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Nasso G, Santarpino G, Di Bari N, Fattouch K, Condello I, Moscarelli M, Del Giglio M, Paparella D, Lamarra M, Savini C, Coppola R, Fiorani V, Speziale G. Cardiac Surgery in Nonagenarians Following the TAVI/TMVI Era: A Multicenter 23-Year Comparative Analysis. J Clin Med 2023; 12:jcm12062177. [PMID: 36983179 PMCID: PMC10054800 DOI: 10.3390/jcm12062177] [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] [Received: 12/26/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Studies reporting on the outcome of 90-year-old patients undergoing cardiac surgery are scant in literature; and currently, those regarding the implementation of trans-catheter techniques number even fewer. Methods: We compared patients aged >89 years operated on between 1998 and 2008 at 8 Italian cardiac surgery centers, with patients of the same age operated on between 2009 and 2021. All of the patients were operated on with “open” surgery, with the exclusion of percutaneous valve repair/implantation procedures. Results: The patients of the two groups (group 98-08—127 patients, and group 09-21—101 patients) had comparable preoperative risk factors in terms of the LogEuroSCORE (98-08: 21.3 ± 6.1 vs. 09-21: 20.9 ± 11.1, p = 0.12). There was a considerable difference in the type of surgery (isolated valve, isolated coronary, and combined surgery, 46.5, 38.5, and 15% vs. 52, 13, and 35% in 98-08 and 09-21, respectively, p = 0.01). Analogous operating durations were recorded (cross-clamp time: 98-08: 46 ± 28 min vs. 09-21: 51 ± 28 min, p = 0.06). The number of packed bypasses was lower in 09-21 (1.3 ± 0.6 vs. 2.4 ± 1.2, p = 0.001). In the postoperative period, there was a statistically significant difference in the 30-day survival in favor of the “more recent” patients (98-08: 17 deaths (13.4%) versus 09-21: 6(5.9%); p = 0.001), also confirmed in the subgroups (12.2% vs. 0% in isolated coronary surgery, p < 0.001; and 12.3% vs. 0% in isolated valve surgery, p < 0.001). Conclusions: Accurate pre-, intra-, and post-operative evaluation/management to reduce biological impacts facilitate significant improvements in the outcomes in nonagenarian patients when compared to the results recorded in previous years.
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Affiliation(s)
- Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70100 Bari, Italy
- Correspondence: ; Tel.: +39-080-564-4168; Fax: +39-080-564-4678
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, 73100 Lecce, Italy
- Department of Cardiac Surgery, Paracelsus Medical University, 40100 Nuremberg, Germany
- Department of Experimental and Clinical Medicine, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Nicola Di Bari
- Department of Cardiac Surgery, “Aldo Moro” University, 70100 Bari, Italy
| | - Khalil Fattouch
- Department of Cardiac Surgery, Maria Eleonora Hospital, GVM Care & Research, 90121 Palermo, Italy
| | - Ignazio Condello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70100 Bari, Italy
| | - Marco Moscarelli
- Department of Cardiac Surgery, Maria Eleonora Hospital, GVM Care & Research, 90121 Palermo, Italy
| | - Mauro Del Giglio
- Department of Cardiac Surgery, Maria Pia Hospital, GVM Care & Research, 10024 Torino, Italy
| | - Domenico Paparella
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70100 Bari, Italy
- Department of Cardiac Surgery, University of Foggia, 71121 Foggia, Italy
| | - Mauro Lamarra
- Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, 40100 Cotignola, Italy
- Department of Cardiac Surgery, Villa Torri Hospital, GVM Care & Research, 40100 Bologna, Italy
| | - Carlo Savini
- Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, 40100 Cotignola, Italy
| | - Roberto Coppola
- Department of Cardiac Surgery, ICLAS Hospital, GVM Care & Research, 16135 Rapallo, Italy
| | - Vinicio Fiorani
- Department of Cardiac Surgery, Salus Hospital, GVM Care & Research, 40100 Reggio Emilia, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70100 Bari, Italy
- Department of Cardiac Surgery, San Carlo di Nancy Hospital, GVM Care & Research, 00042 Rome, Italy
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Ramoni E, Del Giglio M, Ceresa R, Savarese G, Lamarra M, Di Chicco E, Grattoni C. P51 HYBRYD TREATMENT FOR CORONARY ARTERY DISEASE CONCOMITANT WITH MINIMALLY INVASIVE CARDIAC VALVE SURGERY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.049] [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: 11/12/2022]
Abstract
Abstract
Cardiac valvular surgery concomitant with coronary artery bypass grafting has a higher mortality than isolated valve surgery. Therefore, a hybrid approach that combines the benefits of the low risk of percutaneous coronary angioplasty (PCI) with those of minimally invasive valve surgery, should be considered. At present, data on hybrid valve/PCI procedures are limited to clinical cases and small cases, in which the PCI procedure is usually followed by surgery after about 3 weeks. We report our experience in which valve surgery was first performed with a minimally invasive approach (minithoracotomy or ministernotomy), then followed by coronary revascularization with PCI, to reduce the risks of post–surgical bleeding due to anti–aggregating therapy, in a non–randomized but consecutive case. Between July 2019 and June 2021, 22 patients were treated. Median of the days between surgery and PCI was 8, median of total hospitalization was 13 days. In 6 patients the surgical approach was a ministernotomy, in 16 was performed a right minithoracotomy. In 14 (64%) patients PCI was performed on single coronary vessel, in 5 (22.5%) on 2 coronary vessels and in 3 (13.5%) on 3 coronary vessels. There were no reinterventions for postoperative bleeding. One patient presented gastro–intestinal bleeding from a colon polyp. No patients died during hospitalization, nor at the follow–up performed by telephone every 6 months. No patients required valve reintervention or coronary artery bypass during hospitalization or follow–up. One patient underwent a new PCI procedure at 7 months. In conclusion, the hybrid approach consisting of minimally invasive valve surgery followed by PCI may offer an alternative to the standard but more complex operation of coronary artery bypass grafting plus valve surgery through complete sternotomy.
