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Mastrangelo A, Olivares P, Giambuzzi I, Muratori M, Alamanni F, Bartorelli AL. Diagnosis and treatment of a left atrial myxoma originating from an atrial septal defect closure device: a case report. Eur Heart J Case Rep 2023; 7:ytad258. [PMID: 37323531 PMCID: PMC10267617 DOI: 10.1093/ehjcr/ytad258] [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: 08/01/2022] [Revised: 11/01/2022] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
Background Ostium secundum atrial septal defect (osASD) is a common congenital heart disease and transcatheter closure is the preferred treatment. Late device-related complications include thrombosis and infective endocarditis (IE). Cardiac tumours are exceedingly rare. The aetiology of a mass attached to an osASD closure device can be challenging to diagnose. Case summary A 74-year-old man with atrial fibrillation was hospitalized for evaluating a left atrial mass discovered incidentally 4 months earlier. The mass was attached to the left disc of an osASD closure device implanted 3 years before. No shrinkage of the mass was observed despite optimal intensity of anticoagulation. We describe the diagnostic workup and management of the mass that at surgery turned out to be a myxoma. Discussion A left atrial mass attached to an osASD closure device raises the suspect of device-related complications. Poor endothelialisation may promote device thrombosis or IE. Cardiac tumours (CT) are rare, and myxoma is the most common primary CT in adults. Although no clear relationship exists between the implantation of an osASD closure device and a myxoma, the development of this tumour is a possible occurrence. Echocardiography and cardiovascular magnetic resonance play a key role in the differential diagnosis between a thrombus and a myxoma, usually identifying distinctive mass features. Nevertheless, sometimes non-invasive imaging may be inconclusive, and surgery is necessary to make a definitive diagnosis.
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Affiliation(s)
| | - Paolo Olivares
- Department of Interventional Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Carlo Parea 4, 20138 Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Carlo Parea 4, 20138 Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Carlo Parea 4, 20138 Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, Istituto Clinico Sant’Ambrogio, Via Privata Val Vigezzo 5, 20149 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
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Petrella F, Zorzino L, Frassoni S, Bagnardi V, Casiraghi M, Bardoni C, Mohamed S, Musso V, Simonini E, Rossi F, Alamanni F, Venturino M, Spaggiari L. Intraoperative Extra Corporeal Membrane Oxygenator for Lung Cancer Resections Does Not Impact Circulating Tumor Cells. Cancers (Basel) 2022; 14:cancers14205004. [PMID: 36291788 PMCID: PMC9599645 DOI: 10.3390/cancers14205004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The diagnosis of active neoplastic disease was traditionally judged an absolute contraindication for extracorporeal membrane oxygenator (ECMO) because of long-term results uncertainty and co-existing acquired coagulation disorders often diagnosed in this group of patients. There is a growing body of evidence that circulating tumor cells (CTCs) can be detected in the blood of patients before the primary tumor is diagnosed and in the case of carcinoma recurrence; moreover, on some occasions, they persist in the blood of patients after radical resection of the primary tumor. The aim of this prospective, two-arm study is to compare the number of CTCs before and after surgery in patients undergoing lung cancer resection with and without intraoperative ECMO support. Intraoperative ECMO for lung cancer resections did not impact CTC variation after the procedure and did not impact postoperative complications, ICU stay, hospital total length of stay, and post operative C-reactive protein increase. Abstract Background: The diagnosis of active neoplastic disease was traditionally judged an absolute contraindication for extracorporeal membrane oxygenator (ECMO) because of the fear of tumor cells being scattered or seeded. The aim of this study is to compare the number of circulating tumor cells (CTCs) before and after surgery in patients receiving lung cancer resection with and without intraoperative ECMO support. Methods: This is a prospective, non-randomized, two-arms observational study comparing the number of CTCs before and after surgery in patients receiving lung cancer resection with and without intraoperative ECMO support. The ECMO arm includes patients suffering from lung cancer undergoing pulmonary resection with planned intraoperative ECMO support. The non-ECMO arm includes patients suffering from non-early-stage lung cancer undergoing pulmonary resection without planned intraoperative ECMO support. Results: Twenty patients entered the study, eight in the ECMO arm and twelve in the non-ECMO arm. We did not observe any significant difference between the ECMO and non-ECMO groups in terms of postoperative complications (p = 1.00), ICU stay (p = 0.30), hospital stay (p = 0.23), circulating tumor cells’ increase or decrease after surgery (p = 0.24), and postoperative C-reactive protein and C-reactive protein increase (p = 0.80). The procedures in the non-ECMO arm were significantly longer than those in the ECMO arm (p = 0.043). Conclusions: Intraoperative ECMO for lung cancer resections did not impact CTC increase or decrease after the procedure.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Correspondence: or ; Tel.: +39-0257-489-362; Fax: +39-0294-379-218
| | - Laura Zorzino
- Division of Laboratory Medicine, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Claudia Bardoni
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Shehab Mohamed
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Valeria Musso
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Emanuele Simonini
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Fabiana Rossi
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20138 Milan, Italy
| | - Francesco Alamanni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- IRCCS Galeazzi Sant’Ambrogio, Cardiochirurgia Universitaria, 20157 Milan, Italy
| | - Marco Venturino
- Department of Anesthesiology, IRCCS European Institute of Oncology, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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Tarzia V, Ponzoni M, Di Giammarco G, Maccherini M, Maiani M, Agostoni P, Bagozzi L, Marinelli D, Apostolo A, Bernazzali S, Ortis H, Di Mauro M, Bortolussi G, Sani G, Bottio T, Scuri S, Livi U, Alamanni F, Gerosa G. Technology and Technique for left ventricular assist device optimization: A Bi-Tech solution. Artif Organs 2022; 46:2486-2492. [PMID: 35866429 DOI: 10.1111/aor.14368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 04/09/2022] [Revised: 06/18/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated the synergistic effect of the new cone-bearing design of Jarvik 2000 (Jarvik Heart Inc., NY) together with a minimally-invasive approach on outcomes of LVAD patients. METHODS We retrospectively reviewed all patients from 5 institutions involved in the Jarvik 2000 Italian Registry, from October-2008 to October-2016. Patients were divided into three groups according to pump design and implantation technique: pin-bearing design and conventional approach (Group 1); cone-bearing and conventional approach (Group 2); cone-bearing and minimally-invasive implantation (Group 3). RESULTS A total of 150 adult patients with end-stage heart failure were enrolled: 26 subjects in Group 1, 74 in Group 2, and 50 in Group 3. Nineteen patients (73%) in Group 1, 51 (69%) in Group 2, and 36 (72%) in Group 3 were discharged. During follow-up, 22 patients underwent transplantation, while in 3 patients the LVAD was explanted. Overall 1-year survival was 58±10%, 64±6% and 74%±7% in Group 1, 2 and 3, respectively (p=0.034). The competing-risks-adjusted cumulative incidence rate for adverse events was 42.1 [27-62.7] per 100 patient-years in Group 1, 35.4 [25.3-48.2] in Group 2, and 22.1 [12.4-36.4] in Group 3 (p=0.046 for Group 1 vs 3). CONCLUSIONS The association of the modern cone-bearing configuration of Jarvik 2000 and minimally-invasive surgery improved survival and minimized the risk for cardiovascular events, as a result of combining technology and technique.
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Affiliation(s)
- Vincenzo Tarzia
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Matteo Ponzoni
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | | | - Massimo Maiani
- Cardiac Surgery, University of Udine, Udine, Italy; 5Cardiac Surgery, University of Milan, Milan, Italy
| | | | - Lorenzo Bagozzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | | | | | - Helena Ortis
- Cardiac Surgery, University of Udine, Udine, Italy; 5Cardiac Surgery, University of Milan, Milan, Italy
| | | | - Giacomo Bortolussi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Guido Sani
- Cardiac Surgery, University of Siena, Siena, Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Silvia Scuri
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Ugolino Livi
- Cardiac Surgery, University of Udine, Udine, Italy; 5Cardiac Surgery, University of Milan, Milan, Italy
| | | | - Gino Gerosa
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Corona S, Manganiello S, Pepi M, Tamborini G, Muratori M, Ali SG, Capra N, Naliato M, Alamanni F, Zanobini M. Bioprosthetic aortic valve replacement in patients aged 50 years old and younger: Structural valve deterioration at long-term follow-up. Retrospective study. Ann Med Surg (Lond) 2022; 77:103624. [PMID: 35637981 PMCID: PMC9142659 DOI: 10.1016/j.amsu.2022.103624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/10/2022] [Accepted: 04/10/2022] [Indexed: 11/27/2022] Open
Abstract
Background Structural valve deterioration (SVD) remains the major determinant of bioprosthesis durability. The aim of this study was to investigate the SVD incidence, predictors and outcomes in patients aged 50 years and younger after bioprosthetic aortic valve replacement (bAVR). Methods We retrospectively analyzed 73 consecutive patients ≤50 years old who underwent bioprosthetic AVR at our center between 2005 and 2015. Median age at surgery was 44 (interquartile range [IQR]: 39-47) years. Follow-up was 93.2% complete at a median time of 7.2 (IQR: 5.5-9.5) years. Cumulative follow-up was 545.5 valve-years. Bioprosthesis SVD was determined by strict echocardiographic assessment. Results The overall survival-rate at 10/15 years and freedom from SVD at 10/12.5 years were 89.6 ± 5.2%/81.5 ± 9.1% and 73.5 ± 8.2%/41.9 ± 18.9%, respectively. SVD occurred at a median time of 8.2 (IQR: 6.0-9.9) years after bAVR. Age was not found as an independent predictor for SVD at the multivariable model, despite a higher rate of SVD in the age group ≤30 years. Freedom from reoperation due to SVD at 10/15 years was 71.3 ± 14.1%/13.6 ± 12.3%. Reoperation was performed at a median time of 10.0 (IQR: 8.9-11.9) years since first bAVR and was associated with a 100% 12-month survival. Conclusions In our study, the rate and time of SVD occurrence were comparable to those of other studies' older age groups. Strict echocardiographic monitoring of valve performance is mandatory to set the appropriate timing of eventual reoperation. This attitude can improve outcomes of bAVR in younger patients.
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Key Words
- AVR, Aortic Valve Replacement
- Aortic valve replacement
- Bioprosthesis
- EF, Ejection Fraction
- LV, Left Ventricle
- NYHA, New York Heart Association
- PASP, Pulmonary Artery Systolic Pressure
- PPM, Prosthesis-Patient Mismatch
- Reoperation
- SVD, Structural Valve Deterioration
- Structural valve deterioration
- TAVR, Transcatheter Aortic Valve Replacement
- TTE, Transthoracic Echocardiography
- bAVR, bioprosthetic Aortic Valve Replacement
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Affiliation(s)
- Silvia Corona
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Sabrina Manganiello
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Nicolò Capra
- Department of Biostatistics, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Moreno Naliato
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Zanobini
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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5
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Onorato EM, Alamanni F, Muratori M, Smolka G, Wojakowski W, Pysz P, Zorinas A, Zakarkaite D, Eltchaninoff H, Litzer PY, Godart F, Calvert P, Christou C, Mussayev A, Missiroli B, Buzaev I, Curello S, Tesorio T, Bartorelli AL. Safety, Efficacy and Long-Term Outcomes of Patients Treated with the Occlutech Paravalvular Leak Device for Significant Paravalvular Regurgitation. J Clin Med 2022; 11:jcm11071978. [PMID: 35407584 PMCID: PMC8999580 DOI: 10.3390/jcm11071978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 02/10/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 01/27/2023] Open
Abstract
Between December 2014 and March 2021, 144 patients with aortic (Ao) or mitral (Mi) paravalvular leaks (PVLs) were enrolled at 21 sites in 10 countries. Safety data were available for 137 patients, who were included in the safety analysis fraction (SAF), 93 patients with Mi PVLs and 44 patients with Ao PVLs. The full analysis set (FAS) comprised 112 patients with available stratum (aortic/mitral leak) as well as baseline (BL), 180-day or later assessments (2 years). Procedural success (implantation of the device with a proper closure of the PVL, defined as reduction in paravalvular regurgitation of ≥one grade as assessed by echocardiography post implantation) was achieved in 91.3% of FAS patients with Mi PVLs and in 90.0% of those with Ao PVLs. The proportion of patients suffering from significant or severe heart failure (HF), classified as New York Heart Association (NYHA) class III/IV, decreased from 80% at baseline to 14.1% at 2-year follow-up (FAS). The proportion of FAS patients needing hemolysis-related blood transfusion decreased from 35.5% to 3.8% and from 8.1% to 0% in Mi patients and Ao patients, respectively. In total, 35 serious adverse events (SAEs) were reported in 27 patients (19.7%) of the SAF population. The SAEs considered possibly or probably related to the device included device embolization (three patients), residual leak (two patients) and vascular complication (one patient). During follow-up, 12/137 (8.8%) patients died, but none of the deaths was considered to be device-related. Patients implanted with the Occlutech Paravalvular Leak Device (PLD) showed long-lasting improvements in clinical parameters, including NYHA class and a reduced dependency on hemolysis-related blood transfusions.
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Affiliation(s)
- Eustaquio Maria Onorato
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (F.A.); (M.M.); (A.L.B.)
