 0.001) in the TAVI group. Paravalvular regurgitation was more common in TAVI patients (87% vs. 0%, p andlt; 0.001) and 27% had access site complications. Aortic transvalvular velocity was 2.3 +/- 0.4 m/s versus 2.6 +/- 0.5 m/s (p = 0.002) and mean valve pressure gradient was 12 +/- 4 mmHg versus 15 +/- 5 mmHg (p = 0.01) in the TAVI and SAVR groups, respectively. Twenty-nine (64%) of the TAVI patients had logEuroSCORE andlt; 15%. Conclusions. Both TAVI and SAVR have good short term clinical outcome with excellent hemodynamic result. In clinical practice, factors other than high logEuroSCORE play an important role in patient selection for TAVI.
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| 2. |
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| 5. |
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| 6. |
- Ahn, Henrik Casimir, 1949-, et al.
(författare)
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A New Total Artificial Heart Concept Allowing Replacement or Support of the Native Heart
- 2018
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Ingår i: Journal of Clinical & Experimental Cardiology. - Los Angeles, United States : Omics Publishing Group. - 2155-9880. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- A total artificial heart (TAH) is typically used to bridge the time to heart transplantation. A device designed by Robert Jarvik has been improved through the years and under the name of Syncardia™ this has been the most successful commercially available TAH so far. Since 2008 the Carmat™ heart has been under development in Europe. The Scandinavian Real Heart™ is based on a unique physiological concept where the atrio-ventricular valve plane is of utmost importance in the pumping function of the heart. It consists of two identical parts driven separately by independent motors and in this first animal study we have used one part as a left ventricular assist device. This new concept makes the device flexible as it may be used not only as a TAH but also as a separate pump for left or right ventricular assist.
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| 7. |
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| 8. |
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| 9. |
- Ahn, Henrik Casimir, et al.
(författare)
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Can predilatation in transcatheter aortic valve implantation be omitted? - a prospective randomized study
- 2016
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Ingår i: Journal of Cardiothoracic Surgery. - : BIOMED CENTRAL LTD. - 1749-8090. ; 11:124
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of a balloon expandable stent valve includes balloon predilatation of the aortic stenosis before valve deployment. The aim of the study was to see whether or not balloon predilatation is necessary in transcatheter aortic valve replacement (TAVI). Methods: Sixty consecutive TAVI patients were randomized to the standard procedure or to a protocol where balloon predilatation was omitted. Results: There were no significant differences between the groups regarding early hemodynamic results or complication rates. Conclusions: TAVI can be performed safely without balloon predilatation and with the same early results as achieved with the standard procedure including balloon predilatation. The reduction in the number of pacing periods required may be beneficial for the patient.
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| 17. |
- Ahn, Henrik Casimir, et al.
(författare)
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Transvenous Implantation of a Stent Valve in Patients With Degenerated Mitral Prostheses and Native Mitral Stenosis
- 2016
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Ingår i: Annals of Thoracic Surgery. - : Elsevier. - 0003-4975 .- 1552-6259. ; 101:6, s. 2279-2284
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The purpose of this study was to report the use of a transvenous transseptal approach using a stent valve in patients with degenerated biological mitral valve prostheses, regurgitation after mitral repair, and native mitral stenosis.METHODS: Ten patients (median age, 74 years; range, 20-89 years; 5 men and 5 women) with degenerated mitral bioprosthetic valves (n = 7), failed mitral repair (n = 1), or calcified native stenotic valves (n = 2) underwent transvenous implantation of a stent valve.RESULTS: The procedure was initially successful in all patients. Predilation was performed for balloon sizing only in the 2 patients with native mitral stenosis. The stent valve was deployed during 1 period of rapid pacing. A guidewire, as a loop from the right femoral vein and through the left ventricular apex, facilitated a good angle and secure positioning of the stent valve. An ultrasonographically guided puncture of the apex was carried out in 6 patients, and in the other 4 we performed a minithoracotomy before apical puncture. All valves were implanted in a good position with improved function and without significant paravalvular leakage (PVL). There were no periprocedural deaths. The 30-day survival was 80% (8 of 10 patients), and 60% (6 of 10) of patients were still alive a median time of 290 days after the procedure.CONCLUSIONS: Transvenous transseptal implantation of a stent valve was performed in 10 patients with mitral valve disease, with good early functional results. These high-risk patients must be carefully selected by a multidisciplinary team because the procedure carries a high mortality.
