Asklepios Klinik St. Georg

Atrial tachycardias (AT) represent an increasingly common cause of morbidity and mortality. Driven by substantial advances in mapping and ablation technologies, the mechanistic understanding and therapeutic strategies for AT management have evolved rapidly in recent years, and catheter ablation is now regarded as the most effective strategy for maintaining sinus rhythm. Against this background, the recently published international clinical consensus statement on the management of patients with AT introduces, for the first time, astructured 10-point plan for "SMART-AT care" as aframework for the diagnosis and treatment of regular AT. This review highlights key developments and clinical implications, taking into account recent changes within the healthcare system.

Abstract Purpose The treatment of choice for anterior cruciate ligament (ACL) ruptures remains the use of tendon grafts. However, the concept of preserving the ACL instead of replacing it has gained popularity for the treatment of acute femoral avulsion tears. This study aimed to evaluate the effectiveness of ligament-preserving repair technique, for clarity hereafter referred to as the Ligabrace technique, involving suture tape augmentation and cortical button fixation. Methods The study included 50 patients with isolated acute proximal ACL rupture (Sherman I / II) who did not have any other injuries or medical conditions. The patients were divided into two groups: group 1 (n = 25) underwent surgical treatment with the Ligabrace technique, while group 2 (n = 25) received standard ACL reconstruction with hamstring tendons. Preoperative assessments of Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores were conducted at T0, and 12 months postoperatively at T2. Additionally, standardized Magnetic resonance imaging (MRI) and routine clinical examinations of the knee, including instrumented anterior-posterior (AP) stability measurements, were carried out at T1 and T2. Results No significant differences in any of the evaluation criteria were observed in either group at T2. The Lysholm (90,32 (71–100)) and IKDC (87,1 (62,1-100)) scores were comparable for the Ligabrace group and the scores for the hamstring group. The Tegner activity levels were 6.2 ± 1.7 in the Ligabrace group and 5.8 ± 1.7 in the hamstring group. The mean AP translation compared to the noninjured knee was 0.56 mm in the Ligabrace group and 0.72 mm in the hamstring group. Conclusion Overall, primary ACL repair with this technique showed similar outcomes to ACL reconstruction with hamstring tendons in terms of patient-reported outcome scores and clinical investigation in patients with proximal ACL tears in short-term. The initial results for the Ligabrace technique suggest that it may be a viable option for ligament preservation after acute femoral ACL tears.

Acute myeloid leukemia (AML) is the most common indication for allogeneic hematopoietic cell transplantation (alloHCT), yet graft-versus-host disease (GVHD) remains a major post-transplant complication. Conditioning regimens, particularly reduced-intensity approaches, are critical in optimizing outcomes. This subgroup analysis of the phase 3 MC-FludT.14/L trial compared treosulfan-fludarabine with reduced-intensity busulfan-fludarabine in 352 AML patients (aged 31-70) undergoing alloHCT. The primary endpoint was 24-month event-free survival (EFS); secondary endpoints included overall survival (OS), GVHD incidence, relapse/progression, and non-relapse mortality (NRM). Treosulfan compared to busulfan demonstrated superiority: 24-month EFS was 65% vs. 53% (p = 0.01), and OS was 73% vs. 65%. EFS benefits were consistent across AML risk categories and notably higher in patients with hematopoietic cell transplantation comorbidity index >2 (62% vs. 42%, p = 0.02). Treosulfan also showed lower NRM and relapse rates. GVHD outcomes favored treosulfan, with a significantly lower incidence of extensive chronic GVHD at 24 months (15.1% vs. 28.1%, p = 0.01). GVHD-free and relapse-free survival was also improved (53% vs. 40%, p = 0.02). The safety profile was more favorable with treosulfan. These findings support treosulfan-fludarabine as a more effective and safer conditioning regimen than busulfan-fludarabine for AML patients undergoing alloHCT, particularly those at higher risk.

