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Ponzoni M, Morabito G, Corrao G, Gerosa G, Cantarutti A, Rea F. The COVID-19 Pandemic Was Associated with a Change in Therapeutic Management and Mortality in Heart Failure Patients. J Clin Med 2024; 13:2625. [PMID: 38731152 PMCID: PMC11084396 DOI: 10.3390/jcm13092625] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Heart failure (HF)-related mortality has been exacerbated by the COVID-19 pandemic; however, it is unclear how healthcare reassessment has contributed to the excess mortality versus SARS-CoV-2 infection itself. We aimed to assess how the pandemic affected the therapeutic management and prognosis of HF patients. Methods: We retrospectively reviewed the healthcare utilization databases of the Lombardy region (Italy) to identify all newly-diagnosed HF patients from January 2018 to December 2021. Outcomes were the utilization of HF therapies (Sacubitril/Valsartan; cardiac resynchronization therapy [CRT] and/or implantable cardioverter-defibrillator [ICD]; mechanical circulatory support [MCS]; heart transplantation [HTX]) and mortality. Cox regression models were fitted to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for outcomes associated with the pandemic. Results: 36,130 and 17,263 patients were identified in the pre-pandemic and pandemic eras, respectively. The pandemic reduced Sacubitril/Valsartan utilization (HR = 0.77, 95% CI: 0.65-0.91) and CRT/ICD implantation (HR = 0.85, 95% CI: 0.78-0.92), but not MCS (HR = 1.11, 95% CI: 0.86-1.43) and HTX (HR = 0.88, 95% CI: 0.70-1.09). An increased mortality risk was observed during the pandemic (HR = 1.19, 95% CI: 1.15-1.23), which was attributable to SARS-CoV-2 infection (HR for non-COVID-19-related mortality = 1.01, 95% CI: 0.97-1.04). Conclusions: The COVID-19 pandemic was associated with a reduction in medical and interventional therapies for HF and an increase in mortality for HF patients.
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Affiliation(s)
- Matteo Ponzoni
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy;
| | - Gabriella Morabito
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milan, Italy; (G.M.); (G.C.); (A.C.); (F.R.)
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milan, Italy; (G.M.); (G.C.); (A.C.); (F.R.)
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35128 Padua, Italy;
| | - Anna Cantarutti
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milan, Italy; (G.M.); (G.C.); (A.C.); (F.R.)
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milan, Italy; (G.M.); (G.C.); (A.C.); (F.R.)
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
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Migliore F, Schiavone M, Pittorru R, Forleo GB, De Lazzari M, Mitacchione G, Biffi M, Gulletta S, Kuschyk J, Dall'Aglio PB, Rovaris G, Tilz R, Mastro FR, Iliceto S, Tondo C, Di Biase L, Gasperetti A, Tarzia V, Gerosa G. Left ventricular assist device in the presence of subcutaneous implantable cardioverter defibrillator: Data from a multicenter experience. Int J Cardiol 2024; 400:131807. [PMID: 38272130 DOI: 10.1016/j.ijcard.2024.131807] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/24/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure (HF). Subcutaneous implantable cardioverter defibrillator (S-ICD) might be a viable alternative to conventional ICDs with a lower risk of short- and long-term of device-related complications and infections.The aim of this multicenter study was to evaluate the outcomes and management of S-ICD recipients who underwent LVAD implantation. METHODS The study population included patients with a preexisting S-ICD who underwent LVAD implantation for advanced HF despite optimal medical therapy. RESULTS The study population included 30 patients (25 male; median age 45 [38-52] years).The HeartMate III was the most common LVAD type. Median follow-up in the setting of concomitant use of S-ICDs and LVADs was 7 months (1-20).There were no reports of inability to interrogate S-ICD systems in this population. Electromagnetic interference (EMI) occurred in 21 (70%) patients. The primary sensing vector was the one most significantly involved in determining EMI. Twenty-seven patients (90%) remained eligible for S-ICD implantation with at least one optimal sensing vector. The remaining 3 patients (10%) were ineligible for S-ICD after attempts of reprogramming of sensing vectors. Six patients (20%) experienced inappropriate shocks (IS) due to EMI. Six patients (20%) experienced appropriate shocks. No S-ICD extraction because of need for antitachycardia pacing, ineffective therapy or infection was reported. CONCLUSIONS Concomitant use of LVAD and S-ICD is feasible in most patients. However, the potential risk of EMI oversensing, IS and undersensing in the post-operative period following LVAD implantation should be considered. Careful screening for EMI should be performed in all sensing vectors after LVAD implantation.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy.
| | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | | | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | | | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Jurgen Kuschyk
- Cardiology Unit, University Medical Centre Mannheim, Mannheim, Germany
| | - Pietro Bernardo Dall'Aglio
- Department of Cardiology and Angiology, Faculty of Medicine, Heart, Center Freiburg University, University of Freiburg, Germany
| | - Giovanni Rovaris
- Cardiology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Roland Tilz
- Department of Rhythmology, University Heart Center Lubeck, Lubeck, Germany
| | - Florinda Rosaria Mastro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine at Montefiore Health System, Bronx, NY, USA
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
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3
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D'Onofrio A, Antonello M, Piazza M, Gerosa G. Six-year clinical and computed tomography angiography follow-up after Nexus implantation. Eur J Cardiothorac Surg 2024; 65:ezae098. [PMID: 38485695 DOI: 10.1093/ejcts/ezae098] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024] Open
Abstract
Endovascular aortic arch repair (Ar-TEVAR) with single-branch, off-the-shelf Nexus aortic arch system has shown promising early and 3-year outcomes. There is lack of data regarding long-term results of this specific device, particularly regarding patency of supra-aortic bypasses and stability of the connection between the 2 modules. This case report describes 6-year clinical and imaging follow-up of a 74-year-old patient who underwent Ar-TEVAR with Nexus. Over 6 years, the patient experienced minor complications unrelated to the device. The patency of supra-aortic bypasses and integrity of the device's connection were confirmed. Computed tomography angiography constantly showed exclusion of the aneurysm and reduction of the aneurysmal sac. In conclusion, although extended research and broader data are needed, this case provides encouraging evidence of long-term results of Ar-TEVAR with Nexus.
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Affiliation(s)
| | | | - Michele Piazza
- Division of Vascular Surgery, University of Padova, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padua, Padova, Italy
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Tarzia V, Ponzoni M, Lena T, Gerosa G. Simultaneous epicardial atrial fibrillation ablation and left atrial appendage ligation: early considerations. Ann Cardiothorac Surg 2024; 13:176-178. [PMID: 38590986 PMCID: PMC10998970 DOI: 10.21037/acs-2023-afm-0178] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/27/2024] [Indexed: 04/10/2024]
Affiliation(s)
- Vincenzo Tarzia
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Ponzoni
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Tea Lena
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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5
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Bergonzoni E, De Gaspari M, D'Onofrio A, Cibin G, Rizzo S, Basso C, Gerosa G. A cardiac intimal sarcoma mimicking infective endocarditis. Cardiovasc Pathol 2024; 69:107598. [PMID: 38101526 DOI: 10.1016/j.carpath.2023.107598] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/02/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023] Open
Abstract
Primary malignant cardiac tumors are rare and usually misdiagnosed because they can mimic more common intracardiac lesions, therefore, in clinical practice it is important to always consider even uncommon diseases in order to avoid delayed diagnosis and to plan the most appropriate therapeutic strategy in a timely fashion. We report a case of a 73-year-old man with clinical signs and imaging findings (echocardiography) suggesting infective bacterial endocarditis of the mitral valve. However, intraoperative evaluation raised suspicion that the mitral lesions had a different nature. Surgical removal of the mass was performed, and the final correct diagnosis was made through pathologic examination, revealing a mitral valve sarcoma thus allowing for the beginning of specific oncological treatment.
