Pieter van der Starre

All Publications

• Early Outcome in Patients Requiring Conversion to General Anesthesia During Transfemoral Transcatheter Aortic Valve Implantation. The American journal of cardiology Mayr, N. P., Pellegrini, C., Rheude, T., Trenkwalder, T., Alvarez-Covarrubias, H. A., Xhepa, E., van der Starre, P., Wiesner, G., Schunkert, H., Tassani-Prell, P., Joner, M. 2020

  Abstract

  Transfemoral Transcatheter Aortic Valve Implantation (tf-TAVI) has become an established therapy-option for patients with symptomatic severe aortic stenosis. Conscious sedation (CS) has proven to be an alternative to general anesthesia . So far, the outcome of patients undergoing unplanned periprocedural conversion from CS to general anesthesia has not been investigated. All patients undergoing transfemoral transcatheter aortic valve implantation in CS between 2014 and 2019 were included. The primary end point was early safety at 30 days according to Valve Academic Research Consortium-2 criteria. The reasons for conversion and length of ICU-/ hospital stay were further analyzed. Of 1,058 included patients 35 (3.3%) required a conversion. The end point was documented in 13 (37%) of the converted and 110 (11%) of nonconverted patients (p < 0.001). The causes were: unrest in 11/35 patients, procedural complications in 10/35 patients, respiratory distress in 8/35, and cardiovascular decompensation in 6 patients (17.1%). Compared with the group without conversion (Median (interquartile range ), 4 [4-5] days), length of hospital stay was longest in the group with procedural complications (6 [1-11] days) followed by cardiovascular decompensation (5 [4-7] days). In conclusion, the conversion rate to general anesthesia was low in a large cohort of unselected transcatheter aortic valve implantation patients. Additionally, hospital stay was longer dependent on the reason for conversion.

  View details for DOI 10.1016/j.amjcard.2020.04.024

  View details for PubMedID 32386815

• Six-Month Outcome After Unplanned Conversion from Sedation to General Anesthesia in Patients Undergoing Transfemoral Transcatheter Aortic Valve Replacement Mayr, N., Joner, M., Bleiziffer, S., Michel, J., Pellegrini, C., Rheude, T., van der Starre, P., Erdoes, G., Husser, O., Wiesner, G., Schunkert, H., Lange, R., Tassani-Prell, P. ELSEVIER SCIENCE INC. 2019: S52–S53

  View details for DOI 10.1016/j.jcin.2019.01.182

  View details for Web of Science ID 000458868800141

• Periprocedural transfusion in patients undergoing transfemoral transcatheter aortic valve implantation CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS Mayr, N., Wiesner, G., Hapfelmeier, A., van der Starre, P., Husser, O., Bleiziffer, S., Schunkert, H., Lange, R., Tassani-Prell, P., Martin, K. 2018; 92 (1): 141–48

  View details for DOI 10.1002/ccd.27382

  View details for Web of Science ID 000440646400028

• Periprocedural transfusion in patients undergoing transfemoral transcatheter aortic valve implantation. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions Mayr, N. P., Wiesner, G., Hapfelmeier, A., van der Starre, P., Husser, O., Bleiziffer, S., Schunkert, H., Lange, R., Tassani-Prell, P., Martin, K. 2018; 92 (1): 141-148

  Abstract

  The aim of this investigation was to identify patient's characteristics and periprocedural variables related to periprocedural transfusion in transfemoral Transcatheter Aortic Valve Implantation (tf-TAVI).Transfusion of allogenic red-blood cells (RBC) in tf-TAVI and the number of transfused units has been linked to an increased 30-day mortality. In line with the trend of minimization and cost-effectiveness, transfusion should be avoided, wherever possible.Between 2007 and 2015, 1,734 procedures were analyzed from our prospective registry for RBC-transfusion. Multiple logistic regression analysis was used to identify the dependent variables.Transfusion was considered necessary in 14% (n = 243) of the patients. Female gender (OR [95% CI]) (1.680 [1.014-2.783]) and preprocedural moderate (7.594 [4.404-13.095]) and severe anemia (8.202 [0.900-74.752]) according to WHO were the most important preprocedural variables. Periprocedural, pericardial effusion (12.109 [3.753-39.063]), emergency extracorporeal circulation (54.5288 [6.178-481.259]) and major vascular injury (2.647 [1.412-4.962]) were related to transfusion. The same applies to moderate (4.255 [1.859-9.740]) and severe anemia (31.567 [8.560-116.416]) as well as periprocedural experience (0.072 [0.035-0.149] - 0.141[0.079-0.251], P < 0.001) CONCLUSION: Procedural experience, serious adverse events, low pre- and periprocedural Hb levels and female gender were the main variables relating to transfusion. Even in experienced high-volume centers, transfusion is still necessary in a considerable number of patients.

