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Predictor Analysis for Acute Type A Aortic Dissection in Small Aortic Diameters. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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Comparative prognostic value of parameters of right ventricular pulsatile afterload in patients with advanced heart failure awaiting heart transplantation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) function demonstrated a strong impact on survival of patients with advanced heart failure with reduced ejection fraction (HFrEF). In particular, increased RV pulsatile afterload (RVPA) was associated with poor prognosis. Several right heart catheterization-derived parameters have been proposed to characterize RVPA, including pulmonary artery compliance (PAC), elastance (PAE) and pulsatile index (PAPi). However, among these indices, the best prognostic indicator is undetermined.
Purpose
To assess the prognostic relevance of RVPA parameters in patients with advanced HFrEF evaluated for heart transplantation.
Methods
149 patients with end-stage HFrEF underwent right heart catheterization during the evaluation for heart transplantation. All patients were clinically followed up until death or any censoring events including heart transplantation, left ventricular assist device (LVAD) and hospitalization for acute heart failure. Cox regression and ROC-curve analysis were used to test the prognostic value of RVPA determinants. Multivariate regression models with C-statistics were used to test the independent predictive value of RVPA indices.
Results
The mean age of the study population was 56.6±10.1 years and 85.2% were male. The most frequent aetiology of HFrEF was ischemic cardiomyopathy (52.3%). Mean LV ejection fraction was 25.7±10.2%.
During a mean follow up time of 17±15 months, 29 (19.5%) patients met the primary endpoint: 9 (6%) patients died, 4 (2.68%) patients underwent an urgent heart transplantation, 11 (7.3%) patients underwent urgent LVAD implantation (as bridge to transplantation therapy) and 5 (3.3%) were hospitalized for HF.
Patients who met the primary endpoint were significantly older patients (61.2±7.8 vs 55.4±10.2, p=0.006) and with worse hemodynamic profile than event-free survivors (PAC [1.8±0.8 vs. 2.7±2.0, p=0.01], mPAP [33.5±11.3 vs. 29.3±11.0, p=0.05], PVR [3.0±1.6 vs. 2.6±2.0, p=0.09] and PAE [1.12±0.5 vs. 0.98±0.6, p=0.04]).
Among the RVPA parameters PAC<1.9 mL/mmHg (HR 4.0, CI 1.3–6.0, p=0.007) and PAE>0.9 mmHg/mL (HR 2.5, 95% CI 1.1–5.2, p=0.02) were associated with the primary endpoint. On the contrary, PAPi was not significantly associated with the outcome.
PAC demonstrated a superior predictive value for the composite adverse outcome compared with pulmonary vascular resistances (PVR) (AUC comparison p=0.019) and PAPi (p=0.03) but similar compared with PAE (p=0.19) and mPAP (p=0.51). In multivariable regression models, PAC, but not PAE showed incremental prognostic value compared with cardiac index (p=0.02).
Conclusions
Hemodynamic indices of RVPA are associated with worse survival in patients with end-stage heart failure. In particular, PAC and PAE demonstrated superior prognostic value compared with PAPi and steady-state PVR. Moreover, PAC showed incremental prognostic value compared with cardiac index in patients awaiting heart transplantation.
Funding Acknowledgement
Type of funding sources: None.
