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Spiliopoulos K, Magouliotis D, Xanthopoulos A, Athanasiou T, Skoularigis J. Surgical aortic valve replacement in patients aged <50 years and the choice of the prosthesis used: revisiting of the established practice based on convincing evidence or upon 'comparing apples to oranges'? Eur J Cardiothorac Surg 2024; 65:ezae067. [PMID: 38409674 DOI: 10.1093/ejcts/ezae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/25/2024] [Indexed: 02/28/2024] Open
Affiliation(s)
| | | | | | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Larissa University Hospital, Larissa, Greece
| | - John Skoularigis
- Cardiology Department, Larissa University Hospital, Larissa, Greece
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Abbasciano RG, Magouliotis DE, Koulouroudias M, Spiliopoulos K, Xanthopoulos A, Kourliouros A, Casula R, Athanasiou T, Viviano A. Valve Type and Operative Risks in Surgical Explantation of Transcatheter Aortic Valves: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1262. [PMID: 38592075 PMCID: PMC10932147 DOI: 10.3390/jcm13051262] [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: 01/28/2024] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
Indication to perform surgical explantation of TAVR is becoming increasingly more frequent, due to the higher number of transcatheter procedures performed in patients with longer life expectancy. We proposed to perform a systematic review and meta-analysis with metaregression to identify potential factors that can determine an increase in the high mortality and morbidity that characterize these surgical procedures. MEDLINE and Embase were searched for relevant studies. Twelve studies were eligible according to our inclusion criteria. TAVR explantation was confirmed as a procedure with high 30-day mortality (0.17; 95% CI, 0.14-0.21) and morbidity (stroke incidence 5%; 95% CI, 0.04-0.07; kidney injury incidence 16%; 95% CI, 0.11-0.24). The type of transcatheter valve implanted during the index procedure did not influence the outcomes after surgical explantation. The role of these high-risk operations is growing, and it will likely expand in the coming years. Specific tools for risk stratification are required.
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Affiliation(s)
- Riccardo G. Abbasciano
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (R.G.A.); (R.C.)
- Department of Surgery & Cancer, Imperial College, London SW7 2BX, UK;
| | - Dimitrios E. Magouliotis
- Unit of Quality Improvement, Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Marinos Koulouroudias
- Department of Cardiac Surgery, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 413 34 Larissa, Greece;
| | - Antonios Kourliouros
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (R.G.A.); (R.C.)
| | - Thanos Athanasiou
- Department of Surgery & Cancer, Imperial College, London SW7 2BX, UK;
| | - Alessandro Viviano
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (R.G.A.); (R.C.)
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Bourazana A, Xanthopoulos A, Briasoulis A, Magouliotis D, Spiliopoulos K, Athanasiou T, Vassilopoulos G, Skoularigis J, Triposkiadis F. Artificial Intelligence in Heart Failure: Friend or Foe? Life (Basel) 2024; 14:145. [PMID: 38276274 PMCID: PMC10817517 DOI: 10.3390/life14010145] [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: 11/15/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
In recent times, there have been notable changes in cardiovascular medicine, propelled by the swift advancements in artificial intelligence (AI). The present work provides an overview of the current applications and challenges of AI in the field of heart failure. It emphasizes the "garbage in, garbage out" issue, where AI systems can produce inaccurate results with skewed data. The discussion covers issues in heart failure diagnostic algorithms, particularly discrepancies between existing models. Concerns about the reliance on the left ventricular ejection fraction (LVEF) for classification and treatment are highlighted, showcasing differences in current scientific perceptions. This review also delves into challenges in implementing AI, including variable considerations and biases in training data. It underscores the limitations of current AI models in real-world scenarios and the difficulty in interpreting their predictions, contributing to limited physician trust in AI-based models. The overarching suggestion is that AI can be a valuable tool in clinicians' hands for treating heart failure patients, as far as existing medical inaccuracies have been addressed before integrating AI into these frameworks.
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Affiliation(s)
- Angeliki Bourazana
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, IA 52242, USA
| | - Dimitrios Magouliotis
- Department of Cardiothoracic Surgery, University of Thessaly, 41110 Larissa, Greece; (D.M.); (K.S.)
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, 41110 Larissa, Greece; (D.M.); (K.S.)
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London W2 1NY, UK
| | - George Vassilopoulos
- Department of Hematology, University Hospital of Larissa, University of Thessaly Medical School, 41110 Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
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Chrysakis N, Magouliotis DE, Spiliopoulos K, Athanasiou T, Briasoulis A, Triposkiadis F, Skoularigis J, Xanthopoulos A. Heart Transplantation. J Clin Med 2024; 13:558. [PMID: 38256691 PMCID: PMC10816008 DOI: 10.3390/jcm13020558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 01/24/2024] Open
Abstract
Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA compatibility, graft size, ischemic time, age, infections, and the cause of death, as well as imaging and laboratory tests. In 2018, UNOS changed the organ allocation policy for HTx. The aim of this change was to prioritize patients with a more severe clinical condition resulting in a reduction in mortality of people on the waiting list. Advanced heart failure and resistant angina are among the main indications of HTx, whereas active infection, peripheral vascular disease, malignancies, and increased body mass index (BMI) are important contraindications. The main complications of HTx include graft rejection, graft angiopathy, primary graft failure, infection, neoplasms, and retransplantation. Recent advances in the field of HTx include the first two porcine-to-human xenotransplantations, the inclusion of hepatitis C donors, donation after circulatory death, novel monitoring for acute cellular rejection and antibody-mediated rejection, and advances in donor heart preservation and transportation. Lastly, novel immunosuppression therapies such as daratumumab, belatacept, IL 6 directed therapy, and IgG endopeptidase have shown promising results.
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Affiliation(s)
- Nikolaos Chrysakis
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece; (N.C.); (F.T.)
| | | | - Kyriakos Spiliopoulos
- Department of Surgery, University Hospital of Larissa, 41110 Larissa, Greece (K.S.); (T.A.)
| | - Thanos Athanasiou
- Department of Surgery, University Hospital of Larissa, 41110 Larissa, Greece (K.S.); (T.A.)
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, Faculty of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece; (N.C.); (F.T.)
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece; (N.C.); (F.T.)
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece; (N.C.); (F.T.)
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Spiliopoulos K, Magouliotis D, Angelis I, Skoularigis J, Kemkes BM, Salemis NS, Athanasiou T, Gansera B, Xanthopoulos AV. Concomitant Valve Replacement and Coronary Artery Bypass Grafting Surgery: Lessons from the Past, Guidance for the Future? A Mortality Analysis in 294 Patients. J Clin Med 2023; 13:238. [PMID: 38202244 PMCID: PMC10780271 DOI: 10.3390/jcm13010238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/24/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE The aims of this study were to analyze parameters influencing early and late mortality after concomitant valve replacement and coronary artery bypass grafting surgery, using early and long-term information from an institutionally available data registry, and to discuss the results in relation to the current treatment strategies and perspectives. METHODS The study population consisted of 294 patients after combined valve replacement with mechanical prosthesis and CABG surgery. RESULTS There were 201 men (68.4%) and 93 women (31.6%). Concurrent to the coronary artery bypass grafting, 238 patients (80.9%) underwent aortic-, 46 patients (15.6%) mitral- and 10 patients (3.4%) doublevalve replacement. Cumulative duration of follow up was 1007 patient-years (py) with a maximum of 94 months and was completed in 92.2% (271 cases). Overall hospital mortality (30 days) rate was 6.5% (n = 19). It was significantly higher in patients of female gender, older than 70 y, in those suffering preoperative myocardial infarction, presenting with an additive EuroScore > 8 and being hemodynamically unstable after the operation. Cumulative survival rate at 7.6 y was 78.6%. Determinants of prolonged survival were male gender, age at operation < 70 y, preoperative sinus rhythm, normal renal function, additive EuroScore < 8 and the use of internal thoracic artery for grafting. Subsequent multivariate analysis revealed preoperative atrial fibrillation (HR: 2.1, 95% CI: 0.82-5.44, p: 0.01) and risk group of ES > 8 (HR: 3.63, 95% CI: 1.45-9.07, p < 0.01) as independent predictors for lower long-term survival. CONCLUSIONS Hospital mortality (30 d) was nearly 2.5-fold higher in female and/or older than 70 y patients. Preoperative atrial fibrillation and/ or a calculated ES > 8 were independent predisposing factors of late mortality for combined VR and CABG surgery. Tailoring the approach, with the employment of the newest techniques and hybrid procedures, to the individual patient clinical profile enables favorable outcomes for concomitant valvular disease and CAD, especially in high-risk patients.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (D.M.); (T.A.)