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Affiliation(s)
- Emma Bergonzoni
- Department of Cardiac, Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Monica De Gaspari
- Department of Cardiac, Cardiovascular Pathology, Thoracic and Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Augusto D'Onofrio
- Department of Cardiac, Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Giorgia Cibin
- Department of Cardiac, Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stefania Rizzo
- Department of Cardiac, Cardiovascular Pathology, Thoracic and Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Cardiovascular Pathology, Thoracic and Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Gino Gerosa
- Department of Cardiac, Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Gerosa G, Zanatta P, Angelini A, Fedrigo M, Bianco R, Pittarello D, Lena T, Pepe A, Toscano G, Zanella F, Feltrin G, Pradegan N, Tarzia V. Overcoming the Boundaries of Heart Warm Ischemia in Donation After Circulatory Death: The Padua Case. ASAIO J 2024:00002480-990000000-00402. [PMID: 38334806 DOI: 10.1097/mat.0000000000002141] [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: 02/10/2024] Open
Abstract
A 45 year old male obese patient with a previous history of repaired congenital heart disease developed worsening heart failure making heart transplantation listing mandatory. Unfortunately, due to his anthropometric measures, the search for a suitable brain-dead donor was unsuccessful. For this reason, he accepted to be enrolled in the controlled donation after circulatory death (cDCD) program. According to the Italian Law regulating death declaration after cardiac arrest (no-touch period of 20 minutes-one of the longest in the world), we faced a 34 minute cardiac asystole, after which the heart was recovered through a thoraco-abdominal normothermic regional perfusion excluding the epiaortic vessels. The heart was then preserved by means of cold static storage. Heart transplantation was performed successfully without any signs of primary graft failure. Postoperative endomyocardial biopsies were negative for acute cellular and antibody-mediated rejection. Furthermore, echocardiographic and cardiac magnetic resonance evaluation of the heart did not show any functional abnormalities. The patient was discharged on post-operative day (POD) #39 in good clinical conditions.
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Affiliation(s)
- Gino Gerosa
- From the Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Paolo Zanatta
- Department of Critical Care, Anesthesiology and Intensive Care Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Annalisa Angelini
- Cardiovascular Pathology, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Marny Fedrigo
- Cardiovascular Pathology, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Roberto Bianco
- From the Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Demetrio Pittarello
- Cardiac Surgery Anesthesiology and Intensive Care Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Tea Lena
- From the Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy; and
| | - Giuseppe Toscano
- From the Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Fabio Zanella
- From the Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Giuseppe Feltrin
- Regional Health Department, Regional Transplant Center, Veneto Region, Italy
| | - Nicola Pradegan
- From the Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Vincenzo Tarzia
- From the Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
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D'Onofrio A, Piazza M, Andreatta G, Cao I, Lombardi V, Pittarello D, Grego F, Antonello M, Gerosa G. Endovascular aortic arch repair under monitored anaesthesia care: maximizing microinvasiveness. Eur J Cardiothorac Surg 2024; 65:ezae032. [PMID: 38317061 DOI: 10.1093/ejcts/ezae032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Abstract
Patients with aortic arch pathologies after surgery for type-A acute aortic dissection represent a challenging population since open surgery is associated with a non-negligible rate of mortality and complications. Microinvasive endovascular aortic arch repair Arch-Thoracic EndoVascular Aortic Repair (Ar-TEVAR) has shown promising results in high-risk patients. Ar-TEVAR is usually performed under general anaesthesia. We report the case of an 83-year-old man with a history of ascending aorta replacement for type-A acute aortic dissection who was referred for an anastomotic pseudoaneurysm. Ar-TEVAR using an off-the-shelf single-branch aortic arch stent graft was chosen. In order to further minimize procedural invasiveness, monitored anaesthesia care (local anaesthesia with sedation and analgesia) was performed since it provides less stress on the cardiovascular and respiratory systems and overall leads to a faster recovery especially in elderly patients.