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Acute Kidney Injury after Coronary Artery Bypass Grafting: A Risk Factor Analysis. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Impact of Off-Pump Coronary Bypass Surgery Experience on Early Postoperative Outcome Results from the E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting). Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Multicenter Italian Study on Radial Mechanically Assisted Circulatory Support (MIRAMACS): Preliminary Results. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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6
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On-Pump versus Off-Pump Coronary Bypass Grafting in Patients with Non–Dialysis-Dependent Renal Impairment. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Impact of Aortic Manipulation on High Perioperative Cerebral Stroke Risk Undergoing Coronary Artery Bypass Grafting: Results from the E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting). Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Infectious complications in patients receiving ticagrelor or clopidogrel before coronary artery bypass grafting. J Hosp Infect 2020; 104:236-238. [DOI: 10.1016/j.jhin.2019.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/20/2019] [Indexed: 11/27/2022]
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Outcome of Patients with Elevated Risk of Bleeding in on- versus off-pump Coronary Artery Bypass Grafting (CABG). Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Effects of Aortic Valve Replacement on Left Ventricular Diastolic Function in Patients With Aortic Valve Stenosis. Am J Cardiol 2019; 124:409-415. [PMID: 31186115 DOI: 10.1016/j.amjcard.2019.04.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/13/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
The afterload increase imposed by severe aortic valve stenosis (AS) creates concentric left ventricular (LV) remodeling and diastolic dysfunction (DD), which are both markers of poor clinical outcome. Ideally, a correctly timed surgery for isolated AS can reverse the LV remodeling. However, data on LV DD after aortic valve replacement (AVR) are sparse and contrasting. Aims of the study are to define the markers of a favorable evolution of the DD at follow-up. Patients with severe isolated AS, scheduled for AVR were prospectively enrolled. Transthoracic echocardiography with DD assessment was performed before surgery, and at 12 months after surgery. Global LV longitudinal and circumferential strain, peak atrial longitudinal and contraction strain (PALS, PACS) were obtained at baseline. LV septal biopsy to assess fibrosis was performed at the time of AVR. Sixty-seven patients were enrolled, age 72 ± 8 years, 66% female, ejection fraction 61 ± 8%, E/e' 13 ± 6, PALS 23 ± 7%. Normal estimated left atrial pressure was detected in 19/67 (28%) versus 43/67 (64%) at follow-up (p <0.0001). In the 37 patients with biopsy available, fibrosis was 24 ± 12%. PALS and AS severity were correlated with LV fibrosis (R2 = 0.19; p = 0.006, and R2 = 0.15; p = 0.02, respectively). PALS (odds ratio: 1.19 [1.05 to 1.41], p = 0.02) and PACS (odds ratio: 1.24 [1.06 to 1.50], p = 0.006) were the only baseline noninvasive parameters independently associated with normal left atrial pressure at follow-up. Mean follow-up time was 791 ± 245 days, and 8 (12%) patients had cardiovascular events (death, hospital admission due to heart failure or ischemic disease, and onset of atrial fibrillation). Myocardial fibrosis (p = 0.05), baseline PALS (p = 0.004), and PACS (p = 0.03) were associated with cardiovascular events. In conclusion, LV diastolic function generally improves after AVR for severe AS. Baseline PALS, PACS, and LV fibrosis were related to the DD and clinical outcome at follow-up; these parameters might cue a better diastolic response to the afterload correction.
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The Effects of Echo-Optimization of Left Ventricular Assist Devices on Functional Capacity: A RAndomized Controlled Trial (VAFRACT). J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Prevalence and Outcome of CABG in Patients with Severely Reduced Ejection Fraction. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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OC62 REDO MITRAL SURGERY AND HOSPITAL OUTCOME. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549859.74998.9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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RF44 OUTCOME AFTER BILATERAL INTERNAL MAMMARY ARTERY GRAFTING IN HIGH- AND LOW-VOLUME HOSPITALS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550065.57416.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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OC87 VALUE OF SCREENING ASYMPTOMATIC CAROTID ARTERY STENOSIS PRIOR TO CORONARY ARTERY BYPASS GRAFTING. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549900.42650.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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RF14 CONSEQUENCES OF PRESSURE OVERLOAD AS DETECTED BY LEFT ATRIAL AND VENTRICULAR STRAIN IN PATIENTS WITH SEVERE AORTIC STENOSIS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550043.20260.a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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OC88 COMPARATIVE ANALYSIS OF PROTHROMBIN COMPLEX CONCENTRATE AND FRESH FROZEN PLASMA IN THE MANAGEMENT OF PERIOPERATIVE BLEEDING AFTER CORONARY ARTERY BYPASS GRAFTING. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549930.69572.f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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OC71 SURGICAL TREATMENT FOR ISOLATED TRICUSPID VALVE INFECTIVE ENDOCARDITIS. 25-YEAR RESULTS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549876.95190.c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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OC11 CLINICAL FRAILTY SCALE AND OUTCOME AFTER CORONARY ARTERY BYPASS GRAFTING. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549902.50273.ff] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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RF67 REDO MITRAL SURGERY AND HOSPITAL OUTCOME. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550012.26990.