  View details for DOI 10.1002/ccd.27382

  View details for PubMedID 29130582

• Dexmedetomidine versus propofol-opioid for sedation in transcatheter aortic valve implantation patients: a retrospective analysis of periprocedural gas exchange and hemodynamic support CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE Mayr, N., Wiesner, G., van der Starre, P., Hapfelmeier, A., Goppel, G., Kasel, A., Hengstenberg, C., Husser, O., Schunkert, H., Tassani-Prell, P. 2018; 65 (6): 647–57

  Abstract

  Different sedation regimens have been described for use during transfemoral transcatheter aortic valve implantation (tf-TAVI) for treatment in patients with severe aortic stenosis. The purpose of this study was to compare dexmedetomidine (DEX) with a combination of propofol-opioid (PO) with respect to periprocedural gas exchange and hemodynamic support.Data from a cohort of patients sedated with either DEX or PO for tf-TAVI were retrospectively analyzed from a prospectively maintained TAVI registry. Operative risk was determined from comorbidities and risk scores. Periprocedural partial pressure of carbon dioxide (PaCO2) was chosen as the primary endpoint. Other differences in gas exchange, need for catecholamine therapy, the frequency of conversion to general anesthesia, and need for sedative "rescue therapy" (in DEX patients) were secondary endpoints. Inverse probability of treatment weighting (IPTW) was used for analysis to minimize any selection bias.Of the 297 patients (140 PO, 157 DEX) included, the median [interquartile range] periprocedural PaCO2 values of DEX patients were significantly lower than in PO patients (40 [36-45] mmHg vs 44 [40-49] mmHg, respectively; median difference -4 mmHg; 95% confidence interval, -5 to -3 mmHg; P < 0.001). Hypercapnia (PaCO2 > 45 mmHg) was significantly less frequent in DEX patients compared with the PO group (25% vs 42%, respectively; P = 0.005). Vasopressor support was more frequent in the PO group compared with DEX (68% vs 25%, respectively; P < 0.001). Conversion to general anesthesia was not different between groups (9%, PO vs 3%, DEX; P = 0.051). Additional sedatives/opioids were required in 25 (16%) of the DEX patients.In sedated TAVI patients, DEX was associated with lower PaCO2 values and reduced requirements for vasopressor support, making it a promising alternative to PO for sedation during TAVI.www.ClinicalTrials.gov (NCT01390675). Registered 11 July 2011.

  View details for PubMedID 29464420

• Comparison of sedation and general anaesthesia for transcatheter aortic valve implantation on cerebral oxygen saturation and neurocognitive outcome BRITISH JOURNAL OF ANAESTHESIA Mayr, N. P., Hapfelmeier, A., Martin, K., Kurz, A., van der Starre, P., Babik, B., Mazzitelli, D., Lange, R., Wiesner, G., Tassani-Prell, P. 2016; 116 (1): 90-99

  Abstract

  Transcatheter aortic valve implantation (TAVI) is a treatment strategy for patients with severe aortic stenosis. Although general anaesthesia (TAVI-GA) and sedation (TAVI-S) have previously been described for TAVI, the difference in safety and efficacy of both methods has not been studied in a randomized trial.The INSERT trial was a single centre, controlled parallel-group trial with balanced randomization. Sixty-six patients (68-94 yr) with acquired aortic stenosis undergoing transfemoral CoreValve™ were assigned to TAVI-GA or TAVI-S. Comparable operative risk was determined from risk-scores (EUROscore, STS-Score). Monitoring and anaesthetic drugs were standardized. Near-Infrared-Spectroscopy was used to monitor cerebral-oxymetry blinded. Primary outcome was the perioperative cumulative cerebral desaturation. As secondary outcomes, changes in neurocognitive function and respiratory and haemodynamic adverse events were evaluated.Of 66 included patients, 62 (TAVI-GA: n=31, TAVI-S: n=31) were finally analysed. Baseline characteristics were comparable. In 24 patients (39%) cerebral desaturation was observed. Cumulative cerebral desaturation was comparable (TAVI-GA:(median [IQR]) (0[0/1308] s%) vs. TAVI-S:(0[0/276] s%); P=0.505) between the groups. Neurocognitive function did not change within and between groups. Adverse events were more frequently observed in TAVI-S patients (P<0.001). Bradypnoea (n=16, 52%) and the need for airway manoeuvres (n=11, 36%) or bag-mask-ventilation (n=6, 19%) were the most common respiratory adverse events.Cerebral desaturation occurred in both patient groups, but there was no significant difference between the two groups. Based on primary outcome, both methods were shown to be comparable. Neurocognitive outcome was similar. The higher incidence of adverse events in the sedation group suggests a potential advantage of general anaesthesia.NCT 01251328.

  View details for DOI 10.1093/bja/aev294

  View details for Web of Science ID 000367649100016

• Acute cellular insulin resistance and hyperglycemia associated with hypophosphatemia after cardiac surgery. A & A case reports Garazi, E., Bridge, S., Caffarelli, A., Ruoss, S., van der Starre, P. 2015; 4 (2): 22-25

  Abstract

  Successful glycemic control reduces morbidity and mortality in cardiac surgery patients. Protocols that include insulin infusions are commonly followed to achieve target blood glucose levels. Insulin resistance has been reported and linked to low serum phosphate levels in animal models and studies in diabetic outpatients, but not in postoperative patients. The following case series is a retrospective observational review of 8 cardiac surgery patients who developed insulin resistance early after surgery; this resistance was reversed by correcting serum hypophosphatemia. We discuss the multiple underlying mechanisms causing hypophosphatemia.