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Affiliation(s)
- E Ramoni
- VILLA TOTTI HOSPITAL, BOLOGNA; MARIA HOSPITAL, TORINO; VILLA TORRI HOSPITAL, BOLOGNA; OSPEDALE SAN GIOVANNI BATTISTA, FOLIGNO
| | - M Del Giglio
- VILLA TOTTI HOSPITAL, BOLOGNA; MARIA HOSPITAL, TORINO; VILLA TORRI HOSPITAL, BOLOGNA; OSPEDALE SAN GIOVANNI BATTISTA, FOLIGNO
| | - R Ceresa
- VILLA TOTTI HOSPITAL, BOLOGNA; MARIA HOSPITAL, TORINO; VILLA TORRI HOSPITAL, BOLOGNA; OSPEDALE SAN GIOVANNI BATTISTA, FOLIGNO
| | - G Savarese
- VILLA TOTTI HOSPITAL, BOLOGNA; MARIA HOSPITAL, TORINO; VILLA TORRI HOSPITAL, BOLOGNA; OSPEDALE SAN GIOVANNI BATTISTA, FOLIGNO
| | - M Lamarra
- VILLA TOTTI HOSPITAL, BOLOGNA; MARIA HOSPITAL, TORINO; VILLA TORRI HOSPITAL, BOLOGNA; OSPEDALE SAN GIOVANNI BATTISTA, FOLIGNO
| | - E Di Chicco
- VILLA TOTTI HOSPITAL, BOLOGNA; MARIA HOSPITAL, TORINO; VILLA TORRI HOSPITAL, BOLOGNA; OSPEDALE SAN GIOVANNI BATTISTA, FOLIGNO
| | - C Grattoni
- VILLA TOTTI HOSPITAL, BOLOGNA; MARIA HOSPITAL, TORINO; VILLA TORRI HOSPITAL, BOLOGNA; OSPEDALE SAN GIOVANNI BATTISTA, FOLIGNO
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Santarpino G, Lorusso R, Moscarelli M, Mikus E, Wisniewski K, Dell'Aquila AM, Margari V, Carrozzo A, Barbato L, Fiorani V, Lamarra M, Fattouch K, Squeri A, Giannini F, Marchese A, Farahani K, Gregorini R, Comoglio C, Martinelli L, Calvi S, Avolio M, Paparella D, Albertini A, Speziale G. Sutureless versus transcatheter aortic valve replacement: A multicenter analysis of "real-world" data. J Cardiol 2021; 79:121-126. [PMID: 34518075 DOI: 10.1016/j.jjcc.2021.08.022] [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: 04/09/2021] [Revised: 08/08/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recent data suggested that transcatheter aortic valve replacement (TAVR) may be indicated also for low-risk patients. However, robust evidence is still lacking, particularly regarding valve performance at follow-up that confers a limitation to its use in young patients. Moreover, a literature gap exists in terms of 'real-world' data analysis. The aim of this study is to compare the cost-effectiveness of sutureless aortic valve replacement (SuAVR) versus transfemoral TAVR. METHODS Prospectively collected data were retrieved from a centralized database of nine cardiac surgery centers between 2010 and 2018. Follow-up was completed in June 2019. A propensity score matching (PSM) analysis was performed. RESULTS Patients in the TAVR group (n=1002) were older and with more comorbidities than SuAVR patients (n=443). The PSM analysis generated 172 pairs. No differences were recorded between groups in 30-day mortality [SuAVR vs TAVR: n=7 (4%) vs n=5 (2.9%); p=0.7] and need for pacemaker implant [n=10 (5.8%) vs n=20 (11.6%); p=0.1], but costs were lower in the SuAVR group (20486.6±4188€ vs 24181.5±3632€; p<0.01). Mean follow-up was 1304±660 days. SuAVR patients had a significantly higher probability of survival than TAVR patients (no. of fatal events: 22 vs 74; p<0.014). Median follow-up was 2231 days and 2394 days in the SuAVR and TAVR group, respectively. CONCLUSION The treatment of aortic valve stenosis with surgical sutureless or transcatheter prostheses is safe and effective. By comparing the two approaches, patients who can undergo surgery after heart team evaluation show longer lasting results and a more favorable cost ratio.
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Affiliation(s)
- Giuseppe Santarpino
- Città di Lecce Hospital, Department of Cardiac Surgery, GVM Care & Research, Lecce, Italy; Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany; Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University "Magna Graecia", Catanzaro (CZ), Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Hospital, Maastricht, the Netherlands
| | - Marco Moscarelli
- Anthea Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari (BA), Italy
| | - Elisa Mikus
- Maria Cecilia Hospital, Department of Cardiac Surgery, GVM Care & Research, Cotignola (RA), Italy
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany.
| | | | - Vito Margari
- Santa Maria Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari (BA), Italy
| | - Alessandro Carrozzo
- ICLAS, Department of Cardiac Surgery, GVM Care & Research, Rapallo (GE), Italy
| | - Luciano Barbato
- Maria Pia Hospital, Department of Cardiac Surgery, GVM Care & Research, Turin, Italy
| | - Vinicio Fiorani
- Salus Hospital, Department of Cardiac Surgery, GVM Care & Research, Reggio Emilia, Italy
| | - Mauro Lamarra
- Villa Torri, Department of Cardiac Surgery, GVM Care & Research, Bologna, Italy
| | - Khalil Fattouch
- Maria Eleonora Hospital, Department of Cardiac Surgery, GVM Care & Research, Palermo, Italy
| | - Angelo Squeri
- Maria Cecilia Hospital, Department of Cardiology, GVM Care & Research, Cotignola (RA), Italy
| | - Francesco Giannini
- Maria Cecilia Hospital, Department of Cardiology, GVM Care & Research, Cotignola (RA), Italy
| | - Alfredo Marchese
- Santa Maria Hospital, Department of Cardiology, GVM Care & Research, Bari, Italy
| | - Kia Farahani
- Città di Lecce Hospital, Department of Cardiology, GVM Care & Research, Lecce, Italy
| | - Renato Gregorini
- Città di Lecce Hospital, Department of Cardiac Surgery, GVM Care & Research, Lecce, Italy
| | - Chiara Comoglio
- Maria Pia Hospital, Department of Cardiac Surgery, GVM Care & Research, Turin, Italy
| | - Luigi Martinelli
- ICLAS, Department of Cardiac Surgery, GVM Care & Research, Rapallo (GE), Italy
| | - Simone Calvi
- Maria Cecilia Hospital, Department of Cardiac Surgery, GVM Care & Research, Cotignola (RA), Italy
| | - Maria Avolio
- Clinical Data Management, GVM Care & Research, Rome, Italy
| | - Domenico Paparella
- Santa Maria Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari (BA), Italy; Department of Emergency and Organ Transplant, Aldo Moro University of Bari, Bari, Italy
| | - Alberto Albertini
- Maria Cecilia Hospital, Department of Cardiac Surgery, GVM Care & Research, Cotignola (RA), Italy
| | - Giuseppe Speziale
- Anthea Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari (BA), Italy
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Abstract
The authors report a case of renal cell carcinoma metastasis to the pancreas occurring 25 years after nephrectomy. The need for prolonged follow-up of patients is emphasized. The surgical approach Is considered the best way to deal with such late metastases.
