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Brega C, Bianchi A, Savini C. Simplified Tool for Sizing in Minimally Invasive Mitral Annuloplasty: A Homemade Technique. Innovations (Phila) 2023:15569845231178548. [PMID: 37309866 DOI: 10.1177/15569845231178548] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Currently, minimally invasive cardiac surgery (MICS) has been developing and has been largely approved for mitral valve surgery. The more development of MICS, the more the entire surgical setup needs to be appropriate. We developed a homemade tool for mitral annular sizing that is simple and fits the mini surgical access. It is a plastic-based foldable paper that can be easily inserted through the minithoracotomy, using a surgical forceps.
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Affiliation(s)
- Carlotta Brega
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Alessandro Bianchi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Carlo Savini
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
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Brega C, Albertini A. Aortic Root Surgery in Adults: An Unsolved Problem. Aorta (Stamford) 2023; 11:29-35. [PMID: 36848909 PMCID: PMC9970757 DOI: 10.1055/s-0042-1757949] [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] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Nowadays, despite the rapid advancements in interventional cardiology, open surgery still deals with aortic root diseases, to assure the best "ad hoc" treatment. In case of middle-aged adult patients, the optimal operation still represents a matter of debate. A review of the last 10-year literature was conducted, focusing on patients below 65 to 70 years of age. Because of the small sample and the heterogeneity of the papers, no metanalysis was possible. Bentall-de Bono procedure, valve sparing, and Ross operations are the surgical options currently available. The main issues in the Bentall - de Bono operation are lifelong anticoagulation therapy and cavitation in case of mechanical prosthesis implantation and structural valve degeneration in case of biological Bentall. As transcatheter procedures are currently performed as valve in valve, biological prosthesis may be preferable, if the diameter may prevent postoperative high gradients. Conservative techniques, such as remodeling and reimplantation, preferred in the young, guarantee physiologic aortic root dynamics and impose surgical analysis of the aortic root structures to get a durable result. The Ross operation, which shows excellent performance, involves autologous pulmonary valve implantation and is performed only in experienced and high-volume centers. Due to its technical difficulty, it requires a steep learning curve and presents some limitations in specific aortic valve diseases. All three have advantages and downsides, and no ideal solution has still been reported.
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Affiliation(s)
- Carlotta Brega
- Department of Cardiovascular Surgery, GVM Care and Research, Cotignola, RA, Italy,Address for correspondence Carlotta Brega, MD Maria Cecilia Hospital, GVM Care and ResearchVia Corriera 1, 48033 Cotignola, RAItaly
| | - Alberto Albertini
- Department of Cardiovascular Surgery, GVM Care and Research, Cotignola, RA, Italy
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Brega C, Raviola E, Zucchetta F, Tripodi A, Albertini A. Periareolar approach in female patients undergoing mitral and tricuspid valve surgery: An almost invisible surgical access. J Card Surg 2022; 37:2581-2585. [PMID: 35726656 DOI: 10.1111/jocs.16693] [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: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Periareolar minithoracotomy represents an interesting option in minimally invasive cardiac surgery and it is our preferred approach for women. Our aim is to assess the results in female patients, in terms of nipple postoperative pain, local sensitivity, and eventual alterations in mammography after surgery. METHODS Fifty-seven female patients underwent periareolar incision, as minithoracotomy approach, from December 2018 to December 2021. Their mean age was 56 ± 12 years, their body mass index was 22.5 ± 4.8; their surgery was elective in 93%, with mean Euroscore II about 2 ± 1.3. RESULTS Of 57 patients, 87.7% (50 patients) underwent mitral valve repair, whose six with associated procedures; 8.8% (five patients) underwent mitral valve replacement whose two with tricuspid annuloplasty associated and 3.5% (two patients) had isolated tricuspid surgery. The cardiopulmonary bypass and aortic cross-clamp time were 123.2 ± 30.2 and 101.3 ± min respectively. There were no conversions to either full sternotomy or larger thoracotomy approach. There were no in-hospital and follow-up deaths. No strokes or wound infections were observed. Mean follow-up was 16± 9 months. Within the investigated follow-up, 100% of the patients were satisfied with the esthetic result, no remarkable postoperative pain was reported, two patients had slight hyposensitivity in the nipple area. About 50% IThad mammography as prevention screening after surgery and no abnormalities were found. CONCLUSIONS Periareolar minithoracotomy is a feasible surgical option in female patients, with excellent healing and cosmetic results and preserving the tissues of the mammary gland.
