1
|
Dokollari A, Margaryan R, Torregrossa G, Sicouri S, Cameli M, Mandoli GE, Prifti E, Veshti A, Bonacchi M, Gelsomino S. Risk predictors that impact long-term prognosis in patients undergoing aortic valve replacement with the Perceval sutureless bioprosthesis. Cardiovasc Revasc Med 2023; 55:10-19. [PMID: 37062610 DOI: 10.1016/j.carrev.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND The aim of this study is to identify risk predictors that impact long-term prognosis in patients undergoing isolated aortic valve replacement (AVR) with Perceval sutureless bioprosthesis aortic valve implantation. METHODS From 2013 to 2020, 101 consecutive participants who underwent isolated AVR with the Perceval sutureless bioprosthesis were included. Primary endpoint was analysis of all-cause mortality. We performed a propensity-adjusted analysis of patients undergoing redo sutureless vs redo sutured AVR to understand the impact of sutureless valves in redo operations. RESULTS Pre-operative characteristics included a mean age of 71.2-years, mean EuroScore II of 3.51 (±4.48), mean body mass index of 30.2 (±6.8). Mean follow-up was 1.5 years. Intraoperatively, mean cardiopulmonary bypass time and aortic cross-clamp time were 65 ± 29.6 and 47.3 ± 21.3 min, respectively. Valve redeployment was necessary in 9.9 % of cases and there was one intraoperative death. There were two hospital deaths (including the operative death) while only one was cardiac related. Postoperatively, mean ejection fraction was 55.5 % (±4.1 %), mean effective orifice was 1.5 (±0.3) cm2, and mean transvalvular gradient was 14.7 (±4) mmHg. At 7-years follow-up, 87.9 % of patients were alive. Risk predictors for all-cause death were female sex and left ventricular diastolic dysfunction (LVDD) grade ≥ 2. After matching, aortic cross-clamp time, inotrope use, blood product transfusions, respiratory failure, and post-operative arrhythmias were higher in the redo sutured group compared to the sutureless redo group. CONCLUSIONS Sutureless aortic valve implantations have good clinical outcomes. Risk predictors for all-cause death included female sex and LVDD grade ≥ 2.
Collapse
Affiliation(s)
- Aleksander Dokollari
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands; Lankenau Institute for Medical Research, United States of America.
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | | | - Serge Sicouri
- Lankenau Institute for Medical Research, United States of America
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University Hospital of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University Hospital of Siena, Siena, Italy
| | - Edvin Prifti
- Division of Cardiac Surgery University Hospital Center "Mother Teresa" Tirana, Albania
| | - Altin Veshti
- Division of Cardiac Surgery University Hospital Center "Mother Teresa" Tirana, Albania
| | - Massimo Bonacchi
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Sandro Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands
| |
Collapse
|
2
|
Concistrè G, Gasbarri T, Ravani M, Al Jabri A, Trianni G, Bianchi G, Margaryan R, Chiaramonti F, Murzi M, Kallushi E, Varone E, Simeoni S, Leone A, Farneti A, Berti S, Solinas M. Transcatheter Aortic Valve Replacement in Degenerated Perceval Bioprosthesis: Clinical and Technical Aspects in 32 Cases. J Clin Med 2023; 12:6265. [PMID: 37834910 PMCID: PMC10573422 DOI: 10.3390/jcm12196265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Sutureless aortic bioprostheses are increasingly being used to provide shorter cross-clamp time and facilitate minimally invasive aortic valve replacement. As the use of sutureless valves has increased over the past decade, we begin to encounter their degeneration. We describe clinical outcomes and technical aspects in patients with degenerated sutureless Perceval (CorCym, Italy) aortic bioprosthesis treated with valve-in-valve transcatheter aortic valve replacement (VIV-TAVR). METHODS Between March 2011 and March 2023, 1310 patients underwent aortic valve replacement (AVR) with Perceval bioprosthesis implantation. Severe bioprosthesis degeneration treated with VIV-TAVR occurred in 32 patients with a mean of 6.4 ± 1.9 years (range: 2-10 years) after first implantation. Mean EuroSCORE II was 9.5 ± 6.4% (range: 1.9-35.1%). RESULTS Thirty of thirty-two (94%) VIV-TAVR were performed via transfemoral and two (6%) via transapical approach. Vascular complications occurred in two patients (6%), and mean hospital stay was 4.6 ± 2.4 days. At mean follow-up of 16.7 ± 15.2 months (range: 1-50 months), survival was 100%, and mean transvalvular pressure gradient was 18.7 ± 5.3 mmHg. CONCLUSION VIV-TAVR is a useful option for degenerated Perceval and appears safe and effective. This procedure is associated with good clinical results and excellent hemodynamic performance in our largest single-center experience.
Collapse
Affiliation(s)
- Giovanni Concistrè
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Tommaso Gasbarri
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Marcello Ravani
- Department of Cardiology, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (M.R.); (A.A.J.); (G.T.); (S.B.)
| | - Anees Al Jabri
- Department of Cardiology, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (M.R.); (A.A.J.); (G.T.); (S.B.)
| | - Giuseppe Trianni
- Department of Cardiology, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (M.R.); (A.A.J.); (G.T.); (S.B.)
| | - Giacomo Bianchi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Francesca Chiaramonti
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Michele Murzi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Enkel Kallushi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Egidio Varone
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Simone Simeoni
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Alessandro Leone
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Andrea Farneti
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Sergio Berti
- Department of Cardiology, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (M.R.); (A.A.J.); (G.T.); (S.B.)
| | - Marco Solinas
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| |
Collapse
|
3
|
Concistrè G, Bianchi G, Margaryan R, Zancanaro E, Chiaramonti F, Kallushi E, Gasbarri T, Murzi M, Varone E, Simeoni S, Leone A, Santarelli F, Farneti P, Solinas M. Ten-year experience with sutureless Perceval bioprosthesis: single-centre analysis in 1157 implants. J Cardiovasc Med (Hagerstown) 2023; 24:506-513. [PMID: 37115966 DOI: 10.2459/jcm.0000000000001475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIMS We describe long-term clinical and echocardiographic outcomes in the largest single-centre cohort of patients who underwent aortic valve replacement (AVR) with sutureless Perceval (CorCym, Italy) bioprosthesis. METHODS Between March 2011 and March 2021, 1157 patients underwent AVR with Perceval bioprosthesis implantation. Mean age was 77 ± 6 years (range: 46-89 years) and mean EuroSCORE II was 6.7 ± 3.2% (range: 1.7-14.2%). Concomitant procedures were performed in 266 patients (23%). RESULTS Thirty-day mortality was 1.38% (16/1157). Eight hundred and twenty of 891 (92%) isolated AVRs underwent minimally invasive surgery with a ministernotomy ( n = 196) or right minithoracotomy ( n = 624) approach. Cardiopulmonary bypass and aortic cross-clamp times were 81.1 ± 24.3 and 50.6 ± 11.7 min for isolated AVR and 144.5 ± 34.7 and 96.4 ± 21.6 min for combined procedures. At mean follow-up of 53.08 ± 6.7 months (range: 1-120.5 months), survival was 96.5% and mean transvalvular pressure gradient was 13.7 ± 5.8 mmHg. Left ventricular mass decreased from 152.8 to 116.1 g/m 2 ( P < 0.001) and moderate paravalvular leakage occurred in three patients without haemolysis not requiring any treatment. Freedom from reoperation was 97.6%. Eight patients required surgical reintervention and 19 patients transcatheter valve-in-valve procedure for structural prosthesis degeneration at a mean of 5.6 years after first operation (range: 2-9 years). CONCLUSION AVR with a Perceval bioprosthesis is associated with good clinical results and excellent haemodynamic performance in our 10-year experience. Structural degeneration rate of Perceval is comparable with other bioprosthetic aortic valves. Sutureless technology may reduce operative time especially in combined procedures and enable minimally invasive AVR.