  View details for DOI 10.1213/XAA.0000000000000112

  View details for PubMedID 25611002

• Factor VIII Inhibitor Bypass Activity and Recombinant Activated Factor VII in Cardiac Surgery JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Rao, V. K., Lobato, R. L., Bartlett, B., Klanjac, M., Mora-Mangano, C. T., Soran, P. D., Oakes, D. A., Hill, C. C., van der Starre, P. J. 2014; 28 (5): 1221-1226

  Abstract

  Postcardiopulmonary bypass hemorrhage remains a serious complication of cardiac surgery. Given concerns regarding adverse effects of blood product transfusion and limited efficacy of current antifibrinolytics, procoagulant medications, including recombinant factor VIIa (rFVIIa) and factor eight inhibitor bypass activity (FEIBA), increasingly have been used in managing refractory bleeding. While effective, these medications are associated with thromboembolic complications. This study compared the efficacy and risk of adverse events of rFVIIa and FEIBA in cardiac surgical patients with refractory bleeding.This retrospective study evaluated 168 patients who underwent cardiac surgery and received either FEIBA or rFVIIa to manage postbypass hemorrhage. Demographic, clinical, and outcomes data were collected and statistical analysis performed to compare thromboembolic event rates, relative efficacy, and 30-day mortality following administration of these medications.Single university hospital.Patients undergoing cardiac surgery.None.Sixty-one patients received rFVIIa, and 107 received FEIBA. Demographics, surgical procedures, and preoperative anticoagulation were similar between the cohorts; however, the rFVIIa cohort had longer durations of cardiopulmonary bypass (305.1 v 243.8 min, p<0.01). There were no significant differences in the number of thromboembolic events, 30-day mortality, or rates of revision surgery. Neither group demonstrated a clear relationship between dosage and occurrence of thromboembolic events. The rFVIIa cohort received more platelets than the FEIBA cohort (3.13 v 1.67 units, p = 0.01), but transfusion rates of other blood products were similar.This study suggests that rFVIIa and FEIBA have similar efficacy and adverse event profiles in managing intractable postbypass hemorrhage in cardiac surgical patients. Further prospective studies are required.

  View details for DOI 10.1053/j.jvca.2014.04.015

  View details for Web of Science ID 000343188500009

• Immediate Postoperative Percutaneous Stenting of Superior Vena Cava Obstruction Following Heart Transplantation in Adult Patients with Pacemaker Leads JOURNAL OF CARDIAC SURGERY Asseff, D., Sheikh, A. Y., Sze, D., Ha, R., Hofmann, L., van der Starre, P. J. 2014; 29 (5): 733-736

  Abstract

  Vena cava superior syndrome is a serious complication after heart transplantation, leading to low cardiac output, cerebral edema, and multi-organ dysfunction. We report three adult patients who underwent heart and heart-lung transplantation and required immediate postoperative balloon angioplasty and stent placement by interventional radiology. The observed obstructions were located at sites of intraoperatively removed pacemaker or defibrillator wires. Percutaneous stent placement immediately improved the hemodynamic condition of the patients. Early recognition of the complication and availability of immediate intervention are essential to prevent further deterioration.

  View details for DOI 10.1111/jocs.12387

  View details for Web of Science ID 000342851100031

• Immediate postoperative percutaneous stenting of superior vena cava obstruction following heart transplantation in adult patients with pacemaker leads. Journal of cardiac surgery Asseff, D., Sheikh, A. Y., Sze, D., Ha, R., Hofmann, L., van der Starre, P. J. 2014; 29 (5): 733-736

  Abstract

  Vena cava superior syndrome is a serious complication after heart transplantation, leading to low cardiac output, cerebral edema, and multi-organ dysfunction. We report three adult patients who underwent heart and heart-lung transplantation and required immediate postoperative balloon angioplasty and stent placement by interventional radiology. The observed obstructions were located at sites of intraoperatively removed pacemaker or defibrillator wires. Percutaneous stent placement immediately improved the hemodynamic condition of the patients. Early recognition of the complication and availability of immediate intervention are essential to prevent further deterioration.

