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Matteucci M, Ferrarese S, Mantovani V, Corazzari C, Cappabianca G, Messina C, Garis S, Severgnini P, Lorusso R, Musazzi A. Surgical repair of left ventricular free-wall rupture complicating acute myocardial infarction: a single-center 30 years of experience. Front Cardiovasc Med 2024; 10:1348981. [PMID: 38268854 PMCID: PMC10806197 DOI: 10.3389/fcvm.2023.1348981] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024] Open
Abstract
Background Left ventricular free-wall rupture (LVFWR) is a catastrophic complication of acute myocardial infarction (AMI). Historically, cardiac surgery is considered the treatment of choice. However, because of the rarity of this entity, little is known regarding the efficacy and safety of surgical treatment for post-infarction LVFWR. The aim of this study was to report a single-center experience in this field over a period of 30 years. Methods Patients who developed LVFWR following AMI and underwent surgical repair at our Institution from January 1990 to December 2019 were considered. The primary end-point was in-hospital morality rate; secondary outcomes were long-term survival and postoperative complications. Multivariate analysis was carried out by constructing a logistic regression model to identify risk factors for early mortality. Results A total of 35 patients were enrolled in this study. The mean age was 68.9 years; 65.7% were male. The oozing type of LVFWR was encountered in 29 individuals, and the blowout type in 6 subjects. Sutured repair was used in 77.1% of patients, and sutureless repair in the remaining cases. The in-hospital mortality rate was 28.6%. Low cardiac output syndrome was the main cause of postoperative death. Multivariable analysis identified age >75 years at operation, preoperative cardiac arrest, concurrent ventricular septal rupture (VSR) as independent predictors of in-hospital death. Follow-up was complete in 100% of patients who survived surgery (mean follow-up: 9.3 ± 7.8 years); among the survivors, 16 patients died during the follow-up with a 3-year and 12-year overall survival rate of 82.5% and 55.2%, respectively. Conclusions Surgical treatment of LVFWR following AMI is possible with acceptable in-hospital mortality and excellent long-term results. Advanced age, concurrent VSR and cardiac arrest at presentation are independent risk factors of poor early outcome.
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Affiliation(s)
- Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Sandro Ferrarese
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Vittorio Mantovani
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Claudio Corazzari
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Giangiuseppe Cappabianca
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Corinne Messina
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Sara Garis
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Severgnini
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Andrea Musazzi
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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2
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Heuts S, Lorusso R, di Mauro M, Jiritano F, Scrofani R, Antona C, Dato GA, Centofanti P, Ferrarese S, Matteucci M, Miceli A, Glauber M, Vizzardi E, Sponga S, Vendramin I, Garatti A, de Vincentiis C, De Bonis M, Pieri M, Troise G, Tomba MD, Serraino GF. Sheathless Versus Sheathed Intra-Aortic Balloon Pump Implantation in Patients Undergoing Cardiac Surgery. Am J Cardiol 2023; 189:86-92. [PMID: 36516701 DOI: 10.1016/j.amjcard.2022.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/20/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
The intra-aortic balloon pump (IABP) is the most widely available mechanical support device, but its use has been disputed in recent decades. Although several efforts have been made to reduce the associated complication rate, contemporary data on this matter is lacking. The present study aims to evaluate the differences in vascular complications between the sheathless and the sheathed IABP implantation technique in cardiac surgery patients. A retrospective multi-center cohort, consisting of patients treated in 8 cardiac surgical centers, was evaluated. Patients who underwent cardiac surgery with peri-operative IABP support were included. Primary outcome was a composite end point of vascular complications. Propensity score matching (PSM) was performed, and a multivariable regression model was applied to evaluate predictors of vascular complications. The unmatched cohort consisted of 2,615 patients (sheathless n = 1,414, 54%, sheathed n = 1,201, 46%). A total of 878 patients were matched (n = 439 for both groups). The composite vascular complication end point occurred in 3% of patients in the sheathless group, compared with 8% in the sheathed group (p <0.001). Vascular complications were significantly associated with mortality (odds ratio [OR] 3.86, 95% confidence interval [CI] 2.01 to 7.40, p <0.001). Peripheral arterial disease was associated with vascular complications (OR 3.10, 95% CI 1.46 to 6.55, p = 0.003), whereas the sheathless implantation technique was found to be protective (OR 0.36, 95% CI 0.18 to 0.73, p = 0.005). In conclusion, the present retrospective multi-center analysis demonstrated the sheathless implantation technique to be associated with a significant reduction in vascular complication rate. Future studies should focus on even less invasive implantation techniques using smaller-sized catheters, sheathless implantation, and imaging guiding.
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Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands; Cardiac Surgery Unit, A.O. Spedali Civili, Brescia, Italy.
| | - Michele di Mauro
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Federica Jiritano
- Cardiac Surgery Department, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | | | - Carlo Antona
- Cardiac Surgery Department, Ospedale Sacco, Milan, Italy
| | | | - Paolo Centofanti
- Department of Cardiovascular Surgery, Ospedale Mauriziano, Torino, Italy
| | - Sandro Ferrarese
- Department of Cardiac Surgery, Ospedale di Circolo, Varese, Italy
| | - Matteo Matteucci
- Department of Cardiac Surgery, Ospedale di Circolo, Varese, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Mattia Glauber
- Department of Cardiac Surgery, Istituto Clinico S. Ambrogio, Milan, Italy
| | | | - Sandro Sponga
- Department of Cardiac Surgery, Ospediale S. Maria della Misericordia, Udine, Italy
| | - Igor Vendramin
- Department of Cardiac Surgery, Ospediale S. Maria della Misericordia, Udine, Italy
| | - Andrea Garatti
- Department of Cardiac Surgery, Ospedale di S. Donato, Milan, Italy
| | | | - Michele De Bonis
- Department of Cardiac Surgery, Ospedale S. Raffaele, Milan, Italy
| | - Marina Pieri
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Troise
- Department of Cardiac Surgery, Ospedale Poliambulanza, Brescia, Italy
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3
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Matteucci M, Ferrarese S, Kowalewski M, Meani P, Messina C, Giusti R, Velasco M, Scarantino A, Garis S, Borsani P, Corazzari C, Ronco D, Lorusso R, Severgnini P, Musazzi A. Surgical repair of postinfarction ventricular septal rupture: current state of the art. Minerva Surg 2023:S2724-5691.22.09832-X. [PMID: 36723969 DOI: 10.23736/s2724-5691.22.09832-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The incidence of postacute myocardial infarction ventricular septal rupture (post-AMI VSR) has decreased over the past two decades. Nevertheless, individuals who suffer from post-AMI VSR continue to represent a subgroup of patients with high morbidity and mortality. The care for these patients is complex and requires a multidisciplinary approach. However, because of the small number of reports that exist to guide clinical practice, there is a significant variability in care among centers. This review summarizes information on post-AMI VSR diagnosis and outline contemporary best management and practice consideration.
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Affiliation(s)
- Matteo Matteucci
- Unit of Cardiac Surgery, Department of Medicine, and Surgery, ASST dei Sette Laghi, University of Insubria, Varese, Italy - .,Thoracic Research Center, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland - .,Department of Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands -
| | - Sandro Ferrarese
- Unit of Cardiac Surgery, Department of Medicine, and Surgery, ASST dei Sette Laghi, University of Insubria, Varese, Italy
| | - Mariusz Kowalewski
- Thoracic Research Center, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.,Department of Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands.,Department of Cardiac Surgery, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Paolo Meani
- Thoracic Research Center, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.,Department of Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
| | - Corinne Messina
- Unit of Cardiac Surgery, Department of Medicine, and Surgery, ASST dei Sette Laghi, University of Insubria, Varese, Italy
| | - Rosa Giusti
- Unit of Cardiac Surgery, Department of Medicine, and Surgery, ASST dei Sette Laghi, University of Insubria, Varese, Italy
| | - Maria Velasco
- Unit of Cardiac Surgery, Department of Medicine, and Surgery, ASST dei Sette Laghi, University of Insubria, Varese, Italy
| | - Arianna Scarantino
- Unit of Cardiac Surgery, Department of Medicine, and Surgery, ASST dei Sette Laghi, University of Insubria, Varese, Italy
| | - Sara Garis
- Unit of Cardiac Surgery, Department of Medicine, and Surgery, ASST dei Sette Laghi, University of Insubria, Varese, Italy
| | - Paolo Borsani
- Unit of Cardiac Surgery, Department of Medicine, and Surgery, ASST dei Sette Laghi, University of Insubria, Varese, Italy
| | - Claudio Corazzari
- Unit of Cardiac Surgery, Department of Medicine, and Surgery, ASST dei Sette Laghi, University of Insubria, Varese, Italy
| | - Daniele Ronco
- Department of Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
| | - Paolo Severgnini
- Cardiac Surgery Intensive Care Unit, Department of Biotechnology and Life Sciences, ASST dei Sette Laghi, University of Insubria, Varese, Italy
| | - Andrea Musazzi
- Unit of Cardiac Surgery, Department of Medicine, and Surgery, ASST dei Sette Laghi, University of Insubria, Varese, Italy
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4
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Matteucci M, Ferrarese S, Cantore C, Mantovani V, Pedroni G, Cappabianca G, Corazzari C, Kowalewski M, Severgnini P, Lorusso R, Beghi C. Early paravalvular leak after conventional mitral valve replacement: A single-center analysis. J Card Surg 2022; 37:1559-1566. [PMID: 35289962 PMCID: PMC9314703 DOI: 10.1111/jocs.16422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/02/2022] [Accepted: 02/13/2022] [Indexed: 12/01/2022]
Abstract
Introduction Paravalvular leak (PVL) is a well‐recognized complication after mitral valve replacement (MVR). However, there are only a few studies analyzing leak occurrence and postoperative results after surgical MVR. The aim of this study was to assess the rate and determinants of early mitral PVL and to evaluate the impact on survival. Methods We performed a retrospective analysis involving patients who underwent MVR from January 2012 to December 2019 at our Institution. Postoperative transthoracic echocardiography evaluation was done for all subjects before hospital discharge. Multivariable analysis was carried out by constructing a logistic regression model to identify predictors for PVL occurrence. Results Four hundred ninety‐four patients were enrolled. Operative mortality was 4.9%. Early mitral PVL was found in 16 patients (3.2%); the majority were mild (75%). Leaks occurred more frequently along the posterior segment of the mitral valve annulus (62.5%). Only one individual with moderate‐to‐severe PVL underwent reoperation during the same hospital admission. Multivariable analysis revealed that preoperative diagnosis of infective endocarditis was the only factor associated with early leak after MVR (odds ratio: 4.96; 95% confidence interval: 1.45–16.99; p = .011). Overall mortality at follow‐up (mean follow‐up time: 4.7 [SD: 2.5] years) was 19.6% and favored patients without early mitral PVL. Conclusion The incidence of early PVL after MVR is low. PVL is usually mild and develop more frequently along the posterior segment of the mitral valve annulus. Preoperative diagnosis of infective endocarditis increases the risk of PVL formation.
