Eline Bruggemans - Academia.edu (original) (raw)

Papers by Eline Bruggemans

European Journal of Cardio-Thoracic Surgery, 1995

Neuropsychological testing is a sensitive method for quantitative assessment of cognitive dysfunc... more Neuropsychological testing is a sensitive method for quantitative assessment of cognitive dysfunctioning following cardiopulmonary bypass (CPB). However, the methodological problems associated with this method, such as learning effects due to repeated testing and the effects of distress on test performance, have often been underestimated. In this study, these confounding effects were controlled for by including the spouses of patients, exposed to the same potential stress effects associated with the operation, as a nonsurgical control group. The experimental group consisted of 63 patients (40-75 years) undergoing elective coronary artery bypass graft (CABG) surgery. A battery of standardized neuropsychological tests was administered to both groups 2 weeks preoperatively and I week, 1 month, and 6 months postoperatively. Statistical testing of inter-group differences in preoperative to postoperative changes in test performance revealed the following results: (1) For immediate memory and learning, in general test scores showed the same time course for both groups. (2) For recent memory, patients' scores showed a significant deterioration at 1 month after CABG surgery compared with the scores of spouses. This effect had not completely disappeared at 6 months postoperatively. (3) For attention and psychomotor speed as well as verbal fluency, patients' scores had deteriorated significantly at 1 week after surgery, with incomplete recovery at 6 months. These negative cognitive effects were not related to the patients' ages or CPB parameters (duration of CPB, aortic cross-clamp time, mean flow and arterial pressure during CPB and aortic cross-clamping, and minimum nasopharyngeal temperature). No differences in self-ratings of mood over time were found between the patients and spouses. The results indicate that, when adequately controlling for the effects of learning and distress, some cognitive functions are still impaired at 6 months after CABG surgery.

European Journal of Cardio-Thoracic Surgery, 2019

OBJECTIVES Repeat aortic valve interventions after previous stentless aortic valve replacement (A... more OBJECTIVES Repeat aortic valve interventions after previous stentless aortic valve replacement (AVR) are considered technically challenging with an increased perioperative risk, especially after full-root replacement. We analysed our experience with reinterventions after stentless AVR. METHODS A total of 75 patients with previous AVR using a Freestyle stentless bioprosthesis (31 subcoronary, 15 root-inclusion and 29 full-root replacement) underwent reintervention in our centre from 1993 until December 2018. Periprocedural data were retrospectively collected from the department database and follow-up data were prospectively collected. RESULTS Median age was 62 years (interquartile range 47–72 years). Indications for reintervention were structural valve deterioration (SVD) in 47, non-SVD in 13 and endocarditis in 15 patients. Urgent surgery was required in 24 (32%) patients. Reinterventions were surgical AVR in 16 (21%), root replacement in 51 (68%) and transcatheter AVR in 8 (11%) pa...

Perfusion, 2019

Introduction: Gaseous microemboli that originate from the cardiopulmonary bypass circuit may cont... more Introduction: Gaseous microemboli that originate from the cardiopulmonary bypass circuit may contribute to adverse outcome after cardiac surgery. We prospectively evaluated the influence of gaseous microemboli on the release of various biomarkers after use of a minimally invasive extracorporeal technology system. Methods: In 70 patients undergoing coronary artery bypass grafting with minimized cardiopulmonary bypass, gaseous microemboli were measured intraoperatively with a bubble counter. Intra- and postoperative biomarker levels for inflammatory response (interleukin-6, C5b-9), endothelial damage (von Willebrand factor, soluble vascular cell adhesion molecule-1), oxidative stress (malondialdehyde, 8-isoprostane, neuroketal), and neurological injury (neuron-specific enolase, brain-type fatty acid-binding protein) were analyzed using immune assay techniques. The relationship between gaseous microemboli number or volume and the incremental area under the curve (iAUC24h) or peak chang...