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| 18. |
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| 19. |
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| 20. |
- Babic, Ankica, 1960-, et al.
(författare)
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Case Based Reasoning in a Web Based Decision Support System for Thoracic Surgery
- 2013
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Ingår i: IFMBE Proceedings 41. - Cham : Springer. - 9783319008455 - 9783319008462 ; , s. 1413-1416
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Konferensbidrag (refereegranskat)abstract
- Case Based Reasoning (CBR) methodology provides means of collecting patients cases and retrieving them following the clinical criteria. By studying previously treated patients with similar backgrounds, the physician can get a better base for deciding on treatment for a current patient and be better prepared for complications that might occur during and after surgery. This could be taken advantage of when there is not enough data for a statistical analysis, but electronic patient records that provide all the relevant information to assure a timely and accurate clinical insight into a patient particular situation.We have developed and implemented a CBR engine using the Nearest Neighbor algorithm. A patient case is represented as a combination of perioperative variable values and operation reports. Physicians could review a selected number of cases by browsing through the electronic patient record and operational narratives which provides an exhaustive insight into the previously treated cases. An evaluation of the search algorithm suggests a very good functionality.
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| 21. |
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| 22. |
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| 23. |
- Casimir Ahn, Henrik, et al.
(författare)
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Long-term left ventricular support in patients with a mechanical aortic valve
- 2013
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Ingår i: Scandinavian Cardiovascular Journal. - : INFORMA HEALTHCARE, TELEPHONE HOUSE, 69-77 PAUL STREET, LONDON EC2A 4LQ, ENGLAND. - 1401-7431 .- 1651-2006. ; 47:4, s. 236-239
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. The presence of a mechanical prosthesis has been regarded as an increased risk of thromboembolic complications and as a relative contraindication for a left ventricular assist device (LVAD). Five patients in our center had a mechanical aortic valve at the time of device implantation and were studied regarding thromboembolic complications. Design. Five patients operated upon with an LVAD (1 HeartMate I (TM), 4 HeartMate II (TM)) between 2002 and 2011 had a mechanical aortic valve at the time of implantation. The first patient had a patch closure of the aortic valve. In four patients, the prosthesis was left in place. Anticoagulants included aspirin, warfarin, and clopidogrel. Results. The average and accumulated treatment times were 150 and 752 days, respectively. Three of the five patients showed early signs of valve thrombosis on echo with concomitant valve dysfunction. Four patients were transplanted without thromboembolic events during pump treatment. One patient died from a hemorrhagic stroke after 90 days on the LVAD. Conclusions. The strategy of leaving a mechanical heart valve in place at the time of LVAD implantation in five patients led to valvular thrombosis in three but did not provoke embolic events. It increased the complexity of postoperative anticoagulation.
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| 24. |
- Dahlström, Örjan, et al.
(författare)
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Clustering as a data mining method in a Web-based system for thoracic surgery
- 2001
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Ingår i: Journal of the Medical Informatics Association. Symposium Supplement. - Washington : Hanley&Belfus. - 1560535369 ; , s. 888-
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Konferensbidrag (refereegranskat)abstract
- Cluster analysis is one way of data mining from large amounts of information. Being able to perform series of analyses, varying clinical criteria and requests, expected results of the clustering might be truly rewarding. Instead of having a few hypotheses prepared and tested, medical experts can be surprised by obtaining a set of hypotheses to further validate and work on.Internet technologies enable a substantial flexibility that can be taken advantage of when implementing a Web-based tool. Division of Medical Informatics together with Linkoping Heart Center of the Linkoping University is developing procedures for multivariate clustering within the Web-based AssistMe1 system.
