1
|
Gemelli M, Di Tommaso E, Natali R, Dixon LK, Mohamed Ahmed E, Rajakaruna C, Bruno VD. Validation of the German Registry for Acute Aortic Dissection Type A Score in predicting 30-day mortality after type A aortic dissection surgery. Eur J Cardiothorac Surg 2023; 63:ezad141. [PMID: 37027220 PMCID: PMC10824554 DOI: 10.1093/ejcts/ezad141] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 09/18/2022] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVES No reliable scores are available to predict mortality following surgery for type A acute aortic dissection (TAAAD). Recently, the German Registry of Acute Aortic Dissection Type A (GERAADA) score has been developed. We aim to compare how the GERAADA score performs in predicting operative mortality for TAAAD to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II. METHODS We calculated the GERAADA score and EuroSCORE II in patients who underwent TAAAD repair at the Bristol Heart Institute. As there are no precise criteria to calculate the GERAADA score, we used 2 methods: a Clinical-GERAADA score, which evaluated malperfusion with clinical and radiological evidence, and a Radiological-GERAADA score, where malperfusion was assessed by computed tomography scan alone. RESULTS 207 consecutive patients had surgery for TAAAD, and the observed 30-day mortality was 15%. The Clinical-GERAADA score showed the strongest discriminative power with an area under the curve (AUC) of 0.80 [95% confidence interval (CI) 0.71-0.89], while the Radiological-GERAADA score had an AUC of 0.77 (95% CI 0.67-0.87). EuroSCORE II showed acceptable discriminative power with an AUC of 0.77 (95% CI 0.67-0.87). CONCLUSIONS Clinical GERAADA score performed better than the other scores and it is specific and easy to use in the context of a TAAAD. Further validation of the new criteria for malperfusion is needed.
Collapse
Affiliation(s)
- Marco Gemelli
- Cardiothoracic Surgery, Bristol Heart Institute, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Padova, Italy
| | - Ettorino Di Tommaso
- Cardiothoracic Surgery, Bristol Heart Institute, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Roberto Natali
- Cardiothoracic Surgery, Bristol Heart Institute, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Lauren Kari Dixon
- Cardiothoracic Surgery, Bristol Heart Institute, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Eltayeb Mohamed Ahmed
- Cardiothoracic Surgery, Bristol Heart Institute, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Cha Rajakaruna
- Cardiothoracic Surgery, Bristol Heart Institute, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Vito D Bruno
- Cardiothoracic Surgery, Bristol Heart Institute, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
- Cardiovascular Translational Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
2
|
Dimagli A, Di Tommaso E, Bruno VD. Commentary: The importance of being predictable: Postoperative atrial fibrillation. J Thorac Cardiovasc Surg 2023; 165:1078-1079. [PMID: 34303536 DOI: 10.1016/j.jtcvs.2021.06.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Arnaldo Dimagli
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
| | | | | |
Collapse
|
3
|
Di Tommaso L, Di Tommaso E, Giordano R, Mileo E, Santini M, Pilato E, Iannelli G. Endovascular Surgery of Descending Thoracic Aorta Involved in T4 Lung Tumor. J Endovasc Ther 2023; 30:84-90. [PMID: 35114844 DOI: 10.1177/15266028221075551] [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] [Indexed: 01/25/2023]
Abstract
PURPOSE Surgical treatment of primary lung T4 tumors is controversial especially when the cancer invades the mediastinal structures or the descending thoracic aorta. Conventional surgical treatment is associated with a high perioperative mortality and morbidity rate. Thoracic EndoVascular Aortic Repair has emerged as a valid off-label alternative to conventional surgery. We aimed to assess perioperative and midterm aortic-related outcome of patients who have undergone aortic stent-graft implantation, followed by en bloc surgical treatment of the involved aorta and lung cancer resection. MATERIALS AND METHODS From July 2017 to May 2020, we treated 5 patients diagnosed with a T4 lung cancer by the involvement of the descending thoracic aorta. When only the descending thoracic aorta is involved, a 2-stage procedure was considered, with aortic stent-graft implantation performed before tumor resection. One-stage strategy, with stent-graft implantation carried out before thoracotomy, was preferred for patients with the involvement of cardiac and/or other vascular mediastinal structures. RESULTS The mean age was 58.4 ± 6.2 years. All patients were affected by non-small cell lung cancer. All 5 patients required a single stent-graft to completely cover the involved segment of aorta. Four patients underwent a 2-stage procedure. One patient, with the involvement of the left inferior pulmonary vein, required a 1-stage en bloc resection of the left lower lobe, aortic wall adventitia, left inferior pulmonary vein, and reconstruction of the left atrial wall. Primary procedural success was achieved in all. At follow-up, no patient developed aortic-related complications. One patient died 2 years after surgery, due to local recurrence of the tumor. CONCLUSION T4 lung resection combined with aortic stent-graft implantation can be safely performed. Endovascular surgery, by avoiding the use of cardiopulmonary bypass, aortic cross-clamping, and graft replacement, can reduce significant morbidity and mortality rate. Postoperative and long-term outcome of these patients treated with endovascular surgery is mainly related to pulmonary disease, not to aortic treatment.
