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Pitts L, Moon MC, Luehr M, Kofler M, Montagner M, Sündermann S, Buz S, Starck C, Falk V, Kempfert J. The Ascyrus Medical Dissection Stent: A One-Fits-All Strategy for the Treatment of Acute Type A Aortic Dissection? J Clin Med 2024; 13:2593. [PMID: 38731123 PMCID: PMC11084383 DOI: 10.3390/jcm13092593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/09/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
The treatment of DeBakey type I aortic dissection remains a major challenge in the field of aortic surgery. To upgrade the standard of care hemiarch replacement, a novel device called an "Ascyrus Medical Dissection Stent" (AMDS) is now available. This hybrid device composed of a proximal polytetrafluoroethylene cuff and a distal non-covered nitinol stent is inserted into the aortic arch and the descending thoracic aorta during hypothermic circulatory arrest in addition to hemiarch replacement. Due to its specific design, it may result in a reduced risk for distal anastomotic new entries, the effective restoration of branch vessel malperfusion and positive aortic remodeling. In this narrative review, we provide an overview about the indications and the technical use of the AMDS. Additionally, we summarize the current available literature and discuss potential pitfalls in the application of the AMDS regarding device failure and aortic re-intervention.
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Affiliation(s)
- Leonard Pitts
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (M.M.); (S.S.); (S.B.); (C.S.); (V.F.); (J.K.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Michael C. Moon
- Division of Cardiac Surgery, University of Alberta, Edmonton, AB T6G 1H9, Canada;
| | - Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Centre, University of Cologne, 50923 Cologne, Germany;
| | - Markus Kofler
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (M.M.); (S.S.); (S.B.); (C.S.); (V.F.); (J.K.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Matteo Montagner
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (M.M.); (S.S.); (S.B.); (C.S.); (V.F.); (J.K.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Simon Sündermann
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (M.M.); (S.S.); (S.B.); (C.S.); (V.F.); (J.K.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Semih Buz
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (M.M.); (S.S.); (S.B.); (C.S.); (V.F.); (J.K.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Christoph Starck
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (M.M.); (S.S.); (S.B.); (C.S.); (V.F.); (J.K.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Volkmar Falk
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (M.M.); (S.S.); (S.B.); (C.S.); (V.F.); (J.K.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH), 8092 Zurich, Switzerland
| | - Jörg Kempfert
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (M.M.); (S.S.); (S.B.); (C.S.); (V.F.); (J.K.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
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Immohr MB, Mehdiani A, Bauer SJ, Ise H, Sugimura Y, Lichtenberg A, Akhyari P. Combining aortic arch dissection stent implantation and root surgery for aortic dissection type A. J Cardiothorac Surg 2023; 18:72. [PMID: 36765394 PMCID: PMC9912600 DOI: 10.1186/s13019-023-02154-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Acute aortic dissection type A (AADA) is associated with high perioperative morbidity and mortality. A novel non-covered hybrid prosthesis (AMDS, CryoLife, Kennesaw, USA) can be easily implanted to stabilize the true lumen. However, the role of AMDS for patients requiring additional aortic root surgery has not been described. METHODS Between 2010 and 2020 a total of n = 370 patients underwent surgery for AADA in our department. Of those, n = 120 underwent treatment for aortic root in addition to proximal arch replacement without resection of the aorta beyond the innominate artery (Control, n = 111) and were compared to patients who received additional AMDS implantation (AMDS, n = 9). RESULTS Aortic valve repair was performed in 48.6% (Control) and in 55.6% of AMDS patients. Cardiopulmonary bypass (Control: 248 ± 76 min, AMDS: 313 ± 53 min, P < 0.01) time as well as circulatory arrest time of the lower body (Control: 30 ± 15 min, AMDS: 52 ± 12 min, P < 0.01) was prolonged in the AMDS group. Nevertheless, postoperative in-hospital morbidity such as dialysis (Control: 22.4%, AMDS: 11.1%, P = 0.68) and stroke (Control: 17.0%, AMDS: 22.2%, P = 0.65) were comparable. In-hospital death (Control: 21.8%, AMDS: 11.1%, P = 0.68) and the compound end-point MACCE (Control: 38.7%, AMDS: 44.4%, P = 0.74) did also not differ. CONCLUSIONS Addressing the arch by implantation of AMDS prolongs cardiopulmonary bypass and circulatory arrest time, however without relevant impairments of short-term outcome. Combining root surgery with replacement of the proximal aortic arch and AMDS implantation seems feasible and safe as it did not impair the early postoperative outcome.