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Affiliation(s)
- Carlotta Brega
- Department of Cardiovascular, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Eliana Raviola
- Department of Cardiovascular, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Fabio Zucchetta
- Department of Cardiovascular, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Alberto Tripodi
- Department of Cardiovascular, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Alberto Albertini
- Department of Cardiovascular, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
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Mikus E, Calvi S, Albertini A, Tripodi A, Zucchetta F, Brega C, Pin M, Cimaglia P, Ferrari R, Campo G, Serenelli M. Impact of comorbidities on older patients undergoing open heart surgery. J Cardiovasc Med (Hagerstown) 2022; 23:318-324. [PMID: 35013050 DOI: 10.2459/jcm.0000000000001296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The number of elderly patients undergoing cardiac surgery is increasing. Age greater than 80 years has been identified as a strong independent risk factor for shortand long-term survival. The current study is aimed to identify the impact of preoperative comorbidities on early and late outcomes in older patients undergoing cardiac surgery. METHODS Baseline characteristics, procedurals and postoperative complications of all patients undergoing cardiac surgery at our institution are collected. The current analysis is focused on patients aged at least 80 years at the time of intervention and treated from January 2010 to December 2019. RESULTS In-hospital mortality resulted as 6.3%. Redo intervention [odds ratio (OR) 2.49, 95% confidence interval (CI) 1.13-5.48], chronic obstructive pulmonary disease (COPD) (OR 2.99, 95% CI 1.75-5.12) and peripheral arterial disease (PAD) (OR 2.23, 95% CI 1.30-3.81) were independent baseline predictors of outcome in the multivariate analysis. Prolonged extracorporeal circulation time, need for transfusion and prolonged intubation time strongly and independently predicted in-hospital mortality. During a mean follow-up of 3.6 years 34.3% of patients died and unplanned admission (HR 1.33, 95% CI 1.05-1.67), NYHA class III-IV (HR 1.35, 95% CI 1.12-1.64), diabetes (HR 1.27, 95% CI 1.01-1.59), COPD (HR 1.60, 95% CI 1.25-2.04) and PAD (HR 1.32, 95% CI 1.03-1.71) resulted as independent predictors of all-cause death. CONCLUSION Cardiac surgery is feasible in octogenarians, with an acceptable risk of mortality. Chronological age itself should not be the main determinant of choice while referring patients for cardiac surgical intervention. Comorbidities such as COPD, PAD and diabetes need to be taken into account for risk stratification.