Collapse
Affiliation(s)
- Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Ettorino Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Raffaele Giordano
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Emilio Mileo
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Emanuele Pilato
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Gabriele Iannelli
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| |
Collapse
|
4
|
Dixon LK, Dimagli A, Di Tommaso E, Sinha S, Fudulu DP, Sandhu M, Benedetto U, Angelini GD. Females have an increased risk of short-term mortality after cardiac surgery compared to males: Insights from a national database. J Card Surg 2022; 37:3507-3519. [PMID: 36116056 PMCID: PMC9826035 DOI: 10.1111/jocs.16928] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/15/2022] [Accepted: 07/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Female sex is considered a risk factor for mortality and morbidity following cardiac surgery. This study is the first to review the UK adult cardiac surgery national database to compare outcomes following surgical coronary revascularisation and valvular procedures between females and males. METHODS Using data from National Adult Cardiac Surgery Audit, we identified all elective and urgent, isolated coronary artery by-pass grafting (CABG), aortic valve replacement (AVR) and mitral valve replacement/repair (MVR) procedures from 2010 to 2018. We compared baseline data, operative data and outcomes of mortality, stroke, renal failure, deep sternal wound infection, return to theater for bleeding, and length of hospital stay. Multivariable mixed-effect logistical/linear regression models were used to assess relationships between sex and outcomes, adjusting for baseline characteristics. RESULTS Females, compared to males, had greater odds of experiencing 30-day mortality (CABG odd ratio [OR] 1.76, confidence interval [CI] 1.47-2.09, p < .001; AVR OR 1.59, CI 1.27-1.99, p < .001; MVR OR 1.37, CI 1.09-1.71, p = .006). After CABG, females also had higher rates of postoperative dialysis (OR 1.31, CI 1.12-1.52, p < .001), deep sternal wound infections (OR 1.43, CI 1.11-1.83, p = .005) and longer length of hospital stay (β 1.2, CI 1.0-1.4, p < .001) compared to males. Female sex was protective against returning to theater for postoperative bleeding following CABG (OR 0.76, CI 0.65-0.87, p < .001) and AVR (OR 0.72, CI 0.61-0.84, p < .001). CONCLUSION Females in the United Kingdom have an increased risk of short-term mortality after cardiac surgery compared to males. This highlights the need to focus on the understanding of the causes behind these disparities and implementation of strategies to improve outcomes in females.
