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Article: The Staphylococcus aureus cardiac snake.

van Steenbergen, Gijs J / Tunnissen, Willemijn / Timmermans, Naomi / Houthuizen, Patrick / van den Broek, Rene / van Brakel, Thomas

Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation

2023 Volume 31, Issue 11, Page(s) 452–453

Language	English
Publishing date	2023-07-06
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2211468-3
ISSN	1876-6250 ; 1568-5888 ; 0929-7456
ISSN (online)	1876-6250
ISSN	1568-5888 ; 0929-7456
DOI	10.1007/s12471-023-01790-3
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Zs.A 6216: Show issues

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Article ; Online: Continuous erector spinae plane block versus thoracic epidural analgesia in video-assisted thoracoscopic surgery: a prospective randomized open-label non-inferiority trial.

van den Broek, Renee J C / Postema, Jonne M C / Koopman, Joseph S H A / van Rossem, Charles C / Olsthoorn, Jules R / van Brakel, Thomas J / Houterman, Saskia / Bouwman, R Arthur / Versyck, Barbara

Regional anesthesia and pain medicine

2024

Abstract: Background and objectives: The evolving surgical techniques in thoracoscopic surgery necessitate the exploration of anesthesiological techniques. This study aimed to investigate whether incorporating a continuous erector spinae plane (ESP) block into a ... ...

Abstract	Background and objectives: The evolving surgical techniques in thoracoscopic surgery necessitate the exploration of anesthesiological techniques. This study aimed to investigate whether incorporating a continuous erector spinae plane (ESP) block into a multimodal analgesia regimen is non-inferior to continuous thoracic epidural analgesia (TEA) in terms of quality of postoperative recovery for patients undergoing elective unilateral video-assisted thoracoscopic surgery. Methods: We conducted a multicenter, prospective, randomized, open-label non-inferiority trial between July 2020 and December 2022. Ninety patients were randomly assigned to receive either continuous ESP block or TEA. The primary outcome parameter was the Quality of Recovery-15 (QoR-15) score, measured before surgery as a baseline and on postoperative days 0, 1, and 2. Secondary outcome parameters included pain scores, length of hospital stay, morphine consumption, nausea and vomiting, itching, speed of mobilization, and urinary catheterization. Results: Analysis of the primary outcome showed a mean QoR-15 difference between the groups ESP block versus TEA of 1 (95% CI -9 to -12, p=0.79) on day 0, -1 (95% CI -11 to -8, p=0.81) on day 1 and -2 (95% CI -14 to -11, p=0.79) on day 2. Conclusions: The continuous ESP block is non-inferior to TEA in video-assisted thoracoscopic surgery. Trial registration number: Dutch Trial Register (NL6433).
Language	English
Publishing date	2024-01-11
Publishing country	England
Document type	Journal Article
ZDB-ID	1425299-5
ISSN	1532-8651 ; 1098-7339 ; 0146-521X
ISSN (online)	1532-8651
ISSN	1098-7339 ; 0146-521X
DOI	10.1136/rapm-2023-105047
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Zs.B 2399: Show issues

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Article ; Online: Optimal antegrade cerebral perfusion flow in patients undergoing surgery for acute type A aortic dissection: A retrospective single-center analysis.

Gerritse, Matthijs / van Brakel, Thomas J / van Houte, Joris / van Hoeven, Marloes / Overdevest, Eddy / Soliman-Hamad, Mohamed

Perfusion

2023 , Page(s) 2676591231222136

Abstract: Background: Systemic hypothermia with bilateral antegrade selective cerebral perfusion (ASCP) is the preferred cerebral protective strategy for type A aortic dissection surgery. The optimal ASCP flow rate remains uncertain and the target flow cannot ... ...

