Utz Kappert - Academia.edu (original) (raw)
Papers by Utz Kappert
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 28, 2015
Objective of the present study was to compare VARC-2 access and bleeding complications of a compl... more Objective of the present study was to compare VARC-2 access and bleeding complications of a complete percutaneous versus a surgical cut-down approach for transfemoral TAVI "in a real world-all comers" setting. The ideal approach for transfemoral TAVI is still part of a lively debate. Until today, for none of the available techniques superiority could be demonstrated. The present study adds a considerable number of patients to the available experience. The study included 334 consecutive patients, including 199 patients in the percutaneous and 135 patients in the cut-down group. Mean patient's age was 81.4 ± 4.6. Calculated logistic EuroSCORE correlated an intermediate to high surgical risk (17.8% ± 12.3%). Primary study endpoints were vascular access site as well as bleeding complications according the actual VARC-2 criteria. Mean procedure time was significantly shorter in the cut-down group (69 ± 19 min vs. 91 ± 22 min; P < 0.01). Overall rate of VARC-2 access comp...
The Annals of Thoracic Surgery, 2016
An open operation on the aortic arch is a complex procedure that requires not only surgical exper... more An open operation on the aortic arch is a complex procedure that requires not only surgical expertise but also meticulous management to ensure excellent outcomes. In recent years, the procedure has often been performed with the patient under circulatory arrest, with antegrade cerebral perfusion. With such a strategy, efficient monitoring to ensure adequate cerebral perfusion is essential. Here we describe a case of Stanford type A aortic dissection repair in which transcranial Doppler sonography was used as an excellent monitoring tool to allow visualization of cerebral flow and the online status of perfusion, providing instant feedback to allow changes in strategy to optimize inadequate cerebral perfusion.
Kardiologie up2date, 2015
Z Kardiol, 2003
ABSTRACT Coronary perforation and entrapment of catheter materials are rare, but life-threatening... more ABSTRACT Coronary perforation and entrapment of catheter materials are rare, but life-threatening complications, which often require emergency cardiosurgical treatment. Surgical options include tamponade drainage, coronary artery bypass grafting, perforation suturing, and removal of catheter materials. Surgical strategies are not standardized but mainly depend on the surgical anatomy. This is in particular true for the removal of the catheter remnants (stent, guidewire). Keeping this in mind, these patients can be treated with good clinical results.
The Thoracic and Cardiovascular Surgeon, Nov 1, 2007
Octogenarians are increasingly considered for coronary artery bypass grafting (CABG), but still r... more Octogenarians are increasingly considered for coronary artery bypass grafting (CABG), but still represent a high-risk patient group with increased mortality and morbidity. In recent years off-pump surgery has been successfully established in CABG. The avoidance of extracorporeal circulation (ECC) seems to be of particular benefit for this patient group. We retrospectively analyzed our experience with CABG surgery with and without ECC in octogenarians to define the potential benefit of these different approaches in this high-risk group of patients. We analyzed the outcome after isolated CABG of 344 consecutive patients (219 male, 125 female, age: 82 +/- 2.4 years) who were aged 80 or older. Patients were divided into two groups according to the use of ECC. The on-pump group consisted of 237 patients (151 male, 86 female, 82 +/- 2.8 years) and the off-pump group consisted of 107 patients (68 male, 39 female, 82 +/- 1.9 years). The predicted EuroSCORE and EuroSCORE mortality risk were similar for both patient groups. The overall hospital mortality rate was 5.5 % (n = 17): 14 patients (5.9 %) in the on-pump group (n = 237, 100 %) and five patients (4.6 %) in the off-pump group (n = 107, 100 %). The average number of grafts in the on-pump group was 2.8 +/- 0.4 and it was 2.4 +/- 0.6 in the off-pump group ( P = 0.05). Morbidity was comparable in both groups. Significant variables in multivariate regression were preoperative atrial fibrillation ( P = 0.03; RR = 2.7), COPD ( P = 0.0001; RR = 6.5) and prolonged intubation ( P = 0.005; RR = 4.1). Isolated CABG in octogenarians can be performed with good clinical results, although a substantial mortality remains. The results of coronary surgery in this patient group with and without ECC are comparable with respect to mortality and morbidity.
