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Papers by thomas pilgrim

Research paper thumbnail of Incidence and Predictors of Atrioventricular Conduction Impairment After Transcatheter Aortic Valve Implantation

American Journal of Cardiology, 2010

Atrioventricular (AV) conduction impairment is well described after surgical aortic valve replace... more Atrioventricular (AV) conduction impairment is well described after surgical aortic valve replacement, but little is known in patients undergoing transcatheter aortic valve implantation (TAVI). We assessed AV conduction and need for a permanent pacemaker in patients undergoing TAVI with the Medtronic CoreValve Revalving System (MCRS) or the Edwards Sapien Valve (ESV). Sixty-seven patients without pre-existing permanent pacemaker were included in the study. Forty-one patients (61%) and 26 patients (39%) underwent successful TAVI with the MCRS and ESV, respectively. Complete AV block occurred in 15 patients (22%), second-degree AV block in 4 (6%), and new left bundle branch block in 15 (22%), respectively. A permanent pacemaker was implanted in 23 patients (34%). Overall PR interval and QRS width increased significantly after the procedure (p <0.001 for the 2 comparisons). Implantation of the MCRS compared to the ESV resulted in a trend toward a higher rate of new left bundle branch block and complete AV block (29% vs 12%, p ‫؍‬ 0.09 for the 2 comparisons). During follow-up, complete AV block resolved in 64% of patients. In multivariable regression analysis pre-existing right bundle branch block was the only independent predictor of complete AV block after TAVI (relative risk 7.3, 95% confidence interval 2.4 to 22.2). In conclusion, TAVI is associated with impairment of AV conduction in a considerable portion of patients, patients with pre-existing right bundle branch block are at increased risk of complete AV block, and complete AV block resolves over time in most patients.

Research paper thumbnail of Clinical Outcome of High-Risk Patients with Severe Aortic Stenosis and Reduced Left Ventricular Ejection Fraction Undergoing Medical Treatment or TAVI

PLOS One, 2011

Introduction: Reduced left ventricular function in patients with severe symptomatic valvular aort... more Introduction: Reduced left ventricular function in patients with severe symptomatic valvular aortic stenosis is associated with impaired clinical outcome in patients undergoing surgical aortic valve replacement (SAVR). Transcatheter Aortic Valve Implantation (TAVI) has been shown non-inferior to SAVR in high-risk patients with respect to mortality and may result in faster left ventricular recovery.

Research paper thumbnail of Aortenklappenersatz bei älteren Patienten mit schwerer Aortenstenose

Summary Severe calcific aortic stenosis is a disease of the elderly and associated with reduced q... more Summary Severe calcific aortic stenosis is a disease of the elderly and associated with reduced quality of life and adverse prognosis. According to demographic estimations the share of octogenarians will markedly increase in the course of the decades to come. As a consequence, the incidence of symptomatic aortic stenosis will increase along with the need for minimally invasive treatment options.

Research paper thumbnail of Clinical outcome and predictors for adverse events after transcatheter aortic valve implantation with the use of different devices and access routes

American Heart Journal, 2011

Background Transcatheter aortic valve implantation (TAVI) is a treatment option for high-risk pat... more Background Transcatheter aortic valve implantation (TAVI) is a treatment option for high-risk patients with severe aortic stenosis. Previous reports focused on a single device or access site, whereas little is known of the combined use of different devices and access sites as selected by the heart team. The purpose of this study is to investigate clinical outcomes of TAVI using different devices and access sites. Methods A consecutive cohort of 200 patients underwent TAVI with the Medtronic CoreValve Revalving system (Medtronic Core Valve LLC, Irvine, CA; n = 130) or the Edwards SAPIEN valve (Edwards Lifesciences LLC, Irvine, CA; n = 70) implanted by either the transfemoral or transapical access route.