- Correspondence:
| | - Francesco Alamanni
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (F.A.); (M.M.); (A.L.B.)
| | - Manuela Muratori
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (F.A.); (M.M.); (A.L.B.)
| | - Grzegorz Smolka
- 3rd Division of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland; (G.S.); (W.W.); (P.P.)
| | - Wojtek Wojakowski
- 3rd Division of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland; (G.S.); (W.W.); (P.P.)
| | - Piotr Pysz
- 3rd Division of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland; (G.S.); (W.W.); (P.P.)
| | - Aleksejus Zorinas
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (A.Z.); (D.Z.)
| | - Diana Zakarkaite
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (A.Z.); (D.Z.)
| | - Hélène Eltchaninoff
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, 76000 Rouen, France; (H.E.); (P.-Y.L.)
| | - Pierre-Yves Litzer
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, 76000 Rouen, France; (H.E.); (P.-Y.L.)
| | - François Godart
- Department of Pediatric Cardiology and Congenital Heart Disease, University of Lille, 59000 Lille, France;
| | - Patrick Calvert
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK;
| | | | | | - Bindo Missiroli
- Gemelli Molise di Campobasso-Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 86100 Campobasso, Italy;
| | - Igor Buzaev
- Cardiovascular Department, Bashkir State Medical University, 450008 Ufa, Russia;
| | | | - Tullio Tesorio
- Department of Invasive Cardiology, Clinica Montevergine, 83013 Mercogliano, Italy;
| | - Antonio Luca Bartorelli
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (F.A.); (M.M.); (A.L.B.)
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20122 Milan, Italy
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Gripari P, Pepi M, Fusini L, Tamborini G, Mancini ME, Andreini D, Pontone G, Saccocci M, Giambuzzi I, Alamanni F, Zanobini M. Cardiac tumors: imaging findings, clinical correlations and surgical treatment in a 15 years single-center experience. J Cardiovasc Surg (Torino) 2022; 63:212-221. [PMID: 34825795 DOI: 10.23736/s0021-9509.21.12052-x] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The aims of this study were: to present the clinical and pathological characteristics of cardiac tumors in a single-center series of patients; to describe the association of imaging characteristics, clinical presentation and surgical treatment; to analyze if second level imaging tests, computed tomography (CT) and cardiac magnetic resonance (CMR); and to improve the diagnostic accuracy when compared to first-line imaging technique (transthoracic echocardiography [TTE]). METHODS We reviewed the medical and surgical records, TTE, CT and CMR examinations of 86 patients with a histological diagnosis of cardiac tumors between 2004 and 2019. RESULTS The majority were benign tumors (81%) with myxoma accounting for 66% of cases. Among malignancies, metastasis (8%) and primary tumors (10%) were equally recognized. Symptoms at presentation (45% of patients) were associated to larger diameters at TTE. Malignancies were larger (mean diameter 37±14 mm vs. 27±13 mm, P<0.01), more frequently exhibited irregular shape (67% vs. 17%, P<0.01), frayed or polylobulated surface (73% vs. 38%, P=0.035), heterogeneous aspect (67% vs. 32%, P=0.012). A maximum diameter >28 mm and a minimum diameter >19.5 mm emerged as possible cut-off values for the differentiation of benign and malignant tumors. The ability of TTE, CT and CMR features in identifying malignancies was moderate (diagnostic accuracy of 84%, 81%, 76% respectively). The mean survival time after surgery was 1.6±1.4 years in malignancies and 6.8±4.7 years in benign tumors. CONCLUSIONS Cardiac tumors are rare and mostly benign; their nature and clinics related to TTE appearance. CT and CMR may be used synergically with TTE. Surgery is curative in benign tumors, survival remains scarce in malignancies.
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Affiliation(s)
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | | | | | | | - Matteo Saccocci
- Division of Cardiac Surgery, Poliambulanza Foundation, Brescia, Italy
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Fusini L, Muratori M, Tamborini G, Ali SG, Gripari P, Mantegazza V, Roberto M, Trabattoni P, Agrifoglio M, Bartorelli A, Alamanni F, Pontone G, Pepi M. 229 Long-term clinical and echocardiographic outcome following TAVR in patients with severe aortic stenosis and different transvalvular flow state. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.008] [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: 11/14/2022]
Abstract
Abstract
Aims
Haemodynamic classifications of severe aortic stenosis (AS) have important prognostic implications, with low flow state (defined on the basis of a stroke volume index, SVi<35 mL/m2) known to be a predictor of worse prognosis. As transcatheter aortic valve replacement (TAVR) has become widely used for patients with severe AS, issues were raised concerning its efficacy in patients with different haemodynamic classifications combining transvalvular flow state and pressure gradients. In fact, data on TAVR outcomes in patients with low gradient (LG) AS are limited and in some cases controversial. The aim of this study was to evaluate the efficacy and long-term clinical and echocardiographic outcome of TAVR in patients with different transvalvular flow-gradient patterns.
Methods
In this single centre study, 1078 patients (mean age 81±7 years) with severe symptomatic AS (AVA<1 cm2) undergoing TAVR were categorized according to flow-gradient patterns as follow: 867 patients (80%) with normal flow-high gradient (NF-HG: mean transaortic gradient DP mean>40 mmHg), 94 (9%) with paradoxical low flow LG (pLF-LG: DP mean<40 mmHg, ejection fraction EF > 50%, and SVi<35 mL/m2), and 117 (11%) classical LF-LG (DP mean<40 mmHg, EF < 50%, SVi<35 mL/m2).
Results
TAVR was feasible in all AS subtypes with similar rate of unsuccessful procedure (1.3% NF-HG, 1.1% pLF-LG, 0% LF-LG P=470). Valvular function after TAVR was excellent over time with respect to aortic pressure gradient (mean and peak) and aortic valve area regardless of flow state group (Figure A). Overall, intraoperative (P=957) and 30-day mortality (P=817) did not differ significantly among the 3 groups. Longer follow-up showed that, compared to NF-HG patients, pLF-LG had similar all-cause mortality rate [HR 1.35(0.95–1.90), P=0.094] up to 5 years and LF-LG had a significant higher mortality rate [HR 1.89(1.43–2.49), P<0.001],(Figure B). Moreover, LF-LG patients had higher rehospitalization for heart failure (NF-HG: 3%, pLF-LG: 6%, LF-LG 10%, P=0.001).
Conclusions
We provided evidence that TAVR is an effective procedure in all patients with severe AS regardless of transvalvular flow-gradient patterns. A careful haemodynamic classifications of severe AS is of utmost importance for identifying patients who benefits the most from TAVR procedure.
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Vignati C, De Martino F, Muratori M, Salvioni E, Tamborini G, Bartorelli A, Pepi M, Alamanni F, Farina S, Cattadori G, Mantegazza V, Agostoni P. Rest and exercise oxygen uptake and cardiac output changes 6 months after successful transcatheter mitral valve repair. ESC Heart Fail 2021; 8:4915-4924. [PMID: 34551212 PMCID: PMC8712840 DOI: 10.1002/ehf2.13518] [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: 01/27/2021] [Revised: 05/25/2021] [Accepted: 07/05/2021] [Indexed: 11/11/2022] Open
Abstract
Aims Changes in peak exercise oxygen uptake (VO2) and cardiac output (CO) 6 months after successful percutaneous edge‐to‐edge mitral valve repair (pMVR) in severe primary (PMR) and functional mitral regurgitation (FMR) patients are unknown. The aim of the study was to assess the efficacy of pMVR at rest by echocardiography, VO2 and CO (inert gas rebreathing) measurement and during cardiopulmonary exercise test with CO measurement. Methods and results We evaluated 145 and 115 patients at rest and 98 and 66 during exercise before and after pMVR, respectively. After successful pMVR, significant reductions in MR and NYHA class were observed in FMR and PMR patients. Cardiac ultrasound showed reverse remodelling (left ventricular end‐diastolic volume from 158 ± 63 mL to 147 ± 64, P < 0.001; ejection fraction from 51 ± 15 to 48 ± 14, P < 0.001; pulmonary artery systolic pressure (PASP) from 43 ± 13 to 38 ± 8 mmHg, P < 0.001) in the entire population. These changes were significant in PMR (n = 62) and a trend in FMR (n = 53), except for PASP, which decreased in both groups. At rest, CO and stroke volume (SV) increased in FMR with a concomitant reduction in arteriovenous O2 content difference [ΔC(a‐v)O2]. Peak exercise, CO and SV increased significantly in both groups (CO from 5.5 ± 1.4 L/min to 6.3 ± 1.5 and from 6.2 ± 2.4 to 6.7 ± 2.0, SV from 57 ± 19 mL to 66 ± 20 and from 62 ± 20 to 69 ± 20, in FMR and PMR, respectively), whereas peak VO2 was unchanged and ΔC(a‐v)O2 decreased. Conclusions These data confirm pMVR‐induced clinical improvement and reverse ventricular remodelling at a 6‐month analysis and show, in spite of an increase in CO, an unchanged exercise performance, which is achieved through a ‘more physiological’ blood flow distribution and O2 extraction behaviour. Direct rest and exercise CO should be measured to assess pMVR efficacy.
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Affiliation(s)
- Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | | | | | - Antonio Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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9
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Myasoedova VA, Genovese S, Cavallotti L, Bonomi A, Chiesa M, Campodonico J, Rondinelli M, Cosentino N, Baldassarre D, Veglia F, Pepi M, Alamanni F, Colombo GI, Marenzi G, Poggio P. Aortic Valve Sclerosis in High-Risk Coronary Artery Disease Patients. Front Cardiovasc Med 2021; 8:711899. [PMID: 34386534 PMCID: PMC8354333 DOI: 10.3389/fcvm.2021.711899] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/19/2021] [Accepted: 07/06/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Current knowledge regarding the relationship between aortic valve sclerosis (AVSc), cardiovascular risk factors, and mortality in patients with known coronary artery disease (CAD) is still unclear. The present study aimed at investigating the prevalence of AVSc as well as its association with long-term all-cause mortality in high-risk CAD patients that has never been explored in large cohorts thus far. Methods and Results: In this retrospective and observational cohort study we enrolled high-risk CAD patients, hospitalized at Centro Cardiologico Monzino (CCM), Milan, Italy, between January 2006 and December 2016. The morphology and function of the aortic valve were assessed from the recorded echocardiographic images to evaluate the presence of AVSc, defined as a non-uniform thickening of the aortic leaflets with no consequences on hemodynamics. Data on 5-year all-cause mortality was retrieved from a Regional database. Of the 5,489 patients initially screened, 4,938 (mean age 67 ± 11 years, 3,954 [80%] men) were enrolled in the study. In the overall population, AVSc was detected in 2,138 (43%) patients. Multivariable LASSO regression revealed that age, female gender, diabetes mellitus, previous MI, and left ventricular ejection fraction were independently associated with AVSc. All-cause mortality (adjusted hazard ratio: 1.29, 95%CI: 1.05–1.58) was significantly higher in AVSc than in non-AVSc patients. Conclusions: AVSc is frequently detected in high-risk CAD patients and is associated with long-term mortality. Our findings corroborate the hypothesis that AVSc is an underestimated marker of systemic cardiovascular risk. Thus, AVSc detection may be used to improve long-term risk stratification of high-risk CAD patients.
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Affiliation(s)
- Veronika A Myasoedova
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefano Genovese
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Laura Cavallotti
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mattia Chiesa
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Jeness Campodonico
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Maurizio Rondinelli
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Damiano Baldassarre
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Gualtiero I Colombo
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Paolo Poggio
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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10
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Muratori M, Fusini L, Ghulam Ali S, Teruzzi G, Corrieri N, Gripari P, Mapelli M, Annoni A, Tamborini G, Rabbat MG, Pontone G, Alamanni F, Montorsi P, Pepi M. Detection of Mechanical Prosthetic Valve Dysfunction. Am J Cardiol 2021; 150:101-109. [PMID: 34020771 DOI: 10.1016/j.amjcard.2021.03.055] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 01/01/2023]
Abstract
The long-term outcome of mechanical aortic and mitral prosthetic valve (A-PV, M-PV) dysfunction (PVD) remains a serious complication associated with high morbidity and mortality. We sought to evaluate the incremental diagnostic value of combined transthoracic echocardiography (TTE) and fluoroscopy (F) in patients with suspected PVD. A total of 354 patients (178 A-PV, 176 M-PV) were imaged by TTE and F within 5 days of hospital admission. PVD was confirmed by transesophageal echocardiography, computed tomography, effective thrombolysis, or surgical inspection. PVD was confirmed in 101 patients (57%) with M-PV and 99 (55%) with A-PV. Regardless of the mechanism of PVD, TTE shows good sensitivity and specificity, with accuracy of 80% for M-PV and 91% for A-PV. F shows high specificity, but low sensitivity with accuracy of 68% for M-PV and 78% for A-PV. The integration of TTE + F significantly improved accuracy both for M-PV (83%) and A-PV (96%). At ROC analysis, the combined model of TTE + F showed the highest area under the curve for the detection of PVD compared with TTE and F alone (p < 0.001). In conclusion, in patients with a clinical suspicion of PVD, the combined model of TTE + F offers incremental value over TTE or F alone. This multimodality imaging approach overcomes limitations of TTE or F alone and provides prompt identification of patients who may require further imaging assessment and/or closer follow up.
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Affiliation(s)
- Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giovanni Teruzzi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Nicoletta Corrieri
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Massimo Mapelli
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Andrea Annoni
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mark G Rabbat
- Division of Cardiology, Loyola University of Chicago, Chicago, IL; Edward Hines Jr. VA Hospital, Hines, IL
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Piero Montorsi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
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11
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Conte E, Brucato A, Petrella F, Passoni E, Lauri G, Bigliardi M, Elisa DC, Ricciardi G, Selmi C, Agostoni P, Alamanni F, Andreini D. Case Report: Pericardial Effusion Treated With Pericardiectomy Plus Right Atrial Mass Resection: A 2-Year Follow-Up of Cardiac Rosai-Dorfman Disease. Front Cardiovasc Med 2021; 8:668031. [PMID: 34136545 PMCID: PMC8200491 DOI: 10.3389/fcvm.2021.668031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Rosai-Dorfman disease (RDD) is rare a sinus histiocytosis typically causing lymphadenopathy. Heart involvement is anecdotal, and <30 cases of cardiac RDD (cRDD) have been reported so far. Case Presentation: A 46-year old woman with positive clinical history for RDD was admitted to our cardiology department with transthoracic echocardiography diagnosis of severe pericardial effusion and right atrial masses. Pericardiocentesis with catheter insertion was performed 3 days after the admission due to clinical evidence of cardiac tamponade. After 10 weeks of maximal medical therapy for inflammatory pericarditis, including non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, steroids, and anakinra, at least 100 ml of pericardial citric liquid has been daily drained suggesting no clinical improvement. Pericardial liquid analysis demonstrated no malignant cells, but immunohistochemical analysis resulted positive for AE1-AE3, D2-40, S100, and CD68 consistent with an RDD diagnosis. Surgical management was judged clinically indicated, and 2 months after admission, the patient underwent pericardiectomy and debulking of atrial mass with freezing of remaining atrial neoformation. Regular clinical and echocardiography evaluation was performed without pericardial effusion recurrence after 2 years of follow-up. Conclusions: This is the first case ever reported of cRDD who survived after 2 years of follow-up. Pericardiectomy could be feasible and effective for recurrent pericardial effusion in cRDD. Close follow-up and a multidisciplinary environment is needed to take care of cRDD patients.