Clinical Research in Cardiology, Mar 1, 2010
Annals of vascular surgery, Jan 12, 2015
The latest advances in treatment of aortic arch pathologies increasingly included endovascular te... more The latest advances in treatment of aortic arch pathologies increasingly included endovascular technologies. For those purposes, more detailed knowledge about the specific anatomic features are of particular interest, especially with regard on the need for better suitable stent grafts or even development of "off-the-shelf" stents. The study enrolled patients undergoing computed tomography of the chest for other reasons than screening for aortic disease. Patients with aortic pathologies were excluded. Finally, 118 patients were included. Anatomic features of the aortic arch, the supra-aortic branches, distances and takeoff angles as well as specific diameters were assessed and analyzed with respect to the patients height, weight, age, and sex. A significant variability of all measurements was observed. Nonetheless, 4 recurrent types of aortic arch geometry were identified: (1) Classic arch (39%), (2) Gothic arch (39%), (3) Rectangle arch (11.9%), and (4) Plain arch (8.5%). ...
Heart Surgery Forum
Background: To avoid hemodynamic deterioration during tilting of the heart in off-pump surgery, w... more Background: To avoid hemodynamic deterioration during tilting of the heart in off-pump surgery, we perform atrial pacing. We describe hemodynamic evaluation of this simple maneuver.
The Journal of invasive cardiology
Percutaneous defect closure is well established in patients with a symptomatic patent foramen ova... more Percutaneous defect closure is well established in patients with a symptomatic patent foramen ovale (PFO). Despite a safe interventional procedure, severe complications have been described during device implantation or follow up. Two patients are described whose cases may serve to warn of an unusual complication associated with a closure device. Several weeks after percutaneous PFO closure, perforation of a device strut into the aortic root was evident in both asymptomatic patients. The perforations were repaired surgically and both patients had further uneventful follow-ups. Procedures which could decrease the risk of device perforation should be adhered to and the indication for closure should consider this potential complication.
Innovations (Philadelphia, Pa.)
This study aimed to simplify an until-now complex procedure for the treatment of proximal aortic ... more This study aimed to simplify an until-now complex procedure for the treatment of proximal aortic arch pathology (zones 0 and 1), where a deep hypothermic circulatory arrest even with selective cerebral perfusion is still a high-risk procedure with accompanying splanchnic and spinal cord ischemia. From June 2012 until March 2013, 106 patients underwent aortic surgery in our institution, of whom, 20 patients underwent aortic arch surgery. Of the 20 patients, 7 with multiple comorbidities and a high operative risk and no other indication for a cardiopulmonary bypass were selected to undergo an off-pump aortic arch debranching and thoracic endovascular aortic repair: 4 patients had chronic dissections, and 3 patients had arch aneurysms. The procedure was performed through median sternotomy. The supraaortic branches were rerouted to the ascending aorta, and this process was followed by thoracic endovascular aortic repair of the aortic arch and proximal descending aorta. Transaortic anteg...
European Heart Journal, 2015
The Thoracic and Cardiovascular Surgeon, 2015
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie, 2006
Zusammenfassung Koronarchirurgische Interventionen betreffen mit zunehmender Häufigkeit Patienten... more Zusammenfassung Koronarchirurgische Interventionen betreffen mit zunehmender Häufigkeit Patienten in der achten Lebensdekade. Gleichwohl stellen diese, bei relativ hoher Morbidität und Mortalität, eine Hochrisikogruppe dar. In den vergangenen Jahren konnte sich die Off-pump-Chirurgie innerhalb der Koronarchirurgie etablieren. Insbesondere für Hochrisikopatienten scheint der Verzicht der extrakorporalen Zirkulation (EKZ) eine sinnvolle Alternative. Im Rahmen einer retrospektiven Untersuchung untersuchten wir den klinischen Verlauf nach isolierter koronarchirurgischer Versorgung von Patienten in der achten Lebensdekade mit und ohne Einsatz der EKZ.