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Affiliation(s)
- Elisa Mikus
- Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | - Simone Calvi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | | | | | | | | | - Maurizio Pin
- Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | | | - Roberto Ferrari
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Matteo Serenelli
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
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Brega C, Calvi S, Pin M, Anderlucci L, Falcone R, Albertini A. Surgical aortic valve replacement for low-gradient aortic stenosis. J Cardiovasc Med (Hagerstown) 2022; 23:338-343. [PMID: 35486684 DOI: 10.2459/jcm.0000000000001292] [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] [Indexed: 11/05/2022]
Abstract
AIMS Low-gradient aortic stenosis is a challenging entity that needs accurate preoperative evaluation. For this high-risk patient population, ad hoc predictive scores are not available and profile risk is currently revealed by the EuroSCOREs. Aims of this study are to verify the suitability of the ES II as predictor of mortality in low-gradient aortic stenosis and to analyse the role of surgery as a treatment. METHODS From June 2013 to August 2019, 414 patients underwent surgical aortic valve replacement for low-gradient aortic stenosis. Mean age was 75.78 ± 6.77 years and 190 were women. The prognostic value of Logistic EuroSCORE and EuroSCORE II were compared by receiver-operating characteristics (ROC) curve analysis. RESULTS In-hospital, 30-day and 1-year mortality rates were respectively 3.4, 2.9 and 4.8% (14, 12 and 20 patients over 414). In-hospital mortality risk calculated by the Additive EuroSCORE was 7.2 ± 2.7%, by the Logistic EuroSCORE was 9 ± 5.2% and by the ES II was 4.13 ± 2.56%. The prognostic values of the EuroSCORE II and of the EuroSCORE were analysed in a ROC curve analysis for the prediction of in-hospital mortality [area under the curve (AUC): 0.62 vs. 0.58], 30-day mortality (AUC: 0.63 vs. 0.64) and 1-year mortality (AUC: 0.79 vs. 0.65). Both scores did not show significant differences with the only exception of 1-year mortality, for which EuroSCORE II had a better predictive ability than the Logistic EuroSCORE (P < 0.05). CONCLUSION In low-gradient aortic stenosis undergoing surgery, the EuroSCORE II is a strong predictor of 1-year mortality.
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Affiliation(s)
- Carlotta Brega
- Department of Cardiovascular Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | - Simone Calvi
- Department of Cardiovascular Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | - Maurizio Pin
- Department of Cardiovascular Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | - Laura Anderlucci
- Statistical Sciences Department, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Roberta Falcone
- Statistical Sciences Department, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alberto Albertini
- Department of Cardiovascular Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola
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Brega C, Raviola E, Lansac E, Albertini A. Coronary spasm: unpredictability and safety in treatment key role of hybrid setting. Interact Cardiovasc Thorac Surg 2021; 33:637-639. [PMID: 33912969 DOI: 10.1093/icvts/ivab128] [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: 10/21/2020] [Revised: 02/21/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
The present case highlights the crucial role of hybrid setting for diagnosis and treatment of refractory coronary spasms.
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Affiliation(s)
- Carlotta Brega
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Eliana Raviola
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, Paris, France
| | - Alberto Albertini
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
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Brega C, Calvi S, Albertini A. Use of a negative pressure wound therapy system over closed incisions option in preventing post-sternotomy wound complications. Wound Repair Regen 2021; 29:848-852. [PMID: 33780088 DOI: 10.1111/wrr.12914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/01/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
Post-sternotomy surgical site infections may be serious complications responsible for increased morbidity, mortality and length of hospital stay. A variety of wound-healing strategies can be used over closed surgical incisions, including negative pressure wound therapy (NPWT). The aim of the study is to assess sternal wound complications after heart surgery using NPWT in patients at risk for surgical site complication. Considered risk factors affecting wound healing were type 2 diabetes, Body Mass Index (BMI) >30, chronic obstructive pulmonary disease (COPD), chronic renal failure (CRF) and myocardial revascularization by double mammary artery harvesting. With these premises, 90 patients were selected: 30 patients received traditional gauze dressings, 30 advanced dressings (hydrocolloid and carboxymethyl cellulose) and 30 patients NPWT. Thirty-four patients (37.7%) had two risk factors, 41 patients (45.5%) were affected by three risk factors and 15 patients (16.6%) by four risk factors. The NPWT group had lower rates of diabetes and CRF and only one patient presented four risk factors. With regard to surgical times and types of surgical procedure, no significant differences were observed within the three groups. The patients who received NPWT over closed incision experimented a significantly lower rate of deep sternal complication over traditional gauze and hydrocolloid and carboxymethyl cellulose dressings.