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Affiliation(s)
- Matteo Matteucci
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Sandro Ferrarese
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Cristiano Cantore
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Vittorio Mantovani
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giada Pedroni
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giangiuseppe Cappabianca
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Claudio Corazzari
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland.,Thoracic Research Centre, Collegium Medicum, Innovative Medical Forum, Nicolaus Copernicus University, Bydgoszcsz, Poland
| | - Paolo Severgnini
- Department of Biotechnology and Sciences of Life, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cesare Beghi
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
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5
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Adams JH, Ahmad S, Allard D, Anzalone A, Bacholle S, Barrillon P, Bayer J, Bertaina M, Bisconti F, Blaksley C, Blin-Bondil S, Bobík P, Cafagna F, Campana D, Capel F, Casolino M, Cassardo C, Catalano C, Cremonini R, Dagoret-Campagne S, Danto P, del Peral L, de la Taille C, Díaz Damian A, Dupieux M, Ebersoldt A, Ebisuzaki T, Eser J, Evrard J, Fenu F, Ferrarese S, Fornaro C, Fouka M, Gorodetzky P, Guarino F, Guzman A, Hachisu Y, Haungs A, Judd E, Jung A, Karczmarczyk J, Kawasaki Y, Klimov PA, Kuznetsov E, Mackovjak S, Manfrin M, Marcelli L, Medina-Tanco G, Mercier K, Merino A, Mernik T, Miyamoto H, Morales de los Ríos JA, Moretto C, Mot B, Neronov A, Ohmori H, Olinto AV, Osteria G, Panico B, Parizot E, Paul T, Picozza P, Piotrowski LW, Plebaniak Z, Pliego S, Prat P, Prévôt G, Prieto H, Putis M, Rabanal J, Ricci M, Rojas J, Rodríguez Frías MD, Roudil G, Sáez Cano G, Sahnoun Z, Sakaki N, Sanchez JC, Santangelo A, Sarazin F, Scotti V, Shinozaki K, Silva H, Soriano JF, Suino G, Szabelski J, Toscano S, Tabone I, Takizawa Y, von Ballmoos P, Wiencke L, Wille M, Zotov M. A Review of the EUSO-Balloon Pathfinder for the JEM-EUSO Program. Space Sci Rev 2022; 218:3. [PMID: 35153338 PMCID: PMC8807436 DOI: 10.1007/s11214-022-00870-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/31/2021] [Indexed: 06/14/2023]
Abstract
EUSO-Balloon is a pathfinder for JEM-EUSO, the mission concept of a spaceborne observatory which is designed to observe Ultra-High Energy Cosmic Ray (UHECR)-induced Extensive Air Showers (EAS) by detecting their UltraViolet (UV) light tracks "from above." On August 25, 2014, EUSO-Balloon was launched from Timmins Stratospheric Balloon Base (Ontario, Canada) by the balloon division of the French Space Agency CNES. After reaching a floating altitude of 38 km, EUSO-Balloon imaged the UV light in the wavelength range ∼290-500 nm for more than 5 hours using the key technologies of JEM-EUSO. The flight allowed a good understanding of the performance of the detector to be developed, giving insights into possible improvements to be applied to future missions. A detailed measurement of the photoelectron counts in different atmospheric and ground conditions was achieved. By means of the simulation of the instrument response and by assuming atmospheric models, the absolute intensity of diffuse light was estimated. The instrument detected hundreds of laser tracks with similar characteristics to EASs shot by a helicopter flying underneath. These are the first recorded laser tracks measured from a fluorescence detector looking down on the atmosphere. The reconstruction of the direction of the laser tracks was performed. In this work, a review of the main results obtained by EUSO-Balloon is presented as well as implications for future space-based observations of UHECRs.
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Affiliation(s)
- J. H. Adams
- University of Alabama in Huntsville, Huntsville, USA
| | - S. Ahmad
- Omega, Ecole Polytechnique, CNRS/IN2P3, Palaiseau, France
| | - D. Allard
- APC, Univ. Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Paris, France
| | - A. Anzalone
- INAF - Istituto di Astrofisica Spaziale e Fisica Cosmica di Palermo, Palermo, Italy
- Istituto Nazionale di Fisica Nucleare - Sezione di Catania, Catania, Italy
| | - S. Bacholle
- APC, Univ. Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Paris, France
| | - P. Barrillon
- Université Paris-Saclay, CNRS/IN2P3, IJCLab, Orsay, France
| | - J. Bayer
- Institute for Astronomy and Astrophysics, University of Tübingen, Tübingen, Germany
| | - M. Bertaina
- Istituto Nazionale di Fisica Nucleare - Sezione di Torino, Torino, Italy
- Dipartimento di Fisica, Universitá di Torino, Torino, Italy
| | - F. Bisconti
- Dipartimento di Fisica, Universitá di Torino, Torino, Italy
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - C. Blaksley
- APC, Univ. Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Paris, France
| | - S. Blin-Bondil
- Omega, Ecole Polytechnique, CNRS/IN2P3, Palaiseau, France
| | - P. Bobík
- Institute of Experimental Physics, Slovak Academy of Sciences, Košice, Slovakia
| | - F. Cafagna
- Istituto Nazionale di Fisica Nucleare - Sezione di Bari, Bari, Italy
| | - D. Campana
- Istituto Nazionale di Fisica Nucleare - Sezione di Napoli, Naples, Italy
| | - F. Capel
- KTH Royal Institute of Technology, Stockholm, Sweden
| | - M. Casolino
- RIKEN, 2-1 Hirosawa, Wako, Saitama Japan
- Istituto Nazionale di Fisica Nucleare - Sezione di Roma Tor Vergata, Roma, Italy
| | - C. Cassardo
- Dipartimento di Fisica, Universitá di Torino, Torino, Italy
| | - C. Catalano
- IRAP, Université de Toulouse, CNRS, Toulouse, France
| | - R. Cremonini
- Dipartimento di Fisica, Universitá di Torino, Torino, Italy
| | | | - P. Danto
- CNES, 18 avenue Edouard Belin, Toulouse, France
| | | | | | | | - M. Dupieux
- IRAP, Université de Toulouse, CNRS, Toulouse, France
| | - A. Ebersoldt
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - J. Eser
- Colorado School of Mines, Golden, USA
| | - J. Evrard
- CNES, 18 avenue Edouard Belin, Toulouse, France
| | - F. Fenu
- Istituto Nazionale di Fisica Nucleare - Sezione di Torino, Torino, Italy
- Dipartimento di Fisica, Universitá di Torino, Torino, Italy
| | - S. Ferrarese
- Dipartimento di Fisica, Universitá di Torino, Torino, Italy
| | | | - M. Fouka
- Center of Research in Astronomy, Astrophysics, and Geophysics, Algiers, Algeria
| | - P. Gorodetzky
- APC, Univ. Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Paris, France
| | - F. Guarino
- Istituto Nazionale di Fisica Nucleare - Sezione di Napoli, Naples, Italy
- Dipartimento di Scienze Fisiche, Universitá di Napoli Federico II, Naples, Italy
| | - A. Guzman
- Institute for Astronomy and Astrophysics, University of Tübingen, Tübingen, Germany
| | - Y. Hachisu
- RIKEN, 2-1 Hirosawa, Wako, Saitama Japan
| | - A. Haungs
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - E. Judd
- Space Sciences Laboratory, University of California, Berkeley, CA USA
| | - A. Jung
- APC, Univ. Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Paris, France
| | | | | | - P. A. Klimov
- Skobeltsyn Institute of Nuclear Physics, Lomonosov Moscow State University, Moscow, Russia
| | - E. Kuznetsov
- University of Alabama in Huntsville, Huntsville, USA
| | - S. Mackovjak
- Institute of Experimental Physics, Slovak Academy of Sciences, Košice, Slovakia
| | - M. Manfrin
- Dipartimento di Fisica, Universitá di Torino, Torino, Italy
| | - L. Marcelli
- Istituto Nazionale di Fisica Nucleare - Sezione di Roma Tor Vergata, Roma, Italy
| | - G. Medina-Tanco
- Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - K. Mercier
- CNES, 18 avenue Edouard Belin, Toulouse, France
| | | | - T. Mernik
- Institute for Astronomy and Astrophysics, University of Tübingen, Tübingen, Germany
| | - H. Miyamoto
- Université Paris-Saclay, CNRS/IN2P3, IJCLab, Orsay, France
- Dipartimento di Fisica, Universitá di Torino, Torino, Italy
| | | | - C. Moretto
- Université Paris-Saclay, CNRS/IN2P3, IJCLab, Orsay, France
| | - B. Mot
- IRAP, Université de Toulouse, CNRS, Toulouse, France
| | - A. Neronov
- ISDC Data Centre for Astrophysics, Versoix, Switzerland
| | - H. Ohmori
- RIKEN, 2-1 Hirosawa, Wako, Saitama Japan
| | | | - G. Osteria
- Istituto Nazionale di Fisica Nucleare - Sezione di Napoli, Naples, Italy
| | - B. Panico
- Istituto Nazionale di Fisica Nucleare - Sezione di Napoli, Naples, Italy
- Dipartimento di Scienze Fisiche, Universitá di Napoli Federico II, Naples, Italy
| | - E. Parizot
- APC, Univ. Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Paris, France
| | - T. Paul
- Lehman College, City University of New York, New York, USA
| | - P. Picozza
- RIKEN, 2-1 Hirosawa, Wako, Saitama Japan
- Istituto Nazionale di Fisica Nucleare - Sezione di Roma Tor Vergata, Roma, Italy
- Dipartimento di Fisica, Universitá di Roma Tor Vergata, Roma, Italy
| | | | - Z. Plebaniak
- Dipartimento di Fisica, Universitá di Torino, Torino, Italy
- National Centre for Nuclear Research, Lodz, Poland
| | - S. Pliego
- Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - P. Prat
- APC, Univ. Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Paris, France
| | - G. Prévôt
- APC, Univ. Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Paris, France
| | - H. Prieto
- Universidad de Alcalá, Madrid, Spain
| | - M. Putis
- Institute of Experimental Physics, Slovak Academy of Sciences, Košice, Slovakia
| | - J. Rabanal
- Université Paris-Saclay, CNRS/IN2P3, IJCLab, Orsay, France
| | - M. Ricci
- Istituto Nazionale di Fisica Nucleare, Laboratori Nazionali di Frascati, Frascati, Italy
| | - J. Rojas
- Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - G. Roudil
- IRAP, Université de Toulouse, CNRS, Toulouse, France
| | | | - Z. Sahnoun
- Center of Research in Astronomy, Astrophysics, and Geophysics, Algiers, Algeria
| | - N. Sakaki
- RIKEN, 2-1 Hirosawa, Wako, Saitama Japan
| | - J. C. Sanchez
- Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - A. Santangelo
- Institute for Astronomy and Astrophysics, University of Tübingen, Tübingen, Germany
| | | | - V. Scotti
- Istituto Nazionale di Fisica Nucleare - Sezione di Napoli, Naples, Italy
- Dipartimento di Scienze Fisiche, Universitá di Napoli Federico II, Naples, Italy
| | - K. Shinozaki
- Dipartimento di Fisica, Universitá di Torino, Torino, Italy
- National Centre for Nuclear Research, Lodz, Poland
| | - H. Silva
- Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - G. Suino
- Dipartimento di Fisica, Universitá di Torino, Torino, Italy
| | - J. Szabelski
- National Centre for Nuclear Research, Lodz, Poland
| | - S. Toscano
- ISDC Data Centre for Astrophysics, Versoix, Switzerland
| | - I. Tabone
- Dipartimento di Fisica, Universitá di Torino, Torino, Italy
| | | | | | | | - M. Wille
- ECAP, University of Erlangen-Nuremberg, Erlangen, Germany
| | - M. Zotov
- Skobeltsyn Institute of Nuclear Physics, Lomonosov Moscow State University, Moscow, Russia
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6
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Lorusso R, Heuts S, Jiritano F, Scrofani R, Antona C, Actis Dato G, Centofanti P, Ferrarese S, Matteucci M, Miceli A, Glauber M, Vizzardi E, Sponga S, Vendramin I, Garatti A, de Vincentis C, De Bonis M, Ajello S, Troise G, Dalla Tomba M, Serraino F. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6563853. [PMID: 35381083 PMCID: PMC9252119 DOI: 10.1093/icvts/ivac091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Cardiac Surgery, A.O. Spedali Civili, Brescia, Italy
- Corresponding author. Department of Cardiothoracic Surgery, Maastricht University Medical Center+, 6229 HX, Maastricht, Netherlands. Tel: +31-43-387-50-70; e-mail: (R. Lorusso)
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Federica Jiritano
- Department of Cardiac Surgery, Ospedale Universitario, Catanzaro, Italy
| | | | - Carlo Antona
- Department of Cardiac Surgery, Ospedale Sacco, Milan, Italy
| | | | - Paolo Centofanti
- Department of Cardiac Surgery, Ospedale Mauriziano, Torino, Italy
| | - Sandro Ferrarese
- Department of Cardiac Surgery, Ospedale di Circolo, Varese, Italy
| | - Matteo Matteucci
- Department of Cardiac Surgery, Ospedale di Circolo, Varese, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Mattia Glauber
- Department of Cardiac Surgery, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Enrico Vizzardi
- Department of Cardiac Surgery, A.O. Spedali Civili, Brescia, Italy
| | - Sandro Sponga
- Department of Cardiac Surgery, Ospediale S. Maria della Misericordia, Udine, Italy
| | - Igor Vendramin
- Department of Cardiac Surgery, Ospediale S. Maria della Misericordia, Udine, Italy
| | - Andrea Garatti
- Department of Cardiac Surgery, Ospedale di S. Donato, Milan, Italy
| | | | - Michele De Bonis
- Department of Cardiac Surgery, Ospedale S. Raffaele, Milan, Italy
| | - Silvia Ajello
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Troise
- Department of Cardiac Surgery, Ospedale Poliambulanza, Brescia, Italy
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7
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Marazzato J, De Ponti R, Verdecchia P, Blasi F, Golino M, Ferrarese S, Angeli F. 512 Long-term survival in patients with post-operative atrial fibrillation after cardiac surgery: analysis from a prospective-cohort study. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab127.017] [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: 11/13/2022]
Abstract
Abstract
Aims
Post-operative atrial fibrillation (POP AF) is frequent in patients who undergo cardiac surgery. However, its prognostic impact in the long-term remains unclear.
