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Grigioni F, Benfari G, Vanoverschelde JL, Tribouilloy C, Avierinos JF, Bursi F, Suri RM, Guerra F, Pasquet A, Rusinaru D, Marcelli E, Théron A, Barbieri A, Michelena H, Lazam S, Szymanski C, Nkomo VT, Capucci A, Thapa P, Enriquez-Sarano M, Suri R, Clavel M, Maalouf J, Michelena H, Nkomo VT, Enriquez-Sarano M, Tribouilloy C, Trojette F, Szymanski C, Rusinaru D, Touati G, Remadi J, Guerra F, Capucci A, Grigioni F, Russo A, Biagini E, Pasquale F, Ferlito M, Rapezzi C, Savini C, Marinelli G, Pacini D, Gargiulo G, Di Bartolomeo R, Boulif J, de Meester C, El Khoury G, Gerber B, Lazam S, Pasquet A, Noirhomme P, Vancraeynest D, Vanoverschelde JL, Avierinos J, Collard F, Théron A, Habib G, Barbieri A, Bursi F, Mantovani F, Lugli R, Modena M, Boriani G, Bacchi-Reggiani L. Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation. J Am Coll Cardiol 2019; 73:264-274. [DOI: 10.1016/j.jacc.2018.10.067] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 11/15/2022]
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Leone A, Savini C, Folesani G, Pilato E, Gliozzi G, Pacini D, Marozzini C, Palmerini T, Saia F, Costantino A, Votano D, Di Bartolomeo R. OC70 SURGICAL TRANSCATHETER VALVE REPLACEMENT. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549927.23831.c3] [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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Barberio G, Di Marco L, Murana G, Leone A, Berardi M, Gliozzi G, Folesani G, Coppola G, Pacini D, Di Bartolomeo R. VD10 FROZEN ELEPHANT TRUNK AND DAVID PROCEDURE BY USING THORAFLEX AND GORE HYBRID PROSTHESES IN A MARFAN PATIENT WITH ACUTE TYPE A AORTIC DISSECTION. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549978.05905.d0] [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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Muneretto C, Solinas M, Folliguet T, Repossini A, Di Bartolomeo R, Savini C, Concistrè G, Santarpino G, Di Bacco L, Fischlein T. RF43 LONG-TERM FOLLOW-UP OF SUTURELESS VERSUS TRANSCATHETER AORTIC VALVE IN ELDERLY PATIENT WITH AORTIC STENOSIS AT INTERMEDIATE RISK. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550042.43130.9c] [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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Savini C, Coppola G, Murana G, Ammar A, Suarez SM, Costantino A, Votano D, Coco VL, Pacini D, Di Bartolomeo R. EP24 MITRAL VALVE REPAIR AND EVOLUTION OF TECHNIQUES. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549953.55218.c6] [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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Di Marco L, Gliozzi G, Mariani C, Murana G, Leone A, Alfonsi J, Fiorentino F, Pacini D, Di Bartolomeo R. RF94 VALVE-SPARING AORTIC ROOT REPLACEMENT. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550057.81179.bf] [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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Sponga S, Di Mauro M, Pacini D, Murara G, Di Bartolomeo R, Cappabianca G, Beghi C, Weltert L, De Paulis R, De Vincentiis C, Biondi A, Santini F, Salsano A, Salvador L, Picichè M, Mariscalco G, Maselli D, Rinaldi M, Mancuso S, Scrofani R, Cagnoni G, Antona C, Dato G, Centofani P, De Bonis M, Pozzoli A, Cugola D, Galletti L, Villa E, Dossena Y, Troise G, Barili F, Paparella D, Margari V, Lorusso R, Parolari A, Livi U. OC69 SURGERY FOR BENTALL ENDOCARDITIS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549877.33309.a0] [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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Leone A, Coppola G, Di Marco L, Amodio C, Murana G, Mariani C, Barberio G, Pacini D, Di Bartolomeo R. OC29 FROZEN ELEPHANT TRUNK TECHNIQUE IN AORTIC SURGERY. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549854.44504.a6] [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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Murana G, Mariani C, Alfonsi J, Fiorentino M, Coppola G, Folesani G, Leone A, Suarez SM, Pacini D, Di Bartolomeo R. RF08 BENTALL OPERATION WITH ON-X MECHANICAL CONDUIT. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550062.11675.a6] [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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Di Marco L, Berardi M, Leone A, Murana G, Coppola G, Votano D, Amodio C, Folesani G, Pacini D, Di Bartolomeo R. OC03 AXILLARY VERSUS FEMORAL ARTERY CANNULATION IN AORTIC ARCH SURGERY. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549848.06386.54] [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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Savini C, Leone A, Folesani G, Gliozzi G, Murana G, Pacini D, Saia F, Palmerini T, Marozzini C, Costantino A, Di Bartolomeo R. OC08 CHALLENGING CASES IN TRANSCATHETER VALVE REPLACEMENTʼS ERA. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549933.61949.d6] [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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Folesani G, Amodio C, Coco VL, Alfonsi J, Di Marco L, Leone A, Berardi M, Barberio G, Pacini D, Di Bartolomeo R. VD21 VALVE SPARING PROCEDURE IN BICUSPID AORTIC VALVE. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549983.28776.a3] [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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Loforte A, Montalto A, Attisani M, Mariani C, Comisso M, Baronetto A, Fiorentino M, Di Bartolomeo R, Marinelli G, Musumeci F, Rinaldi M. OC30 HEMOCOMPATIBILITY-RELATED ADVERSE EVENTS AND PHYSIOLOGICAL CIRCULATORY INTERFACE OF DIFFERENT GENERATION LEFT VENTRICULAR ASSIST DEVICES. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549899.48487.fe] [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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Gliozzi G, Alfonsi J, Mariani C, Coppola G, Berardi M, Amodio C, Fiorentino M, Pacini D, Galiè N, Martin-Suarez S, Di Bartolomeo R. EP30 PULMONARY ENDARTERECTOMY. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549956.39971.9e] [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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Loforte A, Coppola G, Amodio C, Folesani G, Saia F, Taglieri N, Marozzini C, Savini C, Pacini D, Di Bartolomeo R. VD19 TRANS-FEMORAL IMPLANT OF A BALLOON EXPANDABLE AORTIC VALVE IN A LEAKING SUTURELESS SELF-EXPANDABLE VALVE. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549937.84819.e2] [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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Tessari C, D’Onofrio A, Diena M, Solinas M, Alamanni F, Massetti M, Livi U, Di Eusanio M, Mignosa C, Russo C, Rinaldi M, Di Bartolomeo R, Luzi G, Antona C, De Paulis R, Salvador L, Maselli D, Portoghese M, Alfieri O, De Filippo C, Bortolotti U, Musumeci F, Gerosa G. OC21 EARLY OUTCOMES OF MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT WITH RAPID DEPLOYMENT BIOPROSTHESES. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549887.95122.c8] [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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Alfonsi J, Leone A, Di Marco L, Murana G, Amodio C, Berardi M, Coppola G, Fiorentino M, Pacini D, Di Bartolomeo R. VD11 FROZEN ELEPHANT TRUNK BY USING E-VITA PROSTHESES AND BENTALL PROCEDURE IN A GIANT DESCENDING THORACIC AORTA ANEURYSM. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549980.44023.10] [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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D’Onofrio A, Tessari C, Filippini C, Diena M, Solinas M, Alamanni F, Massetti M, Livi U, Di Eusanio M, Mignosa C, Russo C, Rinaldi M, Di Bartolomeo R, Luzi G, Antona C, De Paulis R, Salvador L, Maselli D, Portoghese M, Alfieri O, De Filippo C, Bortolotti U, Musumeci F, Gerosa G. OC09 CLINICAL AND HEMODYNAMIC OUTCOMES AFTER AORTIC VALVE REPLACEMENT WITH RAPID-DEPLOYMENT BIOPROSTHESES. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549901.50273.24] [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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Foa' A, Corsini A, Norscini G, Agostini V, Pacini D, Melandri G, Di Bartolomeo R, Leone O, Rapezzi C. P6020Histopathologic substrates and clinical correlations in type A acute aortic syndromes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6020] [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: 11/14/2022] Open
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Corsini A, Foa' A, Norscini G, Agostini V, Pacini D, Melandri G, Di Bartolomeo R, Leone O, Rapezzi C. P3973Long-term outcome after acute aortic syndromes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3973] [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: 11/12/2022] Open
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Lazam S, Vanoverschelde JL, Tribouilloy C, Grigioni F, Suri RM, Avierinos JF, de Meester C, Barbieri A, Rusinaru D, Russo A, Pasquet A, Michelena HI, Huebner M, Maalouf J, Clavel MA, Szymanski C, Enriquez-Sarano M, Michelina H, Poulain H, Remadi JP, Touati G, Trojette F, Biagini E, Di Bartolomeo R, Ferlito F, Marinelli G, Pacini D, Pasquale F, Rapezzi C, Savini C, Boulif J, El Khoury G, Gerber B, Noirhomme P, Vancraeynest D, Collard F, Habib G, Metras D, Riberi A, Tafanelli L, Bursi F, Lugli R, Mantovani F, Manicardi C, Grazia M, Bacchi-Reggiani L. Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation. Circulation 2017; 135:410-422. [DOI: 10.1161/circulationaha.116.023340] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022]
Abstract
Background:
Mitral valve (MV) repair is preferred over replacement in clinical guidelines and is an important determinant of the indication for surgery in degenerative mitral regurgitation. However, the level of evidence supporting current recommendations is low, and recent data cast doubts on its validity in the current era. Accordingly, the aim of the present study was to analyze very long-term outcome after MV repair and replacement for degenerative mitral regurgitation with a flail leaflet.