Collapse
Affiliation(s)
| | | | | | - Shubhra Sinha
- Bristol Heart InstituteUniversity of BristolBristolUK
| | | | - Manraj Sandhu
- Bristol Heart InstituteUniversity of BristolBristolUK
| | | | | |
Collapse
|
5
|
Dixon LK, Akberali U, Di Tommaso E, George S, Johnson T, Bruno VD. Hybrid coronary revascularization versus coronary artery bypass grafting for multivessel coronary artery disease: A systematic review and meta-analysis. Int J Cardiol 2022; 359:20-27. [DOI: 10.1016/j.ijcard.2022.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/23/2022] [Accepted: 04/10/2022] [Indexed: 01/07/2023]
|
6
|
Gemelli M, Di Tommaso E, Chivasso P, Sinha S, Ahmed EM, Rajakaruna C, Bruno VD. Blood lactate predicts mortality after surgical repair of type A acute aortic dissection. J Card Surg 2022; 37:1206-1211. [DOI: 10.1111/jocs.16324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 01/30/2023]
Affiliation(s)
- Marco Gemelli
- Bristol Heart Institute University Hospitals of Bristol and Weston NHS Foundation Trust Bristol UK
| | - Ettorino Di Tommaso
- Bristol Heart Institute University Hospitals of Bristol and Weston NHS Foundation Trust Bristol UK
| | - Pierpaolo Chivasso
- Department of Emergency Cardiac Surgery University Hospitals San Giovanni di Dio e Ruggi d'Aragona Salerno Italy
| | - Shubhra Sinha
- Bristol Heart Institute University Hospitals of Bristol and Weston NHS Foundation Trust Bristol UK
| | - Eltayeb M. Ahmed
- Bristol Heart Institute University Hospitals of Bristol and Weston NHS Foundation Trust Bristol UK
| | - Cha Rajakaruna
- Bristol Heart Institute University Hospitals of Bristol and Weston NHS Foundation Trust Bristol UK
| | - Vito Domenico Bruno
- Bristol Heart Institute University Hospitals of Bristol and Weston NHS Foundation Trust Bristol UK
- University of Bristol Medical School – Translational Health Science Bristol UK
| |
Collapse
|
7
|
Gemelli M, Di Tommaso E, Bruno VD, Angelini GD. Surgical treatment of a giant right coronary aneurysm following coronary stent fracture. J Card Surg 2022; 37:1033-1035. [PMID: 34994491 DOI: 10.1111/jocs.16216] [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: 12/21/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Coronary artery aneurysm represents a challenging and potentially fatal disease. AIM AND MATERIAL METHODS We present the case of a giant right coronary artery aneurysm treated surgically after percutaneous intervention and fracture of the stent. RESULTS AND DISCUSSION The aneurism was opened and the coronary ligated proximally and distally. It was not possible to re-established continuity of the coronary artery or perform a bypass graft. An early surgical strategy would have re-established blood flow in the involved coronary artery and avoided chronic ischemia of the supplied myocardial territory.
Collapse
Affiliation(s)
- Marco Gemelli
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Vito D Bruno
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | |
Collapse
|
8
|
Dixon LK, Di Tommaso E, Dimagli A, Sinha S, Sandhu M, Benedetto U, Angelini GD. Impact of sex on outcomes after cardiac surgery: A systematic review and meta-analysis. Int J Cardiol 2021; 343:27-34. [PMID: 34520795 DOI: 10.1016/j.ijcard.2021.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/28/2021] [Accepted: 09/07/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Despite advances in cardiac surgery, observational studies suggest that females have poorer post-operative outcomes than males. This study is the first to review sex related outcomes following both coronary artery bypass graft (CABG) and valve surgery with or without combined CABG. METHODS We identified 30 primary research articles reporting either short-term mortality (in-hospital/30 day), long-term mortality, and post-operative stroke, sternal wound infection and myocardial infarction (MI) in both sexes following CABG and valve surgery with or without combined CABG. Reported adjusted odds/hazard ratio were pooled using an inverse variance model. RESULTS Females undergoing CABG and combined valve and CABG surgery were at higher risk of short-term mortality (odds ratio (OR) 1.40; 95% confidence interval (CI) 1.32-1.49; I2 = 79%) and post-operative stroke (OR 1.2; CI 1.07-1.34; I2 = 90%) when compared to males. However, for isolated AVR, there was no difference found (OR 1.19; 95% CI 0.74-1.89). There was no increased risk in long-term mortality (OR 1.04; 95% CI: 0.93-1.16; I2 = 82%), post-operative MI (OR 1.22; 95%CI: 0.89-1.67; I2 = 60%) or deep sternal wound infection (OR 0.92; 95%CI: 0.65-1.03, I2 = 87%). No evidence of publication bias or small study effect was found. CONCLUSION Females are at a greater risk of short-term mortality and post-operative stroke than males following CABG and valve surgery combined with CABG. However, there is no difference for Isolated AVR. Long-term mortality is equivalent in both sexes. PROSPERO Registration: CRD42021244603.
