Miralem Pasic

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Papers by Miralem Pasic

Ebstein's anomaly

Aortic media in bicuspid valve disease - Reply

The Annals of Thoracic Surgery

R, et al. Morphometric analysis of aortic media in patients with bicuspid and tricuspid aortic va... more R, et al. Morphometric analysis of aortic media in patients with bicuspid and tricuspid aortic valve. Ann Thorac Surg 2002;74:58-62. 2. Robicsek F. The post-stenotic dilatation of great vessels. Acta Morphol Acad Sci Hung 1954;4(Suppl1):41. 3. Robicsek F. The post-stenotic dilatation of great vessels. Acta Med Scand 1955;106:481-5. 4. Holman E. The obscure physiology of post-stenotic dilatation: its relation to the development of aneurysms.

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Rescue Transcatheter Aortic Valve Implantation and Simultaneous Percutaneous Coronary Intervention on Cardiopulmonary Bypass in a Patient with an Extreme Risk Profile

The Heart Surgery Forum, 2012

We report on successful emergency transcatheter aortic valve implantation combined with percutane... more We report on successful emergency transcatheter aortic valve implantation combined with percutaneous coronary revascularization in a polymorbid and preterminal patient in profound cardiogenic shock and with multiorgan failure. The risk scores were almost unbelievably high (Society of Thoracic Surgeons mortality score, 83.9%; Society of Thoracic Surgeons morbidity and mortality score, 96.8%; logistic EuroSCORE, 96.7%). Two and a half years after the procedure, the patient is doing very well.

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Transcatheter aortic valve implantation combined with conventional heart surgery: Hybrid approach for complex cardiac pathologic features

The Journal of Thoracic and Cardiovascular Surgery, 2012

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Transapical Aortic Valve Implantation in 175 Consecutive Patients

Journal of the American College of Cardiology, 2010

The aim of this study was to evaluate the outcome of transapical aortic valve implantation in a s... more The aim of this study was to evaluate the outcome of transapical aortic valve implantation in a single center with expanded procedural experience and to compare it with predicted risk for conventional aortic valve surgery. Background Transapical aortic valve implantation is a new approach for high-risk patients with severe aortic stenosis. There are only limited single-center experiences with very small numbers of patients. Methods Since April 2008, transapical aortic valve implantation was performed in 175 consecutive patients. The mean patient age was 79.8 Ϯ 9 years, with a range of 36 to 97 years. The mean Society of Thoracic Surgeons score was 23.5 Ϯ 19.4% (range 2.7% to 89.5%); 98.3% of patients were in New York Heart Association functional class III or IV. Ten patients were in cardiogenic shock. Results Technical success of the procedure was 100%. There was no conversion to conventional surgery. Cardiopulmonary bypass was used in 8 patients (6 elective, 2 emergency). The 30-day mortality was 5.1% for the entire group, 3.6% for all patients without cardiogenic shock, and 30% for the patients with cardiogenic shock. Survival at 1, 6, and 12 months was 94.9%, 85.5%, and 82.6%, respectively. Conclusions The outcome of transapical aortic valve implantation was very favorable and already reproducible during the learning curve. The method has become de facto our institutional primary choice for treatment of high-risk patients with severe aortic valve stenosis.

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Elective use of femoro-femoral cardiopulmonary bypass during transcatheter aortic valve implantation

European Journal of Cardio-Thoracic Surgery, 2014

OBJECTIVES: Elective use of normothermic cardiopulmonary bypass (CPB) may reduce the risks associ... more

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Improved Technique of Transapical Aortic Valve Implantation: “The Berlin Addition”

The Annals of Thoracic Surgery, 2010

Transapical aortic valve implantation carries some degree of uncertainty regarding the definitive... more Transapical aortic valve implantation carries some degree of uncertainty regarding the definitive valve position. We added angiographic visualization of the aortic root while the prosthetic valve is being slowly deployed. It enables easy correction of the position of the valve so that perfect alignment can be achieved of the relationships between the prosthetic valve, aortic valve annulus, aortic cusps, and the coronary arteries.

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Introducing transapical aortic valve implantation (part 2): Institutional structured training program