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Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientitico (IRCCS), Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio Brucato
- Fatebenefratelli Hospital, University of Milan, Milan, Italy
| | - Francesco Petrella
- IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Emanuela Passoni
- Operative Unit of Dermatology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianfranco Lauri
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientitico (IRCCS), Milan, Italy
| | - Mauro Bigliardi
- ASST-Azienda Socio Sanitaria Territoriale di Mantova, Milan, Italy
| | | | - Gabriella Ricciardi
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientitico (IRCCS), Milan, Italy
| | - Carlo Selmi
- Rheumatology, Humanitas Clinical and Research Center - IRCCS, Milan, Italy.,Department of Biomedical Science, Humanitas University of Milan, Milan, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientitico (IRCCS), Milan, Italy.,Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientitico (IRCCS), Milan, Italy.,Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientitico (IRCCS), Milan, Italy.,Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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12
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D'Onofrio A, Tessari C, Cibin G, Lorenzoni G, Martinelli GL, Solinas M, Gerosa G, Gregori D, Alamanni F, Polvani G, Massetti M, Eusanio MD, Merlo M, Vendramin I, Mangino D, Mignosa C, Russo C, Rinaldi M, De Paulis R, Pacini D, Luzi G, Antona C, Salvador L, Musumeci F, Maselli D, Colli A, Portoghese M, Alfieri O, De Filippo CM. Clinical and Hemodynamic Outcomes of Rapid-Deployment Aortic Bioprostheses. Semin Thorac Cardiovasc Surg 2021; 34:453-461. [PMID: 33979664 DOI: 10.1053/j.semtcvs.2021.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/11/2022]
Abstract
Aim of this retrospective, multicenter study was to evaluate early and mid-term clinical and hemodynamic results of patients who underwent surgical aortic valve replacement (SAVR) with Intuity rapid-deployment bioprostheses (RDB) (Edwards Lifesciences, Irvine, CA). We analyzed data from the Italian Registry of Intuity Valve (INTU-ITA registry) that is a national, real-world and independent from the industry registry. Preoperative variables were defined according to EuroSCORE and postoperative outcomes according to Valve Academic Research Consortium (VARC). Survival distribution was evaluated using the Kaplan-Meier approach. A Cox-Proportional Hazard Model was employed to assess the effect of the covariates on patients' survival. The registry included 1687 patients from 23 centers (June 2012-September 2019). Aortic cross clamp time for isolated SAVR was 55 minutes (IQR: 45-70 minute). Postoperative pace-maker rate was 6.3%. At discharge transaortic peak and mean gradients were: 18 mm Hg (IQR: 14-23 mm Hg) and 10 mmHg (IQR: 8-13 mm Hg), respectively. Indexed effective orifice area was 1.10 cm2/m2 (IQR: 0.91-1.31 cm2/m2) and the incidence of severe patient-prosthesis mismatch was 0.6%. Hemodynamic data for all valve sizes remained stable during follow-up. Thirty-day overall mortality was 1.8% (30 patients), and at follow-up it was 5.3% (89 patients). Kaplan-Meier overall survival was 95.5% (94.3-96.7%); 90.7% (88.3-93.1%); 86.4% (82.6-90.4%) at 1, 3, and 5 years, respectively. Serum creatinine (HR: 1.36; 95%CI: 1.04-1.81; p = 0.0397) and cross-clamp time (HR: 1.01; 95%CI: 1.002-1.017; p = 0.0077) were identified as independent predictors of mortality. According to our data from the INTU-ITA registry, SAVR with RDB provides good early clinical and hemodynamic results that are confirmed at follow-up.
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Affiliation(s)
| | - Chiara Tessari
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Giorgia Cibin
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | | | | | - Marco Solinas
- Division of Cardiac Surgery, Ospedale del Cuore "G. Pasquinucci", Massa
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | | | - Dario Gregori
- Division of Biostatistics, University of Padova, Padova, Italy
| | - Francesco Alamanni
- Departments of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Gianluca Polvani
- Departments of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Massimo Massetti
- Departments of Cardiac Surgery, Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | | | - Maurizio Merlo
- Departments of Cardiac Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Igor Vendramin
- Departments of Cardiac Surgery, S. Maria della Misericordia Hospital - University of Udine, Udine, Italy
| | - Domenico Mangino
- Departments of Cardiac Surgery, L'Angelo Hospital, Mestre-Venezia, Italy
| | - Carmelo Mignosa
- Departments of Cardiac Surgery, G.B. Morgagni Hospital, Catania, Italy
| | - Claudio Russo
- Departments of Cardiac Surgery, Niguarda Hospital, Milan, Italy
| | - Mauro Rinaldi
- Departments of Cardiac Surgery, University Hospital of Turin, Turin, Italy
| | | | - Davide Pacini
- Departments of Cardiac Surgery, University Hospital of Bologna, Bologna, Italy
| | - Giampaolo Luzi
- Departments of Cardiac Surgery, San Carlo Hospital, Potenza, Italy
| | - Carlo Antona
- Departments of Cardiac Surgery, Sacco Hospital, Milan, Italy
| | - Loris Salvador
- Departments of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
| | | | - Daniele Maselli
- Departments of Cardiac Surgery, S. Anna Hospital, Catanzaro, Italy
| | - Andrea Colli
- Departments of Cardiac Surgery, University Hospital of Pisa, Pisa, Italy
| | - Michele Portoghese
- Departments of Cardiac Surgery, Santissima Annunziata Hospital, Sassari, Italy
| | - Ottavio Alfieri
- Departments of Cardiac Surgery, San Raffaele University Hospital, Milano, Italy
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13
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Bogari N, Dannoun A, Athar M, Elkhateeb O, Porqueddu M, Allam R, Alamanni F. Genetic Association of rs10757278 on Chromosome 9p21 and Coronary Artery Disease in a Saudi Population. Int J Gen Med 2021; 14:1699-1707. [PMID: 33981157 PMCID: PMC8109021 DOI: 10.2147/ijgm.s300463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/06/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose Coronary artery disease (CAD) is one of the most important leading causes of morbidity and mortality worldwide. Few studies have been carried out in the Saudi population regarding the association of rs10757278 polymorphism with CAD. This study aimed to investigate the association of the rs10757278 polymorphism with CAD in Saudi population. Materials and Methods In this case-control study, we recruited 437 patients with CAD and 251 cross-matched healthy controls and performed polymorphism genotyping for rs10757278 using a polymerase chain reaction followed by a restriction fragment length polymorphism analysis. Results The G allele (OR-1.44; 95% CI: 1.15–1.80; p=0.001), as GG (OR-2.13; 95% CI: 1.35–3.36; p=0.0009), in the dominant (OR-1.47; 95% CI: 1.03–2.10; p=0.03) and recessive mode (OR-1.84; 95% CI: 1.26–2.70; p=0.001) of inheritance showed a high-risk association. A disease stratified risk analysis was conducted and comparisons were made using an ANOVA analysis. Diabetes showed a risk association (p=0.001). However, a regression analysis confirmed that for the CAD cases, there was an association between the GG genotype and diabetes (p=0.005). Conclusion The results of this study suggest that the polymorphism rs10757278 is related to a high risk of CAD in a Saudi population.
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Affiliation(s)
- Neda Bogari
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Anas Dannoun
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Mohammad Athar
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.,Science and Technology Unit, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Osama Elkhateeb
- Department of Cardiology, King Abdullah Medical City Makkah, Makkah, Kingdom of Saudi Arabia.,Department of Cardiology, Dalhousie University Halifax, Nova Scotia, Canada
| | - Massimo Porqueddu
- Department of Cardiac Surgery, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia.,Department of Cardiac Surgery, Monzino Heart Center, University of Milan, Milano, Italy
| | - Reem Allam
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Francesco Alamanni
- Department of Cardiac Surgery, Monzino Heart Center, University of Milan, Milano, Italy
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14
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Trumello C, Giambuzzi I, Bonalumi G, Bargagna M, Naliato M, Ruggeri S, Fileccia D, Castiglioni A, Alfieri O, Alamanni F, De Bonis M. Rheumatic mitral regurgitation: is repair justified by the long-term results? Interact Cardiovasc Thorac Surg 2021; 33:333-338. [PMID: 33948663 DOI: 10.1093/icvts/ivab091] [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: 09/14/2020] [Revised: 01/07/2021] [Accepted: 02/05/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The best treatment for rheumatic mitral regurgitation is still under debate. Our goal was to assess the long-term results of mitral repair for rheumatic mitral regurgitation performed in 2 referral centres for mitral repair. METHODS Patients who underwent mitral valve repair between 1999 and 2009 were selected. Preoperative and postoperative data were prospectively entered into a dedicated database and retrospectively reviewed. Kaplan-Meier estimates were used to analyse long-term survival. Competing risk analysis was performed by calculating the cumulative incidence function for time to recurrence of mitral regurgitation ≥3+, mitral regurgitation ≥2+, mitral reoperation and the combined end point of repair failure (mitral regurgitation ≥ 3+ and/or mean gradient ≥ 10 mmHg and/or mitral valve REDO) with death as a competing risk. RESULTS A total of 72 patients were included. Mitral calcifications were present in 25 patients (34.7%). Most of the patients (65/72, 90.3%) underwent annuloplasty, and mixes of reparative techniques were used in 21 patients (29.2%). In-hospital mortality was 2.8%. Mean follow-up was 11.6 ± 5.16 (max 19.1 years), 98.6% completed. Survival at 14 years was 70 ± 6.27%. At 14 years, the cumulative incidence function of repair failure was 36.7 ± 6.52%. The presence of severe mitral annulus calcification was an independent predictor of repair failure. CONCLUSIONS Mitral repair for rheumatic mitral regurgitation is characterized by a high rate of failure in the long term (14 years), particularly in patients with severe annular calcifications. These results call for a very selective approach when considering a repair strategy in this setting, especially in case of unfavourable anatomical conditions.
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Affiliation(s)
- Cinzia Trumello
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO University of Milan, Milan, Italy
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy
| | - Marta Bargagna
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Moreno Naliato
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy
| | - Stefania Ruggeri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Fileccia
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO University of Milan, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO University of Milan, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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15
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Volpato V, Mantegazza V, Tamborini G, Gripari P, Muratori M, Fusini L, Zanobini M, Alamanni F, Pepi M. Tricuspid annular dilation in patients undergoing early mitral valve surgery: is it an old story? Int J Cardiovasc Imaging 2021; 37:2439-2446. [PMID: 33899135 DOI: 10.1007/s10554-021-02223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
Patients with mitral valve prolapse (MVP), undergoing early surgery for severe regurgitation, are usually characterized by a low degree of right chambers' remodeling. In this selected population, the mechanisms leading to tricuspid annular (TA) dilatation (TAD) are not well understood. In this setting, we aimed to evaluate, using three-dimensional echocardiography (3DE), how right chambers affect TA size and might contribute to functional tricuspid regurgitation (FTR) progression. We studied 159 patients treated with early isolated surgery for MVP, characterized by: sinus rhythm; normal biventricular function; normal or elevated pulmonary artery pressure; tricuspid regurgitation (TR) ≤ mild; no concomitant cardiac disease. All patients reached a 3-year echocardiographic follow-up. Based on two-dimensional echocardiography, patients were divided in Group 1 (N = 68, 43%, TAD, TA ≥ 21 mm/m2) and Group 2 (N = 91, 57%, no TAD, TA < 21 mm/m2). By 3DE, Group 1 showed larger TA size, right atrial (RA) volume and right ventricular (RV) conical remodeling compared to Group 2 (p < 0.05). The multivariate analysis revealed that RA volume, RV basal diameter and function were independently correlated to TA size (p < 0.05). At the 3-year follow-up there was a low incidence of FTR, with a trend towards FTR progression in Group 1 (p = 0.07). In patients undergoing early surgery for MVP, TAD seems to result from distinctive early-onset geometrical changes of the right chambers, preceding TR, RV dilatation and pulmonary hypertension at rest. An integrated approach, including right chambers' assessment by 3DE, might help to better recognized patients at higher risk for TAD and, potentially for FTR.