European Journal of Cardio-Thoracic Surgery, 2018

OBJECTIVES: The aim of this study was to provide predictive data on the performance of the Freest... more OBJECTIVES: The aim of this study was to provide predictive data on the performance of the Freestyle stentless bioprosthesis that can be used to support and improve the shared decision-making process of prosthetic valve choice for aortic valve replacement. METHODS: Between 1993 and 2014, 604 patients received the Freestyle stentless bioprosthesis (143 subcoronary, 58 root inclusion and 403 full-root replacement). Perioperative data were collected retrospectively, and follow-up data were collected prospectively from 2015. Follow-up was 96% complete (median 4.3 years), with 114 (19%) patients having a follow-up period exceeding 10 years. A competing risks regression model was developed to predict the probability of mortality, structural valve deterioration (SVD) and reoperation for other causes than SVD. RESULTS: The median age of patients was 64 years, 91 (15%) patients had undergone previous aortic valve replacement and 351 (58%) underwent concomitant procedures. The 15-year probability of SVD, reoperation for other causes and death were 16.9%, 8.1% and 47.7%, respectively. Linearized occurrence rates for prosthesis endocarditis, thromboembolic events and bleeding were 0.5%, 0.9% and 0.1% per patient-year, respectively. The constructed predictive model, including age, renal function and implantation technique as significant covariates, had good to fair predictive performance up to 19 years. CONCLUSIONS: The Freestyle stentless bioprosthesis is an efficient prosthesis for aortic valve replacement or root replacement, with low incidences of SVD and valve-related events at long-term follow-up. The predictive model designed in this study can be used to fully inform patients about their expected individual trajectory after implantation of this prosthesis. This improves the shared decision-making process between patients and clinicians.

JACC: Clinical Electrophysiology, 2018

The purpose of this study was to randomly compare the incidence of asymptomatic cerebral embolism... more The purpose of this study was to randomly compare the incidence of asymptomatic cerebral embolism (ACE) between the second-generation pulmonary vein ablation catheter (PVAC Gold) and the irrigated Thermocool catheter. BACKGROUND Pulmonary vein isolation (PVI) with the PVAC is associated with ACE. The PVAC Gold was designed to avoid this complication. METHODS Patients with paroxysmal atrial fibrillation were randomized 1:1 to PVI with the PVAC Gold or Thermocool catheter. Cerebral magnetic resonance imaging was performed in the days before and after ablation and repeated after 3 months in case of a new lesion. Monitoring for microembolic signals (MES) was performed by using transcranial Doppler ultrasonography. Parameters of coagulation were determined before, during, and after ablation. Neuropsychological tests and questionnaires were applied 10 days before and 3 months after ablation. RESULTS Seventy patients were included in the study (mean age 61 AE 9 years; 43 male subjects; CHA 2 DS 2-VASc [congestive heart failure, hypertension, age $75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65 to 74 years, sex category] score 1.6 AE 1.2; international normalized ratio 2.7 AE 0.5; activated clotting time 374 AE 24 s; p > 0.05 for all parameters). Procedural duration was shorter in the PVAC Gold group (140 AE 34 vs. 207 AE 44 min; p < 0.001). Eight (23%; 7 infarcts) patients in the PVAC Gold group exhibited a new ACE, compared with 2 (6%; no infarcts) patients in the Thermocool group (p ¼ 0.042). Median number of MES was higher in the PVAC Gold group (1,111 [interquartile range, 715-2,234] vs. 787 [interquartile range, 532-1,053]; p < 0.001). There were no differences between groups regarding coagulation and neuropsychological outcomes. CONCLUSIONS PVI with the new PVAC Gold was associated with a higher incidence of ACE/cerebral infarcts and number of MES. Both catheters induced a comparable procoagulant state. Because there were no measurable differences in neuropsychological status, the clinical significance of ACE remains unclear.