  View details for DOI 10.1111/jocs.12387

  View details for PubMedID 25039539

• Late profound muscle weakness following heart transplantation due to danon disease MUSCLE & NERVE van der Starre, P., Deuse, T., Pritts, C., Brun, C., Vogel, H., Oyer, P. 2013; 47 (1): 135-137

  Abstract

  Postoperative muscle weakness is a serious complication in surgical intensive care patients. It is mostly described as critical illness polyneuromyopathy. Risk factors include intensive care length of stay, sepsis, poor glycemic control, and combined use of corticosteroids and neuromuscular blocking agents, malnutrition, and electrolyte imbalance.We report a case of late-progressive, profound weakness after heart transplantation for noncompaction cardiomyopathy which required prolonged mechanical ventilation. The patient's muscle strength recovered completely after prolonged rehabilitation.Electromyographic assessment showed myopathy. Muscle biopsy revealed Danon disease, a genetic disorder affecting the lysosomal-associated membrane protein 2 gene (LAMP2).The finding of this genetic disorder was unexpected, because the preoperative echocardiographic diagnosis of noncompaction cardiomyopathy has not been reported in Danon disease. This report underlines the need for early availability of pathology results from the explanted heart, which showed the same disorder.

  View details for DOI 10.1002/mus.23517

  View details for PubMedID 23168931

• Reply. Muscle & nerve van der Starre, P. J. 2013

  View details for DOI 10.1002/mus.23799

  View details for PubMedID 23695897

• Transesophageal Echocardiography Guidance for Stent-Graft Repair of a Thoracic Aneurysm is Facilitated by the Ability of Partial Stent Deployment ANNALS OF VASCULAR SURGERY Crimi, E., Lee, J. T., Dake, M. D., van der Starre, P. J. 2012; 26 (6)

  Abstract

  Transesophageal echocardiography (TEE) is routinely used in our Institution for monitoring correct positioning of thoracic aortic stent grafts. We present a case of successful endovascular repair of three discrete thoracic aortic aneurysms with Zenith TX2 endovascular stent grafts in an 82-year-old female patient. Our focus is on the increased value of TEE guidance because of the ability of partial stent deployment and manipulation during insertion.

  View details for DOI 10.1016/j.avsg.2012.01.013

  View details for PubMedID 22794345

• Comparative Study of Factor Eight Inhibitor Bypass Activity and Recombinant Activated Factor VII in Refractory Post-Cardiopulmonary Bypass Bleeding Scientific Sessions of the American-Heart-Association/Resuscitation Science Symposium Rao, V. K., Bartlett, B., Soran, D., Oakes, D., Hill, C., Lobato, R., Klanjac, M., Mora-Mangano, C., van der Starre, P. LIPPINCOTT WILLIAMS & WILKINS. 2011

  View details for Web of Science ID 000299738708362

• Comparison between RapidTEG (R) and conventional thromboelastography in cardiac surgery patients BRITISH JOURNAL OF ANAESTHESIA Thai, J., REYNOLDS, E. J., Natalia, N., Cornelissen, C., Lemmens, H. J., Hill, C. C., van der Starre, P. J. 2011; 106 (4): 605-606

  View details for DOI 10.1093/bja/aer054

  View details for Web of Science ID 000288566800030

  View details for PubMedID 21421614

• Vancomycin plasma concentrations in cardiac surgery with the use of profound hypothermic circulatory arrest EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY van der Starre, P. J., Kolz, M., Lemmens, H. J., Faix, J. D., Mitchell, S., Miller, C. 2010; 38 (6): 741-744

  Abstract

  This study was undertaken to compare the effect of deep hypothermic circulatory arrest, compared with moderate hypothermia, on the plasma concentrations and pharmacokinetic profile of vancomycin, administered as prophylaxis, in patients undergoing cardiac surgery with cardiopulmonary bypass.Two groups of adult cardiac surgery patients were prospectively studied. One group consisted of 12 patients undergoing valvular surgery with moderate hypothermia, and another group was of 12 patients undergoing surgery with the use of profound hypothermic circulatory arrest. Vancomycin was administered before skin incision, and plasma levels were measured at regular intervals for 24h.The plasma concentrations of vancomycin showed a similar pattern in both groups. The pharmacokinetic profile showed a three-compartment model in both groups.The dosing of vancomycin, if used as antibiotic prophylaxis, does not need to be adjusted in cardiac surgery patients when undergoing profound hypothermic circulatory arrest, since the plasma concentrations and pharmacokinetic profile are similar to patients with moderate hypothermia. The pharmacokinetic profile, consisting of three compartments, was not changed by the differences in temperature.

  View details for DOI 10.1016/j.ejcts.2010.03.029

  View details for Web of Science ID 000285221700018

  View details for PubMedID 20663677

• Lung Transplant Airway Hypoxia A Diathesis to Fibrosis? AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE Dhillon, G. S., Zamora, M. R., Roos, J. E., Sheahan, D., Sista, R. R., van der Starre, P., Weill, D., Nicolls, M. R. 2010; 182 (2): 230-236

