Academic Center for Minimal Invasive Treatment of Valvular Heart Disease

Last updated: 365 days ago.

Erasmus MC Center for Patient-Centered Minimal Invasive Treatment of Valvular Heart Disease is a multidisciplinary collaboration that aims to optimize the treatment of patients with valvular heart disease (VHD) through patient-tailored treatment selection and the application of leading edge patient-specific catheter based or minimal invasive treatment of VHD (MinInvaT-VHD) via research, training and education, thereby, establishing a position of reference clinical and research center for MinInvaT-VHD and associated conditions such as heart failure

Academic Center of Excellence

Research Activities

Translational, clinical and epidemiological research takes place in a local, national and international multidisciplinary team setting involving cardiologists, cardio-thoracic surgeons, vascular surgeons, radiologists and other imaging experts, computer modelling and simulation experts, geriatricians, epidemiologists, biomedical engineers, epidemiologists, and patient representatives.

Focus of translational research: TE heart valve development and optimal implantation strategies for tissue-engineered valves in the 1VALVE CVON consortium

Focus of clinical research: prognostic studies concerning safety&efficacy, early and late outcome, predictive value of patient, disease and procedural characteristics, potential expansion to lower risk patient groups and other valve disease, the aded value of (3D) imaging and computer simulation. Male-female differences in thoracic aortic aneurysm (SIZE MATTERS consortium; ZonMW Gender and Health programme). Shared decision making in prosthetic heart valve selection, congenital heart disease and thoracic aortic aneurysm.

Focus of epidemiological research: (early) HTA of prosthetic heart valves and implantation approaches, development and implementation of patient information portals and decision aids

Scheduled: o International multicenter Randomised Clinical Trials with independent (core lab) analysis of outcome in (1) low risk patients, (2) patients with moderate severe aortic stenosis and impaired LV function (currently not considered an indication for valve replacement therapy) , and (3) patients with biscupid aortic stenosis (currently off label use of TAVI)

Type of

Collaborations

International multicenter Randomised Clinical Trials with independent (core lab) analysis of outcome in (1) low risk patients, (2) patients with moderate severe aortic stenosis and impaired LV function (currently not considered an indication for valve replacement therapy) , and (3) patients with biscupid aortic stenosis (currently off label use of TAVI)o A European conceptual framework for evidence-based patient-tailored information conveyance and decision support in chronic disease (Horizon2020 2016-17 call, though the EU EUVALVE consortium)

SIZE MATTERS: collaboration between Erasmus MC, Radboud University and Leiden University Medical Centers

AVIATOR: online worldwide registry of aortic valve repair and valve-sparing reconstruction (Takkenberg co-PI)

Educational

Contributions

The ACE provides education in the Bachelor and Master phase of the Medicine Program and is involved in the ErasmusMC Master Clinical Research. Students who embark on research in the field of cardiovascular diseases are supervised by our staff. The ACE is represented in the Advisory Board of this Master. in addition, the ACE plays a key role in the implementation of shared decision making education throughout the medical curriculum.

The training of our PhD students is embedded in the cardiovascular research school COEUR. In addition, methodological courses are offered through NIHES. Our teachers play an active role in the corresponding educational programs and contribute to the so-called 'Papendal' PhD courses on cardiovascular physiology.

Our specialists and researchers offer specialized courses in several ACE-related areas. Furthermore, the ACE plays an active international role in education through proctoring. Several international conferences are organized by members of the ACE. Professors within the ACE also hold a chair at TU Delft (Medical Delta). Finally, the director of the Cardiovascular Institute of Education (CvOI) of the Dutch Society of Cardiology (NVVC) is connected to our ACE. Since initiation of programme, the following number of students/collegaues have been involved:

  • Junior med school: 4 students
  • Master Medicine research project: 5 students
  • MSc Clinical Research: 3 of whom ended research program with a successful PhD thesis defense
  • PhDs: 16 of whom 6 completed a PhD thesis, 3 scheduled to complete this year

Patient

Care Activities

The 100% academic nature of patient care provided by the ACE is evidenced by its multidisciplinary infrastructure in which experimental, translational and applied medical research is combined with top clinical care for patients with complex VHD or VHD with complex comorbidities, who often require complex treatment.

Innovation through multidisciplinary collaboration is key in this setting, to develop patient-tailored novel treatmen for those patients who currently have no options. Erasmus MC is recognized by the NFU as a center of specialized VHD care. From its initiation in 2005 a clinical scientific pathway has been defined followed by a prospective multidisciplinary pathway in January 2010 in which the departments of cardiology (interventional, imaging, general), cardio-thoracic surgery, anesthesiology,geriatrics, radiology,vascular surgery, and internal medicineparticipate.