The Journal of Thoracic and Cardiovascular Surgery, 2018

Objective: The added value of total arterial revascularization in coronary artery bypass grafting... more Objective: The added value of total arterial revascularization in coronary artery bypass grafting becomes particularly apparent when evaluating long-term results. We previously reported on our 10-year outcomes of total arterial revascularization using bilateral internal thoracic and gastroepiploic arteries as in situ grafts in patients with 3-vessel disease. This study aimed to increase the follow-up period to 20 years. Methods: We updated clinical outcomes of 201 patients operated on between 1992 and 2002. At that time, the technique was primarily performed in patients with a longer life expectancy. Primary end points were overall survival and freedom from the composite of major adverse cardiac events. Secondary end points were the separate cardiac events. Results: Extended follow-up included all patients. The median follow-up time was 19.2 years (interquartile range, 16.2-20.0). The respective 15-and 20-year Kaplan-Meier estimated survival probabilities were 73.9% (95% confidence interval [CI], 67.2%-79.5%) and 63.5% (95% CI, 55.7%-70.4%) for overall survival and 57.9% (95% CI, 50.7%-64.5%) and 47.9% (95% CI, 40.1%-55.3%) for freedom from major adverse cardiac events. The respective estimated cumulative incidences at 15 and 20 years were 7.0% (95% CI, 3.5%-10.6%) and 7.8% (95% CI, 4.0%-11.6%) for myocardial infarction, 8.6% (95% CI, 4.7%-12.5%) and 9.3% (95% CI, 5.2%-13.3%) for percutaneous reintervention, 7.0% (95% CI, 3.5%-10.5%) and 7.0% (95% CI, 3.5%-10.5%) for reoperation, 8.6% (95% CI, 4.7%-12.6%) and 12.9% (95% CI, 7.6%-18.2%) for cardiac death, and 10.8% (95% CI, 6.5%-15.2%) and 15.2% (95% CI, 9.8%-20.6%) for death from other causes. Conclusions: The use of in situ bilateral internal thoracic and gastroepiploic arteries provides outstanding 15-and 20-year survival and cardiac event-free survival probabilities. Further studies are needed in older patients with more severe comorbidities. Nevertheless, the results from this and scarce other studies on 15-to 20-year outcomes of total arterial revascularization suggest that cardiac surgeons should embrace the application of total arterial grafting to further reduce the risks of long-term cardiac events, especially during the second decade after surgery.

Circulation. Cardiovascular quality and outcomes, 2017

A Dutch online patient decision aid to support prosthetic heart valve selection was recently deve... more A Dutch online patient decision aid to support prosthetic heart valve selection was recently developed. A multicenter randomized controlled trial was conducted to assess whether use of the patient decision aid results in optimization of shared decision making in prosthetic heart valve selection. In a 5-center randomized controlled trial, patients were allocated to receive either standard preoperative care (control group) or additional access to the patient decision aid (intervention group). Legally capable adult patients accepted for elective isolated or combined aortic and mitral valve replacement were included. Primary outcome was preoperative decisional conflict (Decisional Conflict Scale); secondary outcomes included patient knowledge, involvement in valve selection, anxiety and depression, (valve-specific) quality of life, and regret. Out of 306 eligible patients, 155 were randomized (78 control and 77 intervention). Preoperative decisional conflict did not differ between the g...

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2016

Right ventricular outflow tract obstruction (RVOTO) is one of the reasons for late reintervention... more Right ventricular outflow tract obstruction (RVOTO) is one of the reasons for late reinterventions after repair of transposition of the great arteries (TGA) with aortic arch obstruction (AAO). The aim of the present study was to identify predictors of reoperation for RVOTO in patients who underwent arterial switch operation (ASO) and arch repair for TGA or Taussig-Bing anomaly with AAO. Between 1977 and 2015, 45 patients [TGA/intact ventricular septum (IVS) 5, TGA/ventricular septal defect (VSD) 13, Taussig-Bing 27] with coarctation (21), arch hypoplasia (5), coarctation and hypoplasia (12) and aortic arch interruption (7) underwent ASO and arch repair. The median age at the ASO was 19 days (range, 1 day to 12.7 years). AAO was repaired concomitantly with ASO in 36 patients. Operation reports and 2D-echocardiographic data were retrospectively reviewed to determine the following parameters: position of the great arteries, coronary artery anatomy, and diameters of RVOT, aortic annulus...

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 16, 2016

In patients with congenitally corrected transposition of the great arteries (ccTGA) or after atri... more In patients with congenitally corrected transposition of the great arteries (ccTGA) or after atrial (Mustard or Senning) correction for transposition of the great arteries (acTGA), the right ventricle (RV) supports the systemic circulation. The tricuspid valve (TV) (systemic atrioventricular valve) is prone to regurgitation in these patients and this is associated with impending RV failure and decreased survival. This study evaluates mid-term functional improvements, echocardiographic findings and survival after TV surgery in this patient group. From July 1999 to November 2014, 26 patients (mean age 37.1 ± 12.3 years, 14 females) with ccTGA (n = 15) or acTGA (n = 11) had TV surgery. All patients had RV dysfunction and more-than-moderate TV regurgitation (TR); 14 underwent TV replacement (TVR) and 12 had valvuloplasty (TVP). Main outcomes were New York Heart Association (NYHA) functional class, TR and RV dysfunction at 1 year postoperatively and at latest follow-up. Complications and...