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Affiliation(s)
- Moritz Benjamin Immohr
- grid.14778.3d0000 0000 8922 7789Department of Cardiac Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Arash Mehdiani
- grid.14778.3d0000 0000 8922 7789Department of Cardiac Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Sebastian Johannes Bauer
- grid.14778.3d0000 0000 8922 7789Department of Cardiac Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Hayato Ise
- grid.14778.3d0000 0000 8922 7789Department of Cardiac Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Yukiharu Sugimura
- grid.14778.3d0000 0000 8922 7789Department of Cardiac Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Artur Lichtenberg
- grid.14778.3d0000 0000 8922 7789Department of Cardiac Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
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Pacini D, Murana G. Novel hybrid graft for acute type A repair: advance mastering of dissection stenting. Eur J Cardiothorac Surg 2022; 62:6661345. [PMID: 35971687 DOI: 10.1093/ejcts/ezac408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Davide Pacini
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna, Italy
| | - Giacomo Murana
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Vendramin I, Piani D, Lechiancole A, Sponga S, Di Nora C, Londero F, Muser D, Onorati F, Bortolotti U, Livi U. Hemiarch Versus Arch Replacement in Acute Type A Aortic Dissection: Is the Occam's Razor Principle Applicable? J Clin Med 2021; 11:jcm11010114. [PMID: 35011856 PMCID: PMC8745476 DOI: 10.3390/jcm11010114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/25/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM OF THE STUDY In patients with acute Type A aortic dissection (A-AAD) whether repair should be limited to ascending aorta/hemiarch replacement or extended to include the aortic arch is still debated. We have analyzed our experience to compare outcomes of patients with A-AAD treated with these 2 different surgical strategies. METHODS From 2006 to 2020, a total of 213 patients have undergone repair of A-AAD at our Center; in 163 of them ascending aorta/hemiarch replacement (Group 1) and in 75 ascending aorta and arch replacement (Group 2) were performed. The primary endpoint was early survival and secondary endpoints late survival, freedom from late complications and reoperations. Patients were compared according to era of operation: 2006 to 2013 (Era 1) and 2014 to 2020 (Era 2). RESULTS Overall hospital mortality was 12% and 5% in Group 1 and 2; mortality remained stable in Era 1 and 2 for Group 1 (15%), while it decreased from 8% to 1% in Group 2 patients (p = 0.24). Actuarial survival at 5 and 10 years is 72 ± 4% and 49 ± 5% in Group 1 and 77 ± 6% and 66 ± 9% in Group 2 (p = 0.073). Actuarial freedom from reoperation in the entire series is 94 ± 2% and 92 ± 3% at 5 and 10 years. Freedom from reoperation at 5 and 10 years is 92 ± 2% and 89 ± 3% in Group 1 and 98 ± 1% at all intervals in Group 2 (p = 0.068). CONCLUSIONS An aggressive approach to A-AAD provides superior long-term results without increasing mortality. Furthermore, arch replacement during A-AAD repair represents a more stable solution with lower incidence of late aortic-related complications. Immediate aortic arch replacement should be considered in the treatment of A-AAD especially in experienced centers.
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Affiliation(s)
- Igor Vendramin
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
- Correspondence: ; Tel.: +39-432-552431; Fax: +39-432-552975
| | - Daniela Piani
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
| | - Andrea Lechiancole
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
| | - Sandro Sponga
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
| | - Concetta Di Nora
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
| | - Francesco Londero
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
| | - Daniele Muser
- Division of Cardiology, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy;
| | - Francesco Onorati
- Division of Cardiac Surgery, Azienda Ospedaliero-Universitaria di Verona, 37100 Verona, Italy;
| | - Uberto Bortolotti
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
| | - Ugolino Livi
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy; (D.P.); (A.L.); (S.S.); (C.D.N.); (F.L.); (U.B.); (U.L.)
