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Di Mauro M, Guarracini S, Mazzocchetti L, Capuzzi D, Salute L, Di Marco M, Lorusso R, Calafiore AM. Transcatheter bicaval valve system for the treatment of severe isolated tricuspid regurgitation. Features from a single-Centre experience. Int J Cardiol 2024; 402:131864. [PMID: 38367886 DOI: 10.1016/j.ijcard.2024.131864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/20/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The isolated tricuspid valve (TR) has evolved into an entity in its own right. In contrast to TR treatment in left valve surgery, the benefit of surgery for isolated TR remains controversial. In this context, transcatheter valve interventions (TTVI) are becoming increasingly important. In this report, we present our experience with TricValve in a single center. METHODS From March 2022 to September 2023, 13 patients with at least severe isolated TR were scheduled for TricValve implantation. The mean age was 81 years (77-87), 5 were female and 8 were male. All patients were older than 70 years and had at least severe TR, hepatic or peripheral congestion and high surgical risk. RESULTS No procedure failure or device embolization was recorded. One case died in hospital 6 days after implantation and 1 case died after 124 days from irreversible renal and hepatic failure. The survival rate was 80.2% ± 12.8; the proportion of patients in NYHA class I increased significantly to 45% at follow-up. Among the 11 survivors, the median NT -proBNP decreased from 2873 to 148 pg/mL at follow-up (p = 0.003). In addition, a significant reduction in furosemide dosage from 125 mg to 50 mg at follow-up was observed over time. Finally, TR grade improved significantly along with RV size. CONCLUSIONS This procedure appears to be safe and effective in carefully selected patients. Given the extreme simplicity of the procedure, the TricValve will increasingly represent one of the most viable treatment options for this patient group in the future.
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Affiliation(s)
- Michele Di Mauro
- Department of Cardiovascular Disease, "Pierangeli" Hospital, Pescara, Italy; Cardiac Department, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | - Stefano Guarracini
- Department of Cardiovascular Disease, "Pierangeli" Hospital, Pescara, Italy
| | | | - Donato Capuzzi
- Department of Cardiovascular Disease, "Pierangeli" Hospital, Pescara, Italy
| | - Lorenzo Salute
- Department of Cardiovascular Disease, "Pierangeli" Hospital, Pescara, Italy
| | - Massimo Di Marco
- Department of Cardiology, Santo Spirito Hospital, Pescara, Italy
| | - Roberto Lorusso
- Cardiac Department, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
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Guarracini S, Di Sebastiano P, Di Mola FF, Di Renzo R, Mazzocchetti L, Calafiore AM, Di Mauro M. Case Report: Abdominal surgery with the support of Impella (SURGELLA), a new frontier to be explored. Front Cardiovasc Med 2024; 11:1301538. [PMID: 38638881 PMCID: PMC11024443 DOI: 10.3389/fcvm.2024.1301538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
A 74-year-old man with advanced heart failure was admitted to the hospital with a diagnosis of colorectal cancer, and he underwent surgery. To maintain stable hemodynamics, the Impella CP device was used. The patient was weaned from the device shortly after surgery, and he had an uneventful postoperative course. This case may pave the way for non-procrastinating surgery in patients with poorly stable hemodynamics.
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Affiliation(s)
| | - Pierluigi Di Sebastiano
- Unit of Surgical Oncology, Casa di Cura Pierangeli, Largo Luigi Pierangeli 1, Pescara, Italy
- Department of Innovative Technologies In Clinical Medicine & Dentistry, University “G. d'Annunzio” Chieti-Pescara, Chieti, Italy
| | - Fabio Francesco Di Mola
- Unit of Surgical Oncology, Casa di Cura Pierangeli, Largo Luigi Pierangeli 1, Pescara, Italy
- Department of Medical, Oral & Biotechnological Sciences, University “G. D'Annunzio” Chieti-Pescara, Chieti, Italy
| | | | | | | | - Michele Di Mauro
- Department of Cardiology, “Pierangeli” Hospital, Pescara, Italy
- Department of Cardio-Thoracic Surgery, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
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Prapas S, Katsavrias K, Gaudino M, Puskas JD, Di Mauro M, Zografos P, Guarracini S, Linardakis I, Panagiotopoulos I, Di Marco M, Papandreopoulos S, Pomakidou S, Totaro A, Calafiore AM. Saphenous vein to the right coronary system from the right thoracic artery or the aorta. Long-term propensity-matched results of 2 groups. Eur J Cardiothorac Surg 2024; 65:ezae060. [PMID: 38400814 DOI: 10.1093/ejcts/ezae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/09/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES Since 2000, we anastomosed the saphenous vein graft to the right coronary artery system using the stump of the right internal thoracic artery as inflow. The long-term results of patients where the right coronary artery was grafted with the right internal thoracic artery or the ascending aorta as saphenous vein inflow has not been reported. METHODS From 2000 to 2018, 699 consecutive patients had right internal thoracic artery elongated with saphenous vein (I-graft group, n = 358, 51.2%) or saphenous vein from the aorta (Ao-graft group, n = 341, 48.8%) on right coronary artery system. Inclusion criteria were age ≤75 years, bilateral internal thoracic arteries as a Y graft on the left system (three-vessel disease, n = 603, 86.3%) or as a left internal thoracic artery on left anterior descending and right internal thoracic artery elongated with saphenous vein on the right coronary artery system (two-vessel disease, n = 96, 13.7%), only 1 saphenous vein per patient. Propensity-matching identified 272 patients per group. One-hundred and twenty-two patients underwent coronary computed tomographic angiography to asses grafts patency after a median follow-up of 88 (65-93) months. RESULTS In the paired samples, there was no difference in the early outcome. Ten-year survival and freedom from death, non-fatal acute myocardial infarction and repeat revascularization were higher in I-graft group: 90.6 [standard error (SE): 2.0] vs 78.2 (SE: 5.3), P = 0.0266, and 85.2 (SE: 2.4) vs 69.9 (SE: 5.3), P = 0.0179. Saphenous vein graft, at a long-time follow-up, showed a higher patency rate (81.6% (SE: 7.0) vs 50.7% (SE: 7.9), P < 0.0001) and a smaller internal lumen diameter (2.7, standard deviation: 0.4 vs 3.4, standard deviation: 0.6 mm, P < 0.0001) when right internal thoracic artery was the inflow. CONCLUSIONS Grafting the right coronary artery with saphenous vein may entail higher patency rate and better outcome when the inflow is the right internal thoracic artery than when is the ascending aorta. Prospective randomized data are needed to test this hypothesis.
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Affiliation(s)
- Sotirios Prapas
- 1st Department of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | | | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
- Department of Cardiology, "Pierangeli" Hospital, Pescara, Italy
| | | | | | - Ioannis Linardakis
- 1st Department of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | | | | | | | | | - Antonio Totaro
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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Calafiore AM, Prapas S, Guarracini S, Mauro MD. Tricuspid valve adaptation to regurgitation: closing the circle. Eur J Cardiothorac Surg 2023:7163178. [PMID: 37187021 DOI: 10.1093/ejcts/ezad191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
| | - Sotirios Prapas
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | | | - Miche Di Mauro
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute of Maastricht (CARIM), Maastricht, Netherlands
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Melder RJ, Naso F, Nicotra F, Russo L, Vesely I, Tuladhar SR, Calafiore AM, Zilla P, Gandaglia A, Korossis S. Preventing extrinsic mechanisms of bioprosthetic degeneration using polyphenols. Eur J Cardiothorac Surg 2022; 63:6957091. [PMID: 36548449 DOI: 10.1093/ejcts/ezac583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES the purpose of this study was to evaluate the impact of a polyphenols-based treatment on the extrinsic mechanisms responsible for early BHV degeneration. Structural degeneration can be driven by both extrinsic and intrinsic mechanisms. While intrinsic mechanisms have been associated with inherent biocompatibility characteristics of the BHV, the extrinsic ones have been reported to involve external causes, such as chemical, mechanical and hydrodynamic, responsible to facilitate graft damage. METHODS the chemical interaction and the stability degree between polyphenols and pericardial tissue were carefully evaluated. The detoxification of glutaraldehyde in commercial BHVs models as well as the protective effect from in-vivo calcification were taken into relevant consideration. Finally, the hydrodynamic and biomechanical features of the polyphenols-treated pericardial tissue were deeply investigated by pulse duplicator and stress-strain analysis. RESULTS the study demonstrated the durability of the polyphenols-based treatment on pericardial tissue and the stability of the bound polyphenols. The treatment improves glutaraldehyde stabilization's current degree, demonstrating a surprising in-vivo anti-calcific effect. It is able to make the pericardial tissue more pliable while maintaining the correct hydrodynamic characteristics. CONCLUSIONS the polyphenols treatment has proved to be a promising approach capable of acting simultaneously on several factors related to the premature degeneration of cardiac valve substitutes by extrinsic mechanisms.