Methods:
MIDA (Mitral Regurgitation International Database) is a multicenter registry enrolling patients with degenerative mitral regurgitation with a flail leaflet in 6 tertiary European and US centers. We analyzed the outcome after MV repair (n=1709) and replacement (n=213) overall, by propensity score matching, and by inverse probability-of-treatment weighting.
Results:
At baseline, patients undergoing MV repair were younger, had more comorbidities, and were more likely to present with a posterior leaflet prolapse than those undergoing MV replacement. After propensity score matching and inverse probability-of-treatment weighting, the 2 treatments groups were balanced, and absolute standardized differences were usually <10%, indicating adequate match. Operative mortality (defined as a death occurring within 30 days from surgery or during the same hospitalization) was lower after MV repair than after replacement in both the entire population (1.3% versus 4.7%;
P
<0.001) and the propensity-matched population (0.2% versus 4.4%;
P
<0.001). During a mean follow-up of 9.2 years, 552 deaths were observed, of which 207 were of cardiovascular origin. Twenty-year survival was better after MV repair than after MV replacement in both the entire population (46% versus 23%;
P
<0.001) and the matched population (41% versus 24%;
P
<0.001). Similar superiority of MV repair was obtained in patient subsets on the basis of age, sex, or any stratification criteria (all
P
<0.001). MV repair was also associated with reduced incidence of reoperations and valve-related complications.
Conclusions:
Among patients with degenerative mitral regurgitation with a flail leaflet referred to mitral surgery, MV repair was associated with lower operative mortality, better long-term survival, and fewer valve-related complications compared with MV replacement.
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Affiliation(s)
- Siham Lazam
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Jean-Louis Vanoverschelde
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Christophe Tribouilloy
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Francesco Grigioni
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Rakesh M. Suri
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Jean-Francois Avierinos
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Christophe de Meester
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Andrea Barbieri
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Dan Rusinaru
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Antonio Russo
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Agnès Pasquet
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Hector I. Michelena
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Marianne Huebner
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Joseph Maalouf
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Marie-Annick Clavel
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Catherine Szymanski
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Maurice Enriquez-Sarano
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - J. Boulif
- Université Catholique de Louvain, Belgium
| | | | - B. Gerber
- Université Catholique de Louvain, Belgium
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Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwoger M, Haverich A, Iung B, John Manolis A, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, von Allmen RS, Vrints CJM. Corrigendum to: 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J 2015; 36:2779. [DOI: 10.1093/eurheartj/ehv178] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [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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Di Eusanio M, Dimitri Petridis F, Folesani G, Berretta P, Zardin D, Di Bartolomeo R. Axillary and innominate artery cannulation during surgery of the thoracic aorta: a comparative study. J Cardiovasc Surg (Torino) 2014; 55:841-847. [PMID: 24284937] [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
AIM The aim of this paper was to compare hospital outcomes in patients undergoing elective surgery of the thoracic aorta using the right axillary artery (RAA) and the innominate artery (IA) as a cannulation site for cardiopulmonary bypass (CPB) arterial inflow. METHODS Between September 2009 and October 2011, 71 patients underwent elective aortic procedures with RAA (N.=27) and IA (N.=44) cannulation. Selection of RAA vs. IA was not randomized, but rather based on surgical judgment of best indication in each patient. Pre-, intra-, and postoperative variables were compared according to cannulation site. RESULTS Preoperative comorbidities, underlying aortic pathology, and surgical procedures were similar in RAA and IA patients. Hospital mortality was 11.1% and 6.8% in RAA and IA patients, respectively (P=0.243). Overall, 4 brain infarctions occurred, all left sided (RAA: 3.7% vs. IA: 6.8%; P=0.508). One brachial plexus injury, and 1 arterial dissection occurred in RAA group. No cannulation-related morbidity was observed in IA patients. Theoretical CPB flow could be reached in all patients, but resistances through the cannulation sites were more favourable in IA patients. CONCLUSION RAA and IA were associated with similarly valid results. The choice between the two, based on the specific patient's characteristics, can improve outcomes after aortic surgery.