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Affiliation(s)
- F Temellini
- Divisione di Chirurgia Generale, Ospedale Civile di Senigallia, Ancona, Italy
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5
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Affiliation(s)
- Fausto Castriota
- Interventional Catheterization Laboratory Villa Maria Cecilia Hospital Ravenna, Italy
| | - Alberto Cremonesi
- Interventional Catheterization Laboratory Villa Maria Cecilia Hospital Ravenna, Italy
| | - Raffaella Manetti
- Interventional Catheterization Laboratory Villa Maria Cecilia Hospital Ravenna, Italy
| | - Mauro Lamarra
- Interventional Catheterization Laboratory Villa Maria Cecilia Hospital Ravenna, Italy
| | - Giorgio Noera
- Interventional Catheterization Laboratory Villa Maria Cecilia Hospital Ravenna, Italy
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Mikus E, Calvi S, Tripodi A, Dozza L, Lamarra M, Del Giglio M. Minimally invasive reoperative aortic valve replacement. Ann Cardiothorac Surg 2015; 4:67-70. [PMID: 25694980 DOI: 10.3978/j.issn.2225-319x.2014.11.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 09/15/2014] [Indexed: 11/14/2022]
Abstract
The operative mortality associated with repeat heart valve surgery is supposedly higher than the mortality associated with the primary operation. However, controversy still surrounds the risk factors and optimal surgical approach for patients requiring repeat cardiac surgery, particularly for those requiring aortic valve replacements (AVR). While the standard approach generally utilizes full sternotomy and peripheral cannulation, alternative approaches such as minimally invasive sternotomy may play an increasingly important role in this field. This study compares the advantages and disadvantages of a minimally invasive approach in redo AVR with the standard approach, highlighting difficulties and potential solutions.
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Affiliation(s)
- Elisa Mikus
- 1 Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care & Research, ES Health Science Foundation, Cotignola, Italy ; 2 ES Health Science Foundation, Cotignola, Italy
| | - Simone Calvi
- 1 Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care & Research, ES Health Science Foundation, Cotignola, Italy ; 2 ES Health Science Foundation, Cotignola, Italy
| | - Alberto Tripodi
- 1 Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care & Research, ES Health Science Foundation, Cotignola, Italy ; 2 ES Health Science Foundation, Cotignola, Italy
| | - Luca Dozza
- 1 Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care & Research, ES Health Science Foundation, Cotignola, Italy ; 2 ES Health Science Foundation, Cotignola, Italy
| | - Mauro Lamarra
- 1 Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care & Research, ES Health Science Foundation, Cotignola, Italy ; 2 ES Health Science Foundation, Cotignola, Italy
| | - Mauro Del Giglio
- 1 Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care & Research, ES Health Science Foundation, Cotignola, Italy ; 2 ES Health Science Foundation, Cotignola, Italy
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Aratari C, Capestro F, Massi F, Magnano D, Manché A, Lamarra M. Sternal wrapping: developments and results. Asian Cardiovasc Thorac Ann 2014; 21:319-25. [PMID: 24570499 DOI: 10.1177/0218492312458595] [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: 11/15/2022]
Abstract
BACKGROUND Postoperative sternal wound complications are infrequent events that negatively affect recovery and may have serious consequences. Sternal wrapping, a technique of sternal care, has hemostatic properties without bone wax, and offers mechanical and microbiologic protection. METHODS From February 1998 to December 2011, 258 patients in 2 Italian institutions underwent various cardiac surgery procedures with sternal wrapping in place, and were followed up for no less then 6 months. RESULTS Two (0.8%) extremely compromised patients with ischemic sternal osteonecrosis and deep sternal wound infection required a sternal stabilizing procedure. Four (2%) other patients developed sternal wound complications that were treated entirely medically; 3 of them were very trivial, and 1 was an atypical mediastinitis without sternal involvement. Overall, 46.1% of patients (45.3% of isolated coronary artery bypass, 49.3% of isolated on-pump coronary artery bypass, and 18.2% of off-pump coronary artery bypass patients) were transfused. None of the complications was related to sternal wrapping, bleeding from the sternal edge, or sternal wound problems. CONCLUSIONS Sternal wrapping showed a very low incidence and severity of sternal wound complications, with good prevention of sternal osteomyelitis. Hemostatic properties were satisfactory, with transfusion rates within an acceptable range.