Abstract	Background: Systemic hypothermia with bilateral antegrade selective cerebral perfusion (ASCP) is the preferred cerebral protective strategy for type A aortic dissection surgery. The optimal ASCP flow rate remains uncertain and the target flow cannot always be reached due to pressure limitations. The aim of this study was to assess the correlation between ASCP flow and regional cerebral oxygen saturation (rSO2). Methods: A retrospective analysis was performed on 140 patients with acute type A aortic dissection who underwent surgery with moderate hypothermic circulatory arrest and bilateral ASCP between 2015 and 2021. Pearson correlation analysis was performed between ASCP flow and rSO2. Results: The median circulatory arrest duration was 46.5 (IQR:37.0-61.0) minutes. There was no significant correlation between ASCP flow and rSO2 for both the right (r = -.02, Conclusions: There was no correlation between ASCP flow rate and rSO2 in patients with acute type A aortic dissection. Furthermore, ASCP flow below 10 mL/kg/min was not associated with a reduction in rSO2. Definitive associations between ASCP flow and neurological outcome after type A aortic dissection surgery need further investigation.
Language	English
Publishing date	2023-12-11
Publishing country	England
Document type	Journal Article
ZDB-ID	645038-6
ISSN	1477-111X ; 0267-6591
ISSN (online)	1477-111X
ISSN	0267-6591
DOI	10.1177/02676591231222136
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Zs.A 2424: Show issues

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Article: Concomitant atrial fibrillation ablation in minimally invasive cardiac surgery.

Tjon Joek Tjien, Andrew / Akca, Ferdi / Lam, Kayan / Olsthoorn, Jules / Dekker, Lukas / van der Voort, Pepijn / Verberkmoes, Niels / van Brakel, Thomas J

Annals of cardiothoracic surgery

2024 Volume 13, Issue 1, Page(s) 91–98

Abstract: Concomitant atrial fibrillation (AF) ablation in cardiac surgery effectively restores sinus rhythm and may reduce morbidity and mortality. Cardiac surgery has witnessed the transition from the historical Cox Maze procedure to more modern and less ... ...

Abstract	Concomitant atrial fibrillation (AF) ablation in cardiac surgery effectively restores sinus rhythm and may reduce morbidity and mortality. Cardiac surgery has witnessed the transition from the historical Cox Maze procedure to more modern and less invasive approaches for concomitant AF treatment. As minimally invasive cardiac surgery gains traction, ablation methods and careful patient selection become crucial to optimize results. Emerging techniques, including bipolar epicardial radiofrequency and endo/epicardial cryoablation, are central to these advances, targeting specific arrhythmogenic areas within the atria. While pulmonary vein isolation (PVI) is essential, it may be insufficient for patients with persistent or longstanding persistent AF. In such cases, left atrial posterior wall isolation has proven beneficial. Furthermore, recent studies emphasize the significance of left atrial appendage occlusion in concurrent AF treatments, highlighting its role in stroke risk reduction. Notably, the left atrium remains the focal point for concomitant AF surgery over the right, primarily due to concerns like high pacemaker implantation rates and complexities of right atrial ablation sets. Although guidelines support its widespread use, concomitant AF ablation outcomes vary based on patient selection, surgeon's expertise, and clinical context and thus the Heart Team's input is crucial for individualized decisions. In the upcoming sections, we present our patient selection and a visual guide to our techniques for concomitant AF surgery in minimally invasive mitral valve, coronary artery bypass and aortic valve surgery.
Language	English
Publishing date	2024-01-23
Publishing country	China
Document type	Editorial
ZDB-ID	2713627-9
ISSN	2304-1021 ; 2225-319X
ISSN (online)	2304-1021
ISSN	2225-319X
DOI	10.21037/acs-2023-afm-21
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Article ; Online: Aortic valve visualization and pressurization device: a novel device for intraoperative evaluation of aortic valve repair procedures.

Arabkhani, Bardia / Sandker, Stefan C / Braun, Jerry / Hjortnaes, Jesper / van Brakel, Thomas J / Koolbergen, Dave R / Klautz, Robert J M / Hazekamp, Mark G

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

2023 Volume 64, Issue 5

Abstract: Objectives: Aortic valve repair procedures are technically challenging, and current intraoperative evaluation methods often fail to predict the final echocardiographic result. We have developed a novel intraoperative aortic valve visualization and ... ...

