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Bifulco O, Malvindi PG, Berretta P, Brugiatelli L, Cefarelli M, Alfonsi J, D’Alfonso A, Zingaro C, Di Eusanio M. Minimally Invasive Trans-Axillary versus Full Sternotomy Mitral Valve Repair: A Propensity Score-Matched Analysis on Mid-Term Outcomes. Medicina (Kaunas) 2023; 60:29. [PMID: 38256290 PMCID: PMC10821199 DOI: 10.3390/medicina60010029] [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] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Minimally invasive cardiac surgery is an established approach for the treatment of heart valve pathologies and is associated with excellent technical and early postoperative outcomes. Data from medium- and long-term longitudinal evaluation of patients who underwent mitral valve repair (MVr) through transaxillary approach (TAxA) are still lacking. The aim of this study is to investigate mid-term results in patients who underwent TAxA MVr. Materials and Methods: Prospectively collected data of patients who underwent first-time MVr for MV regurgitation between 2017 and 2022, were reviewed. A total of 308 patients received TAxA, while in 220 cases, traditional full sternotomy (FS) was performed. Concomitant aortic and coronary artery bypass grafting (CABG) procedures, infective endocarditis or urgent operations were excluded. A propensity match (PS) analysis was used to overcome preoperative differences between the populations. Follow-up data were retrieved from outpatients' clinic, telephone calls and municipal administration records. Results: After PS-matching, two well-balanced cohorts of 171 patients were analysed. The overall 30-day mortality rate was 0.6% in both cohorts. No statistical difference in postoperative complications was reported. TAxA cohort experienced earlier postoperative extubation (p < 0.001) with a higher rate of extubation performed in the operating theatre (p < 0.001), shorter intensive care unit (ICU) stay (p < 0.001), and reduced hospitalization with 51% of patients discharged home (p < 0.001). Estimated survival at 5 years was 98.8% in TAxA vs. 93.6% in FS cohort (Log rank p = 0.15). The cumulative incidence of reoperation was 2.6% and 4.4% at 5 years, respectively, in TAxA and FS cohorts (Gray test p = 0.49). Conclusions: TAxA approach for MVr was associated with low rates of in-hospital mortality and major postoperative complications being furthermore associated with shorter mechanical ventilation time, shorter ICU stay and reduced hospitalization with a higher rate of patients able to be discharged home. At mid-term, TAxA was associated with excellent survival and low rate of MV reoperation.
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Affiliation(s)
| | - Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60126 Ancona, Italy (M.D.E.)
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Malvindi PG, Bifulco O, Berretta P, Alfonsi J, Cefarelli M, Zingaro C, Capestro F, D’Alfonso A, Di Eusanio M. Improved Early Outcomes in Women Undergoing Aortic Valve Interventions. J Clin Med 2023; 12:5749. [PMID: 37685816 PMCID: PMC10488507 DOI: 10.3390/jcm12175749] [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: 07/20/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Surgical aortic valve replacement (SAVR) in female patients has been associated with higher mortality (up to 3.3-8.9%) and postoperative complication rates when compared with their male counterparts. In recent years, TAVI has been shown to provide a greater benefit than SAVR in women. We sought to assess the early outcomes of the contemporary aortic valve intervention practice (surgical and transcatheter) in patients referred to our cardiac surgery unit. The data of consecutive patients who underwent isolated aortic valve intervention for aortic valve stenosis during the 2018-2022 period were retrieved from our internal database. Several preoperative, intraoperative, and postoperative variables were analyzed, including the predicted risk of a prosthesis-patient mismatch. Nine hundred and fifty-five consecutive patients-514 women and 441 men-were included. Among them, 480 patients-276 female and 204 male-received a transcatheter procedure, and 475-238 women and 237 men-had conventional SAVR. The women were older and had higher EuroSCORE II, while the male patients presented a higher incidence of cardiovascular comorbidities. There was no difference in mortality or major postoperative complication rates after either the surgical or transcatheter procedures between the female and male populations. The availability and targeted use of different techniques and technologies have enabled the safe and effective treatment of female patients treated for severe symptomatic aortic valve stenosis with similar results when compared with their male counterparts.
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Malvindi PG, Tian DH, Bifulco O, Berretta P, Alfonsi J, Cefarelli M, Yan TD, Di Eusanio M. del Nido versus blood cardioplegia in adult cardiac surgery: a meta-analysis. J Cardiovasc Med (Hagerstown) 2023; 24:522-529. [PMID: 37409597 DOI: 10.2459/jcm.0000000000001506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
AIMS Initially developed for myocardial protection in immature cardiomyocytes, del Nido cardioplegia has been increasingly used over the past decade in adult patients. Our aim is to analyse the results from randomized controlled trials and observational studies comparing early mortality and postoperative troponin release in patients who underwent cardiac surgery using del Nido solution and blood cardioplegia. METHODS A literature search was performed through three online databases between January 2010 and August 2022. Clinical studies providing early mortality and/or postoperative troponin evaluation were included. A random-effects meta-analysis with a generalized linear mixed model, incorporating random study effects, was implemented to compare the two groups. RESULTS Forty-two articles were included in the final analysis for a total of 11 832 patients, 5926 of whom received del Nido solution and 5906 received blood cardioplegia. del Nido and blood cardioplegia populations had comparable age, gender distribution, history of hypertension and diabetes mellitus. There was no difference in early mortality between the two groups. There was a trend towards lower 24 h [mean difference -0.20; 95% confidence interval (CI) -0.40 to 0.00; I2 = 89%; P = 0.056] and lower peak postoperative troponin levels (mean difference -0.10; 95% CI -0.21 to 0.01; I2 = 0.87; P = 0.087) in the del Nido group. CONCLUSION del Nido cardioplegia can be safely used in adult cardiac surgery. The use of del Nido solution was associated with similar results in terms of early mortality and postoperative troponin release when compared with blood cardioplegia myocardial protection.
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Affiliation(s)
- Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - David H Tian
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital
- Critical Care Division, The George Institute for Global Health, Sydney
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Tristan D Yan
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital
- Sydney Medical School, Sydney University, Sydney, Australia
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
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Malvindi PG, Berretta P, Capestro F, Bifulco O, Alfonsi J, Cefarelli M, Pierri MD, Di Eusanio M. Results and insights after 413 TAVI procedures performed by cardiac surgeons on their own. Interdiscip Cardiovasc Thorac Surg 2023:7160148. [PMID: 37166498 DOI: 10.1093/icvts/ivad074] [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] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Current evidence on TAVI has been generated exclusively by cardiology studies and no operative data from cardiac surgeons are available. Here we describe the development of our TAVI program and report the results of transfemoral TAVI done by cardiac surgeons on their own. METHODS This study included all the TAVI procedures on native valve performed at Cardiac Surgery Unit, Ospedali Riuniti di Ancona, during the period October 2018 - July 2022. Relevant prospectively collected preoperative, intraprocedural and postoperative data were retrieved from the Institutional database. RESULTS A total of 413 patients were included in the study. Mean patients' age was 82 years and among them 44% (180/413) were male. STS score was 3.1% (2.2 - 4.4). Eighty patients underwent transapical TAVI and 333 patients had a transfemoral approach. We progressively moved from trans-apical TAVI towards trans-femoral procedures that are now routinely performed on conscious sedation and using a fully percutaneous approach.After trans-femoral TAVI, 30-day mortality rate was 1%, cerebral stroke occurred in 2% of the cases, permanent pacemaker implantation was necessary in 23% of the patients and in 6% of the cases there was a moderate/severe degree of aortic regurgitation. There was no association between operators performing TAVI and 30-day mortality. CONCLUSIONS The acquisition of catheter-based skills and an adequate training allowed cardiac surgeons to perform on their own awake and fully percutaneous trans-femoral TAVI with similar results when compared with major randomized clinical trials and registries' experiences.
