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Maione D, De Luca A, Pezzato A, Vitrella G, Perkan A, Rauber E, Butera G, Sinagra G. Bioprosthetic pulmonary valve dysfunction in a primary cardiac sarcoma survivor: Clinical considerations and treatment options. Clin Case Rep 2024; 12:e8401. [PMID: 38356779 PMCID: PMC10865915 DOI: 10.1002/ccr3.8401] [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: 09/18/2023] [Revised: 11/25/2023] [Accepted: 12/14/2023] [Indexed: 02/16/2024] Open
Abstract
The case highlights the good survival after radical surgery and chemotherapy of a cardiac sarcoma, and the need for close follow-up due to possible early postsurgical complications.
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Affiliation(s)
- Davide Maione
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
- Postgraduate School of Cardiovascular Medicine University of TriesteTriesteItaly
| | - Antonio De Luca
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Andrea Pezzato
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
- Postgraduate School of Cardiovascular Medicine University of TriesteTriesteItaly
| | - Giancarlo Vitrella
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Andrea Perkan
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
| | - Elisabetta Rauber
- Cardiothoracovascular Department, Division of Cardiac SurgeryAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Gianfranco Butera
- Division of Interventional CardiologyChildren's Hospital Bambino GesùRomeItaly
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Division of CardiologyAzienda Sanitaria Universitaria Giuliano‐Isontina and University of TriesteTriesteItaly
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Franzese I, Gripshi F, Fiocco A, Rauber E, Ruggiero D, Bussani R, Mazzaro E. Cardiac Vascular Hamartoma: Adult Diagnosis and Cardiac Reconstruction. Ann Thorac Surg 2023; 115:e67-e69. [PMID: 35367435 DOI: 10.1016/j.athoracsur.2022.03.042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 11/18/2022]
Abstract
Cardiac hamartoma is a rare benign tumor of the heart, and the vascular type is an extremely rare histologic diagnosis. A small number of cases have previously been described in childhood. We report the case of a 63-year-old woman with an incidentally detected cardiac mass that was finally diagnosed as vascular hamartoma. Approval for publication was obtained from the patient.
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Affiliation(s)
- Ilaria Franzese
- Division of Cardiac Surgery, Hospital of Trieste, Trieste, Italy.
| | - Florida Gripshi
- Division of Cardiac Surgery, Hospital of Trieste, Trieste, Italy; Division of Cardiac Surgery, University Hospital of Parma, Parma, Italy
| | - Alessandro Fiocco
- Division of Cardiac Surgery, Hospital of Trieste, Trieste, Italy; Division of Cardiac Surgery, University of Padua, Padua, Italy
| | | | - Danilo Ruggiero
- Division of Cardiac Surgery, Hospital of Trieste, Trieste, Italy
| | - Rossana Bussani
- Institute of Pathological Anatomy, University of Trieste, Trieste, Italy
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Hospital of Trieste, Trieste, Italy
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Saro R, De Luca A, Radesich C, Pezzato A, Restivo L, Korcova R, Mazzaro E, Bardari S, Rauber E, Merlo M, Sinagra G. 738 A RARE CASE OF UNICUSPID AORTIC VALVE WITH SEVERE STENOSIS AND REGURGITATION: CLINICAL PRESENTATION AND MANAGEMENT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.737] [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: 12/23/2022]
Abstract
Abstract
A 19-year-old Pakistani migrant, who arrived in our country on foot, presented at emergency department with angina and worsening dyspnoea on exertion. The patient reported an unclear history of aortic valve disease.
Clinical examination revealed a 6/6L systolic murmur with thrill. The electrocardiogram showed sinus rhythm and signs of left ventricular hypertrophy. Chest X-ray reported cardiomegaly and signs of congestion. Troponin I HS was mildly elevated (39 ng/L, n.v. < 18 ng/L).
The patient was admitted to our Cardiology department. Transthoracic echocardiography revealed a mildly dilated left ventricle (LV), with severe hypertrophy, normal kinetics and systolic function (EF 63%), dilated ascending aorta (diam. 41 mm) and severe aortic steno-insufficiency. Transesophageal echocardiography was then performed, revealing a highly calcified, unicuspid unicommissural aortic valve with severe stenosis and regurgitation. A separate origin of left coronary ostia was also documented.