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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OC04 BASELINE ATRIAL STRAIN RELATES TO POST-SURGICAL FOLLOW UP IN SEVERE AORTIC STENOSIS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549885.49380.9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Body Perfusion during Adult Cardiopulmonary Bypass is Improved by Pulsatile flow with Intra-Aortic Balloon Pump. Int J Artif Organs 2018; 32:50-61. [DOI: 10.1177/039139880903200107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To evaluate if the use of an intra-aortic balloon pump (IABP) during cardioplegic arrest improves body perfusion. Methods 158 coronary artery bypass graft (CABG) patients were randomized to linear cardiopulmonary bypass (CPB) (n=71, Group A) or automatic 80 bpm intra-aortic ballon pump (IABP) induced pulsatile CPB (n=87, Group B). We evaluated hemodynamic response by Swan-Ganz catheter, inflammation by cytokines, coagulation and fibrinolysis, transaminase, bilirubin, amylase, lactate and renal function (estimated glomerular filtration rate (eGFR), creatinine, and incidence of renal insufficiency and failure). Results IABP induced Surplus Hemodynamic Energy was 15.8±4.9 mmHg, with higher mean arterial pressure during cross-clamping (p=0.001), and lower indexed systemic vascular resistances during cross-clamping (p=0.001) and CPB discontinuation (p=0.034). IL-2 and IL-6 were lower, while IL-10 proved higher in Group B (p<0.05). Group B showed lower chest drainage (p<0.05), transfusions (p<0.05), INR (p<0.05), and AT-III (p=0.001), together with higher platelets, aPTT (p<0.05), fibrinogen (p<0.05) and D-dimer (p<0.05). Transaminases, bilirubin, amylase, lactate were lower in Group B (p<0.05); eGFR was better in Group B from ITU-arrival to 48 hours, both in preoperative kidney disease Stages 1–2 (p<0.03) and Stage 3 (p<0.05), resulting in lower creatinine from ITU-arrival to 48 hours (p<0.03). Incidence of renal insufficiency (p=0.004) and need for renal replacement therapy (p=0.044) was lower in Group B Stage 3. Group B PaO2/FiO2 and lung compliance improved from aortic declamping to the first day (p<0.003) with shorter intubation time (p=0.01). Conclusion Pulsatile flow by IABP improves whole-body perfusion during CPB.
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Mass-spring models for the simulation of mitral valve function: Looking for a trade-off between reliability and time-efficiency. Med Eng Phys 2017; 47:93-104. [DOI: 10.1016/j.medengphy.2017.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/23/2017] [Accepted: 07/03/2017] [Indexed: 11/27/2022]
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P1640Anatomic aortic valve area by multi-detector computed tomography: pilot study of semi-automatic custom software assessment compared to doppler-echocardiography. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Risk Factors and Complications Affecting Hospital Outcome after Redo Mitral Surgery. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Is TAVI superior to surgery in high-risk patients? Insight into the concept of individual risk assessment. Minerva Med 2014; 105:487-495. [PMID: 25274462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The prevalence of aortic valve stenosis (AS) is growing in developed countries because its prevalence increases with age. A growing number of elderly patients are currently referred to specialized centres to be evaluated for potential therapeutic strategies. Indeed, two techniques are nowadays able to treat high-risk AS patients: TAVI and surgical replacement (AVR). It is the purpose of the present review to summarize current knowledge on safety and efficacy of AVR and TAVI in high-risk patients; to focus on some aspects of recently published guidelines; to emphasize the growing importance of pre-operative individual risk assessment, which is considered the real crucial point for patient selection and trial's comparisons. Indeed, it is worth of noting that currently adopted risk-scores do not show satisfactory performances. Accordingly, it becomes of utmost importance to investigate several baseline but still neglected patients' characteristics (e.g. frailty, functional status, co-morbid conditions, etc.), as well as their pathogenetic relationships with interventional results and follow-up prognosis. All these items are emphasized in the present review. Finally, we have tried to anticipate future scenarios in terms of both ongoing clinical trials and improvements of risk-scores.
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Coastal microbial quality of surface sediments in different environments along the Italian coast. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2014; 16:2165-2171. [PMID: 24977391 DOI: 10.1039/c4em00225c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In order to improve sediment handling following dredging operations, this study aims to statistically derive ranges of distribution for certain microbiological parameters, according to four environmental types inspired by Italian legislation on seaports: ports of international/national importance, ports of regional importance, port channels in brackish environments, and marine coastal areas. A national database was developed using microbiological data from technical reports available at the Italian Ministry of Environment and National Institute of Environmental Protection and Research (ISPRA) for the period 1990-2008. The parameters considered were total coliform bacteria, faecal coliform bacteria, Escherichia coli, enterococci, sulfite-reducing clostridia (SRC), total bacterial counts at 22 °C and at 37 °C, and fungi. The data were statistically analyzed: (1) to verify the correspondence with the identified environmental types and rank them according to the concentration gradient and (2) to describe the data distribution in order to obtain reference ranges typical for each parameter/environmental type. The four environmental types considered were clearly different for enterococci, SRC, and fungi, highlighting a correspondence with Italian legislation. For the remaining parameters, at least two environmental types were merged. In general, the less contaminated environments were small ports and relatively unimpacted coastal areas. The ranges defined for relatively clean coastal areas can be considered a target for other areas both from an environmental point of view and for the sediment management implications. These values could be used as a comparison in environmental surveys addressing marine or brackish sediment handling and may represent a future line of evidence for the assessment of overall sediment quality.