Collapse
Affiliation(s)
- Giovanni Concistrè
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Bianchi G, Zancanaro E, Margaryan R, Concistré G, Varone E, Simeoni S, Solinas M. Outcomes of Emergent Isolated Coronary Bypass Grafting in Heart Failure Patients. Life (Basel) 2022; 12:life12122124. [PMID: 36556489 PMCID: PMC9783056 DOI: 10.3390/life12122124] [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: 11/29/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Patients with previously diagnosed HF are at greater risk for subsequent morbidity and mortality when hospitalized for an Acute Myocardial Infarction (AMI). The purpose of our study was to describe the time trend of the incidence of emergent CABG in patients with and without HF, the clinical characteristics, outcomes, and the risk factors for mortality of surgical revascularization in the short and medium term. This was a single-center retrospective observational study of patients who underwent isolated emergency CABG from January 2009 to January 2020. A propensity-score matching analysis yielded two comparable groups (n = 430) of patients without (n = 215) and with (n = 215) heart failure. In-hospital mortality did not differ in the two groups (2.8%; p > 0.9); the patients with heart failure presented more frequently with cardiogenic shock, and there was an association with mortality and mechanical circulatory support (OR 16.7−95% CI 3.31−140; p = 0.002) and postoperative acute renal failure (OR 15.9−95% CI 0.66−203; p = 0.036). In the early- and mid-term, heart failure and NSTEMI were associated with mortality (HR 3.47−95% CI 1.15−10.5; p = 0.028), along with age (HR 1.28−95% CI 1.21−1.36; p < 0.001). Surgical revascularization offers an excellent solution for patients with acute coronary syndrome, leading to a good immediate prognosis even in those with chronic heart failure.
Collapse
Affiliation(s)
- Giacomo Bianchi
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
- Correspondence: ; Tel.: +39-3404680379
| | - Edoardo Zancanaro
- Department of Cardiac Surgery, Università Vita-Salute San Raffaele, Via Olgettina, 58, 20132 Milan, Italy
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| | - Giovanni Concistré
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| | - Egidio Varone
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| | - Simone Simeoni
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| | - Marco Solinas
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| |
Collapse
|
5
|
Dokollari A, Torregrossa G, Sicouri S, Veshti A, Margaryan R, Cameli M, Mandoli GE, Maccherini M, Montesi G, Cabrucci F, Coku L, Arora R, Li QR, Bonacchi M, Gelsomino S. Pearls, pitfalls, and surgical indications of the Intuity TM heart valve: A rapid deployment bioprosthesis. A systematic review of the literature. J Card Surg 2022; 37:5411-5417. [PMID: 36403259 DOI: 10.1111/jocs.17231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To highlight short- and long-term clinical outcomes of the Intuity TM rapid deployment prosthesis for surgical aortic valve replacement. METHODS We reviewed on PubMed/MEDLINE, Embase, SciELO, LILACS, CCTR/CENTRAL, and Google Scholar for clinical trials, retrospective clinical studies, meta-analysis, and gray literature. RESULTS Fourty-five clinical studies with 12.714 patients were included in the analysis. Thirty-day mortality ranged from 3.8% for Intuity and 3.9% for transcatheter aortic valve replacement (TAVR). The incidence of paravalvular leak (PVL) (Intuity 0% and TAVR 2.17%), permanent pacemaker implantation (Intuity 11.11% and TAVR 12.5%), stroke (Intuity 2.2% and TAVR 2.6%), myocardial infarction (MI) (Intuity 0% and TAVR 1%), were all higher in the TAVR group. Compared to other sutured bioprosthesis (SB), mortality ranged from 0% to 3.9% for Intuity and 0%-6.9% for SB. Long-term cardiac mortality ranged from 0.9% to 1.55% for Intuity and 1.4%-3.3% for the Perceval valve. The incidence of PVL (Intuity 0.24%-0.7% and Perceval 0%-1%), endocarditis (Intuity 0.2%-0.7% and Perceval 1.6%-6.6%), stroke (Intuity 0.36%-1.4% and Perceval 0%-0.8%), MI (Intuity 0.07%-0.26%), and SVD (Intuity 0.12%-0.7% and Perceval 0%) were comparable. Compared to standard full sternotomy (SFS), minimally invasive surgery (MINV) mortality ranged from 0% to 4.3% for MINV and 0%-2.1% for SFS. Hospital costs outcomes ranged from $37,187-$44,368 for the Intuity, $69,389 for TAVR, and $13,543 for SB. Intuity short-term mortality ranged between 0.9% and 12.4% while long-term mortality ranged between 2.6% and 20%. CONCLUSIONS This manuscript provides a 360° overview of the current rapid deployments, sutureless, and TAVR prosthesis.
Collapse
Affiliation(s)
- Aleksander Dokollari
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Altin Veshti
- Department of Cardiac Surgery, Mother Teresa Hospital, University of Tirana, Tirana, Albania
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Matteo Cameli
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Giulia Elena Mandoli
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Massimo Maccherini
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Gianfranco Montesi
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Francesco Cabrucci
- Department of Cardiac Surgery/Cardiology, University of Siena, Siena, Italy
| | - Lindita Coku
- Department of Cardiac Surgery, Appalachian Regional Health, University of Kentucky, Hazard, Kentucky, USA
| | - Rakesh Arora
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Qiao Ri Li
- 2010 Vision Associates, Toronto, Ontario, Canada
| | - Massimo Bonacchi
- Department of Cardiac Surgery/Cardiology, University of Siena, Siena, Italy
| | - Sandro Gelsomino
- Department of Cardiac Surgery, CARIM Maastricht Medical University, Maastricht, Netherlands
| |
Collapse
|
6
|
Romeo MR, Baroni M, Berti S, Bianchi G, Margaryan R, Solinas M, Clemente A, Chiappino D, Bevilacqua S, Megaro M. Primary mitral valve regurgitation scheduled for cardiac surgery: no longer need for coronary angiography? A clinical retrospective & HTA analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1597] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
In patients (pts) undergoing cardiac surgery for primary mitral regurgitation (PMR), coronary angiography (CA) is always scheduled shortly before surgery to rule out significant coronary artery disease (CAD), despite this population is often young and with relatively low risk for CAD. Computed Tomography Coronary Angiography (CTCA) could be an alternative approach to evaluate coronary arteries, at least ruling out significant CAD in selected pts, due to its high negative predictive value.
Purpose
A safer, more appropriate and efficient clinical and diagnostic pathway for patients undergoing cardiac surgery for PMR by stratifying patients prior cardiac surgery according to pretest probability score (PTP) and therefore shifting imaging of epicardial coronary arteries from invasive to noninvasive in specific patients subsets.
Methods
A retrospective analysis (Jan 2014–Dec 2020) was carried out through the extraction of 7343 electronic medical records of pts who underwent cardiac valve surgery. In 1556 pts with PMR (1195 with no-CAD and 361 with CAD) a PTP was retrospectively calculated according to Genders, 2012, to stratify their risk of CAD.
A Decision oriented Health Technology Assessment (DoHTA) and a cost analysis were also performed to support the analysis results. A survey was distributed to a team of experts with a multidisciplinary background to analyze the most significant evaluation areas (Economic Aspects, Clinical Effectiveness, Safety, Innovation) and the sub-criteria related to them.
Following the Core Model Eunethta as a guideline, a Rapid Report HTA has been drawn up to identify the best solution.
Results
Patients characteristics are listed in Picture 1. Pts with normal coronary arteries showed a PTP low-to intermediate while pts with high PTP had CAD and therefore had a real pretest need for a CA (average 11 percent ± 9 in noCAD group vs 20 percent ± 14 in the CAD group). In two thirds of PMR population coronary angiography could have been avoided according to a PTP score <15 percent.
The cost analysis results were significantly lower in CTCA (1,315.00 EUR vs 180.00 EUR, CA vs CTCA respectively), The Decision Oriented HTA conducted by a multidisciplinary team showed a relevant preference for the new pathway (Picture 2) with a score of 70.23 percent of preference among the Team.