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Affiliation(s)
- M Di Eusanio
- Cardiovascular Surgery Department Sant'Orsola‑Malpighi Hospital, Bologna UniversityBologna, Italy -
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24
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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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25
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Di Marco L, Pacini D, Leone A, Petridis FD, Bissoni L, Di Bartolomeo R, Marinelli G. Long-term outcome after acute type A aortic dissection: does an age limit still exist? J Cardiovasc Surg (Torino) 2014; 55:359-365. [PMID: 22669091] [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: 06/01/2023]
Abstract
AIM Aim of the study was to analyze outcome in patients who underwent surgery following type A aortic dissections and to evaluate the long-term survival rates in patients 70 years of age and older and those under 70 years of age, and in males as compared to females. METHODS Between September 1997 and October 2008, 154 patients were retrospectively enrolled. There were 102 males (66.2%) and 52 females (33.8%) with a mean age of 63.5±12; seven patients (4.5%) were over 80 years of age, 46 (29.8%) were between 70 and 80 years of age and 101 were under 70 years of age at the time of surgery. We compared patients 70 years of age and older with those under 70 years of age, analyzing the early and long-term survival results and postoperative complications. RESULTS Overall in-hospital mortality was 17.5% and permanent neurological dysfunction occurred in 10 patients (6.5%). Twenty patients (12.9%) died during follow-up. Among the males, the long-term survival rate was 80%, 68% and 51% at 1, 5 and 10 years, respectively. Among the females, survival rate was 84.6%, 72.3% and 47.5% at 1, 5 and 10 years, respectively. Five- and 10-year survival rates were 78.1% and 59.4%, respectively, for patients under 70 years of age, and 50.8% at 5 years and 26.1% at 10 years for those over 70. CONCLUSION Patients might not be excluded from surgical intervention for acute type A aortic dissection (ATAAD) only due to age. It is important to consider biological age and the clinical features of the patients at the time of surgery. Age is a relative but not absolute contraindication for surgery in ATAAD. Long-term survival was not statistically different between males and females.
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Affiliation(s)
- L Di Marco
- Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy -
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26
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Pacini D, Pantaleo A, Di Marco L, Leone A, Barberio G, Murana G, Castrovinci S, Sottili S, Di Bartolomeo R. Visceral organ protection in aortic arch surgery: safety of moderate hypothermia. Eur J Cardiothorac Surg 2014; 46:438-43. [DOI: 10.1093/ejcts/ezt665] [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] [Indexed: 11/13/2022] Open
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27
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Yan TD, Tian DH, LeMaire SA, Misfeld M, Elefteriades JA, Chen EP, Chad Hughes G, Kazui T, Griepp RB, Kouchoukos NT, Bannon PG, Underwood MJ, Mohr FW, Oo A, Sundt TM, Bavaria JE, Di Bartolomeo R, Di Eusanio M, Roselli EE, Beyersdorf F, Carrel TP, Corvera JS, Della Corte A, Ehrlich M, Hoffman A, Jakob H, Matalanis G, Numata S, Patel HJ, Pochettino A, Safi HJ, Estrera A, Perreas KG, Sinatra R, Trimarchi S, Sun LZ, Tabata M, Wang C, Haverich A, Shrestha M, Okita Y, Coselli J. The ARCH Projects: design and rationale (IAASSG 001). Eur J Cardiothorac Surg 2013; 45:10-6. [DOI: 10.1093/ejcts/ezt520] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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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Pacini D, Di Marco L, Pantaleo A, Barberio G, Murana G, Leone A, Pilato E, Di Bartolomeo R. 001 * VISCERAL PROTECTION DURING SURGERY OF THE THORACIC AORTA: THE SAFETY OF MODERATE HYPOTHERMIA. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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29
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Weiss G, Tsagakis K, Jakob HG, Di Bartolomeo R, Barberio G, Mascaro J, Mestres C, Sioris T, Grabenwoger M. 115 * THE FROZEN ELEPHANT TRUNK TECHNIQUE FOR THE TREATMENT OF COMPLICATED TYPE B AORTIC DISSECTION: EARLY MULTICENTRE EXPERIENCE. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.115] [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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30
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Kempfert J, Holzhey D, Treede H, Möllmann H, Schröfel H, Hofmann S, Czesla M, Thielmann M, Girdauskas E, Huber C, Babin-Ebell J, Lotfi S, Di Bartolomeo R, Wohlhöfer M, Walther T. First 100 commercial TAVI implants using the new transapical ACURATE™ TA device. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332350] [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: 10/27/2022]
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31