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Functional mitral regurgitation in patients with aortic stenosis: prevalence, clinical correlates and pathophysiological determinants: a quantitative prospective study. Eur Heart J Cardiovasc Imaging 2014; 15:631-636. [DOI: 10.1093/ehjci/jet269] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Outcome of redo surgical aortic valve replacement in patients aged more than 80 years: Results from the multicenter RECORD initiative. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Detrimental impact of prosthetic aortic endocarditis on early and long-term outcome: Results from a Multicenter European Initiative. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Incidence and determinants of stroke after surgical aortic valve replacement in patients with prior cardiac surgery: Results from the multicenter RECORD initiative. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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113 * A POSITIVE INFLUENCE OF PULSATILE CARDIOPULMONARY BYPASS ON RENAL FUNCTION IN ELDERLY PATIENTS UNDERGOING AORTIC VALVE SURGERY. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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064 * TEN-YEAR RESULTS OF REDO AORTIC VALVE SURGERY IN CURRENT PRACTICE: RESULTS FROM THE MULTICENTRE EUROPEAN REDO CARDIAC OPERATIONS RESEARCH DATABASE (RECORD) INITIATIVE. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Selective pulmonary pulsatile perfusion with oxygenated blood during cardiopulmonary bypass attenuates lung tissue inflammation but does not affect circulating cytokine levels. Eur J Cardiothorac Surg 2012; 42:942-50. [DOI: 10.1093/ejcts/ezs199] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Atrial fibrillation ablation induces reverse remodelling and impacts cardiac function. Minerva Cardioangiol 2011; 59:17-29. [PMID: 21285928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Atrio-ventricular anatomo-functional response to successful surgical atrial fibrillation (AF) ablation has been poorly investigated. Determinants of AF recurrence following surgical ablation are still debated. METHODS Sixty-nine patients underwent AF ablation during major cardiac surgery. Main outcomes were clinical and echocardiographic results after monopolar and/or bipolar ablation were recorded. Secondary outcomes were freedom from AF, rehospitalization and congestive heart failure (CHF) at follow-up. Predictors of AF-recurrence were evaluated. RESULTS Fifty-three patients (76.8%) were in sinus rhythm (SR) at 31.4±10.6 months of mean follow-up. Overall freedom from AF-recurrence was 61.4±6.6%, from hospital readmission 89.9±3.6%, from CHF 91.9±5.05%. Compared to AF-patients, SR-patients demonstrated better freedom from re-hospitalization (98.1±1.9% vs. 62.5±12.1%; P=0.0001) and CHF (94.7±5.1% vs. 77.8±13.9%; P=0.006). At follow-up SR-patients demonstrated atrial (preoperative 5.9±1.2 cm vs. follow-up 5.2±1.0; P=0.01) and ventricular reverse remodelling (preoperative LVDd 5.8±1.6cm vs. follow-up 5.0±1.3 cm; P=0.002 - preoperative LVDs 4.2±1.8 cm vs. follow-up 3.8±1.2 cm; P=0.045). E/A ratio was normal in 90.6% of SR-patients (69.6% of the total population of the study). TDI at the level of the left lateral annulus showed an improved left ventricular systole (Sm), and diastole (Em, E/Em) for SR-patients compared to AF-patients (Sm 9.30±1.66 vs. 7.81±1.41, P=0.001; Em: 10.55±1.87 vs. 7.44±0.40, P=0.001; E/Em: 0.06±0.02 vs. 0.11±0.05, P=0.0001). Preoperative atrial diameter (OR=23.9; P=0.002) and tricuspid insufficiency at follow-up (OR=3.5; P=0.008) were independent predictors of AF-recurrence. Neither etiology, nor duration of AF, nor even ablation technique influenced SR recovery (P=NS for all measurement). CONCLUSION Radiofrequency AF ablation achieves 76.8% of SR recovery at follow-up. Maintenance of SR improves clinical, haemodynamic and echocardiographic results.