Collapse
Affiliation(s)
- Lauren Kari Dixon
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Ettorino Di Tommaso
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Arnaldo Dimagli
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Shubhra Sinha
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Manraj Sandhu
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Umberto Benedetto
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Gianni D Angelini
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| |
Collapse
|
9
|
Di Tommaso E, Bruno VD. Commentary: Isolated tricuspid valve regurgitation: The worst is yet to come, so act now! J Thorac Cardiovasc Surg 2021:S0022-5223(21)01157-0. [PMID: 34482956 DOI: 10.1016/j.jtcvs.2021.08.010] [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: 07/31/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Ettorino Di Tommaso
- Translational Health Science, University of Bristol Medical School, Bristol, United Kingdom
| | - Vito D Bruno
- Translational Health Science, University of Bristol Medical School, Bristol, United Kingdom.
| |
Collapse
|
10
|
Di Tommaso E, Rapetto F, Guida GA, Zakkar M, Bruno VD. Benefits of mitral valve repair over replacement in the elderly: a systematic review and meta-analysis. J Card Surg 2021; 36:2524-2530. [PMID: 33783032 DOI: 10.1111/jocs.15506] [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: 01/13/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Mitral valve (MV) repair has demonstrated excellent short- and long-term outcomes, however, its merit in the elderly population is still debated. We conducted a meta-analysis of studies that have compared the MV repair to replacement in the elderly population. METHODS A systematic literature search was conducted for any study published on MV surgery on elderly patients (≥75 years old). A pooled risk-ratio meta-analysis was done to evaluate short-term mortality, postoperative complications, surgical timings, and long-term survival rates. RESULTS A total of nine retrospective observational studies were included in the quantitative meta-analysis. Pooled meta-analysis showed a reduced risk of short-term mortality for the MV repair group (risk ratio [RR] = 0.41 [0.24-0.71], p-value = .005). Postoperative neurological complications were in favor of repair, although not significantly (RR = 0.49 [0.21-1.11], p-value = .07). Operative timings (cardiopulmonary bypass and crossclamp time) were not different between the groups although no data were available on the complexity of the repairs. Long-term survival rates were in favor of the repairs (pooled treatment effect of -0.47 [-0.64; -0.29], p = .005). CONCLUSIONS MV surgery is a safe and effective procedure for the elderly. MV repair demonstrated better short-term outcomes compared to replacement. Long-term survival rates are significantly better after repair.