Conclusions
This new pathway, already proposed for selected pts in ESC guidelines on valve diseases (class IIA, LOE C) could be always adopted in PMR pts with low-to intermediate PTP score undergoing cardiac surgery. It could improve workflow efficiency and reduce LOS, and last but not least, avoid an invasive test, reduce radiation exposure and AKI risk in in a relatively young population
The DoHTA provided a more effective and efficient support to the decision-making process.
Funding Acknowledgement
Type of funding sources: None. Picture 1. Patients characteristics (noCAD-CAD)Picture 2. HTA Score CTCA vs CA
Collapse
Affiliation(s)
- M R Romeo
- Fondazione Toscana Gabriele Monasterio, HTA Innovation Lab, Pisa, Italy
| | - M Baroni
- Fondazione Toscana Gabriele Monasterio, Clinical Risk Management, Pisa, Italy
| | - S Berti
- Fondazione Toscana Gabriele Monasterio, Invasive Cardiology Unit, Pisa, Italy
| | - G Bianchi
- Fondazione Toscana Gabriele Monasterio, Cardiac Surgery Dpt, Pisa, Italy
| | - R Margaryan
- Fondazione Toscana Gabriele Monasterio, Cardiac Surgery Dpt, Pisa, Italy
| | - M Solinas
- Fondazione Toscana Gabriele Monasterio, Cardiac Surgery Dpt, Pisa, Italy
| | - A Clemente
- Fondazione Toscana Gabriele Monasterio, Radiology Dpt, Pisa, Italy
| | - D Chiappino
- Fondazione Toscana Gabriele Monasterio, Radiology Dpt, Pisa, Italy
| | - S Bevilacqua
- Fondazione Toscana Gabriele Monasterio, Management Control, Pisa, Italy
| | - M Megaro
- Fondazione Toscana Gabriele Monasterio, Management Control, Pisa, Italy
| |
Collapse
|
7
|
Cefarelli M, Concistrè G, Montecchiani L, Bianchi G, Berretta P, Margaryan R, Alfonsi J, Murzi M, Solinas M, Di Eusanio M. Bioconduit subannular implantation for aortic root endocarditis after previous cardiac surgery: Results from two Italian centers. J Card Surg 2020; 35:3041-3047. [PMID: 32827184 DOI: 10.1111/jocs.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Infective endocarditis (IE) with extensive peri-annular abscesses and aortic root involvement is a life-threatening disease. Aortic root replacement with a valved conduit is the most common intervention in this setting and represents a serious challenge for the surgeon. In the present two-center study we analyzed early and midterm outcomes of a high-risk series of IE patients undergoing aortic root reconstruction with a sub-annular implantation of a totally biological valved conduit at our centers. METHODS The series comprised 29 patients (18 males, mean age: 72.3 ± 10.1 years) operated at "Lancisi Cardiovascular Center" of Ancona and "Pasquinucci Heart Hospital" of Massa, Italy, between May 2016 and October 2019. All patients had undergone a previous cardiac surgery. Median Euroscore-II was 12.6%. Following aggressive debridement, a Bioconduit was implanted using a sub-annular implantation technique in all cases. RESULTS Thirty-day mortality was 13.8% (n = 4). Multiorgan failure was cause of death in all cases. Respiratory complications occurred in eight patients (27.6%). Renal complications requiring temporary or permanent dialysis occurred in six (20.7%) and two (6.9%) patients, respectively. Mortality and morbidity were not related to the surgical approach. At 1-year follow-up three patients died and no patients underwent reoperation neither reported endocarditis of the biological conduit. CONCLUSION Considered the high-risk profile of the study cohort, our results suggest safety and efficacy of our approach at 1-year. Indeed, we contend that our subannular implantation of a 100% pericardial valved conduit, allowing an effective abscess exclusion and a conduit anchoring to healthy tissues, can reduce the risk of reinfection and dehiscence.
Collapse
Affiliation(s)
- Mariano Cefarelli
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Concistrè
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Luca Montecchiani
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Giacomo Bianchi
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Paolo Berretta
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Rafik Margaryan
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Jacopo Alfonsi
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Michele Murzi
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Marco Solinas
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Marco Di Eusanio
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| |
Collapse
|
8
|
Solinas M, Bianchi G, Chiaramonti F, Margaryan R, Kallushi E, Gasbarri T, Santarelli F, Murzi M, Farneti P, Leone A, Simeoni S, Varone E, Marchi F, Glauber M, Concistrè G. Right anterior mini-thoracotomy and sutureless valves: the perfect marriage. Ann Cardiothorac Surg 2020; 9:305-313. [PMID: 32832412 DOI: 10.21037/acs-2019-surd-172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A minimally invasive approach (MIA) reduces mortality and morbidity in patients referred for aortic valve replacement (AVR). Sutureless technology facilitates a MIA. We describe our experience with the sutureless Perceval (LivaNova, Italy) aortic bioprosthesis through a right anterior mini-thoracotomy (RAMT) approach. Methods Between March 2011 and October 2019, 1,049 patients underwent AVR with Perceval bioprosthesis. Five hundred and three patients (48%) were operated through a RAMT approach in the second intercostal space. Considering only isolated AVR (881), 98% of patients were operated with MIA, and Perceval in RAMT approach was performed in 57% of these patients. Eight patients (1.6%) had previously undergone cardiac surgery. The prosthesis sizes implanted were: S (n=91), M (n=154), L (n=218) and XL (n=40). Concomitant procedures were mitral valve surgery (n=6), tricuspid valve repair (n=1), mitral valve repair and tricuspid valve repair (n=1) and miectomy (n=2). Mean age was 78±4 years (range, 65-89 years), 317 patients were female (63%) and EuroSCORE II was 5.9%±8.4%. Results The 30-day mortality was 0.8% (4/503). Cardiopulmonary bypass (CPB) and aortic cross-clamp times were 81.6±30.8 and 50.3±24.5 minutes respectively for stand-alone procedures. In two patients, early moderate paravalvular leakage appeared as a result of incomplete expansion of the sutureless valve due to oversizing of the bioprosthesis, requiring reoperations at two and nine postoperative days with sutured aortic bioprosthesis implantation. Permanent pacemaker implantation within the first thirty days was necessary in 26 (5.2%) patients. At the mean follow-up of 4.6 years (range, 1 month to 8.6 years), survival was 96%, freedom from reoperation was 99.2%, and mean transvalvular pressure gradient was 11.9±4.3 mmHg. Conclusions AVR with the Perceval bioprosthesis in a RAMT approach is a safe and feasible procedure associated with low mortality and excellent hemodynamic performance. Sutureless technology facilitates a RAMT approach.
Collapse
Affiliation(s)
- Marco Solinas
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Giacomo Bianchi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Francesca Chiaramonti
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Enkel Kallushi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Tommaso Gasbarri
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Filippo Santarelli
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Michele Murzi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Pierandrea Farneti
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Alessandro Leone
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Simone Simeoni
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Egidio Varone
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Federica Marchi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Mattia Glauber
- Department of Minimally-Invasive Cardiac Surgery, Istituto Clinico Sant' Ambrogio, Milan, Italy
| | - Giovanni Concistrè
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| |
Collapse
|
9
|
Irabien Ortiz Á, Margaryan R, Bianchi G, Cuerpo G, González-Pinto Á, Solinas M. Reparación endoscópica de endocarditis mitral en pacientes octogenarios. Cirugía Cardiovascular 2020. [DOI: 10.1016/j.circv.2020.02.001] [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: 11/17/2022] Open
|
10
|
Margaryan R, Assanta N, Menciassi A, Burchielli S, Matteucci M, Agostini S, Lionetti V, Luchi C, Cariati E, Pucci A, Coceani F, Murzi B. Selective perfusion of coronary vasculature in preterm sheep: a methodological innovation undermined by unfavourable operation of the foramen ovale. Can J Physiol Pharmacol 2020; 98:211-218. [PMID: 32202442 DOI: 10.1139/cjpp-2018-0648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Antenatal cardiac intervention affords new prospects for hypoplastic left heart syndrome. Its success, however, may come not only from absence of impediments to blood flow but also from a sufficiently developed cardiac wall. Here, we examined the feasibility to perfuse selectively the fetal coronary circulation for treatment with growth promoting agents. Pregnant sheep (94-114 days gestation, term 145 days) were used. An aortic stop-flow procedure was developed for intracoronary access in the nonexposed fetus and human mesenchymal stem cells and their exosomes served as test agents. We found that aortic stop-flow ensures preferential distribution of fluorescent microspheres to the heart. However, intracoronary administration of stem cells or exosomes was detrimental, with fetal demise occurring around surgery or at variable intervals afterwards. Coincidentally, stop-flow caused by itself a marked rise of intraluminal pressure within the occluded aorta along with histological signs of coronary obstruction. We conclude that it is feasible to perfuse selectively the coronary circulation of the preterm fetus, but treatments are not compatible with survival of the animals. The cause for failure is found in the absence of hemodynamic compensation to stop-flow via a left-to-right shunt. This unexpected event is attributed to a largely membranous foramen ovale, characteristic of sheep, that collapses under pressure.