European Journal of Cardio-Thoracic Surgery, 2016

OBJECTIVES: Infective endocarditis of the aortic valve with local aortic root destruction require... more OBJECTIVES: Infective endocarditis of the aortic valve with local aortic root destruction requires radical resection of infected tissues and subsequent reconstruction of periannular structures and the left ventricular outflow tract (LVOT). Homografts or stentless bioprostheses are recommended for use in this specific patient group. The Freestyle stentless bioprosthesis is a porcine aortic root prosthesis, which approaches the surgical versatility of the homograft, but has the advantage of ready availability and uniform quality. We assessed clinical and echocardiographic outcome following the use of this prosthesis in extensive aortic valve endocarditis. METHODS: Between June 2000 and December 2014, 55 Freestyle prostheses were implanted for aortic valve endocarditis involving the root in 54 patients (74% male). The mean age at operation was 61 ± 13 years. The mean EuroSCORE II was 20.1 ± 13.5. Twenty-nine (54%) patients had prosthetic valve endocarditis. The median follow-up time after surgery was 3.5 years, ranging from 0 to 15 years. RESULTS: Early and late mortality were 11% (6 patients) and 14% (7 patients), respectively. Estimated overall survival at 1 and 5 years was 83 and 70%, respectively. There was no survival difference between patients with native or prosthetic valve endocarditis. One patient underwent reoperation for recurrent endocarditis 2.3 years after the initial procedure. No other prosthesis failure occurred. At a median follow-up of 3.3 years, mean gradient over the prosthesis was 4.3 ± 2.3 mmHg. No patient had more than mild aortic regurgitation. CONCLUSIONS: The Freestyle stentless bioprosthesis is a valuable option to reconstruct the LVOT after debridement in extensive aortic valve endocarditis. It is readily available with a versatility and clinical outcome comparable with that of homografts. Although early mortality remains considerable in this high-risk group of patients, late survival is good with low rates of recurrence of endocarditis, immediate local control and good haemodynamic performance on echocardiography.

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 7, 2015

To evaluate our experience with patients reoperated after primary repair of atrioventricular sept... more To evaluate our experience with patients reoperated after primary repair of atrioventricular septal defect (AVSD) and identify predictors of poor outcome. Between 1976 and 2014, 69 patients were reoperated after primary repair of partial (n = 28), intermediate (n = 15) or complete (n = 26) AVSD. Median age at first reoperation was 62.4 (range, 1.6-845) months, median interval to first reoperation was 22.3 (range, 0.2-598) months. Main indications for first reoperation included left atrioventricular valve (LAVV) pathology (66%), residual septal defect (19%) and left ventricle outflow tract obstruction (LVOTO; 4%). Procedures to address LAVV pathology included various valvuloplasties in 47 (77%) patients and valve replacement in 14 (23%) patients. A second, third, fourth and fifth reoperation was required in 27, 12, 4 and 1 patient, respectively. Most common procedures were LAVV replacement (LAVVR), LVOTO relief, pacemaker implantation and right atrioventricular valve procedure. Freed...

European Journal of Cardio-Thoracic Surgery, 2015

OBJECTIVES: As the indication for antiplatelet medication expands, patients may be exposed to an ... more OBJECTIVES: As the indication for antiplatelet medication expands, patients may be exposed to an increased risk of excessive blood loss when cardiac surgery is required. The optimal timing to stop acetylsalicylic acid (ASA) or ASA combined with clopidogrel (ASA+Clo) before surgery is the subject of controversy. METHODS: A total of 1065 patients were selected from a prospective randomized study on the effect of a fibrin sealant application in coronary artery bypass graft surgery [Fibrin sealant Induced Blood Exposure Reduction study; Registration number: NTR1386 (http://www. trialregister.nl)], and divided into three groups according to the use of antiplatelet medication within 10 days prior to surgery: (i) ASA only (n = 662), (ii) ASA+Clo (n = 290) or (iii) no antiplatelet medication (n = 113). To investigate if an optimal stop day could be established, we fitted a series of multiple linear regression models, one for each preoperative day (running from Day −10 up to −1). The specific day corresponding to the best fitting model (highest adjusted R 2 , with blood loss in the first 48 h postoperatively as the dependent variable) was considered as the best estimate for the optimal stop day. Bootstrap analysis (1000 times) was performed to calculate the corresponding confidence interval. Furthermore, major adverse cardiovascular and cerebral events (MACCE) were evaluated. RESULTS: We could not estimate an optimal stop day for patients using ASA or ASA+Clo prior to their operation. Last use of ASA on Day −2 or earlier significantly decreased the percentage of patients receiving platelet transfusions compared with continuation until surgery (7 vs 13% for Day −1, P = 0.007). In patients using ASA+Clo, this percentage was reduced from 41 to 10 (P < 0.001). There was no association between stop day and the occurrence of MACCE. CONCLUSIONS: There is no clinically relevant effect on blood loss indicating an optimal stop day for ASA alone or in combination with Clo. Last use on Day −2 resulted in the reduction of percentage of patients receiving platelet transfusions, especially in the ASA+Clo group.