Abstract	Objectives: Aortic valve repair procedures are technically challenging, and current intraoperative evaluation methods often fail to predict the final echocardiographic result. We have developed a novel intraoperative aortic valve visualization and pressurization (AVP) device, enabling valve inspection under physiological conditions, and measuring aortic valve insufficiency (AI) during cardioplegic arrest. Methods: The AVP device is attached to the (neo)aorta, after any type of aortic valve repair, while the heart is arrested. The root is pressurized (60-80 mmHg) using a saline solution and an endoscope is introduced. The valve is inspected, and the amount of valvular leakage is measured. Postoperative 'gold standard' transesophageal echocardiogram measurements of AI are performed and compared against regurgitation volume measured. Results: In 24 patients undergoing valve-sparing root replacement, the AVP device was used. In 22 patients, postoperative echocardiographic AI was ≤ grade 1. The median leakage was 90 ml/min, IQR 60-120 ml/min. In 3 patients, additional adjustments after visual inspection was performed. In 2 patients, with complex anatomy, the valve was replaced. In one, after evaluation with the device, there was undesirable result visually and residual AI of 330 ml/min, and in another, 260 ml/min residual AI was measured and valve restriction on visual inspection. Conclusions: The novel AVP device enables intraoperative evaluation of the valve under physiological conditions, while still on arrested heart, and allows for targeted adjustments. The AVP device can be an important aid for intraoperative evaluation of the aortic valve, during valve repair and valve-sparing procedures, thereby making the operative result more predictable and the operation more efficient.
MeSH term(s)	Humans ; Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Cardiac Surgical Procedures ; Aortic Valve Insufficiency/diagnostic imaging ; Aortic Valve Insufficiency/surgery ; Aorta/surgery ; Echocardiography ; Treatment Outcome
Language	English
Publishing date	2023-08-24
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezad291
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Zs.A 2303: Show issues

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Article ; Online: Improved Maximal Workload and Systolic Blood Pressure After Cardiac Rehabilitation Following Thoracic Aortic Repair: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Koenders, Niek / van Zetten, Henrita / Smulders, Michelle / Verra, Martin L / van Kimmenade, Roland R J / van Brakel, Thomas / Eijsvogels, Thijs M H / Smith, Tim

Journal of cardiopulmonary rehabilitation and prevention

2023 Volume 43, Issue 6, Page(s) 419–426

Abstract: Purpose: It is of clinical importance to gain more knowledge about the risks and benefits of exercise in patients recovering from thoracic aortic repair. Therefore, the aim of this review was to perform a meta-analysis on changes in cardiorespiratory ... ...

Abstract	Purpose: It is of clinical importance to gain more knowledge about the risks and benefits of exercise in patients recovering from thoracic aortic repair. Therefore, the aim of this review was to perform a meta-analysis on changes in cardiorespiratory fitness, blood pressure, and the incidence of adverse events during cardiac rehabilitation (CR) in patients recovering from thoracic aortic repair. Review methods: We performed a systematic review and random-effects meta-analysis of outcomes before versus after outpatient CR in patients recovering from thoracic aortic repair. The study protocol was registered (PROSPERO CRD42022301204) and published. MEDLINE, EMBASE, and CINAHL were systematically searched for eligible studies. Overall certainty of evidence was scored with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Summary: We included five studies with data from in total 241 patients. Data from one study could not be used in our meta-analysis because they were provided in a different unit of measure. Four studies with data of 146 patients were included in the meta-analysis. The mean maximal workload increased with 28.7 W (95% CI: 21.8-35.6 W, n = 146, low certainty of evidence). The mean systolic blood pressure during exercise testing increased with 25.4 mm Hg (95% CI: 16.6-34.3, n = 133, low certainty of evidence). No exercise-induced adverse events were reported. These outcomes indicate that CR seems beneficial and safe to improve exercise tolerance in patients recovering from thoracic aortic repair, although outcomes were based on data from a small, heterogeneous group of patients.
MeSH term(s)	Humans ; Cardiac Rehabilitation/methods ; Blood Pressure ; Workload ; Exercise ; Cardiorespiratory Fitness
Language	English
Publishing date	2023-05-24
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	2272063-7
ISSN	1932-751X ; 1932-7501
ISSN (online)	1932-751X
ISSN	1932-7501
DOI	10.1097/HCR.0000000000000798
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Zs.A 1998: Show issues

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Article ; Online: The Aortic Root in Acute Type A Dissection: Repair or Replace?

