Aims: Comparing actual management costs in patients with non-valvular atrial fibrillation (AF) treated with percutaneous left atrial appendage closure (LAAC) or OAC only. Methods and results:... Show moreAims: Comparing actual management costs in patients with non-valvular atrial fibrillation (AF) treated with percutaneous left atrial appendage closure (LAAC) or OAC only. Methods and results: Patients undergoing percutaneous LAAC and AF patients treated with OAC only were matched for gender, age, and diagnosis related groups (DRG) clinical complexity level (CCL). Costs for cardiovascular outpatient clinic visits and hospitalizations were derived from the actual reimbursement records. Between 1/2012 and 12/2016, 8478 patients were referred: 7801 (92%) managed with OAC and 677 (8%) with percutaneous LAAC. Matching resulted in 558 patients (279 per group) for final analysis. Age was 74.9 +/- 7.5 years, 244 were female (43.7%), and DRG CCL was 1.8 +/- 1.1.Annualized management cost before percutaneous LAAC was (sic) 3110 (IQR: (sic) 1281-8127). After 4.5 +/- 1.4 years follow-up, annualized management cost was (sic) 1297 (IQR: (sic) 607-2735) in OAC patients and (sic) 1013 (IQR: (sic) 0-4770) in patients after percutaneous LAAC (p = 0.003). Percutaneous LAAC was the strongest independent determinant to reduce follow-up costs (B =-0.8; CI: 1.09-0.6; p < 0.0001). Estimated 3-year survival was 92% in percutaneous LAAC and 90% in OAC patients (p = 0.7). Conclusion: Percutaneous LAAC significantly reduces management costs. Management costs are significantly higher for patients treated with only OAC compared to patients after percutaneous LAAC. In spite of their complex comorbid profile, percutaneous LAAC patients show a follow-up survival rate similar to patients solely treated with OAC. Future studies are necessary to investigate the potential net economic and clinical benefit of percutaneous LAAC in patients treated with OAC only. Show less
Schneider, A.W.; Hazekamp, M.G.; Versteegh, M.I.M.; Weger, A. de; Holman, E.R.; Klautz, R.J.M.; ... ; Braun, J. 2019
OBJECTIVES: Repeat aortic valve interventions after previous stentless aortic valve replacement (AVR) are considered technically challenging with an increased perioperative risk, especially after... Show moreOBJECTIVES: Repeat aortic valve interventions after previous stentless aortic valve replacement (AVR) are considered technically challenging with an increased perioperative risk, especially after full-root replacement. We analysed our experience with reinterventions after stentless AVR.METHODS: A total of 75 patients with previous AVR using a Freestyle stentless bioprosthesis (31 subcoronary, 15 root-inclusion and 29 full-root replacement) underwent reintervention in our centre from 1993 until December 2018. Periprocedural data were retrospectively collected from the department database and follow-up data were prospectively collected.RESULTS: Median age was 62 years (interquartile range 47-72 years). Indications for reintervention were structural valve deterioration (SVD) in 47, non-SVD in 13 and endocarditis in 15 patients. Urgent surgery was required in 24 (32%) patients. Reinterventions were surgical AVR in 16 (21%), root replacement in 51 (68%) and transcatheter AVR in 8 (11%) patients. Early mortality was 9.3% (n = 7), but decreased to zero in the past decade in 28 patients undergoing elective reoperation. Per indication, early mortality was 9% for SVD, 8% for non-SVD and 13% for endocarditis. Aortic root replacement had the lowest early mortality rate (6%), followed by surgical AVR (13%) and transcatheter AVR (25%, 2 patients with coronary artery obstruction). Pacemaker implantation rate was 7%. Overall survival rate at 10 years was 69% (95% confidence interval 53-81%).CONCLUSIONS: Repeat aortic valve interventions after stentless AVR carry an increased, but acceptable, early mortality risk. Transcatheter valve-in-valve procedures after stentless AVR require careful consideration of prosthesis leaflet position to prevent obstruction of the coronary arteries. Show less
Malan, D.F.; Walt, S.J. van der; Raidou, R.G.; Berg, B. van den; Stoel, B.C.; Botha, C.P.; ... ; Valstar, E.R. 2016