  Abstract

  Chronic rejection, manifested pathologically as airway fibrosis, is the major problem limiting long-term survival in lung transplant recipients. Airway hypoxia and ischemia, resulting from a failure to restore the bronchial artery (BA) circulation at the time of transplantation, may predispose patients to chronic rejection. To address this possibility, clinical information is needed describing the status of lung perfusion and airway oxygenation after transplantation.To determine the relative pulmonary arterial blood flow, airway tissue oxygenation and BA anatomy in the transplanted lung was compared with the contralateral native lung in lung allograft recipients.Routine perfusion scans were evaluated at 3 and 12 months after transplantation in 15 single transplant recipients. Next, airway tissue oximetry was performed in 12 patients during surveillance bronchoscopies in the first year after transplant and in 4 control subjects. Finally, computed tomography (CT)-angiography studies on 11 recipients were reconstructed to evaluate the post-transplant anatomy of the BAs.By 3 months after transplantation, deoxygenated pulmonary arterial blood is shunted away from the native lung to the transplanted lung. In the first year, healthy lung transplant recipients exhibit significant airway hypoxia distal to the graft anastomosis. CT-angiography studies demonstrate that BAs are abbreviated, generally stopping at or before the anastomosis, in transplant airways.Despite pulmonary artery blood being shunted to transplanted lungs after transplantation, grafts are hypoxic compared with both native (diseased) and control airways. Airway hypoxia may be due to the lack of radiologically demonstrable BAs after lung transplantation.

  View details for DOI 10.1164/rccm.200910-1573OC

  View details for Web of Science ID 000280206700014

  View details for PubMedID 20339145

  View details for PubMedCentralID PMC3269232

• Dexmedetomidine and the Reduction of Postoperative Delirium after Cardiac Surgery PSYCHOSOMATICS Maldonado, J. R., Wysong, A., van der Starre, P. J., Block, T., Miller, C., Reitz, B. A. 2009; 50 (3): 206-217

  Abstract

  Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances.The authors investigated the effects of postoperative sedation on the development of delirium in patients undergoing cardiac-valve procedures.Patients underwent elective cardiac surgery with a standardized intraoperative anesthesia protocol, followed by random assignment to one of three postoperative sedation protocols: dexmedetomidine, propofol, or midazolam.The incidence of delirium for patients receiving dexmedetomidine was 3%, for those receiving propofol was 50%, and for patients receiving midazolam, 50%. Patients who developed postoperative delirium experienced significantly longer intensive-care stays and longer total hospitalization.The findings of this open-label, randomized clinical investigation suggest that postoperative sedation with dexmedetomidine was associated with significantly lower rates of postoperative delirium and lower care costs.

  View details for Web of Science ID 000267537700004

  View details for PubMedID 19567759

• Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection CIRCULATION-CARDIOVASCULAR INTERVENTIONS Sze, D. Y., Van den Bosch, M. A., Dake, M. D., Miller, D. C., Hofmann, L. V., Varghese, R., Malaisrie, S. C., van der Starre, P. J., Rosenberg, J., Mitchell, R. S. 2009; 2 (2): 105-112

  Abstract

  Endoleaks after stent-graft repair of aortic dissections are poorly understood but seem substantially different from those seen after aneurysm repair. We studied anatomic and clinical factors associated with endoleaks in patients who underwent stent-graft repair of complicated type B aortic dissections.From 2000 to 2007, 37 patients underwent stent-graft repair of acute (< or =14 days; n=23), subacute (15 to 90 days; n=10) or chronic (>90 days; n=4) complicated type B aortic dissections using the Gore Thoracic Excluder (n=17) or TAG stent-grafts (n=20) under an investigator-sponsored protocol. Endoleaks were classified as imperfect proximal seal, flow through fenestrations or branches, or complex (both). Variables studied included coverage of the left subclavian artery, aortic curvature, completeness of proximal apposition, dissection chronicity, and device used. Endoleaks were found during follow-up (mean, 22 months) in 59% of patients, and they were associated with coverage of the left subclavian artery (complex, P<0.001), small radius of curvature (type 1 and complex, P=0.05), and greatest length of unapposed proximal stent graft (complex, P<0.0001). During follow-up, 10 endoleaks resolved spontaneously, 6 required reintervention for false lumen dilatation, and 2 were stable without clinical consequences.Endoleaks are common after stent-graft repair of aortic dissection and may lead to false lumen enlargement necessitating reintervention. Anatomic complexities such as acute aortic curvature and covered side branches were associated with endoleaks, illustrating the need for dissection-specific device development.

  View details for DOI 10.1161/CIRCINTERVENTIONS.108.819722

  View details for PubMedID 20031703

• Obstruction of pulmonary artery catheterization because of lipomatous hypertrophy of the interatrial septum JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Scholten, K. J., Soran, P. D., van der Starre, P. J. 2008; 22 (5): 751-752

  View details for DOI 10.1053/j.jvca.2007.10.002

  View details for Web of Science ID 000259856000021

  View details for PubMedID 18922438

• Unexpected findings during the anesthetic management of a patient with a cardiac paraganglioma JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Soran, P. D., Akram, S., Mihm, F., Fleischmann, D., Reitz, B., van der Starre, P. 2008; 22 (4): 570-572

  View details for DOI 10.1053/j.jvca.2008.01.019

  View details for PubMedID 18662633

• Intraoperative monitoring of elephant trunk kinking with transesophageal echocardiography JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Oakes, D. A., Sze, D. Y., Frisoli, J. K., Mitchell, R. S., Harris, E. J., Thu, C., van der Starre, P. J. 2007; 21 (4): 584-586