The patient was referred to urgent cardiac surgery. A modified Bentall procedure (mechanical valve and prosthetic conduit) was performed with reimplantation of the coronary ostia. Due to a post-surgical complete atrioventricular block, a dual-chamber pacemaker (DDD) was implanted.
Follow-up echocardiography showed reduction of LV volumes and wall thickness and normal prosthetic function.
Unicuspid aortic valve is a very rare congenital disease, with a prevalence of about 0.02% in the adult population and is frequently associated with ascending aorta dilatation. The treatment is aortic valve replacement. Complete atrioventricular block can occur after surgery, requiring cardiac pacing.
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Affiliation(s)
- Riccardo Saro
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Antonio De Luca
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Cinzia Radesich
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Andrea Pezzato
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Luca Restivo
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Renata Korcova
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Enzo Mazzaro
- Cardiovascular Department, Division Of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Stefano Bardari
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Elisabetta Rauber
- Cardiovascular Department, Division Of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Marco Merlo
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Division Of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Trieste , Italy
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Restivo L, De Luca A, Fabris E, Pagura L, Pierri A, Korcova R, Franzese I, Fiocco A, Rauber E, Mazzaro E, Bussani R, Belgrano M, Pappalardo A, Sinagra G. A 20-year experience in cardiac tumors: a single center surgical experience and a review of literature. J Cardiovasc Med (Hagerstown) 2022; 23:722-727. [PMID: 36166324 DOI: 10.2459/jcm.0000000000001375] [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
INTRODUCTION Cardiac tumors are rare and heterogeneous entities which still remain a diagnostic and therapeutic challenge. The treatment for most cardiac tumors is prompt surgical resection. We sought to provide an overview of surgical results from a series of consecutive patients treated at our tertiary care center during almost a 20-year experience. METHODS AND RESULTS In this single center study, 55 consecutive patients with diagnosis of cardiac tumor underwent surgical treatment from January 2002 to April 2021. Of these, 23 (42%) were male and the mean age was 62 ± 12 years. Fifteen (27%) patients were symptomatic at the time of the diagnosis, mostly for dyspnea and palpitations. The most frequent benign cardiac tumor was myxoma (32; 58%), occurring mainly in the left atrium (31; 97%). Pleomorphic sarcoma was the most frequent primary malignant cardiac tumor (4; 7%), mainly located in the ventricles (1; 25% in the left ventricle; 2; 50% in the right ventricle). In all cases of benign tumors surgery was successful with no relapses. Two (50%) pleomorphic sarcomas showed subsequent relapses. After a median follow-up of 44 months, 15 (27%) patients died. Although malignant tumors presented a limited survival, benign tumors showed a very good prognosis. CONCLUSION Cardiac tumors require a multidisciplinary approach to guarantee a prompt diagnosis and appropriate treatment. In our surgical experience, outcome after surgery of benign tumors was excellent, while malignant tumors had poor prognosis despite radical surgery.
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Affiliation(s)
- Luca Restivo
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Antonio De Luca
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Enrico Fabris
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Linda Pagura
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Alessandro Pierri
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Renata Korcova
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Ilaria Franzese
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Alessandro Fiocco
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste.,Department of Surgical, Medical and Molecular Pathology and Critical Care, Division of Cardiac Surgery, University of Pisa, Pisa
| | - Elisabetta Rauber
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Enzo Mazzaro
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Rossana Bussani
- Pathology Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
| | - Manuel Belgrano
- Department of Radiology, Azienda Sanitaria Universitaria Integrata and University of Trieste, Trieste, Italy
| | - Aniello Pappalardo
- Cardiothoracovascular Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste
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Restivo L, De Luca A, Castrichini M, Pierri A, Rauber E, Fabris E, Bussani R, Belgrano MG, Pagnan L, Pappalardo A, Mazzaro E, Sinagra G. 413 Challenges in the field of cardiac tumours: the surgical experience of Trieste. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab142.031] [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: 11/13/2022]
Abstract
Abstract
Aims
Cardiac tumors are rare and heterogeneous entities which still remain a diagnostic and therapeutic challenge. The treatment for most cardiac tumors is prompt surgical resection. We sought to provide an overview of surgical results from a series of consecutive patients treated at our tertiary centre during almost a 20-year experience.
