Clinical research in cardiology : official journal of the German Cardiac Society
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Multicenter Study
Acute heart failure with mid-range left ventricular ejection fraction: clinical profile, in-hospital management, and short-term outcome.
Heart failure with mid-range left ventricular ejection fraction (HFmrEF) is a poorly characterized population as it has been studied either in the context of HF with reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (LVEF) depending on applied LVEF cutoffs. We sought to investigate the clinical profile, in-hospital management, and short-term outcome of HFmrEF patients in comparison with those with HFrEF or HFpEF in a large acute HF cohort. ⋯ Hospitalized HFmrEF patients represent a demographically and clinically diverse group with many intermediate features compared to HFrEF and HFpEF and carry a lower risk of short-term mortality than HFrEF but a similar risk with HFpEF.
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The use of the MitraClip system has gained widespread acceptance for the treatment of patients with mitral regurgitation (MR) who are not suitable for the conventional surgery. This study sought to investigate the early and 1-year outcome after MitraClip therapy of patients with MR and cardiac comorbidities. ⋯ The MitraClip implantation is feasible and safe even in high-risk patients with MR and cardiac comorbidities.
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Despite the completion of more than 60,000 transcutaneous aortic valve implantations (TAVI) per year and an approximately 10-15 % incidence of vascular access site complications (VAC), there is a paucity of data on the efficacy and safety of percutaneous VAC treatment. ⋯ Percutaneous treatment of VAC during TAVI is safe and effectively helps to minimize the need for surgery in the vast majority of VAC. During short- and mid-term follow-up, percutaneous VAC management is associated with low complication rates and good clinical outcomes.
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Multicenter Study Observational Study
Procedural safety of a fully implantable intravenous prostanoid pump for pulmonary hypertension.
In patients with severe pulmonary arterial hypertension, subcutaneous or catheter-based intravenous application of prostanoids carries a risk of local side effects or systemic infections, which limits their use and acceptance. Recently, a fully implantable pump for continuous application of intravenous treprostinil was approved in Germany. However, surgery is a major risk for patients with severe pulmonary arterial hypertension. The purpose of this study was to investigate the safety of a fully implantable pump inserted under local or general anesthesia in patients with severe pulmonary hypertension. ⋯ Our observational study provides preliminary evidence supporting the procedural safety of a fully implantable pump inserted under local or general anesthesia for patients with severe pulmonary hypertension. The observation of major complications in a subset of patients requires extensive pre- and post-operative assessments. Future trials are required to provide further evidence for the long-term safety and efficacy of the pump using this approach.
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Comparative Study
Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation with or without oral anticoagulation.
After transcatheter aortic valve implantation, early leaflet thickening, presumably reflecting thrombus, has recently been described on computed tomography angiography (CTA) in ~10% of the patients. We sought to investigate the impact of the antithrombotic regimen on the course of leaflet thickening. ⋯ The course of leaflet restriction was fundamentally different depending on the presence or absence of anticoagulation, with consistent regression under phenprocoumon, but mostly progression under antiplatelet therapy alone. Changes in leaflet restriction were associated with changes in transvalvular pressure gradients.