  View details for DOI 10.1053/j.jvca.2006.11.002

  View details for Web of Science ID 000248766100023

  View details for PubMedID 17678793

• Detection of intracardiac thromboses after factor VIII inhibitor bypass activity administration by transesophageal echocardiography JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Horstman, D. J., van der Starre, P. J. 2007; 21 (4): 561-563

  View details for DOI 10.1053/j.jvca.2007.01.017

  View details for Web of Science ID 000248766100015

  View details for PubMedID 17678785

• Intraoperative colon mucosal oxygen saturation during aortic surgery 1st Annual Academic Surgical Congress of the Association-for-Academic-Surgery Lee, E. S., Bass, A., Arko, F. R., Heikkinen, M., Harris, E. J., Zarins, C. K., van der Starre, P., Olcott, C. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2006: 19–24

  Abstract

  Colonic ischemia after aortic reconstruction is a devastating complication with high mortality rates. This study evaluates whether Colon Mucosal Oxygen Saturation (CMOS) correlates with colon ischemia during aortic surgery.Aortic reconstruction was performed in 25 patients, using a spectrophotometer probe that was inserted in each patient's rectum before the surgical procedure. Continuous CMOS, buccal mucosal oxygen saturation, systemic mean arterial pressure, heart rate, pulse oximetry, and pivotal intra-operative events were collected.Endovascular aneurysm repair (EVAR) was performed in 20 and open repair in 5 patients with a mean age of 75 +/- 10 (+/-SE) years. CMOS reliably decreased in EVAR from a baseline of 56% +/- 8% to 26 +/- 17% (P < 0.0001) during infrarenal aortic balloon occlusion and femoral arterial sheath placement. CMOS similarly decreased during open repair from 56% +/- 9% to 15 +/- 19% (P < 0.0001) when the infrarenal aorta and iliac arteries were clamped. When aortic circulation was restored in both EVAR and open surgery, CMOS returned to baseline values 56.5 +/- 10% (P = 0.81). Mean recovery time in CMOS after an aortic intervention was 6.4 +/- 3.3 min. Simultaneous buccal mucosal oxygen saturation was stable (82% +/- 6%) during aortic manipulation but would fall significantly during active bleeding. There were no device related CMOS measurement complications.Intra-operative CMOS is a sensitive measure of colon ischemia where intraoperative events correlated well with changes in mucosal oxygen saturation. Transient changes demonstrate no problem. However, persistently low CMOS suggests colon ischemia, thus providing an opportunity to revascularize the inferior mesenteric artery or hypogastric arteries to prevent colon infarction.

  View details for DOI 10.1016/j.jss.2006.05.014

  View details for Web of Science ID 000242202300004

  View details for PubMedID 16978651

• Plasma cefazolin levels during cardiovascular surgery: Effects of cardiopulmonary bypass and profound hypothermic circulatory arrest JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Caffarelli, A. D., Holden, J. P., Baron, E. J., Lemmens, H. J., D'Souza, H., Yau, V., Olcott, C., Reitz, B. A., Miller, D. C., van der Starre, P. J. 2006; 131 (6): 1338-1343

  Abstract

  We sought to assess the effects of cardiopulmonary bypass and profound hypothermic circulatory arrest on plasma cefazolin levels administered for antimicrobial prophylaxis in cardiovascular surgery.Four groups (10 patients per group) were prospectively studied: vascular surgery without cardiopulmonary bypass (group A), cardiac surgery with a cardiopulmonary bypass time of less than 120 minutes (group B), cardiac surgery with a cardiopulmonary bypass time of greater than 120 minutes (group C), and cardiac surgery with cardiopulmonary bypass and profound hypothermic circulatory arrest (group D). Subjects received cefazolin at induction and a second dose before wound closure. Arterial blood samples were obtained preceding cefazolin administration, at skin incision, hourly during the operation, and before redosing. Cefazolin plasma concentrations were determined by using a radial diffusion assay, with Staphylococcus aureus as the indicator microorganism. Cefazolin plasma concentrations were considered noninhibitory at 8 microg/mL or less, intermediate at 16 mug/mL, and inhibitory at 32 microg/mL or greater.In group A cefazolin plasma concentrations remained greater than 16 microg/mL during the complete surgical procedure. In group B cefazolin plasma concentrations diminished to 16 microg/mL or less in 30% of the patients but remained greater than 8 microg/mL. In group C cefazolin plasma concentrations decreased to less than 16 microg/mL in 60% of patients and were less than 8 microg/mL in 50% of patients. In group D cefazolin plasma concentrations reached 16 microg/mL in 66% of the patients but decreased to 8 microg/mL in only 1 patient.For patients undergoing cardiac surgery with a cardiopulmonary bypass time of greater than 120 minutes, a single dose of cefazolin before skin incision with redosing at wound closure does not provide targeted antimicrobial cefazolin plasma levels during the entire surgical procedure. Patients undergoing profound hypothermic circulatory arrest are better protected, but the described protocol of prophylaxis is not optimal.