Collapse
Affiliation(s)
- Ettorino Di Tommaso
- Bristol Medical School, Translational Health Science, University of Bristol, Bristol, UK
| | - Filippo Rapetto
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Gustavo A Guida
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Mustafa Zakkar
- Department of Cardiovascular Sciences, Clinical Sciences Wing, Glenfield General Hospital, University of Leicester, Leicester, UK
| | - Vito D Bruno
- Bristol Medical School, Translational Health Science, University of Bristol, Bristol, UK
| |
Collapse
|
11
|
Di Tommaso E, Bruno VD. Commentary: The rise of minimalism in cardiac surgery. JTCVS Tech 2021; 7:67-68. [PMID: 34318208 PMCID: PMC8311675 DOI: 10.1016/j.xjtc.2021.02.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ettorino Di Tommaso
- Translational Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Vito Domenico Bruno
- Translational Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
12
|
Giordano R, Comentale G, Tommaso LD, Tommaso ED, Mannacio VA, Pilato E, Iannelli G, Palma G, Cantinotti M. Pericardial effusion after pediatric cardiac surgery: A single-center study. Heart Lung 2020; 50:455-460. [PMID: 33268139 DOI: 10.1016/j.hrtlng.2020.10.011] [Citation(s) in RCA: 2] [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: 07/23/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Postoperative pericardial effusion (pPE) still remains a frequent complication after congenital heart surgery and it usually leads to an increased morbidity and re-hospitalization rate. There are only few published papers about pPE clinical course or large randomized studies that analyze its prevalence or preoperative risk factors. In this regard, we report a single-center 10-years retrospective analysis of prevalence, outcomes and risk factors of postoperative pericardial effusion after congenital heart surgery. METHODS A retrospective analysis was carried out on 624 patients who underwent congenital heart surgery from January 2010 to December 2019. Study population was divided in two groups basing of the presence of pPE during the first 30 days after the surgery and their perioperative data were compared. Univariate and multivariate analysis were used to find possible risk factors for pPE developing. RESULTS Ninety-four patients were enrolled in pPE group and 530 in ¬ pPE group. Pericardial effusion was assessed as "mild" in 57 patients (60,6%), as "moderate" in 25 (26,6%), and as "severe" in 12 patients (12,8%). Total correction of Tetralogy of Fallot/Pulmonary atresia seems to be associated with a higher prevalence of pPE in the "Infant" subgroup, while atrial septal defect showed to be a risk factor among "Toddler". In addition, pPE was proved to be much more frequent in Fontan patients in all studied subgroups. Univariate and multivariate analysis revealed that total drain amount, Fontan procedure, postoperative Warfarin therapy, Redo-operations and surgical correction of Tetralogy of Fallot/Pulmonary atresia seem to be risk factors for pPE. Postoperative pericardial effusion was diagnosed between the 4th and the 28th postoperative day but in 88,3% of the cases (83/94) it occurred before the 14th day after the operation. In 58 patients, pPE was clinically silent. CONCLUSIONS Postoperative pericardial effusion was detected in 88.3% of cases within the first 14 days after the operation. About 69% of these patients were asymptomatic therefore it suggests that routinely echocardiogram after intensive care unit discharge could be a useful tool to screen clinically silent pPE at an early stage, especially in high-risk or unstable patients.
Collapse
Affiliation(s)
- Raffaele Giordano
- Dept. of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Via Pansini 5, Napoli, Naples, Italy.
| | - Giuseppe Comentale
- Dept. of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Via Pansini 5, Napoli, Naples, Italy
| | - Luigi Di Tommaso
- Dept. of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Via Pansini 5, Napoli, Naples, Italy
| | - Ettorino Di Tommaso
- Dept. of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Via Pansini 5, Napoli, Naples, Italy
| | - Vito Antonio Mannacio
- Dept. of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Via Pansini 5, Napoli, Naples, Italy
| | - Emanuele Pilato
- Dept. of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Via Pansini 5, Napoli, Naples, Italy
| | - Gabriele Iannelli
- Dept. of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Via Pansini 5, Napoli, Naples, Italy
| | - Gaetano Palma
- Dept. of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Via Pansini 5, Napoli, Naples, Italy
| | | |
Collapse
|
13
|
Bruno VD, Di Tommaso E, Ascione R. Annuloplasty for mitral valve repair in degenerative disease: to be flexible or to be rigid? That's still the question. Indian J Thorac Cardiovasc Surg 2020; 36:563-565. [PMID: 33093751 PMCID: PMC7572951 DOI: 10.1007/s12055-020-01001-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 11/11/2022] Open
Abstract
The choice of ring for mitral valve repair is still largely left to the surgeon's preferences and there are no specific guidelines regulating this decision. Despite this previous researches have described important features appertaining to each of the different types of rings currently available. Particularly, the debate is still open in regards to the flexibility that these devices should or should not have. Later in this issue of the Journal, Panicker and colleagues have reported their results with flexible and rigid rings in mitral valve repair. The results are very interesting and once again are highlighting the importance of using the right ring for the right disease.