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Affiliation(s)
- Valentina Volpato
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy.
| | - Valentina Mantegazza
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Paola Gripari
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Marco Zanobini
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Francesco Alamanni
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
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16
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Corona S, Naliato M, Tondo C, Casella M, Apostolo A, Agostoni P, Salvi L, Alamanni F. Successful Open Chest Epicardial Ablation for Refractory Ventricular Tachycardia in an LVAD Recipient. JACC Case Rep 2021; 3:1055-1060. [PMID: 34317683 PMCID: PMC8311376 DOI: 10.1016/j.jaccas.2021.02.007] [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: 06/29/2020] [Revised: 01/26/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
A patient with history of dilated cardiomyopathy, a cardiac resynchronization therapy defibrillator, and endocardial ablation presented for refractory ventricular tachycardia 3 years after implantation of a Jarvik 2000 left ventricular assist device (Jarvik Heart, Inc., New York, New York). Open-chest epicardial ablation safely and effectively terminated the arrhythmia, without ventricular tachycardia recurrence at 9-month follow-up and in the absence of complications during the hospital stay. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Silvia Corona
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Milan, Italy
- Address for correspondence: Dr Silvia Corona, IRCCS Centro Cardiologico Monzino, Via Parea 4, 20138 Milan, Italy. @SilviaCorona89
| | - Moreno Naliato
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Milan, Italy
| | - Claudio Tondo
- Department of Electrophysiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Cardiovascular Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Michela Casella
- Department of Electrophysiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Anna Apostolo
- Department of Heart Failure and Clinical Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Piergiuseppe Agostoni
- Department of Heart Failure and Clinical Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Anaesthesia and Intensive Care, Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Luca Salvi
- Department of Anaesthesia and Intensive Care, Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Milan, Italy
- Department of Cardiovascular Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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17
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Corona S, Naliato M, Apostolo A, Agostoni P, Salvi L, Alamanni F. Off-Pump Implant Strategy for the Jarvik 2000 LVAD. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1273] [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: 10/21/2022] Open
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18
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Mastroiacovo G, Manganiello S, Pirola S, Tedesco C, Cavallotti L, Antona C, Alamanni F, Pompilio G. Very Long-term Outcome of Minimally Invasive Direct Coronary Artery Bypass. Ann Thorac Surg 2021; 111:845-852. [DOI: 10.1016/j.athoracsur.2020.06.025] [Citation(s) in RCA: 3] [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: 02/22/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
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19
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Fusini L, Muratori M, Ghulam Ali S, Gripari P, Cefalu" C, Junod D, Fabbiocchi F, Roberto M, Trabattoni P, Agrifoglio M, Bartorelli AL, Alamanni F, Pepi M, Tamborini G. Prosthesis-patient mismatch after aortic valve in valve procedure: incidence, predictors and clinical outcomes. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.084] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Transcatheter aortic valve-in-valve (TAVI ViV) implantation is an appealing treatment option for patients with degenerated bioprostheses. However, elevated residual gradients after TAVI ViV procedure are very common. These are an unwanted effects of prosthesis-patient mismatch (PPM). Currently, the actual incidenceof PPM, its predictors and its clinical outcomes have not been completely investigated.
Purpose. The aims of this study was to investigate the incidence, predictors and clinical outcome of PPM and therefore of elevated gradients after TAVI ViV.
Methods. 75 patients (age 78 ± 9 years, 36 male), who underwent TAVI-ViV due to failed aortic biological valve (60 stented, 15 stentless), were enrolled. Mechanism of bioprosthetic valve failure was stenosis (34 cases, 45%), regurgitation (24 cases, 32%) or combination (17 cases, 23%). Elevated residual gradients were defined as a mean DP> 20 mmHg. PPM was identified by the indexed effective orifice area (EOAi) measured by echocardiography (moderate PPM if 0.65 < EOAi < 0.85 cm²/m²; severe PPM if EOAi < 0.6 cm²/m²).
Results. ViV TAVI was feasible in all patients, 33 patients (44%) were implanted with a balloon-expandable valve and 42 (56%) with a self-expandable valve. Post-procedural post-ballooning was performed in 16 out of 42 patients (38%) receiving a self-expandable valve. Post-operative mean DP> 20 mmHg was found in 35 patients (48%). Moderate PPM was found in 24 cases (33%) and severe PPM in 15 (20%). A logistic regression analyses identified small size of surgical prosthesis (size < 23 mm) [OR: 6.061(2.127-17.267), p = 0.001] and failed stented valve [OR: 20.727(2.522-170.364), p = 0.005] as independent predictors for the occurrence PPM. Interestingly PPM did not affect early and 1 years mortality (1 years mortality 1.3 %), while mortality was higher in pts with stentless prostheses (9%)
Conclusions. PPM is a frequent finding after ViV procedures. Despite elevated residual gradients, TAVI ViV resolved prosthetic dysfunction and PPM did not affect mortality. Therefore, this procedure represents a promising new option for patients with failed biological prosthetic valves.
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Affiliation(s)
- L Fusini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - M Muratori
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - P Gripari
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - C Cefalu"
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - D Junod
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - M Roberto
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | | | - F Alamanni
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - M Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - G Tamborini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
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20
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Lorusso R, Ravaux JM, Barili F, Bidar E, Vernooy K, Mauro MD, Miceli A, Parolari A, Daprati A, Myasoedova V, Alamanni F, De Vincentiis C, Aime' E, Nicolini F, Gonzi G, Colli A, Gerosa G, De Bonis M, Paglino G, Bella PD, Dato GA, Varone E, Sponga S, Toniolo M, Proclemer A, Livi U, Mariscalco G, Cottini M, Beghi C, Scrofani R, Foresti D, Tritto FP, Gregorio R, Villa E, Troise G, Pecora D, Serraino F, Jiritano F, Rosato F, Grasso E, Paparella D, Amorese L, Vizzardi E, Solinas M, Arena G, Maselli D, Simon C, Glauber M, Merlo M. Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality. Am J Cardiol 2021; 138:66-71. [PMID: 33065081 DOI: 10.1016/j.amjcard.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/04/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 11/20/2022]
Abstract
Permanent pacemaker implantation (PPI) represents a rare complication after cardiac surgery, with no uniform agreement on timing and no information on follow-up. A multicenter retrospective study was designed to assess pacemaker dependency (PMD) and long-term mortality after cardiac surgery procedures. Between 2004 and 2016, PPI-patients from 18 centers were followed. Time-to-event data were evaluated with semiparametric regression Cox models and semiparametric Fine and Gray model for competing risk framework. Of 859 (0.90%) PPI-patients, 30% were pacemaker independent (PMI) at 6 months. PMD showed higher mortality compared with PMI (10-year survival 80.1% ± 2.6% and 92.2% +2.4%, respectively, log-rank p-value < 0.001) with an unadjusted hazard ratio for death of 0.36 (95% CI 0.20 to 0.65, p< 0.001 favoring PMI) and an adjusted hazard ratio of 0.19 (95% CI 0.08 to 0.45, p< 0.001 with PMD as reference). Crude cumulative incidence function of restored PMI rhythm at follow-up at 6 months, 1 year and 12 years were 30.5% (95% CI 27.3% to 33.7%), 33.7% (95% CI 30.4% to 36.9%) and 37.2% (95% CI 33.8% to 40.6%) respectively. PMI was favored by preoperative sinus rhythm with normal conduction (SR) (HR 2.37, 95% CI 1.65 to 3.40, p< 0.001), whereas coronary artery bypass grafting and aortic valve replacement were independently associated with PMD (HR 0.63, 95% CI 0.45 to 0.88, p = 0.006 and HR 0.807, 95% CI 0.65 to 0.99, p = 0.047 respectively). Time-to-implantation was not associated with increased rate of PMI. Although 30% of PPI-patients are PMI after 6 months, PMD is associated with higher mortality at long term.
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Affiliation(s)
- Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands; Cardiac Surgery Unit, Spedali Civili Hospital, Brescia, Italy
| | - Justine M Ravaux
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
| | - Fabio Barili
- Cardiac Surgery Unit, S. Croce Hospital, Cuneo, Italy
| | - Elham Bidar
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Kevin Vernooy
- Cardiology Department, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Antonio Miceli
- Cardiac Surgery Unit, S. Ambrogio Hospital, Milan, Italy
| | | | | | | | | | | | - Ezio Aime'
- Cardiac Surgery Unit, S. Donato Hospital, Milan, Italy
| | | | | | - Andrea Colli
- Cardiac Surgery Institute, University Hospital, Padua, Italy
| | - Gino Gerosa
- Cardiac Surgery Institute, University Hospital, Padua, Italy
| | | | | | | | | | - Egidio Varone
- Cardiac Surgery Unit, Mauriziano Hospital, Turin, Italy
| | | | | | | | - Ugolino Livi
- Cardiac Surgery, S. Maria Hospital, Udine, Italy
| | | | - Marzia Cottini
- Cardiac Surgery Unit, University Hospital, Varese, Italy
| | - Cesare Beghi
- Cardiac Surgery Unit, University Hospital, Varese, Italy
| | | | | | | | | | | | | | | | | | | | - Francesco Rosato
- University of Bari "Aldo Moro", Department of Emergency and Organ Transplant, Santa Maria Hospital, GVM care & Research, Bari, Italy
| | - Elena Grasso
- Cardiology Department, University of Brescia, Italy
| | | | | | - Enrico Vizzardi
- Cardiac Surgery, Pasquinucci Hospital, Fondazione Monasterio, Massa, Italy
| | - Marco Solinas
- Cardiology Units, Pasquinucci Hospital, Fondazione Monasterio, Massa, Italy
| | - Giuseppe Arena
- Cardiology Units, Pasquinucci Hospital, Fondazione Monasterio, Massa, Italy
| | | | - Caterina Simon
- Cardiac Surgery Unit, Giovanni XXIII Hospital, Bergamo, Italy
| | - Mattia Glauber
- Cardiac Surgery Unit, S. Ambrogio Hospital, Milan, Italy
| | - Maurizio Merlo
- Cardiac Surgery Unit, Giovanni XXIII Hospital, Bergamo, Italy
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21
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Werba JP, Bonomi A, Giroli M, Amato M, Vigo L, Agrifoglio M, Alamanni F, Cavallotti L, Kassem S, Naliato M, Parolari A, Penza E, Polvani G, Pompilio G, Porqueddu M, Roberto M, Salis S, Zanobini M, Amato M, Baldassarre D, Veglia F, Tremoli E. Long-term secondary cardiovascular prevention programme in patients subjected to coronary artery bypass surgery. Eur J Prev Cardiol 2020; 29:997-1004. [PMID: 33624003 DOI: 10.1093/eurjpc/zwaa060] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/29/2020] [Accepted: 08/17/2020] [Indexed: 11/14/2022]
Abstract
AIMS Patients with coronary heart disease (CHD) are at very high risk of recurrent events. A strategy to reduce excess risk might be to deliver structured secondary prevention programmes, but their efficacy has been mostly evaluated in the short term and in experimental settings. This is a retrospective case-control study aimed at assessing, in the real world, the efficacy of a secondary prevention programme in reducing long-term coronary event recurrences after coronary artery bypass surgery (CABG). METHODS AND RESULTS Programme participants (henceforth 'cases') were men and women aged <75 years subjected to CABG between 2002 and 2014, living within 100 km of the hospital. Key programme actions included optimization of treatments according to the most updated European preventive guidelines, surveillance of therapy adherence, and customized lifestyle counselling. Controls were analogous patients not involved in the programme because living farther than 100 km away, matched 1:1 with cases for gender, age at CABG, and year of CABG. Both groups (n = 1248) underwent usual periodic cardiology follow-up at our centre. Data on symptomatic or silent CHD recurrences were obtained from the hospital electronic health records. Cox analysis (adjusted for baseline differences between groups) shows that programme participation was associated with a significantly lower incidence throughout 5 years post-CABG of symptomatic [hazard ratio (95% confidence interval): 0.59 (0.38-0.94)] and silent [0.53 (0.31-0.89)] coronary recurrences. CONCLUSION In a real-world setting, taking part in a structured longstanding secondary prevention programme, in addition to usual cardiology care, meaningfully lowers the risk of coronary recurrences.
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Affiliation(s)
- José Pablo Werba
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Monica Giroli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Manuela Amato
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Lorenzo Vigo
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Marco Agrifoglio
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda, 10, 20122, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda, 19, 20122, Milan, Italy
| | - Laura Cavallotti
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Samer Kassem
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Moreno Naliato
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Alessandro Parolari
- UOC University Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli, 31, 20133, Milan, Italy
| | - Eleonora Penza
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Gianluca Polvani
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda, 19, 20122, Milan, Italy
| | - Giulio Pompilio
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda, 19, 20122, Milan, Italy
| | - Massimo Porqueddu
- Department of Cardiac Surgery, King Fahd Armed Forces Hospital, Al Kurnaysh Rd, Al Andalus, 23311, Jeddah, Saudi Arabia
| | - Maurizio Roberto
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Stefano Salis
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Marco Zanobini
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Mauro Amato
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Damiano Baldassarre
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Via Vanvitelli, 32, 20133, Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Elena Tremoli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
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22
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Ricciardi G, Cavallotti L, Alamanni F, Roberto M. Reoperative transapical transcatheter aortic valve implantation for a degenerated biological valve. JTCVS Tech 2020; 4:118-120. [PMID: 34317981 PMCID: PMC8308182 DOI: 10.1016/j.xjtc.2020.10.037] [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: 09/10/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Gabriella Ricciardi
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Laura Cavallotti
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Maurizio Roberto
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
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23
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Volpato V, Mantegazza V, Tamborini G, Gripari P, Muratori M, Alamanni F, Zanobini M, Fusini L, Pepi M. Is 3D analysis of longitudinal strain useful to predict long-term cardiac events in patients undergoing early mitral valve surgery? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0058] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In patients with mitral valve prolapse (MVP) and significant mitral regurgitation (MR), the presence of reduced 3D left ventricular (LV) global longitudinal strain (GLS) has already been described. However, precise data about this finding in predicting long-term cardiac events are lacking, especially in patients after MV surgery. Particularly, few data are available about the role of 3D GLS in events prediction in patients diagnosed with Barlow or Fibro-Elastic-Deficiency (FED) disease.
Aim
To determinate whether 3D LV GLS may identify a subgroup of patients with MVP and severe MR at higher risk for cardiac events after MV surgery.
Methods
We studied 143 patients diagnosed with MVP with normal LV function, who underwent isolated MV surgery between 2011 and 2017 for severe MR. A comprehensive 2D transthoracic echocardiography (TTE) analysis was performed, degree of MR was obtained using the PISA method (Proximal Isovelocity Surface Area), degree of tricuspid regurgitation was visually estimated. 3D analysis using custom software provided measurement of left atrial (LA) and right atrial (RA) dimension, right ventricular (RV) dimension and function and LV size and function including global longitudinal strain (GLS). Cardiac events (including cardiac death, arrhythmia, hospitalization for heart failure, embolic events or arrhythmia) were recorded during a follow-up of 4.6±2 years.