Research paper thumbnail of Transcatheter Aortic Valve Implantation or Surgical Aortic Valve Replacement as Redo Procedure After Prior Coronary Artery Bypass Grafting

Annals of Thoracic Surgery, 2011

The perioperative risk for redo surgical aortic valve replacement (S-AVR) in patients with severe... more The perioperative risk for redo surgical aortic valve replacement (S-AVR) in patients with severe aortic stenosis and prior coronary artery bypass grafting (CABG) is increased. Transcatheter aortic valve implantation (TAVI) represents an alternative. We assessed the perioperative and mid-term clinical outcome of patients undergoing S-AVR or TAVI.In a retrospective observational, comparative study, 40 consecutive patients underwent redo operation with S-AVR or TAVI between April 2005 and April 2010. Median sternotomy and extracorporeal circulation were used for S-AVR; TAVI access was transfemoral (n = 27; 67.5%), transapical (n = 11; 27.5%), or transsubclavian (n = 2; 5.0%). Clinical and echocardiographic follow-up was at 30 days and 6 months.TAVI patients were older (78.5 ± 6 vs 70.6 ± 8 years, p < 0.001) and presented higher logistic (33.5 ± 17 vs 20.2 ± 14, p < 0.001) European System for Cardiac Operative Risk Evaluation scores. All-cause mortality was 2.5% in both groups and major adverse cardiac and cerebrovascular event rates were comparable (7.5% TAVI vs 17.5% S-AVR, p = 0.311) after 30 days. TAVI was associated with a higher rate of permanent pacemaker implantation (30% vs 0%, p < 0.001) and grade II residual aortic regurgitation in 14%. Incidence of cerebrovascular events was 7.5% in S-AVR vs 2.5% in TAVI (p = 0.61).In elderly, high-risk patients after prior CABG, conventional aortic valve replacement and TAVI are comparable treatment options with favorable clinical outcome. A redo operation itself does not sufficiently justify a TAVI approach.

Research paper thumbnail of Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving System—A Bern-Rotterdam Study

American Heart Journal, 2010

Research paper thumbnail of 2Year Clinical Follow-Up From the Randomized Comparison of Biolimus-Eluting Stents With Biodegradable Polymer and Sirolimus-Eluting Stents With Durable Polymer in Routine Clinical Practice

Jacc-cardiovascular Interventions, 2011

Objectives This study sought to investigate safety and efficacy of biolimus-eluting stents (BES) ... more Objectives This study sought to investigate safety and efficacy of biolimus-eluting stents (BES) with biodegradable polymer as compared with sirolimus-eluting stents (SES) with durable polymer through 2 years of follow-up.

Research paper thumbnail of Comparison of Titanium-Nitride-Oxide–Coated Stents With Zotarolimus-Eluting Stents for Coronary Revascularization

Jacc-cardiovascular Interventions, 2011

Objectives This study sought to compare the efficacy of passive stent coating with titanium-nitri... more Objectives This study sought to compare the efficacy of passive stent coating with titanium-nitride-oxide (TiNO) with drug-eluting stents releasing zotarolimus (ZES) (Endeavor, Medtronic, Minneapolis, Minnesota).

Research paper thumbnail of Medikamenten-freisetzende Ballonkatheter (Drug-eluting Balloons) in der Behandlung der koronaren Herzkrankheit Stellungnahme der Arbeitsgruppe «Interventionelle Kardiologie» und «Akute Koronarsyndrome» der SGK

Summary Drug-eluting balloons use paclitaxel as active sub- stance on account of its high absorpt... more Summary Drug-eluting balloons use paclitaxel as active sub- stance on account of its high absorption rate, rapid as- similation by the intima and long-lasting effect. Clini- cal studies have investigated the safety and effective- ness of drug-eluting balloons in various clinical scenarios and support the use of paclitaxel-eluting bal- loons for the treatment of in-stent restenoses with a re- ference-vessel

Research paper thumbnail of Comprehensive "one stop-shop" percutaneous cardiac intervention

Summary A 78-year-old male retired mathematician with severe aortic stenosis, persistant atrial f... more Summary A 78-year-old male retired mathematician with severe aortic stenosis, persistant atrial fibrillation, reluctance to accept oral anticoagulation, and with suspected coro- nary artery disease was referred for further manage- ment. In a single intervention ,t he left atrial append- age was occluded with a plug, double vessel coronary artery disease was treated with drug-eluting stents, and an aortic bioprosthesis was implanted transfem- orally.