Methods and results
We followed for an average of 10 ± 3 years 1386 patients who underwent a variety of cardiac surgical procedures (cardiac transplantation and surgery for heart failure included) while they were in sinus rhythm. Among 1178 patents without a history of AF, 726 (62%) did not develop AF during the entire duration of the study and 452 (38%) developed new-onset POP AF during the first 30 peri-operative days after heart surgery. Other 125 patients with a positive history of paroxysmal or persistent AF were in sinus rhythm at the time of surgery and 87 of them (70%) developed POP AF. Finally, 83 patients had permanent AF when they underwent surgery. All-cause mortality was the primary outcome of the study. We tested the associations of potential determinants with all-cause mortality using univariable and multivariable statistical analyses by means of Cox proportional hazard models. Overall, 473 patients (34%) died during a long-term follow-up. Compared with patients who never developed AF, neither the patients with new-onset POP AF [adjusted HR = 1.31 (95% CI: 0.90–1.89); P = 0.1609], nor those with history of AF at the time of surgery (adjusted HR = 1.33, 95% CI: 0.71–2.49; P = 0.3736) showed a significantly increased risk of mortality (Figure 1). In new-onset POP AF patients, oral anticoagulation was not associated with mortality [adjusted HR = 1.13 (95% CI: 0.83–1.54), P = 0.4299].
Conclusions
In this huge prospective cohort of patients who underwent different types of heart surgery, POP AF was not associated with an increased risk of mortality. In this setting, the role of long-term anticoagulation remains unclear.
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Affiliation(s)
- Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione—ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Federico Blasi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Michele Golino
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Sandro Ferrarese
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
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8
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Matteucci M, Ferrarese S, Mantovani V, Ronco D, Torchio F, Franzosi C, Marazzato J, De Ponti R, Lorusso R, Beghi C. Surgical treatment of primary cardiac tumors in the contemporary era: A single-centre analysis. J Card Surg 2021; 36:3540-3546. [PMID: 34254361 PMCID: PMC8518736 DOI: 10.1111/jocs.15813] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 12/18/2022]
Abstract
Background Primary cardiac tumors (PCT) are rare lesions but have the potential to cause significant morbidity if not timely treated. We reviewed our single‐center experience in the surgical treatment of PCT with a focus on the long‐term outcome. Methods From 2001 to 2020, 57 consecutive patients underwent surgical resection of PCT at our Institution. Data including the demographic characteristics, tumor histology, surgical procedure, and postoperative outcomes were collected and analyzed. Results Mean age at presentation was 63.6 ± 11.2 years, and 33 (57.9%) of the patients were female. A total of 55 (96.5%) subjects were diagnosed with benign cardiac tumor, while the remaining had malignant tumors. The most common histopathological type was myxoma. All patients survived to hospital discharge. Main postoperative complications were: acute kidney injury (n = 3), sepsis (n = 3), and stroke (n = 2). Mean follow‐up time was 9 ± 5.9 years. Long‐term mortality was 22.8% (13/57). No tumor recurrence was observed among survivors. There was a significant relationship between mortality and pathological characteristics of the tumor, and myxomas had higher survival rates. Conclusion Surgical treatment of PCT is a safe and highly effective strategy associated with excellent short‐term outcomes. Long‐term survival remains poor for primary malignant tumors of the heart.
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Affiliation(s)
- Matteo Matteucci
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy.,Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sandro Ferrarese
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Vittorio Mantovani
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Daniele Ronco
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Federica Torchio
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Cinzia Franzosi
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Jacopo Marazzato
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cesare Beghi
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
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9
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Piffaretti G, Czerny M, Riambau V, Gottardi R, Wolfgruber T, Probst C, Matt P, Antonello M, Gerosa G, Hamady M, Fontana F, Ferrarese S, Lomazzi C, Grassi V, Fernandez-Alonso S, Trimarchi S. Endovascular repair of ascending aortic diseases with custom-made endografts. Eur J Cardiothorac Surg 2021; 59:741-749. [PMID: 33394032 DOI: 10.1093/ejcts/ezaa383] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 04/21/2020] [Revised: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of this article is to report the mid-term results of ascending thoracic endovascular aortic repair using a custom-made device (CMD). METHODS This was a retrospective study performed at tertiary centres. Nine patients considered unfit for open surgery received elective total endovascular repair of the ascending aorta with a Relay® (Terumo Aortic, Sunrise; FL, USA) CMD: pseudoaneurysn (n = 5), localized dissection (n =3) and contained rupture (n = 1). RESULTS Primary clinical success was achieved in all patients with no major complications and no early conversion to open surgery. All patients were discharged home and independent: median length of stay was 7 days (interquartile range, 6-18). No patient was lost to follow-up at a median 26 months (interquartile range, 12-36). Three patients died 2, 6 and 24 months after intervention; 1 was aorta related (late aorto-atrial fistula due to infection that required open surgery). At the last follow-up available, no endoleaks, migrations, fractures or ruptures were observed in the remaining 6 patients. CONCLUSIONS Ascending thoracic endovascular aortic repair with Terumo Aortic CMDs was technically feasible, effective and safe in very selected lesions. CMDs showed good ascending aorta conformability with different configurations and diameters, and satisfactory mid-term durability as shown by both structural integrity and aortic lesion exclusion.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Martin Czerny
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Vicente Riambau
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic University of Barcelona, Barcelona, Spain
| | - Roman Gottardi
- Department of Cardiac Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Wolfgruber
- Department of Cardiac Surgery, Paracelsus Medical University, Salzburg, Austria.,Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - Chris Probst
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Peter Matt
- Department of Cardiac Surgery, Herzzentrum Luzern, Luzern, Switzerland
| | - Michele Antonello
- Vascular and Cardiac Surgery-Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua, Italy
| | - Gino Gerosa
- Vascular and Cardiac Surgery-Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua, Italy
| | - Mohamad Hamady
- Interventional Radiology-Department of Surgery and Cancer, St Mary's Hospital Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Federico Fontana
- Interventional Radiology-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Sandro Ferrarese
- Vascular Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.,Cardiac Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Chiara Lomazzi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Viviana Grassi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Milan, Italy
| | | | - Santi Trimarchi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Milan, Italy.,Department of Clinical and Community Sciences, Ospedale Maggiore Policlinico, Milan, Italy
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10
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Marazzato J, Cappabianca G, Angeli F, Crippa M, Golino M, Ferrarese S, Beghi C, DE Ponti R. Ablation of atrial tachycardia in the setting of prior mitral valve surgery. Minerva Cardiol Angiol 2020; 69:94-101. [PMID: 33146481 DOI: 10.23736/s2724-5683.20.05405-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Data regarding catheter ablation of post-surgical atrial tachycardia occurring after mitral valve surgery are scarce. Through a search of the literature, this study aimed to assess the feasibility of catheter ablation and the characteristics of atrial arrhythmias ablated in these patients. METHODS Studies assessing the main procedure parameters and the electrophysiologic findings of the investigated atrial tachycardia were selected. The electrophysiologic mechanism (focal vs. re-entrant arrhythmias), site of arrhythmia origin (left atrium vs. right atrium) and their anatomic correlation with specific surgical access and/or prior Cox-Maze IV procedure were all addressed. RESULTS Eleven studies including 206 patients undergoing catheter ablation of 297 post-surgical arrhythmia morphologies occurring after mitral valve surgery were considered. Major complications were observed in 2 patients only (0.9%). Restoration of sinus rhythm was achieved in 96% of patients. Macro-reentrant arrhythmia was mostly observed (90.4%) with a non-negligible proportion of focal arrhythmia (9.6%). Left-sided arrhythmia was common (54.4%,) but cavotricuspid isthmus-dependent arrhythmia was frequently reported (33%). Although specific atriotomies showed trends towards peculiar locations of the investigated arrhythmia, Cox-Maze IV procedure was the only independent predictor for left-sided arrhythmia (OR=17.3; 95% CI 7.2-41.2; P<0.0001). CONCLUSIONS Catheter ablation of post-surgical arrhythmia occurring after mitral valve surgery is feasible, and, in this setting, the vast majority of the arrhythmia morphologies are based on macro-reentry and in about one third of cases show cavotricuspid isthmus-dependent arrhythmia. Prior Cox-Maze-IV associated with mitral valve surgery is an independent predictor of left-sided arrhythmia possibly due to non-transmural surgical lesions.