Methods and results
In this single centre study, 55 consecutive patients with cardiac tumor underwent surgical treatment from January 2002 to April 2021. Of these, 42% of patients were male and the mean age was 62 ± 12 years. Almost 27% of patients were symptomatic at the time of the diagnosis, mostly for dyspnoea and palpitations. The most frequent benign cardiac tumor was myxoma (58% of cases), occurring mainly in the left atrium (97%). Pleomorphic sarcoma was the most frequent primary malignant cardiac tumour (7.2% of cases), mainly located in the ventricles (25% left ventricle; 50% right ventricle). In all cases of benign tumors surgery was successful with no relapses. In 50% of cases of pleomorphic sarcoma relapses were observed during follow-up. After a median follow-up of 44 months, 15 (27%) patients died. While malignant tumors presented a limited survival, benign tumours showed a very good prognosis.
Conclusions
Cardiac tumours require a multidisciplinary work-up to guarantee a prompt diagnosis and appropriate treatment. In our surgical experience, the prognosis of benign tumours was excellent, while malignant tumours had poor outcomes despite radical surgery.
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Affiliation(s)
- Luca Restivo
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Antonio De Luca
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Matteo Castrichini
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Alessandro Pierri
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Elisabetta Rauber
- Division of Cardiac Surgery, Cardio Thoraco Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Enrico Fabris
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Rossana Bussani
- Pathology Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Manuel Gianvalerio Belgrano
- Radiology Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Lorenzo Pagnan
- Radiology Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Aniello Pappalardo
- Division of Cardiac Surgery, Cardio Thoraco Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Cardio Thoraco Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Gianfranco Sinagra
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
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Gatti G, Rauber E, Forti G, Benussi B, Gabrielli M, Gripari C, Gustin G, Pappalardo A. Safe cross-clamp time using Custodiol ®-histidine-tryptophan-ketoglutarate cardioplegia in the adult. Perfusion 2019; 34:568-577. [PMID: 30919738 DOI: 10.1177/0267659119837824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/17/2022]
Abstract
INTRODUCTION Safe cross-clamp time using single-dose Custodiol®-histidine-tryptophan-ketoglutarate cardioplegia has not been established conclusively. METHODS Immediate post-operative outcomes of 1,420 non-consecutive, cardiac surgery patients were reviewed retrospectively. Predictors of a combined endpoint made of in-hospital mortality and any major complication post-surgery were found with the multivariable method. Analysis of variance was used to evaluate the impact of cross-clamp time on most relevant complications. Discriminatory power and cut-off value of cross-clamp time were established for in-hospital mortality and each of the major complications (receiver operating characteristic curve analysis). A comparative analysis (with propensity matching) with multidose cold blood cardioplegia on in-hospital mortality post-surgery was performed in non-coronary surgery patients. RESULTS Coronary, aortic valve and mitral valve surgery and surgery on thoracic aorta were performed in 45.4%, 41.9%, 49.5%, 20.6% of cases, respectively. In-hospital mortality and the rate of any major complication post-surgery were 6.5% and 41.9%, respectively. Cross-clamp time had significant impact on in-hospital mortality and almost all major post-operative complications, except neurological dysfunctions (p = 0.084), myocardial infarction (p = 0.12) and mesenteric ischaemia (p = 0.85). Areas under the receiver operating characteristic curve and the optimal cut-off values for in-hospital mortality and any major complication were of 0.657, 0.594, >140 and >127 minutes, respectively. Comorbidities-adjusted odds ratio for any major complication of cross-clamp time <127 minutes was 1.86 (p < 0.0001). Despite similar in-hospital mortality (p = 0.57), there was an earlier significant increase of mortality in Custodiol-HTK than in multidose cold blood propensity-matched, non-coronary surgery patients. CONCLUSIONS The use of Custodiol-HTK cardioplegia is associated with a low risk of serious post-operative complications provided that cross-clamp time is of 2 hours or less.