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Affiliation(s)
- Carlo Aratari
- Division of Cardiac Surgery, Ospedali Riuniti, Ancona, Italy
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8
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Wu JHY, Marchioli R, Silletta MG, Macchia A, Song X, Siscovick DS, Harris WS, Masson S, Latini R, Albert C, Brown NJ, Lamarra M, Favaloro RR, Mozaffarian D. Plasma phospholipid omega-3 fatty acids and incidence of postoperative atrial fibrillation in the OPERA trial. J Am Heart Assoc 2013; 2:e000397. [PMID: 24145742 PMCID: PMC3835252 DOI: 10.1161/jaha.113.000397] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Long‐chain polyunsaturated omega‐3 fatty acids (n‐3 PUFA) demonstrated antiarrhythmic potential in experimental studies. In a large multinational randomized trial (OPERA), perioperative fish oil supplementation did not reduce the risk of postoperative atrial fibrillation (PoAF) in cardiac surgery patients. However, whether presupplementation habitual plasma phospholipid n‐3 PUFA, or achieved or change in n‐3 PUFA level postsupplementation are associated with lower risk of PoAF is unknown. Methods and Results In 564 subjects undergoing cardiac surgery between August 2010 and June 2012 in 28 centers across 3 countries, plasma phospholipid levels of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) were measured at enrollment and again on the morning of cardiac surgery following fish oil or placebo supplementation (10 g over 3 to 5 days, or 8 g over 2 days). The primary endpoint was incident PoAF lasting ≥30 seconds, centrally adjudicated, and confirmed by rhythm strip or ECG. Secondary endpoints included sustained (≥1 hour), symptomatic, or treated PoAF; the time to first PoAF; and the number of PoAF episodes per patient. PoAF outcomes were assessed until hospital discharge or postoperative day 10, whichever occurred first. Relative to the baseline, fish oil supplementation increased phospholipid concentrations of EPA (+142%), DPA (+13%), and DHA (+22%) (P<0.001 each). Substantial interindividual variability was observed for change in total n‐3 PUFA (range=−0.7% to 7.5% after 5 days of supplementation). Neither individual nor total circulating n‐3 PUFA levels at enrollment, morning of surgery, or change between these time points were associated with risk of PoAF. The multivariable‐adjusted OR (95% CI) across increasing quartiles of total n‐3 PUFA at enrollment were 1.0, 1.06 (0.60 to 1.90), 1.35 (0.76 to 2.38), and 1.19 (0.64 to 2.20); and for changes in n‐3 PUFA between enrollment and the morning of surgery were 1.0, 0.78 (0.44 to 1.39), 0.89 (0.51 to 1.55), and 1.01 (0.58 to 1.75). In stratified analysis, demographic, medication, and cardiac parameters did not significantly modify these associations. Findings were similar for secondary PoAF endpoints. Conclusions Among patients undergoing cardiac surgery, neither higher habitual circulating n‐3 PUFA levels, nor achieved levels or changes following short‐term fish oil supplementation are associated with risk of PoAF. Clinical Trial Registration URL: Clinicaltrials.gov Unique identifier: NCT00970489
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Affiliation(s)
- Jason H Y Wu
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
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9
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Nasso G, Bonifazi R, Romano V, Brigiani MS, Fiore F, Bartolomucci F, Lamarra M, Fattouch K, Rosano G, Gaudino M, Spirito R, Gaudio C, Speziale G. Increased plasma homocysteine predicts arrhythmia recurrence after minimally invasive epicardial ablation for nonvalvular atrial fibrillation. J Thorac Cardiovasc Surg 2013; 146:848-53. [DOI: 10.1016/j.jtcvs.2012.07.099] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/11/2012] [Accepted: 07/31/2012] [Indexed: 11/26/2022]
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Mikus E, Calvi S, Tripodi A, Lamarra M, Del Giglio M. Upper 'J' ministernotomy versus full sternotomy: an easier approach for aortic valve reoperation. J Heart Valve Dis 2013; 22:295-300. [PMID: 24151754] [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: 06/02/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Aortic valve replacement (AVR) after previous cardiac surgery is usually associated with an increased risk profile. The study aim was to compare the outcome after AVR through an upper 'J' ministernotomy compared to a standard full sternotomy approach in a redo operation. METHODS A total of 90 patients who underwent reoperative AVR at the authors' institution between October 2007 and January 2012 was retrospectively reviewed. Of these patients, 46 had patent bypass grafts and 44 previously had heart valve replacement or repair. Sixteen patients had endocarditis as the etiology, and 14 had prosthetic valve endocarditis. Of the 90 patients operated on, a minimally invasive upper 'J' ministernotomy was performed in 38, and a full median sternotomy in 52. The median age was 76 years (25th percentile 68.25 years; 75th percentile 79.25 years) for the minimally invasive group, and 73.5 (25th percentile 68 years; 75th percentile 78.75 years) for the full sternotomy group (p = 0.945). No statistically significant differences in terms of body mass index (p = 0.987), left ventricular ejection fraction (p = 0.544) and EuroSCORE (p = 0.162) were found between the two groups. Intraoperative data and postoperative outcomes, in terms of intensive care unit stay, blood loss, transfusions and sternal complications were analyzed. RESULTS All patients underwent AVR. The median (IQR) cardiopulmonary bypass and cross-clamp times were respectively 67 (28) min and 51 (28) min for the minimally invasive group, and 72 (47) min and 53.5 (28) min for the full sternotomy group (p = 0.686 and p = 0.993). The postoperative ventilation time was significantly less in ministernotomy patients (median 6 versus 8.5 h; p = 0.027). One patient affected by endocarditis died in the minimally invasive group (mortality rate 2.6%). Hospital mortality in the traditional group was 3/52 (5.8%). CONCLUSION Minimally invasive aortic valve surgery reoperation through an upper 'J' sternotomy proved to be at least as safe as the standard procedure in terms of hospital morbidity and mortality rates.
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Affiliation(s)
- Elisa Mikus
- Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM for Care & Research, ES Health Science Foundation, Cotignola (RA), Italy.