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie, 2007
ABSTRACT Die Koronarchirurgie ist bei Patienten mit einer terminalen, dialysepflichtigen Nierenin... more ABSTRACT Die Koronarchirurgie ist bei Patienten mit einer terminalen, dialysepflichtigen Niereninsuffizienz als ein Standardverfahren in der Therapie der koronaren Herzkrankheit (KHK) etabliert, gilt jedoch weiterhin als Risikoeingriff. Die Vermeidung der extrakorporalen Zirkulation (EKZ) erscheint besonders für diese Patientengruppe besonders attraktiv. In der vorliegenden retrospektiven Studie wurden die Ergebnisse der Koronarchirurgie bei Patienten mit dialysepflichtiger Niereninsuffizienz mit und ohne EKZ verglichen.Retrospektiv analysiert wurden die klinischen Ergebnisse von 73 isoliert koronarchirurgisch therapierten, terminal niereninsuffizienten dialysepflichtigen Patienten. Betrachtet wurde eine On-Pump-Gruppe (43 Patienten; 7 Frauen, 36 Männer; 65±7,3 Jahre) und eine Off-Pump-Gruppe (30 Patienten; 4 Frauen, 26 Männer; 67±7,2 Jahre) ein.Die demographischen und präoperativen Daten waren innerhalb beider Gruppen vergleichbar. Die Gesamt-Hospitalmortalität lag bei 4,2% (n=3). Davon verstarben zwei Patienten (4,6%) aus der On-Pump-Gruppe, sowie ein Patient (3,3%), aus der Off-Pump-Gruppe. Die Morbidität in beiden Gruppen war vergleichbar. Die durchschnittliche Anzahl an implantierten Grafts betrug 3,1±0,9 in der On-Pump und 2,9±0,8 in der Off-Pump-Gruppe. Während der Nachbeobachtung (mittlerer Nachbeobachtungszeit 25±19 Monate) verstarben 13 Patienten (30,2%) der On-Pump-Gruppe, neun davon (69,2%) aufgrund kardialer Ursache. Innerhalb der Off-Pump-Gruppe verstarben acht Patienten (26,7%), ebenfalls meist (n=5; 62,5%) aufgrund kardialer Ursachen. Koronarchirurgie kann bei Patienten mit terminaler, dialysepflichtiger Niereninsuffizienz mit guten klinischen Ergebnissen und geringer Morbidität durchgeführt werden. Dabei sind die Ergebnisse mit und ohne Einsatz der EKZ vergleichbar. Jedoch unterliegen die mittelfristigen Ergebnisse immer noch relativ häufig kardialen Komplikationen.
Kardiologie up2date, 2009
Insuffizienzen der rechtsseitigen Herzklappen sind selten primäre Erkrankungen, sondern häufig se... more Insuffizienzen der rechtsseitigen Herzklappen sind selten primäre Erkrankungen, sondern häufig sekundäre Folgen eines linksseitigen Klappenvitiums oder eines angeborenen Herzfehlers. Die Klinik des Patien-
Clinical research in cardiology supplements, 2011
Calcified aortic stenosis is the predominant valve disease in the western world. Currently, surgi... more Calcified aortic stenosis is the predominant valve disease in the western world. Currently, surgical aortic valve replacement is the gold standard procedure for symptomatic severe aortic stenosis that can be performed with low morbidity and mortality. The prevalence of aortic stenosis increases with age, and the incidence of several comorbidities also unavoidably elevates the risk of surgical treatment. Therefore, the most adequate and gentle treatment is needed especially for this population. Since the first transcatheter aortic valve implantation (TAVI) was performed in 2002, the main implanting routes are the transfemoral, retrograde access through the common femoral artery, and the antegrade, transapical approach via anterolateral minithoracotomy. Meanwhile, TAVI has become an alternative treatment for patients who are not suitable candidates for surgical therapy in some centers.The initial clinical results are promising and have confirmed the feasibility of this technique. Due ...