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Affiliation(s)
- Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Filippo Capestro
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Michele Danilo Pierri
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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Malvindi PG, Bifulco O, Berretta P, Silvano R, Alfonsi J, Cefarelli M, Zingaro C, Di Eusanio M. del Nido and Histidine-Tryptophan-Ketoglutarate cardioplegia in minimally invasive mitral valve surgery: A propensity-Match study. Perfusion 2023:2676591231161920. [PMID: 36881663 DOI: 10.1177/02676591231161920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION In the last decade, del Nido cardioplegia has been embedded in adult cardiac surgery involving CABG and aortic valve surgical procedures. We reviewed our early experience with del Nido cardioplegia in the setting of minimally invasive mitral valve surgery. METHODS Data on 120 consecutive patients operated between 03/2021 and 06/2022 were retrieved from our internal database (infective endocarditis and urgent operations were excluded). Patients were divided into two groups according to the use of Histidine-Tryptophan-Ketoglutarate or del Nido cardioplegia. A propensity match analysis was performed using thirteen preoperative and intraoperative variables. Several intraoperative data and early postoperative outcomes were investigated, including cardiac enzymes (Troponin I HS and CK-MB) measured upon arrival in the Intensive Care Unit (ICU), after 12 hours and everyday thereafter. RESULTS There was no difference in preoperative characteristics and surgical techniques between both unmatched and matched Histidine-Tryptophan-Ketoglutarate and del Nido populations. Patients in the del Nido group received a lower volume of cardioplegia (p < 0.001) and ultrafiltration during CPB (p < 0.001). Histidine-Tryptophan-Ketoglutarate was associated with a lower rate of post cross-clamp spontaneous defibrillation (p < 0.001) and showed a lower level of blood sodium after CPB (p < 0.001). The release of cardiac enzymes was similar between the two groups (p = 0.72). There was no difference in terms of postoperative morbidity and 30 day mortality. CONCLUSIONS del Nido cardioplegia in the setting of minimally invasive mitral valve surgery seemed safe with acceptable myocardial protection and excellent early outcomes.
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Affiliation(s)
| | - Olimpia Bifulco
- Cardiac Surgery Department, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Department, Polytechnic University of Marche, Ancona, Italy
| | - Raffaele Silvano
- Cardiac Surgery Department, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Department, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Department, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Zingaro
- Cardiac Surgery Department, Polytechnic University of Marche, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Department, Polytechnic University of Marche, Ancona, Italy
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Malvindi PG, Alfonsi J, Berretta P, Cefarelli M, Gatta E, Di Eusanio M. Normothermic frozen elephant trunk: our experience and literature review. Cardiovasc Diagn Ther 2022; 12:262-271. [PMID: 35800357 PMCID: PMC9253169 DOI: 10.21037/cdt-22-73] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/17/2022] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND OBJECTIVE The frozen elephant trunk (FET) technique has undoubtable advantages in treating complex and extensive disease of the aortic arch and the thoracic descending aorta. Despite several improvements in cardiopulmonary bypass conduction and surgical strategy, operative times and the institution of systemic circulatory arrest remain the main determinants of early mortality, cerebral/spinal cord injury and visceral organs dysfunction. We have conducted this review to highlight the recent technical advances in arch and FET surgery aiming at the reduction/avoidance of systemic circulatory arrest, and their impact on early outcomes. METHODS A literature search (from origin to January 2022), limited to publications in English, was performed on online platforms and database (PubMed, Google, ResearchGate). After a further review of associated or similar papers, we found 4 experiences, described by 11 peer-reviewed published papers, which focused on minimising or avoiding systemic circulatory arrest during total arch replacement plus stenting of the descending thoracic aorta. KEY CONTENT AND FINDINGS Recent experiences reported the use of an antegrade endoaortic balloon, advanced and inflated into the stent graft, to provide an early systemic reperfusion soon after the deployment of the stented portion of the FET prosthesis and minimize the circulatory arrest time (down to a mean of 5 minutes), thus avoiding the need of moderate or deep hypothermia (mean systemic temperature 28-30 °C) while allowing a complete arch and FET repair. Our approach, based on off-pump retrograde vascular stent graft deployment in distal arch/descending thoracic aorta, and the use of a retrograde endoballoon, allows the repair of extensive aortic pathologies during uninterrupted normothermic cerebral and lower body perfusion. CONCLUSIONS The use of endoballoon occlusion has emerged in recent years as a safe and effective strategy to allow distal perfusion during FET repair. This technique minimizes or avoids the detrimental effects of hypothermia and systemic circulatory arrest and significantly reduces the operative times.
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Affiliation(s)
- Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Emanuele Gatta
- Vascular Surgery Department, Lancisi Cardiovascular Center, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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Alfonsi J, Berretta P, Malvindi P, Cefarelli M, D‘Alfonso A, Alessandroni E, Capestro F, Zingaro C, Di Eusanio M. P50 IMPLEMENTATION OF PROTOCOLS FOR “ENHANCED RECOVERY AFTER CARDIAC SURGERY” IN AORTIC VALVE SURGERY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.048] [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
Objective
Although, the use of protocols for “enhanced recovery after surgery” (ERAS) have been associated with improved results in different surgical disciplines, no data are available for EARS in cardiac surgery, thus far. In the late 2016 a mutlidisciplinary ERAS program to treat patients who require AVR was implemented in our institution. The aim of this study was to assess safety and 30 day outcomes in patients receiving ERAS management.
Methods
To improve multidisciplinary ERAS program, our mini–invasive approach (Fig. 1), that goes beyond a small incision, includes: (i) mini–surgical access (ministernotomy–minithoracotomy), to reduce the traumatic impact, postoperative pain and to increase patient’s satisfaction; (ii) minimal invasive extracorporeal circulation system, to improve end–organ protection and decrease systemic inflammatory response; (iii) ultra fast–track anaesthesia, to decrease the rate of postoperative complications and assure better and earlier recovery (Fig. 2).
Results
Between September 2016 and December 2021, 600 consecutive patients (mean age 72 years, Euroscore II 1,62%) underwent isolated mini–AVR in our institution. UFT anaesthesia was used in 195 patients (32.5%) and MiECC in 173 (28.8%). All patients received a timely rehabilitation therapy (3–6 hours after surgery) and an early family contact in ICU. At 30 days, the overall mortality and stroke rates were 0,3% (n = 2) and 0,5% (n = 3), respectively. Respiratory insufficiency occurred in 16 pts (2,5%). Median blood loss at 12 hours was 174,5 cc; blood transfusions were reduced to minimum intraoperatively and avoided in 66% of patients. Twenty three patients (3,8%) received definitive pacemaker implantation. The median ICU and in–hospital lengths of stay were 1 and 6 days, respectively.
Conclusions
Findings from our study confirms that mini–AVR yields excellent clinical outcomes with very low mortality and morbidity rates. The implementation of ERAS protocol in patients undergoing mini–AVR demonstrated to be safe and was associated with promising results. Thus, by reducing surgical injury and promoting faster recovery, ERAS management may further enhance minimally invasive interventions.
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Affiliation(s)
- J Alfonsi
- CARDIOCHIRURGIA – OSPEDALI RIUNITI ANCONA, ANCONA
| | - P Berretta
- CARDIOCHIRURGIA – OSPEDALI RIUNITI ANCONA, ANCONA
| | - P Malvindi
- CARDIOCHIRURGIA – OSPEDALI RIUNITI ANCONA, ANCONA
| | - M Cefarelli
- CARDIOCHIRURGIA – OSPEDALI RIUNITI ANCONA, ANCONA
| | - A D‘Alfonso
- CARDIOCHIRURGIA – OSPEDALI RIUNITI ANCONA, ANCONA
| | | | - F Capestro
- CARDIOCHIRURGIA – OSPEDALI RIUNITI ANCONA, ANCONA
| | - C Zingaro
- CARDIOCHIRURGIA – OSPEDALI RIUNITI ANCONA, ANCONA
| | - M Di Eusanio
- CARDIOCHIRURGIA – OSPEDALI RIUNITI ANCONA, ANCONA
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Berretta P, Cefarelli M, Montecchiani L, Alfonsi J, Vessella W, Zahedi MH, Carozza R, Munch C, Di Eusanio M. Minimally invasive versus standard extracorporeal circulation system in minimally invasive aortic valve surgery: a propensity score-matched study. Eur J Cardiothorac Surg 2021; 57:717-723. [PMID: 31746980 DOI: 10.1093/ejcts/ezz318] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The impact of minimally invasive extracorporeal circulation (MiECC) systems on the clinical outcomes of patients undergoing minimally invasive aortic valve replacement (MI-AVR) has still to be defined. This study compared in-hospital and 1 year outcomes of MI-AVR interventions using MiECC systems versus conventional extracorporeal circulation (c-ECC). METHODS Data from 288 consecutive patients undergoing primary isolated MI-AVR using MiECC (n = 102) or c-ECC (n = 186) were prospectively collected. Treatment selection bias was addressed by the use of propensity score matching (MiECC vs c-ECC). After propensity score matching, 2 groups of 93 patients each were created. RESULTS Compared with c-ECC, MiECC was associated with a higher rate of autologous priming (82.4% vs 0%; P < 0.001) and a greater nadir haemoglobin (9.3 vs 8.7 g/dl; P = 0.021) level and haematocrit (27.9% vs 26.4%; P = 0.023). Patients who had MiECC were more likely to receive ultra-fast-track management (60.8% vs 26.9%; P < 0.001) and less likely to receive blood transfusions (32.7% vs 44%; P = 0.04). The in-hospital mortality rate was 1.1% in the MiECC group and 0% in the c-ECC group (P = 0.5). Those in the MiECC group had reduced rates of bleeding requiring revision (0% vs 5.3%; P = 0.031) and postoperative atrial fibrillation (AF) (30.1% vs 44.1%; P = 0.034). The 1-year survival rate was 96.8% and 97.5% for MiECC and c-ECC patients, respectively (P = 0.4). CONCLUSIONS MiECC systems were a safe and effective tool in patients who had MI-AVR. Compared with c-ECC, MiECC promotes ultra-fast-track management and provides better clinical outcomes as regards bleeding, blood transfusions and postoperative AF. Thus, by reducing surgical injury and promoting faster recovery, MiECC may further validate MI-AVR interventions.