Collapse
Affiliation(s)
- Rafik Margaryan
- Fondazione Toscana Gabriele Monasterio, 54100 Massa and 56100 Pisa, Italy
| | - Nadia Assanta
- Fondazione Toscana Gabriele Monasterio, 54100 Massa and 56100 Pisa, Italy
| | - Arianna Menciassi
- Institute of BioRobotics, Scuola Superiore Sant'Anna, 56100 Pisa, Italy
| | - Silvia Burchielli
- Fondazione Toscana Gabriele Monasterio, 54100 Massa and 56100 Pisa, Italy
| | - Marco Matteucci
- Institute of Life Sciences, Scuola Superiore Sant'Anna, 56100 Pisa, Italy
| | - Silvia Agostini
- Institute of Life Sciences, Scuola Superiore Sant'Anna, 56100 Pisa, Italy
| | - Vincenzo Lionetti
- Institute of Life Sciences, Scuola Superiore Sant'Anna, 56100 Pisa, Italy
| | - Carlo Luchi
- Division of Prenatal Medicine, Pisa University Hospital, 56100 Pisa, Italy
| | - Ettore Cariati
- Department for Infant and Mother Care, Tuscany Center University Hospital, 50100 Florence, Italy
| | - Angela Pucci
- Department of Pathology, Pisa University Hospital, 56100 Pisa, Italy
| | - Flavio Coceani
- Institute of Life Sciences, Scuola Superiore Sant'Anna, 56100 Pisa, Italy
| | - Bruno Murzi
- Fondazione Toscana Gabriele Monasterio, 54100 Massa and 56100 Pisa, Italy
| |
Collapse
|
11
|
Concistrè G, Bianchi G, Chiaramonti F, Margaryan R, Marchi F, Kallushi E, Solinas M. Minimally Invasive Sutureless Aortic Valve Replacement is Associated With Improved Outcomes in Patients With Left Ventricular Dysfunction. Innovations�(Phila) 2019; 14:445-452. [DOI: 10.1177/1556984519872990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared with patients with preserved LVEF. To evaluate the impact of sutureless Perceval (LivaNova, Italy) aortic bioprosthesis on LVEF and clinical outcomes in patients with baseline left ventricular (LV) dysfunction who underwent isolated aortic valve replacement (AVR). Methods Between March 2011 and August 2017, 803 patients underwent AVR with Perceval bioprosthesis implantation. Fifty-two isolated AVR had preoperative LVEF ≤45%. Mean age of these patients was 77 ± 6 years, 24 patients were female (46%), and mean EuroSCORE II was 9.4% ± 4.8%. Perceval bioprosthesis was implanted in 9 REDO operations. In 43 patients (83%), AVR was performed in minimally invasive surgery with an upper ministernotomy ( n = 13) or right anterior minithoracotomy ( n = 30). Results One patient died in hospital. Cardiopulmonary bypass and aortic cross-clamp times were 85.5 ± 26 minutes and 55.5 ± 19 minutes, respectively. At mean follow-up of 33 ± 20 months (range: 1 to 75 months), survival was 90%, freedom from reoperation was 100%, and mean transvalvular pressure gradient was 11 ± 5 mmHg. LVEF improved from 37% ± 7% preoperatively to 43% ± 8% at discharge ( P < 0.01) and further increased to 47% ± 9% at follow-up ( P = 0.06), LV mass decreased from 149.8 ± 16.9 g/m2 preoperatively to 115.3 ± 11.6 g/m2 at follow-up ( P < 0.001), and moderate paravalvular leakage occurred in 1 patient without hemolysis not requiring any treatment. Conclusions AVR with sutureless aortic bioprosthesis implantation in patients with preoperative LV dysfunction demonstrated a significant immediate and early improvement in LVEF.
Collapse
Affiliation(s)
- Giovanni Concistrè
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Giacomo Bianchi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Francesca Chiaramonti
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Federica Marchi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Enkel Kallushi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Marco Solinas
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| |
Collapse
|
12
|
Concistrè G, Chiaramonti F, Bianchi G, Margaryan R, Santarelli F, Gasbarri T, Kallushi E, Cerillo A, Murzi M, Farneti P, Solinas M. RF80 SUTURELESS AORTIC PERCEVAL BIOPROSTHESIS IMPLANTATION IN AORTIC VALVE DISEASE AND CONCOMITANT PROCEDURES. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549973.75410.0d] [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]
|
13
|
Bianchi G, Margaryan R, Solinas M. RF39 LEFT VENTRICULAR DYSFUNCTION AFTER MINIMALLY INVASIVE MITRAL VALVE SURGERY IN ASYMPTOMATIC PATIENTS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550018.57485.15] [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]
|
14
|
Bianchi G, Concistrè G, Margaryan R, Laganà A, Solinas M. OC57 PATIENT-PROSTHESIS MISMATCH ION ELDERLY WOMEN. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549886.57004.ec] [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]
|
15
|
Concistrè G, Bianchi G, Chiaramonti F, Margaryan R, Santarelli F, Gasbarri T, Kallushi E, Cerillo A, Murzi M, Farneti P, Solinas M. RF07 AORTIC VALVE REPLACEMENT WITH SUTURELESS PERCEVAL BIOPROSTHESIS IN RIGHT ANTERIOR MINITHORACOTOMY APPROACH. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549969.83034.c7] [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]
|
16
|
Concistrè G, Chiaramonti F, Bianchi G, Margaryan R, Santarelli F, Gasbarri T, Kallushi E, Cerillo A, Murzi M, Farneti P, Solinas M. RF81 SUTURELESS AORTIC PERCEVAL BIOPROSTHESIS IN CARDIAC REOPERATIONS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550038.89764.87] [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]
|
17
|
Concistrè G, Bianchi G, Chiaramonti F, Santarelli F, Gasbarri T, Kallushi E, Cerillo A, Murzi M, Margaryan R, Farneti P, Solinas M. EP36 SUTURELESS AORTIC BIOPROSTHESIS IS ASSOCIATED WITH IMPROVEMENT OF EJECTION FRACTION IN PATIENTS WITH PREOPERATIVE LEFT VENTRICULAR DYSFUNCTION. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550006.14422.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
18
|
Margaryan R, Murzi M. Both sexes should be treated equally: sex difference in patients with ischemic heart failure undergoing surgical revascularization. J Thorac Dis 2018; 10:S3153-S3154. [PMID: 30370102 DOI: 10.21037/jtd.2018.08.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rafik Margaryan
- Department of Adult Cardiac Surgery, Ospedale Del Cuore Fondazione Toscana 'G Monasterio', Massa, Italy
| | - Michele Murzi
- Department of Adult Cardiac Surgery, Ospedale Del Cuore Fondazione Toscana 'G Monasterio', Massa, Italy
| |
Collapse
|
19
|