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany (B.G.)
| | - Dimitrios Magouliotis
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (D.M.); (T.A.)
| | - Ilias Angelis
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany (B.G.)
| | - John Skoularigis
- Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (J.S.); (A.V.X.)
| | - Bernhard M. Kemkes
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany (B.G.)
| | | | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (D.M.); (T.A.)
| | - Brigitte Gansera
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany (B.G.)
| | - Andrew V. Xanthopoulos
- Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (J.S.); (A.V.X.)
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Gemelli M, Doulamis IP, Tzani A, Rempakos A, Kampaktsis P, Alvarez P, Guariento A, Xanthopoulos A, Giamouzis G, Spiliopoulos K, Asleh R, Ruiz Duque E, Briasoulis A. Rejection Requiring Treatment within the First Year following Heart Transplantation: The UNOS Insight. J Pers Med 2023; 14:52. [PMID: 38248753 PMCID: PMC10817284 DOI: 10.3390/jpm14010052] [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: 09/30/2023] [Revised: 12/14/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Heart failure is an extremely impactful health issue from both a social and quality-of-life point of view and the rate of patients with this condition is destined to rise in the next few years. Transplantation remains the mainstay of treatment for end-stage heart failure, but a shortage of organs represents a significant problem that prolongs time spent on the waiting list. In view of this, the selection of donor and recipient must be extremely meticulous, considering all factors that could predispose to organ failure. One of the main considerations regarding heart transplants is the risk of graft rejection and the need for immunosuppression therapy to mitigate that risk. In this study, we aimed to assess the characteristics of patients who need immunosuppression treatment for rejection within one year of heart transplantation and its impact on mid-term and long-term mortality. (2) Methods: The United Network for Organ Sharing (UNOS) Registry was queried to identify patients who solely underwent a heart transplant in the US between 2000 and 2021. Patients were divided into two groups according to the need for anti-rejection treatment within one year of heart transplantation. Patients' characteristics in the two groups were assessed, and 1 year and 10 year mortality rates were compared. (3) Results: A total of 43,763 patients underwent isolated heart transplantation in the study period, and 9946 (22.7%) needed anti-rejection treatment in the first year. Patients who required treatment for rejection within one year after transplant were more frequently younger (49 ± 14 vs. 52 ± 14 years, p < 0.001), women (31% vs. 23%, p < 0.001), and had a higher CPRA value (14 ± 26 vs. 11 ± 23, p < 0.001). Also, the rate of prior cardiac surgery was more than double in this group (27% vs. 12%, p < 0.001), while prior LVAD (12% vs. 11%, p < 0.001) and IABP (10% vs. 9%, p < 0.01) were more frequent in patients who did not receive anti-rejection treatment in the first year. Finally, pre-transplantation creatinine was significantly higher in patients who did not need treatment for rejection in the first year (1.4 vs. 1.3, p < 0.01). Most patients who did not require anti-rejection treatment underwent heart transplantation during the new allocation era, while less than half of the patients who required treatment underwent transplantation after the new allocation policy implementation (65% vs. 49%, p < 0.001). Patients who needed rejection treatment in the first year had a higher risk of unadjusted 1 year (HR: 2.25; 95% CI: 1.88-2.70; p < 0.001), 5 year (HR: 1.69; 95% CI: 1.60-1.79; p < 0.001), and 10 year (HR: 1.47; 95% CI: 1.41-1.54, p < 0.001) mortality, and this was confirmed at the adjusted analysis at all three time-points. (4) Conclusions: Medical treatment of acute rejection was associated with significantly increased 1 year mortality compared to patients who did not require anti-rejection therapy. The higher risk of mortality was confirmed at a 10 year follow-up. Further studies and newer follow-up data are required to investigate the role of anti-rejection therapy in the heart transplant population.
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Affiliation(s)
- Marco Gemelli
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padua, 35122 Padova, Italy; (M.G.); (A.G.)
| | - Ilias P. Doulamis
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA;
| | - Aspasia Tzani
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Athanasios Rempakos
- Medical School of Athens, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Polydoros Kampaktsis
- Division of Cardiology, Columbia University Irving Medical Center, New York City, NY 10032, USA;
| | - Paulino Alvarez
- Division of Cardiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Alvise Guariento
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padua, 35122 Padova, Italy; (M.G.); (A.G.)
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, 413 34 Larissa, Greece; (A.X.); (G.G.)
| | - Grigorios Giamouzis
- Department of Cardiology, University General Hospital of Larissa, 413 34 Larissa, Greece; (A.X.); (G.G.)
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, 412 23 Larissa, Greece;
| | - Rabea Asleh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA;
- Heart Institute, Hadassah University Medical Center, Jerusalem 9112001, Israel
| | - Ernesto Ruiz Duque
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, IA 52242, USA;
| | - Alexandros Briasoulis
- Medical School of Athens, National and Kapodistrian University of Athens, 157 72 Athens, Greece
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, IA 52242, USA;
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Spiliopoulos K, Fludas I, Xanthopoulos A, Magouliotis D, Zotos PA, Salemis NS, Athanasiou T, Schmid FX. New challenges for the surgeon in the modern era of transcatheter aortic valves: Early single center experience of their surgical explantation. Hellenic J Cardiol 2023; 74:77-80. [PMID: 37690523 DOI: 10.1016/j.hjc.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Cardiac Surgery, Helios Klinikum Krefeld, Germany; Department of Cardiothoracic Surgery, University of Thessaly, Larissa, Greece.
| | - Iraklis Fludas
- Department of Anesthesiology and Intensive Care, Helios Klinikum Krefeld, Germany
| | | | | | | | | | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, University of Thessaly, Larissa, Greece
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Spiliopoulos K, Magouliotis D, Xanthopoulos A, Salemis NS. Infective Endocarditis: Controversies and Convictions in the Surgical Treatment. Braz J Cardiovasc Surg 2023; 38:e20230014. [PMID: 37797246 PMCID: PMC10549764 DOI: 10.21470/1678-9741-2023-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, Larissa, Greece. E-mail:
| | - Dimitrios Magouliotis
- Department of Perfusion Technology, Manipal College of Health Professions, Manipal, Karnataka, India
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Suzuki S, Kitai T, Skoularigis J, Spiliopoulos K, Xanthopoulos A. Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure: Current Evidence and Future Opportunities. J Pers Med 2023; 13:1394. [PMID: 37763161 PMCID: PMC10532515 DOI: 10.3390/jpm13091394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Atrial fibrillation (AF) and heart failure (HF) are highly prevalent cardiac disorders worldwide, and both are associated with poor prognosis. The incidence of AF and HF has been increasing substantially in recent years, mainly due to the progressive aging of the population. These disorders often coexist, and may have a causal relationship, with one contributing to the development or progression of the other. AF is a significant risk factor for adverse outcomes in HF patients, including mortality, hospitalization, and stroke. Although the optimal treatment for AF with HF remains unclear, catheter ablation (CA) has emerged as a promising treatment option. This review provides a comprehensive overview of the current scientific evidence regarding the efficacy of CA for managing AF in HF patients. In addition, the potential benefits and risks associated with CA are also discussed. We will also explore the factors that may influence treatment outcomes and highlight the remaining gaps in knowledge in this field.