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11
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Dell'amore A, Albertini A, Lamarra M. Twenty years experience in oncologic surgery for primary cardiac tumors. G Chir 2013; 34:106-111. [PMID: 23660160 PMCID: PMC3915578] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Primary cardiac tumors are uncommon in cardiac surgery. To investigate the clinical presentation, surgical results and long-term follow-up we retrospectively analyzed our experience in the treatment of primary cardiac tumors. PATIENTS AND METHODS Ninety-one patients with primary cardiac tumors underwent surgery in our department in the last 20 years. Fifty-one patients were female, the mean age was 62,2 years. Sixty-three had myxomas, 22 had papillary fibroelastoma, 4 had malignant neoformations and 2 had other benign tumors. RESULTS All myxomas, fibroelastomas and angiomyolipoma were radically removed. Only a palliative treatment was possible in malignant disease. In-hospital mortality was 1.2%. The mean follow-up time was 78.5 months. Three patients had recurrence of myxoma, all patients with malignant disease dead during the follow-up. DISCUSSION Primary benign cardiac tumors can be treated with low morbidity and mortality. The follow-up demonstrates that radical surgery is curative in case of benign tumors. The prognosis of malignant tumors is still poor. Palliative procedures have small impact on survival in these patients.
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Affiliation(s)
- A Dell'amore
- S Orsola-Malpighi Hospital, University of Bogoda, Italy
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12
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Nasso G, Popoff G, Lamarra M, Romano V, Coppola R, Bartolomucci F, Giglio MD, Romeo F, Tavazzi L, Speziale G. Impact of arterial revascularization in patients undergoing coronary bypass. J Card Surg 2012; 27:427-33. [PMID: 22690758 DOI: 10.1111/j.1540-8191.2012.01481.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM A debate over alternative therapeutic strategies for multivessel coronary disease is currently ongoing. We aimed at analyzing the results of myocardial revascularization with arterial conduits. METHODS We retrospectively reviewed 10,752 patients undergoing isolated coronary bypass surgery within our hospital's group. Average follow-up was 37.2 months. Through propensity-matching, we generated three groups (3584 patients each) on the basis of the revascularization strategy: use of one mammary artery plus venous grafts, use of two mammary arteries plus venous graft, and total arterial revascularization. RESULTS Overall operative mortality was 2.8%. Patient-related factors (renal failure, advanced age, recent myocardial infarction, depressed LVEF, diabetes) were identified as predictors of mortality (logistic regression). Although mortality was not statistically different among groups, patients receiving more than one arterial conduit displayed in the long-term better freedom from cardiac death and from adverse cardiac events (repeat revascularization, myocardial infarction, recurrent angina) (Kaplan-Meier analysis). Use of only one arterial conduit, diabetes and depressed LVEF predicted cardiac mortality, and adverse events (Cox regression). No differences in any endpoint emerged among patients receiving two arterial conduit plus venous grafts or total arterial revascularization. CONCLUSIONS These data strongly support the practice of using two arterial conduits rather than one. The operative and late results of coronary surgery with arterial conduits are optimal and should serve as a current benchmark for the comparison with state-of-the-art percutaneous interventions.
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Affiliation(s)
- Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.
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13
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Dell'Amore A, Aquino TM, Pagliaro M, Lamarra M, Zussa C. Aortic valve replacement with and without combined coronary bypass grafts in very elderly patients: early and long-term results. Eur J Cardiothorac Surg 2012; 41:491-498. [DOI: 10.1093/ejcts/ezr029] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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14
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Di Eusanio M, Fortuna D, Cristell D, Pugliese P, Nicolini F, Pacini D, Gabbieri D, Lamarra M. Contemporary outcomes of conventional aortic valve replacement in 638 octogenarians: insights from an Italian Regional Cardiac Surgery Registry (RERIC). Eur J Cardiothorac Surg 2012; 41:1247-52; discussion 1252-3. [DOI: 10.1093/ejcts/ezr204] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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Dell’Amore A, Lanzanova G, Silenzi A, Lamarra M. Hamartoma of Mature Cardiac Myocytes: Case Report and Review of the Literature. Heart Lung Circ 2011; 20:336-40. [DOI: 10.1016/j.hlc.2011.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 01/11/2011] [Accepted: 01/17/2011] [Indexed: 11/29/2022]
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16
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Di Eusanio M, Fortuna D, De Palma R, Dell'Amore A, Lamarra M, Contini GA, Gherli T, Gabbieri D, Ghidoni I, Cristell D, Zussa C, Pigini F, Pugliese P, Pacini D, Di Bartolomeo R. Aortic valve replacement: Results and predictors of mortality from a contemporary series of 2256 patients. J Thorac Cardiovasc Surg 2011; 141:940-7. [DOI: 10.1016/j.jtcvs.2010.05.044] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 03/30/2010] [Accepted: 05/30/2010] [Indexed: 10/19/2022]
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17
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Dell’Amore A, Albertini A, Tripodi A, Barattoni MC, Lamarra M. Total arterial revascularization in multivessel coronary artery disease with left and right internal thoracic artery: the Y graft technique. Indian J Thorac Cardiovasc Surg 2010. [DOI: 10.1007/s12055-010-0063-3] [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: 10/18/2022] Open
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18
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Dell'Amore A, Tripodi A, Cavallucci A, Guerrini F, Ronchi B, Zanoni S, Lamarra M. Efficacy of a New Oxygenator-Integrated Fat and Leukocyte Removal Device. Asian Cardiovasc Thorac Ann 2010; 18:546-50. [DOI: 10.1177/0218492310386516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated the effectiveness of a new oxygenator-integrated device for removing lipid particles and leukocytes from shed mediastinal blood in 20 patients undergoing elective cardiac surgery under cardiopulmonary bypass. Another 20 patients undergoing cardiac surgery without the device served as controls. After filtration with the RemoveLL device, lipid particles, leukocytes, and fats were significantly reduced compared to preoperative levels. In the control group, blood fats and lipid particles at the end of cardiopulmonary bypass were significantly increased compared to preoperative levels. Leukocyte counts at the end of bypass were significantly lower in patients who had the filtration device compared to the control group. Platelets counts and hematocrit changes were not significantly different between the 2 groups.