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Affiliation(s)
- Jacopo Marazzato
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Giangiuseppe Cappabianca
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Matteo Crippa
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Michele Golino
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Sandro Ferrarese
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Cesare Beghi
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Roberto DE Ponti
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy -
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11
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Marazzato J, Cappabianca G, Angeli F, Crippa M, Golino M, Ferrarese S, Beghi C, DE Ponti R. Ablation of atrial tachycardia in the setting of prior mitral valve surgery. Minerva Cardiol Angiol 2020. [PMID: 33146481 DOI: 10.23736/s0026-4725.20.05405-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Data regarding catheter ablation of post-surgical atrial tachycardia occurring after mitral valve surgery are scarce. Through a search of the literature, this study aimed to assess the feasibility of catheter ablation and the characteristics of atrial arrhythmias ablated in these patients. METHODS Studies assessing the main procedure parameters and the electrophysiologic findings of the investigated atrial tachycardia were selected. The electrophysiologic mechanism (focal vs. re-entrant arrhythmias), site of arrhythmia origin (left atrium vs. right atrium) and their anatomic correlation with specific surgical access and/or prior Cox-Maze IV procedure were all addressed. RESULTS Eleven studies including 206 patients undergoing catheter ablation of 297 post-surgical arrhythmia morphologies occurring after mitral valve surgery were considered. Major complications were observed in 2 patients only (0.9%). Restoration of sinus rhythm was achieved in 96% of patients. Macro-reentrant arrhythmia was mostly observed (90.4%) with a non-negligible proportion of focal arrhythmia (9.6%). Left-sided arrhythmia was common (54.4%,) but cavotricuspid isthmus-dependent arrhythmia was frequently reported (33%). Although specific atriotomies showed trends towards peculiar locations of the investigated arrhythmia, Cox-Maze IV procedure was the only independent predictor for left-sided arrhythmia (OR=17.3; 95% CI 7.2-41.2; P<0.0001). CONCLUSIONS Catheter ablation of post-surgical arrhythmia occurring after mitral valve surgery is feasible, and, in this setting, the vast majority of the arrhythmia morphologies are based on macro-reentry and in about one third of cases show cavotricuspid isthmus-dependent arrhythmia. Prior Cox-Maze-IV associated with mitral valve surgery is an independent predictor of left-sided arrhythmia possibly due to non-transmural surgical lesions.
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Affiliation(s)
- Jacopo Marazzato
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Giangiuseppe Cappabianca
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Matteo Crippa
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Michele Golino
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Sandro Ferrarese
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Cesare Beghi
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Roberto DE Ponti
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy -
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12
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Matteucci M, Ferrarese S, Corazzari C, Telli G, Mantovani V, Lorusso R, Beghi C. Ascending aortic aneurysm repair in the setting of Tako-tsubo cardiomyopathy. Perfusion 2020; 36:429-431. [PMID: 32815793 DOI: 10.1177/0267659120950206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tako-tsubo cardiomyopathy (TC) is characterized by acute but transient ventricular dysfunction without obstructive coronary artery disease, generally precipitated by emotional and physical triggers. We describe this syndrome in a 76-year-old woman who was admitted with thoracic pain secondary to TC as shown by echocardiographic assessment, with a concurrent diagnosis of giant ascending aortic aneurism. Surgical intervention was delayed to allow ventricular recovery and then to perform ascending aorta replacement. An individualized perioperative approach was applied to avoid a possible TC recurrence with an uneventful postoperative course.
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Affiliation(s)
- Matteo Matteucci
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy.,Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sandro Ferrarese
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Claudio Corazzari
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Gaia Telli
- Department of Heart and Vessels, Circolo Hospital, University of Insubria, Varese, Italy
| | - Vittorio Mantovani
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cesare Beghi
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
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13
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Piffaretti G, Trimarchi S, Gelpi G, Romagnoni C, Ferrarese S, Tozzi M, Bush RL, Lomazzi C. Hybrid repair of extensive thoracic aortic aneurysms. Eur J Cardiothorac Surg 2020; 58:940-948. [DOI: 10.1093/ejcts/ezaa178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
Our goal was to report the midterm results of hybrid treatment of extensive thoracic aortic aneurysm (ETAA) with the completion of thoracic endovascular aortic repair after proximal ascending-arch graft replacement.
METHODS
This was a multicentre, observational study. Data were collected prospectively between January 2002 and March 2019 and analysed retrospectively. Inclusion criteria for the final analysis were the treatment of elective or urgent ETAA performed in a single-stage or a planned two-stage approach. Early and late survival rates were the primary outcomes.
RESULTS
Indications for repair were degenerative ETAA in 27 (64.3%) patients and dissection-related ETAA in 15 (35.7%). The mean aortic diameter was 68 ± 16 mm (interquartile range 60–75). Five (11.9%) patients had a single-stage repair; and 37 underwent a two-stage approach. Three (7.1%) patients died in-hospital. The median follow-up was 49 months (range 0–204). During the follow-up period, 4 (9.5%) patients underwent aortic reintervention after a median of 32 months; however, no aortic rupture of the treated segment occurred. Overall, the estimated survival rate was 85% ± 6% [95% confidence interval (CI) 70.8–93] at 12 and 36 months and 69.5% ± 9% (95% CI 49.7–84) at 60 months.
CONCLUSIONS
Hybrid repair of ETAA had satisfactory early results in this cohort of patients. At the midterm follow-up, the aneurysm-related mortality rate was acceptable with the reconstruction proving to be durable and safe with few distal aortic events.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Santi Trimarchi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Guido Gelpi
- Cardiac Surgery, ASST Fatebenefratelli Sacco University Teaching Hospital, Milano, Italy
| | - Claudia Romagnoni
- Cardiac Surgery, ASST Fatebenefratelli Sacco University Teaching Hospital, Milano, Italy
| | - Sandro Ferrarese
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
- Cardiac Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Matteo Tozzi
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Ruth L Bush
- University of Houston College of Medicine, Houston, TX, USA
| | - Chiara Lomazzi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Marazzato J, Cappabianca G, Angeli F, Crippa M, Golino M, Ferrarese S, Beghi C, De Ponti R. Catheter ablation of atrial tachycardias after mitral valve surgery: A systematic review and meta‐analysis. J Cardiovasc Electrophysiol 2020; 31:2632-2641. [DOI: 10.1111/jce.14666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Jacopo Marazzato
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | | | - Fabio Angeli
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
- Department of Medicine and Cardiopulmonary Rehabilitation Maugeri Care and Research Institutes, IRCCS Tradate Varese Italy
| | - Matteo Crippa
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Michele Golino
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Sandro Ferrarese
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Cesare Beghi
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
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Vianello A, Arcaro G, Ferrarese S, Molena B, Giraudo C. Acute colonic pseudo-obstruction causing Acute Respiratory Failure in Duchenne Muscular Dystrophy. Pulmonology 2020; 27:273-276. [PMID: 32475791 DOI: 10.1016/j.pulmoe.2020.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- A Vianello
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
| | - G Arcaro
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - S Ferrarese
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - B Molena
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - C Giraudo
- Radiology Institute, Department of Medicine - DIMED, University of Padova, Padova, Italy
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Matteucci M, Ferrarese S, Cantore C, Cappabianca G, Massimi G, Mantovani V, Rossi MB, Beghi C. Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-term outcome. Perfusion 2020; 35:756-762. [PMID: 32098555 DOI: 10.1177/0267659120907440] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Lactate, a product of anaerobic metabolism, is a biomarker and indicator for tissue hypoperfusion and oxygen debt. An elevated blood lactate level has been associated with poor outcome in many clinical conditions, including cardiac surgery. Nevertheless, debate exists regarding which blood lactate concentration is most indicative of poor outcomes. We evaluate the impact of hyperlactatemia, defined as a peak arterial blood concentration ⩾2.0 mmol/L during cardiopulmonary bypass, on surgical results with a focus on long-term outcome. METHODS We reviewed 1,099 consecutive adult patients who underwent cardiac surgery on pump. The patients were divided into two groups based on the presence or not of hyperlactatemia. Pre- and intraoperative risk factors for hyperlactatemia were identified, and the postoperative outcome of patients with or without hyperlactatemia was compared. RESULTS Hyperlactatemia was present in 372 patients (33.8%). Factors independently associated with hyperlactatemia were urgent/emergency procedure, cardiopulmonary bypass duration and aortic cross-clamp time. Patients with hyperlactatemia had significantly higher rate of prolonged mechanical ventilation time, in-hospital stay and requirement of inotropes and intra-aortic balloon pump support (p < 0.001). Operative (30-day) mortality was higher in the group of patients with hyperlactatemia (7.8% vs. 1.1%; p < 0.001). Kaplan-Meier curve showed worse long-term survival (mean follow-up: 4.02 ± 1.58 years) in patients with hyperlactatemia. CONCLUSION Hyperlactatemia during cardiopulmonary bypass has a significant association with postoperative morbidity and mortality. Correction of risk factors for hyperlactatemia, together with prompt detection and correction of this condition, may control complications and improve outcome.
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Affiliation(s)
- Matteo Matteucci
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Sandro Ferrarese
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Cristiano Cantore
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giangiuseppe Cappabianca
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giulio Massimi
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Vittorio Mantovani
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Maria Beatrice Rossi
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
| | - Cesare Beghi
- Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy
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Cappabianca G, Ferrarese S, Tutino C, Corazzari C, Matteucci M, Mantovani V, Musazzi A, De Ponti R, Beghi C. Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta-analysis of clinical studies with a focus on the causes of pacemaker implantation. J Cardiovasc Electrophysiol 2019; 30:2150-2163. [PMID: 31402470 DOI: 10.1111/jce.14117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 03/27/2019] [Revised: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The latest STS guidelines recommend concomitant atrial fibrillation (AF) ablation not only during mitral surgery (Class IA) but also during other-than-mitral cardiac surgery procedures (Class IB) in patients with preoperative AF. Conventional Cox-Maze III/IV procedures are performed on both atria (BA), but several studies reported excellent results with left atrial only (LA) ablations: the scope of this study is to compare the safety and efficacy of BA vs LA approach. METHODS AND RESULTS Pubmed, Scopus, and WOS were searched from inception to November 2018: 28 studies including 7065 patients and comparing the performance of BA vs LA approaches were identified: of these, 16 (57.1%) enrolled exclusively patients with non-paroxysmal AF forms, 10 (35.7%) focused on mitral surgery as main procedure, and 16 (57.1%) regarded patients undergone Cox-Maze with radiofrequency. The 6- and 12-months prevalence of sinus rhythm were higher in the BA group (OR, 1.37, CI, 1.09-1.73, P = .008 and OR, 1.37, CI, 0.99-1.88, P = .05 respectively). Permanent pacemaker (PPM) implantation (OR, 1.85, CI, 1.38-2.49, P < .0001) and reopening for bleeding (OR, 1.70, CI, 1.05-2.75, P = .03) were higher in the BA group. Among patients undergone PPM implantation, BA group had a significantly higher risk of sinoatrial node dysfunction (OR, 3.01, CI, 1.49-6.07, P = .002). CONCLUSIONS Concomitant BA ablation appears superior to LA ablation in terms of efficacy but is associated with a higher risk of bleeding and of PPM implantation, more frequently due to sinoatrial node dysfunction. LA approach should be preferable in patients with a higher risk of bleeding or with perioperative risk factors for PPM implantation.