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Affiliation(s)
| | | | - Francesco Nicotra
- University of Milano-Bicocca, Department of Biotechnology and Biosciences, Milan, Italy
| | - Laura Russo
- University of Milano-Bicocca, Department of Biotechnology and Biosciences, Milan, Italy.,CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Ivan Vesely
- Class III Medical Device Consulting, Maryland, USA
| | - Sugat R Tuladhar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover Medical School, Hannover, Germany
| | | | - Peter Zilla
- Christian Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Sotiris Korossis
- Centre for Biological Engineering, Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, Leicestershire, United Kingdom
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Calafiore AM, de Paulis R, Iesu S, Paparella D, Angelini G, Scognamiglio M, Centofanti P, Nicolardi S, Chivasso P, Canosa C, Zaccaria S, de Martino L, Magnano D, Mastrototaro G, Di Mauro M. Brain and lower body protection during aortic arch surgery. J Card Surg 2022; 37:4982-4990. [PMID: 36403255 DOI: 10.1111/jocs.17207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/27/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Deep hypothermic circulatory arrest (DHCA) at ≤20°C for aortic arch surgery has been widely used for decades, with or without cerebral perfusion (CP), antegrade (antegrade cerebral perfusion [ACP]), or retrograde. In recent years nadir temperature progressively increased to 26°C-28°C (moderately hypothermic circulatory arrest [MHCA]), adding ACP. Aim of this multicentric study is to evaluate early results of aortic arch surgery and if DHCA with 10 min of cold reperfusion at the same nadir temperature of the CA before rewarming (delayed rewarming [DR]) can provide a neuroprotection and a lower body protection similar to that provided by MHCA + ACP. METHODS A total of 210 patients were included in the study. DHCA + DR was used in 59 patients and MHCA + ACP in 151. Primary endpoints were death, neurologic event (NE), temporary (TNE), or permanent (permanent neurologic deficit [PND]), and need of renal replacement therapy (RRT). RESULTS Operative mortality occurred in 14 patients (6.7%), NEs in 17 (8.1%), and PNDs in 10 (4.8%). A total of 23 patients (10.9%) needed RRT. Death + PND occurred in 21 patients (10%) and composite endpoint in 35 (19.2%). Intergroup weighed logistic regression analysis showed similar prevalence of deaths, NDs, and death + PND, but need of RRT (odds ratio [OR]: 7.39, confidence interval [CI]: 1.37-79.1) and composite endpoint (OR: 8.97, CI: 1.95-35.3) were significantly lower in DHCA + DR group compared with MHCA + ACP group. CONCLUSIONS The results of our study demonstrate that DHCA + DR has the same prevalence of operative mortality, NE and association of death+PND than MHCA + ACP. However, the data suggests that DHCA + DR when compared with MHCA + ACP provides better renal protection and reduced prevalence of composite endpoint.
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Affiliation(s)
| | | | - Severino Iesu
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital"San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Domenico Paparella
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Santa Maria Hospital, Bari, Italy
| | - Gianni Angelini
- Department of Cardiac Surgery, Bristol Hearth Institute, Bristol, UK
| | | | | | | | - Pierpaolo Chivasso
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital"San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Carlo Canosa
- Department of Cardiovascular Sciences, Gemelli Molise, Campobasso, Italy
| | | | - Luigi de Martino
- Department of Cardiovascular Sciences, Gemelli Molise, Campobasso, Italy
| | - Diego Magnano
- Department of Cardiovascular Sciences, Gemelli Molise, Campobasso, Italy
| | | | - Michele Di Mauro
- Department of Cardiothoracic and Vascular Surgery, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Totaro A, Testa G, Calafiore AM, Ienco V, Sacra V, Busti A, Pierro A, Sperlongano S, Golino P, Sacra C. Neutrophil to lymphocyte ratio predicts permanent pacemaker implantation in TAVR patients. J Card Surg 2022; 37:5095-5102. [PMID: 36378937 DOI: 10.1111/jocs.17212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In this prospective multicenter analysis, we aimed to investigate the predictive role of neutrophil/lymphocyte ratio (NLR) in permanent pacemaker implantation (PPI) in patients undergoing transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS One hundred and seventy-nine consecutive patients without previous PPI underwent TAVR from February 2017 to September 2021. Patients were further divided based on presence (n = 48) and absence of conduction abnormalities (CAs) at hospital admission (n = 131). RESULTS In patients with previous CAs, NLR values did not differ significantly between patients requiring PPI (n = 16, 33%) and those not requiring it. In contrast, in patients with no CAs at hospital admission, NLR values measured at admission and on TAVR day were significantly higher in patients requiring PPI (n = 17, 13%) (4.07 ± 3.22 vs. 3.01 ± 1.47, p = .025, and 10.81 ± 7.81 vs. 5.84 ± 3.78, p = .000, respectively). Multivariable analysis showed that NLR at TAVR day was an independent predictor of PPI in patients without CAs (OR 1.294; 95% CI 1.028-1.630; p = .028), but not in those with previous CAs. ROC curve analysis showed that the cut point was a NLR value of >7.25. Time to PPI was delayed till 21 days in patients without CAs. CONCLUSIONS In this prospective study, higher NLR values on the day of TAVR day were associated with an increased PPI rate in patients undergoing TAVR with no previous CAs. It is advisable, being inflammation part of the process, to prolong the time of observation for all patients without CAs till at least 21 days not to miss any new CA necessitating PPI.
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Affiliation(s)
- Antonio Totaro
- Department of Cardiovascular Sciences, Gemelli Molise Hospital, Campobasso, Italy.,Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Gianluca Testa
- Department of Cardiovascular Sciences, Gemelli Molise Hospital, Campobasso, Italy.,Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Antonio M Calafiore
- Department of Cardiovascular Sciences, Gemelli Molise Hospital, Campobasso, Italy
| | - Vincenzo Ienco
- Department of Cardiovascular Sciences, Gemelli Molise Hospital, Campobasso, Italy
| | - Vincenzo Sacra
- Department of Traslational Medical Sciences, Division of Cardiology, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Busti
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Antonio Pierro
- Department of Radiology, Gemelli Molise Hospital, Campobasso, Italy
| | - Simona Sperlongano
- Department of Traslational Medical Sciences, Division of Cardiology, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Golino
- Department of Traslational Medical Sciences, Division of Cardiology, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Cosimo Sacra
- Department of Cardiovascular Sciences, Gemelli Molise Hospital, Campobasso, Italy
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Di Mauro M, Bonalumi G, Giambuzzi I, Messi P, Cargoni M, Paparella D, Lorusso R, Calafiore AM. Mitral valve repair with artificial chords: Tips and tricks. J Card Surg 2022; 37:4081-4087. [PMID: 36321669 PMCID: PMC10092434 DOI: 10.1111/jocs.17076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
Mitral valve regurgitation (MR) is a common valvular disorder occurring in up to 10% of the general population. Mitral valve reconstructive strategies may address any of the components, annulus, leaflets, and chords, involved in the valvular competence. The classical repair technique involves the resection of the prolapsing tissue. Chordal replacement was introduced already in the '60, but in the mid '80, some surgeons started to use expanded polytetrafluoroethylene (ePTFE) Gore-Tex sutures. In the last years, artificial chords have been used also using transcatheter approach such as NeoChord DS 1000 (Neochord) and Harpoon TSD-5. The first step is to achieve a good exposure of the papillary muscles that before approaching the implant of the artificial chords. Then, the chords are attached to the papillary muscle, with or without the use of supportive pledgets. The techniques to correctly implant artificial chords are many and might vary considerably from one center to another, but they can be summarized into three big families of suturing techniques: single, running or loop. Regardless of how to anchor to the mitral leaflet, the real challenge that many surgeons have taken on, giving rise to some very creative solutions, has been to establish an adequate length of the chords. It can be established based on anatomically healthy chords, but it is important to bear in mind that surgeons work on the mitral valve when the heart is arrested in diastole, so this length could fail to replicate the required length in the full, beating heart. Hence, some surgeons suggested techniques to overcome this problem. Herein, we aimed to describe the current use of artificial chords in real-world surgery, summarizing all the tips and tricks.