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Barili F, Pacini D, Capo A, Rasovic O, Grossi C, Alamanni F, Di Bartolomeo R, Parolari A. Does EuroSCORE II perform better than its original versions? A multicentre validation study. Eur Heart J 2013; 34:22-29. [DOI: 10.1093/eurheartj/ehs342] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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32
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Pacini D, Leone A, Belotti LMB, Fortuna D, Gabbieri D, Zussa C, Contini A, Di Bartolomeo R. Acute type A aortic dissection: significance of multiorgan malperfusion. Eur J Cardiothorac Surg 2012; 43:820-6. [DOI: 10.1093/ejcts/ezs500] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [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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Pacini D, Di Marco L, Leone A, Di Bartolomeo R, Sodeck G, Englberger L, Carrel T, Czerny M. Antegrade selective cerebral perfusion and moderate hypothermia in aortic arch surgery: clinical outcomes in elderly patients. Eur J Cardiothorac Surg 2012; 42:249-53; discussion 253. [DOI: 10.1093/ejcts/ezr304] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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35
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Jakob H, Tsagakis K, Pacini D, Di Bartolomeo R, Mestres C, Mohr F, Bonser R, Cerny S, Oberwalder P, Grabenwoger M. The International E-vita Open Registry: data sets of 274 patients. J Cardiovasc Surg (Torino) 2011; 52:717-723. [PMID: 21894139] [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: 05/31/2023]
Abstract
AIM After the introduction of the hybrid stent-graft "E-vita-open" by the Essen group in 1/2005 for one stage repair of complex thoracic aortic disease, the International E-vita open Registry was founded in 2008 to study the principles of this treatment algorithm and to control reported favorable single center results on a large patient data set basis up to six years after the first clinical implant. METHODS Retrospective data work-up after prospective data acquisition was achieved by institution of the International E-vita open Registry with anonymous registration and calculation at Essen University Hospital. From January 2005 to December 2010, 274 patients (mean age 60; 74% males) with complex aortic disease, 190 with aortic dissection (88 acute (AAD), 102 chronic aortic dissection (CAD), and 84 with complex thoracic aortic aneurysm (TAA) were included in the studied. RESULTS Eighty-one out of 274 (30%) patients underwent emergency surgery. Stent-graft deployment and arch replacement (238 total, 36 subtotal) was performed under selective antegrade cerebral perfusion (75 min mean). Cardiopulmonary bypass (CPB) and cardiac arrest times were mean 235 and 134 minutes, respectively. In-hospital mortality was 15% (40/274), 18% for AAD, 13% for CAD, and 14% for TAA. New strokes were observed in 6% (16/274), spinal cord injury in 8% (22/274). The false lumen (FL) was evaluated throughout the first hospital stay and at a median follow up time of 59 months after surgery. From the first follow up CT-examination to the last, thoracic complete FL thrombosis increased from 83% to 93% in AAD, from 72% to 92% in CAD. Full exclusion of the aneurysmal disease was achieved in 77% (61/79) during the primary hospital stay. CONCLUSION Favorable single center results could be confirmed by an International community of cardiac surgical centers in regard to hospital mortality and morbidity, as well as a low postoperative complication rate and exclusion of false lumen in aortic dissection.
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Affiliation(s)
- H Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany.
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Leone O, Biagini E, Pacini D, Zagnoni S, Ferlito M, Graziosi M, Di Bartolomeo R, Rapezzi C. The elusive link between aortic wall histology and echocardiographic anatomy in bicuspid aortic valve: implications for prophylactic surgery. Eur J Cardiothorac Surg 2011; 41:322-7. [DOI: 10.1016/j.ejcts.2011.05.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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37
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Di Eusanio M, Russo V, Buttazzi K, Lovato L, Di Bartolomeo R, Fattori R. Endovascular approach for acute aortic syndrome. J Cardiovasc Surg (Torino) 2010; 51:305-312. [PMID: 20523279] [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: 05/29/2023]
Abstract
Acute aortic syndrome (AAS) refers to the spectrum of aortic emergencies that include aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer. These aortic pathologies may lead to aortic rupture and a timely treatment is crucial to obtain clinical success and benefit on survival. Endovascular strategies have gained wide acceptance in the management of AAS and currently represent the new minimally invasive alternative to traditional surgery. In particular in acute complicated aortic dissection endovascular therapy demonstrated a better survival and limited complications with respect to open surgery. Aim of the present study was to provide an overview of AAS and to assess the current role of endovascular aortic repair in its treatment.