  View details for DOI 10.1016/j.jtcvs.2005.11.047

  View details for PubMedID 16733167

• Stent-graft repair of an aortic rupture caused by invasive hemangiopericytoma ANNALS OF THORACIC SURGERY van der Starre, P. J., Sze, D. Y., Guta, C., Mitchell, R. S., Dake, M. D. 2006; 81 (6): 2300-2302

  Abstract

  We describe a patient with a history of hemangiopericytoma, who had hemoptysis develop due to a pseudoaneurysm of the thoracic aorta from an intrathoracic metastasis. Stent-graft repair successfully excluded the aneurysm from the aorta. Transesophageal echocardiography showed to be an important guide for correct placement of the device.

  View details for DOI 10.1016/j.athoracsur.2005.07.016

  View details for Web of Science ID 000238027600059

  View details for PubMedID 16731179

• Nesiritide in cardiovascular anesthesia. Current opinion in anaesthesiology van der Starre, P. J. 2005; 18 (1): 83-87

  Abstract

  Acute heart failure has become a major medical issue in the western population. Because mortality is still as high as 50%, the treatment of these patients has been the focus of many studies. A new approach has recently been proposed, including B-type natriuretic peptide as a medication. The purpose of this review is to discuss these new developments.Recent studies have shown that plasma levels of B-type natriuretic peptide may serve as a marker for the severity of acute decompensated heart failure. Nesiritide, which is the recombinant equivalent of B-type natriuretic peptide, is a vasodilator, acting by increasing cyclic guanosine 3', 5'-monophosphate in the vascular smooth muscle cells. It is mainly considered to be an alternative for nitroglycerin, because it has fewer side-effects, and its activity is more prolonged. Treatment with nesiritide has shown fewer arrhythmias and a lower mortality rate compared with dobutamine and milrinone. In cardiac surgery, nesiritide is mainly administered to patients awaiting heart transplantation, but intraoperatively the doses of nesiritide and anesthetics must be adjusted because of a potential interaction. A few anecdotal reports have shown the advantageous effects of nesiritide in the early post-bypass period.Anesthesiologists will be confronted with increasing numbers of patients with heart failure, who require new forms of medication. Nesiritide is a promising new tool, and its application, which is still mainly restricted to the preoperative period, will probably soon be extended to the early post-bypass period.

  View details for PubMedID 16534321

• Nesiritide in cardiovascular anesthesia CURRENT OPINION IN ANESTHESIOLOGY van der Starre, P. J. 2005; 18 (1): 83-87

  Abstract

  Acute heart failure has become a major medical issue in the western population. Because mortality is still as high as 50%, the treatment of these patients has been the focus of many studies. A new approach has recently been proposed, including B-type natriuretic peptide as a medication. The purpose of this review is to discuss these new developments.Recent studies have shown that plasma levels of B-type natriuretic peptide may serve as a marker for the severity of acute decompensated heart failure. Nesiritide, which is the recombinant equivalent of B-type natriuretic peptide, is a vasodilator, acting by increasing cyclic guanosine 3', 5'-monophosphate in the vascular smooth muscle cells. It is mainly considered to be an alternative for nitroglycerin, because it has fewer side-effects, and its activity is more prolonged. Treatment with nesiritide has shown fewer arrhythmias and a lower mortality rate compared with dobutamine and milrinone. In cardiac surgery, nesiritide is mainly administered to patients awaiting heart transplantation, but intraoperatively the doses of nesiritide and anesthetics must be adjusted because of a potential interaction. A few anecdotal reports have shown the advantageous effects of nesiritide in the early post-bypass period.Anesthesiologists will be confronted with increasing numbers of patients with heart failure, who require new forms of medication. Nesiritide is a promising new tool, and its application, which is still mainly restricted to the preoperative period, will probably soon be extended to the early post-bypass period.

  View details for Web of Science ID 000209516600012

• The value of transesophageal echocardiography for endovascular graft stenting of the ascending aorta JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA van der Starre, P., Guta, C., Dake, M., Ihnken, K., Robbins, R. 2004; 18 (4): 466-468

  View details for DOI 10.1053/j.jvca.2004.05.027

  View details for Web of Science ID 000224223500014

  View details for PubMedID 15365930

• Choice of anesthetics. Anesthesiology clinics of North America van der Starre, P. J., Guta, C. 2004; 22 (2): 251-?

  Abstract

  The choice of anesthetics for vascular surgical patients is not only determined by the kind and extent of the surgical procedure but also by patient comorbidities. Frequently, patients have a history of hypertension, peripheral vascular and coronary artery disease,cerebrovascular disease, and renal impairment. The goal of the chosen anesthetic technique is to protect organ function, mainly of the brain and the heart. In some instances regional anesthesia might be preferred, but no difference in outcome between the two techniques has been shown conclusively. Vascular emergencies are particularly challenging for the anesthesiologist, but in recent years the development of stent graft insertion has improved the short-term outcome in many of these procedures.