- Division of Cardiac Surgery, Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy
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Vendramin I, Lechiancole A, Piani D, Sponga S, Di Nora C, Muser D, Bortolotti U, Livi U. An Integrated Approach for Treatment of Acute Type A Aortic Dissection. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111155. [PMID: 34833373 PMCID: PMC8621250 DOI: 10.3390/medicina57111155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Abstract
Background and objective: We reviewed a single-institution experience to verify the impact of surgery during different time intervals on early and late results in the treatment of patients with type A acute aortic dissection (A-AAD). Materials and Methods: From 2004 to 2021, a total of 258 patients underwent repair of A-AAD; patients were equally distributed among three periods: 2004-2010 (Era 1, n = 90), 2011-2016 (Era 2, n = 87), and 2017-2021 (Era 3, n = 81). The primary end-point was to assess whether through the years changes in indications, surgical strategies and techniques and increasing experience have influenced early and late outcomes of A-AAD repair. Results: Axillary artery cannulation was almost routinely used in Eras 2 (86%) and 3 (91%) while one femoral artery was mainly cannulated in Era 1 (91%) (p < 0.01). Retrograde cerebral perfusion was predominantly used in Era 1 (60%) while antegrade cerebral perfusion was preferred in Eras 2 (94%,) and 3 (100%); (p < 0.01). There was a significant increase of arch replacement procedures from Era 1 (11%) to Eras 2 (33%) and 3 (48%) (p < 0.01). A frozen elephant trunk was mainly performed in Era 3. Hospital mortality was 13% in Era 1, 11% in Era 2, and 4% in Era 3 (p = 0.07). Actuarial survival at 3 years is 74%, in Era 1, 78% in Era 2, and 89% in Era 3 (p = 0.05). Conclusions: With increasing experience and a more aggressive approach, including total arch replacement, repair of A-AAD can be performed with low operative mortality in many patients. Patient care and treatment by a specific team organization allows a faster diagnosis and referral for surgery allowing to further improve early and late outcomes.
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Affiliation(s)
- Igor Vendramin
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
| | - Andrea Lechiancole
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
| | - Daniela Piani
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
| | - Sandro Sponga
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
| | - Concetta Di Nora
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
| | - Daniele Muser
- Cardiothoracic Department, Division of Cardiology, University Hospital of Udine, 33100 Udine, Italy;
| | - Uberto Bortolotti
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
| | - Ugolino Livi
- Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy; (A.L.); (D.P.); (S.S.); (C.D.N.); (U.B.); (U.L.)
- Department of Medical Area (DAME), Division of Cardiac Surgery, University of Udine, 33100 Udine, Italy
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Do oral anticoagulants impact outcomes and false lumen patency after repair of acute type A aortic dissection? J Thorac Cardiovasc Surg 2021:S0022-5223(21)01312-X. [PMID: 34583844 DOI: 10.1016/j.jtcvs.2021.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 08/21/2021] [Accepted: 09/03/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The study objective was to analyze the effects of chronic oral anticoagulation on long-term outcomes after repair of type A acute aortic dissection and its influence on false lumen fate. METHODS We studied 188 patients (median age, 62 years; 74% were male) who underwent repair of type A aortic dissection; patients receiving postoperative chronic oral anticoagulation (n = 59) were compared with those receiving antiplatelet therapy alone (n = 129). RESULTS Median age was similar: 60 years (18-79 years; OAC group) versus 64 years (22-86; no-OAC group) (P = .11); patients taking anticoagulants were more frequently male (88% vs 67%, P = .003). After a median follow-up of 8.4 years (2 months to 30 years), 58 patients died, 18 of aortic-related causes, and 37 patients underwent aortic reintervention. After multivariable adjustment, anticoagulation showed no significant effect on long-term survival (hazard ratio, 0.85; 95% confidence interval, 0.41-1.76; P = .66) or risk of reintervention (hazard ratio, 0.55; 95% confidence interval, 0.27-1.15; P = .11). Analysis of 127 postoperative computed tomography scans showed a patent false lumen in 53% of anticoagulated patients versus 38% of nonanticoagulated patients (P = .09): partially thrombosed in 8% versus 28% (P = .01) and thrombosed in 39% versus 34% (P = .63), respectively. In patients with a control computed tomography, there were 6 late aortic-related deaths, 1 among anticoagulated patients and 5 in those who were not. CONCLUSIONS Chronic anticoagulation after repair of type A acute aortic dissection favors persistent late false lumen patency, which is not a risk factor for late mortality or reoperation. Chronic anticoagulation can be administered safely to patients with repaired type A acute aortic dissection regardless of its specific indication.
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Vendramin I, Peghin M, Tascini C, Bortolotti U, Livi U. Mycobacterium chimaera infection after cardiac surgery: Catastrophic effects of delayed diagnosis. J Card Surg 2020; 36:408. [PMID: 33124088 DOI: 10.1111/jocs.15172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Maddalena Peghin
- Division of Infectious Diseases, University Hospital of Udine, Udine, Italy
| | - Carlo Tascini
- Division of Infectious Diseases, University Hospital of Udine, Udine, Italy
| | - Uberto Bortolotti
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
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