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Affiliation(s)
- Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Luca Montecchiani
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Walter Vessella
- Cardiac Anaesthesia and Intensive Care Unit, Lancisi Cardiovascular Center, Ancona, Italy
| | | | - Roberto Carozza
- Perfusion Unit, Lancisi Cardiovascular Center, Ancona, Italy
| | - Christopher Munch
- Cardiac Anaesthesia and Intensive Care Unit, Lancisi Cardiovascular Center, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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Di Eusanio M, Alfonsi J, Berretta P, Zahedi H, Pierri MD, Cefarelli M. Ultra fast-track trans-axillary mini-aortic valve replacement. Ann Cardiothorac Surg 2020; 9:427-428. [PMID: 33102184 DOI: 10.21037/acs-2020-surd-19] [Citation(s) in RCA: 1] [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: 11/06/2022]
Affiliation(s)
- Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Hossein Zahedi
- Cardiac Anaesthesia and Intensive Care Unit, Lancisi Cardiovascular Center, Ancona, Italy
| | - Michele D Pierri
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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Montecchiani L, Alfonsi J, Cefarelli M, Berretta P, Capestro F, Di Eusanio M. [Transcatheter cerebral embolic protection in open heart surgery: our initial experience in Ancona, Italy]. G Ital Cardiol (Rome) 2020; 21:896-899. [PMID: 33077996 DOI: 10.1714/3455.34444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Neurological events after cardiac surgery or transcatheter aortic valve implantation (TAVI) have a dramatic effect on patients' prognosis. Recent development of transcatheter cerebral protection systems aims to reduce their incidence, even if their use is currently limited to TAVI. Here we report our initial experience with transcatheter cerebral protection devices used in patients at high brain embolic risk undergoing cardiac surgery. METHODS Between December 2018 and March 2020, at the Cardiac Surgery Unit of Lancisi Cardiovascular Center in Ancona, Italy, 9 patients (mean age 77 years; median EuroSCORE II: 2.2%) underwent cardiac surgery using a transcatheter cerebral protection system (Sentinel, Claret Medical, Santa Rosa, CA, USA). In all cases, a preoperative computed tomography scan highlighted the presence of severely calcified ascending aorta. RESULTS The brain protection system was successfully implanted in all patients. Total time for device implantation and removal was less than 10 min in all cases. Four patients underwent aortic valve replacement, 2 mitral surgery, whereas 3 received combined valve surgery. Calcified debris were found within filters in 100% of patients. Postoperatively, there were neither neurological events nor major complications. CONCLUSIONS In our experience, transferring transcatheter brain protection techniques and technologies to cardiac surgery allowed us (with excellent results) to avoid palliative percutaneous or medical management in patients with severe aortic calcifications. Waiting for more solid evidence, we believe that our example supports the concept of hybrid surgery as a therapeutic approach capable of extending traditional surgical indications with improved patients' outcomes.
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Affiliation(s)
- Luca Montecchiani
- S.O.D. Cardiochirurgia, Centro Cardiovascolare Lancisi, Università Politecnica delle Marche, Ancona
| | - Jacopo Alfonsi
- S.O.D. Cardiochirurgia, Centro Cardiovascolare Lancisi, Università Politecnica delle Marche, Ancona
| | - Mariano Cefarelli
- S.O.D. Cardiochirurgia, Centro Cardiovascolare Lancisi, Università Politecnica delle Marche, Ancona
| | - Paolo Berretta
- S.O.D. Cardiochirurgia, Centro Cardiovascolare Lancisi, Università Politecnica delle Marche, Ancona
| | - Filippo Capestro
- S.O.D. Cardiochirurgia, Centro Cardiovascolare Lancisi, Università Politecnica delle Marche, Ancona
| | - Marco Di Eusanio
- S.O.D. Cardiochirurgia, Centro Cardiovascolare Lancisi, Università Politecnica delle Marche, Ancona
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Pierri MD, Alfonsi J, Cefarelli M, Berretta P, Di Eusanio M. COVID 19- Perspective of an Italian Center. J Card Surg 2020; 36:1696-1702. [PMID: 33032377 PMCID: PMC7675508 DOI: 10.1111/jocs.15099] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/20/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022]
Abstract
Italy has been hard hit by severe acute respiratory syndrome coronavirus 2 infection with more than 240,000 cases and 35,000 deaths. During the acute phase of the pandemic, the Italian government decided on the lockdown which lasted about 2 months. During this period, all surgical activities were limited to nondeferable procedures only. The sudden closure posed problems with the management of the heart surgery waiting which at that time included 135 patients. Among these were selected cases with the worst clinical characteristics that were progressively operated on. Compared with a similar period in 2019, the cardiac surgery activity of the "Lancisi Cardiovascular Center" in Ancona has been reduced by 65%. With pandemic mitigation, heart surgery activity has gradually resumed but many open questions remain. Above all, there is the problem of living with a low but persistent level of presence of the virus with the need to organize the activity to ensure patients and staff safety and an optimal level of performance.
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Affiliation(s)
- Michele D Pierri
- Cardiac Surgery Department, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Department, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Department, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Department, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Department, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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Berretta P, Montecchiani L, Vagnarelli F, Cefarelli M, Alfonsi J, Zingaro C, Capestro F, Pierri MD, D'alfonso A, Di Eusanio M. Conduction disorders after aortic valve replacement: what is the real impact of sutureless and rapid deployment valves? Ann Cardiothorac Surg 2020; 9:386-395. [PMID: 33102177 DOI: 10.21037/acs-2020-surd-26] [Citation(s) in RCA: 6] [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] [Indexed: 11/06/2022]
Abstract
Background Although sutureless and rapid deployment aortic valve replacement (SURD-AVR) has been associated with an increased rate of permanent pacemaker (PPM) implantation compared to conventional AVR (c-AVR), the predictors of new conduction abnormalities remain to be clarified. This study aimed to identify risk factors for conduction disorders in patients undergoing AVR surgery. Methods Data from 243 patients receiving minimally invasive AVR were prospectively collected. SURD-AVR was performed in 103 (42.4%) patients and c-AVR in 140 (57.6%). The primary endpoint was the occurrence of new-onset conduction disorders, defined as first degree atrioventricular (AV) block, advanced AV block requiring PPM implantation, left anterior fascicular block (LAFB), left bundle branch block (LBBB) and right bundle branch block (RBBB). Results The unadjusted comparison revealed that SURD-AVR was associated with a higher rate of advanced AV block requiring PPM when compared with c-AVR (10.5% vs. 2.1%, P=0.01). After adjusting for other measured covariates (OR: 1.6, P=0.58) and for the estimated propensity of SURD-AVR (OR: 5.1, P=0.1), no significant relationship between type of AVR and PPM implantation emerged. On multivariable analysis, preoperative first-degree AV block (OR: 6.9, P=0.04) and RBBB (OR: 6.9, P=0.03) were independent risk factors for PPM. Subgroup analysis of patients with normal preoperative conduction revealed similar incidence of PPM between SURD-AVR and c-AVR (1.3% vs. 1.9%, P=0.6). When compared with c-AVR, SURD-AVR was associated with a greater incidence of postoperative new onset LBBB (18.1% vs. 3.2%, P<0.001). This finding was confirmed after adjusting for the estimated propensity of SURD-AVR (OR: 6.3, P=0.009). Conclusions Our study revealed that the risk of PPM implantation in patients receiving surgical AVR is heavily influenced by the presence of pre-existing conduction disturbances rather than the type of valve prosthesis. Conversely, SURD-AVR emerged as an independent predictor for LBBB and was associated with an increased risk of PPM in patients presenting with RBBB.