Results
Study patients were diagnosed with Barlow or FED in 92 (65%) and 51 (35%) of cases, respectively. The baseline 3D analysis showed left chambers dilatation with normal LV function and normal GLS, normal right chambers and systolic pulmonary artery pressure (sPAP). Based on 3D GLS, patients were divided in Group 1 (N=84, 59%, normal GLS ≥−21%) and Group 2 (N=59, 41%, reduced GLS ≤−20%). No differences were noted at baseline between groups (Table 1). At the follow-up, 43 events were recorded, including 1 death, 12 hospitalizations (3 for heart failure, 3 for embolic events and 6 for atrial fibrillation – AF) and 30 minor arrhythmic events, mostly premature ventricular complex (PVCs) and AF. The Kaplan Meier analysis showed no differences in cardiac events between groups (Figure 1, A). Among patients with Barlow, a significant difference in events was detected between patients with reduced and normal GLS at the Kaplan Meier analysis (Figure 1, B). This finding was not found in FED patients.
Conclusions
Patients undergoing MV surgery for MVP with initial LV remodeling and normal function, seem to be characterized by a low rate of major cardiac events. Interestingly, only in the Barlow population, a reduced 3D LV GLS strain may detect cases at higher risk of minor cardiac events, mostly minor arrhythmia.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Volpato
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - G Tamborini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Gripari
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Muratori
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - F Alamanni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Zanobini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
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24
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D'Onofrio A, Tessari C, Lorenzoni G, Cibin G, Martinelli G, Alamanni F, Polvani G, Solinas M, Massetti M, Merlo M, Vendramin I, Di Eusanio M, Mignosa C, Mangino D, Russo C, Rinaldi M, Pacini D, Salvador L, Antona C, Maselli D, De Paulis R, Luzi G, Alfieri O, De Filippo CM, Portoghese M, Musumeci F, Colli A, Gregori D, Gerosa G. Minimally Invasive vs Conventional Aortic Valve Replacement With Rapid-Deployment Bioprostheses. Ann Thorac Surg 2020; 111:1916-1922. [PMID: 33039363 DOI: 10.1016/j.athoracsur.2020.06.150] [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: 03/03/2020] [Revised: 06/13/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this multicenter retrospective study was to compare early and midterm clinical and hemodynamic results of aortic valve replacement with rapid-deployment bioprostheses performed through conventional full-sternotomy vs mini-sternotomy. METHODS Data from the Italian multicenter registry of aortic valve replacement with rapid-deployment bioprostheses (INTU-ITA registry) were analyzed. Patients were divided into 2 groups: full sternotomy (FS) and ministernotomy (MS). Primary endpoint was the comparison of early and midterm mortality. Secondary endpoints were: comparison of intraoperative variables, complications, and hemodynamic performance. A propensity score weighting approach was used for data analysis. RESULTS A total of 1057 patients were analyzed: 435 (41.2%) and 622 (58.8%) in group FS and MS, respectively. Thirty-day mortality was 1.6% and 0.6% in FS and MS groups, respectively (P = .074). cardiopulmonary bypass time was 78.5 minutes and 83 minutes in FS and MS groups, respectively (P = .414). In the overall cohort, the incidence of intraoperative complications and of device success was 3.8% (40 patients) and 95.9% (1014 patients), respectively, with no significant differences between groups. Survival at 1, 3, and 5 years was 94.1%, 98.1%, 88.5% and 91.8%, 85.2%, and 84.8% in FS and MS groups, respectively (P = .412). The 2 groups showed similar postoperative gradients (median mean gradient, FS: 10.0 mm Hg, MS: 11.0 mm Hg; P = .170) and also similar incidence of patient-prosthesis mismatch (FS: 7%, MS: 6.4%, P = .647). CONCLUSIONS According to our data, rapid-deployment bioprostheses allow the performance of minimally invasive aortic valve replacement with similar surgical times and similar clinical and hemodynamic outcomes to conventional surgery and should be considered the first choice in these procedures.
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Affiliation(s)
- Augusto D'Onofrio
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy.
| | - Chiara Tessari
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| | - Giulia Lorenzoni
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| | - Giorgia Cibin
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| | | | - Francesco Alamanni
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Marco Solinas
- Department of Cardiac Surgery, Ospedale del Cuore "G. Pasquinucci", Massa, Italy
| | - Massimo Massetti
- Department of Cardiac Surgery, Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - Maurizio Merlo
- Department of Cardiac Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Igor Vendramin
- Department of Cardiac Surgery, S. Maria della Misericordia Hospital, University of Udine, Udine, Italy
| | | | - Carmelo Mignosa
- Department of Cardiac Surgery, G.B. Morgagni Hospital, Catania, Italy
| | - Domenico Mangino
- Department of Cardiac Surgery, L'Angelo Hospital, Mestre-Venezia, Italy
| | - Claudio Russo
- Department of Cardiac Surgery, Niguarda Hospital, Milan, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, University Hospital of Turin, Turin, Italy
| | - Davide Pacini
- Department of Cardiac Surgery, University Hospital of Bologna, Bologna, Italy
| | - Loris Salvador
- Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Carlo Antona
- Department of Cardiac Surgery, Sacco Hospital, Milan, Italy
| | - Daniele Maselli
- Department of Cardiac Surgery, S. Anna Hospital, Catanzaro, Italy
| | | | - Giampaolo Luzi
- Department of Cardiac Surgery, San Carlo Hospital, Potenza, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele University Hospital, Milano, Italy
| | | | - Michele Portoghese
- Department of Cardiac Surgery, Santissima Annunziata Hospital, Sassari, Italy
| | | | - Andrea Colli
- Department of Cardiac Surgery, University Hospital of Pisa, Pisa, Italy
| | - Dario Gregori
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
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25
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Belluschi I, De Bonis M, Alfieri O, Del Forno B, Alamanni F, Polvani G, Pompilio G, Roberto M, Merlino LG, Troise G, Triboldi A, Di Credico G, Odinolfi FE, Giamberti A, Frigiola A, De Vincentiis C, Menicanti L, Monaco F, Melisurgo G, Scandroglio AM, Ambrosio A, Bottinelli E, Castiglioni A. First reorganization in Europe of a regional cardiac surgery system to deal with the coronavirus-2019 pandemic. Eur J Cardiothorac Surg 2020; 58:25-29. [PMID: 32437514 PMCID: PMC7314078 DOI: 10.1093/ejcts/ezaa185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiac Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Giulio Pompilio
- Department of Cardiac Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Maurizio Roberto
- Department of Cardiac Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | | | - Giovanni Troise
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | | | | | - Alessandro Giamberti
- Department of Pediatric Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Alessandro Frigiola
- Department of Pediatric Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Carlo De Vincentiis
- Department of Adult Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Lorenzo Menicanti
- Department of Adult Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Fabrizio Monaco
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulio Melisurgo
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Mara Scandroglio
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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26
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Spaggiari L, Sedda G, Petrella F, Venturino M, Rossi F, Guarize J, Galetta D, Casiraghi M, Iacono GL, Bertolaccini L, Alamanni F. Preliminary Results of Extracorporeal Membrane Oxygenation Assisted Tracheal Sleeve Pneumonectomy for Cancer. Thorac Cardiovasc Surg 2020; 69:240-245. [PMID: 32814351 DOI: 10.1055/s-0040-1714071] [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] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Tracheal sleeve pneumonectomy is a challenge in lung cancer management and in achieving long-term oncological results. In November 2018, we started a prospective study on the role of extracorporeal membrane oxygenation (ECMO) in tracheal sleeve pneumonectomy. We aim to present our preliminary results. METHODS From November 2018 to November 2019, six patients (three men and three women; median age: 61 years) were eligible for tracheal sleeve pneumonectomy for lung cancer employing the veno-venous ECMO during tracheobronchial anastomosis. RESULTS Only in one patient, an intrapericardial pneumonectomy without ECMO support was performed, but cannulas were maintained during surgery. The median length of surgery was 201 minutes (range: 162-292 minutes), and the average duration of the apneic phase was 38 minutes (range: 31-45 minutes). No complications correlated to the positioning of the cannulas were recorded. There was only one major postoperative complication (hemothorax). At the time of follow-up, all patients were alive; one patient alive with bone metastasis was being treated with radiotherapy. CONCLUSION ECMO-assisted oncological surgery was rarely described, and its advantages include hemodynamic stability with low bleeding complications and a clean operating field. As suggested by our preliminary data, ECMO-assisted could be a useful alternative strategy in select lung cancer patients.
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Affiliation(s)
- Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Francesco Petrella
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Marco Venturino
- Department of Anesthesiology, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Fabiana Rossi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Juliana Guarize
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Domenico Galetta
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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27
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Vigorelli V, Resta J, Bianchessi V, Lauri A, Bassetti B, Agrifoglio M, Pesce M, Polvani G, Bonalumi G, Cavallotti L, Alamanni F, Genovese S, Pompilio G, Vinci MC. Abnormal DNA Methylation Induced by Hyperglycemia Reduces CXCR 4 Gene Expression in CD 34 + Stem Cells. J Am Heart Assoc 2020; 8:e010012. [PMID: 31018749 PMCID: PMC6512087 DOI: 10.1161/jaha.118.010012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background CD 34+ stem/progenitor cells are involved in vascular homeostasis and in neovascularization of ischemic tissues. The number of circulating CD 34+ stem cells is a predictive biomarker of adverse cardiovascular outcomes in diabetic patients. Here, we provide evidence that hyperglycemia can be "memorized" by the stem cells through epigenetic changes that contribute to onset and maintenance of their dysfunction in diabetes mellitus. Methods and Results Cord-blood-derived CD 34+ stem cells exposed to high glucose displayed increased reactive oxygen species production, overexpression of p66shc gene, and downregulation of antioxidant genes catalase and manganese superoxide dismutase when compared with normoglycemic cells. This altered oxidative state was associated with impaired migration ability toward stromal-cell-derived factor 1 alpha and reduced protein and mRNA expression of the C-X-C chemokine receptor type 4 ( CXCR 4) receptor. The methylation analysis by bisulfite Sanger sequencing of the CXCR 4 promoter revealed a significant increase in DNA methylation density in high-glucose CD 34+ stem cells that negatively correlated with mRNA expression (Pearson r=-0.76; P=0.004). Consistently, we found, by chromatin immunoprecipitation assay, a more transcriptionally inactive chromatin conformation and reduced RNA polymerase II engagement on the CXCR 4 promoter. Notably, alteration of CXCR 4 DNA methylation, as well as transcriptional and functional defects, persisted in high-glucose CD 34+ stem cells despite recovery in normoglycemic conditions. Importantly, such an epigenetic modification was thoroughly confirmed in bone marrow CD 34+ stem cells isolated from sternal biopsies of diabetic patients undergoing coronary bypass surgery. Conclusions CD 34+ stem cells "memorize" the hyperglycemic environment in the form of epigenetic modifications that collude to alter CXCR 4 receptor expression and migration.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Francesco Alamanni
- 1 IRCCS Centro Cardiologico Monzino Milan Italy.,3 Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | | | - Giulio Pompilio
- 1 IRCCS Centro Cardiologico Monzino Milan Italy.,3 Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
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28
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Guglielmo M, Fusini L, Muscogiuri G, Baessato F, Loffreno A, Cavaliere A, Rizzon G, Baggiano A, Rabbat MG, Muratori M, Tamborini G, Danza LML, Del Torto A, Tonet E, Viani G, Mushtaq S, Conte E, Bonalumi G, Gripari P, Zanobini M, Andreini D, Alamanni F, Pepi M, Guaricci AI, Pontone G. T1 mapping and cardiac magnetic resonance feature tracking in mitral valve prolapse. Eur Radiol 2020; 31:1100-1109. [PMID: 32803414 DOI: 10.1007/s00330-020-07140-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/10/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES T1 mapping (T1-map) and cardiac magnetic resonance feature tracking (CMR-FT) techniques have been introduced for the early detection of interstitial myocardial fibrosis and deformation abnormalities. We sought to demonstrate that T1-map and CMR-FT may identify the presence of subclinical myocardial structural changes in patients with mitral valve prolapse (MVP). METHODS Consecutive MVP patients with moderate-to-severe mitral regurgitation and comparative matched healthy subjects were prospectively enrolled and underwent CMR-FT analysis to calculate 2D global and segmental circumferential (CS) and radial strain (RS) and T1-map to determine global and segmental native T1 (nT1) values. RESULTS Seventy-three MVP patients (mean age, 57 ± 13 years old; male, 76%; regurgitant volume, 57 ± 21 mL) and 42 matched control subjects (mean age, 56 ± 18 years; male, 74%) were included. MVP patients showed a lower global CS (- 16.3 ± 3.4% vs. - 17.8 ± 1.9%, p = 0.020) and longer global nT1 (1124.9 ± 97.7 ms vs. 1007.4 ± 26.1 ms, p < 0.001) as compared to controls. Moreover, MVP patients showed lower RS and CS in basal (21.6 ± 12.3% vs. 27.6 ± 8.9%, p = 0.008, and - 13.0 ± 6.7% vs. - 14.9 ± 4.1%, p = 0.013) and mid-inferolateral (20.6 ± 10.7% vs. 28.4 ± 8.7%, p < 0.001, and - 12.8 ± 6.3% vs. - 16.5 ± 4.0%, p < 0.001) walls as compared to other myocardial segments. Similarly, MVP patients showed longer nT1 values in basal (1080 ± 68 ms vs. 1043 ± 43 ms, p < 0.001) and mid-inferolateral (1080 ± 77 ms vs. 1034 ± 37 ms, p < 0.001) walls as compared to other myocardial segments. Of note, nT1 values were significantly correlated with CS (r, 0.36; p < 0.001) and RS (r, 0.37; p < 0.001) but not with regurgitant volume. CONCLUSIONS T1-map and CMR-FT identify subclinical left ventricle tissue changes in patients with MVP. Further studies are required to correlate these subclinical tissue changes with the outcome. KEY POINTS • T1 mapping (T1-map) and cardiac magnetic resonance feature tracking (CMR-FT) techniques have been introduced for the early detection of interstitial myocardial fibrosis and deformation abnormalities. • In MVP patients, we demonstrated a longer global nT1 with associated reduced global circumferential (CS) and radial strain (RS) as compared to control subjects. • Among MVP patients, the mid-basal left ventricle inferolateral wall showed longer nT1 with reduced CS and RS as compared to other myocardial segments. Further studies are required to correlate these subclinical tissue changes with the outcome.