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Affiliation(s)
- Giangiuseppe Cappabianca
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Sandro Ferrarese
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Cassandra Tutino
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Claudio Corazzari
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Matteo Matteucci
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Vittorio Mantovani
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Andrea Musazzi
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Cesare Beghi
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
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Piffaretti G, Gelpi G, Tadiello M, Ferrarese S, Socrate AM, Tozzi M, Bellosta R. Transposition of the left vertebral artery during endovascular stent-graft repair of the aortic arch. J Thorac Cardiovasc Surg 2019; 159:2189-2198.e1. [PMID: 31301891 DOI: 10.1016/j.jtcvs.2019.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 03/28/2019] [Revised: 05/29/2019] [Accepted: 06/04/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to present our experience with the management of isolated left vertebral artery during hybrid aortic arch repairs with thoracic endovascular aortic repair completion. METHODS This is a single-center, observational, cohort study. Between January 2007 and December 2018, 9 patients (4.5%) of 200 who underwent thoracic endovascular aortic repair were identified with isolated left vertebral artery. The isolated left vertebral artery was the dominant vertebral artery in 4 cases and entered the Circle of Willis to form the basilar artery in all cases. Isolated left vertebral artery transposition was performed in 2 patients during open ascending/arch repair before thoracic endovascular aortic repair completion. In 4 patients, isolated left vertebral artery transposition was performed concomitant with carotid-subclavian bypass during thoracic endovascular aortic repair completion ("zone 2" thoracic endovascular aortic repair). Primary outcomes were early (<30 days) and late survival, freedom from aortic-related mortality, and isolated left vertebral artery patency. RESULTS Primary technical success was achieved in all cases. Isolated left vertebral artery-related complication occurred in 1 patient (Horner syndrome). Immediate thrombosis, vagus/recurrent laryngeal nerve palsy, lymphocele, and chylothorax were never observed. Postoperative cerebrovascular accident or spinal cord injury was not observed. Median follow-up was 15 months (range, 3-72). We did not observe aortic-related mortality during the follow-up. Aortic-related intervention was never required. Both isolated left vertebral artery and carotid-subclavian bypass are still patent in all patients with no sign of anastomotic pseudoaneurysm or stenosis. CONCLUSIONS Although isolated left vertebral artery is not a frequent occurrence, it is not so rare. It may pose additional difficulties during hybrid aortic arch surgical repairs, but isolated left vertebral artery transposition was feasible, safe, and a durable reconstruction.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
| | - Guido Gelpi
- Cardiac Surgery-Sacco University Teaching Hospital, Milan, Italy
| | - Marco Tadiello
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Sandro Ferrarese
- Cardiac Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | | | - Matteo Tozzi
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Raffaello Bellosta
- Vascular Surgery, Department of Cardiovascular Surgery, Poliambulanza Foundation, Brescia, Italy
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Shinozaki K, Monte S, Ferrarese S, Manfrin M, Bertaina ME, Anzalone A, Bisconti F, Bruno A, Diaz A, Eser J, Fenu F, Michel A, Vrabel M, Wiencke L. Cloud distribution evaluated by the WRF model during the EUSO-SPB1 flight. EPJ Web Conf 2019. [DOI: 10.1051/epjconf/201921005006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
EUSO-SPB1 was a balloon-borne mission of the JEM-EUSO (Joint Experiment Missions for Extreme Universe Space Observatory) Program aiming at the ultra-high energy cosmic ray (UHECR) observations from space. We operated the EUSO-SPB1 telescope consisting of 1 m2 Fresnel refractive optics and multi-anode photomultiplier tubes. With a total of 2304 channels, each performed the photon counting every 2.5 µs, allowing for spatiotemporal imaging of the air shower events in an ~ 11°× 11° field of view. EUSO-SPB1 was the first balloon-borne fluorescence detector with a potential to detect air shower events initiated by the EeV energy cosmic rays. On 24 April 2017 UTC, EUSO-SPB1 was launched on the NASA’s Super Pressure Balloon that flew at ~16 – 33 km flight height for ~12 days. Before the flight was terminated, ~27 hours of data acquired in the air shower detection mode were transmitted to the ground. In the present work, we aim at evaluating the role of the clouds during the operation of EUSO-SPB1. We employ the WRF (Weather Research and Forecasting) model to numerically simulate the cloud distribution below EUSO-SPB1. We discuss the key results of the WRF model and the impact of the clouds on the air shower measurement and the efficiency of the cosmic ray observation. The present work is a part of the collaborative effort to estimate the exposure for air shower detections.
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Cappabianca G, Corazzari C, Tutino C, Musazzi A, Ferrarese S, Beghi C. RF74 SAFETY AND EFFICACY OF BIATRIAL VS LEFT ATRIAL APPROACHES IN PATIENTS UNDERGOING CONCOMITANT ATRIAL FIBRILLATION ABLATION DURING CARDIAC SURGERY. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550085.89696.b1] [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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Ferrarese S, Laporta A, Corazzari C, Matteucci M, Cappabianca G, Beghi C. EP33 RISK FACTORS AND OUTCOME AFTER SURGICALLY TREATED TYPE A AORTIC DISSECTION. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549964.60163.b6] [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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Cappabianca G, Ferrarese S, Musazzi A, Terrieri F, Corazzari C, Matteucci M, Beghi C. Predictive factors of long-term survival in the octogenarian undergoing surgical aortic valve replacement: 12-year single-centre follow-up. Heart Vessels 2016; 31:1798-1805. [PMID: 26843194 DOI: 10.1007/s00380-016-0804-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/22/2016] [Indexed: 11/27/2022]
Abstract
The improvement of life expectancy created more surgical candidates with severe symptomatic aortic stenosis and age >80. Therefore, the main objective of this observational, retrospective single-centre study is to compare the long-term survival of octogenarians that have undergone surgical aortic valve replacement (AVR) to the survival of the general population of the same age and to establish whether any perioperative characteristics can anticipate a poor long-term result, limiting the prognostic advantage of the procedure at this age. From 2000 to 2014, 264 octogenarians underwent AVR at our institution. Perioperative data were retrieved from our institutional database and patients were followed up by telephonic interviews. The follow-up ranged between 2 months and 14.9 years (mean 4.1 ± 3.1 years) and the completeness was 99.2 %. Logistic multivariate analysis and Cox regression were respectively applied to identify the risk factors of in-hospital mortality and follow-up survival. Our patient population ages ranged between 80 and 88 years. Isolated AVR (I-AVR) was performed in 136 patients (51.5 %) whereas combined AVR (C-AVR) in 128 patients (48.5 %). Elective procedures were 93.1 %. Logistic EuroSCORE was 15.4 ± 10.6. In-hospital mortality was 4.5 %. Predictive factors of in-hospital mortality were the non-elective priority of the procedure (OR 5.7, CI 1.28-25.7, p = 0.02), cardiopulmonary bypass time (OR 1.02, CI 1.01-1.03, p = 0.004) and age (OR 1.36, CI 1.01-1.84, p = 0.04). Follow-up survival at 1, 4, 8 and 12 years was 93.4 % ± 1.6 %, 72.1 % ± 3.3 %, 39.1 % ± 4.8 % and 20.1 % ± 5.7 %, respectively. The long-term survival of these patients was not statistically different from the survival of an age/gender-matched general population living in the same geographic region (p = 0.52). Predictive factors of poor long-term survival were diabetes mellitus (HR 1.55, CI 1.01-2.46, p = 0.05), preoperative creatinine >200 μmol/L (HR 2.07, CI 1.21-3.53, p = 0.007) and preoperative atrial fibrillation (HR 1.79, CI 1.14-2.80, p = 0.01). In our experience, AVR can be safely performed in octogenarians. After a successful operation, the survival of these patients returns similar to the general population. Nevertheless, the preoperative presence of major comorbidities such as diabetes mellitus, renal dysfunction and atrial fibrillation significantly impact on long-term results.
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Affiliation(s)
- Giangiuseppe Cappabianca
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
| | - Sandro Ferrarese
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Andrea Musazzi
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Francesco Terrieri
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Claudio Corazzari
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Matteo Matteucci
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Cesare Beghi
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
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Valore L, Buscemi M, Cassardo C, Cilmo M, Coco M, Ferrarese S, Guarino F, Iarlori M, Mathes H, Rizi V, Tonachini A, Wiencke L, Will M. ARCADE: Description of the project and setup of the Lidar/AMT system. EPJ Web of Conferences 2015. [DOI: 10.1051/epjconf/20158903010] [Citation(s) in RCA: 1] [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: 11/14/2022] Open
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Ambrosetti M, Ageno W, Calori A, Ferrarese S, Barosi A, Marchetti P, Salvato L, Sala A. Fluctuations in warfarin dose response after heart valve surgery: implications for cardiac rehabilitation. Monaldi Arch Chest Dis 2009; 72:29-32. [PMID: 19645210 DOI: 10.4081/monaldi.2009.340] [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: 11/23/2022] Open
Abstract
UNLABELLED In patients undergoing heart valve surgery (HVS) who require warfarin therapy, the maintenance of low variability in the level of anticoagulation early after operation is generally difficult. Aim of this study was to evaluate the time in therapeutic range (TTR) in HVS patients receiving oral anticoagulation therapy (OAT) during phase I-II of cardiac rehabilitation (CR), and, secondly, to identify clinical variables associated with inadequate anticoagulation. METHODS Observational study of consecutive in-hospital patients directly tracked from a cardiac surgery unit to a CR facility. OAT was monitored both in terms of administered warfarin doses and resulted INR values, from day 1 to day 15 after operation. Clinical variables were tested in a logistic regression model for the prediction of inadequate anticoagulation, defined as the presence of nontherapeutic INRs for > or = 5 days between day 8 and 15. RESULTS Eighty-one patients (males 56%, age 62 +/- 19 yrs.), following valvuloplasty (37%), mechanical (17%), and bioprosthetic (45%) valve replacement were considered. The prescribed warfarin dosages were significantly higher from day 1 to day 7 than from day 8 to day 15 (4.6 +/- 3.6 and 3.0 +/- 1.1 mg respectively, p< 0.001). Overall, TTR was 6 +/- 3 days, while time with elevated and lower INRs accounted for 1.3 +/- 1.6 and 8.0 +/- 3.5 days respectively. At day 7, only 25% of patients (n= 20) showed a therapeutic INR value. Inadequate anticoagulation between postoperative day 8 and 15 was displayed in 41 (51%) patients, with hypertension as the only independent predictor (p< 0.001) at multivariate analysis. CONCLUSIONS Despite intensive monitoring, half of patients have nontherapeutic INR values (mainly subtherapeutic) in the first two weeks after HVS while on warfarin. Giving the high risk of completing the hospitalization phase without a stable OAT in many patients, both cardiac surgeons and cardiologists should not miss the opportunity to improve patients education, and consider a direct track to anticoagulation management services after discharge.
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Affiliation(s)
- Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, VA, Italy.
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Mariscalco G, Piffaretti G, Ferrarese S, Tozzi M, Cattaneo P, Sala A. Rare Complication after Cardiac Surgery: A Case Report of Pyoderma Gangrenosum. J Card Surg 2009; 24:93-7. [DOI: 10.1111/j.1540-8191.2008.00728.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ambrosetti M, Ageno W, Ferrarese S, Tramarin R, Salerno-Uriarte JA. [Thromboprophylaxis against venous thromboembolism after coronary surgery: underevaluated, underused, or both?]. G Ital Cardiol (Rome) 2008; 9:740-744. [PMID: 19058664] [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
Little evidence exists about the risk of venous thromboembolism after coronary artery bypass graft (CABG) surgery. According to available studies, about one fifth of CABG patients develop symptomatic or asymptomatic deep vein thrombosis, whereas less than 1% of patients suffer from clinically evident pulmonary embolism. Deep vein thrombosis and pulmonary embolism may influence the outcome of coronary revascularization in terms of morbidity and mortality in the short and medium-term, but unfortunately no clear consensus still exists regarding proper thromboprophylaxis measures. As the incidence of deep vein thrombosis and pulmonary embolism after CABG is similar to the incidence in patients undergoing general surgery, heparin prophylaxis could be considered targeted on patients' individual prothrombotic risk.
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Affiliation(s)
- Marco Ambrosetti
- U.O. di Cardiologia eAngiologia Riabilitativa, Clinica "Le Terrazze", Cunardo (VA).