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Affiliation(s)
- Sho Suzuki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano 390-8621, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
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Magouliotis DE, Sgantzou I, Salemis NS, Rountas C, Samara A, Zotos PA, Athanasiou T, Spiliopoulos K. Pneumomediastinum: Experience with 87 Patients. Acta Med Acad 2023; 52:88-94. [PMID: 37933505 DOI: 10.5644/ama2006-124.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/27/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE The aim of the present series was first to present our experience in the management of 37 patients with spontaneous pneumomediastinum (SPM), and further to indicate the necessity of identifying true SPM cases as they are currently inadequately defined. METHODS This is a single-center, retrospective study, conducted in a university hospital. Consecutive adult patients with pneumomediastinum (PM) between January 2009 and March 2020 were involved in the series. The data about age, gender, symptoms, signs, treatment, length of hospital stay (LOS), and in-hospital mortality were evaluated. RESULTS In total, 87 cases with pneumomediastinum (37 with spontaneous and 50 with secondary PM) were analyzed. Patients in both groups were of similar ages (P=0.4). Sufferers with secondary PM were more likely to have: an associated pneumothorax (19% vs 58%, P<0.05), a chest tube placed (18.9% vs 58%, P<0.05), an associated pleural effusion (0% vs 18%, P<0.05). They presented with a longer LOS (3.9 vs 5.3 days, P<0.05), and were more likely to die (0% vs 10%, P<0.05). Additionally they showed a higher prevalence of radiologic subcutaneous emphysema (49% vs 74%, P<0.05). CONCLUSION Spontaneous pneumomediastinum is an onset of clinical importance with a low mortality rate, short LOS and good longterm prognosis. It often presents with chest pain, dyspnea and/or subcutaneous emphysema. However, secondary causes of mediastinal air must be ruled out, due to their potential devastating outcome if not diagnosed promptly. A consensus aimed at an update of the classification guidelines is more than indispensable.
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Affiliation(s)
| | - Ioanna Sgantzou
- Department of Radiology, University of Thessaly, Larissa, Greece
| | | | - Christos Rountas
- Department of Radiology, University of Thessaly, Larissa, Greece
| | - Athina Samara
- Department of Radiology, University of Thessaly, Larissa, Greece
| | | | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, University of Thessaly, Larissa, Greece
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Frisiras A, Giannas E, Bobotis S, Kanella I, Arjomandi Rad A, Viviano A, Spiliopoulos K, Magouliotis DE, Athanasiou T. Comparative Analysis of Morbidity and Mortality Outcomes in Elderly and Nonelderly Patients Undergoing Elective TEVAR: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5001. [PMID: 37568406 PMCID: PMC10420243 DOI: 10.3390/jcm12155001] [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: 06/11/2023] [Revised: 07/14/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE Due to an ever-increasing ageing population and limited available data around the use of thoracic endovascular aortic repair (TEVAR) in elderly patients, investigating its efficacy and safety in this age cohort is of vital importance. We thus reviewed the existing literature on this topic to assess the feasibility of TEVAR in elderly patients with severe thoracic aortic pathologies. METHODS We identified all original research studies that assessed TEVAR in elderly patients published up to 2023. Morbidity, as assessed by neurological and respiratory complications, endoleaks, and length of stay, was the primary endpoint. Short-term mortality and long-term survival were the secondary endpoints. The Mantel-Haenszel random and fixed effects methods were used to calculate the odds ratios for each outcome. Further sensitivity and subgroup analyses were performed to validate the outcomes. RESULTS Twelve original studies that evaluated elective TEVAR outcomes in elderly patients were identified. Seven studies directly compared the use of TEVAR between an older and a younger patient group. Apart from a shorter hospital stay in older patients, no statistically significant difference between the morbidity outcomes of the two different cohorts was found. Short-term mortality and long-term survival results favoured the younger population. CONCLUSIONS The present meta-analysis indicates that, due to a safe perioperative morbidity profile, TEVAR should not be contraindicated in patients based purely on old age. Further research using large patient registries to validate our findings in elderly patients with specific aortic pathologies and both elective and emergency procedures is necessary.
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Affiliation(s)
- Angelos Frisiras
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | - Emmanuel Giannas
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | - Stergios Bobotis
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | - Ilektra Kanella
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | | | - Alessandro Viviano
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London W12 0HS, UK;
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Dimitrios E. Magouliotis
- Unit of Quality Improvement, Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London W2 1NY, UK
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12
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Magouliotis DE, Fergadi MP, Zotos PA, Rad AA, Xanthopoulos A, Bareka M, Spiliopoulos K, Athanasiou T. Differences in long-term survival outcomes after coronary artery bypass grafting using single vs multiple arterial grafts: a meta-analysis with reconstructed time-to-event data and subgroup analyses. Gen Thorac Cardiovasc Surg 2023; 71:77-89. [PMID: 36394709 PMCID: PMC9886578 DOI: 10.1007/s11748-022-01891-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We reviewed the available literature on patients with coronary artery disease undergoing isolated coronary artery bypass grafting (CABG) with either single (SAG) or multiple arterial grafting (MAG). METHODS Original research studies that evaluated the long-term survival of MAG versus SAG were identified, from 1995 to 2022. The median overall survival (OS) and event-free OS were the primary endpoints. Comparison of median OS between the right internal mammary artery (RIMA) and radial artery (RA) as a second arterial conduit was the secondary endpoint. Subgroup analyses were performed regarding patients older than 70 years, with diabetes mellitus, and females. A sensitivity analysis was performed with the leave-one-out method. RESULTS Forty-four studies were included in the qualitative and thirty-nine in the quantitative synthesis. After pooling data from 180 to 459 patients, the MAG group demonstrated a higher OS (HR, 0.589; 95% CI, 0.58-0.60; p < 0.0001) and event-free OS compared with the SAG group (HR, 0.828; 95% CI, 0.80-0.86; p < 0.0001). In addition, RITA was associated with superior OS compared with RA as a second arterial conduit (HR, 0.936; 95% CI, 0.89-0.98; p = 0.009). MAG was also superior to SAG in patients over 70 years, females, and patients with diabetes mellitus. Sensitivity analysis demonstrated a small-size study effect on the female subgroup analysis. CONCLUSION The present meta-analysis indicates that MAG is associated with enhanced survival outcomes compared to SAG for patients undergoing isolated CABG.
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Affiliation(s)
| | - Maria P. Fergadi
- Department of Radiology, University of Thessaly, Larissa, Greece
| | - Prokopis-Andreas Zotos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | | | | | - Metaxia Bareka
- Department of Anesthesiology, University of Thessaly, Larissa, Greece
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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13
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Magouliotis DE, Zotos PA, Karamolegkou AP, Tatsios E, Spiliopoulos K, Athanasiou T. Long-Term Survival after Extended Sleeve Lobectomy (ESL) for Central Non-Small Cell Lung Cancer (NSCLC): A Meta-Analysis with Reconstructed Time-to-Event Data. J Clin Med 2022; 12:jcm12010204. [PMID: 36615005 PMCID: PMC9821210 DOI: 10.3390/jcm12010204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE We conducted a thorough literature search on patients with central non-small cell lung cancer (NSCLC) undergoing either extended sleeve lobectomy (ESL) or pneumonectomy (PN). METHODS We identified all original research studies that compared the long-term survival of ESL versus PN from 1990 to 2022. The primary endpoints were the median overall survival (OS) and disease-free survival (DFS). Complications, operative mortality, and the reoperation rate were the secondary endpoints. Regarding the primary endpoints, independent patient data were extracted from the included studies, and pooled Kaplan-Meier curves were constructed. A sensitivity analysis was performed using the leave-one-out method. RESULTS Nine studies were included in the qualitative and seven in the quantitative synthesis, including 431 patients. Patients in the ESL group demonstrated a significantly higher OS compared with the PN group (HR, 0.63; 95% CI, 0.46-0.87; p = 0.005). In addition, patients undergoing ESL presented a significantly higher DFS compared to the PN group (HR, 0.57; 95% CI, 0.40-0.80; p = 0.004). These findings were further validated with a sensitivity analysis. The most common complications in the ESL group were bronchopleural fistula (4.6%), stricture (3.1%), prolonged air leakage (7.3%), sputum retention (4.6%), pneumonia (7.7%), and pulmonary vein thrombosis (1.5%). ESL was associated with a low reoperation rate (1.5%) and operative mortality (1.2%). CONCLUSIONS The present meta-analysis indicates that ESL is associated with enhanced survival outcomes compared to PN for patients with central NSCLC. Further randomized controlled trials are necessary to validate our findings.