Collapse
Affiliation(s)
- Vito Domenico Bruno
- Translational Health Science, Faculty of Health Science, Bristol Heart Institute, University of Bristol Medical School, Marlborough Street, Bristol, BS2 8HW UK
| | - Ettorino Di Tommaso
- Translational Health Science, Faculty of Health Science, Bristol Heart Institute, University of Bristol Medical School, Marlborough Street, Bristol, BS2 8HW UK
| | - Raimondo Ascione
- Translational Health Science, Faculty of Health Science, Bristol Heart Institute, University of Bristol Medical School, Marlborough Street, Bristol, BS2 8HW UK
| |
Collapse
|
14
|
Di Tommaso L, Di Tommaso E, Giordano R, Pilato E, Iannelli G. Off-Label Treatment With Transfemoral Bare Stents for Isolated Aortic Arch Dissection. Ann Thorac Surg 2020; 111:1325-1330. [PMID: 32888927 DOI: 10.1016/j.athoracsur.2020.06.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/16/2020] [Revised: 04/16/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Aortic arch dissection is a catastrophic acute event involving the aorta. Its accurate diagnosis and treatment are mandatory to optimize patient outcome. We aimed to assess the efficacy and safety of endovascular treatment with transfemoral bare stents of isolated aortic arch dissection as a valid alternative in patients unsuitable for conventional surgery. METHODS In this case series, we report our experience with 3 patients affected by isolated aortic arch dissection treated with endovascular surgery from February 2019 to May 2019. All patients were associated with severe comorbidities emergently referred at our center. Vascular access was achieved by surgical exposure of the right common femoral artery performed under general anesthesia. All patients were observed for at least 3 months. RESULTS All patients were treated in a hybrid operative room with transfemoral implantation of a bare metal Jotec E-XL stent released in the aortic arch. The postoperative period was uneventful, and all 3 patients were discharged or transferred on the fourth postoperative day. At follow-up, computed tomography scans showed good results in all patients. CONCLUSIONS A purely endovascular approach to located aortic arch dissections, with bare stents, remains challenging, although it has been proven to be a valid alternative treatment in some off-label cases.
Collapse
Affiliation(s)
- Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy.
| | - Ettorino Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Raffaele Giordano
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Emanuele Pilato
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Gabriele Iannelli
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| |
Collapse
|
15
|
Bruno VD, Chivasso P, Rapetto F, Guida G, Di Tommaso E, Chau HM, Vohra H. Impact of Body Mass Index on Short- and Long-Term Outcomes After Isolated First-Time Surgical Aortic Valve Replacement for Aortic Stenosis. J Cardiothorac Vasc Anesth 2019; 33:2995-3000. [PMID: 30898426 DOI: 10.1053/j.jvca.2019.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/28/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To ascertain whether body mass index (BMI) has a clinical effect on short- and long-term postoperative outcomes after surgical aortic valve replacement in patients with severe aortic stenosis. DESIGN Single-center, retrospective study. SETTING Tertiary referral hospital. PARTICIPANTS The study comprised 1,561 patients who underwent isolated first-time aortic valve replacement between 2005 and 2012. INTERVENTIONS Fourteen underweight patients were removed from the analysis. The remaining patients were divided into the following 4 groups according to their BMI: 418 as normal weight (≥18.5 to <25 kg/m2), 629 as overweight (≥25 to <30 kg/m2), 342 as obese (≥30 to <35 kg/m2), and 158 as very obese (≥35 kg/m2). Early mortality and postoperative complications were compared, and long-term survival rates were investigated. MEASUREMENT AND MAIN RESULTS Thirty-day mortality was higher in the normal weight group but did not reach statistical significance (p = 0.054), and the incidence of postoperative complications was not different for cerebrovascular accident (p = 0.70), re-sternotomy for bleeding (p = 0.17), sternal wound infection (p = 0.07), and dialysis (p = 0.07). With a mean follow-up time of 4.92 ± 2.82 years, survival rate was better in the overweight group. A Cox proportional hazard model found BMI inversely correlated with long-term mortality when analyzed in a univariable fashion (hazard ratio 0.95; p = 0.009), but this apparent protective effect disappeared when adjusted for preoperative covariates (hazard ratio 0.98, 95% confidence interval 0.96-1.004; p = 0.12). CONCLUSION Once adjusted for preoperative characteristics, obesity does not represent an independent predictor for long-term survival rates. There was a higher incidence of 30-day mortality in the normal weight group compared with the overweight and very obese groups. The incidence of deep sternal wound infection was higher in very obese patients.