The Annals of Thoracic Surgery, 2014

Background. Management of pulmonary atresia with intact ventricular septum (PAIVS) is challenging... more Background. Management of pulmonary atresia with intact ventricular septum (PAIVS) is challenging and depends on the individual patient's morphologic characteristics. We evaluated outcomes of 25 years of experience in morphologically driven management of PAIVS. Methods. Between January 1985 and December 2011, 60 patients were treated for PAIVS. Patients were retrospectively categorized into mild (n [ 27), moderate (n [ 18), and severe (n [ 15) right ventricular (RV) hypoplasia subgroups based on morphologic characteristics at first presentation. Tricuspid valve (TV) annulus z score increases were analyzed in patients who underwent biventricular repair and in patients who underwent 1.5ventricular repair. Median follow-up time was 9.8 years (range, 0-25 years). One patient was lost to follow-up. Results. Fifty-nine (98.3%) patients underwent operation. There were 7 early postprocedure deaths and 1 late death. Estimated overall survival was 86.5% at 10 years after initial admission for the total group, and 96.3%,

Interactive CardioVascular and Thoracic Surgery, 2014

Objectives: To evaluate outcome and risk factors of reoperation after previous repair of atrioven... more Objectives: To evaluate outcome and risk factors of reoperation after previous repair of atrioventricular septal defect (AVSD). Methods: Between 1976 and 2014, 72 patients were reoperated after initial repair of partial (n = 28), intermediate (n = 15), or complete (n = 29) AVSD. Results: Median age at first reoperation was 57 (range 1.6-844) months, median interval to first reoperation was 22 (range 0-598) months. Main indications for first reoperation included left atrioventricular valve (LAVV) regurgitation (85%), residual septal defect (25%), and left ventricular outflow tract obstruction (LVOTO; 6%). Procedures for LAVV regurgitation included various types of valvuloplasty in 47 (66%) patients and valve replacement in 14 (19%) patients. There were 10 early and 5 late deaths. Estimated overall survival at 1 and 10 years was 87% and 82%. LAVV replacement was a risk factor for mortality (HR, 3.8; P = 0.022). A 2nd, 3rd, 4th, and 5th reoperation was required in 27, 12, 4, and 1 patients, respectively. Most common procedures were LAVV replacement, LVOTO relief, pacemaker implantation and RAVV repair or replacement. Freedom from additional valve operation after redo LAVV valvuloplasty at 1 and 10 years was 84% and 65%, respectively, with absence of Down syndrome being a risk factor (HR, 3.0; P = 0.043). At last follow-up (median 9.8, range 0-34 years), 81% survivors were in NYHA class I or II. Conclusion: LAVV pathology was the most common indication for reoperation. LAVV replacement was a risk factor for death. Absence of Down syndrome was a risk factor for LAVV valvuloplasty failure. AVSD type appeared not to be a risk factor for mortality or reoperation.

Netherlands Heart Journal, 2012

Despite improvements in surgical techniques and the implementation of effective brain protection ... more Despite improvements in surgical techniques and the implementation of effective brain protection strategies, the incidence of brain injury after cardiac surgery has remained relatively constant over the years as patients have become older and sicker. Cognitive dysfunction is the most common clinical manifestation of brain injury after cardiac surgery. Its occurrence is related to a combination of three factors that are often associated with cardiopulmonary bypass (CPB): embolism, hypoperfusion, and the inflammatory response. However, such factors and their potential cerebral consequences are not exclusive to CPB. Postoperative cognitive dysfunction also afflicts patients who undergo cardiac surgery without CPB as well as nonsurgery patients who undergo transcatheter interventions. There is growing evidence that patient-related factors such as the presence of (cerebro)vascular risk factors play an important role in both early and late postoperative cognitive dysfunction.