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Affiliation(s)
- Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of Milan, Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of Milan, Milan, Italy
| | - Pietro Messi
- DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of Milan, Milan, Italy.,Department of Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Marco Cargoni
- Department of Cardiac Anesthesia, Mazzini Hospital, Teramo, Italy
| | - Domenico Paparella
- Department of Medical and Surgical Sciences, Division of Cardiac Surgery, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Calafiore AM, Prapas S, Totaro A, Guarracini S, Katsavrias K, Di Mauro M. A morphofunctional analysis of the regurgitant mitral valve as a guide to repair: Another point of view. J Card Surg 2022; 37:4064-4071. [PMID: 36116054 DOI: 10.1111/jocs.16924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 01/06/2023]
Abstract
Based on Carpentier's classification and principles, the techniques for mitral valve repair continue to evolve. We herein report our experience with the morphofunctional echocardiographic analysis of single mitral leaflets, as different anatomic features, even if conflicting, may coexist not only in the two leaflets but in the same leaflet as well. A classification is proposed, based on the length (normal, short, or long) and mobility (normal, restricted, or excessive) of mitral leaflets. The surgical techniques adopted for mitral valve repair are the direct consequence of this analysis.
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Affiliation(s)
| | - Sotirios Prapas
- Department of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece
| | - Antonio Totaro
- Dipartimento di Malattie Cardiovascolari, Gemelli Molise, Campobasso, Italia
| | | | - Kostas Katsavrias
- Department of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece
| | - Michele Di Mauro
- Department of Crdiothoracic Surgery, Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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10
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Fattouch K, Calafiore AM. Mitral valve repair: Regulatory or ethical problem? J Card Surg 2022; 37:4094-4096. [PMID: 35916157 DOI: 10.1111/jocs.16823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 01/06/2023]
Abstract
The long-term outcome of patients undergoing mitral valve repair (MVr) is based on what happens during the more or less 60 min of aortic cross-clamping necessary to transform a leaking valve into a well-functioning one. As a consequence, the experience of the surgeon performing the procedure is the only determinant of the success rate that deserves to be taken into account. It is clear from the literature that the number of cases/year is inversely related to the number of early and late deaths, repair failures, and reoperations. However, there is no agreement on the minimum caseload/year that represents the threshold to identify surgeons that can perform or not MVr. This problem then cannot be regulated by specific guidelines of Scientific Societies, but only by the ethical perception, we have of our profession.
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Affiliation(s)
- Khalil Fattouch
- Department of Surgical, Oncologic and Stomatological Disciplines, GVM Care and Research, Maria Eleonora Hospital, University of Palermo, Palermo, Italy
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11
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Paparella D, Squiccimarro E, Di Mauro M, Katsavrias K, Calafiore AM. Acute iatrogenic complications after mitral valve repair. J Card Surg 2022; 37:4088-4093. [PMID: 36273407 DOI: 10.1111/jocs.17055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/04/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Mitral valve repair is the procedure of choice to correct mitral regurgitation. However, some dangerous iatrogenic complications can occur at the end of the procedure. Therefore, we sought to review the most frequent and clinically relevant acute iatrogenic complication following mitral valve repair. METHODS A thorough review of the literature has been performed. Criteria for considering studies for this non-systematic review were as follows: observational and interventional studies investigating the acute iatrogenic complications following mitral valve repair, and essential review studies pertinent to the topic. RESULTS The most frequent is the systolic anterior motion. Due to a systolic dislocation of the anterior leaflet toward the outflow tract, it causes both obstruction of the outflow tract and mitral regurgitation. Often it is due to excess of catecholamines or to reduced filling of the left ventricle but sometimes needs further surgical maneuvers, focused on moving posteriorly the coaptation line. It can be obtained by shortening the posterior leaflet or increasing the size of the ring or applying an Alfieri stitch to limit the movements of the anterior leaflet. Another complication, often underdiagnosed and potentially lethal, is the injury of the circumflex artery that happens at the level of the anterolateral commissure or P1 zone. Two mechanisms are involved. The first one is the direct injury of the artery by a stitch (roughly 25% of the patients present a distance artery-annulus <3 mm. The second one is the distortion of the artery, attracted toward the annulus by a misplaced stitch. The attraction causes kinking with stenosis of different degrees till functional occlusion. However, the artery has to be far from the annulus and the atrial tissue has to be stiff and resistant, as after an infective process, to move the circumflex artery toward the annulus without tearing. Positioning the stitches very close to the mitral leaflets in the dangerous area is the only prevention to the complication. The treatment in the operating theater is partial or total removal/reimplantation of the annular sutures or coronary artery bypass grafting to the circumflex area. If the injury is demonstrated only after coronary angiography, percutaneous revascularization can be attempted before further surgical treatment. CONCLUSIONS Acute iatrogenic complication after mitral repair exists and may compromize patient outcome. Raising awareness about these issues, the precautions to prevent them, and the manners of resolution is therefore mandatory.
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Affiliation(s)
- Domenico Paparella
- Department of Medical and Surgical Sciences, Division of Cardiac Surgery, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Enrico Squiccimarro
- Department of Medical and Surgical Sciences, Division of Cardiac Surgery, University of Foggia, Foggia, Italy.,Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Kostas Katsavrias
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
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12
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Guarracini F, Martin M, Marini M, Branzoli S, Casagranda G, Muser D, Forleo GB, Gasperetti A, Di Marco M, Guarracini S, Bonmassari R, Mazzone P, Calafiore AM, Di Mauro M. Left Atrial Appendage Closure: A Current Overview Focused on Technical Aspects and Different Approaches. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2305155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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13
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Di Mauro M, Cargoni M, Liberi R, Lorusso R, Calafiore AM. Mitral valve repair or replacement. How long is this feud to last? J Card Surg 2022; 37:1599-1601. [PMID: 35365876 PMCID: PMC9322328 DOI: 10.1111/jocs.16479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
Choosing to perform mitral valve (MV) repair or replacement remains a hot and highly debated topic. The current guidelines seem to be conflicting in this specific field and the evidence at our disposal are scarce, only one small randomized trial and few larger retrospective studies. The meta‐analysis by Gamal and coworkers tries to summarize the current evidence, concluding that MV replacement for the treatment of ischemic mitral regurgitation (MR) is at least as safe as repair and certainly offers a more stable result over time than the latter. Obviously, the implantation of a prosthesis, especially a mechanical one, brings with it a series of problems, such as anticoagulation and, above all, a possible lack of ventricular remodeling, especially if a chordal sparing replacement is not performed. It must be said, on the other hand, that isolated annuloplasty cannot act as a counterpart to replacement, because ischemic MR cannot be considered only an annular disease. Therefore, wanting to mimic the nature that, after an infarction, enacts a series of changes involving also the mitral leaflets and chordae, the surgeons are called to act also on these two entities and not only to downsize the annulus. In a nutshell, a procedure should not be opposed in a fundamentalist way to another one, but we must accept the concept of armamentarium where both procedures are present and tail on the single patient, and also on the surgeon's expertize, the technique guaranteeing the best possible result.
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Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Marco Cargoni
- Department of Cardiac Anaesthesia and Intensive Care, "Mazzini" Hospital, Teramo, Italy
| | - Roberta Liberi
- Department of Heart Disease, "SS Annunziata" Hospital, Chieti, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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14
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Calafiore AM, Haverich A, Gaudino M, Di Mauro M, Fattouch K, Prapas S, Zilla P. Immunoreaction to xenogenic tissue in cardiac surgery: alpha-Gal and beyond. Eur J Cardiothorac Surg 2022; 62:6535925. [PMID: 35211732 DOI: 10.1093/ejcts/ezac115] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Michele Di Mauro
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Khalil Fattouch
- Department of Surgical, Oncologic and Stomatological Disciplines, University of Palermo, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy
| | - Sotirios Prapas
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | - Peter Zilla
- Christian Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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15
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Lorusso R, Calafiore AM, Di Mauro M. Acute infective endocarditis during COVID-19 pandemic time: The dark side of the moon. J Card Surg 2022; 37:1168-1170. [PMID: 35106812 PMCID: PMC9303710 DOI: 10.1111/jocs.16281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/04/2022]
Abstract
The COVID‐19 pandemic has remarkably impacted the hospital management and the profile of patients suffering from acute cardiovascular syndromes. Among them, acute infective endocarditis (AIE) represented a rather frequent part of these urgent/emergent procedures. The paper by Liu et al. has clearly shown the higher risk features which patients with a diagnosis of AIE presented at hospital admission during the first part (first and second waves) of the outbreak, often requiring challenging operations, but fortunately not associated with the worse outcome if compared to results obtained before the SARS‐2 pandemic. The report discussed herein presents several other aspects worth discussion and comments, particularly in relation to hospital management and postdischarge outcome which certainly deserve to be highlighted, but also further investigations.