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Mariscalco G, Klersy C, Zanobini M, Banach M, Ferrarese S, Borsani P, Cantore C, Biglioli P, Sala A. Atrial fibrillation after isolated coronary surgery affects late survival. Circulation 2008; 118:1612-8. [PMID: 18824644 DOI: 10.1161/circulationaha.108.777789] [Citation(s) in RCA: 219] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) after coronary artery bypass graft surgery is a difficult problem and a continuing source of morbidity and mortality. However, the prognostic implications of postoperative AF are still in dispute. Our aim was to ascertain the impact of AF after coronary artery bypass graft on postoperative survival and to assess its prognostic role in cause-specific mortality. METHODS AND RESULTS We conducted a prospective observational study of 1832 patients undergoing isolated coronary artery bypass graft between January 2000 and December 2005 at 2 cardiac surgery centers in northern Italy. Patients affected by postoperative AF were identified and followed up until death or study end (April 30, 2007). A total of 570 patients (31%) developed AF after coronary surgery. Patients affected by postoperative AF experienced a longer hospital stay (7 days [25th to 75th percentile, 7 to 10 days] versus 7 days [25th to 75th percentile, 6 to 8 days]; P<0.001). Hospital mortality also was higher in AF patients (3.3% versus 0.5%; P<0.001). On discharge, 1806 patients were alive; 143 were lost to follow-up. The remaining 1663 were followed up for a median of 51 months (25th to 75th percentile, 41 to 63 months); 126 of them died after a median of 14 months (25th to 75th percentile, 5 to 32 months). Long-term mortality rates were significantly higher for patients with postoperative AF (2.99 per 100 person-years; 95% confidence interval, 2.33 to 3.84; 61 deaths) compared with those without the arrhythmia (1.34 per 100 person-years; 95% confidence interval, 1.05 to 1.71; 65 deaths), with an adjusted hazard ratio of 2.13 (P<0.001) and 2.56 (P=0.001) when also accounting for the prescription of warfarin at discharge. With Cox regression, patients with AF were shown to be at higher risk of dying from embolism (adjusted hazard ratio, 4.33; 95% confidence interval, 1.78 to 10.52) but not from other causes. CONCLUSIONS Postoperative AF affects early and late mortality after isolated coronary artery bypass graft surgery. Patients affected by AF are at higher risk of fatal embolic events. Careful postoperative surveillance with a specific antiarrhythmic and antithrombotic prophylaxis, aimed at reducing AF and its complications, is recommended.
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Affiliation(s)
- Giovanni Mariscalco
- Department of Surgical Sciences, Cardiac Surgery Division, Varese University Hospital, I-21100 Varese, Italy.
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Mariscalco G, Lorusso R, Klersy C, Ferrarese S, Tozzi M, Vanoli D, Domenico BV, Sala A. Observational Study on the Beneficial Effect of Preoperative Statins in Reducing Atrial Fibrillation After Coronary Surgery. Ann Thorac Surg 2007; 84:1158-64. [PMID: 17888963 DOI: 10.1016/j.athoracsur.2007.05.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [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] [Received: 02/21/2007] [Revised: 05/06/2007] [Accepted: 05/07/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent evidence supports the important role of inflammation in atrial fibrillation (AF) after coronary artery bypass grafting (CABG) and there is growing evidence that statin has cardiac antiarrhythmic effects. The aim of this study was to assess the efficacy of preoperative statins in preventing AF after CABG in a longitudinal observational study. METHODS Over a two-year period, 405 consecutive patients underwent isolated CABG procedures. Univariate analysis was performed exploring the relationship regarding statin use and AF development. A propensity score for treatment with statins was obtained from core patient characteristics. The role of statin therapy on postoperative AF was assessed by means of a conditional logistic model, while stratifying on the quintiles of the propensity score. All analysis was performed retrospectively. RESULTS Postoperative AF occurred in 29.5% of the patients with preoperative statin therapy compared with 40.9% of those patients without it (p = 0.021). No statistical differences among development of AF and type, dose, or duration of preoperative statin therapy were observed. Preoperative statins were associated with a 42% reduction in risk of AF development after CABG surgery (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.37 to 0.91, p = 0.017, while stratifying on the propensity score). No different effect of statins on AF was observed with respect to age groups (< or = 70 and > 70 years) (interaction p = 0.711). CONCLUSIONS Preoperative statins may reduce postoperative AF after CABG. Patients undergoing elective revascularization may benefit from a preventive statin approach.
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Affiliation(s)
- Giovanni Mariscalco
- Department of Surgical Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy.
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Cattaneo P, Bruno VD, Mariscalco G, Marchetti P, Ferrarese S, Salerno-Uriarte J, Sala A. Early Hemodynamic Results of the Shelhigh SuperStentless Aortic Bioprostheses. J Card Surg 2007; 22:379-84. [PMID: 17803572 DOI: 10.1111/j.1540-8191.2007.00430.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/27/2022]
Abstract
BACKGROUND Stentless valves have been demonstrated excellent hemodynamic performances favoring the recovery of left ventricular function and the ventricular hypertrophy regression. The aim of the study was to evaluate the early hemodynamic performance of the Shelhigh SuperStentless aortic valve (AV). METHODS Between July 2003 and June 2005, 35 patients (18 females; age 70.8 +/- 11.7 years, range: 22-85) underwent AV replacement with the Shelhigh SuperStentless bioprostheses. Most recurrent etiology was senile degeneration in 25 (71%) patients and 24 (69%) were in New York Heart Association (NYHA) functional class III or IV. Concomitant coronary artery bypass grafting was performed in nine patients (25.7%) and mitral valve surgery in two patients (5.7%). Doppler echocardiography was performed before surgery, at six-month and one-year follow-up. RESULTS There were no hospital deaths and no valve-related perioperative complications. During one-year follow-up, no endocarditis or thromboembolic events were registered, no cases of structural dysfunction or valve thrombosis were noted. Mean and peak transvalvular gradients significantly decrease after AV replacement, with an evident reduction to approximately 50% of the preoperative values at six months. A 20% reduction was also observed for left ventricular mass (LVM) index at six months, with a further regression at one year. Correspondingly, significant increases in effective orifice area (EOA) and indexed EOA were determined after surgery (0.87 +/- 0.14 versus 1.84 +/- 0.29 cm2 and 0.54 +/- 0.19 versus 1.05 +/- 0.20 cm2/m2, respectively). Valve prosthesis-patient mismatch was moderate in five patients and severe in one case. CONCLUSIONS Shelhigh SuperStentless AV provided good and encouraging hemodynamic results. Long-term follow-up is necessary to evaluate late hemodynamic performance and durability of this stentless bioprosthesis.
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Affiliation(s)
- Paolo Cattaneo
- Department of Cardiology and Cardiac Rehabilitation Clinical Institute Multimedica Holding Santa Maria, Castellanza, Varese, and Multimedica Sesto San Giovanni, Milano, Italy
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Polvani G, Barili F, Dainese L, Topkara VK, Cheema FH, Penza E, Ferrarese S, Parolari A, Alamanni F, Biglioli P. Reduction Ascending Aortoplasty: Midterm Follow-Up and Predictors of Redilatation. Ann Thorac Surg 2006; 82:586-91. [PMID: 16863769 DOI: 10.1016/j.athoracsur.2006.03.025] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 03/06/2006] [Accepted: 03/13/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Reduction ascending aortoplasty is an alternative procedure to the replacement of the ascending aorta in case of ascending aorta aneurysm without aortic root involvement. This study was designed to evaluate the midterm follow-up of aortoplasty and to determine predictors of redilatation. METHODS From January 1, 1998, to April 30, 2005, 68 patients with dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with other cardiac procedures. All patients underwent associated surgical procedures. Sixty patients (88.2%) underwent associated aortic valve replacement. Cumulative follow-up time was 191.4 patient-years and was 100% complete. Median follow-up time was 2.5 years, and mean follow-up time was 2.9 +/- 1.7 years (range, 0.4 to 6.3 years). RESULTS The overall perioperative mortality rate was 1.5%. Overall survival estimates at 3 and 6 years were 93.3% +/- 4.5% and 89.3% +/- 5.9%, respectively. The actuarial freedom from cardiac-related death at 3 and 6 years was 100% and 95.7% +/- 4.3%, respectively. Ascending aorta redilatation occurred in 5 patients (7.5%). The actuarial freedom from redilatation at 3 and 6 years was 97.7% +/- 2.3% and 79.8% +/- 8.4%, respectively. The actuarial freedom from reoperation at 3 and 6 years was 100% and 86.3% +/- 7.5%, respectively. Only preoperative diameter was a significant predictor of redilatation using multivariate stepwise logistic regression analysis. CONCLUSIONS Unsupported reduction aortoplasty is a safe and effective technique with low mortality, low morbidity, and rare late complications for selected chronic aneurysm of the ascending aorta with diameter less than 55 mm.
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Affiliation(s)
- Gianluca Polvani
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, University of Milan, Milan, Italy
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Castelli P, Caronno R, Ferrarese S, Mantovani V, Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Sala A. New Trends in Prosthesis Infection in Cardiovascular Surgery. Surg Infect (Larchmt) 2006; 7 Suppl 2:S45-7. [PMID: 16895504 DOI: 10.1089/sur.2006.7.s2-45] [Citation(s) in RCA: 20] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Adult cardiovascular surgery entails, in many cases, the use of some kind of prosthesis. Among the potential complications, prosthetic device infection is one of the most devastating in incidence, as well as in prognosis and damage to surrounding tissues. RESULTS The most common bacterial agents in vascular and cardiac prosthetic device infections are Staphylococcus aureus and S. epidermidis among gram-positive bacteria and Escherichia coli, Proteus mirabilis, and Pseudomonas aeruginosa among gram-negative bacteria. CONCLUSION The alternative modalities of treatment for prosthetic device infection encompass partial or total explantation of the prosthesis and its replacement with an infection-resistant graft (e.g., homologous tissue, autologous tissue, or synthetic prosthesis bonded with antibiotics).
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Affiliation(s)
- Patrizio Castelli
- Department of Surgical Sciences, Division of Vascular Surgery and Research Centre for the Study and Application of New Technologies in Vascular Surgery, University of Insubria, Varese, Italy.
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Mariscalco G, Engström KG, Ferrarese S, Cozzi G, Bruno VD, Sessa F, Sala A. Relationship between atrial histopathology and atrial fibrillation after coronary bypass surgery. J Thorac Cardiovasc Surg 2006; 131:1364-72. [PMID: 16733171 DOI: 10.1016/j.jtcvs.2006.01.040] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [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: 10/16/2005] [Revised: 12/18/2005] [Accepted: 01/30/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation is common after coronary surgery. The cellular condition of atrial myocytes might play a part in the postoperative development of atrial fibrillation. Our study aimed to investigate whether patients in whom postoperative atrial fibrillation develops show pre-existent alterations in histopathology of the right atrium and how such changes are expressed in relation to the use of cardiopulmonary bypass. METHODS Seventy patients undergoing elective coronary revascularization were prospectively randomized to on-pump conventional surgery (conventional coronary artery bypass grafting, n = 35) or off-pump surgery on the beating heart (off-pump coronary artery bypass grafting, n = 35). Samples from the right atrial appendage were immediately collected after opening the pericardium. In the on-pump group samples were also taken after weaning from cardiopulmonary bypass. Focusing on degenerative alterations, histology was studied by means of light microscopy and for confirmation of particular findings by means of electronic microscopy. RESULTS Twenty-two (31%) patients had postoperative atrial fibrillation, with the rate not being different between the off-pump coronary artery bypass grafting and conventional coronary artery bypass grafting groups (P = .797). Left atrial enlargement and inotropic requirement were related to atrial fibrillation. Interstitial fibrosis, vacuolization, and nuclear derangement of myocytes were the histologic abnormalities associated with the development of postoperative atrial fibrillation. However, in multivariate analysis fibrosis was confounded by myocyte vacuolization (P = .002) and nuclear derangement (P = .016), representing independent atrial fibrillation predictors. As expected, the conventional coronary artery bypass grafting and off-pump coronary artery bypass grafting groups showed similar histology, but more importantly, no atrial changes were detected in relation to cardiopulmonary bypass exposure in the conventional coronary artery bypass grafting group. Atrial histology showed degenerative changes that correlated with advanced age and left atrial enlargement. CONCLUSIONS Our study supports the contention that atrial fibrillation after coronary surgery is associated with pre-existing histopathologic changes of the right atrium. Patients randomly allocated to off-pump coronary artery bypass grafting procedures showed a similar rate of atrial fibrillation and a similar relationship to atrial histology as did those exposed to cardiopulmonary bypass. Cardiopulmonary bypass did not cause additional changes in tested histology variables.