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Affiliation(s)
- Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Giuseppe Muscogiuri
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Francesca Baessato
- Divisione di Cardiologia, Dipartimento di Medicina, Università degli Studi, Verona, Italy
| | - Antonella Loffreno
- U.O.C. Cardiologia 1, Ospedale di Circolo e Fondazione Macchi, Università degli Studi, Varese, Italy
| | - Annachiara Cavaliere
- Dipartimento di Medicina, Istituto di Radiologia, Università degli Studi, Padua, Italy
| | - Giulia Rizzon
- Dipartimento di Medicina, Istituto di Radiologia, Università degli Studi, Padua, Italy
| | - Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, IL, USA.,Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Manuela Muratori
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Gloria Tamborini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | | | - Alberico Del Torto
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
| | - Giacomo Viani
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Giorgia Bonalumi
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Paola Gripari
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Marco Zanobini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Andrea I Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.
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29
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Myasoedova VA, Di Minno A, Songia P, Massaiu I, Alfieri V, Valerio V, Moschetta D, Andreini D, Alamanni F, Pepi M, Trabattoni D, Poggio P. Sex-specific differences in age-related aortic valve calcium load: A systematic review and meta-analysis. Ageing Res Rev 2020; 61:101077. [PMID: 32334093 DOI: 10.1016/j.arr.2020.101077] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 11/28/2022]
Abstract
Aging of the aortic valve, characterized by leaflet thickening and loss of extensibility, leads to progressive changes in valve function. These age-related mechanisms have not been evaluated yet in sex-specific calcific aortic valve stenosis (CAVS) onset and progression. Recent studies reported the association between high aortic valve calcification (AVC) load and male gender in patients with CAVS while women present faster progression than men. To evaluate these age- and sex-specific differences, we performed a systematic review and meta-analysis with meta-regression. A systematic search related to AVC measured by computed tomography and gender-specific differences was conducted according to PRISMA guidelines. Seven studies, enrolling 1859 men and 1055 women, were included in the quantitative synthesis. We found a significant difference between men and women both in AVC load and density. AVC load mean difference (MD), between men and women, was 1131 ± 243 AU (p < 0.0001; I2: 96.5 %, p < 0.001), while AVC density MD was 159 ± 20 AU/cm2 (p < 0.0001) without heterogeneity among the studies (I2: 23.5, p = 0.3). Meta-regression analyses showed that AVC load MD positively correlated with age and other cardiovascular risk factors such as diabetes, hypertension, and coronary artery disease presence. Our meta-analysis shows a significant association of incremental AVC load with male gender, regardless of the individual anatomical characteristics and the cardiovascular risk factors. Further studies are needed: i) to clarify if there are different sex-related pathophysiological processes driving the development and the progression of age-related CAVS, and ii) to determine if a sex-specific therapeutic strategy should be applied for CAVS treatment and/or prevention.
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Affiliation(s)
| | - Alessandro Di Minno
- Università deli Studi di Napoli Federico II, Dipartimento di Farmacia, Napoli, Italy
| | | | | | | | - Vincenza Valerio
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Università deli Studi di Napoli Federico II, Dipartimento di Medicina Clinica e Chirurgia, Napoli, Italy
| | - Donato Moschetta
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Università degli Studi di Milano, Dipartimento di Scienze Farmacologiche e Biomolecolari, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Università degli Studi di Milano, Dipartimento di Scienze Cliniche e di Comunità, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Università degli Studi di Milano, Dipartimento di Scienze Cliniche e di Comunità, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Paolo Poggio
- Centro Cardiologico Monzino IRCCS, Milan, Italy.
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30
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Bonalumi G, Giambuzzi I, Barbone A, Ranieri C, Cavallotti L, Trabattoni P, Naliato M, Polvani G, Torracca L, Pelenghi S, Ragni F, Russo CF, Guerra F, Trimarchi S, Civilini E, Romani F, Bellosta R, Losa S, Roberto M, Alamanni F. A call to action becomes practice: cardiac and vascular surgery during the COVID-19 pandemic based on the Lombardy emergency guidelines. Eur J Cardiothorac Surg 2020; 58:319-327. [PMID: 32584978 PMCID: PMC7337742 DOI: 10.1093/ejcts/ezaa204] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Giorgia Bonalumi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy.,DISCCO University of Milan, Milan, Italy
| | - Alessandro Barbone
- Department of Cardiovascular Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Camilla Ranieri
- Health Care Management, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Laura Cavallotti
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Piero Trabattoni
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Moreno Naliato
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy.,DISCCO University of Milan, Milan, Italy
| | - Lucia Torracca
- Department of Cardiovascular Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Stefano Pelenghi
- Division of Cardiovascular Surgery, Fondazione-IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | - Franco Ragni
- Vascular Surgery Unit, Fondazione-IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | | | - Francisco Guerra
- Cardiovascular Surgery, IRCCS Sesto San Giovanni Multimedica, Sesto San Giovanni, Milan, Italy
| | - Santi Trimarchi
- DISCCO University of Milan, Milan, Italy.,Vascular Surgery Department, IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Efrem Civilini
- Department of Cardiovascular Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Federico Romani
- Cardiovascular Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Raffaello Bellosta
- Vascular Surgery Unit, Cardiovascular Surgery Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Sergio Losa
- Cardiovascular Surgery, IRCCS Sesto San Giovanni Multimedica, Sesto San Giovanni, Milan, Italy
| | - Maurizio Roberto
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy.,DISCCO University of Milan, Milan, Italy
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31
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Bogari NM, Aljohani A, Dannoun A, Elkhateeb O, Porqueddu M, Amin AA, Bogari DN, Taher MM, Buba F, Allam RM, Bogari MN, Alamanni F. Association between HindIII (rs320) variant in the lipoprotein lipase gene and the presence of coronary artery disease and stroke among the Saudi population. Saudi J Biol Sci 2020; 27:2018-2024. [PMID: 32714026 PMCID: PMC7376116 DOI: 10.1016/j.sjbs.2020.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 12/14/2022] Open
Abstract
Lipoprotein Lipase (LPL) is known to be a key enzyme for lipid metabolism specifically in an enzymatic glycoprotein which provide tissues without fatty-acids and eliminates triglycerides (TG) by the circulation. Mutations in LPL were proven to cause alteration in fractions within lipoprotein, causing the development of atherosclerosis which predispose to weakening coronary artery disease (CAD) and stroke. We examined the linkage between genetic variant HindIII in LPL on lipoprotein fractions, stroke occurrences and CAD. In this case-control study, we have recruited 315 CAD cases and 205 age-matched controls. A total of 520 genomic DNA was digested with the purified PCR products for restriction fragment length polymorphism with HindIII restriction enzyme. The distribution of genotypes in a decreasing order were TT, 148 (47%), GT 135 (42.9%) and GG 32 (10.2%) in CAD groups of the study while the pattern in controls were GT 91 (44.4%), TT 86 (42%) and GG 28 (13.7%). None of all the allele or genotype frequencies were found to be significant in our study (p greater than 0.05), while the biochemical levels for both TG and LDL-c were shown to be prone in CAD patients when compare with the controls. Furthermore, the occurence of strokes were more in CAD groups vs. controls: 72 (22.9%) vs. 7 (3.4%) [p 0.000]. This could indicate the influence of HindIII variant on plasma lipid levels, and the possibility of considering it a risk factor for atherosclerosis leading to CAD and stroke occurrence.
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Affiliation(s)
- Neda M Bogari
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University (UQU), Saudi Arabia
| | - Ashwag Aljohani
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University (UQU), Saudi Arabia
| | - Anas Dannoun
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University (UQU), Saudi Arabia
| | - Osama Elkhateeb
- Department of Cardiology, King Abdulla Medical city, Makkah, Saudi Arabia.,Department of Cardiology, Dalhousie University Halifax, Nova Scotia, Canada
| | - Masimo Porqueddu
- Department of Cardiac Surgery, King Fahd Armed Medical Forces Hospitals, Jeddah, KSA, Saudi Arabia.,Department of Cardiac Surgery, Monzino Heart Center, University of Milan, Milan, Italy
| | - Amr A Amin
- Biochemistry Department, Faculty of medicine, UQU, Saudi Arabia.,Faculty of Medicine, Ain-Shams University, Egypt
| | - Dema N Bogari
- Biomedical Sciences, University of Brighton, England, UK
| | - Mohiuddin M Taher
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University (UQU), Saudi Arabia.,Science and technology Unit, UQU, Saudi Arabia
| | - Faruk Buba
- Department of Internal Medicine, College of Medical Sciences, University of Maiduguri, Nigeria
| | - Reem M Allam
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Egypt
| | | | - Francesco Alamanni
- Department of Cardiac Surgery, Monzino Heart Center, University of Milan, Milan, Italy
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32
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Giambuzzi I, Mastroiacovo G, Roberto M, Pirola S, Alamanni F, Cavallotti L, Bonalumi G. Preoperative neurological dysfunctions: what is their meaning in patients presenting with acute type A aortic dissection? Minerva Cardioangiol 2020; 68:511-517. [PMID: 32524808 DOI: 10.23736/s0026-4725.20.05230-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Type A aortic dissection (AAD) is a life-threatening disease with very high mortality. The gold standard treatment is surgical, as medical treatment has been proven to be ineffective. It is still unclear the role of preoperative neurological dysfunction in the prognosis of the patient. Therefore, the choice of performing surgery in patients with neurological symptoms is still left to the surgeon at the time of the diagnosis. The aim of this study is to make a narrative review of the current literature about the management of patients with neurological symptoms in AAD patients. EVIDENCE ACQUISITION A bibliographical research was performed on PubMed, looking for papers containing the words: "((preoperative neurological symptoms in type a aortic dissection) OR brain injury type A aortic dissection) AND ("2010"[Date - Publication]: "3000"[Date - Publication])". A total of 35 papers were found. EVIDENCE SYNTHESIS A total of 6 papers were chosen to be reviewed. All of them concluded that even patients with severe neurological symptoms (up to comatose state) had a good chance to recover neurological functions after surgery if treated in the first hours from the onset of symptoms. Interestingly, a hemorrhagic stroke was rarely found. CONCLUSIONS Preoperative neurological dysfunction have been long considered a contraindication to surgery. Nevertheless, several authors show neurological and survival good results in patients with preoperative neurological dysfunction. They also stress the importance of surgical timing finding in 5 to 10 hours the surgical time limit to improve neurological dysfunction. A preoperative neurological dysfunction could be considered a strong advice towards surgical intervention. It is time to change and consider prompt surgery not only for survival but also for cerebral protection.
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Affiliation(s)
- Ilaria Giambuzzi
- Unit of Heart Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy -
| | | | - Maurizio Roberto
- Unit of Heart Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Sergio Pirola
- Unit of Heart Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | | | - Laura Cavallotti
- Unit of Heart Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Giorgia Bonalumi
- Unit of Heart Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
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33
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D'Onofrio A, Salizzoni S, Filippini C, Tessari C, Bagozzi L, Messina A, Troise G, Tomba MD, Rambaldini M, Dalén M, Alamanni F, Massetti M, Mignosa C, Russo C, Salvador L, Di Bartolomeo R, Maselli D, De Paulis R, Alfieri O, De Filippo CM, Portoghese M, Bortolotti U, Rinaldi M, Gerosa G. Surgical aortic valve replacement with new-generation bioprostheses: Sutureless versus rapid-deployment. J Thorac Cardiovasc Surg 2020; 159:432-442.e1. [DOI: 10.1016/j.jtcvs.2019.02.135] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 01/10/2019] [Accepted: 02/07/2019] [Indexed: 12/13/2022]
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Fusini L, Muratori M, Teruzzi G, Corrieri N, Innocenti E, Tamborini G, Mapelli M, Ghulam Ali S, Alamanni F, Montorsi P, Pepi M. P1579 Detection of mechanical prosthetic valve dysfunction: an integrated multimodality imaging approach. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.999] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although the long-term outcome of mechanical mitral and aortic prosthetic valve (M-PV, Ao-PV), PV dysfunction (PVD) remains a very serious complication associated with high morbidity and mortality. PVD, in terms of thrombosis/pannus or paravalvular leak, is not associated with a peculiar clinical presentation. However, a prompt PVD detection is essential for referring the patient to the optimal treatment (clinical follow-up, thrombolysis, surgery). An integrated multimodality imaging approach, comprising several parameters by transthoracic echocardiography (TTE) and fluoroscopy (F), is mandatory to address the patient to the best therapeutic option.
Purpose
This study aims to evaluate the incremental diagnostic value of combined TTE + F over each imaging modality alone in pts with Ao-PV or M-PV symptomatic for dyspnea, embolic events, fever or haemolysis and therefore at high suspicion for PVD.