Arabkhani, Bardia / Verhoef, Jos / Tomšič, Anton / van Brakel, Thomas J / Hjortnaes, Jesper / Klautz, Robert J M

The Annals of thoracic surgery

2022 Volume 115, Issue 6, Page(s) 1396–1402

Abstract: Background: The effect of an "aggressive" approach on the aortic root in acute type A aortic dissection (ATAAD) remains insufficiently explored.: Methods: Retrospective analysis was conducted between 1992 and 2020 of a single-center, prospective ... ...

Abstract	Background: The effect of an "aggressive" approach on the aortic root in acute type A aortic dissection (ATAAD) remains insufficiently explored. Methods: Retrospective analysis was conducted between 1992 and 2020 of a single-center, prospective cohort of consecutive patients aged ≥18 years diagnosed with ATAAD. Patients were divided into 2 groups: aortic root replacement (ARR; prosthetic or valve-sparing root replacement, n = 141) and conservative root approach (CRA; root sparing of partially dissected root, n = 90; and supracoronary ascending replacement in nondissected root, n = 68). Inverse probability weighting was used to compare patients with different preoperative characteristics. Mean follow-up was 5.1 (0-21) years in ARR and 7.1 (0-25) years in CRA. Results: The frequency of ARR increased over the years, with 19% and 78% of patients undergoing ARR in the earliest and most recent periods, respectively. Early mortality decreased over the years, despite a more aggressive approach, and remained lower in ARR. CRA was associated with a higher hazard of late mortality (hazard ratio, 1.38; 95% CI, 1.12-1.68; P = .001) and reintervention (hazard ratio, 2.08; 95% CI, 1.44-3.56; P = .001). After CRA, new-onset aortic valve insufficiency was a common cause of reintervention. Conclusions: Over the years, there was a gradual increase in the root replacement approach in ATAAD. Root replacement was associated with better long-term survival and fewer reinterventions compared with the conservative approach, whereas the in-hospital mortality decreased during these years. Hence, aggressive root replacement is safe and may be applied in ATAAD with good long-term clinical results, without increased hospital mortality.
MeSH term(s)	Humans ; Adolescent ; Adult ; Aortic Valve/surgery ; Retrospective Studies ; Aorta, Thoracic/surgery ; Prospective Studies ; Treatment Outcome
Language	English
Publishing date	2022-07-21
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2022.06.041
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Zs.A 252: Show issues

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Article ; Online: Outcomes after cardiac rehabilitation in patients following repair of thoracic aortic aneurysm or dissection: a protocol for a systematic review and meta-analysis.

Koenders, Niek / van Zetten, Henrita / Smulders, Michelle / Verra, Martin L / van Kimmenade, Roland R J / van Brakel, Thomas / Eijsvogels, Thijs M H / Smith, Tim

Systematic reviews

2023 Volume 12, Issue 1, Page(s) 16

Abstract: Background: Patients receiving thoracic aortic repair suffer from long-term impairment in daily functioning and quality of life following intervention due to a combination of their life-threatening condition (i.e. aortic aneurysm or dissection), ... ...

Abstract	Background: Patients receiving thoracic aortic repair suffer from long-term impairment in daily functioning and quality of life following intervention due to a combination of their life-threatening condition (i.e. aortic aneurysm or dissection), undergoing major surgery, as well as long-term exercise restrictions thereafter. Despite the known risks of exercise, it is vital that patients regain physical activity in order to recover their daily functioning and quality of life. Cardiac rehabilitation could be a safe and effective treatment to support patients to become physically active by providing exercise training, comprehensive rehabilitation services, and safety recommendations. Despite new insights in recent literature and clinical practice, international guidelines do not recommend cardiac rehabilitation due to limited evidence. We aim to fill this knowledge gap by performing a systematic review and meta-analysis on the effectiveness of cardiac rehabilitation in patients following thoracic aortic repair. Methods: This protocol has been developed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). MEDLINE, Embase, and CINAHL will be searched for eligible observational and interventional studies from inception up to April 2022. Screening (title/abstract and full text), data extraction, risk of bias assessment, and therapeutic validity rating will be conducted by two independent reviewers. A random-effects model will be used to meta-analyse performance-based outcomes, patient-reported outcomes, clinician-reported outcomes, and researcher-reported outcomes. Subsequently, meta-bias and confidence in evidence will be analysed by two independent reviewers. Discussion: To exercise or not to exercise in patients following thoracic aortic repair has been a topic of discussion for years. The intended systematic review and meta-analysis will provide comprehensive evidence on the effectiveness of phase III outpatient exercise-based cardiac rehabilitation in patients following thoracic aortic repair. Findings from this review may inform future guidelines for the management of patients with thoracic aortic disease. Systematic review registration: PROSPERO CRD42022301204.
MeSH term(s)	Humans ; Cardiac Rehabilitation/methods ; Quality of Life ; Systematic Reviews as Topic ; Meta-Analysis as Topic ; Aortic Aneurysm, Thoracic ; Review Literature as Topic
Language	English
Publishing date	2023-02-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2662257-9
ISSN	2046-4053 ; 2046-4053
ISSN (online)	2046-4053
ISSN	2046-4053
DOI	10.1186/s13643-023-02180-x
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Article ; Online: Is Gorlin-Chaudhry-Moss syndrome associated with aortopathy?