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Affiliation(s)
- Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | | | - Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
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16
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Prapas S, Katsavrias K, Di Mauro M, Zografos P, Guarracini S, Papandreopoulou S, Calafiore AM. Wrapping of the moderately dilated ascending aorta by fresh autologous pericardium. J Card Surg 2022; 37:921-926. [DOI: 10.1111/jocs.16272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sotirios Prapas
- Division of Cardiac Surgery A Henry Dunant Hospital Athens Greece
| | | | - Michele Di Mauro
- Cardio Thoracic Surgery Unit, Heart and Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM) Maastricht University Medical Centre (MUMC) Maastricht The Netherlands
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17
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Di Mauro M, Bonalumi G, Calafiore AM, Lorusso R. Valve endocarditis, to repair or not to repair, is that really the question? J Card Surg 2022; 37:1016-1018. [PMID: 35023588 DOI: 10.1111/jocs.16232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
The meta-analysis by He et al. has the worth to cover, as much as possible, a gap of scientific evidence were conducting a randomized trial appears very complex for ethical and logistical reasons. The authors concluded that mitral valve repair (MVP) provides better-pooled results, both early and late, with respect to mitral valve replacement. However, the superiority of MVP is driven by some single large cohort studies where surgeons had wide experience in the field of MVP for infective endocarditis. This finding is also confirmed by other studies. But if mitral repair produces such a better short- and long-term survival than replacement, why are there no clear indications from consensus and guidelines pushing surgeons toward the pursuit of a reconstructive procedure at almost any cost? We wonder to repair or not to repair, is that really the question? The AATS consensus suggests repairing "whenever possible" but without providing more specific indications. If the two primary goals of surgery are total removal of infected tissues and reconstruction of cardiac morphology, including repair or replacement of the affected valve(s), probably MVP should be performed in case of less extensive tissue detriment by the infection. In more wide valve involvement, MVP may be the choice but only in very expert hands and in Centers with a very large volumes of valve repairing. This decision cannot, therefore, be the result of the choice of an individual but must derive from a careful multidisciplinary discussion to be held in an EndoTeam.
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Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | | | - Roberto Lorusso
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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18
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Di Mauro M, Calafiore AM. Commentary: Preoperative cerebral malperfusion in aortic dissection: Symptoms may be deceivers. JTCVS Tech 2021; 10:196-197. [PMID: 34984379 PMCID: PMC8691918 DOI: 10.1016/j.xjtc.2021.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Antonio M. Calafiore
- Department of Cardiac Surgery, Anthea Hospital, GVM Medical and Research, Bari, Italy
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19
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Calafiore AM, Totaro A, Prapas S, Katsavrias K, Guarracini S, Lorusso R, Paparella D, Di Mauro M. A historical appraisal of the techniques of left ventricular volume reduction in ischemic cardiomyopathy: Who did what? J Card Surg 2021; 37:409-414. [PMID: 34812531 DOI: 10.1111/jocs.16144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
Resection or exclusion of scars following a myocardial infarction on the left anterior descending artery territory started even before the beginning of the modern era of cardiac surgery. Many techniques were developed, but there is still confusion on who did what. The original techniques underwent modifications that brought to a variety of apparently new procedures that, however, were only a "revisitation" of what described before. In some case, old techniques were reproposed and renamed, without giving credit to the surgeon that was the original designer. Herein we try to describe which are the seminal procedures and some of the most important modifications, respecting however the merit of who first communicated the procedure to the scientific world.
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Affiliation(s)
| | - Antonio Totaro
- Department of Cardiovascular Sciences Gemelli Molise, Campobasso, Italy
| | - Sotirios Prapas
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | - Kostas Katsavrias
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | | | - Roberto Lorusso
- Department of Cardiac Surgery, Santa Maria Hospital GVM, University of Foggia, Foggia, Italy
| | - Domenico Paparella
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Michele Di Mauro
- Department of Cardiac Surgery, Santa Maria Hospital GVM, University of Foggia, Foggia, Italy
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20
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Di Mauro M, Calafiore AM, Lorusso R. All roads lead to Rome, but some are safer. J Card Surg 2021; 36:4320-4321. [PMID: 34459523 DOI: 10.1111/jocs.15956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Abstract
Since the first in-human implantation, trans-catheter aortic valve replacement (TAVR) has shown an exciting development in both technical and technological terms, becoming the standard of care for many patients, even not only inoperable ones. Although trans-femoral (TF) access has the scepter of first-line route for TAVR, in some cases, this access is not feasible, so several alternative routes were introduced over time. The network meta-analysis by Hameed et al. has the great merit to provide a comprehensive picture. Hence, through either direct and indirect comparison, the authors confirmed as TF is the gold standard as access, followed by trans-carotid and trans-subclavian. Conversely, trans-thoracic (trans apical and trans-aortic) routes are the least safe and should be reserved only to sporadic cases.
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Affiliation(s)
- Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Antonio M Calafiore
- Department of Cardiac Surgery, Anthea Hospital, GVM Research and Care, Bari, Italy
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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21
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Guarracini F, Branzoli S, Marini M, Guarracini S, Di Mauro M, Calafiore AM, La Meir M. Totally thoracoscopic concomitant left atrial appendage closure and left ventricular epicardial lead implantation. J Card Surg 2021; 36:4403-4406. [PMID: 34418154 DOI: 10.1111/jocs.15928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation in patients with heart failure due to ventricular dyssynchrony needs decision-making on the rate and rhythm control strategies together with cardiac resynchronization therapy and antithrombotic prophylaxis. Transvenous biventricular pacing and percutaneous appendage closure in patients with heart failure and atrial fibrillation with high bleeding risk are valid therapeutic options but anatomical exclusion criteria could be present. Here, we report two patients who underwent successful totally thoracoscopic concomitant left appendage occlusion and epicardial left ventricular lead implantation.
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Affiliation(s)
| | - Stefano Branzoli
- Department of Cardiac Surgery, Santa Chiara Hospital, Trento, Italy.,Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium
| | | | | | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Antonio M Calafiore
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Mark La Meir
- Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium
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22
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Calafiore AM, Di Marco M, Guarracini S, Katsavrias K, Di Mauro M. Mitral valve repair for mitral regugitation in the elderly: Yes, we have to, but look at the etiologies! J Card Surg 2021; 36:2531-2532. [PMID: 33783016 DOI: 10.1111/jocs.15507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
The meta-analysis by Di Tommaso et al. demonstrated as elderly patients with mitral regurgitation (MR) undergoing mitral valve repair had lower short-term mortality and higher long-term survival with respect to patients undergoing mitral valve replacement. The benefit of repair is such, that initial surgical strategy is advisable in the elderly even in case of mild symptoms if compared with conservative management. However, even if repair can be performed in presence of some specific etiologies, as degenerative MR or secondary MR, there are always cases where a replacement can be an acceptable solution compared to a repair with uncertain future, regardless of our believes and our technical ability.
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Affiliation(s)
| | - Massimo Di Marco
- Department of Cardiology, "Santo Spirito" Hospital, Pescara, Italy
| | | | - Kostas Katsavrias
- Department of Cardiac Surgery, Henry Durant Hospital, Athens, Greece
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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23
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Di Mauro M, Lorusso R, Parolari A, Ravaux JM, Bonalumi G, Guarracini S, Ricci F, Benedetto U, Calafiore AM. The best approach for functional tricuspid regurgitation: A network meta-analysis. J Card Surg 2021; 36:2072-2080. [PMID: 33651449 DOI: 10.1111/jocs.15378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE For many years, functional tricuspid regurgitation (FTR) was considered negligible after treatment of left-sided heart valve surgery. The aim of the present network meta-analysis is to summarize the results of four approaches to establish the possible gold standard. METHODS A systematic search was performed to identify all publications reporting the outcomes of four approaches for FTR, not tricuspid annuloplasty (no TA), suture annuloplasty (SA), flexible (FRA), rigid rings (RRA). All studies reporting at least one the four endpoints (early and late mortality, early and late moderate or more TFR) were included in a Bayesian network meta-analysis. RESULTS There were 31 included studies with 9663 patients. Aggregate early mortality was 5.3% no TA, 7.2% SA, 6.6% FRA, and 6.4% RRA; early TR moderate-or-more was 9.6%, 4.8%, 4.6%, and 3.8%; late mortality was 22.5%, 18.2%, 11.9%, and 11.9%; late TR moderate-or-more was 27.9%, 18.3%, 14.3%, and 6.4%. Rigid or semirigid ring annuloplasty was the most effective approach for decreasing the risk of late moderate or more FTR (-85% vs. no TA; -64% vs. SA; -32% vs. FRA). Concerning late mortality, no significant differences were found among different surgical approaches; however, flexible or rigid rings reduced significantly the risk of late mortality (78% and 47%, respectively) compared with not performing TA mortality. No differences were found for early outcomes. CONCLUSIONS Ring annuloplasty seems to offer better late outcomes compare to either suture annuloplasty or not performing TA. In particular rigid or semirigid rings provide more stable FTR across time.