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Affiliation(s)
- Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Elisabetta Rauber
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Gabriella Forti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Bernardo Benussi
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Marco Gabrielli
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Carla Gripari
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Gianfranco Gustin
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Aniello Pappalardo
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
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Gatti G, Benussi B, Bollini M, Forti G, Poletti A, Rauber E, Gabrielli M, De Monte A, Sinagra G, Pappalardo A. Liberal bilateral internal thoracic artery use in people with diabetes neutralizes the negative impact of insulin-requiring status. J Cardiovasc Med (Hagerstown) 2017; 18:596-604. [PMID: 28549016 DOI: 10.2459/jcm.0000000000000529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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 Bilateral internal thoracic artery (BITA) grafts are underused in insulin-dependent diabetic patients because of increased risk of postoperative complications. The impact of the insulin-requiring status on outcomes after routine BITA grafting was investigated in this retrospective study. METHODS Skeletonized BITA grafts were used in 3228 (71.6%) of 4508 consecutive patients having multivessel coronary disease who underwent isolated coronary bypass surgery at the authors' institution from January 1999 to August 2015. Among these BITA patients, diabetes mellitus and the insulin-requiring status were present in 972 (30.1%) and 237 (7.3%) cases, respectively. After the one-to-one propensity score-matching, 215 pairs of insulin-dependent/noninsulin-dependent people with diabetes were compared as the postoperative outcomes. The operative risk was calculated for each patient according to the logistic European System for Cardiac Operative Risk Evaluation (logistic EuroSCORE). RESULTS As expected, insulin-dependent people with diabetes had higher risk profiles than noninsulin-dependent people with diabetes (median logistic EuroSCORE, 4.1 vs. 3.5%, P = 0.086). However, there were no differences in in-hospital mortality both in unmatched and propensity score-matched series (2.5 vs. 2%, P = 0.65 and 2.8 vs. 1.9%, P = 0.52, respectively). In propensity score-matched pairs, only prolonged invasive ventilation (P = 0.0039) and deep sternal wound infection (P = 0.071) were more frequent in insulin-dependent people with diabetes. No differences were found as the late outcomes. CONCLUSION In diabetic patients, the insulin-requiring status is by itself a risk factor neither for in-hospital death nor for poor late outcomes after routine BITA grafting. Only the risk of prolonged invasive ventilation and deep sternal wound infection are increased early after surgery.
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Affiliation(s)
- Giuseppe Gatti
- aCardiovascular Department, University Hospital of Trieste bHospital Unit for Diabetes Control, Ospedali Riuniti, Trieste, Italy
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Prati G, Gatti G, Belgrano M, Pinamonti B, Rauber E, Gripshi F, Pappalardo A, Sinagra G. Disseminated echinococcosis: follow your heart. J Cardiovasc Med (Hagerstown) 2017; 17 Suppl 2:e146-e148. [PMID: 28482352 DOI: 10.2459/jcm.0000000000000389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
: In this report, we present a rare case of cardiac echinococcosis presenting with cerebral haemorrhage due to rupture of a mycotic aneurysm in a peripheral branch of the media cerebral artery. Further investigations lead to discovery of multiple cysts in the heart and liver. The complementary use of transthoracic and transoesophageal echocardiography, MRI and computed tomography lead to the final diagnosis of disseminated echinococcosis and allowed precise evaluation of the anatomical and structural characteristics of the cardiac mass, its boundaries and its relationship with the surrounding anatomic structures.