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Affiliation(s)
- Carlotta Brega
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Simone Calvi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Alberto Albertini
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
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Albertini A, Raviola E, Zucchetta F, Brega C, Mikus E, Tripodi A. Aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium to avoid the prosthesis-patient mismatch of a severely obese 57-year-old patient—a case report. J Vis Surg 2021. [DOI: 10.21037/jovs-20-110] [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]
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Zucchetta F, Raviola E, Brega C, Mangieri A, Albertini A. ACURATE neo Bioprosthesis in Stenotic Bicuspid Aortic Valve Developing Aortic Ulceration and Endocarditis. JACC Cardiovasc Interv 2020; 14:e11-e13. [PMID: 33358651 DOI: 10.1016/j.jcin.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Fabio Zucchetta
- Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy.
| | - Eliana Raviola
- Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Carlotta Brega
- Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM care and Research, Cotignola (RA), Italy
| | - Alberto Albertini
- Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
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Mikus E, Calvi S, Brega C, Zucchetta F, Tripodi A, Pin M, Manfrini M, Cimaglia P, Masiglat J, Albertini A. Minimally invasive aortic valve surgery in obese patients: Can the bigger afford the smaller? J Card Surg 2020; 36:582-588. [PMID: 33345384 DOI: 10.1111/jocs.15267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/16/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Ministernotomy and right minithoracotomy are well-known minimally invasive approaches for aortic valve replacement (AVR); however, controversial opinions exist for their utilization in obese patients. The aim of this study is to check a potential positive role of minimally invasive surgery in this population. METHODS From January 2010 to November 2019, 613 obese patients (defined by a body mass index ≥30) underwent isolated AVR at our institution. Surgical approach included standard median sternotomy (176 patients), partial upper sternotomy (271 patients), or right anterior minithoracotomy (166 patients). Intra- and postoperative data were retrospectively collected. RESULTS Patients treated with minimally invasive approaches had shorter cardiopulmonary bypass time (p = .012) and aortic cross-clamp time (p = .022), mainly due to the higher utilization of sutureless valve implantation. They also presented advantages in terms of reduced postoperative ventilation time (p = .010), incidence of wound infection (p = .009), need of inotropic support (p = .004), and blood transfusion (p = .001). The univariable logistic regression showed the traditional full sternotomy approach as compared with ministernotomy (p = .026), active smoking (p = .009), peripheral vascular disease (p = .003), ejection fraction (p = .026), as well Logistic European system for cardiac operative risk evaluation (EuroSCORE; p = .015) as factors associated with hospital mortality. The multivariable logistic regression adjusted for the logistic EuroSCORE revealed that surgical approaches do not influence hospital mortality. CONCLUSIONS Obese patients with severe aortic valve pathology can be treated with minimally invasive approaches offering a less biological insult and reduced postoperative complications, but without impact on hospital mortality.
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Affiliation(s)
- Elisa Mikus
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Simone Calvi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Carlotta Brega
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Fabio Zucchetta
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Alberto Tripodi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Maurizio Pin
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Marco Manfrini
- Biostatistics and Epidemiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Paolo Cimaglia
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Joyce Masiglat
- Department of Cardio-Thoracic and Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Alberto Albertini
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
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Pisani A, Braham W, Brega C, Lajmi M, Provenchere S, Danial P, Alkhoder S, Para M, Ghodbane W, Nataf P. Right axillary artery cannulation for venoarterial extracorporeal membrane oxygenation: a retrospective single centre observational study. Eur J Cardiothorac Surg 2020; 59:601-609. [DOI: 10.1093/ejcts/ezaa397] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Our goal was to assess the safety, outcomes and complication rate of axillary artery cannulation for venoarterial extracorporeal membrane oxygenation (VA-ECMO).
METHODS
A retrospective analysis was conducted on data obtained from the review of medical charts of all consecutive patients undergoing VA-ECMO implantation between January 2013 and December 2017 at a teaching hospital. Only patients with right axillary VA-ECMO implantation in a non-emergency setting were included. Post-procedural outcomes and local and systemic complications were analysed.