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Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Alessandro Parolari
- IRCCS Policlinic S. Donato and Department of Biomedical Sciences for Health, UOC of University Cardiac Surgery and Translational Research, University of Milan, Milan, Italy
| | - Justine M Ravaux
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Stefano Guarracini
- Department of Cardiovascular Disease, "Pierangeli" Hospital, Pescara, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Umberto Benedetto
- Department of Cardiothoracic Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
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24
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Di Mauro M, Guarracini S, Capuzzi D, Calafiore AM. Commentary: Another step forward ischemic mitral regurgitation comprehension. JTCVS Open 2021; 5:61-62. [PMID: 36003182 PMCID: PMC9390775 DOI: 10.1016/j.xjon.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiovascular Disease, “Pierangeli” Hospital, Pescara, Italy
- Address for reprints: Michele Di Mauro, MD, PhD, MSc, Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
| | - Stefano Guarracini
- Department of Cardiovascular Disease, “Pierangeli” Hospital, Pescara, Italy
| | - Donato Capuzzi
- Department of Cardiovascular Disease, “Pierangeli” Hospital, Pescara, Italy
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25
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Calafiore AM, Katsavrias K, Di Marco M, Guarracini S, Di Mauro M. Commentary: Vasa vasorum dysfunction and acute aortic syndromes: When guidelines do not follow the evolution of knowledge. JTCVS Open 2021; 5:33-34. [PMID: 36003167 PMCID: PMC9390436 DOI: 10.1016/j.xjon.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 01/16/2023]
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26
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Ramponi F, Seco M, Brereton RJL, Gaudino MFL, Puskas JD, Calafiore AM, Vallely MP. Toward stroke-free coronary surgery: The role of the anaortic off-pump bypass technique. J Card Surg 2021; 36:1499-1510. [PMID: 33502822 DOI: 10.1111/jocs.15372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
Surgical coronary revascularization remains the preferred strategy in a significant portion of patients with coronary artery disease due to superior long-term outcomes. However, there is a significant risk of perioperative neurologic injury that has influenced guideline recommendations. These complications occur in 1%-5% of patients, ranging from overt neurologic deficits with permanent disability, to subtle cerebral defects noted on neuroimaging that may result in slow cognitive and functional decline. The primary mechanism by which these events occur is thromboembolism from manipulation of the ascending aorta. This occurs during cardiopulmonary bypass, aortic cross-clamping, and partial occlusion clamping (side clamp). Elderly patients and patients with aortic atheroma are, therefore, at significantly increased risk. Initial surgical techniques addressed this by aggressively debriding or replacing the ascending aorta during coronary artery bypass grafting (CABG). Strategies then moved toward minimizing aortic manipulation through pump-assisted beating heart surgery and off-pump surgery with partial occlusion clamping or proximal anastomosis devices. Finally, anaortic off-pump CABG aims to avoid all manipulation of the ascending aorta through advanced off-pump grafting techniques combined with in situ and composite grafts. This has been demonstrated to result in the greatest reduction in risk. Establishing successful anaortic off-pump CABG programs requires subspecialization and focused interest groups dedicated to advancing CABG outcomes.
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Affiliation(s)
- Fabio Ramponi
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Saint Luke's, New York, New York, USA
| | | | - Michael P Vallely
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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27
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Calafiore AM, Totaro A, Guarracini S, Prapas S, Di Marco M, Katsavrias K, Gaudino M, Lorusso R, Di Mauro M. Patient-prosthesis mismatch is a preventable disease but how to prevent it is a story not yet written. J Card Surg 2021; 36:978-980. [PMID: 33428258 DOI: 10.1111/jocs.15317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 01/08/2023]
Affiliation(s)
| | - Antonio Totaro
- Department of Cardiovascular Sciences, Gemelli Molise, Campobasso, Italy
| | | | - Sotirios Prapas
- Department of Cardiac Surgery, Henry Durant Hospital, Athens, Greece
| | - Massimo Di Marco
- Department of Cardiology, "Santo Spirito" Hospital, Pescara, Italy
| | - Kostas Katsavrias
- Department of Cardiac Surgery, Henry Durant Hospital, Athens, Greece
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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Calafiore AM, Castellano G, Guarracini S, Di Marco M, Totaro A, Sacra C, Katsavrias K, Di Mauro M. Respect or resect: A single strategy does not fit all. J Card Surg 2021; 36:969-970. [PMID: 33428260 DOI: 10.1111/jocs.15318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Gaetano Castellano
- Department of Cardiovascular Sciences, Gemelli Molise, Campobasso, Italy
| | | | - Massimo Di Marco
- Department of Cardiology, "Santo Spirito" Hospital, Pescara, Italy
| | - Antonio Totaro
- Department of Cardiovascular Sciences, Gemelli Molise, Campobasso, Italy
| | - Cosimo Sacra
- Department of Cardiovascular Sciences, Gemelli Molise, Campobasso, Italy
| | - Kostas Katsavrias
- Department of Cardiac Surgery, Henry Durant Hospital, Athens, Greece
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Di Mauro M, Raviola E, Guarracini S, Di Marco M, Lorusso R, Calafiore AM. Is surgery the fair competitor for MitraClip? J Card Surg 2021; 36:1120-1122. [PMID: 33428264 DOI: 10.1111/jocs.15295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/01/2022]
Abstract
In the last decades, the overlapping areas of intervention between cardiac surgeons and interventional cardiologists are rocketing, especially in the field of treatment of heart valve disease. But, while for the aortic valve the competition, even for nonhigh risk patients, has become tightened, in the context of mitral regurgitation, the surgery seems to not have competitors. In fact looking the results of studies published so far, a question arises: Is surgery the fair competitor for the Mitraclip? The meta-analysis by Abdul Khader et al. summarized few evidences present in this field, only 11 observational studies and 1 randomized trial, providing an awesome response: "NO." Is therefore not a case if recently two trials, MITRA-FR and COAPT, chose to use as competitor for MitraClip, more rightly, medical therapy instead of surgery. In conclusions, in case of mitral regurgitation (MR), surgery is still largely the gold standard treatment and so MitraClip cannot be mention at all as competitor of surgery. It can be the right choice of case of primary MR where patients showed high risk for surgery. In case of secondary MR, especially with large and poor left ventricle we should wait for a clear answer on its role, yet.
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Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Eliana Raviola
- Department of Cardiac Surgery, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Massimo Di Marco
- Department of Cardiology, "Santo Spirito" Hospital, Pescara, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Calafiore AM, Totaro A, Testa N, Sacra C, Castellano G, Guarracini S, Di Marco M, Prapas S, Gaudino M, Lorusso R, Paparella D, Di Mauro M. The secret life of the mitral valve. J Card Surg 2020; 36:247-259. [PMID: 33135267 DOI: 10.1111/jocs.15151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023]
Abstract
In secondary mitral regurgitation, the concept that the mitral valve (MV) is an innocent bystander, has been challenged by many studies in the last decades. The MV is a living structure with intrinsic plasticity that reacts to changes in stretch or in mechanical stress activating biohumoral mechanisms that have, as purpose, the adaptation of the valve to the new environment. If the adaptation is balanced, the leaflets increase both surface and length and the chordae tendineae lengthen: the result is a valve with different characteristics, but able to avoid or to limit the regurgitation. However, if the adaptation is unbalanced, the leaflets and the chords do not change their size, but become stiffer and rigid, with moderate or severe regurgitation. These changes are mediated mainly by a cytokine, the transforming growth factor-β (TGF-β), which is able to promote the changes that the MV needs to adapt to a new hemodynamic environment. In general, mild TGF-β activation facilitates leaflet growth, excessive TGF-β activation, as after myocardial infarction, results in profibrotic changes in the leaflets, with increased thickness and stiffness. The MV is then a plastic organism, that reacts to the external stimuli, trying to maintain its physiologic integrity. This review has the goal to unveil the secret life of the MV, to understand which stimuli can trigger its plasticity, and to explain why the equation "large heart = moderate/severe mitral regurgitation" and "small heart = no/mild mitral regurgitation" does not work into the clinical practice.