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Affiliation(s)
| | - Michele Piazza
- Division of Vascular Surgery, University of Padova, Padova, Italy
| | - Giulio Andreatta
- Division of Cardiac Anesthesia and Intensive Care, University of Padova, Padova, Italy
| | - Irene Cao
- Division of Cardiac Surgery, University of Padua, Padova, Italy
| | | | - Demetrio Pittarello
- Division of Cardiac Anesthesia and Intensive Care, University of Padova, Padova, Italy
| | - Franco Grego
- Division of Vascular Surgery, University of Padova, Padova, Italy
| | | | - Gino Gerosa
- Division of Cardiac Surgery, University of Padua, Padova, Italy
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Pollari F, Nardi P, Mikus E, Ferraro F, Gemelli M, Franzese I, Chirichilli I, Romagnoni C, Santarpino G, Nicolardi S, Scrofani R, Musumeci F, Mazzaro E, Gerosa G, Massetti M, Savini C, Ruvolo G, Di Mauro M, Di Marco L, Barili F, Parolari A, Fischlein T. Comparison of 4 mortality scores for surgical repair of type A aortic dissection: a multicentre external validation. Eur J Cardiothorac Surg 2024; 65:ezae005. [PMID: 38212996 DOI: 10.1093/ejcts/ezae005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVES In the last decades, 4 different scores for the prediction of mortality following surgery for type A acute aortic dissection (TAAD) were proposed. We aimed to validate these scores in a large external multicentre cohort. METHODS We retrospectively analysed patients who underwent surgery for TAAD between 2000 and 2020. Patients were enrolled from 10 centres from 2 European countries. Outcomes were the early (30-day and/or in-hospital) and 1-year mortality. Discrimination, calibration and observed/expected (O/E) ratio were evaluated. RESULTS A total of 1895 patients (31.7% females, mean age 63.72 ± 12.8 years) were included in the study. Thirty-day mortality and in-hospital mortality were 21.7% (n = 412) and 22.5% (n = 427) respectively. The German Registry of Acute Aortic Dissection Type A (GERAADA) score shows to have the best discrimination [area under the curve (AUC) 0.671 and 0.672] in predicting as well the early and the 1-year mortality, followed by the International Registry of Acute Aortic Dissection (IRAD) model 1 (AUC 0.658 and 0.672), the Centofanti (AUC 0.645 and 0.66) and the UK aortic score (AUC 0.549 and 0.563). According to Hosmer-Lemeshow and Brier tests, the IRAD model I and GERAADA, respectively, were well calibrated for the early mortality, while the GERAADA and Centofanti for the 1-year mortality. The O/E analysis showed a marked underestimation for patients labelled as low-risk for UK aortic score and IRAD model I for both outcomes. CONCLUSIONS The GERAADA score showed the best performance in comparison with other scores. However, none of them achieved together a fair discrimination and a good calibration for predicting either the early or the 1-year mortality.