Research paper thumbnail of Impact of Body Mass Index on the Five-Year Outcome of Patients Having Percutaneous Coronary Interventions With Drug-Eluting Stents

American Journal of Cardiology, 2011

The purpose of this study was to assess the impact of body mass index (BMI) on clinical outcome o... more The purpose of this study was to assess the impact of body mass index (BMI) on clinical outcome of patients treated by percutaneous coronary intervention (PCI) using drugeluting stents. Patients were stratified according to BMI as normal (<25 kg/m 2 ), overweight (25 to 30 kg/m 2 ), or obese (>30 kg/m 2 ). At 5-year follow-up all-cause death, myocardial infarction, clinically justified target vessel revascularization (TVR), and definite stent thrombosis were assessed. A complete dataset was available in 7,427 patients, of which 45%, 22%, and 33% were classified according to BMI as overweight, obese, and normal, respectively. Mean age of patients was significantly older in those with a normal BMI (p <0.05). Incidence of diabetes mellitus, hypertension, and dyslipidemia increased as BMI increased (p <0.05). Significantly higher rates of TVR (15.3% vs 12.8%, p ‫؍‬ 0.02) and early stent thrombosis (1.5% vs 0.9%, p ‫؍‬ 0.04) were observed in the obese compared to the normal BMI group. No significant difference among the 3 BMI groups was observed for the composite of death/myocardial infarction/TVR or for definite stent thrombosis at 5 years, whereas the normal BMI group was at higher risk for all-cause death at 5 years (obese vs normal BMI, hazard ratio 0.74, confidence interval 0.53 to 0.99, p ‫؍‬ 0.05; overweight vs normal BMI, hazard ratio 0.73, confidence interval 0.59 to 0.94, p ‫؍‬ 0.01) in the multivariate Cox proportional hazard model. Age resulted in a linearly dependent covariate with BMI in the all-cause 5-year mortality multivariate model (p ‫؍‬ 0.001). In conclusion, the "obesity paradox" observed in 5-year all-cause mortality could be explained by the higher rate of elderly patients in the normal BMI group and the existence of colinearity between BMI and age. However, obese patients had a higher rate of TVR and early stent thrombosis and a higher rate of other risk factors such as diabetes mellitus, hypertension, and hypercholesterolemia.

Research paper thumbnail of Clinical Outcomes of Patients With Severe Aortic Stenosis at Increased Surgical Risk According to Treatment Modality

Journal of The American College of Cardiology, 2011

The aim of this study was to assess the role of transcatheter aortic valve implantation (TAVI) co... more The aim of this study was to assess the role of transcatheter aortic valve implantation (TAVI) compared with medical treatment (MT) and surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) at increased surgical risk.

Research paper thumbnail of Incidence and Predictors of Atrioventricular Conduction Impairment After Transcatheter Aortic Valve Implantation

American Journal of Cardiology, 2010

Atrioventricular (AV) conduction impairment is well described after surgical aortic valve replace... more Atrioventricular (AV) conduction impairment is well described after surgical aortic valve replacement, but little is known in patients undergoing transcatheter aortic valve implantation (TAVI). We assessed AV conduction and need for a permanent pacemaker in patients undergoing TAVI with the Medtronic CoreValve Revalving System (MCRS) or the Edwards Sapien Valve (ESV). Sixty-seven patients without pre-existing permanent pacemaker were included in the study. Forty-one patients (61%) and 26 patients (39%) underwent successful TAVI with the MCRS and ESV, respectively. Complete AV block occurred in 15 patients (22%), second-degree AV block in 4 (6%), and new left bundle branch block in 15 (22%), respectively. A permanent pacemaker was implanted in 23 patients (34%). Overall PR interval and QRS width increased significantly after the procedure (p <0.001 for the 2 comparisons). Implantation of the MCRS compared to the ESV resulted in a trend toward a higher rate of new left bundle branch block and complete AV block (29% vs 12%, p ‫؍‬ 0.09 for the 2 comparisons). During follow-up, complete AV block resolved in 64% of patients. In multivariable regression analysis pre-existing right bundle branch block was the only independent predictor of complete AV block after TAVI (relative risk 7.3, 95% confidence interval 2.4 to 22.2). In conclusion, TAVI is associated with impairment of AV conduction in a considerable portion of patients, patients with pre-existing right bundle branch block are at increased risk of complete AV block, and complete AV block resolves over time in most patients.

Research paper thumbnail of Clinical Outcome of High-Risk Patients with Severe Aortic Stenosis and Reduced Left Ventricular Ejection Fraction Undergoing Medical Treatment or TAVI

PLOS One, 2011

Introduction: Reduced left ventricular function in patients with severe symptomatic valvular aort... more Introduction: Reduced left ventricular function in patients with severe symptomatic valvular aortic stenosis is associated with impaired clinical outcome in patients undergoing surgical aortic valve replacement (SAVR). Transcatheter Aortic Valve Implantation (TAVI) has been shown non-inferior to SAVR in high-risk patients with respect to mortality and may result in faster left ventricular recovery.