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Affiliation(s)
- Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Luca Montecchiani
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | | | - Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Zingaro
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Filippo Capestro
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Michele D Pierri
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Alessandro D'alfonso
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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13
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Cefarelli M, Concistrè G, Montecchiani L, Bianchi G, Berretta P, Margaryan R, Alfonsi J, Murzi M, Solinas M, Di Eusanio M. Bioconduit subannular implantation for aortic root endocarditis after previous cardiac surgery: Results from two Italian centers. J Card Surg 2020; 35:3041-3047. [PMID: 32827184 DOI: 10.1111/jocs.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Infective endocarditis (IE) with extensive peri-annular abscesses and aortic root involvement is a life-threatening disease. Aortic root replacement with a valved conduit is the most common intervention in this setting and represents a serious challenge for the surgeon. In the present two-center study we analyzed early and midterm outcomes of a high-risk series of IE patients undergoing aortic root reconstruction with a sub-annular implantation of a totally biological valved conduit at our centers. METHODS The series comprised 29 patients (18 males, mean age: 72.3 ± 10.1 years) operated at "Lancisi Cardiovascular Center" of Ancona and "Pasquinucci Heart Hospital" of Massa, Italy, between May 2016 and October 2019. All patients had undergone a previous cardiac surgery. Median Euroscore-II was 12.6%. Following aggressive debridement, a Bioconduit was implanted using a sub-annular implantation technique in all cases. RESULTS Thirty-day mortality was 13.8% (n = 4). Multiorgan failure was cause of death in all cases. Respiratory complications occurred in eight patients (27.6%). Renal complications requiring temporary or permanent dialysis occurred in six (20.7%) and two (6.9%) patients, respectively. Mortality and morbidity were not related to the surgical approach. At 1-year follow-up three patients died and no patients underwent reoperation neither reported endocarditis of the biological conduit. CONCLUSION Considered the high-risk profile of the study cohort, our results suggest safety and efficacy of our approach at 1-year. Indeed, we contend that our subannular implantation of a 100% pericardial valved conduit, allowing an effective abscess exclusion and a conduit anchoring to healthy tissues, can reduce the risk of reinfection and dehiscence.
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Affiliation(s)
- Mariano Cefarelli
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Concistrè
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Luca Montecchiani
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Giacomo Bianchi
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Paolo Berretta
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Rafik Margaryan
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Jacopo Alfonsi
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Michele Murzi
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Marco Solinas
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Marco Di Eusanio
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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14
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Lovato L, Cefarelli M, Gatta E, Di Eusanio M, Fattori R. Devices for thoracic endovascular aortic repair of type B aortic dissection: is there any chance for Marfan syndrome? Expert Rev Med Devices 2020; 17:683-696. [DOI: 10.1080/17434440.2020.1782735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Luigi Lovato
- Cardio-Thoracic-Vascular Department, Cardiovascular Radiology Unit and Marfan Center; S.Orsola-Malpighi Hospital; University of Bologna, Italy
| | - Mariano Cefarelli
- Cardiovascular Department, Cardiac Surgery Unit and Marfan Center; Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Emanuele Gatta
- Cardiovascular Department, Vascular Surgery Unit and Marfan Center; Lancisi Cardiovascular Center, Ancona, Italy
| | - Marco Di Eusanio
- Cardiovascular Department, Cardiac Surgery Unit and Marfan Center; Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Rossella Fattori
- Cardiovascular Department, Marfan Center; Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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15
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Di Eusanio M, Cefarelli M, Alfonsi J, Berretta P, Gatta E. Arch Surgery for Type Ia Endoleak: How to Remain Normothermic and Avoid Circulatory Arrest. Ann Thorac Surg 2020; 110:e139-e141. [DOI: 10.1016/j.athoracsur.2020.03.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/19/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
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Abstract
Novel coronavirus disease-2019 (COVID-19) is an ominous infectious disease that seems capable to attack any organ system, leading in the most severe cases to patient death. COVID-19 has been associated with multiple cardiovascular complications of inflammatory and immune origin, leading to a wide spectrum of vascular damage, myocardial injury, stroke, and pulmonary obstruction. We report the case of a patient with COVID-19 infection who developed an acute aortic syndrome with the characteristics of aortic intramural hematoma.
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Affiliation(s)
- Francesca Terzi
- Cardiology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Rossella Fattori
- Cardiovascular Center, Marfan Center, Ospedali Riuniti Marche, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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17
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Di Eusanio M, Cefarelli M, Alfonsi J, Berretta P, Gatta E. Normothermic frozen elephant trunk surgery without circulatory arrest: how we do it in Ancona. Ann Cardiothorac Surg 2020; 9:244-245. [PMID: 32551261 DOI: 10.21037/acs.2020.02.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marco Di Eusanio
- Cardiac Surgery Department, Lancisi Cardiovascular Center, Politechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Department, Lancisi Cardiovascular Center, Politechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Department, Lancisi Cardiovascular Center, Politechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Department, Lancisi Cardiovascular Center, Politechnic University of Marche, Ancona, Italy
| | - Emanuele Gatta
- Vascular Surgery Department, Lancisi Cardiovascular Center, Ancona, Italy
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18
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Capestro F, Berretta P, Alfonsi J, Cefarelli M, Pierri M, Di Eusanio M. Catheter-based cerebral protection system in open cardiac surgery: An example of true hybrid surgery. Multimed Man Cardiothorac Surg 2020; 2020. [PMID: 32356620 DOI: 10.1510/mmcts.2020.012] [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: 11/06/2022]
Abstract
Postoperative stroke after cardiac surgery is an ominous complication. Clinical manifestations range from cognitive disturbances and altered states of consciousness to focal neurological deficits. Stroke is also a well-documented risk of catheter-based cardiac interventions. Recently, the growth of transcatheter procedures has led to the increasing development of devices that are designed to minimize neurological events during valve implantation. In this video tutorial we demonstrate how to transfer a catheter-based cerebral protection technology into an open cardiac surgical intervention. The operation shown in this tutorial was an aortic valve replacement and the cerebral protection device implanted was the Sentinel Cerebral Protection System (Boston Scientific, Marlborough, MA, USA).
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Affiliation(s)
- Filippo Capestro
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Ospedali Riuniti di Ancona, Polytechnic University of Marche, Ancona, Italy
| | | | - Jacopo Alfonsi
- Cardiac Surgery Unit Cardio-thoraco-vascular Department S.Orsola-Malpighi Hospital University of Bologna Italy
| | - Mariano Cefarelli
- Department of Cardiovascular Surgery S. Orsola-Malpighi Hospital Alma Mater Studiorum - University of Bologna Bologna Italy
| | - Michele Pierri
- SOD Cardiochirurgia Ospedali Riuniti 'Umberto I - Lancisi - Salesi' Università Politecnica delle Marche, Ancona
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19
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Carozza R, Fazzi D, Pietrini A, Cefarelli M, Mazzocca F, Vessella W, Berretta P, Romagnoli M, Alfonsi J, Zahedi HM, Munch C, Di Eusanio M. Minimally invasive aortic valve replacement: extracorporeal circulation optimization and minimally invasive extracorporeal circulation system evolution. Perfusion 2020; 35:865-869. [PMID: 32228201 DOI: 10.1177/0267659120913385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment of aortic valve disease has become less and less invasive during the last years, thanks to progress in anesthesiology, surgical techniques, and perfusion management. In fact, it has been demonstrated that shorter skin incision, combined with ultra-fast-track anesthesia and minimized extracorporeal circuit could improve clinical outcomes. Current evidence shows that minimally invasive extracorporeal circulation system is associated with reduced red blood cells' transfusion rate, improved end-organ perfusion, decreased incidence of postoperative atrial fibrillation, air embolism leakage, and so less cerebral accidents with better neurological outcomes. Moreover, the use of a closed circuit seems to be more physiologic for the patients, reducing systemic inflammatory response due to less air-blood contact and the use of biocompatible surfaces. In the literature, the benefits of minimally invasive extracorporeal circulation are described mostly for coronary surgery but few data are nowadays available for minimally invasive extracorporeal circulation during aortic valve replacement. In this article, we describe our perfusion protocol in minimally invasive aortic valve replacement.