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Use of clonidine following the weaning phase of the elderly patients underwent elective on-pump cardiac surgery: a prospective randomized study. BMC Geriatr 2010. [PMCID: PMC3290245 DOI: 10.1186/1471-2318-10-s1-a97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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The Sequential Organ Failure Assessment (SOFA) score: a useful prognostic instrument after cardiac surgery for the elderly patient. BMC Geriatr 2010. [PMCID: PMC3290247 DOI: 10.1186/1471-2318-10-s1-a99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Intensive versus conventional insulinotherapy after elective and on-pump myocardial revascularization in the elderly patient: a prospective and randomized study. BMC Geriatr 2010. [PMCID: PMC3290246 DOI: 10.1186/1471-2318-10-s1-a98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Intensive versus conventional insulinotherapy after elective and on-pump myocardial revascularization: a prospective and randomized study. LA CLINICA TERAPEUTICA 2010; 161:e33-e37. [PMID: 20499017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Strict glycemic control is increasingly recognized as an important goal in a broad spectrum of critically ill patients. We analyzed the inflammatory and clinical response of patients submitted to intensive or conventional insulinotherapy in a specific clinical context. MATERIALS AND METHODS We analyzed a prospective and randomized collected database of an Intensive Care Unit (ICU) in a University Hospital. The database comprised a total of 50 patients aged 30 to 80 (ASA II-III) who underwent elective and on-pump myocardial revascularization from September 2006 to June 2008. On ICU admission, patients were randomly assigned to Group 1 (intensive insulinotherapy) or Group 2 (conventional insulinotherapy). Data collected included glucose and lactate blood levels, haemodynamic parameters, cytokines (TNFalpha, IL-6, IL-8, IL-10), C-Reactive Protein, white blood cells and platelets blood levels, body temperature, Sequential Organ Failure Assessment (SOFA) score, Infection Probability Score (IPS) and ICU length of stay (LOS). Within-between group analysis, one-way ANOVA and unpaired t-test were used when appropriate. RESULTS Pre- and perioperative variables were comparable between the two groups (p=NS for all measurements). Glucose and lactate blood levels were lower in Group 1 (p less than 0.0001). Stroke Volume Index was higher in Group 1 (p less than 0.05). Moreover, we observed statistically significant differences between groups in terms of inflammatory parameters and severity scores. No difference was observed in ICU LOS. CONCLUSIONS Intensive insulinotherapy after elective on-pump myocardial revascularization significantly modulates the inflammatory response. Different inflammatory patterns could correlate with different clinical response as suggested by SOFA and IP score analysis.
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Inflammatory response after cardiopulmonary bypass: a randomized comparison between conventional hemofiltration and steroids. THE JOURNAL OF CARDIOVASCULAR SURGERY 2009; 50:555-564. [PMID: 19262457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM Recent reports have shown anti-inflammatory effects with conventional hemofiltration (CUF) in patients undergoing cardiopulmonary bypass (CPB). The aim of this study was to evaluate the immunological and the hemodynamic response to CUF or metilprednisolone in patients undergoing coronary artery bypass grafting. METHODS Twenty-four consecutive patients were prospectively randomized to receive CUF (12 patients, Group A) or metilprednisolone (12 patients, Group B). Hemodynamic response was evaluated by Swan-Ganz catheter, immunological response was analyzed by IL-2, IL-4, IL-6, TNF-alpha, IFN-gamma, IL-10 before anesthetic induction (T0), at aortic-declamping (T1), at the end of surgery (T2), ITU admission (T3) and 24 hours (T4). Troponin I was measured at the same time-points. Hematological and coagulative controls were performed. RESULTS Morbidity and mortality were comparable between the two groups. Group A demonstrated lower cardiac index at T1 (2.1 +/- 0.69 L/min m2 vs. 3.917 +/- 1.28, P = 0.034) without significantly higher indexed-systemic-vascular-resistances at the end of surgery (1 101 +/- 434.3 dyne s cm(-5) m(-2) vs. 797.7 +/- 316.67, P = 0.233). When proinflammatory and anti-inflammatory cytokines were considered, all improved during the postoperative time course, without differences between the 2 Groups (P = NS). Hematological and coagulative data were similar in the two groups, in terms of white blood cells, platelets, prothrombin time, and activated partial thromboplastin time (P = NS). CONCLUSIONS Anti-inflammatory action of CUF was comparable to steroids, thus determining a similar proinflammatory response to CPB. However, hemodynamics was slightly impaired by CUF. Therefore, there is no reason to prefer CUF to steroids in patients undergoing elective CABG.
