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Thelin, Stefan
Publications (10 of 79) Show all publications
Budtz-Lilly, J., Vikholm, P., Wanhainen, A., Astudillo, R., Thelin, S. & Mani, K. (2019). Technical eligibility for endovascular treatment of the aortic arch after open type A aortic dissection repair. Journal of Thoracic and Cardiovascular Surgery
Open this publication in new window or tab >>Technical eligibility for endovascular treatment of the aortic arch after open type A aortic dissection repair
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2019 (English)In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685XArticle in journal (Refereed) Submitted
Abstract [en]

Objective: To report on the technical eligibility of patients previously treated for Stanford type A aorta dissection (AAD) for endovascular aortic arch repair based on contemporary anatomical criteria for an arch inner-branched stentgraft (AIBS). 

 

Methods: All patients treated for AAD from 2004-2015 at a single aortic centre were identified. Extent of repair and use of circulatory arrest were reported. Survival and reoperation were assessed using Kaplan Meier and competing risk models. Anatomic assessment was performed using 3-dimensional CT-imaging software. Primary outcome was survival ≥ 1 year and fulfilment of the AIBS anatomical criteria. 

 

Results: A total of 198 patients were included (158 Debakey I, 32 Debakey II, and 8 Intramural hematoma). Mortality was 30-days: 16.2%, 1-year: 19.2%, 10-years: 45.0%. There were 129 patients with imaging beyond 1 year (mean, 47.8 months), while 89 (69.0%) were AIBS eligible. During follow-up, 19 (14.7%) patients met the threshold criteria for aortic arch treatment, of which 14 (73.7%) would be considered eligible for AIBS. Patients who underwent AAD repair with circulatory arrest and no distal clamp were more often eligible for endovascular repair (88.8%) than those operated with a distal clamp (72.5%), p=0.021. Among patients who did not meet the AIBS anatomical criteria, the primary reasons were mechanical valve (40%) and insufficient proximal seal (30%). 

 

Conclusion: More than two thirds of post AAD patients repair are technically eligible for endovascular AIBS repair. Development of devices that can accommodate a mechanical aortic valve and a greater awareness of sufficient graft length would significantly increase availability.

National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-393182 (URN)
Available from: 2019-09-17 Created: 2019-09-17 Last updated: 2019-09-20Bibliographically approved
Pozzoli, A., Vicentini, L., Thelin, S., Lapenna, E., Nilsson, L. & Alfieri, O. (2018). Application of cryoenergy to improve septal exposure during transaortic septal myectomy in hypertrophic obstructive cardiomyopathy. GENERAL THORACIC AND CARDIOVASCULAR SURGERY, 66(4), 243-245
Open this publication in new window or tab >>Application of cryoenergy to improve septal exposure during transaortic septal myectomy in hypertrophic obstructive cardiomyopathy
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2018 (English)In: GENERAL THORACIC AND CARDIOVASCULAR SURGERY, ISSN 1863-6705, Vol. 66, no 4, p. 243-245Article in journal (Refereed) Published
Abstract [en]

For the past few decades, the transaortic septal myectomy (Morrow's procedure) has been the gold standard for treating severe left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy (HOCM) patients. 30-day mortality has been reported at less than 1% in dedicated centers. However, in a subgroup of patients, the interventricular septal obstruction is localized very distally, below the aortic valve plane, and the transaortic approach can be very challenging. A subset of these patients can present with residual obstruction after surgery, due to inadequate length of septal excision, leading to reoperation. The aim of this work is to illustrate an original application of cryoenergy to improve the transaortic exposure of the interventricular septum and thus enable surgeons to perform very distal myectomies in HOCM patients.