RESULTS
One hundred and seventy-four [131 male (75.3%), 43 female (24.7%); mean age 56.8 ± 15.1 years] patients underwent femoral-axillary VA-ECMO. Indications were cardiogenic shock from any cause (n = 78, 44.8%) or post-cardiotomy syndrome (n = 96, 55.2%). Fifty-three (30.5%) patients died while on VA-ECMO support. At the time of VA-ECMO ablation, 89 (51.1%) patients had recovered; 13 (7.5%) patients were bridged to a long-term mechanical support device and 19 (10.9%) patients underwent heart transplants. Thirty-day and 1-year mortality was 36.2% (n = 63) and 49.4% (n = 86), respectively. The 1-year survival rate of patients who were weaned from VA-ECMO support was 72.7% (n = 88). The complications of axillary cannulation were bleeding (n = 7, 4%), local infection (n = 3, 1.7%), upper limb ischaemia (n = 2, 1.1%) and brachial plexus injury (n = 1, 0.6%). Left ventricle unloading was required for 9 (5.2%) patients. The median duration of VA-ECMO support was 7 (range 1–26) days.
CONCLUSIONS
Right axillary artery cannulation is a safe and reliable method for VA-ECMO support with a low rate of local complications. In the absence of a control group with femoro-femoral cannulation, no definitive conclusion about the superiority of axillary over femoral cannulation can be drawn.
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Affiliation(s)
- Angelo Pisani
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Wael Braham
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Carlotta Brega
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Moklhes Lajmi
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Sophie Provenchere
- Department of Anesthesia, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
- Université de Paris, Centre d'Investigation Clinique 1425, INSERM, Paris, France
| | - Pichoy Danial
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Soleiman Alkhoder
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Marylou Para
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
- Université de Paris, LVTS UMRS 1148, INSERM, Paris, France
| | - Walid Ghodbane
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Patrick Nataf
- Department of Cardiovascular Surgery, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
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Brega C, Raviola E, Zucchetta F, Panzavolta M, Tripodi A, Albertini A. Radial artery supply to the left mammary artery in a redo coronary bypass. J Card Surg 2020; 36:349-352. [PMID: 33124057 DOI: 10.1111/jocs.15183] [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: 09/18/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Single-inflow coronary bypass through left internal thoracic artery and Y graft is effective in myocardial revascularization, but left sublavian diseases may affect its safety. AIM OF THE STUDY To assess that, in presence of a composite Y graft, issues involving the origin of the left internal thoracic artery are relatively easy to manage, even in reoperations. METHODS A critical stenosis of the subclavian artery involving the origin of a bilateral internal thoracic artery Y graft was bypassed using a free radial artery graft. RESULTS Bypass was performed between the left thoracic artery and the ascending aorta, off-pump and with excellent results. CONCLUSIONS In consideration of the excellent long term results of total arterial revascularization, radial artery is a feasible graft option, even in case of a composite Y graft in place.
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Affiliation(s)
- Carlotta Brega
- Cardiovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Eliana Raviola
- Cardiovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Fabio Zucchetta
- Cardiovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Marco Panzavolta
- Cardiovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Alberto Tripodi
- Cardiovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Alberto Albertini
- Cardiovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
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Brega C, Pisani A, Braham W, Nataf P. Surgical management of iatrogenic coronary artery perforations: when percutaneous treatment fails. Indian J Thorac Cardiovasc Surg 2020; 36:231-233. [PMID: 33061129 DOI: 10.1007/s12055-019-00900-4] [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: 08/25/2019] [Revised: 10/23/2019] [Accepted: 11/07/2019] [Indexed: 11/25/2022] Open
Abstract
Coronary perforation is a rare complication of percutaneous coronary interventions and a challenging scenario which imposes prompt recognition and treatment. Although it may be successfully managed percutaneously, a surgical treatment may be preferable in some cases. We report the case of a patient with a coronary perforation with initial percutaneous treatment complicated with extravascular implantation of a covered stent and liver laceration, who was succesfully treated by cardiac surgery. This case suggests the importance of the proximity of an onsite cardiac surgery center when complex coronary artery percutaneous interventions are performed in hospitals with offsite surgical support.