Margaryan R, Murzi M. Individualized clopidogrel suspension strategy coronary artery bypass surgery: what is the best choice? J Thorac Dis 2018; 10:S969-S971. [PMID: 29850177 DOI: 10.21037/jtd.2018.03.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rafik Margaryan
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Michele Murzi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| |
Collapse
|
20
|
Bianchi G, Margaryan R, Kallushi E, Cerillo AG, Farneti PA, Pucci A, Solinas M. Outcomes of Video-assisted Minimally Invasive Cardiac Myxoma Resection. Heart Lung Circ 2017; 28:327-333. [PMID: 29277548 DOI: 10.1016/j.hlc.2017.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/20/2017] [Accepted: 11/26/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Myxomas are the most frequent cardiac tumours. Their diagnosis requires prompt removal. In our centre, for valve surgery we use a minimally invasive approach. Here, we report our experience of cardiac myxoma removal through right lateral mini-thoracotomy (RLMT) with particular focus on its feasibility, efficacy and patient safety. METHODS Between February 2006 and January 2017, 30 consecutive patients (aged 66±12.6years, range 35-83 years) underwent atrial myxoma resection through video-assisted RLMT. Percutaneous venous drainage was performed in all patients and direct cannulation of the ascending aorta was performed in 28 out of 30 (93.3%). The diagnosis of atrial myxoma was confirmed by histology. RESULTS Complete surgical resection was achieved in all patients. The mean cardiopulmonary bypass (CPB) time was 76.5±40.8minutes and average aortic cross-clamping time was 41.5±29.8minutes. No patient suffered postoperative complications. Five patients (16.7%) received a blood transfusion. Mechanical ventilation ranged from 3 to 51hours (median 6hours), intensive care unit (ICU) stay ranged from 1 to 5days (median 1day). Total hospital length of stay (HLOS) was 5.6±2 days. Home discharge rate was 56.7%. No in-hospital mortality was reported. During follow-up (55.6±32.3 months; range 4-132 months), one tumour recurrence was observed. There were three late non-cardiac deaths. Overall survival was 100%, 85.7% and 85.7% at 1, 5 and 10 years, respectively. CONCLUSIONS The use of video-assisted RLMT is an effective and reproducible strategy in all patients requiring expedited surgery for left atrial myxoma, independently of coexisting morbidity such as systemic embolisation or previous surgery. This technique leads to complete tumour resection, prompt recovery, early home discharge and high freedom from both symptoms and tumour recurrence.
Collapse
Affiliation(s)
- Giacomo Bianchi
- Adult Cardiac Surgery Department - Fondazione Toscana "G. Monasterio", Ospedale del Cuore "G. Pasquinucci", Massa, Italy.
| | - Rafik Margaryan
- Adult Cardiac Surgery Department - Fondazione Toscana "G. Monasterio", Ospedale del Cuore "G. Pasquinucci", Massa, Italy
| | - Enkel Kallushi
- Adult Cardiac Surgery Department - Fondazione Toscana "G. Monasterio", Ospedale del Cuore "G. Pasquinucci", Massa, Italy
| | - Alfredo Giuseppe Cerillo
- Adult Cardiac Surgery Department - Fondazione Toscana "G. Monasterio", Ospedale del Cuore "G. Pasquinucci", Massa, Italy
| | - Pier Andrea Farneti
- Adult Cardiac Surgery Department - Fondazione Toscana "G. Monasterio", Ospedale del Cuore "G. Pasquinucci", Massa, Italy
| | - Angela Pucci
- Department of Histopathology, Pisa University Hospital, Pisa, Italy
| | - Marco Solinas
- Adult Cardiac Surgery Department - Fondazione Toscana "G. Monasterio", Ospedale del Cuore "G. Pasquinucci", Massa, Italy
| |
Collapse
|
21
|
Murzi M, Cerillo AG, Gasbarri T, Margaryan R, Kallushi E, Farneti P, Solinas M. Antegrade and retrograde perfusion in minimally invasive mitral valve surgery with transthoracic aortic clamping: a single-institution experience with 1632 patients over 12 years. Interact Cardiovasc Thorac Surg 2017; 24:363-368. [PMID: 28040754 DOI: 10.1093/icvts/ivw370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/19/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives The aim of the present study was to evaluate the impact of a retrograde arterial perfusion (RAP) strategy versus an antegrade arterial perfusion (AAP) strategy in a consecutive, large cohort of patients who underwent minimally invasive mitral valve surgery with transthoracic aortic clamping through a right minithoracotomy. Methods Between 2003 and 2015, 1632 consecutive patients underwent first-time minimally invasive mitral valve surgery with transthoracic aortic clamping at our institution; 141 (8.6%) of these patients received retrograde perfusion with femoral artery cannulation, whereas 1421 (91.4%) received antegrade perfusion with ascending aorta cannulation. Logistic regression was used to evaluate outcomes and risk factors for death and stroke between groups. Results The overall frequency of 30-day mortality was 0.7% (13/1632) and was similar between groups (retrograde arterial perfusion RAP 0.7% vs AAP 0.8%; P = 0.903). The overall postoperative stroke rate was 1.3% (22/1632). The stroke rate was significantly higher in patients receiving retrograde perfusion (3.5% vs 1.1%; P = 0.005). Risk factors for death were advanced age (odds ratio (OR) = 1.3; P = 0.004), mitral valve replacement (OR = 3.9; P = 0.05), emergent procedure (OR = 3.4; P = 0.014) and conversion to sternotomy (OR = 3.7; P = 0.001). Multivariable regression analysis revealed that retrograde perfusion was an independent risk factor for stroke (OR = 3.3; P = 0.004). Other risk factors were conversion to sternotomy (OR = 12; P = 0.001), active endocarditis (OR = 5.8; P = 0.07) and hypercholesterolaemia (OR = 2.4; P = 0.048). Interaction modelling revealed that the only significant risk factor for a neurological event was the use of retrograde perfusion in patients older than 70 years with an atherosclerotic burden (OR = 6.4; P = 0.033). Conclusions Minimally invasive mitral valve procedures can be performed with low morbidity and mortality. The use of retrograde perfusion is associated with a higher incidence of neurological complications in older patients with atherosclerotic burden. Central aortic cannulation permits avoidance of complications associated with retrograde perfusion and extends the suitability of minimally invasive mitral procedures to those patients who have an absolute contraindication for femoral artery cannulation.