The Journal of Thoracic and Cardiovascular Surgery, 2013

Objectives: The purpose of the present study was to test whether the cumulative knowledge from th... more Objectives: The purpose of the present study was to test whether the cumulative knowledge from the field of transapical transcatheter aortic valve implantation, when incorporated into a structured training and then gradually dispersed by internal proctoring, might eliminate the negative effect of the learning curve on the clinical outcomes. Methods: The present study was a retrospective, single-center, observational cohort study of prospectively collected data from all 500 consecutive high-risk patients undergoing transapical transcatheter aortic valve implantation at our institution from April 2008 to December 2011. Of the 500 patients, 28 were in cardiogenic shock. Differences during the study period in baseline characteristics, procedural and postprocedural variables, and survival were analyzed using different statistical methods, including cumulative sum charts. Results: The overall 30-day mortality was 4.6% (95% confidence interval, 3.1%-6.8%) and was 4.0% (95% confidence interval, 2.6%-6.2%) for patients without cardiogenic shock. Throughout the study period, no significant change was seen in the 30-day mortality (Mann-Whitney U test, P ¼ .23; logistic regression analysis, odds ratio, 0.83 per 100 patients; 95% confidence interval, 0.62-1.12; P ¼ .23). Also, no difference was seen in survival when stratified by surgeon (30-day mortality, P ¼ .92). An insignificant change was seen toward improved overall survival (hazard ratio, 0.90 per 100 patients; 95% confidence interval, 0.77-1.04; P ¼ .15). Conclusions: The structured training program can be used to introduce transapical transcatheter aortic valve implantation and then gradually dispersed by internal proctoring to other members of the team with no concomitant detriment to patients.

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„Ross-Operation“: viele falsche Mythen, die korrigiert werden sollen

Zeitschrift für Herz-,Thorax- und Gefäßchirurgie

Transcatheter Aortic Valve Implantation in Failed Bioprosthetic Surgical Valves

JAMA, 2014

Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it... more Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed. OBJECTIVE To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves. DESIGN, SETTING, AND PARTICIPANTS Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8% [interquartile range, 7.7%-16%]). Surgical valves were classified as small (Յ21 mm; 29.7%), intermediate (>21 and <25 mm; 39.3%), and large (Ն25 mm; 31%). Implanted devices included both balloon-and self-expandable valves. MAIN OUTCOMES AND MEASURES Survival, stroke, and New York Heart Association functional class. RESULTS Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2% (95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P = .01). Similarly, patients with small valves had worse 1-year survival (74.8% [95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P = .001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (Յ21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P = .02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P = .008). CONCLUSIONS AND RELEVANCE In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.

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Transapical Aortic Valve Implantation

Journal of the American College of Cardiology, 2012

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Ergebnisse von Mitralklappen- rekonstruktionen bei Floppy Mitral Valve

Zeitschrift f�r Herz-, Thorax- und Gef��chirurgie

ABSTRACT Zusammenfassung Eine Floppy mitral valve wird durch eine abnorme Vergrößerung der Segel,... more ABSTRACT Zusammenfassung Eine Floppy mitral valve wird durch eine abnorme Vergrößerung der Segel, einer Verlängerung oder Ruptur von Sehnenfäden sowie durch eine Ausdehnung des Klappenanulus charakterisiert. Diese Konstellation führt zu einem Segelprolaps in den linken Vorhof und einer daraus resultierenden Mitralinsuffizienz. Pathologisch-anatomisch findet sich eine myxoide Degeneration der Klappe.¶ Am Deutschen Herzzentrum Berlin wurden in der Zeit von April 1986 bis Juni 1995 531 Mitralrekonstruktionen vorgenommen, bei 171 Patienten (mittleres Alter 55,8 Jahre, 103 männlich, 68 weiblich) lag dabei eine durch „Floppy valves“ verursachte Mitralinsuffizienz vor. In 141 Fällen erfolgte die Rekonstruktion durch eine Plikaturplastik nach Gerbode, entweder isoliert oder in Kombination mit einer Anulo- oder Perikardstreifenplastik. Die restlichen Rekonstruktionen stellten entweder eine alleinige Anuloplastik oder komplexe Rekonstruktionen dar, die u.a. Verkürzungen oder Transpositionen von Chorden beinhalteten. In keinem der Fälle wurde eine Ringprothese implantiert.¶ Die Frühletalität betrug 1,7% (3Patienten). Die Überlebensraten für das 2., 5. und 8. Jahr beliefen sich auf 91,86 sowie 82%. 7 Patienten (4%) benötigten frühpostoperativ aufgrund einer neuerlichen Chorda- oder Segelruptur einen Mitralklappenersatz. In der Nachbeobachtungszeit (1–108 Monate, im Mittel 45,2Monate) wurden weitere 13 Klappenersätze durchgeführt, 2 Patienten erhielten eine erneute Klappenrekonstruktion. Echokardiografisch zeigte sich spätpostoperativ in 38% keine, in 35% eine geringe und in 23% eine mäßiggradige Mitralinsuffizienz. Klinisch konnten 89% der Patienten dem NYHA-Stadium I oder II zugeordnet werden gegenüber 75% in den Klassen III oder IV präoperativ.¶ Mitralklappenrekonstruktionen bei floppy valve zeigen akzeptable früh- und mittelfristigen Ergebnisse auch ohne Anwendung von rigiden oder flexiblen Implantaten.