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Affiliation(s)
- Dimitrios E. Magouliotis
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece
- Correspondence:
| | - Prokopis-Andreas Zotos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Anna P. Karamolegkou
- Department of Anesthesiology, Hippocration General Hospital of Athens, 41500 Athens, Greece
| | - Evangelos Tatsios
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London W2 1NY, UK
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14
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Bezemek Z, Spiliopoulos K. Rate of homogenization for fully-coupled McKean-Vlasov SDEs. STOCH DYNAM 2022. [DOI: 10.1142/s0219493723500132] [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: 11/10/2022]
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15
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Bezemek Z, Spiliopoulos K. Large deviations for interacting multiscale particle systems. Stoch Process Their Appl 2022. [DOI: 10.1016/j.spa.2022.09.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Salemis NS, Christofyllakis C, Spiliopoulos K. Primary breast carcinoma en cuirasse. A rare presentation of an aggressive malignancy and review of the literature. Breast Dis 2021; 39:155-159. [PMID: 33252056 DOI: 10.3233/bd-201020] [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] [Indexed: 12/30/2022]
Abstract
Breast carcinoma en cuirasse is a very rare form of cutaneous metastases of breast cancer. The clinical presentation is that of a diffuse indurated carcinomatous infiltration of the skin and subcutaneous tissues of the mammary region and the anterior aspect of the chest. In most cases, breast carcinoma en cuirasse develops post-mastectomy and represents a dramatic presentation of an aggressive tumor associated with a dismal prognosis. Because of the rarity of this type of malignancy, the optimal approach to treatment has not been clearly defined. The systemic treatment has been associated with limited efficacy, and the primary goal is palliative care and preservation of the quality of life through skin-directed therapies. Herein, a very rare case of primary breast carcinoma en cuirasse is presented, along with a review of the literature. Early diagnosis and prompt treatment of any potential skin metastases of breast cancer are essential to prevent the catastrophic natural progression of the disease.
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Affiliation(s)
- Nikolaos S Salemis
- Breast Caner Surgery Unit, Army General Hospital, Athens, Greece.,IASO Women's Hospital, Athens, Greece.,IASO Thessalias Hospital, Larissa, Greece
| | | | - Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, Larissa University Hospital, Larissa, Greece
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17
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Spiliopoulos K, Anyfantakis ZA, Diminikos I, Xanthopoulos A, Magouliotis DE, Skoularigis J, Triposkiadis F. Acute myocardial infarction not attributed to coronary artery disease: A seldom initial presentation of a left ventricular myxoma. Clin Case Rep 2021; 9:e04029. [PMID: 34084484 PMCID: PMC8142312 DOI: 10.1002/ccr3.4029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/03/2020] [Revised: 01/22/2021] [Accepted: 02/18/2021] [Indexed: 12/02/2022] Open
Abstract
Although myxoma represents the most frequent non-malignant cardiac primary tumor; it is extremely rare met in the left ventricle. Clinical features of the neoplasm extend from symptomless to critical signs of either ischemia or embolism. We describe here an unusual case of a huge left ventricular myxoma in a 68-year-old man, presented with clinical and ECG findings of an inferior wall myocardial infarction. The patient was primarily referred to our institution for coronary angiography, which showed no coronary artery disease. Further examinations revealed a left ventricular mass as the possible source of embolization, thus the patient underwent surgery for tumor excision. The postoperative course was unremarkable. A bibliographical analysis demonstrated that those tumors are rare but treatable causes of embolic myocardial infarction, thus profound clinical intuition, proper utilization of imaging modalities, administration of anticoagulants preoperatively, as well immediate surgical removal are justified.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular SurgeryFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Zacharias A. Anyfantakis
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Ilias Diminikos
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Andrew Xanthopoulos
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Dimitrios E. Magouliotis
- Department of SurgeryFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - John Skoularigis
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Filippos Triposkiadis
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
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18
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Spiliopoulos K, Magouliotis D, Angelis I, Gansera B. Bilateral internal thoracic artery grafting: time to reconsider our strategy? Eur J Cardiothorac Surg 2021; 59:928-929. [PMID: 33067631 DOI: 10.1093/ejcts/ezaa338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/13/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios Magouliotis
- Department of Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ilias Angelis
- Department of Cardiac Surgery, European Interbalkan Medical Center, Thessaloniki, Greece
| | - Brigitte Gansera
- Department of Cardiac Surgery, Chirurgisches Klinikum München Süd, Munich, Germany
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19
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Magouliotis D, Fergadi M, Spiliopoulos K, Athanassiadi K. FP01.01 Uniportal Versus Multiportal Video-Assisted Thoracoscopic Surgery for Non-Small Cell Lung Cancer: An Updated Meta-Analysis. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.068] [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: 11/15/2022]
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20
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Spiliopoulos K, Engels P, Kimpouri K, Floudas I, Salemis NS, Schmid FX. The Current Role of Surgery in the Treatment of Cardiac Metastases from Malignant Melanoma: an Educational Presentation. Braz J Cardiovasc Surg 2021; 36:112-115. [PMID: 33438848 PMCID: PMC7918379 DOI: 10.21470/1678-9741-2020-0379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 12/19/2022] Open
Abstract
A 71 year-old male with a history of multiple excisions of an initial Clark's level V melanoma of the breast followed by combined radiation and interferon treatment, as well as a recurrence, 3 years later, of a BRAF-positive tumor of the shoulder, with subsequent therapy with dabrafenib and trametinib, presented again with progressive intracardiac masses causing significant right ventricular outflow obstruction. Additionally, the patient complained of dyspnea and fatigue on exertion, thus he was scheduled for surgical resection.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Cardiac Surgery, Helios Klinikum Krefeld, Germany.,Department of Thoracic and Cardiovascular Surgery, University of Thessaly, Larissa, Greece
| | - Peter Engels
- Department of Cardiac Surgery, Helios Klinikum Krefeld, Germany
| | | | - Iraklis Floudas
- Department of Cardiac Surgery, Helios Klinikum Krefeld, Germany
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21
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Magouliotis DE, Fergadi MP, Spiliopoulos K, Athanassiadi K. Uniportal Versus Multiportal Video-Assisted Thoracoscopic Lobectomy for Lung Cancer: An Updated Meta-analysis. Lung 2021; 199:43-53. [PMID: 33388973 PMCID: PMC7929953 DOI: 10.1007/s00408-020-00411-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 07/21/2020] [Accepted: 12/02/2020] [Indexed: 12/30/2022]
Abstract
Objective We reviewed the available literature on patients with lung cancer undergoing either uniportal (UVATS) or multiport video-assisted thoracoscopic surgery (MVATS). Methods Original research studies that evaluated perioperative and long-term outcomes of UVATS versus MVATS were identified, from January 1990 to April 2020. The perioperative, along with the oncologic and long-term survival outcomes, were calculated according to either a fixed or a random effect model, appropriately. The Q statistics and I2 statistic were used to test for heterogeneity among the studies. Results Twenty studies were included, incorporating a total of 1,469 patients treated with UVATS and 3,231 treated with MVATS. The incidence of complications was lower in patients treated with UVATS [OR: 0.76 (95% CI 0.62, 0.93); p = 0.008]. The chest tube duration was significantly lower in the UVATS group (WMD: − 0.63 [95% CI − 1.03, − 0.23]; p = 0.002). Length of hospital stay (L.O.S.) was also lower in the UVATS patient group (WMD: − 0.54 [− 0.94, − 0.13]; p = 0.009), along with postoperative pain [WMD: − 0.57 (95% CI − 0.97, − 0.18); p = 0.004]. No significant differences were found regarding the mean operative time (M.O.T.), mean blood loss, the number of resected lymph nodes, the 30-day mortality, along with the survival at 1 and 3 years postoperatively. Conclusions The present meta-analysis indicates that UVATS is associated with enhanced outcomes in patients undergoing surgery for lung cancer. Well-designed, randomized studies, comparing UVATS to MVATS, are necessary to further assess their long-term clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00408-020-00411-9.