The above has been integrated into a multidisciplinary clinical & clinical scientific program (TAVI Care & Cure, MEC 2014-277) that started in November 2013 in which all patients are structurally seen – clinically and in the frame work of the TAVI Care & Cure protocol) by the dedicated team. Value Based Health Care is addressed through participation in the national Meetbaar Beter initiative. Through our academic care approach the ACE has achieved national and international leadership in VHD research innovation and care

Societal Relevance to Research, Education and Patient Care

As the Dutch population continues to age, and the concomitant VHD epidemic has become an increasing health burden, the knowledge that is generated in the ACE is highly relevant to the public and society: addressing the urgent need for safe and effective lesser invasive patient-tailored and patient-friendly (i.e. minimal invasive) VHD diagnosis and treatment at a reasonable cost.

From a patient, societal and business perspective the ACE provides an important contribution, reflecting upon current results but at the same time advancing new technology and encouraging active patient involvement. The team that comprises this ACE represents leaders and young top talent in the VHD field as evidenced by: - their contribution to the development of international VHD guidelines such as the 2012 European VHD management guidelines and the VARC I and II guidelines for reporting outcome after heart valve catheter interventions, setting new care standards - their valuable contribution to the body of (MinInvaT-)VHD knowledge in the literature - the development of education and training for students and professionals, - their leadership roles (in the boards of) professional and scientific international societies (ESC, EACTS, Heart Valve Society) - delivering specialized VHD care coupled to technical innovations and patient empowerment

Viability of Research, Education and Patient Care

Balanced advanced knowledge sharing is ensured through our Heart Team approach, an interdisciplinary team effort in the clinic, education and research. Next to the involvement of clinicians and scientists, the inclusion of the patient perspective in our ACE brings in a new dimension that allows for accelerated knowledge application in patient care and society.

Young talent is fostered through our research school COEUR, and our extended international network of centers of expertise that allow PhDs to gain international experience and even pursue a career abroad, as multiple PhDs have done in the past few years. Our extensive publication list highlights that we aim for international toplevel journals, and that we actively particpate in the most prestigious international conferences in cardiovascular disease.

Talent is identified early on, usually at medical graduate level, and mentored throughout the MSc/PhD trajectory. A detailed bibliometric network analysis is not yet available for this ACE. Erasmus MC ranks number 1 in the Netherlands with respect to MNCS (1.76) and MNJS (1.53)(2009-2013/14). The normalized impact of the domain Cardiac&Cardiovascular systems in ErasmusMC is 1.64 (scores>1,2 are considered high), representing 7.2% of the ErasmusMC research output.

Key and relevant publications of the last five years

  • 1. de Jaegere PP, De Santis G, Rodriguez-Olivares R, Bosmans J, Bruining N, Dezutter T, Rahhab Z, El Faquir N, Collas V, Bosmans B, Verhegghe B, Ren C, Geleinse M, Schultz C, van Mieghem N, De Beule M, Mortier P. Patient-Specific Computer Modeling to Predict Aortic Regurgitation After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2016 Mar 14;9(5):508-14. (key)
  • 2. Siregar S, Nieboer D, Vergouwe Y, Versteegh MI, Noyez L, Vonk AB, Steyerberg EW, Takkenberg JJ. Improved Prediction by Dynamic Modeling: An Exploratory Study in the Adult Cardiac Surgery Database of the Netherlands Association for Cardio-Thoracic Surgery. Circ Cardiovasc Qual Outcomes. 2016 Mar;9(2):171-81.doi: 10.1161/CIRCOUTCOMES.114.001645. Epub 2016 Mar 1. PubMed PMID: 26933048. (key)
  • 3. Mokhles MM, Siregar S, Versteegh MI, Noyez L, van Putte B, Vonk AB, Roos-Hesselink JW, Bogers AJ, Takkenberg JJ; data registry committee of the Netherlands Association for Cardio-Thoracic Surgery.. Male-female differences and survival in patients undergoing isolated mitral valve surgery: a nationwidecohort study in the Netherlands. Eur J Cardiothorac Surg. 2016 May 12. pii: ezw151. [Epub ahead of print] PubMed PMID: 27174553.
  • 4. Treasure T, King A, Hidalgo Lemp L, Golesworthy T, Pepper J, Takkenberg JJ. Developing a shared decision support framework for aortic root surgery in Marfan syndrome. Heart. 2018 Mar;104(6):480-486. doi: 10.1136/heartjnl-2017-311598. Epub 2017 Aug 5. PubMed PMID: 28780581; PubMed Central PMCID: PMC5861390.
  • 5. Korteland NM, Ahmed Y, Koolbergen DR, Brouwer M, de Heer F, Kluin J, Bruggemans EF, Klautz RJ, Stiggelbout AM, Bucx JJ, Roos-Hesselink JW, Polak P, Markou T, van den Broek I, Ligthart R, Bogers AJ, Takkenberg JJ. Does the Use of a Decision Aid Improve Decision Making in Prosthetic Heart Valve Selection? A Multicenter Randomized Trial. Circ Cardiovasc Qual Outcomes. 2017 Feb;10(2). pii:e003178. doi: 10.1161/CIRCOUTCOMES.116.003178. Epub 2017 Feb 22. PubMed PMID:28228452.
  • 6. Huygens SA, Goossens LMA, van Erkelens JA, Takkenberg JJM, Rutten-van Mölken MPMH. How much does a heart valve implantation cost and what are the health care costs afterwards? Open Heart. 2018 Feb 14;5(1):e000672. doi:10.1136/openhrt-2017-000672. eCollection 2018. Erratum in: Open Heart. 2018 Apr 5;5(1):e000672corr1. PubMed PMID: 29531755; PubMed Central PMCID: PMC5845412.
  • 7. Korteland NM, Etnel JRG, Arabkhani B, Mokhles MM, Mohamad A, Roos-Hesselink JW, Bogers AJJC, Takkenberg JJM. Mechanical aortic valve replacement in non-elderly adults: meta-analysis and microsimulation. Eur Heart J. 2017 Dec 1;38(45):3370-3377. doi: 10.1093/eurheartj/ehx199. PubMed PMID: 29045647.
  • 8. Petronio AS, Sinning JM, Van Mieghem N, Zucchelli G, Nickenig G, Bekeredjian R, Bosmans J, Bedogni F, Branny M, Stangl K, Kovac J, Schiltgen M, Kraus S, de Jaegere PP. Optimal Implantation Depth and Adherence to Guidelines on Permanent Pacing to Improve the Results of Transcatheter Aortic Valve Replacement With the Medtronic CoreValve System: The CoreValve Prospective, International, Post-Market ADVANCE-II Study. JACC Cardiovasc Interv. 2015 May;8(6):837-46 (International multicenter study, last author study design & chairman executive committee) (key)
  • 9. Van Mieghem NM, El Faquir N, Rahhab Z, Rodríguez-Olivares R, Wilschut J, Ouhlous M, Galema TW, Geleijnse ML, Kappetein AP, Schipper ME, de Jaegere PP. Incidence and predictors of debris embolizing to the brain during transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2015 Apr 27;8(5):718-24.
  • 10. Van Mieghem NM, Schipper ME, Ladich E, Faqiri E, van der Boon R, Randjgari A, Schultz C, Moelker A, van Geuns RJ, Otsuka F, Serruys PW, Virmani R, de Jaegere PP. Histopathology of Embolic Debris Captured During Transcatheter Aortic Valve Replacement. Circulation. 2013 127(22):2194-201 (key)