Methods
We enrolled 388 consecutive pts (62 ± 11y, 213 Ao-PV, 175 M-PV) suspected for PVD. All patients were imaged by TTE and F within 2 days after the admission to the hospital. TTE was defined positive for PVD in presence of intra/para-prosthetic regurgitation or high transprosthetic gradient (DP > 20 mmHg in Ao-PV, DP >10 mmHg in M-PV) combined with other altered Doppler parameters (for Ao-PV: DVI < 0.25, AT > 95ms; for M-PV: Peak Mitral Velocity > 2.2m/sec, VTIPrMV/VTILVO > 2.5, PHT > 130ms). A positive F for PVD was defined by leaflet/s restriction. In all pts, PVD was confirmed by transoesophageal echocardiography (TOE), positive response of thrombolysis (T), or surgical inspection (S).
Results
PVD was found in 46% (99/213) of Ao-PV and in 56% (98/175) of M-PV at TOE/T/S. Sensitivity (SE), specificity (SP), negative predictive value (NPV), positive predictive value (PPV) and diagnostic accuracy (ACC) for TTE, F and combined TTE + F are reported in Table. The integration of TTE + F data significantly improved ACC both for Ao-PV and M-PV. At ROC analysis, the combined model of TTE + F showed the highest AUC for the detection of PVD compared with TTE and F alone (Figure).
Conclusions
In patients with clinical suspicion of PVD, the combined model of TTE + F had a significant incremental value over TTE or F alone to diagnose PVD. This multimodality imaging approach allows to overcome limitations of TTE or F alone and consequently provides a prompt PVD detection even though TOE remains the gold standard to diagnose paravalvular leak and non-obstructive thrombosis.
Table Ao-PV: TTE(n = 211) Ao-PV: F(n = 204) Ao-PV: TTE + F(n = 202) MV-PV: TTE(n = 175) MV-PV: F(n = 159) MV-PV: TTE + F(n = 159) Sensitivity/Specificity 86(79-93)/89(84-95) 59(49-68)/99(97-100) 94(89-99)/88(81-94) 83(75-90)/78(68-87) 45(35-55)/98(95-100) 87(81-94)/75(64-86) ACC 88(83-92) 79(74-85) 91(87-95) 81(75-90) 67(59-74) 82(76-88) Comparison of diagnostic accuracy between TTE, F, and TTE + F for detecting PVD
Abstract P1579 Figure. ROC curves
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Affiliation(s)
- L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Muratori
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Teruzzi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - N Corrieri
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - E Innocenti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Tamborini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Mapelli
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - F Alamanni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Montorsi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
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35
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Guglielmo M, Fusini L, Muscogiuri G, Baggiano A, Loffreno A, Baessato F, Bonalumi G, Zanobini M, Alamanni F, Pepi M, Pontone G. 1045 T1-mapping and CMR feature tracking in mitral valve prolapse. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.637] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Several studies suggest that mitral valve prolapse (MVP) can be related to sudden cardiac death, owing to sustained ventricular arrhythmias (VAs). In patients with sudden cardiac death and complex VAs, a high percentage of either left ventricle (LV) papillary muscle fibrosis or inferobasal fibrosis has been described using cardiac magnetic resonance (CMR) with late gadolinium enhancement technique (LGE). However, LGE presents several technical limitations and requires contrast agent administration. Thanks to T1 mapping (T1-map) and feature tracking (FT) techniques, CMR may identify myocardial fibrosis and deformation abnormalities respectively. We sought to demonstrate that, in patients with MVP, T1 map can accurately identify the presence of myocardial fibrosis which, being related to myocardial stiffness, is associated to abnormal deformation indexes at CMR FT strain evaluation.
METHODS
Consecutive patientswith indication to mitral valve surgery for severe mitral regurgitation due to mitral valve prolapse were prospectively enrolled. CMR including Modified Look-Locker (MOLLI) sequences for T1 mapping was performed in each patient. In addition, CMR FT analysis of steady state free precession (SSFP) cine images was performed to obtain 2D global and segmental circumferential and radial strains.
RESULTS
70 consecutive patients (age: 59 ± 12) were successfully evaluated with CMR. T1 native values were significantly higher in the basal and mid LV inferolateral wall compared to the remote myocardium (1074 ± 67 vs 1046 ± 40 msec, p< 0.001). Moreover, the average radial and circumferential strains of the basal and mid LV inferolateral were significantly reduced compared to those of the remote myocardium (21.1 ± 10.4 and -12.8 ± 5.6 vs 31.6 ± 9.1 and -17.3 ± 3.6 respectively, p < 0.001).
CONCLUSIONS
In patients with MVP and severe mitral regurgitation native T1 values of the LV inferolateral are higher as compared to remote myocardium and associated with reduced circumferential and radial strains. T1 mapping and CMR FT strain may be used as tools for the early identification of tissue changes in the LV inferolateral myocardial segment. Further studies are needed to evaluate if these changes are able to predict LGE development and are associated with higher risk for VAs
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Affiliation(s)
- M Guglielmo
- Monzino Cardiology Center, IRCCS, Milan, Italy
| | - L Fusini
- Monzino Cardiology Center, IRCCS, Milan, Italy
| | | | - A Baggiano
- Monzino Cardiology Center, IRCCS, Milan, Italy
| | | | | | - G Bonalumi
- Monzino Cardiology Center, IRCCS, Milan, Italy
| | - M Zanobini
- Monzino Cardiology Center, IRCCS, Milan, Italy
| | - F Alamanni
- Monzino Cardiology Center, IRCCS, Milan, Italy
| | - M Pepi
- Monzino Cardiology Center, IRCCS, Milan, Italy
| | - G Pontone
- Monzino Cardiology Center, IRCCS, Milan, Italy
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36
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Fusini L, Muratori M, Corrieri N, Capodaglio I, Tamborini G, Ghulam Ali S, Italiano G, Gripari P, Salvi L, Roberto M, Fabbiocchi F, Agrifoglio M, Bartorelli AL, Alamanni F, Pepi M. 624 Is TAVI a useful procedure in paradoxical low flow-low gradient aortic stenosis? A long-term mortality study. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.310] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Clinical outcomes of patients with paradoxical low-flow, low-gradient aortic stenosis (PLF-LG) undergoing valve replacement are controversial. PLF-LG is a combination of a small aortic valve area (AVA < 1cm²), a preserved left ventricular (LV) ejection fraction (LVEF≥50%), and a ‘paradoxical’ low mean gradient due to the presence of low LV stroke volume (≤35 mL/m²). The low flow state is explained by the presence of a high afterload and pronounced LV concentric remodeling, with impaired LV filling. Surgical aortic valve replacement has been associated with very positive outcomes in normal-flow high-gradient (NF-HG) AS, whereas poorer outcomes has been reported in patients with PLF-LG AS.
Purpose
The aim of this study is to determine the clinical outcomes in patients with PLF-LG AS undergoing transcatheter aortic valve implantation (TAVI) compare to NF-HG patients.
Methods
A total of 624 patients (age 81 ± 7 years) with symptomatic severe AS and preserved LVEF who underwent TAVI, was enrolled and divided in 2 groups: group NF-HG included 554 patients (89%) and group PLF-LG including 70 patients (11%). At 1-year follow-up, death and clinical events were reported.
Results
TAVI was feasible in all patients. A significant reduction in mean aortic pressure gradient was observed after TAVI both in PLF-LG (baseline, 30 ± 6 mmHg; 1-year, 12 ± 4 mmHg; p < 0.001) and in NF-HG (baseline, 55 ± 12 mmHg; 1-year, 11 ± 4 mmHg; p < 0.001) together with an increase in AVA (PLF-LG: baseline, 0.73 ± 0.16 cm², 1-year: 1.82 ± 0.43 cm², p < 0.001; NF-HG: baseline, 0.66 ± 0.18 cm², 1-year: 1.84 ± 0.38cm², p < 0.001). Perioperative mortality at 30-days was similar in group NF-HG (17/554, 3%) and in group PLF-LG (2/70, 3%). Figure shows the survival curves up to 5 years follow-up according to the two groups. PLF-LG and HG-AS had similar survival rate throughout the long-term follow-up. Similarly, rehospitalization rate was not different in the two groups (PLF-LG: 12% vs NF-HG: 7%, p = 0.127).
Conclusions
Differently from surgical series, TAVI in PLF-LG AS is a useful procedure showing similar mortality and rehospitalization rates compared to NF-HG AS patients.
Abstract 624 Figure. Survival curve
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Affiliation(s)
- L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Muratori
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - N Corrieri
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - G Tamborini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - G Italiano
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Gripari
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - L Salvi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Roberto
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | | | | | - F Alamanni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
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37
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Petrella F, Salvi L, Venturino M, Alamanni F, Spaggiari L. Veno-venous extracorporeal membrane oxygenation tracheal sleeve pneumonectomy. ACTA ACUST UNITED AC 2020. [DOI: 10.21037/shc.2019.10.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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38
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Fusini L, Muratori M, Tamborini G, Ghulam Ali S, Gripari P, Salvi L, Roberto M, Trabattoni P, Agrifoglio M, Bartorelli AL, Alamanni F, Pepi M. P927Long-term mortality in patients with paradoxical low-flow low-gradient versus normal-flow high-gradient aortic stenosis undergoing transcatheter aortic valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0522] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Controversial data exist on clinical outcomes of patients with paradoxical low-flow, low-gradient aortic stenosis (PLF-LG) undergoing valve replacement. This entity is a combination of a small aortic valve area (AVA<1cm2), a preserved left ventricular ejection fraction (LVEF≥50%), and a “paradoxical” low mean gradient due to the presence of low LV stroke volume (≤35 mL/m2). The low flow state is explained by the presence of a high afterload and pronounced LV concentric remodeling, with impaired LV filling. Currently, poorer outcomes have been reported after surgical aortic valve replacement in patients with PLF-LG AS compared with the normal-flow high-gradient (NF-HG) AS.
Purpose
The aim of this study was to determine the clinical outcomes in patients with PLF-LG AS undergoing transcatheter aortic valve implantation (TAVI) compare to NF-HG patients.
Methods
A total of 609 patients (age 81±6 years) with symptomatic severe AS and preserved LVEF who underwent TAVI, was enrolled and divided in two groups: group A included patients with NF-HG (542 patients) and group B including those with PLF-LG (66 patients). At 1-year follow-up, death and clinical events were reported.
Results
TAVI was feasible in all patients. A significant reduction in mean aortic pressure gradient was observed after TAVI both in PLF-LG (baseline, 30±5 mmHg; 1-year, 11±4 mmHg; p<0.001) and in NF-HG (baseline, 53±11 mmHg; 1-year, 12±4 mmHg; p<0.001) together with an increase in AVA (PLF-LG: baseline, 0.74±0.16 cm2, 1-year: 1.83±0.41 cm2, p<0.001; NF-HG: baseline, 0.65±0.16 cm2, 1-year: 1.84±0.35cm2, p<0.001). Perioperative mortality at 30-days was similar in group A (17/542, 3%) and in group B (2/66, 3%). Figure shows the survival curves up to 5 years follow-up according to the two groups. PLF-LG and HG-AS had similar survival rate throughout the long-term follow-up. Similarly, rehospitalization rate was not different in the two groups (PLF-LG: 12% vs NF-HG: 7%, p=0.121).
Kaplan-Meier analysis
Conclusions
Differently from surgical series, TAVI patients with PLF-LG AS had showed similar mortality and rehospitalization rates compared to NF-HG.
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Affiliation(s)
- L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Muratori
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Tamborini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - P Gripari
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - L Salvi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Roberto
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | | | | | - F Alamanni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
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Fusini L, Muratori M, Teruzzi G, Ghulam Ali S, Innocenti E, Corrieri N, Tamborini G, Mapelli M, Alamanni F, Montorsi P, Pepi M. P1780Usefulness of multimodality imaging approach in the diagnosis of mechanical prosthetic valve dysfunction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0532] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although the long-term outcome of mechanical mitral and aortic prosthetic valve (M-PV, Ao-PV), PV dysfunction (PVD) remains a very serious complication associated with high morbidity and mortality. Thrombosis/pannus and paravalvular leak are the 2 main mechanisms of PVD. The diagnosis of PVD, based on clinical presentation may be challenging, but it is essential for referring the patient to the optimal treatment (clinical follow-up, thrombolysis, surgery). An integrated multimodality imaging approach, comprising several parameters by transthoracic echocardiography (TTE) and fluoroscopy (F), is mandatory to pursue the correct therapeutic pathway.
Purpose
This study aims to evaluate the incremental diagnostic value of combined TTE+F over each imaging modality alone in symptomatic pts with Ao-PV or M-PV and high suspicion of PVD.
Methods
387 consecutive pts (63±11y, 213 Ao-PV, 173 M-PV) suspected for PVD, symptomatic for dyspnea, embolic events, fever or haemolysis were enrolled. All patients were imaged by TTE and F within 2 days after the admission to the hospital. TTE was defined positive for PVD in presence of intra/para-prosthetic regurgitation or high transprosthetic gradient (>20mmHg in Ao-PV, >8mmHg in M-PV) together with altered Doppler parameters (for Ao-PV: DVI <0.25, AT>95ms; for M-PV: Peak Mitral Velocity>2m/sec, VTIPrMV/VTILVO>2.5, PHT>130ms). F was defined positive for PVD when leaflet/s restriction occurs. PVD was confirmed by transoesophageal echocardiography (TOE) or positive response of thrombolysis (T), or surgical inspection (S).
Results
PVD was found in 46% (99/213) of Ao-PV and in 53% (91/173) of M-PV at TOE/T/S. Sensitivity (SE), specificity (SP), negative predictive value (NPV), positive predictive value (PPV) and diagnostic accuracy (ACC) for TTE, F and combined TTE+F are reported in Table. The integration of TTE+F data significantly improved ACC both for Ao-PV and M-PV. At ROC analysis, the combined model of TTE+F showed the highest AUC for the detection of PVD compared with TTE and F alone (Figure).
