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Gregoric ID, Patel M, Akay MH, Salas De Armas I, Patel J, Jezovnik MK, Radovancevic R, Kar B. Off-pump Left Ventricular Assist Device Implantation Through Median Sternotomy Versus Sternal Sparing Approach. ASAIO J 2023; 69:e265-e266. [PMID: 36521006 DOI: 10.1097/mat.0000000000001847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Igor D Gregoric
- From the Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas
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2
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Off-pump implantation of left ventricular assist device via minimally invasive left thoracotomy: Our single-center experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:37-44. [PMID: 36926145 PMCID: PMC10012981 DOI: 10.5606/tgkdc.dergisi.2023.23370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/23/2022] [Indexed: 03/18/2023]
Abstract
Background The aim of this study was to compare our experience of left ventricular assist device implantation via minimally invasive left thoracotomy with off-pump versus on-pump technique. Methods Between June 2013 and April 2020, nine patients (8 males, 1 female; mean age: 47±11.9 years; range, 30 to 61 years) who underwent off-pump left ventricular assist device implantation and nine patients (8 males, 1 female; mean age: 47±11.4 years; range, 29 to 60 years) who underwent on-pump minimally invasive left thoracotomy were retrospectively analyzed. Postoperative outcomes and mid-term results of both groups were evaluated. Results Outflow graft was anastomosed to the ascending aorta with J-sternotomy in all patients. The median duration of intubation and intensive care unit stay were one (IQR: 1.5) day and eight (IQR: 6.5) days in the off-pump group, respectively and one (IQR: 0) day and seven (IQR: 7) days in the on-pump group, respectively. Intra-aortic balloon pump was needed during the weaning of cardiopulmonary bypass in one (11%) of the patients in both groups. Postoperative right ventricular failure was observed in two (22%) patients in the offpump group who were treated medically and recovered. There was no need for revision due to bleeding or postoperative extracorporeal membrane oxygenator implantation in either group. In the off-pump group, three patients underwent heart transplantation after median 854 (IQR: 960) days. Three patients died one month, two and four years after implantation. Three patients were still alive with left ventricular assist device and were being uneventfully followed for 365, 400, and 700 days after implantation. Conclusion Off-pump technique is safe and feasible option for implantation of left ventricular assist device via minimally invasive left thoracotomy.
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Pienta M, Shore S, Pagani FD, Likosky DS. Rates and types of infections in left ventricular assist device recipients: A scoping review. JTCVS OPEN 2021; 8:405-411. [PMID: 36004147 PMCID: PMC9390679 DOI: 10.1016/j.xjon.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/06/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Michael Pienta
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Supriya Shore
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Mich
| | - Francis D. Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Donald S. Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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4
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Shore S, Pienta MJ, Watt TMF, Yost G, Townsend WA, Cabrera L, Fetters MD, Chenoweth C, Aaronson KD, Pagani FD, Likosky DS. Non-patient factors associated with infections in LVAD recipients: A scoping review. J Heart Lung Transplant 2021; 41:1-16. [PMID: 34801350 DOI: 10.1016/j.healun.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/08/2021] [Accepted: 10/02/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Infections are the most common complication in recipients of durable left ventricular assist devices (LVAD) and are associated with increased morbidity, mortality, and expenditures. The existing literature examining factors associated with infection in LVAD recipients is limited and principally comprises single-center studies. This scoping review synthesizes all available evidence related to identifying modifiable, non-patient factors associated with infections among LVAD recipients. METHODS Published studies were identified through searching 5 bibliographic databases: PubMed, Scopus, EMBASE, CINAHL, and Web of Science Core Collection. Inclusion criteria required examination of factors associated with infections among recipients of contemporary, implantable, continuous flow LVADs. Key study characteristics were extracted by 4 independent reviewers and current literature described narratively. The Systems Engineering Initiative for Patient Safety (SEIPS) model was used to develop a taxonomy for non-patient related factors (e.g., tasks, tools, technologies, organization, and environment) associated with infections following LVAD implantation. All analyses took place between February 2019 and May 2021. FINDINGS A total of 43 studies met inclusion criteria. The majority of included studies were observational (n = 37), single-center (n = 29), from the U.S. (n = 38), and focused on driveline infections (n = 40). Among the 22 evaluated sub-domains of non-patient related factors, only two: increasing center experience and establishing a silicone-skin interface at the driveline exit site, were identified as consistently being associated with a lower risk of infection. CONCLUSION This review identified 43 studies that described non-patient related factors associated with infection in LVAD recipients. Only two factors were consistently associated with lower infection risk in LVAD recipients: increasing experience and establishing a silicone-skin interface at driveline exit site. The large variability in reporting across multiple studied interventions limited the ability to discern their effectiveness.