Collapse
Affiliation(s)
- Michele Murzi
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Alfredo G Cerillo
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Tommaso Gasbarri
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Rafik Margaryan
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Enkel Kallushi
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Pierandrea Farneti
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Marco Solinas
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| |
Collapse
|
22
|
Margaryan R, Moscarelli M, Gasbarri T, Bianchi G, Kallushi E, Giuseppe Cerillo A, Farneti P, Solinas M. Euroscore Performance in Minimally Invasive Cardiac Surgery. Innovations 2017. [DOI: 10.1177/155698451701200409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rafik Margaryan
- From the Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazine Toscana ‘G. Monasterio’, Massa, Italy
| | - Marco Moscarelli
- From the Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazine Toscana ‘G. Monasterio’, Massa, Italy
| | - Tommaso Gasbarri
- From the Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazine Toscana ‘G. Monasterio’, Massa, Italy
| | - Giacomo Bianchi
- From the Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazine Toscana ‘G. Monasterio’, Massa, Italy
| | - Enkel Kallushi
- From the Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazine Toscana ‘G. Monasterio’, Massa, Italy
| | - Alfredo Giuseppe Cerillo
- From the Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazine Toscana ‘G. Monasterio’, Massa, Italy
| | - Pierandrea Farneti
- From the Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazine Toscana ‘G. Monasterio’, Massa, Italy
| | - Marco Solinas
- From the Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazine Toscana ‘G. Monasterio’, Massa, Italy
| |
Collapse
|
23
|
Margaryan R, Moscarelli M, Gasbarri T, Bianchi G, Kallushi E, Cerillo AG, Farneti P, Solinas M. EuroSCORE Performance in Minimally Invasive Cardiac Surgery: Discrimination Ability and External Calibration. Innovations (Phila) 2017; 12:282-286. [PMID: 28582328 DOI: 10.1097/imi.0000000000000377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Prediction of operative risk in adults undergoing cardiac surgery remains a challenge. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is one of the most commonly used in clinical settings. Recently, the new EuroSCORE II was published attempting to improve the accuracy of risk prediction. We sought to assess the predictive value of EuroSCORE or EuroSCORE II in selected field of minimally invasive cardiac surgery. METHODS Patients who underwent cardiac surgery operation with minimally invasive approach from 2007 to 2013 identified from prospective cardiac surgical database. Additional variables included in EuroSCORE II, but not in original EuroSCORE, were retrospectively collected via electronic health records reviewing. The C-statistic was calculated for the EuroSCORE (additive and logistic) and EuroSCORE II. The Hosmer-Lemeshow test was used to assess model calibration by comparing observed and expected morality in number of risk strata. RESULTS There were 39 hospitals deaths (1.6%). A total of 2472 patients were identified from the main database. The mean ± SD logistic EuroSCORE was 7.6 ± 8.3, mean ± SD additive EuroSCORE was 6.1 ± 2.7, and mean ± SD EuroSCORE II was 2.9 ± 4.2. EuroSCORE logistic model performed with substantial accuracy of 0.78, EuroSCORE additive performed with accuracy of 0.78, and EuroSCORE II performed as almost perfect 0.82. Model calibration was poor in EuroSCORE II (χ = 17.57, P = 0.02), calibration for logistic EuroSCORE was also poor (χ = 140.58, P < 0.01), and additive model also (χ = 94.95, P < 0.01). The area under the curve was high in all algorithms; logistic EuroSCORE was 0.78 (95% confidence interval = 0.71-0.85), additive EuroSCORE was 0.79 (95% confidence interval = 0.71-0.86), and EuroSCORE II was 0.82 (95% confidence interval = 0.75-0.89). CONCLUSIONS In overall settings, original EuroSCORE and EuroSCORE II perform poorly in minimally invasive operation conditions. Data suggest that EuroSCORE could not be used for estimating operative risks correctly. New risk score should be explored, developed, and implemented for selective minimally invasive cohorts.
Collapse
Affiliation(s)
- Rafik Margaryan
- From the Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazine Toscana 'G. Monasterio', Massa, Italy
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Margaryan R, Arcieri L, Poli V, Murzi B. False-aneurysm after xenograft implantation for right ventricular outflow tract reconstruction. J Card Surg 2016; 32:60-61. [PMID: 27859636 DOI: 10.1111/jocs.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rafik Margaryan
- Biomedical Research Division, Institute of Life Sciences, Sant'Anna School, Pisa, Italy
| | - Luigi Arcieri
- Department of Pediatric Cardiac Surgery, Heart Hospital, "G. Monasterio" Foundation, Massa, Italy
| | - Vincenzo Poli
- Department of Pediatric Cardiac Surgery, Heart Hospital, "G. Monasterio" Foundation, Massa, Italy
| | - Bruno Murzi
- Department of Pediatric Cardiac Surgery, Heart Hospital, "G. Monasterio" Foundation, Massa, Italy
| |
Collapse
|
25
|
Celiento M, Ravenni G, Margaryan R, Ferrari G, Blasi S, Pratali S, Bortolotti U. The Modified Bentall Procedure: A Single-Institution Experience in 249 Patients with a Maximum Follow Up of 21.5 Years. J Heart Valve Dis 2016; 25:448-455. [PMID: 28009948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The study aim was to evaluate the long-term clinical outcomes of the modified Bentall procedure (MBP) with a mechanical conduit. METHODS Between 1993 and 2014, a total of 249 patients (mean age 62 ± 12 years; range: 25-87 years) underwent a MBP at the authors' institution. The main indication was annuloaortic ectasia in 102 patients (41%), followed by acute aortic dissection in 82 patients (33%); moderate to severe aortic regurgitation was present in 79% of cases. A bicuspid aortic valve was found in 17% of patients, and Marfan syndrome in 7%. The mean NYHA functional class was 2.5 ± 1.1. Concomitant procedures were performed in 36 patients (14%). The mean follow up was 8.7 ± 5.0 years (range: 0.3-21.5 years) and was 99% complete. The total follow up was 6.475 patient-years (pt-yr). RESULTS Operative mortality was 3% in elective cases. Age, prolonged cardiopulmonary bypass times and mechanical ventilation >96 h were independent risk factors for early mortality. Actuarial survival at 15 and 20 years was 62% and 60%, respectively. Risk factors for late mortality were age and emergency operation. Actuarial freedom from thromboembolism (linearized incidence 0.93%/pt-yr) was 82% at 15 years, and 74% at 20 years. Seven patients required reoperation (0.38%/pt-yr), with an actuarial freedom from reoperation of 91% at 15 years and 87% at 20 years. The incidence of overall valve-related complications was 0.32%/pt-yr, with actuarial freedoms of 94% at 15 and 20 years. CONCLUSIONS The MBP has shown excellent long-term results with a low incidence of procedure-related complications up to 20 years postoperatively. For this reason, it is considered to be a valid option for the treatment of aortic root disease, whenever valvesparing procedures are not indicated.
Collapse
Affiliation(s)
- Michele Celiento
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Giacomo Ravenni
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Rafik Margaryan
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Gabriele Ferrari
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Stefania Blasi
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Stefano Pratali
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Uberto Bortolotti
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy. Electronic correspondence:
| |
Collapse
|
26
|
Moscarelli M, Cerillo A, Athanasiou T, Farneti P, Bianchi G, Margaryan R, Solinas M. Minimally invasive mitral valve surgery in high-risk patients: operating outside the boxplot. Interact Cardiovasc Thorac Surg 2016; 22:756-61. [PMID: 26953330 DOI: 10.1093/icvts/ivw038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/11/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES (i) To establish who is at high risk for mitral surgery. (ii) To assess the performance of minimally invasive mitral valve surgery in high-risk patients by presenting early and late outcomes and compare these with those of the non-high-risk population. METHODS We reviewed our database of prospective data of 1873 consecutive patients who underwent minimally invasive mitral surgery from 2003 to 2015. To establish an unbiased definition of risk cut-off, we considered as high-risk the 'outliers of risk' identified using boxplot analysis in relation to EuroSCORE II. RESULTS Two hundred and five patients were outliers, with 98 as minor (EuroSCORE II ≥ 6%) and 107 as major outliers (EuroSCORE II ≥ 9%). Outliers accounted for several different comorbidities. Nineteen patients died while in hospital (9.2%); different postoperative complications were observed. Outliers had a significantly lower mean survival time and a higher risk of cardiac-related death than the general population; however, the worst outcomes were observed in major outliers. No statistically significant difference was found with regard to the need for mitral reintervention and the degree of mitral regurgitation at follow-up. CONCLUSIONS Boxplot analysis helped to achieve an internal definition of risk cut-off, starting from EuroSCORE II ≥ 6%. Minimally invasive mitral surgery in these outliers of risk was associated with acceptable early and long-term results; however, major outliers with EuroSCORE II ≥ 9% may benefit from catheter-based procedures.