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Affiliation(s)
- Roberto Carozza
- Department of Cardiovascular, Perfusion Unit, Lancisi Cardiovascular Center, Ospedali Riuniti, Ancona, Italy
| | - Diego Fazzi
- Department of Cardiovascular, Perfusion Unit, Lancisi Cardiovascular Center, Ospedali Riuniti, Ancona, Italy
| | - Armando Pietrini
- Department of Cardiovascular, Perfusion Unit, Lancisi Cardiovascular Center, Ospedali Riuniti, Ancona, Italy
| | - Mariano Cefarelli
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Francesca Mazzocca
- Department of Cardiovascular, Perfusion Unit, Lancisi Cardiovascular Center, Ospedali Riuniti, Ancona, Italy
| | - Walter Vessella
- Department of Cardiovascular, Cardiac Anaesthesia and Intensive Care Unit, Lancisi Cardiovascular Center, Ospedali Riuniti, Ancona, Italy
| | - Paolo Berretta
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Monica Romagnoli
- Department of Cardiovascular, Perfusion Unit, Lancisi Cardiovascular Center, Ospedali Riuniti, Ancona, Italy
| | - Jacopo Alfonsi
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Hossein M Zahedi
- Department of Cardiovascular, Cardiac Anaesthesia and Intensive Care Unit, Lancisi Cardiovascular Center, Ospedali Riuniti, Ancona, Italy
| | - Christopher Munch
- Department of Cardiovascular, Cardiac Anaesthesia and Intensive Care Unit, Lancisi Cardiovascular Center, Ospedali Riuniti, Ancona, Italy
| | - Marco Di Eusanio
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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20
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Di Eusanio M, Berretta P, Cefarelli M, Gatta E. ‘Double layer’ frozen elephant trunk with balloon endoclamping: a technique to simplify the 2-stage open repair of thoraco-abdominal aortic aneurysms. Eur J Cardiothorac Surg 2020; 58:389-391. [DOI: 10.1093/ejcts/ezaa070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/18/2019] [Revised: 01/27/2020] [Accepted: 02/13/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Staged replacement of the aortic arch and thoraco-abdominal aorta (TAA) with a frozen elephant trunk followed by TAA repair is a valuable treatment for patients with chronic TAA dissection. However, in patients with an unclampable descending thoracic aorta, the retrieval of the trunk can be problematic and the proximal stent graft-to-graft anastomosis technically challenging. Here we present our ‘double layer’ frozen elephant trunk technique to treat patients with TAA dissection.
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Affiliation(s)
- Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Emanuele Gatta
- Vascular Surgery Unit, Lancisi Cardiovascular Center, Ancona, Italy
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21
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Berretta P, Cefarelli M, Alfonsi J, Montecchiani L, Pierri MD, Munch C, Di Eusanio M. [One-year outcomes of surgical aortic valve replacement: a single, high-volume center experience]. G Ital Cardiol (Rome) 2020; 21:216-223. [PMID: 32100734 DOI: 10.1714/3306.32770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The introduction of transcatheter aortic valve replacement (AVR) mandates attention to outcomes after surgical AVR (SAVR). The aim of this study was to assess 1-year outcomes in a contemporary large cohort of patients undergoing AVR. METHODS Data from 520 patients who underwent isolated SAVR between October 2016 and April 2019 were prospectively collected. RESULTS The mean age of the study population was 72.8 ± 10.1 years and the average EuroSCORE II was 1.8 ± 1.5%. SAVR was performed using minimally invasive approaches (MI-AVR) in 306 patients (58.9%). However, the rate of MI-AVR considerably increased over the observational period from 47.9% to 86.7% (p<0.001). MI-AVR patients received rapid deployment valves in 40% of cases, minimally invasive extracorporeal circulation system in 34.4% and ultra fast track anesthetic management with table extubation in 38.2%. Overall 30-day mortality was 0.4% (n=2). The rates of postoperative stroke and atrioventricular block requiring pacemaker implantation were 0.6% (n=3) and 3.8% (n=20), respectively. At 1 year, the estimated survival, stroke and rehospitalization rates were 97.3%, 1% and 4.5%, respectively. Overall, the estimated incidence of the composite endpoint - death, stroke and rehospitalization - was 7%. CONCLUSIONS Contemporary SAVR in a high-volume center yields excellent clinical outcomes with very low mortality and morbidity. In this setting, the extensive use of minimally invasive approaches combined with the modern techniques and technologies demonstrated to improve clinical outcomes and increase patient and family satisfaction.
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Affiliation(s)
- Paolo Berretta
- S.O.D. Cardiochirurgia, Centro Cardiovascolare Lancisi, Università Politecnica delle Marche, Ancona
| | - Mariano Cefarelli
- S.O.D. Cardiochirurgia, Centro Cardiovascolare Lancisi, Università Politecnica delle Marche, Ancona
| | - Jacopo Alfonsi
- S.O.D. Cardiochirurgia, Centro Cardiovascolare Lancisi, Università Politecnica delle Marche, Ancona
| | - Luca Montecchiani
- S.O.D. Cardiochirurgia, Centro Cardiovascolare Lancisi, Università Politecnica delle Marche, Ancona
| | - Michele Danilo Pierri
- S.O.D. Cardiochirurgia, Centro Cardiovascolare Lancisi, Università Politecnica delle Marche, Ancona
| | - Christopher Munch
- S.O.D. Anestesia e Rianimazione Cardiochirurgica, Centro Cardiovascolare Lancisi, Ancona
| | - Marco Di Eusanio
- S.O.D. Cardiochirurgia, Centro Cardiovascolare Lancisi, Università Politecnica delle Marche, Ancona
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22
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Di Eusanio M, Berretta P, Alfonsi J, Cefarelli M. Aortic root endocarditis: a Biointegral Bioconduit subannular implantation. Ann Cardiothorac Surg 2019; 8:713-714. [PMID: 31832370 DOI: 10.21037/acs.2019.09.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marco Di Eusanio
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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Di Eusanio M, Cefarelli M, Berretta P, Capestro F. Minimally invasive aortic valve replacement with a catheter-based cerebral protection system: transferring percutaneous technologies into a surgical intervention. Eur J Cardiothorac Surg 2019; 56:1016-1017. [PMID: 31056703 DOI: 10.1093/ejcts/ezz126] [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: 01/29/2019] [Revised: 03/21/2019] [Accepted: 03/24/2019] [Indexed: 11/14/2022] Open
Abstract
Patients with severe aortic valve stenosis are currently treated with 2 different interventional techniques: surgical aortic valve replacement or transcatheter aortic valve implantation (TAVI). Both have strengths and limitations. On the one hand, TAVI represents a valuable option in high- and intermediate-risk patients and is commonly preferred over surgical aortic valve replacement in subjects with porcelain or severely calcified aorta, on the other, the lack of data on valve durability raises concerns on its use in young, low-risk patients. We present herein the case of a low-risk 71-year-old patient with a severely calcified ascending aorta. We successfully combined our minimally invasive surgical approach with the use of a percutaneous cerebral protection system commonly employed during TAVI procedures. We believe that cardiac surgeons could adopt transcatheter technology to improve operative results.
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Affiliation(s)
- Marco Di Eusanio
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Ospedali Riuniti di Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Ospedali Riuniti di Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Ospedali Riuniti di Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Filippo Capestro
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Ospedali Riuniti di Ancona, Polytechnic University of Marche, Ancona, Italy
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24
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Di Eusanio M, Berretta P, Alfonsi J, Pierri MD, Zingaro C, Capestro F, D'Alfonso A, Fazzi D, Raffaeli V, Munch C, Vessella W, Cefarelli M. [Surgical treatment of aortic valve disease: early results of a 360° minimally invasive approach]. G Ital Cardiol (Rome) 2019; 20:523-528. [PMID: 31530953 DOI: 10.1714/3207.31841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Over the years, with the introduction of minimally invasive techniques and technologies aimed at reducing surgical trauma, aortic valve surgery has considerably developed and improved. Our approach includes: reduced incisions (upper "J" ministernomy or anterior right minithoracotomy), "ultra fast-track" anesthesia protocols, sutureless and rapid deployment valve prostheses and miniaturized circuits of extracorporeal circulation. The aim of this study was to evaluate the clinical outcomes associated with this multidisciplinary approach. METHODS Between October 2016 and November 2018, 429 patients underwent isolated aortic valve replacement at the Cardiac Surgery Unit of the "Ospedali Riuniti" of Ancona, Italy. Overall, 91 patients (21.2%) were operated according to our minimally invasive approach. A severe aortic valve stenosis was the indication for surgery in 90.1% of patients, aortic valve insufficiency in the remaining 18.7%. RESULTS There were neither in-hospital deaths nor major or minor neurological events. Atrial fibrillation was the main postoperative complications (n=26, 28.6%). Four patients (4.4%) underwent permanent pacemaker implantation due to third-degree atrioventricular block, and a surgical bleeding revision was performed in 3.3%. No episodes of respiratory failure were reported. The median length of hospital stay was 6 days (5-8 days). CONCLUSIONS Our initial experience with a 360° minimally invasive approach for the treatment of patients undergoing aortic valve replacement shows encouraging clinical outcomes; this approach may lead to an improved perception of surgery both by patients and their families. However, further clinical studies are needed to evaluate the long-term results.