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Affiliation(s)
| | - Antonio Totaro
- Department of Cardiovascular Sciences, Gemelli Molise, Campobasso, Italy
| | - Nicola Testa
- Department of Cardiovascular Sciences, Gemelli Molise, Campobasso, Italy
| | - Cosimo Sacra
- Department of Cardiovascular Sciences, Gemelli Molise, Campobasso, Italy
| | - Gaetano Castellano
- Division of Anesthesia and Intensive Care, Gemelli Molise, Campobasso, Italy
| | | | - Massimo Di Marco
- Department of Cardiology, "Santo Spirito" Hospital, Pescara, Italy
| | - Sotirios Prapas
- Department of Cardiac Surgery, Henry Durant Hospital, Athens, Greece
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, New York, USA
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Domenico Paparella
- Department of Emergency and Organ Transplants, Santa Maria Hospital, GVM Care & Research, Aldo Moro University of Bari, Bari, Italy
| | - Michele Di Mauro
- Department of Cardiology, "Pierangeli" Hospital, Pescara, Italy.,Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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Di Mauro M, Lorusso R, Di Franco A, Foschi M, Rahouma M, Soletti G, Calafiore AM, Gaudino M. What is the best graft to supplement the bilateral internal thoracic artery to the left coronary system? A meta-analysis. Eur J Cardiothorac Surg 2020; 56:21-29. [PMID: 30649244 DOI: 10.1093/ejcts/ezy476] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/13/2018] [Accepted: 11/27/2018] [Indexed: 12/25/2022] Open
Abstract
This meta-analysis was designed to assess the effect of the use of arterial conduits (ACs) versus great saphenous vein (GSV) grafts as a third conduit for revascularization of the right coronary artery system, in addition to the bilateral internal mammary artery on the left coronary artery. PubMed and OVID's version of MEDLINE were searched from January 2000 to September 2017 for relevant publications. The primary end point was the long-term mortality rate. The secondary end point was early mortality, defined as either in-hospital death or death within 30 days after the operation. Meta-regression was used to evaluate the effect of female gender and diabetes on the primary and secondary outcomes. A total of 10 studies (4121 patients) were selected for the systematic review and meta-analysis comparing ACs (1619) versus the GSV (2502), 6 (2548) comparing the GSV (2548) versus the right gastroepiploic artery (1023) and 5 comparing the GSV (2548) versus the radial artery (596). The pooled analysis did not show any difference between ACs and the GSV in terms of long-term mortality rates [hazard ratio (HR) = 0.75, 95% confidence interval (CI) = 0.56-1.01; P = 0.061]. When using the leave-one-out analysis, after the exclusion of 1 study (outlier), ACs were significantly associated with lower long-term mortality rates (HR = 0.67, 95% CI = 0.54-0.83; P < 0.001). When the results were stratified according to the type of study, no differences with regard to long-term results were found between ACs and the GSV, either in the pooled analysis of the 6 propensity score-matched studies (HR = 0.69, 95% CI = 0.43-1.08; P = 0.107) or in the pooled analysis of the 4 non-propensity score-matched studies (HR = 0.88, 95% CI = 0.62-1.23; P = 0.438). Again, when the outlier was excluded, the pooled analysis of the propensity score-matched studies confirmed that ACs were associated with lower long-term mortality rates (HR = 0.58, 95% CI = 0.43-0.80; P < 0.001). Comparisons between the GSV and either the right gastroepiploic artery or the radial artery showed similar results. No publication bias was found. This meta-analysis is the first to compare the GSV to the radial artery and the right gastroepiploic artery for right coronary artery grafting in patients receiving a bilateral internal mammary artery to left coronary artery. The choice of a third AC seems to be preferable in order to achieve better long-term survival.
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Affiliation(s)
| | - Roberto Lorusso
- Cardiac Surgery Department, Maastricht University Medical Center, Maastricht, Netherlands
| | - Antonino Di Franco
- Cardiothoracic Surgery Department, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | | | - Mohamed Rahouma
- Cardiothoracic Surgery Department, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Giovanni Soletti
- Cardiothoracic Surgery Department, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Antonio M Calafiore
- Cardiac Surgery Department, Fondazione "Papa Giovanni Paolo II", Campobasso, Italy
| | - Mario Gaudino
- Cardiothoracic Surgery Department, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
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Mauro MD, Calafiore AM, Di Franco A, Nicolini F, Formica F, Scrofani R, Antona C, Messina A, Troise G, Mariscalco G, Beghi C, De Bonis M, Trumello C, Miceli A, Glauber M, Ranucci M, De Vincentiis C, Gaudino M, Lorusso R. Association between cardioplegia and postoperative atrial fibrillation in coronary surgery. Int J Cardiol 2020; 324:38-43. [PMID: 33022288 DOI: 10.1016/j.ijcard.2020.09.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this multicenter study was to evaluated whether cold or warm cardioplegia are associated with postoperative atrial fibrillation (POAF) and the prognostic role of the latter on early stroke and neurological mortality. METHOD This was a retrospective analysis of prospective collected data from 9 cardiac centers in Italy and the United States including patients undergoing surgery between 2010 and 2018. From the 9 institutional databases, 17,231 patients underwent isolated CABG on-pump, using either warm cardioplegia (n = 7730) or cold cardioplegia (n = 9501); among the latter group blood and crystalloid cardioplegia were used in 691 and 8810 patients, respectively. After matching, two pairs of 4162 patients (overall cohort 8324) were analyzed. RESULTS In matched population, the rate of POAF was 18% (1472 cases), 15% (608) in warm group versus 21% (864) in cold group (p < 0.001). Multivariable analysis confirmed that cold cardioplegia was associated with higher rate of POAF, along with age, hypercholesterolemia, LVEF, reoperation, preoperative IABP, previous stroke, cardiopulmonary and cross-clamp. Moreover, cold cardioplegia as well as POAF increased the rate of postoperative stroke as well as early mortality and neurological mortality Propensity-weighted cohort included 11,830 (70%) patients out of 17,231. After adjustment, both cold blood and cold crystalloid cardioplegia negatively influenced POAF, stroke and neurological mortality. CONCLUSIONS Warm cardioplegia may reduce the rate of POAF in CABG patients with respect to cold cardioplegia, either blood or crystalloid. This has a prognostic impact on postoperative stroke and neurological mortality.
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Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | | | - Antonino Di Franco
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Francesco Nicolini
- Cardiac Surgery Unit, Ospedale Maggiore, University of Parma, Parma, Italy
| | - Francesco Formica
- Cardiac Surgery Unit, Ospedale Maggiore, University of Parma, Parma, Italy
| | - Roberto Scrofani
- Cardiac Surgery Unit, Ospedale Sacco, University of Milan, Milan, Italy
| | - Carlo Antona
- Cardiac Surgery Unit, Ospedale Sacco, University of Milan, Milan, Italy
| | - Antonio Messina
- Cardiac Surgery Unit, Poliambulanza Hospital, Fondazione Poliambulanza, Brescia, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Hospital, Fondazione Poliambulanza, Brescia, Italy
| | - Giovanni Mariscalco
- Department of Cardiothoracic Surgery, University of Leicester, Leicester, UK
| | - Cesare Beghi
- Cardiac Surgery Unit, Ospedale di Circolo, University of Varese, Varese, Italy
| | - Michele De Bonis
- Cardiac Surgery Unit, San Raffaele Hospital, University of Milan, Milan, Italy
| | - Cinzia Trumello
- Cardiac Surgery Unit, San Raffaele Hospital, University of Milan, Milan, Italy
| | - Antonio Miceli
- Cardiac Surgery Unit, S. Ambrogio Hospital, Milan, Italy
| | - Mattia Glauber
- Cardiac Surgery Unit, S. Ambrogio Hospital, Milan, Italy
| | - Marco Ranucci
- Cardiac Surgery and Intensive Care Units, S. Donato Hospital, IRCCS, University of Milan, Milan, Italy
| | - Carlo De Vincentiis
- Cardiac Surgery and Intensive Care Units, S. Donato Hospital, IRCCS, University of Milan, Milan, Italy
| | - Mario Gaudino
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Cardiac Surgery Unit, Community Hospital, Brescia, Italy
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Calafiore AM, Lorusso R, Kheirallah H, Alsaied MM, Alfonso JJ, Di Baldassare A, Gallina S, Gaudino M, Di Mauro M. Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty. J Card Surg 2020; 35:1891-1900. [PMID: 32652675 DOI: 10.1111/jocs.14840] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the present retrospective study was to evaluate the influence of preoperative right ventricular (RV) and tricuspid valve (TV) remodeling on the fate of tricuspid annuloplasty (TA) and right ventricle. METHODS From May 2009 to December 2015, 423 patients who had undergone TA for functional tricuspid regurgitation (TR) were included in the study. Residual and recurrent TR were defined as moderate or more TR at discharge and follow-up, respectively. RV remodeling was defined as RV dysfunction and/or dilation. RESULTS Residual TR after TA was recorded in 54 patients (13%). Five-year freedom from TR recurrence was 81% ± 3% in patients without residual TR and 41 ± 8 in patients with residual TR (P < .001). In patients without residual TR, the following risk factors for recurrent TR and late RV remodeling were identified: preoperative systolic pulmonary artery pressure, preoperative RV remodeling, severe preoperative TR or less than severe TR but with TV apparatus remodeling, and etiology of mitral regurgitation. Cox analysis with time-dependent variables confirmed TR recurrence (hazard ratio [HR]: 3.1) and late RV remodeling (HR: 6.5) as risk factors for lower survival. No protective effect of either flexible band or rigid ring TA compared with DeVega procedure was found. Similarly, preoperative atrial fibrillation and pacemaker dependency, late failure of mitral valve surgery did not affect the fate of TR. CONCLUSIONS Prophylactic TA should be encouraged among surgeons. TA at the time of left-sided valve surgery should take into consideration not only annular size, but also tethering severity and RV remodeling.