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Affiliation(s)
- Carlotta Brega
- Department of Cardiac Surgery, Hôpital Bichat-Claude-Bernard, 46 rue Huchard, Paris, France
| | - Angelo Pisani
- Department of Cardiac Surgery, Hôpital Bichat-Claude-Bernard, 46 rue Huchard, Paris, France
| | - Wael Braham
- Department of Cardiac Surgery, Hôpital Bichat-Claude-Bernard, 46 rue Huchard, Paris, France
| | - Patrick Nataf
- Department of Cardiac Surgery, Hôpital Bichat-Claude-Bernard, 46 rue Huchard, Paris, France
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Mikus E, Calvi S, Tavazzi L, Brega C, Tripodi A, Pin M, Manfrini M, Zucchetta F, Tenti E, Albertini A. Pacemaker need after sutureless aortic valve replacement: the role of the learning curve. J Cardiovasc Med (Hagerstown) 2020; 22:133-138. [DOI: 10.2459/jcm.0000000000001095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pisani A, Hounat F, Brega C, Borghese O, Braham W, Alkhoder S. Infective endocarditis following transcatheter aortic valve implantation. Ann Cardiol Angeiol (Paris) 2020; 69:204-206. [PMID: 32797937 DOI: 10.1016/j.ancard.2020.07.013] [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: 03/09/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022]
Abstract
Trans-catheter aortic valve implantation (TAVI) has recently emerged as a less invasive alternative to surgical aortic valve replacement (SAVR) in high risk patients. Although several procedures have been performed worldwide, infective endocarditis (IE) has been reported to be a rare TAVI complication, nevertheless if IE occurs it represents a life-threatening condition and treatment is challenging. TAVI-IE are thus normally treated conservatively by targeted antibiotic therapy with a high reported mortality (40%). Surgical explant represent the definitive strategy but, the intervention is at a high risk (risk of complication 87%, with an in hospital mortality of about 47%). In the present paper, we report the case of a 71-year-old patient affected by an early endocarditis after TAVI (TAVI-IE) treated at our Institution by surgical explant. The case highlights a paradox: if TAVI procedures are indicated over traditional surgical valve replacement in treatment of high surgical risk patients, what should be the best management when TAVI-IE occurs in these same population of patients?
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Affiliation(s)
- A Pisani
- Department of Cardiovascular Surgery, Bichat-Claude Bernard Hospital, 46, rue Henri-Huchard, 75018 Paris, France.
| | - F Hounat
- Department of Cardiovascular Surgery, Bichat-Claude Bernard Hospital, 46, rue Henri-Huchard, 75018 Paris, France
| | - C Brega
- Department of Cardiovascular Surgery, Bichat-Claude Bernard Hospital, 46, rue Henri-Huchard, 75018 Paris, France
| | - O Borghese
- Vascular Surgery Unit, Foch Hospital, 40, rue Worth-Suresnes, 92150, France
| | - W Braham
- Department of Cardiovascular Surgery, Bichat-Claude Bernard Hospital, 46, rue Henri-Huchard, 75018 Paris, France
| | - S Alkhoder
- Department of Cardiovascular Surgery, Bichat-Claude Bernard Hospital, 46, rue Henri-Huchard, 75018 Paris, France
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Youssefi P, Brega C, Shraer N, Zacek P, Debauchez M, Lansac E. Isolated Bicuspid Aortic Valve Repair With Double Annuloplasty: How I Teach It. Ann Thorac Surg 2019; 108:1596-1604. [DOI: 10.1016/j.athoracsur.2019.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/15/2019] [Indexed: 11/29/2022]
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Brega C, Zakkar M, Lansac E. Aortic valve cord mimicking fibroelastoma. Eur J Cardiothorac Surg 2017. [PMID: 28637231 DOI: 10.1093/ejcts/ezx204] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] Open
Affiliation(s)
| | - Mustafa Zakkar