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Affiliation(s)
| | | | - Andrea Cavallucci
- Technical Perfusion Service Villa Maria Cecilia GVM Hospital for Care and Research Cotignola, Italy
| | - Franco Guerrini
- Technical Perfusion Service Villa Maria Cecilia GVM Hospital for Care and Research Cotignola, Italy
| | - Barbara Ronchi
- Technical Perfusion Service Villa Maria Cecilia GVM Hospital for Care and Research Cotignola, Italy
| | - Silvia Zanoni
- Intensive Care Unit Villa Maria Cecilia GVM Hospital for Care and Research Cotignola, Italy
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19
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Speziale G, Nasso G, Barattoni MC, Bonifazi R, Esposito G, Coppola R, Popoff G, Lamarra M, Scorcin M, Greco E, Argano V, Zussa C, Cristell D, Bartolomucci F, Tavazzi L. Operative and Middle-Term Results of Cardiac Surgery in Nonagenarians. Circulation 2010; 121:208-13. [DOI: 10.1161/circulationaha.108.807065] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuseppe Speziale
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Giuseppe Nasso
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Maria Cristina Barattoni
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Raffaele Bonifazi
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Giampiero Esposito
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Roberto Coppola
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Georges Popoff
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Mauro Lamarra
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Marcio Scorcin
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Ernesto Greco
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Vincenzo Argano
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Claudio Zussa
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Donald Cristell
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Francesco Bartolomucci
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Luigi Tavazzi
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
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Dell'Amore A, Del Giglio M, Calvi S, Pagliaro M, Fedeli C, Magnano D, Tripodi A, Lamarra M. Mini re-sternotomy for aortic valve replacement in patients with patent coronary bypass grafts. Interact Cardiovasc Thorac Surg 2009; 9:94-97. [DOI: 10.1510/icvts.2008.201038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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21
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Dell'Amore A, Castriota F, Calvi S, Magnano D, Noera G, Lamarra M. Post-traumatic carotid-jugular arterio-venous fistula. Heart Lung Circ 2009; 18:293. [PMID: 19643371 DOI: 10.1016/j.hlc.2008.10.020] [Citation(s) in RCA: 5] [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] [Received: 10/07/2008] [Revised: 10/10/2008] [Accepted: 10/27/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Andrea Dell'Amore
- Department of Cardiovascular Surgery, Villa Maria Cecila Hospital, Cotignola, Lugo (RA), Italy.
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22
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Albertini A, Dell’Amore A, Tripodi A, Del Giglio M, Pagliaro M, Calvi S, Aquino T, Fedeli C, Magnano D, Zussa C, Lamarra M. Anomalous Systemic Arterial Supply to the Left Lung Base Without Sequestration. Heart Lung Circ 2008; 17:505-7. [DOI: 10.1016/j.hlc.2007.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 08/02/2007] [Accepted: 08/13/2007] [Indexed: 12/25/2022]
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23
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Tripodi A, Dell'Amore A, Aquino T, Pagliaro M, Fedeli C, Magnano D, Calvi S, Zussa C, Lamarra M. Acute Coronary Syndrome in a Patient with a Single Coronary Artery Arising from the Right Sinus of Valsalva: A Case Report. Heart Lung Circ 2008; 17:421-3. [PMID: 17904902 DOI: 10.1016/j.hlc.2007.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 07/18/2007] [Accepted: 07/25/2007] [Indexed: 11/27/2022]
Abstract
Coronary anomalies can involve origin or distribution of the artery. Most of these anomalies are not clinically important. A single coronary artery arising from the right coronary sinus of Valsalva is an extremely rare anatomic anomaly. Usually coronary artery malformation is associated with other cardiac malformations and the diagnosis is made after birth. More rarely, coronary artery anomalies are an isolated and asymptomatic cardiac malformation.
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Affiliation(s)
- Alberto Tripodi
- Department of Cardiovascular Surgery, Villa Maria Cecila Hospital, Via Corriera 1, Cotignola, Lugo (RA) 48100, Italy
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Giglio MD, Dell'Amore A, Aquino T, Calvi S, Calli M, Marri C, Boni F, Lamarra M. Minimally invasive coronary artery bypass grafting using the inferior J-shaped ministernotomy in high-risk patients. Interact Cardiovasc Thorac Surg 2008; 7:402-5. [DOI: 10.1510/icvts.2007.172973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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25
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Albertini A, Dell'Amore A, Zussa C, Lamarra M. Modified Bentall operation: the double sewing ring technique. Eur J Cardiothorac Surg 2007; 32:804-6. [PMID: 17766138 DOI: 10.1016/j.ejcts.2007.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 07/11/2007] [Accepted: 07/11/2007] [Indexed: 11/25/2022] Open
Abstract
The Bentall-DeBono operation is the technique of choice for aortic root replacement. As more patients do not accept or have contraindications to lifelong anticoagulation, the biological Bentall operation is a good option for these patients, even though complex reoperations would then be required for bioprosthesis degeneration. We studied a modified technique to simplify the reoperations in patients undergoing biological Bentall procedure. A bioprosthetic valved conduit was obtained creating two separate sewing rings at different levels of the vascular graft. One ring was used to sew the bioprosthesis on the vascular graft. The second ring was used to fix the vascular graft on the native aortic annulus. In case of reoperation, the bioprosthesis could be removed cutting only the suture on the first ring. Then the same ring could be used to fix the new prosthesis. Since 2006, we have performed 12 biological Bentall operations with our modification. The mean age was 63.2 years (range 43-77 years), the mean cardiopulmonary time was 79+/-12 min and the mean aortic cross-clamping time was 68+/-10 min. We had no in-hospital mortality; the postoperative period was uneventful in all patients. In our experience this modification seems to be simple and reproducible, without increasing the operative risk and postoperative morbidity.