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Safety and efficacy of transbrachial intra-aortic balloon pumping with the use of 7-Fr catheters in patients undergoing coronary bypass surgery. Interact Cardiovasc Thorac Surg 2009; 9:135-7. [DOI: 10.1510/icvts.2009.205823] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Expression profiles in surgically-induced carotid stenosis: a combined transcriptomic and proteomic investigation. J Cell Mol Med 2009; 12:1956-73. [PMID: 19012726 PMCID: PMC4506163 DOI: 10.1111/j.1582-4934.2008.00212.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Vascular injury aimed at stenosis removal induces local reactions often leading to restenosis. The aim of this study was a concerted transcriptomic-proteomics analysis of molecular variations in a model of rat carotid arteriotomy, to dissect the molecular pathways triggered by vascular surgical injury and to identify new potential anti-restenosis targets. RNA and proteins extracted from inbred Wistar Kyoro (WKY) rat carotids harvested 4 hrs, 48 hrs and 7 days after arteriotomy were analysed by Affymetrix rat microarrays and by bidimensional electrophoresis followed by liquid chromatography and tandem mass spectrometry, using as reference the RNA and the proteins extracted from uninjured rat carotids. Results were classified according to their biological function, and the most significant Kyoro Encyclopedia of Genes and Genomes (KEGG) pathways were identified. A total of 1163 mRNAs were differentially regulated in arteriotomy-injured carotids 4 hrs, 48 hrs and 7 days after injury (P < 0.0001, fold-change > or =2), while 48 spots exhibited significant changes after carotid arteriotomy (P < 0.05, fold-change > or =2). Among them, 16 spots were successfully identified and resulted to correspond to a set of 19 proteins. mRNAs were mainly involved in signal transduction, oxidative stress/inflammation and remodelling, including many new potential targets for limitation of surgically induced (re)stenosis (e.g. Arginase I, Kruppel like factors). Proteome analysis confirmed and extended the microrarray data, revealing time-dependent post-translational modifications of Hsp27, haptoglobin and contrapsin-like protease inhibitor 6, and the differential expression of proteins mainly involved in contractility. Transcriptomic and proteomic methods revealed functional categories with different preferences, related to the experimental sensitivity and to mechanisms of regulation. The comparative analysis revealed correlation between transcriptional and translational expression for 47% of identified proteins. Exceptions from this correlation confirm the complementarities of these approaches.
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Early intra-aortic balloon pumping following perioperative myocardial injury improves hospital and mid-term prognosis. Interact Cardiovasc Thorac Surg 2008; 8:310-5. [DOI: 10.1510/icvts.2008.190884] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Valve preservation in acute type A aortic dissection: 13-year experience. THE JOURNAL OF CARDIOVASCULAR SURGERY 2008; 49:685-689. [PMID: 18670388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM Aortic dissection is frequently complicated by regurgitation of the aortic valve resulting from leaflet prolapse or tearing of the annulus or leaflet. The authors have evaluated the results using the technique of aortic valve preservation in patients with acute type A aortic dissection (AAD). METHODS In a consecutive series of 79 AAD observed from January 1994 to September 2007, 51 (64.6%) presented aortic valve insufficiency (AI). All patients were emergency operated on via median sternotomy and femoral (46/79, 58.2%) or axillary artery-right atrium (33/79, 41.8%) cardiopulmonary bypass with 60 cases (75.9%) of antegrade selective cerebral perfusion. The dissected aorta was resected and the aortic valve was replaced in 2 patients/51 (3.9%) and was preserved in the remaining 49 cases as follows: 42 (85.7%) commissural resuspensions due to commissural prolapse, 3 (6.1%) resuspensions due to cusp prolapse, 3 (6.1%) commissural plication and 1 (2.1%) circumclusion due to annular dilatation. RESULTS The overall hospital mortality was 20.3% (16/79) with a percentage of 19.6% (10/51) in the AI group. 1 patient presented a type B dissection at 1 months and died after reoperation. The remaining 40 patients with a preserved native valve were followed by echocardiography and computed tomography (CT) (follow-up ranged from 3 to 165 months) with 4 late deaths. Twenty-six patients had absent or grade I AI (72.2%), 8 had grade II AI (22.2%) and 2 presented grade III or IV AI (5.6%). Actuarial freedom from significant AI was 96.2+/-2.4% and 94.2+/-2.3% at 5 and 10 years respectively. CONCLUSION The experience with this technique demonstrates the effectiveness of valve conservative treatment within a vascular graft. The reconstruction of the sinotubular junction reducing annular dilatation with appropriated sized graft is obviously mandatory. Although this procedure is not applicable to every patient, we firmly believe that is a valid option when a morphologically intact valve is present.