Place, publisher, year, edition, pages
SPRINGER JAPAN KK, 2018
Keywords
Hypertrophic cardiomyopathy, Cryoenergy, Transaortic myectomy, Residual left ventricular outflow tract obstruction
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-351698 (URN)10.1007/s11748-017-0815-8 (DOI)000428564100010 ()28825167 (PubMedID)
Available from: 2018-06-04 Created: 2018-06-04 Last updated: 2018-06-04Bibliographically approved
Janiec, M., Friberg, Ö. & Thelin, S. (2018). Long-term clinical outcomes after coronary artery bypass grafting with pedicled saphenous vein grafts. Journal of Cardiothoracic Surgery, 13(1), Article ID 122.
Open this publication in new window or tab >>Long-term clinical outcomes after coronary artery bypass grafting with pedicled saphenous vein grafts
2018 (English)In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 13, no 1, article id 122Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Coronary artery bypass grafting (CABG) using saphenous vein grafts (SVG) is vitiated by poor long-term patency of the vein grafts. Pedicled SVG harvested with the "no-touch" (NT) technique have demonstrated improved patency and could confer better outcomes. We aim to compare long-term results after CABG where NT or conventional technique was used for vein graft harvesting in a hypothesis-generating registry-based study.

METHODS: Two propensity score matched cohorts (1349 patients) undergoing CABG with veins harvested with NT (NTT) or conventional (CT) technique in Sweden over the period 2005-2015 were used to compare long-term outcomes. Mortality, postoperative incidence of coronary angiography and need for reintervention was recorded and multivariable hazard ratios adjusted for risk factors were calculated.

RESULTS: The mean follow-up time (SD) was 6.8 (3.3) years for NTT and 6.6 (3.2) years for CT. The adjusted hazard ratios for death, first angiography and need for reintervention for NTT patients were (95% CI) 0.97 (0.80-1.19), 0.76 (0.63-0.93), 0.91 (0.78-1.05), and 0.91 (0.71-1.17), respectively. Failed grafts were found in 43.2% of NTT patients and 53.6% of CT patients at angiography.

CONCLUSIONS: In this study NT grafting was associated with a lower risk for repeat angiography, however no difference could be observed for mortality and need for reintervention. The earlier reported improvements in patency of NT veins could possibly be reflected in an improved clinical outcome during the first 10 years after surgery.

Keywords
CABG, Coronary artery bypass grafting, No-touch, Pedicled vein grafts
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-369713 (URN)10.1186/s13019-018-0800-z (DOI)000451321400001 ()30477543 (PubMedID)
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-09-01Bibliographically approved
Lindblom, R. P., Shen, Q., Axén, S., Landegren, U., Kamali-Moghaddam, M. & Thelin, S. (2018). Protein Profiling in Serum and Cerebrospinal Fluid Following Complex Surgery on the Thoracic Aorta Identifies Biological Markers of Neurologic Injury.. Journal of Cardiovascular Translational Research, 11(6), 503-516
Open this publication in new window or tab >>Protein Profiling in Serum and Cerebrospinal Fluid Following Complex Surgery on the Thoracic Aorta Identifies Biological Markers of Neurologic Injury.
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2018 (English)In: Journal of Cardiovascular Translational Research, ISSN 1937-5387, E-ISSN 1937-5395, Vol. 11, no 6, p. 503-516Article in journal (Refereed) Published
Abstract [en]

Surgery on the arch or descending aorta is associated with significant risk of neurological complications. As a consequence of intubation and sedation, early neurologic injury may remain unnoticed. Biomarkers to aid in the initial diagnostics could prove of great value as immediate intervention is critical. Twenty-three patients operated in the thoracic aorta with significant risk of perioperative neurological injury were included. Cerebrospinal fluid (CSF) and serum were obtained preoperatively and in the first and second postoperative days and assessed with a panel of 92 neurological-related proteins. Three patients suffered spinal cord injury (SCI), eight delirium, and nine hallucinations. There were markers in both serum and CSF that differed between the affected and non-affected patients (SCI; IL6, GFAP, CSPG4, delirium; TR4, EZH2, hallucinations; NF1). The study identifies markers in serum and CSF that reflect the occurrence of neurologic insults following aortic surgery, which may aid in the care of these patients.