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Affiliation(s)
| | | | | | | | - Whitney A Townsend
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
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5
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Salas De Armas IA, Patel JA, Akay MH, Patel MK, Rajagopal K, Karabulut MN, Kar B, Gregoric ID. Off-Pump Continuous-Flow Left Ventricular Assist Device Implantation. Tex Heart Inst J 2021; 48:464664. [PMID: 33946106 DOI: 10.14503/thij-19-7033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Continuous-flow left ventricular assist device implantation is the typical treatment for end-stage heart failure. Improvements in device engineering and technology, surgical experience and technique, and perioperative management have advanced the field, and short-term results approach those of heart transplantation. Further improvements may be achieved by minimizing adverse physiologic effects associated with cardiopulmonary bypass. Therefore, we have developed an off-pump implantation approach for continuous-flow left ventricular assist devices. We detail our surgical technique for off-pump implantation of the HeartWare device.
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Affiliation(s)
- Ismael A Salas De Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas.,Center for Advanced Heart Failure, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Jayeshkumar A Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas.,Center for Advanced Heart Failure, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Mehmet H Akay
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas.,Center for Advanced Heart Failure, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Manish K Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas.,Center for Advanced Heart Failure, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Keshava Rajagopal
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas.,Center for Advanced Heart Failure, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Mehmet N Karabulut
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas.,Center for Advanced Heart Failure, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas.,Center for Advanced Heart Failure, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas.,Center for Advanced Heart Failure, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
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Al-Naamani A, Fahr F, Khan A, Bireta C, Nozdrzykowski M, Feder S, Deshmukh N, Jubeh M, Eifert S, Jawad K, Schulz U, Borger MA, Saeed D. Minimally invasive ventricular assist device implantation. J Thorac Dis 2021; 13:2010-2017. [PMID: 33841987 PMCID: PMC8024790 DOI: 10.21037/jtd-20-1492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Durable mechanical circulatory support (MCS) systems are established therapy option in patients with end-stage heart failure, with increasing importance during the last years due to donor organ shortage. Left ventricular assist devices (LVADs) are traditionally implanted through median sternotomy (MS). However, improvement in the pump designs during the last years led to evolvement of new surgical approaches that aim to reduce the invasiveness of the procedure. Numerous reports and studies have shown the viability and possible advantages of less-invasive approach compared to the sternotomy approach. The less invasive implant strategies for LVADs, while vague in definition, are characterized by minimizing surgical trauma and if possible, cardio-pulmonary bypass related complications. Usually it involves minimizing or completely avoiding sternal trauma, avoiding heart luxation while simultaneously leaving the major part of pericardium intact. There is no consensus between the centers regarding the ideal approach for LVAD implantation. Some centers, like our center, perform by default VAD implantation using less invasive approach in almost all patients and some centers use only sternotomy approach. The aim of this review article is to shed light on the currently available less invasive options of LVAD implantation, with particular focus on the centrifugal pumps, and their possible advantages compared to traditional sternotomy approach.
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Affiliation(s)
- Ameen Al-Naamani
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Florian Fahr
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Asim Khan
- Department of Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Christian Bireta
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Michael Nozdrzykowski
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Stefan Feder
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Nikhil Deshmukh
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Manal Jubeh
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Sandra Eifert
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.,Cardiac Surgery, Peter Munk Cardiac Center, University of Toronto, Toronto, Canada
| | - Uwe Schulz
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Diyar Saeed
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
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7
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Mokadam NA, McGee E, Wieselthaler G, Pham DT, Bailey SH, Pretorius GV, Boeve TJ, Ismyrloglou E, Strueber M. Cost of Thoracotomy Approach: An Analysis of the LATERAL Trial. Ann Thorac Surg 2020; 110:1512-1519. [PMID: 32224242 DOI: 10.1016/j.athoracsur.2020.02.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 02/07/2020] [Accepted: 05/24/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Less invasive techniques for left ventricular assist device implantation have been increasingly prevalent over past years and have been associated with improved clinical outcomes. The procedural economic impact of these techniques remains unknown. We sought to study and report economic outcomes associated with the thoracotomy implantation approach. METHODS The LATERAL clinical trial evaluated the safety and efficacy of the thoracotomy approach for implantation of the HeartWare centrifugal-flow ventricular assist device system (HVAD). We collected UB-04 forms in parallel to the trial, allowing analysis of index hospitalization costs. All charges were converted to costs using hospital-specific cost-to-charge ratios and were subsequently compared with Medicare cost data for the same period (2015-2016). Because thoracotomy implants were off-label for all left ventricular assist devices during that period, the Medicare cohort was assumed to consist predominately of traditional sternotomy patients. RESULTS Thoracotomy patients demonstrated decreased costs compared with sternotomy patients during the index hospitalization. Mean total index hospitalization costs for thoracotomy were $204,107 per patient, corresponding to 21.6% reduction (P < .001) and $56,385 savings per procedure compared with sternotomy. Across almost all cost categories, thoracotomy implants were less costly. CONCLUSIONS In LATERAL, a clinical trial evaluating the safety and efficacy of the thoracotomy approach for HVAD, costs were lower than those reported in Medicare patient claims occurring over the same period. Because Medicare data can be presumed to consist of predominately sternotomy procedures, thoracotomy appears less expensive than traditional sternotomy.