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Affiliation(s)
- Giulio Prati
- aCardiovascular Department, University Hospital 'Ospedali Riuniti', Polo Cardiologico - via Valdoni n°7bPostgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy
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Fabris E, Perkan A, Rauber E, Vitrella G, Sallusti R, Pavan D, Pappalardo A, Salvi A, Sinagra G. Bilateral coronary obstruction in high-risk transcatheter aortic valve-in-valve implantation: When procedural strategy counts. Int J Cardiol 2016; 203:672-4. [DOI: 10.1016/j.ijcard.2015.10.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 10/24/2015] [Indexed: 11/15/2022]
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Gatti G, Dell'Angela L, Barbati G, Benussi B, Forti G, Gabrielli M, Rauber E, Luzzati R, Sinagra G, Pappalardo A. A predictive scoring system for deep sternal wound infection after bilateral internal thoracic artery grafting. Eur J Cardiothorac Surg 2015; 49:910-7. [DOI: 10.1093/ejcts/ezv208] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 05/04/2015] [Indexed: 11/12/2022] Open
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Gatti G, Dell’Angela L, Benussi B, Dreas L, Forti G, Gabrielli M, Rauber E, Luzzati R, Sinagra G, Pappalardo A. Bilateral internal thoracic artery grafting in octogenarians: where are the benefits? Heart Vessels 2015; 31:702-12. [DOI: 10.1007/s00380-015-0675-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
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Rauber E, Massardier-Pilonchery A, Bergeret A. De la presbyacousie au travail à la compensation auditive. ARCH MAL PROF ENVIRO 2014. [DOI: 10.1016/j.admp.2014.03.005] [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: 11/16/2022]
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Zingone B, Gatti G, Spina A, Rauber E, Dreas L, Forti G, Pappalardo A. Current role and outcomes of ascending aortic replacement for severe nonaneurysmal aortic atherosclerosis. Ann Thorac Surg 2010; 89:429-34. [PMID: 20103316 DOI: 10.1016/j.athoracsur.2009.11.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 09/25/2009] [Revised: 11/11/2009] [Accepted: 11/11/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Severe atherosclerosis of the ascending aorta is a challenging issue potentially affecting indications for surgery, operative choices, and patients' outcome. No standard treatment has emerged to date, and uncertainties persist about criteria for selecting patients and procedures. METHODS Replacement of the atherosclerotic ascending aorta was performed in 64 patients at time of either aortic (n = 49), mitral (n = 21), or tricuspid (n = 7) valve surgery. Coronary artery bypass grafting was performed in 53 patients, and the majority of patients underwent combined procedures (n = 49). Mean age was 72.0 +/- 7.6 years. The expected operative mortality, by logistic European System for Cardiac Operative Risk Evaluation, was 29.0% accounting for ascending aortic replacement and 13.1% disregarding it. Circulatory arrest under deep hypothermia, eventually combined with either retrograde or antegrade brain perfusion, was required in 61 cases. RESULTS Early death, stroke, and myocardial infarction rates were 10.9%, 6.3%, and 7.8%, respectively. Factors univariately associated with early deaths were preoperative renal failure requiring dialysis (p = 0.001) and longer cardiopulmonary bypass (p = 0.001) and cardioplegia (p = 0.008) times. Cumulative survival at 1, 3, and 5 years was 86% +/- 4%, 74% +/- 6%, and 68% +/- 8%, respectively. CONCLUSIONS Replacement of the atherosclerotic ascending aorta can be carried out at acceptable mortality rates despite the high rates of preoperative comorbidity and the significant incidence of postoperative complications.
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Affiliation(s)
- Bartolo Zingone
- Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