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Affiliation(s)
- Marco Di Eusanio
- S.O.D. Cardiochirurgia Adulti, Ospedali Riuniti "Umberto I-Lancisi-Salesi"', Università Politecnica delle Marche, Ancona
| | - Paolo Berretta
- S.O.D. Cardiochirurgia Adulti, Ospedali Riuniti "Umberto I-Lancisi-Salesi"', Università Politecnica delle Marche, Ancona
| | - Jacopo Alfonsi
- S.O.D. Cardiochirurgia Adulti, Ospedali Riuniti "Umberto I-Lancisi-Salesi"', Università Politecnica delle Marche, Ancona
| | - Michele Danilo Pierri
- S.O.D. Cardiochirurgia Adulti, Ospedali Riuniti "Umberto I-Lancisi-Salesi"', Università Politecnica delle Marche, Ancona
| | - Carlo Zingaro
- S.O.D. Cardiochirurgia Adulti, Ospedali Riuniti "Umberto I-Lancisi-Salesi"', Università Politecnica delle Marche, Ancona
| | - Filippo Capestro
- S.O.D. Cardiochirurgia Adulti, Ospedali Riuniti "Umberto I-Lancisi-Salesi"', Università Politecnica delle Marche, Ancona
| | - Alessandro D'Alfonso
- S.O.D. Cardiochirurgia Adulti, Ospedali Riuniti "Umberto I-Lancisi-Salesi"', Università Politecnica delle Marche, Ancona
| | - Diego Fazzi
- Servizio di Perfusione, Ospedali Riuniti "Umberto I-Lancisi-Salesi"', Università Politecnica delle Marche, Ancona
| | - Valentina Raffaeli
- S.O.D. Medicina Riabilitativa-Area Cardiologica, Ospedali Riuniti "Umberto I-Lancisi-Salesi"', Università Politecnica delle Marche, Ancona
| | - Christopher Munch
- S.O.D. Anestesia e Terapia Intensiva Cardiochirurgica, Ospedali Riuniti "Umberto I-Lancisi-Salesi"', Università Politecnica delle Marche, Ancona
| | - Walter Vessella
- S.O.D. Anestesia e Terapia Intensiva Cardiochirurgica, Ospedali Riuniti "Umberto I-Lancisi-Salesi"', Università Politecnica delle Marche, Ancona
| | - Mariano Cefarelli
- S.O.D. Cardiochirurgia Adulti, Ospedali Riuniti "Umberto I-Lancisi-Salesi"', Università Politecnica delle Marche, Ancona
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Zingaro C, Cefarelli M, Berretta P, Matteucci S, Pierri M, Di Eusanio M. Endoscopic vein-graft harvesting in coronary artery bypass surgery: Tips and tricks. Multimed Man Cardiothorac Surg 2019; 2019. [PMID: 31290620 DOI: 10.1510/mmcts.2019.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Despite increased use of arterial grafts, the greater saphenous vein remains the most commonly used conduit in coronary artery bypass grafting. The use of less invasive techniques for vessel harvesting has gained interest in recent years, and, many studies have reported that endoscopic vein-graft harvesting reduces postoperative pain, the incidence of wound complications, and the length of hospital stay, as well as eliminating the need for a large longitudinal incision. Over the past decade, our cardiac surgery department has gained considerable experience (>1000 cases) with this endoscopic approach. In this video tutorial, we demonstrate our endoscopic techniques for saphenous vein-graft harvesting using two widely used devices: the VirtuoSaph Endoscopic Vein Harvesting System from Terumo (Tokyo, Japan), an open tunnel system, and the VasoView System from Maquet Cardiovascular (Rastatt, Germany), a closed tunnel system.
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Affiliation(s)
- Carlo Zingaro
- SOD Cardiochirurgia, Ospedali Riuniti 'Umberto I - Lancisi - Salesi' Università Politecnica delle Marche, Ancona
| | - Mariano Cefarelli
- Department of Cardiovascular Surgery S. Orsola-Malpighi Hospital Alma Mater Studiorum - University of Bologna Bologna Italy
| | | | - Sacha Matteucci
- SOD Cardiochirurgia Ospedali Riuniti 'Umberto I - Lancisi - Salesi' Università Politecnica delle Marche, Ancona
| | - Michele Pierri
- SOD Cardiochirurgia Ospedali Riuniti 'Umberto I - Lancisi - Salesi' Università Politecnica delle Marche, Ancona
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Di Eusanio M, Cefarelli M, Zingaro C, Capestro F, Matteucci SML, D'alfonso A, Pierri MD, Aiello ML, Berretta P. Mini Bentall operation: technical considerations. Indian J Thorac Cardiovasc Surg 2019; 35:87-91. [PMID: 33061071 DOI: 10.1007/s12055-018-0669-4] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/11/2018] [Accepted: 03/06/2018] [Indexed: 01/16/2023] Open
Abstract
Bentall operation via median sternotomy has been largely shown to be safe and long-term efficacious and currently represents the "gold standard" intervention in patients presenting with aortic valve and root disease. However, over the last years, minimally invasive techniques have gained wider clinical application in cardiac surgery. In particular, minimally invasive aortic valve replacement through ministernotomy has shown excellent outcomes and becomes the first choice approach in numerous experienced centers. Based on these favorable results, ministernotomy approach has also been proposed for complex cardiac procedures such as aortic root replacement and arch surgery. Herein, we present our technique for minimally invasive Bentall operation using a ministernotomy approach.
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Affiliation(s)
- Marco Di Eusanio
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti, Politechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti, Politechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Carlo Zingaro
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti, Politechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Filippo Capestro
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti, Politechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Sacha Marco Luciano Matteucci
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti, Politechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Alessandro D'alfonso
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti, Politechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Michele Danilo Pierri
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti, Politechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Marco Luigi Aiello
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti, Politechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti, Politechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
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Cefarelli M, Berretta P, Pierri M, Capestro F, D’Alfonso A, Di Eusanio M. VD04 AORTIC ROOT REPLACEMENT WITH “FRENCH CUFF” TECHNIQUE. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549979.44023.76] [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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Berretta P, Cefarelli M, Zingaro C, Pierri M, Capestro F, Di Eusanio M. VD16 SUTURELESS MINIAVR WITH RIGHT ANTERIOR THORACOTOMY AND ULTRA FAST TRACK ANAESTHESIA. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549945.78982.d2] [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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Berretta P, Wessella V, Pierri M, Fazzi D, Cefarelli M, Zingaro C, Capestro F, D’alfonso A, Di Eusanio M. OC06 BUILDING UP A MULTIDISCIPLINARY 360° MINIMALLY INVASIVE PROGRAM FOR AVR. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549881.34202.f8] [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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30
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Matteucci M, Cefarelli M, Pierri M, Capestro F, Berretta P, Di Eusanio M. VD14 OPEN SURGICAL TREATMENT OF GIANT CORONARY ARTERY ANEURYSMS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549938.84819.06] [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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31
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Zingaro C, Cefarelli M, Matteucci M, Berretta P, D’Alfonso A, Di Eusanio M. VD09 ENDOSCOPIC VEIN-GRAFT HARVESTING TECHNIQUE IN CORONARY-ARTERY BYPASS SURGERY. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549986.38185.3d] [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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32
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Berretta P, Cefarelli M, Montalto A, Savini C, Miceli A, Rubino AS, Troise G, Patanè L, Di Eusanio M. [Surgical indications for thoracic aortic disease: beyond the "magic numbers" of aortic diameter]. G Ital Cardiol (Rome) 2018; 19:429-436. [PMID: 29989600 DOI: 10.1714/2938.29539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thoracic aortic aneurysm (TAA) is a silent disease that can become rapidly lethal once dissection or rupture occurs. To prevent aortic catastrophe, prophylactic aortic replacement is the mainstay of therapy in patients with TAA. Currently, surgical indications for TAA repair are predominantly based on the aortic size. However, the effectiveness of the diameter criterion to predict aortic rupture and dissection has been largely questioned over the last years. Growing evidence suggests that aortic size alone may not be sufficient to predict the risk in all TAAs. In this setting, other predictors such as genetic, environmental, biochemical and hemodynamic factors have been proposed. The aim of this paper is to review and discuss on current evidence, controversies and future directions for the treatment of patients with TAA.