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| 25. |
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| 26. |
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| 27. |
- Fors, Carina, et al.
(författare)
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Analysis of breathing-related variations in ECG-triggered laser Doppler perfusion signals measured on the beating heart during surgery
- 2006
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Ingår i: Computers in cardiology. - 0276-6574. ; 33, s. 181-184
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Tidskriftsartikel (refereegranskat)abstract
- Laser Doppler perfusion monitoring (LDPM) is amethod to assess microvascular perfusion. A modified,ECG-triggered LDPM system has been developed tomeasure myocardial perfusion with minimum influencefrom heart motion. With this method, one systolic (PLS)and one diastolic (PLD) perfusion value is obtained.The aim of this study was to analyse breathing-relatedvariations in PLS and PLD measured during open-heartsurgery. The phase delays between PLS, PLD, meanarterial blood pressure (MAP), heart rate and, indirectly,the respiration were determined.MAP tended to be in phase with or precede thevariations in PLD, i.e., PLD was at a maximum at the endof inspiration or at the beginning of expiration. No clearrelation between PLS and any of the other signals couldbe found.
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| 28. |
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| 29. |
- Fors, Carina, 1978-
(författare)
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Evaluation of a Laser Doppler System for Myocardial Perfusion Monitoring
- 2007
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Coronary artery bypass graft (CABG) surgery is a common treatment for patients with coronary artery disease. A potential complication of CABG is myocardial ischemia or infarction. In this thesis, a method - based on laser Doppler flowmetry (LDF) - for detection of intra- and postoperative ischemia by myocardial perfusion monitoring is evaluated.LDF is sensitive to motion artifacts. In previous studies, a method for reduction of motion artifacts when measuring on the beating heart has been developed. By using the ECG as a reference, the perfusion signal is measured in intervals during the cardiac cycle where the cardiac motion is at a minimum, thus minimizing the artifacts in the perfusion signal.The aim of this thesis was to investigate the possibilities to use the ECG-triggered laser Doppler system for continuous monitoring of myocardial perfusion in humans during and after CABG surgery. Two studies were performed. In the first study, changes in myocardial perfusion during CABG surgery were investigated (n = 13), while the second study focused on postoperative measurements (n = 13). In addition, an ECG-triggering method was implemented and evaluated.It was found that the large variations in myocardial perfusion during CABG surgery could be monitored with the ECG-triggered laser Doppler system. Furthermore, a perfusion signal of good quality could be registered postoperatively from the closed chest in ten out of thirteen patients. In eight out of ten patients, a proper signal was obtained also the following morning, i.e., about 20 hours after probe insertion. The results show that respiration and blood pressure can have an influence on the perfusion signal.In conclusion, the results indicate that the method is able to detect fluctuations in myocardial perfusion under favourable circumstances. However, high heart rate, abnormal cardiac motion, improper probe attachment and limitations in the ECG-triggering method may result in variations in the perfusion signal that are not related to tissue perfusion.
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| 30. |
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| 31. |
- Fors, Carina, 1978-, et al.
(författare)
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Online Laser Doppler Measurements of Myocardial Perfusion
- 2008
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Ingår i: IFMBE Proceedings 22,2008. - Berlin, Heidelberg : Springer Berlin Heidelberg. - 9783540892076 - 9783540892083 ; , s. 1718-1721
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Konferensbidrag (refereegranskat)abstract
- Laser Doppler perfusion monitoring is a suitable method for microvascular blood perfusion measurements. When used on a moving tissue or organ, the Doppler signal arising from the moving blood cells may be distorted. ECG triggering of the laser Doppler signal can be used for reducing the influence from movements during measurements on the beating heart. The aim of this study was to determine the most appropriate triggering intervals during the cardiac cycle for online measurements. Recordings from thirteen coronary artery bypass graft (CABG) patients were included in the study. During surgery, the fibre-optic probe was passed through the chest wall and sutured to the left anterior ventricular wall with the probe tip inserted 3–5 mm into the myocardium. After the patient arrived at the intensive care unit a second measurement was initiated and lasted for about two hours. Before the probe was removed a third measurement was performed for about 5 minutes the following morning. A total of 97 data sequences were analysed and the intervals of low and stable perfusion signal were compared to the positions of the T and P peaks in the ECG.It was found that the most appropriate time intervals were in late systole at the T peak [−3, 9] ms and just before the P peak [−28, -10] ms in late diastole. However, the position of these intervals may vary between individuals, because of e.g., abnormal cardiac motion. With the use of the appropriate interval online measurement of the myocardial perfusion on a beating heart appears possible.