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Affiliation(s)
- M Di Eusanio
- Cardiovascular Radiology and Cardiac Surgery, Cardiothoracovascular Department, University Hospital S. Orsola, Bologna, Italy
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38
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Mestres C, Tsagakis K, Gorlitzer M, Grabenwöger M, Di Bartolomeo R, Pacini D, Benedik J, Cerny S, Jakob H. 246. Sustitución de arco aórtico y «trompa de elefante congelada» en la disección aguda tipo a. estudio multicéntrico europeo. Cirugía Cardiovascular 2010. [DOI: 10.1016/s1134-0096(10)70706-3] [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: 11/30/2022] Open
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39
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Botta L, La Palombara C, Rosati M, Di Bartolomeo R, Fattori R. Subclavian Embolization Associated to Carotid-Subclavian Bypass and Stent-Graft Repair of Acute Type-B Dissection. Thorac Cardiovasc Surg 2009; 57:240-2. [DOI: 10.1055/s-2008-1039220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fattori R, Russo V, Lovato L, Di Bartolomeo R. Optimal Management of Traumatic Aortic Injury. Eur J Vasc Endovasc Surg 2009; 37:8-14. [DOI: 10.1016/j.ejvs.2008.09.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 09/30/2008] [Indexed: 01/31/2023]
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Di Bartolomeo R, Pacini D, Armaro A, Di Marco L, Marsilli D. Complex repair of the thoracic aorta with the E-vita open prosthesis. J Cardiovasc Surg (Torino) 2008; 49:825-828. [PMID: 19043397] [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: 05/27/2023]
Abstract
AIM The treatment of complex aortic pathologies of the thoracic aorta remains a challenging issue in aortic surgery. The'' Frozen elephant trunk'' technique represents a recent development of the classic elephant trunk technique combining endovascular with conventional surgery. METHODS Between January 2007 and January 2008, 24 patients were operated on for complex pathologies of the thoracic aorta using the frozen elephant trunk technique with the E-vita open prosthesis. There were 21 male (87.5%) and the mean age was 62.4+/-9.9 years. The majority of patients (N=11) presented type A chronic dissection, 6 (25%) patients had chronic aneurysm of distal aortic arch and 5 (20.8%) type B aortic dissection associated with ascending aorta/aortic arch aneurysm. There were 2 cases of acute aortic dissection (1 type A and 1 type B). Nine patients (37.5%) underwent previous cardiovascular operations. RESULTS The overall in-hospital mortality was 4.2% (1 patient). None patient developed postoperative stroke and 1 patient suffered from spinal cord ischemia (1 paraparesis, 1 paraplegia). There were 2 cases (8.3%) of renal failure (dialysis), 2 patients (8.3%) had pulmonary complications and 2 patients (8.3%) needed rethoracotomy for bleeding. Five patients (21.7%) required extension of the descending thoracic aorta repair with endovascular treatment for persistent perfusion of dilated false lumen. CONCLUSION The Frozen Elephant trunk technique with the new E-vita open prosthesis combines surgical and interventional technologies and it represents a feasible and efficient option in the treatment of complex aortic pathologies. However long term follow up is required.
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Affiliation(s)
- R Di Bartolomeo
- Department of Cardiac Surgery, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Di Bartolomeo R, Botta L, Leone A, Pilato E, Martin-Suarez S, Bacchini M, Pacini D. Bio-ValsalvaTM prosthesis: 'new' conduit for 'old' patients. Interact Cardiovasc Thorac Surg 2008; 7:1062-6. [DOI: 10.1510/icvts.2008.187849] [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] [Indexed: 11/06/2022] Open
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44
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Russo V, Gostoli V, Lovato L, Montalti M, Marzocchi A, Gavelli G, Branzi A, Di Bartolomeo R, Fattori R. Clinical value of multidetector CT coronary angiography as a preoperative screening test before non-coronary cardiac surgery. Heart 2007; 93:1591-8. [PMID: 17164488 PMCID: PMC2095762 DOI: 10.1136/hrt.2006.105023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 10/10/2006] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Myocardial scintigraphy and/or conventional angiography (CA) are often performed before cardiac surgery in an attempt to identify unsuspected coronary artery disease which might result in significant cardiac morbidity and mortality. Multidetector CT coronary angiography (MDCTCA) has a recognised high negative predictive value and may provide a non-invasive alternative in this subset of patients. The aim of this study was to evaluate the clinical value of MDCTCA as a preoperative screening test in candidates for non-coronary cardiac surgery. METHODS 132 patients underwent MDCTCA (Somatom Sensation 16 Cardiac, Siemens) in the assessment of the cardiac risk profile before surgery. Coronary arteries were screened for > or = 50% stenosis. Patients without significant stenosis (Group 1) underwent surgery without any adjunctive screening tests while all patients with coronary lesions > or = 50% at MDCTCA (Group 2) underwent CA. RESULTS 16 patients (12.1%) were excluded due to poor image quality. 72 patients without significant coronary stenosis at MDCTCA were submitted to surgery. 30 out of 36 patients with significant (> or = 50%) coronary stenosis at MDCTCA and CA underwent adjunctive bypass surgery or coronary angioplasty. In 8 patients, MDCTCA overestimated the severity of the coronary lesions (> 50% MDCTCA, < 50% CA). No severe cardiovascular perioperative events such as myocardial ischaemia, myocardial infarction or cardiac failure occurred in any patient in Group 1. CONCLUSIONS MDCTCA seems to be effective as a preoperative screening test prior to non-coronary cardiac surgery. In this era of cost containment and optimal care of patients, MDCTCA is able to provide coronary vessel and ventricular function evaluation and may become the method of choice for the assessment of a cardiovascular risk profile prior to major surgery.