  View details for PubMedID 15182868

• Continuous, noninvasive, and localized microvascular tissue oximetry using visible light spectroscopy ANESTHESIOLOGY Benaron, D. A., Parachikov, I. H., Friedland, S., Soetikno, R., Brock-Utne, J., van der Starre, P. J., Nezhat, C., Terris, M. K., Maxim, P. G., Carson, J. J., Razavi, M. K., Gladstone, H. B., Fincher, E. F., Hsu, C. P., Clark, F. L., Cheong, W. F., Duckworth, J. L., Stevenson, D. K. 2004; 100 (6): 1469-1475

  Abstract

  The authors evaluated the ability of visible light spectroscopy (VLS) oximetry to detect hypoxemia and ischemia in human and animal subjects. Unlike near-infrared spectroscopy or pulse oximetry (SpO2), VLS tissue oximetry uses shallow-penetrating visible light to measure microvascular hemoglobin oxygen saturation (StO2) in small, thin tissue volumes.In pigs, StO2 was measured in muscle and enteric mucosa during normoxia, hypoxemia (SpO2 = 40-96%), and ischemia (occlusion, arrest). In patients, StO2 was measured in skin, muscle, and oral/enteric mucosa during normoxia, hypoxemia (SpO2 = 60-99%), and ischemia (occlusion, compression, ventricular fibrillation).In pigs, normoxic StO2 was 71 +/- 4% (mean +/- SD), without differences between sites, and decreased during hypoxemia (muscle, 11 +/- 6%; P < 0.001) and ischemia (colon, 31 +/- 11%; P < 0.001). In patients, mean normoxic StO2 ranged from 68 to 77% at different sites (733 measures, 111 subjects); for each noninvasive site except skin, variance between subjects was low (e.g., colon, 69% +/- 4%, 40 subjects; buccal, 77% +/- 3%, 21 subjects). During hypoxemia, StO2 correlated with SpO2 (animals, r2 = 0.98; humans, r2 = 0.87). During ischemia, StO2 initially decreased at -1.3 +/- 0.2%/s and decreased to zero in 3-9 min (r2 = 0.94). Ischemia was distinguished from normoxia and hypoxemia by a widened pulse/VLS saturation difference (Delta < 30% during normoxia or hypoxemia vs. Delta > 35% during ischemia).VLS oximetry provides a continuous, noninvasive, and localized measurement of the StO2, sensitive to hypoxemia, regional, and global ischemia. The reproducible and narrow StO2 normal range for oral/enteric mucosa supports use of this site as an accessible and reliable reference point for the VLS monitoring of systemic flow.

  View details for Web of Science ID 000221551300018

  View details for PubMedID 15166566

• Successful treatment of a Stanford type A dissection by percutaneous placement of a covered stent graft in the ascending aorta JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Ihnken, K., Sze, D., Dake, M. D., Fleischmann, D., van der Starre, P., Robbins, R. 2004; 127 (6): 1808-1810

  View details for DOI 10.1016/j.jteves.2003.12.019

  View details for Web of Science ID 000221895700036

  View details for PubMedID 15173740

• Magnesium in addition to Sotalol does not influence the incidence of postoperative atrial tachyarrhythmias after coronary artery bypass surgery JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Geertman, H., van der Starre, P. J., Sie, H. T., Beukema, W. P., van Rooryen-Butijn, M. 2004; 18 (3): 309-312

  Abstract

  Postoperative atrial tachyarrhythmias (POATs) after coronary artery bypass grafting (CABG) are reported in 11% to 40% of patients. Several etiologic factors are mentioned. Prophylactic intervention with sotalol is reported to reduce the incidence of POAT. The authors studied the effect of magnesium chloride (MgCl2) in addition to sotalol in the prevention of POAT.Prospective, randomized, double-blinded, placebo-controlled trial.Single center.After institutional approval and written informed consent, patients undergoing CABG with use of cardiopulmonary bypass were included in a prospective, randomized, placebo-controlled double-blind study. In 74 patients, intravenous MgCl2, 50 mmol/24 hours, was continuously administered after the induction of anesthesia during 36 hours; 73 patients received placebo. In both groups, sotalol orally was started 16 to 24 hours after CABG. The incidence and duration of in-hospital POAT were evaluated.A total of 147 patients could be evaluated: in the magnesium-treated group (n = 74), 25 patients developed POAT (34%) and in the placebo group (n = 73) 19 patients (26%) (p = 0.36). There was no statistically significant difference in duration of POAT between the groups. In the magnesium-treated group, 9 patients experienced serious bradyarrhythmias (12%), and in the placebo group no serious bradyarrhythmias were observed (p = 0.003). There was no mortality in either group.These results show that MgCl(2), in addition to sotalol, is not more effective than sotalol alone in the prevention of tachyarrhythmias after CABG. The data showed that this combination may also induce serious bradyarrhythmias.

  View details for DOI 10.1053/j.jvca.2004.03.010

  View details for Web of Science ID 000222863400010

  View details for PubMedID 15232810