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 28, 2015
Objective of the present study was to compare VARC-2 access and bleeding complications of a compl... more Objective of the present study was to compare VARC-2 access and bleeding complications of a complete percutaneous versus a surgical cut-down approach for transfemoral TAVI "in a real world-all comers" setting. The ideal approach for transfemoral TAVI is still part of a lively debate. Until today, for none of the available techniques superiority could be demonstrated. The present study adds a considerable number of patients to the available experience. The study included 334 consecutive patients, including 199 patients in the percutaneous and 135 patients in the cut-down group. Mean patient's age was 81.4 ± 4.6. Calculated logistic EuroSCORE correlated an intermediate to high surgical risk (17.8% ± 12.3%). Primary study endpoints were vascular access site as well as bleeding complications according the actual VARC-2 criteria. Mean procedure time was significantly shorter in the cut-down group (69 ± 19 min vs. 91 ± 22 min; P < 0.01). Overall rate of VARC-2 access comp...
The Annals of Thoracic Surgery, 2016
An open operation on the aortic arch is a complex procedure that requires not only surgical exper... more An open operation on the aortic arch is a complex procedure that requires not only surgical expertise but also meticulous management to ensure excellent outcomes. In recent years, the procedure has often been performed with the patient under circulatory arrest, with antegrade cerebral perfusion. With such a strategy, efficient monitoring to ensure adequate cerebral perfusion is essential. Here we describe a case of Stanford type A aortic dissection repair in which transcranial Doppler sonography was used as an excellent monitoring tool to allow visualization of cerebral flow and the online status of perfusion, providing instant feedback to allow changes in strategy to optimize inadequate cerebral perfusion.
Kardiologie up2date, 2015
Z Kardiol, 2003
ABSTRACT Coronary perforation and entrapment of catheter materials are rare, but life-threatening... more ABSTRACT Coronary perforation and entrapment of catheter materials are rare, but life-threatening complications, which often require emergency cardiosurgical treatment. Surgical options include tamponade drainage, coronary artery bypass grafting, perforation suturing, and removal of catheter materials. Surgical strategies are not standardized but mainly depend on the surgical anatomy. This is in particular true for the removal of the catheter remnants (stent, guidewire). Keeping this in mind, these patients can be treated with good clinical results.
The Thoracic and Cardiovascular Surgeon, Nov 1, 2007
Octogenarians are increasingly considered for coronary artery bypass grafting (CABG), but still r... more Octogenarians are increasingly considered for coronary artery bypass grafting (CABG), but still represent a high-risk patient group with increased mortality and morbidity. In recent years off-pump surgery has been successfully established in CABG. The avoidance of extracorporeal circulation (ECC) seems to be of particular benefit for this patient group. We retrospectively analyzed our experience with CABG surgery with and without ECC in octogenarians to define the potential benefit of these different approaches in this high-risk group of patients. We analyzed the outcome after isolated CABG of 344 consecutive patients (219 male, 125 female, age: 82 +/- 2.4 years) who were aged 80 or older. Patients were divided into two groups according to the use of ECC. The on-pump group consisted of 237 patients (151 male, 86 female, 82 +/- 2.8 years) and the off-pump group consisted of 107 patients (68 male, 39 female, 82 +/- 1.9 years). The predicted EuroSCORE and EuroSCORE mortality risk were similar for both patient groups. The overall hospital mortality rate was 5.5 % (n = 17): 14 patients (5.9 %) in the on-pump group (n = 237, 100 %) and five patients (4.6 %) in the off-pump group (n = 107, 100 %). The average number of grafts in the on-pump group was 2.8 +/- 0.4 and it was 2.4 +/- 0.6 in the off-pump group ( P = 0.05). Morbidity was comparable in both groups. Significant variables in multivariate regression were preoperative atrial fibrillation ( P = 0.03; RR = 2.7), COPD ( P = 0.0001; RR = 6.5) and prolonged intubation ( P = 0.005; RR = 4.1). Isolated CABG in octogenarians can be performed with good clinical results, although a substantial mortality remains. The results of coronary surgery in this patient group with and without ECC are comparable with respect to mortality and morbidity.