Table 1. Comparison of diagnostic accuracy between TTE, F, and TTE+F TTE-Ao-PV (n=211) F-Ao_PV (n=204) TTE+F-Ao-PV (n=202) TTE-M-PV (n=172) F-M-PV (n=158) TTE+F-M-PV (n=157) SE / SP / NPV / PPV / ACC (%) 86 / 89 / 88 / 88 / 88 59 / 99 / 72 / 98 / 79 94 / 88 / 94 / 88 / 91 74 / 90 / 75 / 89 / 81 49 / 96 / 60 / 93 / 70 81 / 86 / 78 / 88 / 83
Figure 1. ROC curves
Conclusions
In patients with clinical suspicion of PVD, TTE and F are both valid tools to evaluate the PV performance. However, the combined model of TTE+F had a significant incremental value over TTE or F alone to diagnose the presence of PVD. This multimodality imaging approach allows to overcome several weaknesses of the TTE or F alone and consequently provides a prompt recognition of PVD even though TOE remains the gold standard to diagnose paravalvular Leak and non-obstructive thrombosis.
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Affiliation(s)
- L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Muratori
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Teruzzi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - E Innocenti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - N Corrieri
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Tamborini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Mapelli
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - F Alamanni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Montorsi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
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40
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Muratori M, Fusini L, Tamborini G, Ghulam Ali S, Gripari P, Fabbiocchi F, Salvi L, Trabattoni P, Roberto M, Agrifoglio M, Alamanni F, Bartorelli AL, Pepi M. Mitral valve regurgitation in patients undergoing TAVI: Impact of severity and etiology on clinical outcome. Int J Cardiol 2019; 299:228-234. [PMID: 31353154 DOI: 10.1016/j.ijcard.2019.07.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/30/2018] [Revised: 06/21/2019] [Accepted: 07/17/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mitral regurgitation (MR) is frequently associated with severe aortic stenosis, but its influence on outcomes after transcatheter aortic valve implantation (TAVI) remains controversial. This study sought to assess the baseline etiology and degree of MR in TAVI population, identify the predictors of MR changes and investigate the clinical and prognostic impact of baseline MR at mid and long-term follow-up. METHODS We enrolled 572 consecutive patients who underwent TAVI. MR degree and etiology were evaluated by echocardiography at baseline and 1-year follow-up. Clinical outcomes were obtained up to 3-year follow-up. RESULTS At baseline, 168 patients (29%) had moderate-to-severe MR (MR ≥ 2). Organic MR was more frequently associated with MR ≥ 2 (MR < 2: 20%, MR ≥ 2: 43%, p < 0.001). Relevant MR had improved more in functional MR (79%) compared to organic MR (50%, p = 0.001). At the multivariate analysis, the coexistence of coronary artery disease (p = 0.026), absence of atrial fibrillation (p = 0.038) and functional etiology (p = 0.025) were predictors of MR improvement after TAVI. Patients with baseline MR ≥ 2 had a higher mortality rate than those with MR < 2 at 1-year and 3-year follow-up. Moreover, a landmark analysis starting from 1-year to 3-year follow-up, demonstrated that organic MR was associated with an increased risk of mortality throughout 3-year follow-up compared with functional MR, irrespective of MR severity. CONCLUSIONS Baseline MR ≥ 2 in TAVI patients was associated with early and late mortality rate. At 1-year, significant improvement in MR severity was observed mainly in patients with functional MR ≥ 2. Organic MR ≥ 2 had a negative impact on 3-year, but not 1-year, mortality rate.
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Affiliation(s)
| | | | | | | | | | | | - Luca Salvi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | - Marco Agrifoglio
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
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Porro B, Songia P, Myasoedova VA, Valerio V, Moschetta D, Gripari P, Fusini L, Cavallotti L, Canzano P, Turnu L, Alamanni F, Camera M, Cavalca V, Poggio P. Endothelial Dysfunction in Patients with Severe Mitral Regurgitation. J Clin Med 2019; 8:jcm8060835. [PMID: 31212807 PMCID: PMC6616454 DOI: 10.3390/jcm8060835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/15/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 01/05/2023] Open
Abstract
Mitral valve prolapse (MVP) is the most common cause of severe mitral regurgitation. It has been reported that MVP patients—candidates for mitral valve repair (MVRep)—showed an alteration in the antioxidant defense systems as well as in the L-arginine metabolic pathway. In this study, we investigate if oxidative stress and endothelial dysfunction are an MVP consequence or driving factors. Forty-five patients undergoing MVRep were evaluated before and 6 months post surgery and compared to 29 controls. Oxidized (GSSG) and reduced (GSH) forms of glutathione, and L-arginine metabolic pathway were analyzed using liquid chromatography-tandem mass spectrometry methods while osteoprotegerin (OPG) through the ELISA kit and circulating endothelial microparticles (EMP) by flow cytometry. Six-month post surgery, in MVP patients, the GSSG/GSH ratio decreased while symmetric and asymmetric dimethylarginines levels remained comparable to the baseline. Conversely, OPG levels significantly increased when compared to their baseline. Finally, pre-MVRep EMP levels were significantly higher in patients than in controls and did not change post surgery. Overall, these results highlight that MVRep completely restores the increased oxidative stress levels, as evidenced in MVP patients. Conversely, no amelioration of endothelial dysfunction was evidenced after surgery. Thus, therapies aimed to restore a proper endothelial function before and after surgical repair could benefit MVP patients.
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Affiliation(s)
- Benedetta Porro
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | - Paola Songia
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | | | - Vincenza Valerio
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80138 Naples, Italy.
| | | | - Paola Gripari
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | - Laura Fusini
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | | | - Paola Canzano
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | - Linda Turnu
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | | | - Marina Camera
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20133 Milan, Italy.
| | - Viviana Cavalca
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | - Paolo Poggio
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
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Guglielmo M, Muscogiuri G, Baggiano A, Guaricci A, Andreini D, Mushtaq S, Conte E, Bonalumi G, Zanobini M, Alamanni F, Pepi M, Pontone G. P163Cardiac magnetic resonance with 4D Flow Imaging for mitral regurgitation severity assessment. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Guglielmo
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - G Muscogiuri
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - A Baggiano
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | | | - D Andreini
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - S Mushtaq
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - E Conte
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - G Bonalumi
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - M Zanobini
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - F Alamanni
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - M Pepi
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - G Pontone
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
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Guglielmo M, Baggiano A, Muscogiuri G, Guaricci AI, Andreini D, Mushtaq S, Conte E, Bonalumi G, Zanobini M, Alamanni F, Pepi M, Pontone G. P600Left ventricle volumes and function assessment with CRM 4D FLOW imaging. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez116.006] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Guglielmo
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - A Baggiano
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - G Muscogiuri
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | | | - D Andreini
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - S Mushtaq
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - E Conte
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - G Bonalumi
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - M Zanobini
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - F Alamanni
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - M Pepi
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
| | - G Pontone
- Monzino Cardiology Center, IRCCS, Milan, Italy, Milan, Italy
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Muratori M, Fusini L, Tamborini G, Gripari P, Ghulam Ali S, Mapelli M, Fabbiocchi F, Trabattoni P, Roberto M, Agrifoglio M, Alamanni F, Bartorelli AL, Pepi M. Five-year echocardiographic follow-up after TAVI: structural and functional changes of a balloon-expandable prosthetic aortic valve. Eur Heart J Cardiovasc Imaging 2019; 19:389-397. [PMID: 28379513 DOI: 10.1093/ehjci/jex046] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 01/27/2017] [Accepted: 02/23/2017] [Indexed: 02/02/2023] Open
Abstract
Aims Scarce data are available on the long-term structural and functional changes of prosthetic valves after transcatheter aortic valve implantation (TAVI). The objective was to evaluate with echocardiography the long-term structural and functional changes of prosthetic valves after TAVI. Methods and results Structural valve deterioration (SVD) was defined as leaflet thickening ≥3mm, presence of calcification and abnormal leaflet motion. Five-year echocardiographic follow-up was available in 96 out of 318 patients who underwent TAVI with a balloon-expandable device between April 2008 and December 2011. At 1-year follow-up, no patient showed SVD. At 5-year follow-up, SVD were observed in 29 (30%) patients who showed also a significant reduction of aortic valve area (AVA) together with an increase of mean and peak aortic pressure gradients at the latest echocardiography evaluation. Moreover, rate of central aortic valve regurgitation ≥2 was higher in SVD patients as compared to those without SVD, while there was no difference in terms of paravalvular regurgitation. Despite SVD, one patient only reached the criteria for severe stenosis and no reintervention was needed at 5-year follow-up. Variables independently associated with SVD were female sex, small body surface area, use of a 23 mm valve, and small AVA at pre-discharge echocardiogram. Conclusion At 5-year follow-up, 30% of patients who underwent TAVI with a balloon-expandable valve showed initial SVD. However, SVD was not associated with severe stenosis in most of the patients and had no significant impact on and clinical outcome.
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Affiliation(s)
- Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Massimo Mapelli
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Franco Fabbiocchi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Piero Trabattoni
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Maurizio Roberto
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Marco Agrifoglio
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, via Commenda 9/12, 20122 Milan, Italy
| | - Francesco Alamanni
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, via Commenda 9/12, 20122 Milan, Italy
| | - Antonio L Bartorelli
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, via G.B. Grassi 74, 20157 Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
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Bogari NM, Aljohani A, Amin AA, Al-Allaf FA, Dannoun A, Taher MM, Elsayed A, Rednah DI, Elkhatee O, Porqueddu M, Alamanni F, Khogeer SAA, Fawzy A. A genetic variant c.553G > T (rs2075291) in the apolipoprotein A5 gene is associated with altered triglycerides levels in coronary artery disease (CAD) patients with lipid lowering drug. BMC Cardiovasc Disord 2019; 19:2. [PMID: 30606120 PMCID: PMC6318928 DOI: 10.1186/s12872-018-0965-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/26/2018] [Accepted: 11/22/2018] [Indexed: 01/08/2023] Open
Abstract
Background Elevated plasma triglycerides (TGs) are widely used as a major cardiovascular risk predictor and are thought to play an important role in the progression of coronary heart disease (CHD). It has been demonstrated that lipid lowering was associated with lower mortality in patients with CHD. The present study therefore aimed to investigate the consequences of the genetic variant c.553G > T (rs2075291) in apolipoprotein A5 gene to determination of triglycerides levels in CAD patients receiving, atorvastatin, lipid lowering drug. Methods We here report that a recently identified genetic variant, c.553G > T in the APOA5 gene which causes a substitution of a cysteine for a glycine residue at amino acid residue 185(G185C) is also associated with increased TG levels. To investigate theses effects, a case-control study compressing 608 subjects from the same area was performed. Results TG levels in T allele patients were significantly lower than the control GT allele patient (χ2 = 2.382E2a, P-value < 0.001). Overall, patients carrying T allele showed lower levels of TG than patients carrying GG allele. The homozygous patient for the T allele presented normal cholesterol levels of 134 mg/dl, and the levels in GG patients ranged from 25 to 340 mg/dl (P-value < 0.001). In summary, we demonstrated that the presence of c.553G > T variant (rs2075291); in APOA5 gene increases human plasma TG levels. Conclusion Nevertheless, T allele is found to reduce TG levels in CAD patients who are on the cholesterol medication, atorvastatin. Thus, c.553G > T variant can be considered as a significant predicator of hypertriglyceridemia. In addition, it could be used as a hallmark for the diagnosis and prognosis of CAD.
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Affiliation(s)
- Neda M Bogari
- Medical Genetics department, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Ashwag Aljohani
- Medical Genetics department, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
| | - Amr A Amin
- Biochemistry Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.,Faculty of Medicine, AinShams University, Giza, Egypt
| | - Faisal A Al-Allaf
- Medical Genetics department, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Anas Dannoun
- Medical Genetics department, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Mohiuddin M Taher
- Medical Genetics department, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.,Science and Technology Unit, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Atalla Elsayed
- ST JAMES'S HOSPITAL-Republic of Ireland, Ireland, Dublin.,Occupational Medicine, the University of Manchester, Manchester, UK
| | | | - Osama Elkhatee
- Department of Cardiology, Dalhousie University Halifax, Halifax, Nova Scotia, Canada
| | - Massimo Porqueddu
- Department of Cardiac Surgery, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Francesco Alamanni
- Department of Cardiac Surgery, Head of Cardiac Surgery, Monzino Heart Center - University of Milan, Milan, Italy
| | - Soud Abdulraof A Khogeer
- Biochemistry Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Ahmed Fawzy
- Division of Human Genetics and Genome Research, Department of Molecular Genetics and human Enzymology, National Research Centre, 33Bohouth St. Dokki, Giza, Egypt.
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Apostolo A, Paolillo S, Contini M, Vignati C, Tarzia V, Campodonico J, Mapelli M, Massetti M, Bejko J, Righini F, Bottio T, Bonini N, Salvioni E, Gugliandolo P, Parati G, Lombardi C, Gerosa G, Salvi L, Alamanni F, Agostoni P. Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance. J Heart Lung Transplant 2018; 37:1361-1371. [DOI: 10.1016/j.healun.2018.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/27/2018] [Accepted: 07/05/2018] [Indexed: 11/24/2022] Open
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Saccocci M, Ricciardi G, Corona S, Previtali I, Zanobini M, Pepi M, Alamanni F. EP20 INTRACARDIAC MASSES. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549959.85712.e5] [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: 11/05/2022]
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Travaglini S, Bonalumi G, Naliato M, Cavallotti L, Dozio A, Alamanni F. RF60 PERICARDIECTOMY. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550083.82072.31] [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: 11/05/2022]
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Ricciardi G, Bonalumi G, Naliato M, Cavallotti L, Manganiello S, Alamanni F. EP15 HOW I DO IT. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549965.37292.47] [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: 11/05/2022]
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50
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Maurizio R, Kassem S, Bonalumi G, Ricciardi G, Naliato M, Salvi L, Brambillasca C, Bertera A, Pedroletti D, Alamanni F. RF04 AORTIC ARCH ANEURYSM. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550060.04051.a9] [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: 11/05/2022]
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