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Affiliation(s)
- V Russo
- Cardiovascular Department, Cardiovascular Radiology Unit, University Hospital S. Orsola, Padiglione 21, Via Massarenti 9, 40138 Bologna, Italy
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Fattori R, Buttazzi K, Russo V, Lovato L, Botta L, Gostoli V, Bartolini S, Di Bartolomeo R. Evolving concepts in the treatment of traumatic aortic injury. A review article. J Cardiovasc Surg (Torino) 2007; 48:625-631. [PMID: 17989632] [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: 05/25/2023]
Abstract
Traumatic aortic injury (TAI) has long been considered a surgical emergency, despite the high mortality and morbidity rates in traumatized patients submitted to open surgery. Initial medical management until stabilization of associated traumatic lesions has long been a matter of debate because of the inherent risk of rupture in some of these cases. Endovascular techniques in the management of polytraumatized patients provides an additional low-invasive treatment option. Because of its lower invasiveness, without thoracotomy or the use of heparin, endovascular repair can be performed in acute patients, without the risk of destabilizing pulmonary, head or abdominal traumatic lesions. Following the publication of early small series and case reports, endovascular repair has become a widely accepted method for treating both acute and chronic traumatic lesions. Our series comprised 51 TAI patients submitted to endovascular aneurysm repair from July 1997 to December 2006, of which 24 had chronic post-traumatic aneurysms and 27 were treated in the acute or subacute phase after the traumatic event. No mortality occurred; aneurysm sealing was consistently good. Major complications included a cerebellar stroke in 1 patient due to occlusion of the left subclavian artery. No failure of aortic procedure, mortality or complications were observed during the follow-up period. Should long-term follow-up in larger series show substantial durability of the graft material, endovascular treatment will become the management of choice for TAIs.
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Affiliation(s)
- R Fattori
- Unit of Cardiovascular Radiology, Cardiothoracovascular Department, University Hospital S. Orsola, Bologna, Italy.
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Botta L, Suarez SM, Dell'Amore A, Grigioni F, Arpesella G, Di Bartolomeo R, Marinelli G. Intraoperative rupture of the donor aorta during heart transplantation: surgical management with a Bentall-de Bono procedure. Transplant Proc 2007; 39:1573-4. [PMID: 17580191 DOI: 10.1016/j.transproceed.2006.11.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Revised: 10/06/2006] [Accepted: 11/02/2006] [Indexed: 11/30/2022]
Abstract
Aortic complications are uncommon in cardiac allograft recipients. Primary acute aortic rupture is an extremely rare and dramatic event that can occur in the early phase after transplantation. In this article we describe a case of acute intraoperative rupture of the donor aorta just after aortic declamping during orthotopic cardiac transplantation procedure, successfully treated with a Bentall-De Bono operation.
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Affiliation(s)
- L Botta
- Department of Cardiac Surgery, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy.