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| 32. |
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| 33. |
- Granfeldt, Hans, et al.
(författare)
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A single center experience with the HeartMate II (TM) Left Ventricular Assist Device (LVAD)
- 2009
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 43:6, s. 360-365
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. Left ventricular assist devices (LVAD), used in the setting bridge-to-transplantation and destination therapy, for patients with deteriorating severe heart failure are continuously developing. The second generation, the axial flow pumps, have been introduced since some years. Design. Eleven consecutive patients, seven male, with severe heart failure due to ischemic cardiomyopathy (n = 5), dilated cardiomyopathy (n = 5) and cytotoxic ethiology (n = 1) were implanted with the HeartMate-II (TM). They were preoperatively treated with inotropic support (n = 9), ventricular assist device (n = 2) and mechanical ventilation (n = 4). Results. Eight patients were bridged to transplant after median 155 days (range, 65 to 316 days). One patient is ongoing for 748 days, intended for destination therapy. Ten of eleven patients were discharged after median 64 days (range, 40 to 105 days). Four patients were reoperated due to bleeding. Two embolic events were recorded. One perioperative death. Conclusion. Eleven HM-II (TM) LVADs have been implanted in our institution with good early results. Eight patients were successfully bridged to heart transplantation. One patient is intended for destination therapy and is ongoing since November 2006. In these severely ill patients, this technique offers a good chance surviving until heart transplantation. In selected cases the technique also offers the possibility of a permanent support and longevity.
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| 34. |
- Granfeldt, Hans, et al.
(författare)
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The Linkoping-Lund surgical experience with the HeartMate left ventricular assist system
- 1995
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Ingår i: Annals of Thoracic Surgery. - 1552-6259. ; 59:Suppl. 1, s. 52-55
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Tidskriftsartikel (refereegranskat)abstract
- Four transplant candidates fulfilling the Food and Drug Administration criteria for a permanent left ventricular assist device received a pneumatic HeartMate system as a bridge to heart transplantation. All patients survived and were fully rehabilitated at the time of transplantation, which was carried out 2 to 6 months after the initial operation. There were no major complications associated with the procedures. We are impressed by the effectiveness and safety of the device.
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| 35. |
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| 36. |
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| 37. |
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| 38. |
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| 39. |
- Hübbert, Laila, et al.
(författare)
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Axial flow pump treatment during myocardial depression in calves : an invasive hemodynamic and echocardiographic tissue Doppler study.
- 2008
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Ingår i: ASAIO journal (1992). - Philadelphia, PA USA : Lippincott Williams & Wilkins. - 1058-2916 .- 1538-943X. ; 54:4, s. 367-371
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate flow characteristics and myocardial function after implantation of an axial pump left ventricular assist device while varying afterload and during progressive myocardial depression. Ten calves were included, seven of which fulfilled the protocol. Invasive hemodynamic monitoring and echocardiography with color-coded systolic tissue Doppler velocity (TD velocity) were used during prepump conditions, at three different pump speeds, during modification of the systemic vascular resistance (SVR), and during increasing degrees of beta-blockade. The TD velocity decreased with the myocardial function whereas left ventricular size, fractional shortening, and pump speed did not correlate significantly with the TD velocity. The TD velocity correlated significantly with native stroke volume, heart rate, SVR and cardiac output but none of these alone could explain more than 20% of the changes in TD velocity. The axial flow pump studied is effective in unloading the severely depressed heart and has a high capacity for maintaining an adequate cardiac output, regardless of differing hemodynamic conditions, pump speed or decreasing LV function. Echocardiography with volumetric rendering and TD velocity imaging are valuable tools for monitoring and quantifying residual myocardial function during pump treatment.