Ruptured Mycotic Extracranial Carotid Aneurysm Treated by Excision, PTFE Graft Interposition, and Local Antibiotic Application—A Case Report

Vascular Surgery

Morphologie und chirurgische Therapie angeborener Koronarfisteln

Zeitschrift f�r Herz-, Thorax- und Gef��chirurgie

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Beating heart mitral valve surgery: results in 120 consecutive patients considered unsuitable for conventional mitral valve surgery†

Interactive cardiovascular and thoracic surgery, Jan 3, 2017

The purpose of the study was to test whether a beating heart mitral valve operation was a valuabl... more The purpose of the study was to test whether a beating heart mitral valve operation was a valuable option in a heterogeneous group of patients considered very high risk for conventional mitral valve surgery. We conducted a retrospective, single-centre, observational cohort study of 120 patients (mean age 63.7 ± 12.1 years, range 25.3-88.8 years; mean logistic EuroSCORE 26.1 ± 20.6%, range 1.5-84.3%) undergoing beating heart mitral valve operations using normothermic cardiopulmonary bypass without aortic cross-clamping and without cardioplegia between September 2002 and April 2014. Preoperatively, 14 (11.7%) patients were in cardiogenic shock, 16 (13%) on a ventilator, 33 (27.5%) receiving inotropic support, 12 (10%) on dialysis and 1 on extracorporeal membrane oxygenation. Sixty-five (54%) patients had had at least 1 (range 1-6) previous heart operation. The mean follow-up period was 920 ± 973 days. A mitral valve procedure was performed alone in 75 (62.5%) patients and combined wit...

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Quality of Life After Transcatheter Aortic Valve Replacement: Prospective Data From GARY (German Aortic Valve Registry)

JACC. Cardiovascular interventions, Dec 26, 2016

This study sought to analyze health-related quality-of-life (HrQoL) outcomes of patients undergoi... more This study sought to analyze health-related quality-of-life (HrQoL) outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) based on data from GARY (German Aortic Valve Registry). Typically, patients currently referred for and treated by TAVR are elderly with a concomitant variable spectrum of multiple comorbidities, disabilities, and limited life expectancy. Beyond mortality and morbidity, the assessment of HrQoL is of paramount importance not only to guide patient-centered clinical decision-making but also to judge this new treatment modality in this high-risk patient population. In 2011, 3,875 patients undergoing TAVR were included in the GARY registry. HrQoL was prospectively measured using the EuroQol 5 dimensions questionnaire self-complete version on paper at baseline and 1 year. Complete follow-up EuroQol 5 dimensions questionnaire evaluation was available for 2,288 patients (transvascular transcatheter aortic valve replacement [TAVR-TV]: n = 1,626 and ...

Multislice computed tomography-guided surgical repair of acquired posterior left ventricular aneurysms: demonstration of mitral valve and left ventricular reverse remodelling

Interactive cardiovascular and thoracic surgery, 2016

Involvement of the mitral valve (MV) apparatus represents a challenge in surgical ventricular rep... more Involvement of the mitral valve (MV) apparatus represents a challenge in surgical ventricular repair (SVR) of posterior left ventricular (LV) aneurysms. This study sought to investigate whether multislice computed tomography (MSCT) assessment can be used to optimize the surgical procedure for posterior LV aneurysms. Thirty patients (m : w = 24 : 6, age 38-78, median 66 years; mean New York Heart Association class 2.98) with posterior LV aneurysm were operated upon. MSCT was performed in 24 patients before and after surgery. End-diastolic and end-systolic volumes of LV and aneurysm were indexed to body surface area (LVEDVI/LVESVI, AEDVI/AESVI). The MV apparatus was characterized by coaptation distance (CD), tenting area (TA), MV closure angle (MVCA), MV annulus area (MVAA) and interpapillary muscle distance (IMD). Thirty-day mortality was 10% and 5-year survival rate was 83%. After surgery, LVEDVI decreased from 151.2 ± 84.1 to 85.7 ± 28.3 ml/m(2) (P = 0.001) and LVESVI from 110.6 ± ...

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Cardiac surgery in nonagenarians

Thorac Cardiovasc Surg, 2010

Abstract 2980: Cerebral Embolism After Transapical Aortic Valve Implantation

Circulation, Nov 3, 2009

Transapical aortic valve implantation and 'off-pump' arterial coronary bypass in a patient with a porcelain aorta

The Journal of Heart Valve Disease, Nov 1, 2011

A simple hybrid procedure, namely transapical aortic valve implantation combined with &amp;am... more A simple hybrid procedure, namely transapical aortic valve implantation combined with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;off-pump&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; coronary artery bypass using an internal thoracic artery, was performed in a patient with porcelain aorta, aortic valve stenosis and coronary artery disease. This approach does not require cardiopulmonary bypass, and avoids aortic or peripheral arterial cannulation and clamping of the aorta. This hybrid approach can be regarded as a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;new technique&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; being applied to an &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;old idea&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;.

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