Collapse
Affiliation(s)
- Vito D Bruno
- Bristol Medical School, Translational Health Science, University of Bristol, Bristol, UK.
| | - Pierpaolo Chivasso
- Bristol Heart Institute, University Hospitals of Bristol NHS Foundation Trust, Bristol, UK
| | - Filippo Rapetto
- Bristol Heart Institute, University Hospitals of Bristol NHS Foundation Trust, Bristol, UK
| | - Gustavo Guida
- Bristol Heart Institute, University Hospitals of Bristol NHS Foundation Trust, Bristol, UK
| | - Ettorino Di Tommaso
- Bristol Heart Institute, University Hospitals of Bristol NHS Foundation Trust, Bristol, UK
| | - Hoi Man Chau
- Department of General Surgery, Great Western Hospital, Swindon, UK
| | - Hunaid Vohra
- Bristol Heart Institute, University Hospitals of Bristol NHS Foundation Trust, Bristol, UK
| |
Collapse
|
16
|
Di Tommaso L, Giordano R, Di Tommaso E, Di Palo G, Iannelli G. Treatment with transfemoral bare-metal stent of residual aortic arch dissection after surgical repair of acute type an aortic dissection. J Thorac Dis 2019; 10:6097-6106. [PMID: 30622781 DOI: 10.21037/jtd.2018.10.51] [Citation(s) in RCA: 5] [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] [Indexed: 11/06/2022]
Abstract
Background Here we evaluate the usefulness of transfemoral uncovered stent implantation to avoid secondary conventional surgery for residual type A aortic dissection (TAAD) of the aortic arch after ascending aorta replacement. Methods From June 2009 to April 2015, 11 patients were treated with transfemoral implantation of uncovered stents in the aortic arch after surgical replacement of ascending aorta performed on average 4.7±2.3 years earlier. An enlarged dissected aortic arch or a dangerous median growth of more than 5 mm/yr or impending rupture presenting as chest pain were indications for treatment. The dissected aortic tracts diameter must not exceed 45 mm. Five patients (45.5%) were treated with Djumbodies Dissection System, 6 patients (54.5%) with Jotec E-XL aortic stent. Results There were no perioperative deaths or permanent neurologic complications. Primary procedural success was obtained in all patients and the residual TAAD in aortic arch was obliterated, with disappearance of the false lumen. Median intensive care unit (ICU) stay was 24 hours; post-operative hospital stay was 5.2±1.4 days. One death, not aortic related, occurred during follow-up period (mean 5.2±1.9 years). Descending thoracic aorta diameter significantly increased in 3 patients (27.3%): one patient (9.0%) needed a secondary conventional surgery, the other 2 (18.2%) of a distal extension with PETTICOAT approach. Conclusions Endovascular approach with uncovered metal bare stent is surely an evolving strategy to perform a purely endovascular treatment, indicated only for treatment of an aortic arch with a diameter of less than 40 or 45 mm, to avoid progressive thoracic aortic dilatation and/or rupture.