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Zingone B, Rauber E, Gatti G, Pappalardo A, Benussi B, Forti G, Tognolli U, Gabrielli M. Diagnosis and management of severe atherosclerosis of the ascending aorta and aortic arch during cardiac surgery: focus on aortic replacement. Eur J Cardiothorac Surg 2007; 31:990-7. [PMID: 17383888 DOI: 10.1016/j.ejcts.2007.02.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 02/19/2007] [Accepted: 02/20/2007] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Severe atherosclerosis of the ascending aorta and arch frequently causes difficulties during heart operations, hindering surgical manoeuvres and potentially leading to systemic embolism. The aim of our study was to assess the safety and effectiveness of replacing the atherosclerotic ascending aorta in this setting. METHODS Aortic atherosclerosis was characterized by epiaortic ultrasonographic scanning in 90.1% of 1927 consecutive adult patients undergoing cardiac operations, and by computed tomographic chest scanning in selected cases. Thirty-six of the 152 patients requiring major derangements from our standard practice due to aortic atherosclerosis underwent replacement of the ascending aorta and constitute the study group. Replacement of the aorta was extended to the arch in 13 cases (36.1%). It was associated with single or multiple valve surgery in 34 patients (94.4%) and with coronary revascularization in 30 (83.3%). Two patients (5.6%) underwent coronary bypass grafting without valve surgery. A cryoablation procedure was associated in three patients with permanent atrial fibrillation. Deep hypothermic circulatory arrest was employed in 34 patients (94.4%), while proximal aortic disease allowed conventional distal crossclamping in 2 cases. The risk of operative mortality was estimated by the logistic EuroSCORE both with and withholding the variable "surgery of the thoracic aorta". All survivors were followed-up for 1-41 months (16+/-12). RESULTS Two patients died in the hospital (5.6%) and two during follow-up, for a cumulative survival of 91.3% and 85.6% at 1 and 3 years, respectively (hospital deaths included). The hospital death rate compared favourably with the expected estimates of 25.5% (p<0.05) and 10.3% (p=0.67) obtained by the EuroSCORE full model and without "aortic surgery", respectively. In-hospital adverse neurologic events occurred in six patients (16.7%), including stroke in one patient (2.8%) and neurocognitive disturbances in five (13.9%), although they were all transient and cleared before discharge. Excess bleeding required re-exploration in four patients (11.1%), and one more patient underwent emergency grafting for acute postoperative coronary occlusion. Ten patients (38.5%) were intubated for longer than 24h. CONCLUSION Despite significant perioperative morbidity, replacement of the severely atherosclerotic aorta is worth consideration to avert expectedly higher death and stroke rates.
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Affiliation(s)
- Bartolo Zingone
- Cardiovascular Department, Cardiac Surgery Unit, Ospedali Riuniti di Trieste, Italy.
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Zingone B, Gatti G, Rauber E, Pappalardo A, Benussi B, Dreas L. Surgical management of the atherosclerotic ascending aorta: is endoaortic balloon occlusion safe? Ann Thorac Surg 2006; 82:1709-14. [PMID: 17062234 DOI: 10.1016/j.athoracsur.2006.05.113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Revised: 05/22/2006] [Accepted: 05/25/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Occlusion of the atherosclerotic ascending aorta by an endoaortic inflatable balloon has been proposed as an alternative to conventional cross-clamping to prevent injury to the vessel and distal embolization of debris. The safety and the effectiveness of endoaortic occlusion have not been documented in this setting. METHODS Endoaortic occlusion was employed in 52 of 2,172 consecutive patients. Surgeon's choice was based on preoperative identification of aortic calcifications or intraoperative epiaortic ultrasonographic scanning. Deaths and strokes were analyzed casewise and in aggregate. RESULTS In 10 patients (19.2%), the endoaortic balloon had to be replaced by the ordinary cross-clamp because of incomplete occlusion (n = 5), hindered exposure (n = 2), or balloon rupture (n = 3). In-hospital death occurred in 13 patients (25%), and stroke on awakening from anesthesia in 2 (3.8%). The death rate of patients treated by endoaortic occlusion was significantly higher compared with all other patients (4.2%, p < 0.0001) and with the expected estimate by European System for Cardiac Operative Risk Evaluation (10.5%, p = 0.05). By multivariable analysis, use of endoaortic occlusion was independently associated with in-hospital death (odds ratio = 5.609, 95% confidence interval: 2.684 to 11.719). Although the stroke rate was higher in the endoaortic occlusion group compared with all other patients, the difference was only possibly significant (3.8% versus 0.8%, p = 0.067). CONCLUSIONS In this series, the endoaortic occlusion was frequently ineffective, and was associated with a significantly higher risk of in-hospital death and a numerically higher risk of stroke.