Research paper thumbnail of Aortenklappenersatz bei älteren Patienten mit schwerer Aortenstenose

Summary Severe calcific aortic stenosis is a disease of the elderly and associated with reduced q... more Summary Severe calcific aortic stenosis is a disease of the elderly and associated with reduced quality of life and adverse prognosis. According to demographic estimations the share of octogenarians will markedly increase in the course of the decades to come. As a consequence, the incidence of symptomatic aortic stenosis will increase along with the need for minimally invasive treatment options.

Research paper thumbnail of Clinical outcome and predictors for adverse events after transcatheter aortic valve implantation with the use of different devices and access routes

American Heart Journal, 2011

Background Transcatheter aortic valve implantation (TAVI) is a treatment option for high-risk pat... more Background Transcatheter aortic valve implantation (TAVI) is a treatment option for high-risk patients with severe aortic stenosis. Previous reports focused on a single device or access site, whereas little is known of the combined use of different devices and access sites as selected by the heart team. The purpose of this study is to investigate clinical outcomes of TAVI using different devices and access sites. Methods A consecutive cohort of 200 patients underwent TAVI with the Medtronic CoreValve Revalving system (Medtronic Core Valve LLC, Irvine, CA; n = 130) or the Edwards SAPIEN valve (Edwards Lifesciences LLC, Irvine, CA; n = 70) implanted by either the transfemoral or transapical access route.

Research paper thumbnail of Transcatheter Aortic Valve Implantation or Surgical Aortic Valve Replacement as Redo Procedure After Prior Coronary Artery Bypass Grafting

Annals of Thoracic Surgery, 2011

The perioperative risk for redo surgical aortic valve replacement (S-AVR) in patients with severe... more The perioperative risk for redo surgical aortic valve replacement (S-AVR) in patients with severe aortic stenosis and prior coronary artery bypass grafting (CABG) is increased. Transcatheter aortic valve implantation (TAVI) represents an alternative. We assessed the perioperative and mid-term clinical outcome of patients undergoing S-AVR or TAVI.In a retrospective observational, comparative study, 40 consecutive patients underwent redo operation with S-AVR or TAVI between April 2005 and April 2010. Median sternotomy and extracorporeal circulation were used for S-AVR; TAVI access was transfemoral (n = 27; 67.5%), transapical (n = 11; 27.5%), or transsubclavian (n = 2; 5.0%). Clinical and echocardiographic follow-up was at 30 days and 6 months.TAVI patients were older (78.5 ± 6 vs 70.6 ± 8 years, p < 0.001) and presented higher logistic (33.5 ± 17 vs 20.2 ± 14, p < 0.001) European System for Cardiac Operative Risk Evaluation scores. All-cause mortality was 2.5% in both groups and major adverse cardiac and cerebrovascular event rates were comparable (7.5% TAVI vs 17.5% S-AVR, p = 0.311) after 30 days. TAVI was associated with a higher rate of permanent pacemaker implantation (30% vs 0%, p < 0.001) and grade II residual aortic regurgitation in 14%. Incidence of cerebrovascular events was 7.5% in S-AVR vs 2.5% in TAVI (p = 0.61).In elderly, high-risk patients after prior CABG, conventional aortic valve replacement and TAVI are comparable treatment options with favorable clinical outcome. A redo operation itself does not sufficiently justify a TAVI approach.

Research paper thumbnail of Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving System—A Bern-Rotterdam Study

American Heart Journal, 2010

Research paper thumbnail of 2Year Clinical Follow-Up From the Randomized Comparison of Biolimus-Eluting Stents With Biodegradable Polymer and Sirolimus-Eluting Stents With Durable Polymer in Routine Clinical Practice

Jacc-cardiovascular Interventions, 2011

Objectives This study sought to investigate safety and efficacy of biolimus-eluting stents (BES) ... more Objectives This study sought to investigate safety and efficacy of biolimus-eluting stents (BES) with biodegradable polymer as compared with sirolimus-eluting stents (SES) with durable polymer through 2 years of follow-up.