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Affiliation(s)
- Dimitrios E Magouliotis
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, UK. .,Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece. .,Unit of Thoracic Surgery, Evangelismos Hospital, Athens, Greece.
| | - Maria P Fergadi
- Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, Larissa University Hospital, Larissa, Greece
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22
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Salemis NS, Koliarakis N, Spiliopoulos K, Kimpouri K, Marinos L. Primary cutaneous follicle center lymphoma of the breast: Management of an exceedingly rare malignancy. Intractable Rare Dis Res 2020; 9:263-265. [PMID: 33139988 PMCID: PMC7586880 DOI: 10.5582/irdr.2020.03095] [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] [Indexed: 11/05/2022] Open
Abstract
Primary cutaneous follicle center lymphoma (PCFCL) is defined as a low-grade B-cell non- Hodgkins lymphoma, which primarily occurs and remains confined to the skin, without evidence of extracutaneous or systemic involvement at the time of diagnosis. PCFCL affecting the breast skin is an exceedingly rare entity with only two cases reported in the English literature. We present a case of PCFCL affecting the periareolar breast skin and review the relevant literature. Our patient was a 64-year-old female who presented with an erythematous plaque in the periareolar region of the left breast. The diagnosis of PCFCL was confirmed by a biopsy performed with a seven-month delay, as the tumor had been initially misdiagnosed as a benign lesion. The patient was successfully treated with local radiation therapy. PCFCL is an indolent lymphoma associated with an excellent prognosis. For localized lesions, skin-directed therapies mainly consisting of radiation therapy or complete surgical excision are curative therapeutic approaches, while systemic chemotherapy should be reserved for patients with extensive disease. This case highlights the need to consider PCFCL as an important differential diagnosis in patients presenting with non-resolving erythematous breast skin lesions. A timely biopsy should be obtained to avoid delays in the initiation of appropriate treatment.
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Affiliation(s)
- Nikolaos S. Salemis
- Breast Cancer Surgery Unit, Army General Hospital, Athens, Greece
- IASO Women's Hospital, Athens, Greece
- IASO Thessalias Hospital, Larissa, Greece
- Address correspondence to:Nikolaos S. Salemis, Breast Cancer Surgery, Army General Hospital, 19 Taxiarhon Street, 19014 Kapandriti, Athens, Greece. E-mail:
| | - Nikolaos Koliarakis
- Department of Radiation Oncology, Andreas Syggros Hospital of Dermatology and Venereology, Athens, Greece
| | - Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, Larissa University Hospital, Larissa, Greece
| | | | - Leonidas Marinos
- Department of Haematopathology, Evaggelismos General Hospital, Athens, Greece
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23
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Spiliopoulos K, Schmid FX. A technique to resect the Edwards SAPIEN 3 Transcatheter Heart Valve 18 months after implantation in case of surgical aortic valve replacement. Gen Thorac Cardiovasc Surg 2020; 69:774-777. [PMID: 33108610 DOI: 10.1007/s11748-020-01529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) evolved to an established treatment for meanwhile moderate-risk surgical patients suffering from severe aortic stenosis. Due to its less invasiveness, avoiding the use of cardiopulmonary bypass, the procedure demonstrated to be an efficient and safe treatment option. However, long-term results regarding these new valve prostheses are still lacking. Potential prosthesis failure and/ or dysfunction would require either, if feasible, a transcatheter "valve in valve" procedure, or a conventional surgical valve replacement. In the literature, anecdotal reports are describing surgical removal techniques of the currently transcatheter-implanted prostheses. We herein propose a modified surgical removal technique of an infected Edwards SAPIEN 3 Transcatheter Heart Valve 18 months after its implantation.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Cardiac Surgery, Helios Klinikum Krefeld, Krefeld, Germany. .,Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Thessaly, Panepistimiou 3 (Viopolis), Post Box 1400, 41500, Larissa, Greece.
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24
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Salemis NS, Nakos G, Stavrinou N, Spiliopoulos K. Metastatic brachial plexopathy as the initial manifestation of breast cancer. Breast J 2020; 26:2409-2411. [PMID: 33089592 DOI: 10.1111/tbj.14096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Nikolaos S Salemis
- Breast Cancer Surgery Unit, Army General Hospital, Athens, Greece.,IASO Women's Hospital, Athens, Greece.,IASO Thessalias Hospital, Larissa, Greece
| | - Georgios Nakos
- Department of Pathology, Army General Hospital, Athens, Greece
| | | | - Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, Larissa University Hospital, Larissa, Greece
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25
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Spiliopoulos K, Tsantsaridou A, Magouliotis DE, Charisi E, Kimpouri K, Salemis NS. Spontaneous Pneumomediastinum in a Teenager After Physical Exercise: a Benign and Rare, but Sometimes Challenging, Entity. Med Arch 2020; 74:315-317. [PMID: 33041453 PMCID: PMC7520064 DOI: 10.5455/medarh.2020.74.315-317] [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] [Indexed: 11/03/2022] Open
Abstract
Introduction Pneumomediastinum defines a condition in which free air is present in the mediastinum usually caused by alveolar rupture resulting from a sudden increase in the intrathoracic pressure and air tracking along the tracheobronchial tree. Case report We present a case of a 16-year-old male patient referred to our department due to persisting odynophagia, and retrosternal chest pain. A performed chest-CT revealed presence of free air in the mediastinum, without evidence of pneumothorax, or subcutaneous emphysema. Under the diagnosis of spontaneous pneumomediastinum (SPM) the treatment included conservative therapy with analgesics, rest, and oxygen. Conclusion SPM is a rare benign condition with nonspecific presenting clinical signs; thus its diagnosis remains mostly one of exclusion. Thorough history-taking, beside radiographic studies, may be the key to confirm the diagnosis.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, General University Hospital of Larissa, Larissa, Greece
| | - Angeliki Tsantsaridou
- Department of Thoracic and Cardiovascular Surgery, General University Hospital of Larissa, Larissa, Greece
| | | | - Evangeli Charisi
- Department of Thoracic and Cardiovascular Surgery, General University Hospital of Larissa, Larissa, Greece
| | | | - Nikolaos S Salemis
- Breast Unit, 2nd Department of Surgery, Army General Hospital, Athens, Greece
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26
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Spiliopoulos K, Magouliotis DE, Spanos K, Salemis NS, Tsantsaridou A, Karagiorgas G, Giannoukas AD, Rountas C. Facing a dilemma in the treatment of an internal mammary artery mycotic pseudoaneurysm: coil embolization or surgery? A case report and brief literature review. J Surg Case Rep 2020; 2020:rjaa271. [PMID: 32874543 PMCID: PMC7449557 DOI: 10.1093/jscr/rjaa271] [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: 06/01/2020] [Revised: 06/26/2020] [Accepted: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
While aneurysms of the internal mammary artery (IMA) complicate occasionally surgical procedures employing median sternotomy, or are associated with direct thoracic trauma, mycotic pseudoaneurysms of the vessel are rarely reported in the literature. We herein report a case of a 22-year-old man who developed a mycotic internal mammary artery pseudoaneurysm secondary to staphylococcal chest wall abscesses and was effectively treated by coil embolization. Additionally, the report provides a brief review focusing on the current state of treatment options for internal mammary artery aneurysms.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios E Magouliotis