PhD theses of the last five years

  • 1. Martijn van Geldorp “Prognosis of patients with severe aortic valve stenosis”: (prof dr JJM Takkenberg and prof dr AP Kappetein): thesis defense Feb 2013
  • 2. Mostafa Mokhles “Patient outcome and allograft function over time after allograft heart valve implantation” (CUM LAUDE; promotor prof dr JJM Takkenberg and prof dr AJJC Bogers; in collaboration with Cleveland Clinic Foundation, Cleveland, OH, USA): The
  • 3. R.J. Nuis: Transcatheter aortic valve implantation: current results, insights & future challenges, June 11, 2013, Erasmus University Rotterdam, The Netherlands. (promotor prof dr PPT de Jaegere)
  • 4. Boon van der Robert, May 14, 2014. Transcatheter Aortic Valve Implantation: Insights into clinical complications
  • 5. Houthuizen Patrick, June 11, 2014. Left bundle branch block. Controversies in aortic valve interventions and cardiac resynchronisation therapy, (promotor prof dr F Prinzen & prof dr PPT de Jaegere)
  • 6. Mieghem Nicolas, October 01, 2014. Transcatheter Aortic Valve Therapies. From cutting edge to. (promotor prof dr PPT de Jaegere),
  • 7. Ruben Osnabrugge, 25 February 2015. Costs, Quality and Value in Cardiovascular Interventions. Implications for clinical decision-making and policy development (promotor prof dr AP Kappetein)
  • 8. Helena Heuvelman “Characteristics, treatment options and prognosis of patients with aortic stenosis” (prof dr JJM Takkenberg and prof dr AJJC Bogers): Thesis defense date 29 May 2015
  • 9. Nelleke Korteland “Optimizing clinical decision-making in prosthetic aortic valve selection” (Promotor prof dr JJM Takkenberg and Prof Dr AJJC Bogers): Thesis defense: 18 December 2018
  • 10. Bardia Arabkhani “Aortic aneurysm and aortic valve disease: Treatment options” (Promotor prof dr JJM Takkenberg and prof dr AJJC Bogers) Thesis defense: 28 June 2017

Non-scientific publications related to the ACE

  • - www.hartklepkeuze.nl
  • - www.hartklep.keuzehulp.nl
  • - https://www.skipr.nl/actueel/id29918-online-hulp-bij-hartklepkeuzestress.html
  • - “Iedereen moet zich kunnen ontplooien”, Algemeen Dagblad 28 april 2016 (Interview Takkenberg in role as CDO, referring to own research on gender differences in cardiac surgery)
  • https://www.youtube.com/watch?v=FPowklWiSZU (Dress red day 2018)
  • https://wkolay.net/program/yenilikler2014/video_en.php?oid=MjE5MDc=
  • https://www.ntvg.nl/artikelen/nieuws/hulp-bij-klepkeuzestress
  • https://mijnaha.nl/user/login

Principal coordinator(s)