Legué, Juno / François, Jules H M / van Rijswijk, Carla S P / van Brakel, Thomas J

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

2020 Volume 58, Issue 3, Page(s) 654–655

Abstract: Gorlin-Chaudhry-Moss syndrome (GCMS) is a rare disorder consisting of craniofacial dysostosis, hypertrichosis, underdeveloped genitalia, and ocular and dental anomalies. Recently, GCMS has been reclassified together with Fontaine syndrome as Fontaine ... ...

Abstract	Gorlin-Chaudhry-Moss syndrome (GCMS) is a rare disorder consisting of craniofacial dysostosis, hypertrichosis, underdeveloped genitalia, and ocular and dental anomalies. Recently, GCMS has been reclassified together with Fontaine syndrome as Fontaine progeroid syndrome (FPS), after a common genetic basis was found. It was previously thought that GCMS/FPS was not associated with aortopathy, but in recent years 3 patients with aortic disease have been described. We describe the fourth case, who is the oldest patient with GCMS/FPS reported in the medical literature: a 45-year-old patient who presented with acute aortic dissection. We therefore recommend screening patients previously diagnosed with GCMS/FPS for aortic pathology to aid early detection and avoid patient presentation in an acute setting.
MeSH term(s)	Abnormalities, Multiple ; Craniofacial Abnormalities ; Ductus Arteriosus, Patent ; Humans ; Hypertrichosis ; Middle Aged
Language	English
Publishing date	2020-07-07
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezaa108
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Article: Activin A and ALK4 Identified as Novel Regulators of Epithelial to Mesenchymal Transition (EMT) in Human Epicardial Cells.

Dronkers, Esther / van Herwaarden, Tessa / van Brakel, Thomas J / Sanchez-Duffhues, Gonzalo / Goumans, Marie-José / Smits, Anke M

Frontiers in cell and developmental biology

2021 Volume 9, Page(s) 765007

Abstract: The epicardium, the mesothelial layer covering the heart, is a crucial cell source for cardiac development and repair. It provides cells and biochemical signals to the heart to facilitate vascularization and myocardial growth. An essential element of ... ...

Abstract	The epicardium, the mesothelial layer covering the heart, is a crucial cell source for cardiac development and repair. It provides cells and biochemical signals to the heart to facilitate vascularization and myocardial growth. An essential element of epicardial behavior is epicardial epithelial to mesenchymal transition (epiMT), which is the initial step for epicardial cells to become motile and invade the myocardium. To identify targets to optimize epicardium-driven repair of the heart, it is vital to understand which pathways are involved in the regulation of epiMT. Therefore, we established a cell culture model for human primary adult and fetal epiMT, which allows for parallel testing of inhibitors and stimulants of specific pathways. Using this approach, we reveal Activin A and ALK4 signaling as novel regulators of epiMT, independent of the commonly accepted EMT inducer TGFβ. Importantly, Activin A was able to induce epicardial invasion in cultured embryonic mouse hearts. Our results identify Activin A/ALK4 signaling as a modulator of epicardial plasticity which may be exploitable in cardiac regenerative medicine.
Language	English
Publishing date	2021-12-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2737824-X
ISSN	2296-634X
ISSN	2296-634X
DOI	10.3389/fcell.2021.765007
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