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| 40. |
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| 41. |
- Häggblad, Erik, et al.
(författare)
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Myocardial tissue oxygenation estimated with calibrated diffuse reflectance spectroscopy during coronary artery bypass grafting
- 2008
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Ingår i: Journal of Biomedical Optics. - : SPIE-Intl Soc Optical Eng. - 1083-3668 .- 1560-2281. ; 13:5, s. 054030-
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Tidskriftsartikel (refereegranskat)abstract
- We present a study using a method able to assess tissue oxygenation, taking into account the absorption and the level of scattering in myocardial tissue using a calibrated fiber optic probe. With this method, interindividual comparisons of oxygenation can be made despite varying tissue optical properties during coronary artery bypass grafting (CABG). During CABG, there are needs for methods allowing continuous monitoring and prediction of the metabolism in the myocardial tissue. 14 patients undergoing CABG are investigated for tissue oxygenation during different surgical phases using a handheld fiber optic spectroscopic probe with a source-detector distance of less than 1 mm. The probe is calibrated using a light transport model, relating the absorption and reduced scattering coefficients (mu(a) and mu()(s)) to the measured spectra. By solving the inverse problem, absolute measures of tissue oxygenation are evaluated by the sum of oxygenized hemoglobin and myoglobin. Agreement between the model and measurements is obtained with an average correlation coefficient R-2 of 0.96. Oxygenation is found to be significantly elevated after aorta cross-clamping and cardioplegic infusion, as well as after reperfusion, compared to a baseline (p < 0.05). Tissue oxygenation decreases during cardiac arrest and increases after reperfusion.
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| 42. |
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| 43. |
- Karlsson, Daniel M G, 1974-, et al.
(författare)
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Analysis and processing of laser Doppler perfusion monitoring signals recorded from the beating heart
- 2003
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Ingår i: Medical and Biological Engineering and Computing. - : Springer. - 0140-0118 .- 1741-0444. ; 41:3, s. 255-262
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Tidskriftsartikel (refereegranskat)abstract
- Laser Doppler perfusion monitoring (LDPM) can be used for monitoring myocardial perfusion in the non-beating heart. However, the movement of the beating heart generates large artifacts. Therefore the aim of the study was to develop an LDPM system capable of correlating the laser Doppler signals to the cardiac cycle and to process the signals to reduce the movement artifacts. Measurements were performed on three calves, both on the normal beating heart and during occlusion of the left anterior descending coronary artery (LAD). The recorded LDPM signals were digitally processed and correlated to the sampled ECG. Large variations in the output (perfusion) and DC signals during the cardiac cycle were found, with average coefficients of variation of 0.36 and 0.14 (n-14), respectively. However, sections with a relatively low, stable output signal were found in late diastole, where the movement of the heart is at a minimum. Occlusion of the LAD showed the importance of recording the laser Doppler signals at an appropriate point in the cardiac cycle, in this case late systole, to minimise movement artifacts. It is possible to further reduce movement artifacts by increasing the lower cutoff frequency when calculating the output signal.
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| 44. |
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| 45. |
- Karlsson, Daniel M. G., et al.