- Department of Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Spanos
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | | - Angeliki Tsantsaridou
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Georgios Karagiorgas
- Department of Radiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christos Rountas
- Department of Radiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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27
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Spiliopoulos K, Skoularigis J, Triposkiadis F. Surgery for infective endocarditis: old problem-still unanswered questions? Eur J Cardiothorac Surg 2020; 57:1016. [PMID: 31930306 DOI: 10.1093/ejcts/ezz362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/06/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, Larissa University Hospital, Larissa, Greece
| | - John Skoularigis
- Cardiology Department, Larissa University Hospital, Larissa, Greece
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Spanos K, Spiliopoulos K, Giannoukas AD, Mavroforou A. The importance of informed consent when elderly patients refuse aortic valve replacement. J Cardiovasc Surg (Torino) 2020; 61:520-521. [PMID: 32319273 DOI: 10.23736/s0021-9509.20.11324-7] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kostas Spanos
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece -
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Anna Mavroforou
- Department of Medical Ethics, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Magouliotis DE, Spiliopoulos K, Fergadi MP, Athanassiadi K. Novel Candidate Genes of the Bcl-2 Interactome as Mediators of Apoptosis in Lung Transplant Recipients With Primary Graft Dysfunction. Prog Transplant 2020; 30:184-186. [PMID: 32238051 DOI: 10.1177/1526924820913517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dimitrios E Magouliotis
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, United Kingdom.,Department of Surgery, University of Thessaly, Biopolis, Larissa, Greece.,Unit of Thoracic Surgery, Evangelismos Hospital, Athens, Greece
| | - Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, Larissa University Hospital, Larissa, Greece
| | - Maria P Fergadi
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
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Spiliopoulos K, Magouliotis D, Skoularigis J, Triposkiadis F. Comments on "Treatment of Pericardial Effusion Through Subxiphoid Tube Pericardiostomy and Computerized Tomography - Or Echocardiography - Guided Percutaneous Catheter Drainage Methods". Braz J Cardiovasc Surg 2019; 34:642. [PMID: 31719019 PMCID: PMC6852451 DOI: 10.21470/1678-9741-2019-0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kyriakos Spiliopoulos
- Larissa University Hospital Department of Thoracic and Cardiovascular Surgery Larissa Greece Department of Thoracic and Cardiovascular Surgery, Larissa University Hospital, Larissa, Greece
| | - Dimitrios Magouliotis
- Larissa University Hospital Department of Surgery Larissa Greece Department of Surgery, Larissa University Hospital, Larissa, Greece
| | - John Skoularigis
- Larissa University Hospital Cardiology Department Larissa Greece Cardiology Department, Larissa University Hospital, Larissa, Greece
| | - Filippos Triposkiadis
- Larissa University Hospital Cardiology Department Larissa Greece Cardiology Department, Larissa University Hospital, Larissa, Greece
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Magouliotis D, Tasiopoulou V, Spiliopoulos K, Svokos K, Svokos A, Athanassiadi K. Differential gene expression of aquaporins (AQP) in lung transplant recipients with acute lung rejection. Transplantation 2018. [DOI: 10.1183/13993003.congress-2018.pa2596] [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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Deutsch O, Rippinger N, Spiliopoulos K, Eichinger W, Gansera B. "Blame it on the Comorbidities": A 5-Year Follow-Up of 53 Chronic Dialysis-Dependent Patients Who Underwent Cardiac Surgery. Thorac Cardiovasc Surg 2015; 64:548-554. [PMID: 25785766 DOI: 10.1055/s-0034-1543979] [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: 10/23/2022]
Abstract
Objectives This study evaluates midterm survival rates and risk factors for mortality of chronic dialysis-dependent patients undergoing cardiac surgery. Methods Fifty-three dialysis-dependent patients (34 males, aged 67 ± 12 years) with end-stage renal disease operated within March 2007 and May 2012 were analyzed retrospectively. Survival rates were calculated using Kaplan-Meier methods. Predictors of midterm survival were identified with multivariate Cox-regression analysis. Results Twenty-three patients received isolated coronary artery bypass graft surgery, 17 received isolated valve replacement, and 13 received combined procedures. Thirty-day mortality was 24.5% (n = 13). Follow-up was complete for 94.3% (n = 50). Survival rates at 1, 3, and 5 years were: 82, 50, and 17%, respectively. Neither age, gender, poor ejection fraction, emergency, ECC/X-clamp (cross-clamp) time, nor use of left internal thoracic artery or right internal thoracic artery had any influence on midterm survival. Causes of death within midterm follow-up period were related to cardiac events in 16% and neurological events in 16%. In the majority (47%), cause of death was associated with peripheral arterial disease (PAD).The only comorbidity, which could be identified as a significant risk factor, was PAD (p = 0.035). Five patients underwent successful renal transplantation within the follow-up period. Conclusion Although 30-day mortality in this high-risk patient population was increased, midterm survival rates were comparable to the results described in the literature. Cause of death within midterm follow-up period was mostly noncardiac related. Given the limited number of patients, predictors for enhanced 30-day mortality, such as preoperative myocardial infarction, prolonged extracorporeal circulation, operation time, and diabetes mellitus, did not have an influence on midterm survival.
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Affiliation(s)
- Oliver Deutsch
- Department of Cardiac Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany
| | - Nathalie Rippinger
- Department of Cardiac Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany
| | | | - Walter Eichinger
- Department of Cardiac Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany
| | - Brigitte Gansera
- Department of Cardiac Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany
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Spiliopoulos K, Deutsch O, Eichinger W, Gansera B. Comments on "Impact of type of procedure and surgeon on EuroSCORE operative risk validation". Braz J Cardiovasc Surg 2015; 29:667. [PMID: 25714225 PMCID: PMC4408834 DOI: 10.5935/1678-9741.20140120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kyriakos Spiliopoulos
- Klinikum München Bogenhausen GmbH, Munich, Germany Department of Thoracic and Cardiovascular Surgery, University of Thessaly
| | - Oliver Deutsch
- Department of Cardiovascular Surgery, Klinikum München Bogenhausen GmbH, Munich, Germany
| | - Walter Eichinger
- Department of Cardiovascular Surgery, Klinikum München Bogenhausen GmbH, Munich, Germany
| | - Brigitte Gansera
- Department of Cardiovascular Surgery, Klinikum München Bogenhausen GmbH, Munich, Germany
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Spiliopoulos K, Gansera L, Weiland HC, Schuster T, Eichinger W, Gansera B. Chronic stress and coping among cardiac surgeons: a single center study. Braz J Cardiovasc Surg 2014; 29:308-15. [PMID: 25372902 PMCID: PMC4412318 DOI: 10.5935/1678-9741.20140083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/12/2013] [Accepted: 06/22/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction Cardiac surgeons stress may impair their quality of life and professional
practice. Objective To assess perceived chronic stress and coping strategies among cardiac surgeons.