Clinical Research in Cardiology, Mar 1, 2010
Annals of vascular surgery, Jan 12, 2015
The latest advances in treatment of aortic arch pathologies increasingly included endovascular te... more The latest advances in treatment of aortic arch pathologies increasingly included endovascular technologies. For those purposes, more detailed knowledge about the specific anatomic features are of particular interest, especially with regard on the need for better suitable stent grafts or even development of "off-the-shelf" stents. The study enrolled patients undergoing computed tomography of the chest for other reasons than screening for aortic disease. Patients with aortic pathologies were excluded. Finally, 118 patients were included. Anatomic features of the aortic arch, the supra-aortic branches, distances and takeoff angles as well as specific diameters were assessed and analyzed with respect to the patients height, weight, age, and sex. A significant variability of all measurements was observed. Nonetheless, 4 recurrent types of aortic arch geometry were identified: (1) Classic arch (39%), (2) Gothic arch (39%), (3) Rectangle arch (11.9%), and (4) Plain arch (8.5%). ...
Heart Surgery Forum
Background: To avoid hemodynamic deterioration during tilting of the heart in off-pump surgery, w... more Background: To avoid hemodynamic deterioration during tilting of the heart in off-pump surgery, we perform atrial pacing. We describe hemodynamic evaluation of this simple maneuver.
The Journal of invasive cardiology
Percutaneous defect closure is well established in patients with a symptomatic patent foramen ova... more Percutaneous defect closure is well established in patients with a symptomatic patent foramen ovale (PFO). Despite a safe interventional procedure, severe complications have been described during device implantation or follow up. Two patients are described whose cases may serve to warn of an unusual complication associated with a closure device. Several weeks after percutaneous PFO closure, perforation of a device strut into the aortic root was evident in both asymptomatic patients. The perforations were repaired surgically and both patients had further uneventful follow-ups. Procedures which could decrease the risk of device perforation should be adhered to and the indication for closure should consider this potential complication.
Innovations (Philadelphia, Pa.)
This study aimed to simplify an until-now complex procedure for the treatment of proximal aortic ... more This study aimed to simplify an until-now complex procedure for the treatment of proximal aortic arch pathology (zones 0 and 1), where a deep hypothermic circulatory arrest even with selective cerebral perfusion is still a high-risk procedure with accompanying splanchnic and spinal cord ischemia. From June 2012 until March 2013, 106 patients underwent aortic surgery in our institution, of whom, 20 patients underwent aortic arch surgery. Of the 20 patients, 7 with multiple comorbidities and a high operative risk and no other indication for a cardiopulmonary bypass were selected to undergo an off-pump aortic arch debranching and thoracic endovascular aortic repair: 4 patients had chronic dissections, and 3 patients had arch aneurysms. The procedure was performed through median sternotomy. The supraaortic branches were rerouted to the ascending aorta, and this process was followed by thoracic endovascular aortic repair of the aortic arch and proximal descending aorta. Transaortic anteg...
European Heart Journal, 2015
The Thoracic and Cardiovascular Surgeon, 2015
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie, 2006
Zusammenfassung Koronarchirurgische Interventionen betreffen mit zunehmender Häufigkeit Patienten... more Zusammenfassung Koronarchirurgische Interventionen betreffen mit zunehmender Häufigkeit Patienten in der achten Lebensdekade. Gleichwohl stellen diese, bei relativ hoher Morbidität und Mortalität, eine Hochrisikogruppe dar. In den vergangenen Jahren konnte sich die Off-pump-Chirurgie innerhalb der Koronarchirurgie etablieren. Insbesondere für Hochrisikopatienten scheint der Verzicht der extrakorporalen Zirkulation (EKZ) eine sinnvolle Alternative. Im Rahmen einer retrospektiven Untersuchung untersuchten wir den klinischen Verlauf nach isolierter koronarchirurgischer Versorgung von Patienten in der achten Lebensdekade mit und ohne Einsatz der EKZ.