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Affiliation(s)
- Bartolo Zingone
- Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
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Zingone B, Rauber E, Gatti G, Pappalardo A, Benussi B, Dreas L, Lattuada L. The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke. Eur J Cardiothorac Surg 2006; 29:720-8. [PMID: 16522368 DOI: 10.1016/j.ejcts.2006.02.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Revised: 01/31/2006] [Accepted: 02/02/2006] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To assess the impact of epiaortic scanning on the incidence of perioperative stroke in patients undergoing cardiac surgery. METHODS Patients consecutively enrolled in our surgical database between January 2000 and August 2004 were subdivided into three groups depending on the planned use of epiaortic ultrasonographic scan. Patients treated before the availability of the equipment constituted group A (n=366). Epiaortic scanning was next performed selectively in group B (n=1116) and finally adopted on a regular basis in group C patients (n=690). Comparisons of stroke rates were performed in the whole series both according to the actual use of epiaortic scan and to the intended scan policy. A sub-analysis was additionally performed in the CABG cohort, where expected stroke rates could also be estimated by a validated model. Multivariable analysis was employed to identify predictors of early stroke. RESULTS In the whole series, total stroke rates were 3.3%, 1.1%, and 1.9% for groups A, B, and C, respectively (p=0.02). Correspondingly, in the CABG cohort they were 3.4%, 0.5%, and 1.7%, respectively (p=0.002), with no substantial change following risk-adjustment. For the CABG cohort, total stroke rates were no different from expected estimates in the no-scan group A patients (3.4% vs 3.9%, ns). On the other hand, they were lower than expected in groups B+C (0.9% vs 2.8%, p=0.001), in patients actually scanned (1.4% vs 3.4%, p=0.01) and, among the latter, in those with significant aortic pathology (1.3% vs 4.5%, p=0.03). The risk reduction was particularly evident for early strokes, with no difference between scan groups: the rates were 0.5% and 0.6% for groups B and C, respectively, versus 2.2% in group A for the whole series (p<0.03), and 0.4% and 0.5% versus 1.9% in group A (p=0.02) for the CABG cohort. By multivariable analysis a no-scan policy (OR=4.0, 95% CL 1.4-11.4) and extracardiac arteriopathy (OR=3.0, 95% CL 1.1-8.0) were independently associated with early stroke. CONCLUSIONS The use of epiaortic scanning is associated with a lower risk of intraoperative adverse events leading to early postoperative stroke.
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Affiliation(s)
- Bartolo Zingone
- Division of Cardiac Surgery, Ospedali Riuniti, Strada di Fiume 447, 34100 Trieste, Italy.
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Zingone B, Dreas L, Pappalardo A, Benussi B, Forti G, Tognolli U, Gabrielli M, Rauber E, Bollini M, Poletti A, Campailla A, Zanei P, Sagrati G, Mezgec D. [A quality improvement program in cardiac surgery. Four-year experience from the Ospedali Riuniti of Trieste]. Ital Heart J Suppl 2004; 5:119-27. [PMID: 15080531] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Dissatisfaction with clinical outcomes prompted an intervention to assess and improve processes and outcomes in a cardiac surgery unit. METHODS Starting on September 1st, 1998, 1836 consecutive patients requiring a heart operation in our unit were prospectively enrolled by recording a series of anamnestic, clinical and procedural descriptors in a dedicated database. Expected mortality rates were estimated by means of nine different stratification models, one of which also allowed the prediction of excess intensive care unit and total hospital length of stay. Communication within the team has been re-engineered during the time frame studied. Some procedures have been modified and some others newly introduced according to a problem-oriented approach. RESULTS One hundred and twenty-one patients died before discharge or within 30 days of the operation. The overall observed mortality rate (6.6%) was not significantly different from the predicted estimates (relative risk-RR 0.9, 95% confidence interval-CI 0.7-1.2 compared with EuroSCORE and RR 1.2, 95% CI 0.9-1.6 compared with the "Provincial Adult Cardiac Care Network" model). Two out of seven "dedicated" coronary surgery models predicted a mortality rate significantly lower than observed. Both rates of intensive care and total postoperative length of stay exceeding predefined thresholds turned out to be significantly higher than the predicted estimates: 14.3 vs 10.1% for intensive care (RR 1.4, 95% CI 1.2-1.7) and 13.6 vs 10.6% for total postoperative stay (RR 1.3, 95% CI 1.1-1.5). During the study period the yearly raw mortality rate gradually decreased, for the series as a whole, from 9.5% during the year 1999 to 4.1% during the year 2002, and for the coronary surgery sample from 6.5 to 2.1%, with no significant differences from the expected estimates over the 3 most recent years. A similar trend was noted for both intensive care unit and total hospital length of stay. CONCLUSIONS Implementing an internal continuous quality improvement program effectively assisted in improving surgical outcomes by motivating people involved, drawing attention to procedures to be re-engineered and by providing the proper benchmarks for assessing the results.