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Affiliation(s)
- Giovanni Mariscalco
- Department of Surgical Sciences, Cardiac Surgery Division, Varese University Hospital, University of Insubria, Varese, Italy.
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Mariscalco G, Blanzola C, Leva C, Cattaneo P, Mantovani V, Ferrarese S, Sala A. Unruptured ventricular septal wall dissection. A case report. J Cardiovasc Surg (Torino) 2006; 47:349-52. [PMID: 16760872] [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: 05/10/2023]
Abstract
Dissection of the interventricular septum (IVS) is a rare condition, which can uncommonly complicate an acute myocardial infarction (AMI). We describe a case of unruptured IVS dissection observed 16 days after 2 close episodes of AMI. The diagnosis was made by transthoracic echocardiography. An echo-free space within the thickness of IVS, extended from the apex to the mid-portion, for a total length of about 30 mm was evident. The careful examination of the left ventricle did not reveal any discontinuity of the myocardial wall. The stable clinical condition, the absence of flow within the dissection, the demonstration of its favourable evolution during the hospitalisation and the characteristics of the underlying coronary disease (left anterior descending artery occlusion without myocardial viability) led to the decision of avoiding surgery. The predischarge contrast echocardiographic examination (Levovist) showed clearly the border of the infarcted zone and demonstrated an area reduction and echogenicity increase of the neocavitation, with partially organised thrombi. The patient recovered uneventfully and was discharged on medical therapy with a clinical and echocardiographic follow-up program. We believe that for IVS hemorrhagic dissection a nonsurgical option can be proposed; surgery should only be considered for myocardial revascularization when indicated. A close echocardiographic follow-up is mandatory.
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Affiliation(s)
- G Mariscalco
- Department of Surgical Sciences, Cardiac Surgery Division, Varese University Hospital, Varese, Italy.
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35
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Leva C, Mariscalco G, Ferrarese S, Bruno VD, Orrù A, Cattaneo P, Sala A. The role of zofenopril in myocardial protection during cardioplegia arrest: an isolated rat heart model. J Card Surg 2006; 21:44-9. [PMID: 16426347 DOI: 10.1111/j.1540-8191.2006.00167.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
BACKGROUND Zofenopril has beneficial effects in acute myocardial infarction, and improves the functional recovery after ischemia and reperfusion. AIM OF THE STUDY The aim of this study was to investigate the cardioprotective effects of zofenopril, when added to a standard cardioplegic solution or when orally administered as pretreatment. METHODS A Langendorff model for isolated rat hearts was employed: three groups of eight hearts each were used, respectively, with plain St. Thomas cardioplegia as control (group A and C), and the same solution added with 12.5 mg of zofenopril (group B). The third group (C) was pretreated for 7days with oral administration of zofenopril (6.5 mg/day). The hearts had a baseline perfusion for 30 minutes with Krebs-Henseleit solution at 37 degrees C, cardioplegia administration for 3 minutes, then 30 minutes of ischemia without any perfusion, and finally 30 minutes of reperfusion with Krebs-Henseleit solution at 37 degrees C. RESULTS Left ventricle developed pressure was significantly higher in the reperfusion period only in the pretreated group (group C) with respect to groups A and B (p = 0.016). Similar results were obtained regarding dP/dt curves (p = 0.020). No differences were demonstrated between groups for cellular viability expressed as creatine phospho-kinase (p = ns) and lactate dehydrogenase release (p = ns). CONCLUSIONS Zofenopril as oral pretreatment showed protective effects in an isolated model of cardioplegic arrest, although improvements in myocardial viability (enzymatic release) could not be demonstrated. Further experimental and clinical evaluations are necessary to assess the direct cardioprotective effect of zofenopril, modifying the length of treatment and the dosage of the drug.
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Affiliation(s)
- Cristian Leva
- Department of Surgical Sciences, Cardiothoracic Division, Varese University Hospital, Varese, Italy
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Mariscalco G, Mantovani V, Ferrarese S, Leva C, Orrù A, Sala A. Coronary artery aneurysm: management and association with abdominal aortic aneurysm. Cardiovasc Pathol 2006; 15:100-4. [PMID: 16533698 DOI: 10.1016/j.carpath.2005.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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] [Received: 07/11/2005] [Revised: 10/17/2005] [Accepted: 11/16/2005] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Coronary artery aneurysm (CAA) is a dilatation that exceeds 1.5 times the diameter of a normal adjacent coronary artery. Several studies suggest that pathogenetic mechanisms involved in this disease and in abdominal aortic aneurysm (AAA) are similar. Surgery for CAA is mandatory when the aneurysm is three to four times larger than the original vessel diameter. We reviewed our experience in the surgical treatment of this unusual disease and analyzed its association with AAA. MATERIALS AND METHODS Between October 1993 and March 2005, 11 patients (9 men; mean age=66 years) underwent surgery for CAA. In all cases, coronary aneurysms were diagnosed as incidental findings in coronary angiographies. The coronary aneurysms were isolated and longitudinally incised: the proximal and distal openings were identified and sutured. The sacs were obliterated with running sutures. Myocardial protection was achieved by retrograde cardioplegia only. Coronary artery bypass grafting was performed distally to the excluded aneurysms in all patients. RESULTS One patient died of respiratory failure early after the operations; all other patients are alive, asymptomatic for angina, and free from repeated acute myocardial infarction after a median follow-up of 76 months (range=4-141 months). A total of six patients underwent surgical repair or endoprosthesis implantation because of AAAs. CONCLUSIONS Our operative techniques ensured durable results. We recommend screening for abdominal aneurysms in all affected patients because of the frequent association between CAA and AAA as a result of their similar pathogenetic mechanism.
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Affiliation(s)
- Giovanni Mariscalco
- Department of Surgical Sciences, Cardiac Surgery Division, Varese University Hospital, 21100 Varese, Italy.
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Mantovani V, Mariscalco G, Borsani P, Tenconi S, Bruno VD, Leva C, Ferrarese S, Sala A. Effects of adenosine and defibrotide adjunct to a standard crystalloid cardioplegic solution. J Cardiovasc Surg (Torino) 2005; 46:291-6. [PMID: 15956928] [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: 05/03/2023]
Abstract
AIM Adenosine has many actions potentially useful as adjunct to a cardioplegia. Defibrotide was recently shown to have protective effects during cardiac arrest. The aim of this study was to compare these 2 substances to delineate their profile of action in the setting of cardioplegic arrest. METHODS A Langendorff model for isolated rat hearts was employed: 3 groups of 8 hearts each were used, respectively with plain St. Thomas cardioplegia as control (group C), and the same solution added with adenosine (group A) or defibrotide (group D). The hearts had a baseline perfusion for 30 minutes with Krebs-Henseleit solution at 37 degrees C, cardioplegia administration for 3 minutes, then 30 minutes of ischemia without any perfusion and finally 30 minutes of reperfusion with Krebs-Henseleit solution at 37 degrees C. RESULTS The time to attain heart arrest was 20% shorter in group A, but this difference did not reach statistical significance (A: 13.6+/-1.5; D: 16.8+/-2.7; C: 17.3+/-2.2 s). The heart rate during reperfusion in group A was almost identical to baseline, while in both group C and D it was significantly lower (A: 101%, D: 93.4%, C: 82.4%, p<0.01).A and D decreased significantly the release of creatine phospokinase compared to group C (p=0.006). Lactate dehydrogenase release was lower in both treatment groups, although statistical significance was not reached. Peak positive dP/dT decreased more in controls during reperfusion (A: -23+/-6%, D: -17+/-5%, C: -31+/-5%, p=ns). Negative dP/dT was significantly worse in controls compared to both treatments (A: -19+/-6%, D: -12+/-5%, C: -34+/-7%, p=0.035). CONCLUSIONS Both adenosine and defibrotide have protective effects in an isolated model of cardioplegic arrest. Adenosine is significantly more active on heart rate while defibrotide is more active on contractily. Further studies are justified in order to test the combination of these 2 drugs.
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Affiliation(s)
- V Mantovani
- Department of Cardiac Surgery, Ospedale di Circolo-Fondazione Macchi, University of Insubria, Varese, Italy.
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Leva C, Mariscalco G, Bruno VD, Mantovani V, Musazzi A, Ferrarese S, Boscarini M, Sala A. ["Hybrid" management of aortic coarctation associated with atrioventricular valve regurgitation in the adult]. Ital Heart J Suppl 2005; 6:297-301. [PMID: 15934427] [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: 05/02/2023]
Abstract
The incidence of heart valve disease associated with aortic coarctation is 40% in patients < 30 years and 27% in younger patients. This report describes the case of a 41-year-old man, admitted for severe mitral and tricuspid valve incompetence, causing impairment of left ventricular function and pulmonary hypertension. During hospitalization an occasional finding of aortic coarctation was diagnosed. The optimal management of aortic coarctation associated with atrioventricular valve regurgitation remains a matter of debate. In this report the proper decision-making and the management are discussed.
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Affiliation(s)
- Cristian Leva
- Dipartimento di Cardiochirurgia, Università degli Studi dell'Insubria, Ospedale di Circolo e Fondazione Macchi, Varese.
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Leva C, Mariscalco G, Blanzola C, Ferrarese S, Mantovani V, Tenconi S, Sala A. [Giant aneurysm of a saphenous vein graft with fistulization into the right atrium: differential diagnosis and treatment]. Ital Heart J Suppl 2004; 5:394-7. [PMID: 15182067] [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: 04/29/2023]
Abstract
The aneurysm of an aortocoronary saphenous vein graft is a rare but potentially fatal complication of coronary artery bypass grafting. This case came to our observation after a single episode of hypotension, followed by dyspnea in a man previously operated on for coronary artery bypass grafting. A para-hilar mass was found on routine roentgenogram. The spiral computed tomographic scan was suggestive for aortic pseudoaneurysm. The correct diagnosis was obtained by cardiac catheterization showing a giant graft aneurysm determining compression and fistulous communication into the right atrium. The difficult diagnosis and the surgical treatment are discussed.
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Affiliation(s)
- Cristian Leva
- Cattedra di Cardiochirurgia, Università degli Studi dell'Insubria, Ospedale di Circolo e Fondazione Macchi, Varese.
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Abstract
We describe a case of impending paradoxical embolism of a 22 cm long thromboembolus, straddling over a patent foramen ovale, detected by transthoracic and transesophageal echo 11 days after a coronary artery bypass operation. The patient underwent successful emergency removal of the clot and closure of the patent foramen ovale. A vena cava filter was placed because of new thrombi detected in deep veins of the legs.