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie, 2007
ABSTRACT Die Koronarchirurgie ist bei Patienten mit einer terminalen, dialysepflichtigen Nierenin... more ABSTRACT Die Koronarchirurgie ist bei Patienten mit einer terminalen, dialysepflichtigen Niereninsuffizienz als ein Standardverfahren in der Therapie der koronaren Herzkrankheit (KHK) etabliert, gilt jedoch weiterhin als Risikoeingriff. Die Vermeidung der extrakorporalen Zirkulation (EKZ) erscheint besonders für diese Patientengruppe besonders attraktiv. In der vorliegenden retrospektiven Studie wurden die Ergebnisse der Koronarchirurgie bei Patienten mit dialysepflichtiger Niereninsuffizienz mit und ohne EKZ verglichen.Retrospektiv analysiert wurden die klinischen Ergebnisse von 73 isoliert koronarchirurgisch therapierten, terminal niereninsuffizienten dialysepflichtigen Patienten. Betrachtet wurde eine On-Pump-Gruppe (43 Patienten; 7 Frauen, 36 Männer; 65±7,3 Jahre) und eine Off-Pump-Gruppe (30 Patienten; 4 Frauen, 26 Männer; 67±7,2 Jahre) ein.Die demographischen und präoperativen Daten waren innerhalb beider Gruppen vergleichbar. Die Gesamt-Hospitalmortalität lag bei 4,2% (n=3). Davon verstarben zwei Patienten (4,6%) aus der On-Pump-Gruppe, sowie ein Patient (3,3%), aus der Off-Pump-Gruppe. Die Morbidität in beiden Gruppen war vergleichbar. Die durchschnittliche Anzahl an implantierten Grafts betrug 3,1±0,9 in der On-Pump und 2,9±0,8 in der Off-Pump-Gruppe. Während der Nachbeobachtung (mittlerer Nachbeobachtungszeit 25±19 Monate) verstarben 13 Patienten (30,2%) der On-Pump-Gruppe, neun davon (69,2%) aufgrund kardialer Ursache. Innerhalb der Off-Pump-Gruppe verstarben acht Patienten (26,7%), ebenfalls meist (n=5; 62,5%) aufgrund kardialer Ursachen. Koronarchirurgie kann bei Patienten mit terminaler, dialysepflichtiger Niereninsuffizienz mit guten klinischen Ergebnissen und geringer Morbidität durchgeführt werden. Dabei sind die Ergebnisse mit und ohne Einsatz der EKZ vergleichbar. Jedoch unterliegen die mittelfristigen Ergebnisse immer noch relativ häufig kardialen Komplikationen.
Kardiologie up2date, 2009
Insuffizienzen der rechtsseitigen Herzklappen sind selten primäre Erkrankungen, sondern häufig se... more Insuffizienzen der rechtsseitigen Herzklappen sind selten primäre Erkrankungen, sondern häufig sekundäre Folgen eines linksseitigen Klappenvitiums oder eines angeborenen Herzfehlers. Die Klinik des Patien-
Clinical research in cardiology supplements, 2011
Calcified aortic stenosis is the predominant valve disease in the western world. Currently, surgi... more Calcified aortic stenosis is the predominant valve disease in the western world. Currently, surgical aortic valve replacement is the gold standard procedure for symptomatic severe aortic stenosis that can be performed with low morbidity and mortality. The prevalence of aortic stenosis increases with age, and the incidence of several comorbidities also unavoidably elevates the risk of surgical treatment. Therefore, the most adequate and gentle treatment is needed especially for this population. Since the first transcatheter aortic valve implantation (TAVI) was performed in 2002, the main implanting routes are the transfemoral, retrograde access through the common femoral artery, and the antegrade, transapical approach via anterolateral minithoracotomy. Meanwhile, TAVI has become an alternative treatment for patients who are not suitable candidates for surgical therapy in some centers.The initial clinical results are promising and have confirmed the feasibility of this technique. Due ...