Methods Twenty-two cardiac surgeons answered two self-assessment questionnaires, the Trier
Inventory for Chronic Stress and the German SGV for coping strategies. Results Participants mean age was 40±14.1 years and 13 were male; eight were senior
physicians and 14 were residents. Mean values for the Trier Inventory for Chronic
Stress were within the normal range. Unexperienced physicians had significantly
higher levels of dissatisfaction at work, lack of social recognition, and
isolation (P<0.05). Coping strategies such as play down,
distraction from situation, and substitutional satisfaction were also
significantly more frequent among unexperienced surgeons. "Negative" stress-coping
strategies occur more often in experienced than in younger colleagues
(P=0.029). Female surgeons felt more exposed to overwork
(P=0.04) and social stress (P=0.03). Conclusion Cardiac surgeons show a tendency to high perception of chronic stress phenomena
and vulnerability for negative coping strategies.
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Affiliation(s)
| | - Laura Gansera
- Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
| | | | - Tibor Schuster
- Institute for Medical Statistics and Epidemiology, Technical University Munich, Germany
| | - Walter Eichinger
- Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
| | - Brigitte Gansera
- Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
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Spiliopoulos K, Giamouzis G, Haschemi A, Karangelis D, Antonopoulos N, Fink G, Kemkes BM, Gansera B. Surgical management of infective endocarditis: early and long-term mortality analysis. single-center experience and brief literature review. Hellenic J Cardiol 2014; 55:462-474. [PMID: 25432198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION In this study we evaluated factors that affect the early and long-term postoperative outcomes of patients with infective endocarditis. METHODS We retrospectively reviewed 94 patients (68 male, 26 female, mean age 58.3 ± 13.1 years, range 20-85 years) with proven infective native (n=85) or prosthetic valve (n=9) endocarditis who underwent heart valve surgery between September 1997 and December 2007. Fifty-four patients (57.4%) underwent aortic, 28 (29.8%) mitral, 3 (3.2%) tricuspid, 8 (8.5%) double, and one patient (1%) triple valve surgery. In 75.5% of the procedures we implanted mechanical valves, in 13.8% biological prostheses, and 10.7% were reconstructive or other procedures. Midterm follow up was 100% complete with a cumulative duration of 545 patient-years (maximum 12 years). RESULTS Overall hospital mortality (30 days) was 8.5% (n=8). Causes of early mortality were low cardiac output syndrome in 2 cases, sepsis with multiple organ failure in 5 cases, and intracerebral bleeding in one patient. Development of postoperative low cardiac output syndrome (p=0.01) was identified as an independent predictor of early mortality. Overall late mortality was 25.6% (n=22) with a cumulative rate of 4.03% per patient-year. Causes of late death were predominantly of extracardiac origin. Kaplan-Meier survival analysis revealed a cumulative survival rate at 12 years of 57.2%. Cox regression analysis identified diabetes mellitus (p=0.016) and postoperative low cardiac output syndrome (p=0.03) as independent late mortality factors. CONCLUSIONS Heart valve surgery in patients with infective endocarditis is associated with increased but acceptable early and long-term mortality. The mid-term prognosis is similar to that of patients undergoing elective valve replacement surgery.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Cardiovascular Surgery, Heart Center, Klinikum München Bogenhausen GmbH, Munich, Germany
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Spiliopoulos K, Deutsch O, Eichinger W, Gansera B. eComment. EuroSCORE II and its Achilles' heel. Interact Cardiovasc Thorac Surg 2014; 19:733-4. [PMID: 25344566 DOI: 10.1093/icvts/ivu339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Cardiovascular Surgery, Klinikum München Bogenhausen GmbH, Munich, Germany
| | - Oliver Deutsch
- Department of Cardiovascular Surgery, Klinikum München Bogenhausen GmbH, Munich, Germany
| | - Walter Eichinger
- Department of Cardiovascular Surgery, Klinikum München Bogenhausen GmbH, Munich, Germany
| | - Brigitte Gansera
- Department of Cardiovascular Surgery, Klinikum München Bogenhausen GmbH, Munich, Germany
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Karangelis D, Bouliaris K, Koufakis T, Spiliopoulos K, Desimonas N, Tsilimingas N. Management of isolated sternal fractures using a practical algorithm. J Emerg Trauma Shock 2014; 7:170-3. [PMID: 25114426 PMCID: PMC4126116 DOI: 10.4103/0974-2700.136858] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/03/2013] [Indexed: 11/18/2022] Open
Abstract
Background: The implementation of seat belt legislation has led to an increase in the frequency of isolated sternal fractures (ISFs) in motor vehicle crash. Aims: We reviewed retrospectively the medical records of our tertiary center in order to find out the frequency of ISFs, review our experience in their management, and define the mean length of hospitalization. Materials and Methods: From January 2008 to April 2012, 64 patients were admitted to the accident and emergency department of the University Hospital of Larissa, Greece, suffering from sternal fractures (SFs). Of these 64 patients, 45 had sustained ISF, while the remaining 19 had SF and additional injuries (intrathoracic and extrathoracic). The files of these 45 patients were further investigating as concerning the mechanism of injury, hospitalization days, morbidity, and mortality. Results: All the patients had been involved in motor vehicle crashes and most of them were wearing seat belts during the accident (91%). The hospital length of stay (LOS) was 1.85 ± 1.67. All the patients had upon admission chest radiograms, serial electrocardiographs (ECGs), echocardiograms, and cardiac enzyme levels. Two patients had abnormal ECG and abnormal cardiac enzymes which contributed in prolonged hospitalization. However, there was no incidence of cardiac complications or deaths. Conclusions: ISFs, with normal electrocardiogram, cardiac enzymes, and chest X-ray in the absence of complications, require no further investigation.
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Affiliation(s)
- Dimos Karangelis
- Department of Cardiac Surgery, Manchester Royal Infirmary, Manchester, United Kingdom ; Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa, Greece
| | - Konstantinos Bouliaris
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa, Greece
| | - Theocharis Koufakis
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa, Greece
| | - Kyriakos Spiliopoulos
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa, Greece
| | - Nicholaos Desimonas
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa, Greece
| | - Nikolaos Tsilimingas
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Larissa, Greece
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Salemis NS, Seretis C, Nakos G, Kantounakis I, Stoumpos C, Spiliopoulos K. Synchronous occurrence of breast cancer and pulmonary sclerosing hemangioma: management and review of the literature. Breast Dis 2014; 34:61-5. [PMID: 23838116 DOI: 10.3233/bd-130352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary sclerosing hemangioma (PSH) is a rare tumor accounting for 0.2-1% of all primary lung tumors. Simultaneous occurrence of PSH with breast cancer has very rarely been reported in the literature. We describe here a case of simultaneous occurrence of PSH with breast cancer. A pathological diagnosis of PSH was confirmed by computed tomography (CT)-guided biopsy. Due to the patient's poor performance status and the benign nature of PSH, surgical excision was not considered and the patient was managed conservatively with regular follow-up. Although surgical excision is the preferred treatment for PSH, conservative management may be a reasonable option in carefully selected patients.