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Affiliation(s)
- Alberto Albertini
- Department Cardiovascular Surgery, Villa Maria Cecilia Hospital, Via Corriera 1, Cotignola, Lugo (RA), Italy
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Magnano D, Montalbano R, Lamarra M, Ferri F, Lorini L, Clarizia S, Rescigno G. Ineffectiveness of Local Wound Anesthesia to Reduce Postoperative Pain After Median Sternotomy. J Card Surg 2005; 20:314-8. [PMID: 15985128 DOI: 10.1111/j.1540-8191.2005.200318.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Postoperative pain control still represents a major challenge in every surgical field. Bupivacaine wound infiltration is frequently used to reduce the pain related to the surgical incision itself. In this randomized study, we investigated the efficacy of bupivacaine local anesthesia after median sternotomy to reduce postoperative pain. Forty-seven patients undergoing major cardiac surgery procedures were allocated randomly to group A (bupivacaine wound infiltration 0.5%; 10 mL, followed by continuous infusion: 10 mg/24 H) or to group C (controls). Extubation time, postoperative arterial blood gases, postoperative pain (assessed by means of a visual analog scale), and morphine consumption were the endpoints of the study. Patients of group C were extubated earlier; blood gases and VAS values were similar in both group. Bupivacaine local analgesia did not improve postoperative pain control after median sternotomy.
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Affiliation(s)
- Diego Magnano
- Department of Cardiac Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
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Mascagni R, Al Attar N, Lamarra M, Calvi S, Tripodi A, Mebazaa A, Lessana A. Edge-to-Edge Technique to Treat Post-Mitral Valve Repair Systolic Anterior Motion and Left Ventricular Outflow Tract Obstruction. Ann Thorac Surg 2005; 79:471-3; discussion 474. [PMID: 15680816 DOI: 10.1016/j.athoracsur.2004.08.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Systolic anterior motion of the mitral valve causing left ventricular outflow tract obstruction is an uncommon complication of mitral valve repair that may necessitate immediate additional surgical action. We prospectively evaluated the technique of the edge-to-edge suture on post-mitral repair systolic anterior motion, which persisted despite conservative treatment. METHODS From March 2002 to March 2004, 4 of 112 patients requiring mitral valve repair surgery for chronic degenerative mitral regurgitation had systolic anterior motion with severe left ventricular outflow tract obstruction and mitral regurgitation. All 4 patients (mean age, 50 years) had posterior leaflet prolapse with chordal rupture with a billowing anterior leaflet, but without chordal rupture. Repair was achieved through a quadrangular resection of the posterior leaflet, completed by plication of the annulus in 2 patients and leaflet sliding in the other 2. All patients had mitral annuloplasty; two patients had a complete CE Physio ring (Edwards Lifesciences, Irvine, CA) inserted, whereas the other 2 patients had an open CG Future band (Medtronic, Minneapolis, MN). Routine perioperative transesophageal echocardiography showed systolic anterior motion, severe left ventricular outflow tract obstruction (> 50 mm Hg), and mitral regurgitation. After resuming cardiopulmonary bypass, all patients had an edge-to-edge suture at the middle part of the free edge of the anterior and posterior leaflets. RESULTS The control transesophageal echocardiography showed in all cases disappearance of the systolic anterior motion, of the left ventricular outflow tract obstruction and of mitral regurgitation. Mean follow-up was 14 months (range, 6 to 28 months). All patients were in New York Heart Association's functional class I. CONCLUSIONS With the edge-to-edge repair, the early and 2-year results were satisfactory with total disappearance of the systolic anterior motion, of the left ventricular outflow tract obstruction and of the recurrent mitral regurgitation.
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Affiliation(s)
- Roberto Mascagni
- Department of Cardiac Surgery and Cardiology, Villa Maria Cecilia Hospital, Cotignola, RA, Italy
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Rescigno G, Pensa PM, Muti M, Chiarella M, Lamarra M, Noera G. Porcelain aorta in coronary artery bypass graft operations: an alternative approach. Heart Surg Forum 2003; 6:E48-9. [PMID: 12821438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2002] [Accepted: 01/04/2003] [Indexed: 03/03/2023]
Abstract
Porcelain aorta represents a serious condition for coronary artery bypass graft operations. Here we describe a simple technique to avoid any aortic manipulation during an off-pump coronary artery bypass graft procedure. The right internal thoracic artery is used as the source of blood inflow for single or sequential venous grafts. We have used this technique with good results in 5 elderly patients with eggshell aorta.
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Affiliation(s)
- Giuseppe Rescigno
- Department of Cardiac Surgery, Villa Maria Cecilia, Cotignola, Italy.
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Abstract
Haemorrhagic shock, usually as a consequence of major trauma, is the most frequent cause of death among people younger than 40 years. Reports indicate that melanocortin peptides are effective in reversing haemorrhagic shock. We found that in patients with aortic-dissection-induced haemorrhagic shock, the addition of an early intravenous bolus injection of the melanocortin andrenocorticotrophic hormone (ACTH)-(1-24) to standard treatment significantly improved cardiovascular function and increased survival rate. Because administration of ACTH-(1-24) is simple, and because melanocortin peptides have no acute toxicity, their use in the early critical care of patients in shock should be more extensively assessed.
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Noera G, Pensa P, Lamarra M, Mascagni R, Cremonesi A, Balestra G. Hemodynamic evaluation of the Carbomedics R, St Jude Medical HP and Sorin-Bicarbon valve in patients with small aortic annulus. Eur J Cardiothorac Surg 1997; 11:473-5; discussion 475-6. [PMID: 9105811 DOI: 10.1016/s1010-7940(96)01090-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
UNLABELLED A Doppler echocardiographic study was performed to evaluate the hemodynamic performance of three 19 mm size currently used bileaflet valve prosthesis (St Jude Medical Hydrodinamic Plus, Sorin-Bicarbon and Carbomedic Reduced) implanted in aortic position. METHODS Patients, 30, with the same profile receiving 19 mm size valve (ten for each valve type) were selected when body surface area (BSA) was > 1.7 m2. Doppler echocardiography was carried out at rest and after exercise, 60 days after surgery. Peak (Pg) and mean (Mg) gradients across the valve were recorded: the effective orifice area (EOA), and performance index (PI) were calculated. RESULTS No significant differences were observed between St Jude Medical and Sorin Bicarbon as far as peak and mean gradient, effective orifice area and performance index at rest and after exercise. A significant difference (P < 0.05) was demonstrated in the above mentioned parameters when Carbomedics-R valve were tested. This type of valve showed a lower EOA and PI with higher Pg and Mg gradient both at rest and after exercise. CONCLUSION The St Jude Hydrodymanic plus (Hp) and Sorin Bicarbon valves had similar performance and a better hemodynamic trend when compared to the Carbomedics-R valve in patients with large body surface areas. The Carbomedics-R valve shows a ineffective use of the total area of the prosthesis both at rest and after exercise.