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Affiliation(s)
- Bartolo Zingone
- Struttura Complessa di Cardiochirurgia, Dipartimento Medico-Chirurgico di Cardiologia, Ospedali Riuniti di Trieste, Trieste.
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Rauber E, Pancrazio F, Spivach A, Stanta G. [Thyroid metastasis due to right colonic carcinoma]. MINERVA GASTROENTERO 1998; 44:221-4. [PMID: 16495909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Clinical evident metastases to the thyroid gland are rarely found antemortem. A case of a 62 year-old man with a history of right colonic carcinoma, who presented a mass in the right lobe of his thyroid gland one year after the removal of a metachronous metastasis in his right lung, is presented. The tumour of the thyroid was found to be metastatic adenocarcinoma from his previous colonic cancer. The clinical finding of metastases to the thyroid gland is rare, particularly from a colorectal primary neoplasm. However, the possibility of a tumour of the thyroid gland representing a secondary malignancy is to be considered in any patient with a prior history of cancer.
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Affiliation(s)
- E Rauber
- Istituto di Patologia Chirurgica e Propedeutica Clinica, Università degli Studi, Ospedale di Cattinara, Trieste
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Adovasio R, Rauber E, Mucelli FP. [Endovascular treatment of isolated aneurysms of the hypogastric artery: technical considerations apropos of 2 cases]. Chir Ital 1998; 48:47-50. [PMID: 9522100] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Isolated aneurysm of the internal iliac artery is uncommon, with an incidence approaching 0.4%; its diagnosis is difficult; its natural course is progressive expansion and rupture. Two cases of hypogastric aneurysms, promptly treated with embolization, are reported. In selected patients the endovascular technique can represent a good alternative to the traditional surgical treatment that is associated with higher complication and mortality rate.
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Affiliation(s)
- R Adovasio
- Istituto di Patologia Speciale Chirurgica, Università degli Studi di Trieste
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Adovasio R, Pandullo C, Nadal A, Rauber E. [Ischemic heart disease and postoperative mortality in major vascular surgery. An up-to-date diagnostic approach]. Minerva Cardioangiol 1997; 45:477-82. [PMID: 9489316] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study is to evaluate the efficacy the dobutamine stress echocardiography in predicting the perioperative cardiac risk of patients undergoing major vascular surgery. METHODS Seventy-seven consecutive and not selected patients, undergoing a surgical treatment requiring aortic cross clamping, were assessed also with a transthoracic dobutamine stress echocardiography. With electrocardiographic and echocardiographic monitoring ventricular ischemia or wall motion abnormalities, 5 micrograms/kg per min of chlorhydrate dobutamine for 5 minutes were infused, followed by other 10 micrograms/kg per min increased up to 40 micrograms/kg per min. During the last 4 minutes 0.25 mg of atropin were infused increasingly up to 1 mg. RESULTS Of all these patients, 26 had a stress ischemia but only 4 cases underwent a coronary angiography and only 2 of these underwent a preventive myocardial revascularization. Due to poor cardiac conditions pointed out with the dobutamine stress, 3 patients were not treated surgically. With an aggressive intra- and perioperative monitoring 73 patients underwent a surgical treatment: they were 28 aorto-bifemoral, 3 aorto-aortic grafts, 1 aorto-bisiliac thoraco-abdominal interposition graft, and 20 aorto-bifemoral, 4 aorto-femoral, 1 aorto-aortic thoraco-abdominal, 1 aorto-renal by-pass and 7 aorto-iliac-femoral thromboendoarterectomies. In the postoperative period 4 cardiac ischemic complications and 2 deaths (2.5%) were observed. CONCLUSIONS According to our personal opinion, stress echocardiography can be considered a test with a excellent feasibility and safety rate, not expensive and with a good reproducibility and reliability. It allowed to predict the cardiac risk in our patients suggesting not only the surgical but also the anesthesiologic and the perioperative therapeutic management.
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Affiliation(s)
- R Adovasio
- Istituto di Patologia Speciale Chirurgica, Università degli Studi, Trieste
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