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Deutsch O, Rippinger N, Spiliopoulos K, Eichinger W, Gansera B. “Blame it on the comorbidities” A 5-year follow-up of 53 chronic dialysis-dependent patients who underwent cardiac surgery. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367293] [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: 10/25/2022]
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Hapfelmeier A, Brandl K, Spiliopoulos K, Gundling F, Eichinger W, Gansera B. The Mosaic Bioprosthesis in the Aortic Position: 17 Years' Results. Thorac Cardiovasc Surg 2013; 62:26-34. [DOI: 10.1055/s-0033-1345724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Alexander Hapfelmeier
- Institute of Medical Statistics and Epidemiology, Technical University Munich, Munich, Germany
| | - Kristina Brandl
- Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
| | | | - Felix Gundling
- Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
| | - Walter Eichinger
- Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
| | - Brigitte Gansera
- Department of Cardiovascular Surgery, Clinic Bogenhausen, Munich, Germany
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Spiliopoulos K, Tsantsaridou A, Papamichali R, Kimpouri K, Salemis NS, Koukoulis GK, Tsilimingas NB. Recurrent spontaneous pneumothorax in a 42 years old woman with pulmonary lymphangioleiomyomatosis: insights and pitfalls of the surgical treatment. J Clin Med Res 2013; 5:70-4. [PMID: 23390481 PMCID: PMC3564573 DOI: 10.4021/jocmr1170w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2012] [Indexed: 11/03/2022] Open
Abstract
Lymphangioleiomyomatosis (LAM) is a rare disease that occurs predominantly in females between the ages of 30 and 50 years and is clinically characterized by progressive dyspnoea on exertion, recurrent pneumothoraces, abdominal and thoracic lymphadenopathy, as well tumors-like angiomyolipomas and lymphangiomyomas. We present the case of a 42-year-old woman, who developed recurrent pneumothoraces and was subsequently diagnosed with LAM. Although pneumothorax is a common complication of the disease, its optimal approach to treatment and prevention remains unclear. Chemical or surgical pleurodesis are often performed in order to prevent recurrence, but may predispose to perioperative complications in the event of future lung transplantation.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, University of Thessaly, Larissa, Greece
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Spiliopoulos K, Kiask T, Katsari E, Rippinger N, Eichinger W, Gansera B, Deutsch O. Cardiac Surgery in Dialysis-Dependent Patients: Impact of Gender on Early Outcome in Single-Center Experience with 204 Consecutive Cases. Thorac Cardiovasc Surg 2013; 61:22-8. [DOI: 10.1055/s-0032-1331841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, University of Thessaly School of Medicine, Larissa, Greece
| | - Theodor Kiask
- Department of Cardiac Surgery, Clinic Bogenhausen, City Hospital Munich, Munich, Germany
| | - Elpiniki Katsari
- Klinik für Herz- Thorax- und Gefäßchirurgie, Klinikum Karlsburg, Karlsburg, Germany
| | - Nathalie Rippinger
- Department of Cardiac Surgery, Clinic Bogenhausen, City Hospital Munich, Munich, Germany
| | - Walter Eichinger
- Department of Cardiac Surgery, Clinic Bogenhausen, City Hospital Munich, Munich, Germany
| | - Birgitte Gansera
- Department of Cardiac Surgery, Clinic Bogenhausen, City Hospital Munich, Munich, Germany
| | - Oliver Deutsch
- Department of Cardiac Surgery, Clinic Bogenhausen, City Hospital Munich, Munich, Germany
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Schmidtler F, Gansera B, Spiliopoulos K, Angelis I, Neumaier-Prauser P, Kemkes BM. Retraction Note: Dringliche oder notfallmäßige Koronarrevaskularisation unter Verwendung beider Arteria Thoracica interna nach vorheriger Thrombozytenaggregationshemmung mit Clopidogrel. Clin Res Cardiol 2012. [PMID: 23192411 DOI: 10.1007/s00392-012-0526-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gansera B, Schmidtler F, Angelis I, Weingartner J, Spiliopoulos K, Kemkes BM. Retraction Note: Thrombendarteriektomie der Arteria carotis und simultane Herzoperation. Clin Res Cardiol 2012. [PMID: 23192412 DOI: 10.1007/s00392-012-0527-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Spiliopoulos K, Giamouzis G, Karayannis G, Karangelis D, Koutsias S, Kalogeropoulos A, Georgiopoulou V, Skoularigis J, Butler J, Triposkiadis F. Current status of mechanical circulatory support: a systematic review. Cardiol Res Pract 2012; 2012:574198. [PMID: 22970403 PMCID: PMC3433124 DOI: 10.1155/2012/574198] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/09/2012] [Indexed: 12/22/2022] Open
Abstract
Heart failure is a major public health problem and its management requires a significant amount of health care resources. Even with administration of the best available medical treatment, the mortality associated with the disease remains high. As therapeutical strategies for heart failure have been refined, the number of patients suffering from the disease has expanded dramatically. Although heart transplantation still represents the gold standard therapeutical approach, the implantation of mechanical circulatory support devices (MCSDs) evolved to a well-established management for this disease. The limited applicability of heart transplantation caused by a shortage of donor organs and the concurrent expand of the patient population with end-stage heart failure led to a considerable utilization of MCSDs. This paper outlines the current status of mechanical circulatory support.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, Larissa University Hospital, P.O. Box 1425, 411 10 Larissa, Greece
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Schmidtler F, Gansera B, Spiliopoulos K, Angelis I, Neumaier-Prauser P, Kemkes BM. ZURÜCKGEZOGEN: Dringliche oder notfallmäßige Koronarrevaskularisation unter Verwendung beider Arteria Thoracica interna nach vorheriger Thrombozytenaggregationshemmung mit Clopidogrel. ACTA ACUST UNITED AC 2010; 93:679-85. [PMID: 15365735 DOI: 10.1007/s00392-004-0115-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2004] [Accepted: 03/31/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Application of clopidogrel before diagnostic or therapeutical percutaneous coronary interventions has become standard for stent-thrombosis prevention. The irreversible platelet inhibition causes increasing bleeding complications if urgent coronary artery bypass grafting becomes necessary. This study evaluates the effect on bleeding complications of clopidogrel in urgent CABG using bilateral internal thoracic artery (ITA) and saphenous veins in all patients. METHODS We retrospectively analyzed 166 patients (operated between 1/00-12/02) with urgent or emergency CABG, using both ITAs and compared 83 patients with previous (within 5 days) clopidogrel and aspirin application to 83 patients without clopidogrel. We evaluated chest tube output, reexploration rate and necessity of blood products, ventilation time and ICU stay. RESULTS Both groups were comparable with age, gender, number of performed anastomoses (mean 4/ patient). Chest tube output (24 h) was higher in the clopidogrel group (935 +/- 599 ml vs 754 +/- 335 ml (p = 0.018)), as well as reexploration rate with 7.2% (6 of 83) vs 0% (0 of 83) (p < 0.001). Number of blood products in the clopidogrel group for red cells was 2.41 +/- 1.88 U vs 1.84 +/- 1.47 U p = 0.03, for plateletes 0.43 +/- 0.88 U vs 0.024 +/- 0.22 p = 0.0001, for fresh frozen plasma 0.41 +/- 1.14 U vs 0.096 +/- 0.59 U p = 0.029. Mechanical ventilation time was 11.35 +/- 8.77 h vs 10.57 +/- 9.12 h p = 0.51, ICU stay 32.1 +/- 21.8 h vs. 29.8 +/- 21.1 h (p = 0.48). CONCLUSIONS Previous application of clopidogrel in combination with aspirin before urgent CABG induces increased chest tube output, reexploration rate and necessity of blood products, especially of plateletes. Nevertheless, routine use of both ITAs in patients after clopidogrel exposure can be performed with acceptable bleeding complications.
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Affiliation(s)
- F Schmidtler
- Krankenhaus München-Bogenhausen, Abteilung für Kardiovaskularchirurgie, Englschalkingerstr. 77, 81925 München, Germany
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Spiliopoulos K, Haschemi A, Fink G, Kemkes BM. Infective Endocarditis Complicated by Paravalvular Abscess: A Surgical Challenge. An 11-Year Single Center Experience. Heart Surg Forum 2010; 13:E67-73. [DOI: 10.1532/hsf98.20081141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Haschimi A, Costi M, Spiliopoulos K, Szolnoky J, Eichinger W. Long term results of isolated aortic and mitral valve replacement with Medtronic Mosaik valve: 16 years outcome in a single center. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246985] [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: 10/20/2022]
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