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Aortic tube grafts wrapping with hemostatic fleeces reduces postoperative pericardial effusions. THE JOURNAL OF CARDIOVASCULAR SURGERY 2008; 49:393-397. [PMID: 18446127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Pericardial effusions often complicate the postoperative course of ascending aortic surgery. We evaluated whether an unconventional use of hemostatic fleeces (TachoSil, Nycomed; Austria), wrapped around aortic tube grafts, may reduce such complication. Twenty-nine consecutive patients undergoing button-Bentall were submitted - according to surgeon's choice - to 360 degrees wrapping of the aortic grafts with hemostatic fleeces immediately before sternal wiring (11 patients - group A) or sternal wiring without any wrapping of the prosthesis (18 patients - group B). Hospital outcome was recorded. No differences were recorded in hospital mortality and major organ morbidity. When pericardial complications were considered, group A showed lower chest drains (P=0.0001), time of chest drainage (P=0.002), pretamponade/tamponade with need for pericardiocentesis (P=0.039), predischarge echocardiographic amount of pericardial effusion (P=0.026), fever (P=0.029), need for anti-inflammatory (P=0.05) or antibiotic drugs (P=0.007), hospital stay (P=0.010) and white blood cell count (P=0.016 on postoperative day 3; P=0.014 on day 6). Wrapping of aortic tube grafts with hemostatic fleeces is effective in reducing pericardial effusion and its deleterious effects following aortic surgery.
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Metal content and toxicity of produced formation water (PFW): study of the possible effects of the discharge on marine environment. ARCHIVES OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2007; 53:183-90. [PMID: 17549537 DOI: 10.1007/s00244-006-0098-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 11/10/2006] [Indexed: 05/15/2023]
Abstract
A preliminary chemical and ecotoxicological assessment was performed on the produced formation water (PFW) and superficial sediment around a gas platform (Fratello Cluster), located in the Adriatic Sea (Italy), in order to evaluate the effects of PFW discharged from the installation. The ecotoxicological bioassays, with the marine bacterium Vibrio fischeri and the sea urchin Paracentrotus lividus, were associated with chemical data to estimate the possible effects on living organisms. PFW collected on the platform was toxic, but no significant effect was recorded on marine sediment. Only the sediment station nearest to the discharge point showed higher values of some contaminants (zinc and arsenic) in comparison to other sites and only some stations showed low toxicity.
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Perioperative optic neuropathy following off-pump coronary artery bypass grafting. THE JOURNAL OF CARDIOVASCULAR SURGERY 2006; 47:585-7. [PMID: 17033608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Visual loss from ischemic perioperative optic neuropathy (PON) rarely occurs during the postoperative period of patients undergoing cardiac surgery. Since the first description, PON has been associated with cardiopulmonary bypass (CPB), being some CPB-related complications and epiphenomena considered the causes of such terrible complication. In particular, the risk for micro-embolization during aortic cannulation and clamping, the CPB-related inflammatory response, the hemodilution and the hypothermia during CPB could be responsible of PON. However, some cases of PON still remain idiopathic. We report here a very rare case of PON following off-pump surgery in a patient with severe coronary disease and multiorgan comorbidities. The case reported opens the debate on the potential mechanisms underlying PON, other than cardiopulmonary bypass.
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Usefulness of the axillary artery as vascular access for cardiopulmonary bypass. THE JOURNAL OF CARDIOVASCULAR SURGERY 2006; 47:457-60. [PMID: 16953166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
AIM In this paper we report our clinical experience with extended utilization of axillary artery cannulation for cardiopulmonary bypass (CPB) and discuss the indications and the results of the procedure in terms of complications and usefulness. METHODS Between January 1999 and May 2004, 26 patients underwent right axillary artery cannulation for CPB. Fifteen patients presented acute type A aortic dissection and were operated urgently. Axillary cannulation was also used in 11 elective cases: 3 reoperative coronary surgery, 3 valve redo-operations and 5 cases of aortic valve regurgitation+aneurysm of the ascending aorta. RESULTS All axillary artery cannulations were successful (21 direct and 5 with a side graft) without neurologic or vascular injuries to the right upper extremities. Hospital mortality was 7.7% and included 2 patients operated in an emergency procedure because of acute type A aortic dissection. In all cases, this cannulation site provided adequate perfusion, with a range of peak flows from 4.1 to 5.7 L/min. CONCLUSION Our preliminary results demonstrate that the right axillary artery may be considered an alternative cannulation site for achieving full CPB and providing antegrade flow, thus avoiding complications related to retrograde flow when femoral artery perfusion is performed. This safe and useful method may be used not only in aortic surgery but in other such complex cardiac procedures as redo-operations.