Collapse
Affiliation(s)
- Marco Moscarelli
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy NHLI, Imperial College of London, London, UK
| | - Alfredo Cerillo
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College, Paddington, London, UK
| | - Pierandrea Farneti
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Giacomo Bianchi
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Rafik Margaryan
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Marco Solinas
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| |
Collapse
|
27
|
Moscarelli M, Bianchi G, Margaryan R, Cerillo A, Farneti P, Murzi M, Solinas M. Accuracy of EuroSCORE II in patients undergoing minimally invasive mitral valve surgery. Interact Cardiovasc Thorac Surg 2015; 21:748-53. [PMID: 26403175 DOI: 10.1093/icvts/ivv265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/20/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES EuroSCORE II has been implemented with the view to providing better performance than the previous logistic EuroSCORE. However, until now, no external validations have been carried out in the minimally invasive context. Therefore, we sought to validate the accuracy of EuroSCORE II in a retrospective series of consecutive patients undergoing minimally invasive mitral valve surgery. METHODS Data of 1609 consecutive patients who underwent minimally invasive mitral valve surgery in our institution were retrospectively reviewed. The accuracy of EuroSCORE II was assessed in terms of discrimination and calibration. Discrimination was tested via analysis of the area under the curve of receiver operator characteristic; calibration was achieved by calculating the observed versus expected mortality ratio and the Hosmer-Lemeshow test for test probability; global accuracy was assessed by using Brier's score; results were compared with the previous logistic EuroSCORE version. EuroSCORE II performance was also tested for discrimination of postoperative complications. Discrimination subgroup analysis was carried out for single surgeon results, and for high-risk patients those outliers were defined after boxplot analysis (EuroSCORE II ≥6%). RESULTS EuroSCORE II showed good discrimination power (area under the curve 0.846), and was statistically superior to logistic EuroSCORE (P = 0.01). In terms of calibration, both EuroSCORE II and logistic over-predicted mortality; with regard to adverse events, the discrimination of EuroSCORE II was adequate for acute renal failure, low-output syndrome and increased intensive care unit stay; area under the curve of receiver operating characteristic for high-risk patients with EuroSCORE ≥6% was suboptimal (0.654); single surgeon results did not influence the discrimination of EuroSCORE II. CONCLUSIONS EuroSCORE II showed good discrimination power in our series of minimally invasive mitral valve patients; however, it over-predicted mortality. Individual performance did not influence discrimination. Performance was suboptimal for prediction of complications and for high-risk subgroup in-hospital mortality.
Collapse
Affiliation(s)
- Marco Moscarelli
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy Honorary Research Fellow, National Heart and Lung Institute (NHLI), Imperial College, London, UK
| | - Giacomo Bianchi
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Rafik Margaryan
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Alfredo Cerillo
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Pierandrea Farneti
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Michele Murzi
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Marco Solinas
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| |
Collapse
|
28
|
Moscarelli M, Margaryan R, Cerillo A, Kallushi E, Farneti P, Solinas M. Minimally Invasive Mitral Valve Surgery in Truly High-Risk Patients: Are We Pushing the Boundaries? An Observational Study. Innovations 2015. [DOI: 10.1177/155698451501000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marco Moscarelli
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
- NHLI, Imperial College of London, London, United Kingdom
| | - Rafik Margaryan
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Alfredo Cerillo
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Enkel Kallushi
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Pierandrea Farneti
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| | - Marco Solinas
- Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy
| |
Collapse
|
29
|
Margaryan R, Kallushi E, Gilmanov D, Micelli A, Murzi M, Solinas M, Cerillo AG, Glauber M. Sutureless Aortic Valve Prosthesis Sizing Estimation and Prediction Using Multidetector-Row Computed Tomography. Innovations�(Phila) 2015; 10:230-5; discussion 235. [DOI: 10.1097/imi.0000000000000182] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The sutureless prostheses may facilitate minimally invasive aortic valve replacement because of easy and fast deployment. However, correct device sizing remains a crucial step of this procedure, which may be difficult and time consuming in minimal invasive approaches. We sought to analyze the accuracy of contrast-enhanced preoperative multidetector-row computed tomography (MDCT) in predicting the size of the prosthesis to be implanted in patients undergoing aortic valve replacement through a right anterior minithoracotomy (RAMT). Methods From January 2011 to September 2013, 235 patients underwent aortic valve surgery as sole procedure with implantation (Sorin Perceval S) in RAMT. Inclusion criterion for this study was presence of preoperative multidetector-row computed tomography (MDCT) with contrast enhancement and Doppler echocardiography. A preoperative MDCT was used to measure the aortic annulus as the diameter derived from either the area (aD) or the circumference (cD) of the virtual basal ring, left ventricular outflow tract (LVOT) diameter derived either from the area(aLVOT) or the circumference (cLVOT). Multidetector-row CT was reviewed by a single operator who was blind to implanted valve size. The operator measured the aortic annulus and LVOT in multiplanar reconstruction modality. Aortic annular diameter and LVOT diameter were retrieved from echocardiographic records. Predictive models were built based on logistic regression; outcome variable was the sutureless valve size, and covariates (annular and LVOT measurements) were used as single and multivariate predictors. A classification tree was built and then pruned with limited nodes to be able to obtain better predictive performance. Results We identified 54 patients who had preoperative contrast-enhanced MDCT. Seven patients received a size S, 21 received a size M, and 26 received a size L prosthesis. The mean age of the patients at the time of intervention was 76.3 ± 6.8 years, and the mean logistic EuroSCORE was 10.4% ± 8.7%. Echocardiographic measurements showed lower accuracy compared to MDCT measurements. Echocardiographic LVOT measurement was 61.11% to predict the valve size, whereas annulus measurement was 53.7%. The aLVOT from MDCT had an accuracy of approximately 62.96%, and cLVOT had 64.81% predictive accuracy. Aortic annulus perimeter cD had the highest accuracy to predict the valve size [62.96%, under the curve, 0.61] followed by aortic annular surface aD having an accuracy of approximately 70.37% (under the curve, 0.75). Classification tree models, after pruning with 4 nodes, increased their accuracy (83.33%), and it was easy to interpret and possibly to implement for clinical use. Conclusions Multidetector-row CT-derived estimates seem to have higher predictive value for valve size determination in patients undergoing RAMT with the Perceval S prosthesis, thus facilitating this delicate procedure and preventing the selection of wrong candidates. Possibly for precise aortic annulus measurement, contrast-enhanced MDCT is preferable.