Keywords
Biomarkers, Cardiovascular surgery, Neurologic injury, Thoracic aortic disease
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-369702 (URN)10.1007/s12265-018-9835-8 (DOI)000453355000007 ()30367354 (PubMedID)
Available from: 2018-12-16 Created: 2018-12-16 Last updated: 2019-01-15Bibliographically approved
Bagge, L., Probst, J., Jensen, S. M., Blomström, P., Thelin, S., Holmgren, A. & Blomström-Lundqvist, C. (2018). Quality of life is not improved after mitral valve surgery combined with epicardial left atrial cryoablation as compared with mitral valve surgery alone: a substudy of the double blind randomized SWEDish Multicentre Atrial Fibrillation study (SWEDMAF). Europace, 20(FI_3), f343-f350
Open this publication in new window or tab >>Quality of life is not improved after mitral valve surgery combined with epicardial left atrial cryoablation as compared with mitral valve surgery alone: a substudy of the double blind randomized SWEDish Multicentre Atrial Fibrillation study (SWEDMAF)
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2018 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no FI_3, p. f343-f350Article in journal (Refereed) Published
Abstract [en]

Aims

Concomitant surgical ablation of atrial fibrillation (AF) in patients undergoing mitral valve surgery (MVS) has almost become routine despite lack of convincing information about improved quality-of-life (QOL) and clinical benefit. Quality-of-life was therefore assessed after MVS with or without epicardial left atrial cryoablation.

Methods and results

Sixty-five patients with permanent AF randomized to MVS with or without left atrial cryoablation, in the double-blinded multicentre SWEDMAF trial, replied to the Short Form 36 QOL survey at 6 and 12 months follow-up. The QOL scores at 12 month follow-up did not differ significantly between patients undergoing MVS combined with cryoablation vs. those undergoing MVS alone regarding Physical Component Summary mean 42.8 (95% confidence interval 38.3–47.3) vs. mean 44.0 (40.1–47.7), P = 0.700 or Mental Component Summary mean 53.1 (49.7–56.4) vs. mean 48.4 (44.6–52.2), P = 0.075. All patients, irrespective of allocated procedure, reached the same QOL after surgery as an age-matched Swedish general population. The Physical Component Summary in patients with sinus rhythm did also not differ from those in AF at 12 months; mean 45.4 (42.0–48.7) vs. mean 40.5 (35.5–45.6), P = 0.096) nor was there a difference in Mental Component Summary; mean 51.0 (48.0–54.1) vs. mean 49.6 (44.6–54.5), P = 0.581).

Conclusion

Left atrial cryoablation added to MVS does not improve health-related QOL in patients with permanent AF, a finding that raises concerns regarding recommendations made for this combined procedure.

Keywords
concomitant surgical ablation; mitral valve surgery; atrial fibrillation; quality of life; ablation;
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-338091 (URN)10.1093/europace/eux253 (DOI)000454047100014 ()29016835 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20150751Swedish Research Council, 2014-36708-117759-70
Available from: 2018-01-07 Created: 2018-01-07 Last updated: 2019-01-14Bibliographically approved
Tovedal, T., Lubberink, M., Morell, A., Estrada, S., Golla, S. S., Myrdal, G., . . . Lennmyr, F. (2017). Blood Flow Quantitation by Positron Emission Tomography During Selective Antegrade Cerebral Perfusion. Annals of Thoracic Surgery, 103(2), 610-616
Open this publication in new window or tab >>Blood Flow Quantitation by Positron Emission Tomography During Selective Antegrade Cerebral Perfusion
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2017 (English)In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 103, no 2, p. 610-616Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Perfusion strategies during aortic surgery usually comprise hypothermic circulatory arrest (HCA), often combined with selective antegrade cerebral perfusion (SACP) or retrograde cerebral perfusion. Cerebral blood flow (CBF) is a fundamental parameter for which the optimal level has not been clearly defined. We sought to determine the CBF at a pump flow level of 6 mL/kg/min, previously shown likely to provide adequate SACP at 20°C in pigs.

METHODS: Repeated positron emission tomography (PET) scans were used to quantify the CBF and glucose metabolism throughout HCA and SACP including cooling and rewarming. Eight pigs on cardiopulmonary bypass were assigned to either HCA alone (n = 4) or HCA+SACP (n = 4). The CBF was measured by repeated [(15)O]water PET scans from baseline to rewarming. The cerebral glucose metabolism was examined by [(18)F]fluorodeoxyglucose PET scans after rewarming to 37°C.