Collapse
Affiliation(s)
- Luigi Di Tommaso
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Ettorino Di Tommaso
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Giusi Di Palo
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Gabriele Iannelli
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| |
Collapse
|
17
|
Di Tommaso L, Giordano R, Di Tommaso E, Iannelli G. Female gender and left ventricular dysfunction in myocardial surgical revascularization: the strange couple. J Thorac Dis 2018; 10:S2160-S2164. [PMID: 30123549 DOI: 10.21037/jtd.2018.06.42] [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] [Indexed: 11/06/2022]
Affiliation(s)
- Luigi Di Tommaso
- Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Raffaele Giordano
- Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Ettorino Di Tommaso
- Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriele Iannelli
- Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy
| |
Collapse
|
18
|
Di Tommaso L, Giordano R, Di Tommaso E, Iannelli G. Endovascular treatment for chronic type B aortic dissection: current opinions. J Thorac Dis 2018; 10:S978-S982. [PMID: 29850179 DOI: 10.21037/jtd.2018.03.145] [Citation(s) in RCA: 3] [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] [Indexed: 11/06/2022]
Affiliation(s)
- Luigi Di Tommaso
- Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Raffaele Giordano
- Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Ettorino Di Tommaso
- Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriele Iannelli
- Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| |
Collapse
|
19
|
Di Tommaso L, Mannacio VA, Di Tommaso E, Pinna GB, Fontana I, Iannelli G. Endovascular Treatment of Distal Aortic Arch Aneurysm Associated with Coarctation of Aorta in a Jehovah's Witness. Tex Heart Inst J 2017; 44:399-401. [PMID: 29276439 DOI: 10.14503/thij-16-6093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Late aneurysm formation in the proximal aorta or distal aortic arch is a recognized sequela of untreated stenosis of the aortic isthmus and is associated with substantial risk of aortic rupture. We describe the case of a 44-year-old man with untreated coarctation of the aorta who presented with a prestenotic dissecting thoracic aortic aneurysm. He declined surgery because he was a Jehovah's Witness. Instead, we performed emergency endovascular aortic repair in which 2 stent-grafts were placed in the descending aorta. Our experience suggests that this procedure is a useful and safe alternative to open surgery in patients who have aneurysms associated with coarctation of the aorta.
Collapse
|
20
|
Mannacio V, Mottola M, Ruggiero D, D'Alessio A, Surace GG, Di Tommaso E, Amato B, Iannelli G. Treatment of a rapidly expanding thoracoabdominal aortic aneurysm after endovascular repair of descending thoracic aortic aneurysm in an old patient. BMC Surg 2012; 12 Suppl 1:S26. [PMID: 23173764 PMCID: PMC3499194 DOI: 10.1186/1471-2482-12-s1-s26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Aortic pathology progression and/or procedure related complications following endovascular repair should always be considered mostly in older patients. We herein describe a hybrid procedure for treatment of rapidly expanding thoracoabdominal aneurysm following endovascular treatment of a descending thoracic aortic aneurysm in an older patient. Case presentation A 82-year-old man at 18 months after endovascular surgery for a contained rupture of descending thoracic aortic aneurysm revealed a type IV thoracoabdominal aneurysm with significant increase of the aortic diameters at superior mesenteric and renal artery levels. A hybrid approach consisting of preventive visceral vessel revascularization and endovascular repair of entire abdominal aorta was performed. Under general anaesthesia and by xyphopubic laparotomy, the infrarenal aneurysmatic aorta and common iliac arteries were replaced by a bifurcated woven prosthetic graf. From each of the prosthetic branches two reverse 14x7 mm bifurcated PTFE prosthetic grafts were anastomized to both renal arteries and to the celiac axis and superior mesenteric artery, respectively. Vessel ischemia was restricted to the time required for anastomosis. Three 10 cm Gore endovascular stent-grafts for a total length of 15 cm, were used. The overlapping of the stent-grafts was carried out from the bottom upwards, starting from the aorto-iliac prosthetic body up to the healthy segment of thoracic aorta, 40 mm from the previous stent-grafts. The patient was discharged on the 9th postoperative day. Conclusion This technique offers the advantage of a less invasive treatment, reducing the risk of paraplegia, visceral ischaemia and pulmonary complications, mostly in older patients.
Collapse
Affiliation(s)
- Vito Mannacio
- Department of Cardiac Surgery, University of Napoli Federico II, Napoli, Italy.
| | | | | | | | | | | | | | | |
Collapse
|