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Affiliation(s)
- Antonio M Calafiore
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.,Department of Cardiac Surgery, Gemelli Molise, Campobasso, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Hatim Kheirallah
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mojtaba Mohammed Alsaied
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Juan J Alfonso
- Department of Clinical Research, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Angela Di Baldassare
- Department of Medicine and Aging Sciences, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Sabina Gallina
- Department of Medicine and Aging Sciences, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Mario Gaudino
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York City, New York
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Di Mauro M, Calafiore AM, Parolari A, Lorusso R. Commentary: Looking Into the Seeds of Time. Semin Thorac Cardiovasc Surg 2020; 33:105-106. [PMID: 32615309 DOI: 10.1053/j.semtcvs.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | | | - Alessandro Parolari
- UOC Cardiac Surgery and Translational Research, IRCCS San Donato and University of Milan, San Donato Milanese, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
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Calafiore AM, Totaro A, Paparella D, Gaudino M, Prapas S, Mick SL, Di Mauro M. Mimicking natural mitral adaptation to ischaemic regurgitation: a proposed change in the surgical paradigm. Eur J Cardiothorac Surg 2020; 58:35-39. [DOI: 10.1093/ejcts/ezaa163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Antonio Totaro
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | - Domenico Paparella
- Department of Emergency and Organ Transplants, Aldo Moro University of Bari, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Sotirios Prapas
- Department of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece
| | - Stephanie L Mick
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Calafiore AM, Totaro A, Testa N, Di Mauro M. Minimally invasive mitral valve repair: for every patient, for every surgeon or still a work in progress? J Thorac Dis 2020; 12:1621-1623. [PMID: 32395300 PMCID: PMC7212125 DOI: 10.21037/jtd.2020.02.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Antonio Totaro
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | - Nicola Testa
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | - Michele Di Mauro
- Division of Cardiac Surgery, D'Annunzio University, Chieti, Italy
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Di Mauro M, Lorusso R, Parolari A, Calafiore AM. Commentary: A wide road is better than a simple bridge. JTCVS Tech 2020; 3:179-180. [PMID: 34317862 PMCID: PMC8302927 DOI: 10.1016/j.xjtc.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart & Vascular Center, Maastricht University Medical Centre, Maastricht, The Netherlands
- Address for reprints: Michele Di Mauro, MD, PhD, MSc Biostat, Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, P Debyelaan 25, 6202 AZ, Maastricht, The Netherlands.
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Center, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alessandro Parolari
- Unità Operativa Complessa Cardiac Surgery and Translational Research, Istituto di Ricerca e Cura a Carattere Scientifico San Donato and University of Milan, San Donato Milanese, Italy
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Lorusso R, Di Mauro M, Foschi M, Calafiore AM. Commentary: Mater artium necessitas (necessity is the mother of invention). JTCVS Tech 2020; 2:86-87. [PMID: 34317763 PMCID: PMC8298929 DOI: 10.1016/j.xjtc.2020.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/08/2020] [Accepted: 03/11/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
- Address for reprints: Michele Di Mauro, MD, PhD, Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
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Calafiore AM, Totaro A, De Amicis V, Pelini P, Pinna G, Testa N, Alfonso JJ, Mazzei V, Sacra C, Gaudino M, Di Mauro M. Surgical mitral plasticity for chronic ischemic mitral regurgitation. J Card Surg 2020; 35:772-778. [PMID: 32126160 DOI: 10.1111/jocs.14487] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The outcome of mitral valve (MV) repair for chronic ischemic mitral regurgitation (IMR) is suboptimal, due to the high recurrence rate of moderate or severe mitral regurgitation (MR) during follow-up. The MV adapts to new MR increasing its area to cover the enlarged annular area (mitral plasticity). As this process is often incomplete, we aimed to evaluate if augmenting the anterior leaflet (AL) and cutting the second-order chords (CC) together with restrictive mitral annuloplasty, a strategy we call "surgical mitral plasticity," could improve the midterm results of MV repair for IMR. MATERIALS AND METHODS From November 2017 to October 2019, 22 patients with chronic IMR underwent surgical mitral plasticity. Mean age was 73 ± 7 years and six were female. Mean ejection fraction was 32% ± 11%, IMR grade was moderate in 10 and severe in 12. Mean clinical and echocardiographic follow-up was 12 ± 6 months. RESULTS There was no early death, and one patient died 6 months after surgery. Ejection fraction improved from 32% ± 15% to 40% ± 6% (P = .031). IMR was absent or mild in all patients, and none showed recurrent moderate or more IMR. Tenting area decreased significantly from 2.5 ± 0.5 to 0.5 ± 0.3 cm² and coaptation length increased from 1.9 ± 0.7 to 7.8 ± 1.6 mm. All patients were in New York Heart Association class I or II. CONCLUSIONS Mitral plasticity, if uncomplete, is ineffective in preventing IMR to become significant. Surgical mitral plasticity, by completing incomplete process of MV adaptation, has a strong rationale, which however needs to be validated with longer follow-up.
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Affiliation(s)
| | - Antonio Totaro
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | | | - Piero Pelini
- Division of Cardiac Surgery, D'Annunzio University, Chieti, Italy
| | - Giovanni Pinna
- Division of Cardiac Surgery, Federico II University, Naples, Italy
| | - Nicola Testa
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | - Juan J Alfonso
- Department of Research, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Valerio Mazzei
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | - Cosimo Sacra
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Michele Di Mauro
- Division of Cardiac Surgery, D'Annunzio University, Chieti, Italy
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Calafiore AM, Kofidis T, Gaudino M. Commentary: Surgical mitral plasticity: Another brick in the wall? JTCVS Open 2020; 1:17-19. [PMID: 36003195 PMCID: PMC9390659 DOI: 10.1016/j.xjon.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/02/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio M. Calafiore
- Department of Cardiac Surgery and Cardiology, Fondazione “Papa Giovanni Paolo II,” Campobasso, Italy
| | - Theodoros Kofidis
- Department of Cardiothoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
- Address for reprints: Mario Gaudino, MD, Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065.
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Di Mauro M, Foschi M, Amendolara F, Calafiore AM. Commentary: Cardiac surgery around the clock! J Thorac Cardiovasc Surg 2020; 162:69-70. [PMID: 32093869 DOI: 10.1016/j.jtcvs.2020.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Michele Di Mauro
- Department of Heart Disease, SS Annunziata Hospital, Chieti, Italy.
| | | | | | - Antonio M Calafiore
- Department of Cardiac Surgery, Pope John Paul II Foundation, Campobasso, Italy
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Calafiore AM, Totaro A, Testa N, Sacra C, Calvo E, Di Mauro M. Association of tethering of the second-order chords and prolapse of the first-order chords of the anterior leaflet: A risk factor for early and late repair failure. J Card Surg 2020; 35:916-919. [PMID: 32073685 DOI: 10.1111/jocs.14469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Second-order chord tethering of the anterior leaflet is a risk factor for failure of posterior leaflet prolapse repair. MATERIALS AND METHODS We describe two cases of second-order chord tethering of the anterior leaflet associated with severe mitral regurgitation due to prolapse or chordal rupture of the anterior leaflet, causing early and late failure of repair. RESULTS We described two cases where this phenomenon happened. CONCLUSIONS Our cases demonstrate that the second-order chords of the prolapsing AL can be tethered and that this aspect should be carefully evaluated before surgery, as it can progress over time, affecting the results of surgical repair.