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Ventricular assistance with microaxial flow pump following mitral repair for dilated cardiomyopathy. Int J Artif Organs 2006; 29:591-5. [PMID: 16841288 DOI: 10.1177/039139880602900608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Postcardiotomy heart failure is still the main cause of death in patients undergoing palliative surgery for end-stage dilative cardiomyopathy. New micro-axial flow ventricular assisting devices (LVAD) have been suggested in such cases. OBJECTIVE Evaluate the effect of the new LVAD on short-term outcome of a patient admitted for end-stage heart failure. STUDY DESIGN Case report. DATA SOURCES One patient admitted for severe mitral regurgitation secondary to end-stage dilative cardiomyopathy and chronic atrial fibrillation (AF). INTERVENTION Preoperative intraaortic balloon pump (IABP) insertion, mitral plasty with radiofrequency ablation of AF, microaxial flow LVAD support. RESULTS The patient was unweanable from cardiopulmonary bypass until microaxial flow LVAD unloaded the left ventricle and restored adequate cardiac function. The patient was discharged home and is still well at 5 months folllow-up. CONCLUSIONS The miniinvasive insertion and withdrawal, low anticoagulation protocols, and the possibility of coupling with IABP make the microaxial flow LVAD promising for patients with end-stage heart failure undergoing surgery.
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Myocardial protection with insulin cardioplegia: who can really benefit? THE JOURNAL OF CARDIOVASCULAR SURGERY 2005; 46:569-76. [PMID: 16424845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
AIM The aim of the study was to evaluate the effects on myocardial protection of insulin-enriched warm blood cardioplegia (IWBC) in coronary artery bypass grafting (CABG) and in subgroups of patients with associated cardiac co-morbidities. METHODS Between May 2000 and December 2002, 268 consecutive patients underwent CABG with warm blood cardioplegia (group A) or IWBC (10 UI/L) (group B). Hospital outcome, ECG, echocardiography and biochemical markers of ischemia were compared. Differences between subgroups of patients with unstable angina (UA), ventricular hypertrophy (VH) and diabetes were assessed. RESULTS Hospital mortality, incidence of postoperative myocardial infarction and low output syndrome, IABP requirement, postoperative atrial fibrillation, in-hospital and in-ITU stay, postoperative recovery of left ventricular function and enzyme leakage did not show differences between the 2 groups; inotropic support was lower in IWBC. Moreover, patients with UA and IWBC showed a lower troponin I (TnI) (12 h: 0.82+/-0.57 ng/mL vs 2.56+/-1.18, P < 0.0001; 24 h: 0.71+/-0.64 vs 2.16+/-1.52, P < 0.0001; 48 h: 0.69+/-1.13 vs 1.79+/-1.43, P = 0.001; 72 h: 0.44+/-0.83 vs 1.01+/-1.02, P = 0.001), lower incidence of atrial fibrillation (4.2% versus 60.6%; P < 0.0001) and intraoperative defibrillation (0% versus 27.3%; P = 0.007). Furthermore, patients with VH treated with IWBC showed lower level of TnI (12 h: 0.41+/-0.32 ng/mL vs 2.93+/-0.67, P < 0.0001; 24 h: 0.37+/-0.45 vs 2.40+/-1.28, P < 0.0001; 48 h: 0.22+/-0.18 vs 1.95+/-1.33, P < 0.0001; 72 h: 0.12+/-0.12 vs 1.31+/-1.56, P < 0.0001), lower atrial fibrillation (6.5% vs 48%, P < 0.0001) and ventricular defibrillation (0% vs 20%, P = 0.011). CONCLUSIONS Insulin addiction to blood cardioplegia does not show any benefit in the global population and in diabetics; nevertheless, better myocardial protection can be demonstrated in patients with unstable angina and left ventricular hypertrophy.
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