RESULTS: Cooling to 20°C decreased the cortical CBF from 0.31 ± 0.06 at baseline to 0.10 ± 0.02 mL/cm(3)/min (p = 0.008). The CBF was maintained stable by SACP of 6 mL/kg/min during 45 minutes. After rewarming to 37°C, the mean CBF increased to 0.24 ± 0.07 mL/cm(3)/min, without significant differences between the groups at any time-point exclusive of the HCA period. The net cortical uptake (Ki) of [(18)F]fluorodeoxyglucose after rewarming showed no significant difference between the groups.

CONCLUSIONS: Cooling autoregulated the CBF to 0.10 mL/cm(3)/min, and 45 minutes of SACP at 6 mL/kg/min maintained the CBF in the present model. Cerebral glucose metabolism after rewarming was similar in the study groups.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-302609 (URN)10.1016/j.athoracsur.2016.06.029 (DOI)000397165400067 ()27592601 (PubMedID)
Available from: 2016-09-07 Created: 2016-09-07 Last updated: 2018-09-03Bibliographically approved
Lindblom, R. P., Tovedal, T., Norlin, B., Hillered, L., Popova, S., Alafuzoff, I. & Thelin, S. (2017). Mechanical reperfusion with leucocyte-filtered blood does not prevent injury following global cerebral ischaemia. European Journal of Cardio-Thoracic Surgery, 51(4), 773-781
Open this publication in new window or tab >>Mechanical reperfusion with leucocyte-filtered blood does not prevent injury following global cerebral ischaemia
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2017 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 51, no 4, p. 773-781Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Prolonged global cerebral ischaemia leads to irreversible injury, often with lethal outcome. Brain injuries are partly caused by the uncontrolled reperfusion that occurs once the circulation is re-established. Recent animal experiments suggest that controlled reperfusion following lengthy ischaemia might prevent severe brain injury. This study aimed at further exploring cerebral alterations and outcome following prolonged global cerebral ischaemia and mechanically manipulated reperfusion.

METHODS: Three groups of pigs were included; one sham operated (n = 3) and two that underwent 30-min global cerebral ischaemia. All vessels that supply the brain were isolated intrathoracically, after which they were occluded for 30 min in the ischaemic groups. In one of the ischaemic groups uncontrolled reperfusion was applied (URep, n = 6), i.e. normal circulation was restored 30 min after arrested cerebral circulation. The second ischaemic group received mechanical reperfusion (MRep, n = 6) with leucocyte-filtered blood at constant flow and pressure for 20 min using extracorporeal circulation following the 30-min ischaemia, after which normal blood flow resumed. All animals were monitored for 3 h after start of uncontrolled reperfusion. Haemodynamic parameters, arterial and sagittal sinus blood gases, cerebral oxygen extraction rates and intraparenchymal biomarkers using microdialysis were measured. Brain histology was performed post-mortem.

RESULTS: Global brain ischaemia led to the same extent of severe morphological changes at the level of light microscopy in the two ischaemic experimental groups, regardless of reperfusion protocol. Furthermore, no significant differences were found between the URep and MRep groups regarding cerebral blood gases or microdialysis biomarkers.

CONCLUSIONS: Mechanical reperfusion following the current protocol does not modify brain alterations caused by 30 min of arrested cerebral circulation.

National Category
Basic Medicine
Identifiers
urn:nbn:se:uu:diva-315862 (URN)10.1093/ejcts/ezw367 (DOI)000398558800026 ()28007877 (PubMedID)
Available from: 2017-02-21 Created: 2017-02-21 Last updated: 2018-01-13Bibliographically approved
Bagge, L., Probst, J., Blomström, P., Thelin, S. & Blomström-Lundqvist, C. (2017). Quality of Life Is Not Significantly Improved by Adding Epicardial Left Atrial Cryoablation to Mitral Valve Surgery Than if Performed Alone. Paper presented at 22nd Annual International Atrial Fibrillation (AF) Symposium, JAN 12-14, 2017, Orlando, FL. Cardiovascular Electrophysiology, 28(5), 589-590, Article ID MA19.
Open this publication in new window or tab >>Quality of Life Is Not Significantly Improved by Adding Epicardial Left Atrial Cryoablation to Mitral Valve Surgery Than if Performed Alone
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2017 (English)In: Cardiovascular Electrophysiology, ISSN 1045-3873, E-ISSN 1540-8167, Vol. 28, no 5, p. 589-590, article id MA19Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-333844 (URN)10.1111/jce.13184 (DOI)000403296100037 ()
Conference
22nd Annual International Atrial Fibrillation (AF) Symposium, JAN 12-14, 2017, Orlando, FL
Available from: 2017-11-22 Created: 2017-11-22 Last updated: 2017-11-22Bibliographically approved
Tovedal, T., Thelin, S. & Lennmyr, F. (2016). Cerebral oxygen saturation during pulsatile and non-pulsatile cardiopulmonary bypass in patients with carotid stenosis.. Perfusion, 31(1), 72-77
Open this publication in new window or tab >>Cerebral oxygen saturation during pulsatile and non-pulsatile cardiopulmonary bypass in patients with carotid stenosis.
2016 (English)In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 31, no 1, p. 72-77Article in journal (Refereed) Published
Abstract [en]