Collapse
Affiliation(s)
- Rafik Margaryan
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
- Cardiac Surgery Residency Programme, Università Di Siena, Siena, Italy
| | - Enkel Kallushi
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
| | - Daniyar Gilmanov
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
- Cardiac Surgery Residency Programme, Università Di Siena, Siena, Italy
| | - Antonio Micelli
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
| | - Michele Murzi
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
| | - Marco Solinas
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
| | - Alfredo Giuseppe Cerillo
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
| | - Mattia Glauber
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
| |
Collapse
|
30
|
Margaryan R, Kallushi E, Gilmanov D, Micelli A, Murzi M, Solinas M, Cerillo AG, Glauber M. Sutureless Aortic Valve Prosthesis Sizing Estimation and Prediction Using Multidetector-Row Computed Tomography. Innovations 2015. [DOI: 10.1177/155698451501000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rafik Margaryan
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
- Cardiac Surgery Residency Programme, Università Di Siena, Siena, Italy
| | - Enkel Kallushi
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
| | - Daniyar Gilmanov
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
- Cardiac Surgery Residency Programme, Università Di Siena, Siena, Italy
| | - Antonio Micelli
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
| | - Michele Murzi
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
| | - Marco Solinas
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
| | - Alfredo Giuseppe Cerillo
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
| | - Mattia Glauber
- Adult Cardiac Surgery Department, Ospedale Del Cuore, Fondazione Toscana ‘G. Monasterio’, Massa, Italy
| |
Collapse
|
31
|
Bader A, Brodarac A, Hetzer R, Kurtz A, Stamm C, Baraki H, Kensah G, Asch S, Rojas S, Martens A, Gruh I, Haverich A, Kutschka I, Cortes-Dericks L, Froment L, Kocher G, Schmid RA, Delyagina E, Schade A, Scharfenberg D, Skorska A, Lux C, Li W, Steinhoff G, Drey F, Lepperhof V, Neef K, Fatima A, Wittwer T, Wahlers T, Saric T, Choi YH, Fehrenbach D, Lehner A, Herrmann F, Hollweck T, Pfeifer S, Wintermantel E, Kozlik-Feldmann R, Hagl C, Akra B, Gyongyosi M, Zimmermann M, Pavo N, Mildner M, Lichtenauer M, Maurer G, Ankersmit J, Hacker S, Mittermayr R, Mildner M, Haider T, Nickl S, Zimmermann M, Beer L, Lebherz-Eichinger D, Schweiger T, Mitterbauer A, Keibl C, Werba G, Frey M, Ankersmit HJ, Herrmann S, Lux CA, Steinhoff G, Holfeld J, Tepekoylu C, Wang FS, Kozaryn R, Schaden W, Grimm M, Wang CJ, Holfeld J, Tepekoylu C, Kozaryn R, Urbschat A, Zacharowski K, Grimm M, Paulus P, Avaca MJ, Kempf H, Malan D, Sasse P, Fleischmann B, Palecek J, Drager G, Kirschning A, Zweigerdt R, Martin U, Katsirntaki K, Haller R, Ulrich S, Sgodda M, Puppe V, Duerr J, Schmiedl A, Ochs M, Cantz T, Mall M, Martin U, Mauritz C, Kensah G, Lara AR, Dahlmann J, Zweigerdt R, Schwanke K, Hegermann J, Skvorc D, Gawol A, Azizian A, Wagner S, Krause A, Drager G, Ochs M, Haverich A, Gruh I, Martin U, Klopsch C, Gaebel R, Kaminski A, Chichkov B, Jockenhoevel S, Steinhoff G, Klose K, Roy R, Brodarac A, Kang KS, Bieback K, Nasseri B, Choi YH, Kurtz A, Stamm C, Lepperhof V, Polchynska O, Kruttwig K, Bruggemann C, Xu G, Drey F, Neef K, Saric T, Lichtenauer M, Werba G, Mildner M, Baumgartner A, Hasun M, Nickl S, Beer L, Mitterbauer A, Zimmermann M, Gyongyosi M, Podesser BK, Ankersmit HJ, Ludwig M, Tolk A, Skorska A, Noack T, Steinhoff G, Margaryan R, Assanta N, Menciassi A, Burchielli S, Matteucci M, Lionetti V, Luchi C, Cariati E, Coceani F, Murzi B, Martens A, Rojas SV, Kensah G, Rotarmel A, Baraki H, Haverich A, Martin U, Gruh I, Kutschka I, Nasseri BA, Klose K, Ebell W, Dandel M, Kukucka M, Gebker R, Choi YH, Hetzer R, Stamm C, Paulus P, Holfeld J, Urbschat A, Mutlak H, Ockelmann P, Tacke S, Zacharowski K, Scheller B, Pereszlenyi A, Rojas SV, Martens A, Baraki H, Schwanke K, Zweigerdt R, Martin U, Haverich A, Kutschka I, Rojas SV, Martens A, Meier M, Baraki H, Schecker N, Rathert C, Zweigerdt R, Martin U, Haverich A, Kutschka I, Roy R, Brodarac A, Kukucka M, Kurtz A, Becher PM, Choi YH, Drori-Carmi N, Bercovich N, Zahavi-Goldstein E, Jack M, Netzer N, Pinzur L, Chajut A, Tschope C, Stamm C, Ruch U, Kaminski A, Strauer BE, Tiedemann G, Steinhoff G, Schade A, Delyagina E, Scharfenberg D, Lux C, Steinhoff G, Schlegel F, Dhein S, Akhavuz O, Mohr FW, Dohmen PM, Schlegel F, Salameh A, Oelmann K, Kiefer P, Dhein S, Mohr FW, Dohmen PM, Schwanke K, Merkert S, Templin C, Jara-Avaca M, Muller S, Haverich A, Martin U, Zweigerdt R, Skorska A, von Haehling S, Ludwig M, Slavic S, Curato C, Altarche-Xifro W, Unger T, Steinhoff G, Li J, Zhang Y, Li WZ, Ou L, Lux CA, Ma N, Steinhoff G, Haase A, Alt R, Schwanke K, Martin U. 3rd EACTS Meeting on Cardiac and Pulmonary Regeneration Berlin-Brandenburgische Akademie, Berlin, Germany, 14-15 December 2012. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivs561] [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: 11/13/2022] Open
|
32
|
Bernabei M, Margaryan R, Arcieri L, Bianchi G, Pak V, Murzi B. Aortic arch reconstruction in newborns with an autologous pericardial patch: contemporary results. Interact Cardiovasc Thorac Surg 2012; 16:282-5. [PMID: 23223671 DOI: 10.1093/icvts/ivs510] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The incidence of recurrent aortic arch obstruction after Norwood procedure and other types of aortic arch reconstruction in newborns remains high. Biological and synthetic materials are used to enlarge the aorta. We report our experience using autologous pericardium to reconstruct the aortic arch in patients with hypoplastic left heart syndrome, aortic arch interruption and hypoplastic aortic arch. METHODS A retrospective analysis of 39 consecutively operated patients evaluated after an initial Norwood and other types aortic arch repair was performed. The presence of recurrent arch obstruction (mean gradient ≥ 20 mmHg) and its management were noted. The mean weight of our patients was 3.2 ± 0.7 kg. RESULTS The mean age at primary surgical correction was 7.4 ± 6.8 (range 1-35 days). All patients were discharged without a significant residual gradient at the aortic arch except 4 who had a peak gradient of ≥ 30 mmHg. The overall incidence of recurrent arch obstruction was 28.2% (11 patients). Four (12.1%) patients had a distal obstruction, 1 (3%) had proximal obstruction and 1 had a mid-transverse arch obstruction. All patients underwent aortic arch reintervention consisting of balloon dilatation, and only after unsuccessful dilatation, 3 underwent surgical patch aortoplasties. CONCLUSIONS The use of autologous pericardium in aortic arch reconstruction procedure is effective and associated with an acceptable incidence of recurrent arch obstruction. Its availability and characteristics make it an attractive alternative to other materials.
Collapse
Affiliation(s)
- Massimo Bernabei
- Department of Congenital Heart Disease, Ospedale Del Cuore Fondazione G. Monasterio, Massa, Italy
| | | | | | | | | | | |
Collapse
|
33
|
Arcieri L, Margaryan R, Murzi M, Cantinotti M, Murzi B. Repair of partial anomalous pulmonary venous connection in the Scimitar syndrome using vacuum-assisted venous drainage. J Card Surg 2012; 27:618-20. [PMID: 22757741 DOI: 10.1111/j.1540-8191.2012.01491.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Partial anomalous pulmonary venous connection with drainage into the inferior vena cava (Scimitar syndrome, SS) is rare in adults. Surgical procedures to correct SS often require circulatory arrest. We describe a method to avoid circulatory arrest using vacuum-assisted venous drainage.
Collapse
Affiliation(s)
- Luigi Arcieri
- Pediatric Cardiac Surgery Unit, Department of Pediatric Cardiology and Cardiac Surgery, Heart Hospital, G.M. Tuscany Foundation, Massa, Italy.
| | | | | | | | | |
Collapse
|
34
|
Margaryan R, Arcieri L, Cantinotti M, Murzi B. Surgical closure of big pulmonary artery-left atrial fistula. Interact Cardiovasc Thorac Surg 2010; 10:113-4. [DOI: 10.1510/icvts.2009.215350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
35
|
|
36
|
Cantinotti M, Maizza AF, Murzi M, Assanta N, Margaryan R, Recla S, Murzi B. Aortic arch laceration during aortic coarctation repair in a low-weight neonate and use of an extra-anatomical conduit. J Cardiovasc Med (Hagerstown) 2009; 10:497-8. [PMID: 19359996 DOI: 10.2459/jcm.0b013e32832a49b7] [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: 11/05/2022]
Abstract
We report the case of a 3-day-old male baby, weighing 1.6 kg with severe aortic coarctation and associated cardiac anomalies and extracardiac defects. We adopted an extra-anatomical conduit running from the left carotid artery to the descending aorta after laceration of the distal aortic arch due to extreme tissue fragility and baby immaturity.
Collapse
|