Research paper thumbnail of Comparison of Titanium-Nitride-Oxide–Coated Stents With Zotarolimus-Eluting Stents for Coronary Revascularization

Jacc-cardiovascular Interventions, 2011

Objectives This study sought to compare the efficacy of passive stent coating with titanium-nitri... more Objectives This study sought to compare the efficacy of passive stent coating with titanium-nitride-oxide (TiNO) with drug-eluting stents releasing zotarolimus (ZES) (Endeavor, Medtronic, Minneapolis, Minnesota).

Research paper thumbnail of Medikamenten-freisetzende Ballonkatheter (Drug-eluting Balloons) in der Behandlung der koronaren Herzkrankheit Stellungnahme der Arbeitsgruppe «Interventionelle Kardiologie» und «Akute Koronarsyndrome» der SGK

Summary Drug-eluting balloons use paclitaxel as active sub- stance on account of its high absorpt... more Summary Drug-eluting balloons use paclitaxel as active sub- stance on account of its high absorption rate, rapid as- similation by the intima and long-lasting effect. Clini- cal studies have investigated the safety and effective- ness of drug-eluting balloons in various clinical scenarios and support the use of paclitaxel-eluting bal- loons for the treatment of in-stent restenoses with a re- ference-vessel

Research paper thumbnail of Comprehensive "one stop-shop" percutaneous cardiac intervention

Summary A 78-year-old male retired mathematician with severe aortic stenosis, persistant atrial f... more Summary A 78-year-old male retired mathematician with severe aortic stenosis, persistant atrial fibrillation, reluctance to accept oral anticoagulation, and with suspected coro- nary artery disease was referred for further manage- ment. In a single intervention ,t he left atrial append- age was occluded with a plug, double vessel coronary artery disease was treated with drug-eluting stents, and an aortic bioprosthesis was implanted transfem- orally.

Research paper thumbnail of Impact of Body Mass Index on the Five-Year Outcome of Patients Having Percutaneous Coronary Interventions With Drug-Eluting Stents

American Journal of Cardiology, 2011

The purpose of this study was to assess the impact of body mass index (BMI) on clinical outcome o... more The purpose of this study was to assess the impact of body mass index (BMI) on clinical outcome of patients treated by percutaneous coronary intervention (PCI) using drugeluting stents. Patients were stratified according to BMI as normal (<25 kg/m 2 ), overweight (25 to 30 kg/m 2 ), or obese (>30 kg/m 2 ). At 5-year follow-up all-cause death, myocardial infarction, clinically justified target vessel revascularization (TVR), and definite stent thrombosis were assessed. A complete dataset was available in 7,427 patients, of which 45%, 22%, and 33% were classified according to BMI as overweight, obese, and normal, respectively. Mean age of patients was significantly older in those with a normal BMI (p <0.05). Incidence of diabetes mellitus, hypertension, and dyslipidemia increased as BMI increased (p <0.05). Significantly higher rates of TVR (15.3% vs 12.8%, p ‫؍‬ 0.02) and early stent thrombosis (1.5% vs 0.9%, p ‫؍‬ 0.04) were observed in the obese compared to the normal BMI group. No significant difference among the 3 BMI groups was observed for the composite of death/myocardial infarction/TVR or for definite stent thrombosis at 5 years, whereas the normal BMI group was at higher risk for all-cause death at 5 years (obese vs normal BMI, hazard ratio 0.74, confidence interval 0.53 to 0.99, p ‫؍‬ 0.05; overweight vs normal BMI, hazard ratio 0.73, confidence interval 0.59 to 0.94, p ‫؍‬ 0.01) in the multivariate Cox proportional hazard model. Age resulted in a linearly dependent covariate with BMI in the all-cause 5-year mortality multivariate model (p ‫؍‬ 0.001). In conclusion, the "obesity paradox" observed in 5-year all-cause mortality could be explained by the higher rate of elderly patients in the normal BMI group and the existence of colinearity between BMI and age. However, obese patients had a higher rate of TVR and early stent thrombosis and a higher rate of other risk factors such as diabetes mellitus, hypertension, and hypercholesterolemia.

Research paper thumbnail of Clinical Outcomes of Patients With Severe Aortic Stenosis at Increased Surgical Risk According to Treatment Modality

Journal of The American College of Cardiology, 2011

The aim of this study was to assess the role of transcatheter aortic valve implantation (TAVI) co... more The aim of this study was to assess the role of transcatheter aortic valve implantation (TAVI) compared with medical treatment (MT) and surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) at increased surgical risk.