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Affiliation(s)
- G Noera
- Department of Cardiothoracic Surgery, Casa di Cura Villa Maria Cecilia, Cotignola (RA), Italy
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32
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Noera G, Pensa P, Lodi R, Lamarra M, Biagi B, Guelfi P. Influence of different harvesting techniques on the arterial wall of the internal mammary artery graft: microscopic analysis. Thorac Cardiovasc Surg 1993; 41:16-20. [PMID: 8103610 DOI: 10.1055/s-2007-1013814] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [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: 01/28/2023]
Abstract
An histological comparison was made between left internal mammary arteries (LIMAs) harvested and prepared with different techniques prior to coronary artery bypass grafting. The mobilization of LIMA was made as follows: conventional technique (group I), extra pleural takedown with lysis of the endothoracic fascia (group II), and LIMA skeletonization (group III). Each group was divided into two other sub-groups according to the LIMA graft preparation: papaverine-saline solution sprayed on the pedicle (sub-group A) and intraluminal hydrostatic dilatation (sub-group B). Free blood flow from the LIMAs was measured immediately before cardiopulmonary bypass and ultrasonic duplex scanning (UDS) was performed to analyze the flow patterns and velocities during the early postoperative course. The results showed that the technique by which the LIMA is harvested bears no significant relationship to microscopical graft damage, while intimal lesions were observed in all sub-groups that adopted intraluminal hydrostatic dilatation (sub-group B). No difference in intraoperative LIMA flows were noted between groups and sub-groups of patients except in the case of group I-sub-group B, in which the flow was markedly reduced. Intramural haematoma or subadventitial blood effusion was observed with low incidence and magnitude in all groups and subgroups of patients, without any reduction of blood flow, and all LIMAs were patent at UDS measurements. In conclusion, the results showed that the method by which the IMA is harvested bears little and insignificant relationship to arterial wall damage.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Noera
- Department of Thoracic Surgery, University of Modena, Italy
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Abstract
A case of successful emergency reoperation for mitral valve replacement 2 hours after a cesarean section is reported. The use of aprotinin (Trasylol; Bayer AG, Leverkusen, Germany) greatly simplified the surgical procedure and was in our opinion the most important factor in an uncomplicated outcome.
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Affiliation(s)
- M Lamarra
- Department of Cardiac Surgery, University Hospital of Wales, Cardiff, United Kingdom
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34
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Angelini GD, Lamarra M, Azzu AA, Bryan AJ. Wound infection following early repeat sternotomy for postoperative bleeding. An experience utilizing intraoperative irrigation with povidone iodine. J Cardiovasc Surg (Torino) 1990; 31:793-5. [PMID: 2262509] [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: 12/31/2022]
Abstract
A prospective observational study of median sternotomy wound infection was carried out in two consecutive groups of unselected patients undergoing early repeat sternotomy for postoperative haemorrhage. In Group A the pericardial cavity and sternotomy wound layers were irrigated with aqueous povidone iodine prior to repeat closure, while Group B did not receive povidone iodine. No median sternotomy infections were recorded in Group A compared to 5 cases in Group B (0 out of 22 vs 5 out of 21 patients, p less than 0.05). Amongst the patients with wound infection, three developed sternal dehiscence and mediastinitis with one death. The data suggests that povidone iodine irrigation may be effective in reducing wound infection in patients undergoing early repeat sternotomy after cardiac surgery.
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Affiliation(s)
- G D Angelini
- Department of Cardiac Surgery, University Hospital of Wales, Cardiff, UK
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35
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36
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Angelini GD, Bryan AJ, Lamarra M. Refractory supra-ventricular tachyarrhythmias due to early posterior pericardial effusion following open-heart surgery. Thorac Cardiovasc Surg 1988; 36:162-3. [PMID: 3264946 DOI: 10.1055/s-2007-1020068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Three cases are presented of supra-ventricular tachyarrhythmias following open heart surgery refractory to direct current cardioversion and pharmacological treatment. Echocardiography demonstrated a moderate to large posterior pericardial effusion in each case. Surgical evacuation of the effusion was followed by reversion to sinus rhythm.
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Affiliation(s)
- G D Angelini
- Cardiothoracic Department, University Hospital of Wales, Cardiff, Great Britain
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Temellini F, Solazzi LE, Lamarra M, Galdenzi S, Quagliarini P. [Anatomo-radiographic and endoscopic discrepancies in gastric ulcer: why elective surgical treatment]. MINERVA CHIR 1987; 42:1383-6. [PMID: 3696424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Massini C, Lamarra M, Iacobone G, Brugnami R, Bianchini F, Costantini C, Noera G, Mannello B, Palminiello A. [Emergency surgical treatment of infectious endocarditis. Experience developed on 19 consecutive cases]. G Ital Cardiol 1983; 13:363-6. [PMID: 6671492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Our experience with the emergency surgical treatment of 19 consecutive cases of infective endocarditis (IE) is reported. The aortic valve was always affected, either alone (n = 16) or together with the mitral valve (n = 3). All patients were male. In 10 cases it was possible to identify the infecting agent (a staphylococcus was found in 6). Congestive heart failure (CHF) was the principal indication for surgery in 14 cases (in 6 active IE was associated). Five patients (1 with CHF) underwent operative treatment because of systemic emboli. Fifteen patients were in New York Heart Association (NYHA) functional class IV, 3 in class III and 1 was in class II. Two patients (10.5%), both operated on for CHF, died in the early postoperative period. Early prosthetic valve dehiscence occurred in 2 cases, reoperation was successful in both. Follow-up of operative survivors ranges between 7 and 108 months (mean = 53.24 +/- 41.89). One patients died 10 months after operation with CHF following late prosthetic dehiscence. Out of 16 currently surviving patients 14 are in NHYA functional class I, 1 is in class II and 1 in class III. No one of them has had relapse of IE.
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