There is a paucity of data regarding the longer-term durability of transcatheter heart valves. This analysis aimed to describe the 5-year clinical outcomes and valve durability for patients treated with the Portico transcatheter heart valves across 3 studies harmonized in their prospective enrollment, inclusion/exclusion criteria, centralized independent core laboratory echocardiographic analysis, and independent clinical events committee adjudication. Patient-level data from the PORTICO IDE randomized controlled trial, the PORTICO I postmarket study, and the PORTICO continued access protocol were pooled using a random-effects meta-analysis model. All 3 studies collected follow-up data at discharge, 30 days, and annually through 5 years. Adverse events and pooled echocardiographic data were assessed using Valve Academic Research Consortium-2 definitions. Durability definitions were adapted from Valve Academic Research Consortium-3 and European Association of Percutaneous Cardiovascular Interventions/European Society of Cardiology/European Association for Cardio-Thoracic Surgery consensus guidelines. A total of 1464 patients with severe symptomatic aortic stenosis and high or extreme surgical risk were included. Median age was 83 years, 61.7% were women, and the median Society of Thoracic Surgeons score was 4.9%. At 5 years, all-cause mortality and stroke rates were 49.4% and 12.3%, respectively. Transvalvular gradient and effective orifice area at 5 years were 6.2 mm Hg and 1.83 cm2, respectively, with paravalvular leak ≥moderate severity occurring in 1.9%. The 5-year bioprosthetic valve failure rate was 2.7%, including a 0.7% valve-related death rate and a 2.0% valve reintervention rate, but no patients with severe hemodynamic structural valve deterioration. Moderate hemodynamic structural valve deterioration occurred in 0.9% of the patients at 5 years. Hemodynamic performance and transcatheter heart valve durability remained stable irrespective of annular size. The use of the Portico transcatheter heart valve system in patients at high or extreme surgical risk demonstrated favorable clinical outcomes and hemodynamic performance with low transvalvular gradients and greater than mild paravalvular leak. Furthermore, bioprosthetic valve failure rates were low with no incidence of severe hemodynamic structural valve deterioration at 5 years, irrespective of annular size. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02000115 and NCT01802788.

Acknowledgements We thank all the local investigators and assistant personnel for their great effort. Furthermore, we thank all the POTTER-AF collaborators.

ZusammenfassungVorhofflimmern (AF) ist die häufigste Rhythmusstörung in den Industrieländern und ist mit einer erhöhten Morbidität und Mortalität assoziiert. Jeder Dritte in Europa wird im Laufe seines Lebens an Vorhofflimmern erkranken. Das Risiko steigt dabei mit zunehmendem Alter. Aufgrund des demografischen Wandels stellt die hohe Inzidenz und Prävalenz von Vorhofflimmern eine erhebliche Belastung für das Gesundheitssystem dar. Der Prävention, Früherkennung und Behandlung von Vorhofflimmern kommen daher eine immer größere Bedeutung zu. Die Empfehlungen richteten sich dabei bisher stets nach den Leitlinien der kardiologischen Fachgesellschaften und den zuletzt im Jahr 2024 erschienenen Vorhofflimmern-Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC). Erstmals steht nun eine deutsche S3-Leitlinie der Arbeitsgemeinschaft Wissenschaftlicher Fachgesellschaften (AWMF) zur Verfügung, die in einem breiten Konsens vieler Fachgesellschaften auch außerhalb der Kardiologie unter strengen systematischen Bedingungen gemäß den Vorgaben der AWMF konsentiert wurde. Neu ist in beiden Leitlinien ein Fokus auf die Behandlung von Begleiterkrankungen und die Einstellung von Risikofaktoren durch lebensstilmodifizierende Maßnahmen im Sinne eines „AF-Pathway“. Bei der Behandlung von klinischem Vorhofflimmern spielt neben der Prävention von Schlaganfällen eine Prüfung einer frühen Rhythmuskontrolle, auch durch eine Katheterablation, eine immer wichtigere Rolle.