Pulsatile and non-pulsatile cardiopulmonary bypass (CPB) flows may have different impact on cerebral oxygen saturation in patients with restricted cerebral arterial blood supply. Twenty patients, ten diagnosed with carotid stenosis (CS, n = 10) and ten without known carotid disease (Controls, n = 10), were subjected to one period of pulsatile and one period of non-pulsatile flow (6-8 min each) during CPB at 32°C. Cerebral oxygen saturation was registered by near-infrared light spectroscopy (NIRS). The mean arterial pressure (MAP) was significantly lowered by pulsatile CPB flow. The NIRS tissue oxygenation index (TOI) tended to decrease in the CS group and increase in the Controls during pulsatile flow compared with non-pulsatile; however, the changes were not statistically significant. No significant correlations were seen between the changes in MAP and TOI across the observation periods. In conclusion, pulsatile CPB flow caused slightly decreased mean arterial pressure while the effect on cerebral oxygenation was unclear. Pulsatile flow was not found superior to non-pulsatile flow in patients with or without carotid stenosis.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-266555 (URN)10.1177/0267659115586280 (DOI)000366585600012 ()25948696 (PubMedID)
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2017-12-01Bibliographically approved
Edvinsson, M., Ilbäck, N.-G., Frisk, P., Thelin, S. & Nyström-Rosander, C. (2016). Trace Element Changes in Thoracic Aortic Dissection. Biological Trace Element Research, 169(2), 159-163
Open this publication in new window or tab >>Trace Element Changes in Thoracic Aortic Dissection
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2016 (English)In: Biological Trace Element Research, ISSN 0163-4984, E-ISSN 1559-0720, Vol. 169, no 2, p. 159-163Article in journal (Refereed) Published
Abstract [en]

Thoracic aortic dissection is a life-threatening condition with an incompletely understood pathogenesis. Trace elements are essential for the functioning of different processes in the body, including the immune system and associated responses to infection/inflammation. Because inflammation may be part of the pathogenesis of thoracic aortic dissection, we investigated whether trace element changes associated with inflammation occur in serum and tissue samples during the disease. The study included 21 patients undergoing surgery for thoracic aortic dissection, 10 forensic autopsy specimens for tissue controls and 23 healthy blood donors for serum controls. Levels of magnesium (Mg), calcium (Ca), vanadium (V), manganese (Mn), iron (Fe), cobalt (Co), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), cadmium (Cd) and mercury (Hg) were measured in the aortic tissue and serum by inductively coupled plasma-mass spectrometry (ICP-MS). In the serum, Ca, V, Cu and Zn decreased, whereas Fe increased. In the tissue, Cu and Zn decreased and Fe tended to increase. The Cu/Zn ratio in the serum, a marker of infection/inflammation, did not change in the patients. Concerning trace element changes in the serum and tissue, our data do not support the hypothesis that inflammation is involved in the pathogenesis of thoracic aortic dissection.

National Category
Endocrinology and Diabetes Medical Biotechnology (with a focus on Cell Biology (including Stem Cell Biology), Molecular Biology, Microbiology, Biochemistry or Biopharmacy)
Identifiers
urn:nbn:se:uu:diva-266501 (URN)10.1007/s12011-015-0432-2 (DOI)000368366400002 ()26152852 (PubMedID)
Funder
Swedish Research Council Formas
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2019-03-11Bibliographically approved
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