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Affiliation(s)
- Nahush A Mokadam
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Edwin McGee
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Georg Wieselthaler
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Duc Thinh Pham
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen H Bailey
- Department of Thoracic and Cardiac Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - G Victor Pretorius
- Department of Surgery, University of California San Diego, La Jolla, California
| | - Theodore J Boeve
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - Eleni Ismyrloglou
- Department of Cardiac Rhythm and Heart Failure, Medtronic Bakken Research Center BV, Maastricht, the Netherlands
| | - Martin Strueber
- Department of Cardiothoracic Surgery, Newark Beth Israel Medical Center, Newark, New Jersey
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Schumer EM, Slaughter MS. Cirugía mínimamente invasiva para la implantación de dispositivos de asistencia ventricular: ¿es siempre recomendable? Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schumer EM, Slaughter MS. The Minimally Invasive Approach to Left Ventricular Assist Device Implantation: Is Smaller Better? ACTA ACUST UNITED AC 2017; 71:2-3. [PMID: 28993047 DOI: 10.1016/j.rec.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/17/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Erin M Schumer
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky, United States
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky, United States.
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Sahutoglu C, Turksal E, Bilic U, Kocabas S, Zekiye Askar F, Ozturk P, Ertugay S, Engin C, Yagdi T, Ozbaran M. Anesthetic Management for Left Ventricular Assist Device Implantation Through Left Thoracotomy: Evaluation of On-Pump Versus Off-Pump. Transplant Proc 2017; 49:587-592. [PMID: 28340838 DOI: 10.1016/j.transproceed.2017.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ventricular assist devices (VADs) are alternative approaches to medical treatment in patients with acute or chronic heart failure. The goal of this study was to compare an anesthetic approach in patients undergoing implantation of a VAD with (on-pump) or without (off-pump) cardiopulmonary bypass (CPB) through left thoracotomy. METHODS A total of 32 patients were divided into 2 groups: on-pump (group 1) and off-pump (group 2). A standard anesthesia protocol was used in all patients. Baseline characteristics of the patients, intraoperative hemodynamic and respiratory variables, anesthetic agents and vasoactive drugs administered, the amount of blood products, extubation, length of hospital stay and intensive care unit stay, and postoperative complications were recorded. RESULTS Patients' mean age was 54.7 ± 13.3 years (range, 18-74 years). Eighteen patients underwent surgery with CPB. Demographic data of the patients, preoperative characteristics, intraoperative use of blood products, intraoperative complications, and anesthetic drugs used were similar between groups (P > .05). The duration of surgery (219 ± 23 vs 273 ± 56 minutes) and anesthesia (274 ± 38 vs 323 ± 57 minutes) were shorter in group 2; there was no difference between the 2 groups in terms of mechanical ventilation time, length of stay in the intensive care unit, and length of hospital stay. There was no decrease in postoperative oxygen parameters and an increase in patient lactate levels with the use of CPB. The use of fresh frozen plasma and platelet suspension in the postoperative period was significantly higher in group 1 (P < .05). The rate of complications and mortality rate were comparable between the 2 groups (P > .05). CONCLUSIONS Our study results show that the use of CPB during VAD implantation via left thoracotomy increases operation time and use of blood products, while causing no change in the rate of complications.
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Affiliation(s)
- C Sahutoglu
- Department of Anesthesiology and Reanimation, Ege University Medical Faculty, Izmir, Turkey.
| | - E Turksal
- Department of Anesthesiology and Reanimation, Ege University Medical Faculty, Izmir, Turkey
| | - U Bilic
- Department of Anesthesiology and Reanimation, Ege University Medical Faculty, Izmir, Turkey
| | - S Kocabas
- Department of Anesthesiology and Reanimation, Ege University Medical Faculty, Izmir, Turkey
| | - F Zekiye Askar
- Department of Anesthesiology and Reanimation, Ege University Medical Faculty, Izmir, Turkey
| | - P Ozturk
- Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey
| | - S Ertugay
- Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey
| | - C Engin
- Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey
| | - T Yagdi
- Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey
| | - M Ozbaran
- Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey
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Botta L, De Chiara B, Macera F, Cannata A, Costetti A, Voltolini A, Moreo A, Cipriani M, Frigerio M, Russo CF. HeartWare-HVAD for end-stage heart failure: a review of clinical experiences with ≥50 patients. Expert Rev Med Devices 2017; 14:423-437. [DOI: 10.1080/17434440.2017.1325318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Luca Botta
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Benedetta De Chiara
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Francesca Macera
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Aldo Cannata
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Alessandro Costetti
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Alessandra Voltolini
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Antonella Moreo
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Manlio Cipriani
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Maria Frigerio
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
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