(författare)
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Myocardial perfusion monitoring during coronary artery bypass using an electrocardiogram-triggered laser Doppler technique
- 2005
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Ingår i: Medical and Biological Engineering and Computing. - : Springer. - 0140-0118 .- 1741-0444. ; 43:5, s. 582-588
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Tidskriftsartikel (refereegranskat)abstract
- Electrocardiogram (ECG)—triggered laser Doppler perfusion monitoring (LDPM) was used to assess myocardial perfusion, with minimum myocardial tissue motion influence, during coronary artery bypass grafting (CABG). Thirteen subjects were investigated at six phases: pre- and post-CABG; post aorta cross-clamping; pre and post left internal mammary artery (LIMA) graft declamping; and post aorta declamping. The perfusion signal was calculated in late systole and late diastole, with expected minimum tissue motion, and compared with arrested heart measurements. Patient conditions or artifacts caused by surgical activity made it impossible to perform and analyse data in all six phases for some patients. No significant (n=5) difference between perfusion signals pre- and post-CABG was found. Diastolic perfusion signal levels were significantly (p<0.02) lower compared with systolic levels. After aorta cross-clamping, the signal level was almost zero. A distinct perfusion signal increase after LIMA and aorta declamping, compared with pre-LIMA declamping, was found in ten cases out of 13. A significantly (p<0.04) lower perfusion signal in the arrested heart compared with in the beating heart was registered. Influence from mechanical ventilation was observed in 14 measurements out of 17. In conclusion, ECG-triggered LDPM can be used to assess myocardial perfusion during CABG. Perfusion signals were lower in the arrested heart compared with in the beating heart and in late diastole compared with late systole. No significant difference between pre- and post-CABG was found.
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| 46. |
- Karlsson, M G Daniel, 1974-, et al.
(författare)
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Myocardial tissue motion influence on laser Doppler perfusion monitoring using tissue Doppler imaging
- 2004
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Ingår i: Medical and Biological Engineering and Computing. - : Springer. - 0140-0118 .- 1741-0444. ; 42:6, s. 770-776
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Tidskriftsartikel (refereegranskat)abstract
- Tissue motion of the beating heart generates large movement artifacts in the laser Doppler perfusion monitoring (LDPM) signal. The aim of the study was to use tissue Doppler imaging (TDI) to localise intervals during the cardiac cycle where the influence of movement artifacts on the LDPM signal is minimum. TDI velocities and LDPM signals were investigated on three calves, for normal heartbeat and during occlusion of the left anterior descending coronary artery. Intervals of low tissue velocity (TDIint<1 cm s−1) during the cardiac cycle were identified. During occlusion, these intervals were compared with low LDPM signal intervals (LDPMint<50% compared with baseline). Low-velocity intervals were found in late systole (normal and occlusion) and late diastole (normal). Systolic intervals were longer and less sensitive to heart rate variation compared with diastolic ones. The overlap between LDPMint and TDIint in relation to TDIint length was 84±27% (n=14). The LDPM signal was significantly (p<0.001, n=14) lower during occlusion if calculated during minimum tissue motion inside TDIint), compared with averaging over the entire cardiac cycle without taking tissue motion into consideration. In conclusion, movement artifacts are reduced if the LDPM signal is correlated to the ECG and investigated during minimum wall motion. The optimum interval depends on the application; late systole and late diastole can be used.
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| 47. |
- Kircher, Albert, et al.
(författare)
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Knowledge representation forms for data mining methodologies as applied in thoracic surgery
- 2000
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Ingår i: AMIA,2000. - Philadelphia : Hanley & Belfus Inc. - 156053480X ; , s. 428-432
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Konferensbidrag (refereegranskat)abstract
- Typical ways of disseminating and using results of clinical research are scientific journals and reports. Presentation forms are condensed and comprehensible mainly to the experts following the specific topics. A vast amount of information remains unutilized due to the complex form of presenting the knowledge. Subject of this research is to explore possibilities of representation and also visualization of the results obtained using data mining methodologies. The intention is to formulate more than scientific ways to communicate facts that are of interest for the clinicians, medical students and even patients. Internet technologies as already widely established media support knowledge representation forms such as hypertext documents and structured knowledge components. The "Assist Me" decision support system for surgical treatment of cardiac patients integrates several forms of data mining and representation methodologies. We are showing a feasibility study in which scientific outcomes were forwarded to a broad group of potential users.
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| 48. |
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| 49. |
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| 50. |
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