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Affiliation(s)
- Vittorio Mantovani
- Department of Cardiac Surgery and Cardiology, Ospedale di Circolo-Fondazione Macchi, Università dell'lnsubria, Varese, Italy.
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Abstract
OBJECTIVE Rupture of ventricular free wall (VFWR) may complicate acute myocardial infarction and accounts for high mortality. Surgical repair is the only therapeutic option. A review of our surgical experience is presented. METHODS Seventeen patients (11 men, mean age 68 years) underwent surgery for VFWR. Patch covering technique was used in 13 patients, infarctectomy with patch reconstruction in three patients, direct suture without patch in one patient. Coronary artery bypass grafting was performed in eleven patients. RESULTS Hospital mortality was 17.6% (three patients). Three patients died of cancer during the follow-up. The remaining 11 patients are in good condition after a mean follow-up of 45.8 months (range 7.5-84.2). CONCLUSIONS Postinfarction rupture of ventricular free wall treated surgically gives excellent long-term results. Our first choice for repair is the covering technique with a large pericardial patch anchored with biological glue and epicardial sutures.
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Affiliation(s)
- Vittorio Mantovani
- Department of Cardiac Surgery, Ospedale di Circolo-Fondazione Macchi, Università dell'Insubria, Viale Borri 57, 21100 Varese, Italy.
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Cattozzo G, Finazzi S, Ferrarese S, Sala A, Melzi d'Eril GV. Serum cardiac troponin I after conventional and minimal invasive coronary artery bypass surgery. Clin Chem Lab Med 2001; 39:392-5. [PMID: 11434387 DOI: 10.1515/cclm.2001.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated myocardial release of cardiac troponin I (cTnI) in patients treated with conventional coronary artery bypass grafting (CABG), which employs extracorporeal circulation, and different kinds of minimal invasive coronary artery bypass grafting (MICABG), a surgical technique where the operation is performed without extra-corporeal circulation. Furthermore, we evaluated the usefulness of serum cTnI measurement to detect perioperative myocardial infarction (PMI) after coronary artery bypass surgery. Thirty-one patients were included: sixteen underwent CABG, fifteen underwent different MICABG and five patients had PMI. Blood specimens for cTnI measurements were collected up to 72 hours after opening the graft. Aortic cross-clamping time was a minor determinant of myocardial damage; on the other side, the trauma during surgery correlated with the number of involved arteries and with the manoeuvre employed to obtain heart dislocation, and appeared a more important determinant of myocardial damage. In patients with PMI, the cumulative release of cTnI was higher than in patients free from PMI; however, only after 24-72 hours we observed significant differences in serum cTnI values, because the increased perioperative values of cTnI complicated the interpretation of the myocardial status and a single cut-off could not be used to exclude PMI.
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Affiliation(s)
- G Cattozzo
- Laboratorio di Analisi, Ospedale Del Ponte-A. O. Fondazione Macchi, Varese, Italy.
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Mantovani V, Grossi C, Ferrarese S, Sala A. Edge-to-edge repair of congenital familiar tricuspid regurgitation: case report. J Heart Valve Dis 2000; 9:641-3. [PMID: 11041178] [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: 02/18/2023]
Abstract
We report a case of edge-to-edge (Alfieri's technique) repair of congenital familiar tricuspid regurgitation in a 49-year-old woman, who had severe tricuspid regurgitation, atrial septal defect with left-to-right shunt, and two stenoses in peripheral branches of the left pulmonary artery, of no clinical relevance. The repair was performed through a longitudinal inferior partial sternotomy. The atrial septal defect was closed by direct suture; the anterior and posterior leaflets of the tricuspid valve were sutured together. The chordae to the prolapsing medial part of the anterior leaflet were shortened by direct suture to the leaflet free edge. Annuloplasty was performed by means of a Carpentier ring. The final step was edge-to-edge approximation of the septal leaflet to the new antero-posterior position with two interrupted stitches. The hemodynamic result was excellent, and the patient eventually returned to full active life.
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Affiliation(s)
- V Mantovani
- Department of Cardiac Surgery, Ospedale di Circolo-Fondazioine Macchi, University of Insubria, Varese, Italy
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Ugenti I, De Ceglie A, Ferrarese F, Ferrarese S. [Hartmann's operation in acute perforated diverticulitis]. Chir Ital 1999; 51:429-34. [PMID: 10742892] [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: 02/16/2023]
Abstract
Acute perforated diverticulitis of the colon is still a serious clinical event that requires an emergency treatment which is based upon clinical staging and pathological characteristics. Surgical treatment, performed in Hinchey's stages III and IV, is correlated with the presence of infection in the peritoneal cavity: it is always necessary to remove the septic focus, but there are different reconstruction strategies. The resection of the diseased colonic segment can be performed with primary anastomosis or Hartmann's operation with reconstruction in a later time. In our experience, based on 97 patients (33 of which, Hinchey's III and IV, underwent emergency surgical treatment) we preferred Hartmann's operation which carries a low risk of mortality in seriously ill patients.
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Affiliation(s)
- I Ugenti
- Cattedra di Fisiopatologia Chirurgica, Università degli Studi di Bari
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Polignano FM, Pezzolla A, Camporeale S, Ferrarese F, Ferrarese S. Improved acceptability of laparoscopic surgery and increasing rate of cholecystectomy implications for surgeon and patients. Hepatogastroenterology 1999; 46:2796-800. [PMID: 10576347] [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: 02/14/2023]
Abstract
BACKGROUND/AIMS The aim of our study was to evaluate the impact of introduction of laparoscopic cholecystectomy (LC) and reasons for the increase in cholecystectomy rate, by a retrospective review of all admissions for gallbladder disease before and after the introduction of laparoscopic surgery in our department. METHODOLOGY Chi-squared test was used for statistical analysis of the comparisons. RESULTS Comparing the 2 periods, cholecystectomy rate increased by 35% (p<0.01) and patients aged 25-44 years were more likely to undergo LC (p<0.001); a 35% decrease in unjustified refusal (p<0.02) was also observed. The number of both longstanding disease patients and asymptomatic ones operated upon was not different (p=1; p=0.06), while a 46% increase (p=0.02) in cholecystectomy rate was shown in patients with low-grade symptoms or at 1st colic episode. CONCLUSIONS An increase in the patient pool due to improved acceptability was responsible for the increase in cholecystectomy rate after introduction of laparoscopic surgery, rather than lowered surgical threshold, as previously suggested by other authors. Judiciousness is required to prevent the increased acceptability of LC from leading to its uncontrolled and unrestricted use, as alteration of the surgical threshold may occur without surgeon awareness, particularly when dealing with low grade symptomatic patients.
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Affiliation(s)
- F M Polignano
- 1st Department of Surgical Pathophysiology, University of Bari, Policlinico Hospital, Italy
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Polignano FM, Caradonna P, De Ceglie A, Ferrarese F, Camporeale S, Ferrarese S. [Rare causes of serious digestive hemorrhages]. MINERVA CHIR 1997; 52:359-68. [PMID: 9265118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The rare causes of massive hemorrhage in the gastrointestinal tract are not completely classifiable. They are characterized by high variability, as shown in several isolated reports. In our experience of 17 cases, clinical and endoscopic features were sometimes typical of a rare pathology, others were referable to common pathologies and exactly diagnosed only by angiography or surgery. Our experience points out the difficulties in the surgical prescription and timing, when the endoscopic diagnosis was lacking or unsure, or when a massive haemorrhagic recurrence forced diagnostic laparatomy. The role of endoscopy and the advantages of intraoperative enteroscopy have been compellingly demonstrated. Diagnostic and therapeutic angiography has been the main method in vascular hemorrhage.
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Affiliation(s)
- F M Polignano
- Cattedra di I Clinica Chirurgica, Università degli Studi, Bari
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Rizzuti T, Ferrarese S, Varesi G, Masini T. [Ectopic neuroglial tissue associated with intrapulmonary congenital cystic adenomatoid malformation]. Minerva Pediatr 1997; 49:89-92. [PMID: 9198734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Few cases of ectopic neurological tissue have been reported in the lung. The aim of the present study was to give a brief overview of these cases and to examine an additional case of intrapulmonary neuroglial heterotopia. We have identified only sixteen similar cases in the literature. CASE DESCRIPTION The object of our study was a male fetus of Asian parents at the 23rd week of gestation, in which ultrasound tests revealed the presence of anterior encephalocele. Routine postmortem examination of lung samples showed neuroglial tissue and a congenital adenomatoid cystic malformation of type II. The lesion was made up of multiple small cysts lined with columnar or ciliated cuboidal epithelium. A possible link between adenomatoid malformation and intrapulmonary neurological tissue has not so far been reported in the literature. Immunohistochemical analysis showed the presence in the pulmonary parenchyma of neuronal cells (neuron-specific enolase positive), astrocytes (glial fibrillary acidic protein positive) and intra-alveolar squamous cells (citokeratines positive), indicative of fetal aspiration of amniotic fluid. CONCLUSIONS There are several possible explanations for the presence of intrapulmonary neuroglial heterotopia: fetal aspiration, neural crest migration defects or vascular embolization with implantation. However, in the view of the microscopic findings and at the same time recognizing the intrapulmonary aspiration of amniotic fluid, the authors maintain that the most likely explanation for the heterotopia is that of consequential multiple malformations. Moreover neuroglial ectopy and cystic adenomatoid congenital malformation of the lung could have appeared simultaneously, due to embryologic insult between the 4th and the 20th week of gestation.
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Affiliation(s)
- T Rizzuti
- Anatomia Patologica, Istituti Clinici di Perfezionamento
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Polignano FM, Caradonna P, Maiorano E, Ferrarese S. Recurrence of acute colonic pseudo-obstruction in selective adrenergic dysautonomia associated with infectious toxoplasmosis. Scand J Gastroenterol 1997; 32:89-94. [PMID: 9018773 DOI: 10.3109/00365529709025069] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Acute colonic pseudo-obstruction is a life-threatening condition associated with several pathologic conditions, whose pathophysiology is still uncertain. CASE Autonomic function in a young patient operated on for acute colonic pseudo-obstruction was carefully evaluated; none of the common clinical conditions described in the literature was found to have caused the syndrome. Selective adrenergic failure was suggested by the presence of severe orthostatic hypotension, low basal plasma catecholamine level, and absence of the expected increase on standing and by the findings of provocation tests, cardiovascular tests, and acetylcholine sweat spot test. Biopsy specimens from the colon and small-bowel wall did not show any morphologic or immunohistochemical alteration either in muscle layers or in the autonomic plexus, testifying to the possible occurrence of extrinsic denervation in the presence of an intact plexus. Infectious toxoplasmosis was proved through indirect and direct hemagglutination assays, enzyme-linked immunosorbent assay IgG, IgM, and IgA, immunosorbent agglutination IgM assay, and the protozoa were demonstrated in a biopsy specimen from the rectus abdominis muscle. CONCLUSIONS Selective adrenergic denervation of the gut resulted in recurrent episodes of colonic pseudo-obstruction, probably by direct toxicity or a cross-reaction between the immune process and a toxoplasmic antigen, stressing the importance of sympathetic inhibitory modulation on colon motor activity.
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Ferrarese S, Venezia P. [Angiodysplasia of the colon]. Recenti Prog Med 1985; 76:469-71. [PMID: 3878556] [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: 01/07/2023]
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Fersini M, Ferrarese S. [Carcinogenetic potentiality of the operated stomach. Physiopathological and histopathological findings and possibilities of early diagnosis]. MINERVA CHIR 1982; 37:1655-8. [PMID: 7177411] [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: 01/23/2023]
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