- Institute Mutualiste Montsouris, Paris, France.,Department of Cardiothoracic Surgery, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK
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Sportelli E, Regesta T, Salsano A, Ghione P, Brega C, Bezante GP, Passerone G, Santini F. Does patient-prosthesis mismatch after aortic valve replacement affect survival and quality of life in elderly patients? J Cardiovasc Med (Hagerstown) 2016; 17:137-43. [PMID: 26237424 DOI: 10.2459/jcm.0000000000000292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND To evaluate the impact of patient-prosthesis mismatch (PPM) on survival, functional status, and quality of life (QoL) after aortic valve replacement (AVR) with small prosthesis size in elderly patients. METHODS Between January 2005 and December 2013, 152 patients with pure aortic stenosis, aged at least 75 years, underwent AVR, with a 19 or 21 mm prosthetic heart valve. PPM was defined as an indexed effective orifice area less than 0.85 cm/m. Median age was 82 years (range 75-93 years). Mean follow-up was 56 months (range 1-82 months) and was 98% complete. Late survival rate, New York Heart Association functional class, and QoL (RAND SF-36) were assessed. RESULTS Overall, PPM was found in 78 patients (53.8%). Among them, 42 patients (29%) had an indexed effective orifice area less than 0.75 cm/m and 17 less than 0.65 cm/m (11.7%). Overall survival at 5 years was 78 ± 4.5% and was not influenced by PPM (P = NS). The mean New York Heart Association class for long-term survivors with PPM improved from 3.0 to 1.7 (P < 0.001). QoL (physical functioning 45.18 ± 11.35, energy/fatigue 49.36 ± 8.64, emotional well being 58.84 ± 15.44, social functioning 61.29 ± 6.15) was similar to that of no-PPM patients (P = NS). CONCLUSION PPM after AVR does not affect survival, functional status, and QoL in patients aged at least 75 years. Surgical procedures, often time-consuming, contemplated to prevent PPM, may therefore be not justified in this patient subgroup.
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Affiliation(s)
- Elena Sportelli
- aDivision of Cardiac Surgery bDivision of Cardiology, IRCCS San Martino-IST, University of Genova Medical School, Genova, Italy
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Salsano A, Giacobbe DR, Sportelli E, Olivieri GM, Brega C, Di Biase C, Coppo E, Marchese A, Del Bono V, Viscoli C, Santini F. Risk factors for infections due to carbapenem-resistant
Klebsiella pneumoniae
after open heart surgery. Interact Cardiovasc Thorac Surg 2016; 23:762-768. [DOI: 10.1093/icvts/ivw228] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/17/2016] [Accepted: 06/02/2016] [Indexed: 11/12/2022] Open
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Amendola A, Brega C, Zaccaro P, Aleo L, Di Filippo S, Capobianchi M. DUE PIATTAFORME ANALITICHE PER LA DETERMINAZIONE DELLA CARICA VIRALE DI HIV-1 A CONFRONTO: bDNA versus Real-time PCR. Microbiol Med 2007. [DOI: 10.4081/mm.2007.2883] [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: 11/23/2022] Open
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Abbate I, Finnstrom N, Garbuglia A, Solmone M, Zaniratti S, Bennici E, Neri S, Brega C, Paterno M, Capobianchi M. USO COMBINATO DI AFFIGENE CMV TRENDER E BIOROBOT MDX PER LA DETERMINAZIONE QUANTITATIVA DI CMV DNA. Microbiol Med 2007. [DOI: 10.4081/mm.2007.2784] [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: 11/23/2022] Open
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Abbate I, Bennici E, Neri S, Brega C, Paterno M, Capobianchi M. DETERMINAZIONE QUANTITATIVA DI BKV E JCV DNA CON AFFIGENE BKV TRENDER ED UNA IN HOUSE REAL-TIME PCR PER JCV ASSOCIATA ALL’USO DEL SISTEMA BIOROBOT MDX. Microbiol Med 2007. [DOI: 10.4081/mm.2007.2785] [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: 11/22/2022] Open
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