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Affiliation(s)
- Paolo Berretta
- S.O.D. Cardiochirurgia, Ospedali Riuniti "Umberto I-Lancisi-Salesi", Università Politecnica delle Marche, Ancona
| | - Mariano Cefarelli
- S.O.D. Cardiochirurgia, Ospedali Riuniti "Umberto I-Lancisi-Salesi", Università Politecnica delle Marche, Ancona
| | | | - Carlo Savini
- U.O. Cardiochirurgia, A.O. S. Orsola-Malpighi, Università degli Studi, Bologna
| | - Antonio Miceli
- U.O. Cardiochirurgia, Istituto Clinico S. Ambrogio, Ospedale San Donato, Milano
| | - Antonino S Rubino
- Dipartimento di Cardiochirurgia, Centro Cuore G.B. Morgagni, Pedara (CT)
| | - Giovanni Troise
- U.O. Cardiochirurgia, Istituto Ospedaliero Fondazione Poliambulanza, Brescia
| | - Leonardo Patanè
- Dipartimento di Cardiochirurgia, Centro Cuore G.B. Morgagni, Pedara (CT)
| | - Marco Di Eusanio
- S.O.D. Cardiochirurgia, Ospedali Riuniti "Umberto I-Lancisi-Salesi", Università Politecnica delle Marche, Ancona
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Berretta P, Cefarelli M, Vessella W, Pierri MD, Carozza R, Abramucci G, Munch C, Zahedi HM, Di Eusanio M. Ultra fast track surgery: a rapid deployment aortic valve replacement through a J-ministernotomy. J Vis Surg 2018; 4:90. [PMID: 29963379 DOI: 10.21037/jovs.2018.04.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/13/2018] [Indexed: 01/25/2023]
Abstract
Aortic valve surgery has been undergone continuous development over the last years, involving less invasive techniques and the use of new technologies to reduce the traumatic impact of the intervention and extend the operability toward increasingly high-risk patients. Minimally invasive aortic valve replacement (AVR) has gradually been recognized as a less traumatic technique compared to median sternotomy, becoming first choice approach in numerous experienced centers. Herein we present our multidisciplinary minimally invasive approach for AVR, involving: (I) reduced chest incision; (II) rapid deployment AVR; (III) minimally invasive extracorporeal circulation system; and (IV) ultra fast track (UFT) anaesthetic management.
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Affiliation(s)
- Paolo Berretta
- Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy
| | - Walter Vessella
- Cardiac Anaesthesia and Intensive Care Unit, Ospedali Riuniti, Ancona, Italy
| | - Michele D Pierri
- Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy
| | | | - Giulia Abramucci
- Preventive Cardiology and Rehabilitation Unit, Ospedali Riuniti, Ancona, Italy
| | - Christopher Munch
- Cardiac Anaesthesia and Intensive Care Unit, Ospedali Riuniti, Ancona, Italy
| | - Hossein M Zahedi
- Cardiac Anaesthesia and Intensive Care Unit, Ospedali Riuniti, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy
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Di Bartolomeo R, Berretta P, Pantaleo A, Murana G, Cefarelli M, Alfonsi J, Barberio G, Leone A, Di Marco L, Pacini D. Long-Term Outcomes of Open Arch Repair After a Prior Aortic Operation: Our Experience in 154 Patients. Ann Thorac Surg 2017; 103:1406-1412. [DOI: 10.1016/j.athoracsur.2016.08.090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 10/20/2022]
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Loforte A, Gremolini M, Cefarelli M, Jafrancesco G, Pilato E, Potena L, Masetti M, Grigioni F, Marinelli G. Influence of the MELD-XI (Model of End-Stage Liver Disease Excluding INR) on Heart Transplant Outcomes. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.606] [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: 10/19/2022] Open
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Berretta P, Di Marco L, Pacini D, Cefarelli M, Alfonsi J, Castrovinci S, Di Eusanio M, Di Bartolomeo R. Reoperations versus primary operation on the aortic root: a propensity score analysis. Eur J Cardiothorac Surg 2017; 51:322-328. [PMID: 28186292 DOI: 10.1093/ejcts/ezw250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/09/2016] [Accepted: 06/22/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paolo Berretta
- Division of Cardiac Surgery, "G. Mazzini" Hospital, Teramo, Italy
| | - Luca Di Marco
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| | - Davide Pacini
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| | - Mariano Cefarelli
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| | - Jacopo Alfonsi
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| | | | - Marco Di Eusanio
- Division of Cardiac Surgery, "G. Mazzini" Hospital, Teramo, Italy
| | - Roberto Di Bartolomeo
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
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Loforte A, Murana G, Cefarelli M, Jafrancesco G, Sabatino M, Martin Suarez S, Pilato E, Pacini D, Grigioni F, Bartolomeo RD, Marinelli G. Role of Intra-Aortic Balloon Pump and Extracorporeal Membrane Oxygenation in Early Graft Failure After Cardiac Transplantation. Artif Organs 2017; 40:E136-45. [PMID: 27530673 DOI: 10.1111/aor.12793] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/06/2016] [Accepted: 05/31/2016] [Indexed: 11/28/2022]
Abstract
Early graft failure (EGF) is a major risk factor for death after heart transplantation (Htx). We investigated the predictive risk factors for moderate-to-severe EGF requiring an intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) circulatory support as treatment after Htx. Between January 2000 and December 2014, 412 consecutive adult patients underwent isolated Htx at our institution. Moderate and severe EGF were defined as the need for IABP and ECMO support, respectively, within 24 h after Htx. All available recipient and donor variables were analyzed to assess the risk of EGF occurrence. Overall, moderate-to-severe EGF occurred in 46 (11.1%) patients. Twenty-nine (63.04%) patients required peripheral or central ECMO support in the treatment of severe EGF and 17 (36.9%) patients required IABP support for the treatment of moderate EGF. The predictive risk factors for moderate-to-severe EGF in recipients, as assessed by logistic regression analysis, were a preoperative transpulmonary gradient > 12 mm Hg (odds ratio [OR] 5.2; P = 0.023), a preoperative inotropic score > 10 (OR 8.5; P = 0.0001), and preoperative ECMO support (OR 4.2; P = 0.012). For donors, the predictive risk factor was a donor score ≥ 17 (OR 8.3; P = 0.006). The absence of EGF was correlated with improved long-term survival: 94% at 1 year and 81% at 5 years without EGF versus 76% and 36% at 1 year (P < 0.001), and 70% and 28% at 5 years (P < 0.001) with EGF requiring IABP and ECMO support, respectively. In-hospital weaned and survived patients after IABP or ECMO treatment for moderate-to-severe EGF had a similar 5-year conditional survival rate as transplant patients who had not suffered EGF: 88% without EGF versus 84% with EGF treated with mechanical circulatory support devices (P = 0.08). The occurrence of EGF is a multifactorial deleterious event that depends on donor and recipient profiles. IABP and ECMO support are reliable treatment strategies, depending on the grade of EGF. Furthermore, surviving patients treated with IABP or ECMO have the same long-term conditional survival rate as patients who have not suffered EGF.
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Affiliation(s)
| | - Giacomo Murana
- Departments of Cardiovascular Surgery and Transplantation
| | | | | | - Mario Sabatino
- Cardiology and Transplantation, S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | | | | | - Davide Pacini
- Departments of Cardiovascular Surgery and Transplantation
| | - Francesco Grigioni
- Cardiology and Transplantation, S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
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Murana G, Cefarelli M, Kloppenburg G, Morshuis WJ, Heijmen RH. Surgical exclusion of a saccular aneurysm within a patent ductus arteriosus in an adult patient with Ortner's syndrome. Future Cardiol 2016; 12:613-616. [PMID: 27759427 DOI: 10.2217/fca-2016-0034] [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: 11/21/2022] Open
Abstract
In adult the patent ductus arteriosus is a rare condition associated sometimes with lethal complications. We describe the case of a 44-year-old woman with a history of systemic lupus erythematosus admitted to our hospital with hoarseness and severe dyspnea. Clinical imaging examinations indicated a saccular aneurysm within a persistent ductus arteriosus with signs of impending rupture. Patient was not considered suitable for transcatheter closure and therefore she underwent open aortic repair. The procedure was uneventful and any significant complications occurred during postoperative course.
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Affiliation(s)
- Giacomo Murana
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mariano Cefarelli
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Geoffrey Kloppenburg
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Wim J Morshuis
- Department of Cardiac Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Colli A, Besola L, Bizzotto E, Manzan E, Zucchetta F, Pittarello D, Rucinskas K, Aidietis A, Janusauskas V, Zakarkaite D, Drasutiene A, Danner B, Sievert H, Kurnicka K, Wrobel K, Salizzoni S, Rinaldi M, Savini C, Pacini D, Cefarelli M, Gerosa G. TCT-42 Transcatheter echo guided Mitral Valve Repair with Neochord Implantation for posterior leaflet disease: Results from Neochord Independent International Registry. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.180] [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: 10/20/2022]
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40
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Di Bartolomeo R, Murana G, Cefarelli M, Alfonsi J, Di Marco L, Buia F, Luigi L, Pacini D. Corrigendum to 'Hybrid two-stage repair of thoracoabdominal aortic aneurysm'[Multimedia Man Cardiothoracic Surg 13 May 2016]. Multimed Man Cardiothorac Surg 2016; 2016:mmw010. [PMID: 27371831 DOI: 10.1093/mmcts/mmw010] [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: 11/12/2022]
Affiliation(s)
- Roberto Di Bartolomeo
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giacomo Murana
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Mariano Cefarelli
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Jacopo Alfonsi
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Luca Di Marco
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Francesco Buia
- Department of Radiology, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Lovato Luigi
- Department of Radiology, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Davide Pacini
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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Di Bartolomeo R, Murana G, Cefarelli M, Alfonsi J, Di Marco L, Buia F, Lovato L, Pacini D. Hybrid two-stage repair of thoracoabdominal aortic aneurysm. Multimed Man Cardiothorac Surg 2016; 2016:mmw008. [PMID: 27188444 DOI: 10.1093/mmcts/mmw008] [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] [Received: 01/10/2016] [Accepted: 03/31/2016] [Indexed: 11/12/2022]
Abstract
Thoracoabdominal aortic aneurysm is a challenging disease that often requires an invasive surgical repair. Recently, a less invasive hybrid approach has been proposed to improve postoperative outcomes in high-risk patients. It consists of an open first stage where arterial visceral rerouting is obtained, using a vascular graft followed by a second stage where the remaining thoracoabdominal aorta is covered with a stent graft. Initial results using this approach seem promising. Here, we sought to describe the hybrid two-stage technique that is most frequently used in this extensive aortic pathology.