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Affiliation(s)
| | - Antonio Totaro
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | - Nicola Testa
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | - Cosimo Sacra
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | - Eugenio Calvo
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | - Michele Di Mauro
- Division of Cardiac Surgery, Gabriele d'Annunzio University, Chieti, Italy
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Di Mauro M, Foschi M, Liberti G, Calafiore AM. Commentary: In medio stat virtus. J Thorac Cardiovasc Surg 2020; 161:1774-1775. [PMID: 32007249 DOI: 10.1016/j.jtcvs.2019.11.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Michele Di Mauro
- Department of Heart Disease, SS Annunziata Hospital, Chieti, Italy.
| | | | - Gerardo Liberti
- Department of Heart Disease, SS Annunziata Hospital, Chieti, Italy
| | - Antonio M Calafiore
- Department of Cardiac Surgery, Pope John Paul II Foundation, Campobasso, Italy
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44
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Di Mauro M, Gallina S, Tancredi F, Calafiore AM. Commentary: Opportunity knocks for every heart surgeon, but you have to give a tricuspid a ring. J Thorac Cardiovasc Surg 2020; 161:1800-1801. [PMID: 31959436 DOI: 10.1016/j.jtcvs.2019.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/01/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Michele Di Mauro
- Department of Heart Disease, SS Annunziata Hospital, Chieti, Italy.
| | - Sabina Gallina
- Department of Heart Disease, SS Annunziata Hospital, Chieti, Italy
| | | | - Antonio M Calafiore
- Department of Cardiac Surgery, Pope John Paul II Foundation, Campobasso, Italy
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Di Mauro M, Bonalumi G, Calafiore AM, Parolari A. Commentary: There is nothing like looking, if you want to find something. JTCVS Tech 2020; 1:5. [PMID: 34317697 PMCID: PMC8288719 DOI: 10.1016/j.xjtc.2019.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 12/05/2022] Open
Affiliation(s)
- Michele Di Mauro
- Department of Heart Disease, SS Annunziata Hospital, Chieti, Italy
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Antonio M Calafiore
- Department of Cardiac Surgery, Pope John Paul II Foundation, Campobasso, Italy
| | - Alessandro Parolari
- UOC Cardiac Surgery and Translational Research, IRCCS San Donato and University of Milan, San Donato Milanese, Italy
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46
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Di Mauro M, Parolari A, Calafiore AM. Commentary: Like most shortcuts, it could be an ill-chosen route. J Thorac Cardiovasc Surg 2019; 161:46-47. [PMID: 32067792 DOI: 10.1016/j.jtcvs.2019.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Michele Di Mauro
- Department of Heart Disease, SS Annunziata Hospital, Chieti, Italy.
| | - Alessandro Parolari
- UOC Cardiac Surgery and Translational Research, IRCCS San Donato and University of Milan, San Donato Milanese, Italy
| | - Antonio M Calafiore
- Department of Cardiac Surgery, Pope John Paul II Foundation, Campobasso, Italy
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Tam DY, Tran A, Mazine A, Tang GHL, Gaudino MFL, Calafiore AM, Friedrich JO, Fremes SE. Tricuspid valve intervention at the time of mitral valve surgery: a meta-analysis. Interact Cardiovasc Thorac Surg 2019; 29:193–200. [PMID: 30848789 DOI: 10.1093/icvts/ivz036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/08/2019] [Accepted: 01/28/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The surgical management of tricuspid regurgitation (TR) at the time of mitral valve surgery remains controversial. Our objectives were to determine the safety and efficacy of tricuspid valve (TV) repair during mitral valve surgery in a meta-analysis. METHODS MEDLINE and EMBASE were searched from 1946 to 2017 for all studies comparing TV repair to no intervention at the time of mitral valve surgery on early and late mortality and late TR. A random-effects meta-analysis of all outcomes was performed. RESULTS One thousand four hundred and seventeen studies were retrieved and a total of 17 studies [2 randomized clinical trial (n = 211), 11 adjusted observational studies (n = 3848) and 4 unadjusted observational studies (n = 67 010)] that compared TV repair (n = 11 787) to no intervention (n = 56 027) at a mean follow-up of 6.0 ± 0.64 years were included. There was no difference in 30-day/in-hospital mortality between repair and no repair [risk ratio (RR) 1.19, 95% confidence interval (95% CI) 0.70-2.02; P = 0.52]. The incidence of new permanent pacemaker implantation was higher in the TV repair group (RR 2.73, 95% CI 2.57-2.89; P < 0.01). TV repair was protective against late moderate or greater TR [incident rate ratio (IRR) 0.28, 95% CI 0.17-0.47; P < 0.01] and severe TR (IRR 0.38, 95% CI 0.17-0.84). There was a numerically lower rate of late TV reoperation (IRR 0.39, 95% CI 0.12-1.25; P = 0.11) that did not reach statistical significance. Overall, there was no difference in late mortality between the 2 treatments (IRR 0.87, 95% CI 0.63-1.24; P = 0.43). CONCLUSIONS TV repair appears safe in the perioperative period and may reduce future recurrent TR without any survival benefit.
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Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Andrew Tran
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY, USA
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Antonio M Calafiore
- Department of Cardiovascular Disease, John Paul II Foundation, Campobasso, Italy
| | - Jan O Friedrich
- Department of Critical Care and Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Calafiore AM, Totaro A, Sacra C, Foschi M, Tancredi F, Pelini P, Gaudino M, Di Mauro M. Unbalanced mitral valve remodeling in ischemic mitral regurgitation: Implications for a durable repair. J Card Surg 2019; 34:885-888. [DOI: 10.1111/jocs.14119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio M Calafiore
- Department of Cardiac Surgery and CardiologyFondazione “Papa Giovanni Paolo II” Campobasso Italy
| | - Antonio Totaro
- Department of Cardiac Surgery and CardiologyFondazione “Papa Giovanni Paolo II” Campobasso Italy
| | - Cosimo Sacra
- Department of Cardiac Surgery and CardiologyFondazione “Papa Giovanni Paolo II” Campobasso Italy
| | | | | | - Piero Pelini
- Department of Cardiac Surgery and CardiologyFondazione “Papa Giovanni Paolo II” Campobasso Italy
| | - Mario Gaudino
- Department of Cardiothoracic SurgeryWeill Cornell Medicine New York New York
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Calafiore AM, Foschi M, Kheirallah H, Alsaied MM, Alfonso JJ, Tancredi F, Gaudino M, Di Mauro M. Early failure of tricuspid annuloplasty. Should we repair the tricuspid valve at an earlier stage? The role of right ventricle and tricuspid apparatus. J Card Surg 2019; 34:404-411. [DOI: 10.1111/jocs.14042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/04/2019] [Accepted: 03/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Antonio M. Calafiore
- Department of Cardiac Surgery and CardiologyPrince Sultan Cardiac CenterRiyadh Saudi Arabia
| | | | - Hatim Kheirallah
- Department of Cardiac Surgery and CardiologyPrince Sultan Cardiac CenterRiyadh Saudi Arabia
| | | | - Juan J. Alfonso
- Department of Clinical ResearchPrince Sultan Cardiac CenterRiyadh Saudi Arabia
| | | | - Mario Gaudino
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York New York
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Calafiore AM, Totaro A, Sacra C, Foschi M, Gaudino M, Di Mauro M. Failure of annuloplasty alone to correct ischemic mitral regurgitation. What we learned from two randomized controlled trials. J Card Surg 2019; 34:155-157. [DOI: 10.1111/jocs.14011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Antonio M Calafiore
- Department of Cardiac Surgery and CardiologyPope John Paul II FoundationCampobasso Italy
| | - Antonio Totaro
- Department of Cardiac Surgery and CardiologyPope John Paul II FoundationCampobasso Italy
| | - Cosimo Sacra
- Department of Cardiac Surgery and CardiologyPope John Paul II FoundationCampobasso Italy
| | | | - Mario Gaudino
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
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