This thesis examines how computer software can be used to analyse medical images of an aseptically loosening hip prosthesis, and subsequently to plan and guide a minimally invasive cement injection... Show moreThis thesis examines how computer software can be used to analyse medical images of an aseptically loosening hip prosthesis, and subsequently to plan and guide a minimally invasive cement injection procedure to stabilize the prosthesis. We addressed the detection and measurement of periprosthetic bone lesions from CT image volumes. Post-operative CTs of patients treated at our institution were analysed. We developed tissue classification algorithms that automatically label periprosthetic bone, cement and fibrous interface tissue. An existing particle-based multi-material meshing algorithm was adapted for improved Finite Element model creation. We then presented HipRFX, a proof-of-concept software tool for planning and guidance during percutaneous cement refixation procedures. Show less
This thesis focuses on indications for and the clinical outcome of PVP for the treatment of long-standing OVCFs (i.e. after more than 8 weeks after onset of symptoms). Secondly, emphasis is made on... Show moreThis thesis focuses on indications for and the clinical outcome of PVP for the treatment of long-standing OVCFs (i.e. after more than 8 weeks after onset of symptoms). Secondly, emphasis is made on the value of vertebral body biopsy during the vertebroplasty procedure in order to aid in early diagnosis of unexpected conditions. Thirdly, in line with the worldwide emerging registration and control of medical implants, emphasis is put on the need for careful registration of cement leakages, since these count for the largest number of clinically relevant complications of the vertebroplasty procedure. The correlation between the amount of BME and the clinical outcome (pain) of PVP is discussed in Chapter 2. In Chapter 3, the outcome of a routine bone biopsy during PVP in treatment of __osteoporotic__ vertebral fractures, was studied. A prospective follow-up study on the clinical outcome (Quality of Life as measured with the SF 36) up to 36 months after PVP for long-standing OVCFs, is discussed in Chapter 4. In Chapter 5, the clinical outcome of PVP in patients with long-standing OVCFs, treated with either low or medium viscosity PMMA bone cement, was evaluated in a prospective comparative follow-up study. In Chapter 6, a new system for Evaluation and registration of eXtra vertebral cement leakage based on Anatomy and Volume of the leakage using CT-scan analysis (the EXACT classification system), is proposed. Finally, in Chapter 7 a review of the scientific evidence for PVP is presented. Show less
Parkinson__s disease (PD) is an age-related neurodegenerative disorder. Pharmacotherapy is the first line symptomatic treatment of this neurological disease. Currently Levodopa (L-DOPA) is still... Show moreParkinson__s disease (PD) is an age-related neurodegenerative disorder. Pharmacotherapy is the first line symptomatic treatment of this neurological disease. Currently Levodopa (L-DOPA) is still considered the drug of first choice, but its possible neurotoxicity and the induction of movement disability after chronic use demand for alternative therapies. An attractive alternative is the use of (semi-)synthetic dopamine agonists. It has been suggested that continuous dopamine receptor stimulation is the best symptomatic treatment of Parkinson__s disease. Therefore the administration of dopamine agonists in a continuous, well-controlled manner by transdermal iontophoresis is an attractive therapeutic strategy in the symptomatic treatment of PD. This dissertation describes the administration of a series of dopamine agonists across the skin using iontophoresis. With iontophoresis a small current is applied across the skin to enhance the transdermal transport of charged molecules. With transdermal iontophoresis a continuous drug administration is achieved. And by adjusting the applied current density it is possible to titrate the dose to the requirements of the patient. In addition, continuous administration results in a continuous stimulation of the dopamine receptors in the striatum. These results demonstrate that transdermal iontophoresis of dopamine agonist is a promising method for the symptomatic treatment of PD. Show less