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Affiliation(s)
- Roberto Di Bartolomeo
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giacomo Murana
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Mariano Cefarelli
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Jacopo Alfonsi
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Luca Di Marco
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Francesco Buia
- Department of Radiology, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Luigi Lovato
- Department of Radiology, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Davide Pacini
- Department of Cardiovascular Surgery, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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Loforte A, Cefarelli M, Murana G, Jafrancesco G, Alfonsi J, Pilato E, Martin Suarez S, Potena L, Grigioni F, Marinelli G. Impact of Recipient Body Mass Index on Orthotopic Heart Transplantation Outcomes. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.843] [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: 11/28/2022] Open
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43
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Castrovinci S, Pacini D, Di Marco L, Berretta P, Cefarelli M, Murana G, Alfonsi J, Pantaleo A, Leone A, Di Eusanio M, Di Bartolomeo R. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis. Eur J Cardiothorac Surg 2016; 50:223-9. [DOI: 10.1093/ejcts/ezw038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 01/11/2016] [Indexed: 11/12/2022] Open
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Di Eusanio M, Castrovinci S, Cefarelli M, Berretta P, Alfonsi J, Murana G, Di Bartolomeo R. Minimally invasive root surgery: a Bentall procedure through a J-ministernotomy. Ann Cardiothorac Surg 2015; 4:198-200. [PMID: 25870820 DOI: 10.3978/j.issn.2225-319x.2014.11.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 09/20/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Marco Di Eusanio
- Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Sebastiano Castrovinci
- Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mariano Cefarelli
- Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Berretta
- Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Jacopo Alfonsi
- Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giacomo Murana
- Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Roberto Di Bartolomeo
- Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Di Bartolomeo R, Pantaleo A, Berretta P, Murana G, Castrovinci S, Cefarelli M, Folesani G, Di Eusanio M. Frozen elephant trunk surgery in acute aortic dissection. J Thorac Cardiovasc Surg 2015; 149:S105-9. [DOI: 10.1016/j.jtcvs.2014.07.098] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/26/2014] [Accepted: 07/24/2014] [Indexed: 10/24/2022]
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Loforte A, Pilato E, Martin Suarez S, Folesani G, Jafrancesco G, Castrovinci S, Cefarelli M, Potena L, Magnani G, Grigioni F, Caramelli F, Frascaroli G, Di Bartolomeo R, Marinelli G. [Extracorporeal membrane oxygenation for the treatment of refractory cardiogenic shock in adults: strategies, results, and predictors of mortality]. G Ital Cardiol (Rome) 2015; 15:577-85. [PMID: 25424022 DOI: 10.1714/1672.18312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The RotaFlow (Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) and Levitronix CentriMag (Levitronix LCC, Waltham, MA, USA) veno-arterial extracorporeal membrane oxygenation (ECMO) support systems have been investigated as treatment for refractory cardiogenic shock. METHODS Between 2004 and 2012, 119 consecutive adult patients were supported on RotaFlow (n=104) or CentriMag (n=15) ECMO at our Institution (79 men; mean age 57.3 ± 12.5 years, range 19-78 years). Indications for support were: failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n=47) and primary graft failure (n=26); post-acute myocardial infarction cardiogenic shock (n=11); acute myocarditis (n=3), and cardiogenic shock on chronic heart failure (n=32). RESULTS A central ECMO setting was established in 64 (53.7%) patients while peripherally in 55 (46.2%). Overall mean support time was 10.9 ± 8.7 days (range 1-43 days). Forty-two (35.2%) patients died on ECMO. Overall success rate, in terms of survival on ECMO (n=77), weaning from mechanical support (n=51; 42.8%) and bridge to heart transplantation (n=26; 21.8%), was 64.7%. Sixty-eight (57.1%) patients were successfully discharged. Stepwise logistic regression identified blood lactate levels and creatine kinase-MB relative index at 72h after ECMO initiation, and number of packed red blood cells (PRBCs) transfused on ECMO as significant predictors of mortality. Central ECMO population had a higher rate of continuous veno-venous hemofiltration need and bleeding events compared with the peripheral setting. CONCLUSIONS ECMO support provides encouraging results in different subsets of patients in cardiogenic shock. Blood lactate levels, creatine kinase-MB relative index and PRBCs transfused should be strictly monitored during veno-arterial ECMO running. Type of ECMO implantation, if peripheral or central, should be decided according to the specific patient subset.
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Di Bartolomeo R, Di Marco L, Cefarelli M, Leone A, Pantaleo A, Di Eusanio M, Barberio G, Pacini D. The Bologna experience with the Thoraflex™ hybrid frozen elephant trunk device. Future Cardiol 2015; 11:39-43. [DOI: 10.2217/fca.14.56] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Background: We present our initial experience with the frozen elephant trunk using a Thoraflex™ hybrid device for the treatment of the complex thoracic aorta lesions. Materials & methods: Between March 2013 and March 2014, ten patients underwent thoracic aorta surgery using the frozen elephant trunk approach with the Thoraflex hybrid device. Indications for surgery were: residual type A chronic dissection (eight patients), degenerative aneurysm (one patient) and type B chronic aortic dissection (one patient). Selective antegrade cerebral perfusion and moderate hypothermia were used in all cases. Results: In-hospital mortality was 0% and no patients presented with paraplegia, paraparesis or major neurological events. One patient experienced transient ischemic attack. Two patients underwent reoperation for bleeding. All postoperative angiography CT scans confirmed the desired results. Conclusion: Our initial experience demonstrated excellent early results. The Thoraflex hybrid prosthesis with the four-branched arch graft increases the spectrum of techniques available for the surgeon in the treatment of complex diseases of the thoracic aorta.
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Affiliation(s)
- Roberto Di Bartolomeo
- Department of Cardiac Surgery, S Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Luca Di Marco
- Department of Cardiac Surgery, S Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Mariano Cefarelli
- Department of Cardiac Surgery, S Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Alessandro Leone
- Department of Cardiac Surgery, S Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Antonio Pantaleo
- Department of Cardiac Surgery, S Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Marco Di Eusanio
- Department of Cardiac Surgery, S Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Giuseppe Barberio
- Department of Cardiac Surgery, S Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Davide Pacini
- Department of Cardiac Surgery, S Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
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Di Eusanio M, Berretta P, Cefarelli M, Castrovinci S, Folesani G, Alfonsi J, Pantaleo A, Murana G, Di Bartolomeo R. Long-term outcomes after aortic arch surgery: results of a study involving 623 patients. Eur J Cardiothorac Surg 2014; 48:483-90. [DOI: 10.1093/ejcts/ezu468] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/04/2014] [Indexed: 11/12/2022] Open
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49
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Di Eusanio M, Berretta P, Folesani G, Cefarelli M, Alfonsi J, Murana G, Castrovinci S, Di Bartolomeo R. 125 * TOTAL ARCH REPLACEMENT VERSUS MORE CONSERVATIVE MANAGEMENT IN TYPE A ACUTE AORTIC DISSECTION. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.125] [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: 11/14/2022] Open
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50
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Di Eusanio M, Pantaleo A, Cefarelli M, Castrovinci S, Di Bartolomeo R. Frozen elephant trunk surgery in type B aortic dissection. Ann Cardiothorac Surg 2014; 3:400-2. [PMID: 25133103 DOI: 10.3978/j.issn.2225-319x.2014.05.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/25/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Marco Di Eusanio
- Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Italy
| | - Antonio Pantaleo
- Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Italy
| | - Mariano Cefarelli
- Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Italy
| | - Sebastiano Castrovinci
- Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Italy
| | - Roberto Di Bartolomeo
- Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Italy
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