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Pacini D, Di Marco L, Marsilli D, Mikus E, Loforte A, Sobaih F, Di Bartolomeo R. Nine years experience of aortic arch repair with the aid of antegrade selective cerebral perfusion. J Cardiovasc Surg (Torino) 2006; 47:691-8. [PMID: 17043617] [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: 05/12/2023]
Abstract
AIM Antegrade selective cerebral perfusion (ASCP) is gaining widespread popularity in aortic arch surgery because it has been demonstrated to be an optimal technique of cerebral protection. This study demonstrates the clinical results of aortic arch repair with ASCP. METHODS Between November 1996 and September 2004, 250 patients underwent thoracic aorta replacement using ASCP under moderate hypothermia. Mean patients age was 63+/-11.5 years. Presenting pathologies were chronic aneurysm in 136 patient (54.4%), type A acute aortic dissection in 80 patients (32%), post-dissection aneurysm in 30 patients (12%). Ascending aorta and hemiarch replacement was performed in 63 patients (25.2%), ascending aorta and total arch replacement in 131 patients (52.4%), total arch replacement in 33 patients (13.2%), total arch and descending aorta replacement in 10 patients (4%) and complete replacement of the thoracic aorta in 13 patients (5.2%). RESULTS Hospital mortality was 11.6%. Multivariate analysis showed preoperative renal failure (P=0.050), cerebral perfusion time (P<0.001), pulmonary complications (P=0.009) and postoperative dialysis (P=0.030) as risk factors for hospital mortality. Permanent neurologic deficits occurred in 4 patients (1.6%) and coronary artery disease (P=0.029) was found to be the only independent risk factor. Transient neurologic deficits were noted in 18 patients (7.2%). Multivariate analysis revealed age (P=0.043), coronary artery disease (P=0.036), urgent/emergency status of the operation (P=0.016) and concomitant aortic valve replacement (P=0.001) to be independent predictors of transient neurologic dysfunction. The actuarial survival rate at 7 years was 61.7%. CONCLUSIONS | Our results confirmed that ASCP is a safe method of brain protection allowing complex aortic repairs to be performed with good results in terms of hospital mortality and neurologic outcome. Cerebral perfusion time did not influence postoperative outcome. The use of moderate hypothermia avoided all undesirable effects of deep hypothermia.
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Affiliation(s)
- D Pacini
- Department of Cardiac Surgery, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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Botta L, Russo V, Grigioni F, Arpesella G, Rocchi G, Di Bartolomeo R, Fattori R. Unusual rapid evolution of type B aortic dissection in a marfan patient following heart transplantation: successful endovascular treatment. Eur J Vasc Endovasc Surg 2006; 32:358-60. [PMID: 16750918 DOI: 10.1016/j.ejvs.2006.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 02/16/2006] [Accepted: 04/01/2006] [Indexed: 11/23/2022]
Abstract
A patient with Marfan syndrome with previous Bentall operation for mitral and tricuspid valve repair, required orthotopic cardiac transplantation for end stage cardiomyopathy. Postoperatively he suffered type-B aortic dissection, despite normal aortic diameters. Following sudden increase of aortic diameters, two years later, he underwent successful stent graft implantation. In patients with Marfan syndrome, post transplantation morbidity is high, with a 40% incidence of thoracic aortic dissection. This case highlights the potential of endovascular approach for treating post-transplantation aortic dissection.
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Affiliation(s)
- L Botta
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
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Settepani F, Martìn-Suàrez S, Pilato E, Di Bartolomeo R. Biatrial myxoma: surgical experience of a rare cardiac tumor. J Cardiovasc Surg (Torino) 2005; 46:593-4. [PMID: 16424849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Pacini D, Di Marco L, Loforte A, Angeli E, Dell'amore A, Bergonzini M, Di Bartolomeo R. Reoperations on the ascending aorta and aortic root. Early and late results? J Cardiovasc Surg (Torino) 2005; 46:491-8. [PMID: 16278640] [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: 05/05/2023]
Abstract
AIM We have retrospectively evaluated our results after aortic root and ascending aorta reoperations to determine risk factors of early death and late mortality. METHODS From January 1986 to April 2002, 73 patients underwent ''reoperative'' procedures on the aortic root and the ascending aorta. The mean age was 56.1+/-13.4 years and males numbered 62 (84.9%). The most frequent indication for reoperation was degenerative aortic aneurysm (49.3%) followed by post-dissection aneurysm (11%). Aortic root replacement with composite valve graft was performed in 47 patients (64.4%) and with aortic homograft in 2 (2.7%). Nineteen patients (26%) underwent ascending aorta replacement with tubular graft, and 4 (5.5%) underwent tailoring aortoplasty of the ascending aorta. RESULTS The 30-day mortality rate was 16.4% (12 patients). Mortality following elective operations was 8%, and that following urgent or emergency operations was 34.8% (p=0.002). Late survival of hospital survivors at 1, 5 and 10 years was 93.8%, 77.7% and 37%, respectively. In the multivariate Cox regression analysis chronic renal failure (p=0.003) and urgent or emergency operation (p=0.018) were found to be independent predictors of late mortality. CONCLUSIONS Reoperations on the ascending aorta can be accomplished with acceptable early mortality and satisfactory long-term RESULTS More radical treatment of the aortic pathology at the initial operation may reduce the need for further reoperations. A careful follow-up is extremely important for detecting complications of the first operation or progression of the aortic pathology before an emergency operation, predictive of poorer early and late outcome, is needed.
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Affiliation(s)
- D Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy.
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