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Affiliation(s)
- Francesco Pollari
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Paolo Nardi
- Department of Cardiac Surgery, Tor Vergata Policlinic University, Tor Vergata University of Rome, Rome, Italy
| | - Elisa Mikus
- Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Francesco Ferraro
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Cardiovascular Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Gemelli
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Ilaria Franzese
- Division of Cardiac Surgery, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Ilaria Chirichilli
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Claudia Romagnoni
- Cardiac Surgery Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy
- Cardiac Surgery Unit, Department of Experimental and Clinical Science, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Roberto Scrofani
- Cardiac Surgery Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Massimo Massetti
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy
- Cardiovascular Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Savini
- Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giovanni Ruvolo
- Department of Cardiac Surgery, Tor Vergata Policlinic University, Tor Vergata University of Rome, Rome, Italy
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Luca Di Marco
- Division of Cardiac Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Fabio Barili
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
- University Cardiac Surgery Unit, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Alessandro Parolari
- University Unit of Cardiac Surgery, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
- Department of Biomedical Sciences, University of Milano, Milano, Italy
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
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Cattapan C, Guariento A, Bertelli F, Galliotto F, Vazzoler C, Magagna P, Gerosa G, Vida V. The introduction of surgical simulation on three-dimensional-printed models in the cardiac surgery curriculum: an experimental project. J Cardiovasc Med (Hagerstown) 2024; 25:165-172. [PMID: 38149703 PMCID: PMC10836787 DOI: 10.2459/jcm.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 11/01/2023] [Indexed: 12/28/2023]
Abstract
AIMS Training in congenital cardiac surgery has become more and more difficult because of the reduced opportunities for trainees in the operating room and the high patient anatomical variability. The aim of this study was to perform a pilot evaluation of surgical simulation on a simple 3D-printed heart model in training of young surgeons and its potential inclusion in the curriculum of residency programs. METHODS A group of 11 residents performed a surgical correction of aortic coarctation using a 3D-printed surgical model. After teaching the surgical procedure, a simulation was performed twice, at different times, and was evaluated quantitatively and qualitatively by a senior surgeon. A 3D model-based training program was then developed and incorporated into our cardiac surgery training program. RESULTS A significant improvement in surgical technique was observed between the first and second surgical simulations: median of 65% [interquartile range (IQR) = 61-70%] vs. 83% (IQR = 82-91%, P < 0.001). The median time required to run the simulation was significantly shorter during the second simulation: 39 min (IQR = 33-40) vs. 45 min (IQR = 37-48; P = 0.02). Regarding the simulation program, a basic and an advanced program were developed, including a total of 40 different simulated procedures divided into 12 sessions. CONCLUSION Surgical simulation using 3D-printing technology can be an extremely valuable tool to improve surgical training in congenital heart disease. Our pilot study can represent the first step towards the creation of an integrated training system on 3D-printed models of congenital and acquired heart diseases in other Italian residency programs.
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Affiliation(s)
- Claudia Cattapan
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
| | - Francesco Bertelli
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
| | - Francesco Galliotto
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
| | - Carlotta Vazzoler
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
| | - Paolo Magagna
- Cardiac Surgery Unit, Dipartimento Strutturale Cardio-vascolare, San Bortolo Hospital, Vicenza
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
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Gemelli M, Addonizio M, Geatti V, Gallo M, Dixon LK, Slaughter MS, Gerosa G. Techniques and Technologies to Improve Vein Graft Patency in Coronary Surgery. Med Sci (Basel) 2024; 12:6. [PMID: 38249082 PMCID: PMC10801616 DOI: 10.3390/medsci12010006] [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: 11/14/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Vein grafts are the most used conduits in coronary artery bypass grafting (CABG), even though many studies have suggested their lower patency compared to arterial alternatives. We have reviewed the techniques and technologies that have been investigated over the years with the aim of improving the quality of these conduits. We found that preoperative and postoperative optimal medical therapy and no-touch harvesting techniques have the strongest evidence for optimizing vein graft patency. On the other hand, the use of venous external support, endoscopic harvesting, vein preservation solution and anastomosis, and graft configuration need further investigation. We have also analyzed strategies to treat vein graft failure: when feasible, re-doing the CABG and native vessel primary coronary intervention (PCI) are the best options, followed by percutaneous procedures targeting the failed grafts.
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Affiliation(s)
- Marco Gemelli
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy; (M.A.); (V.G.); (G.G.)
| | - Mariangela Addonizio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy; (M.A.); (V.G.); (G.G.)
| | - Veronica Geatti
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy; (M.A.); (V.G.); (G.G.)
| | - Michele Gallo
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY 40292, USA; (M.G.); (M.S.S.)
| | - Lauren K. Dixon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London WC2A 3PE, UK;
| | - Mark S. Slaughter
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY 40292, USA; (M.G.); (M.S.S.)
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy; (M.A.); (V.G.); (G.G.)
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11
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Migliore F, Pittorru R, De Lazzari M, Tarzia V, Pastore G, Marcantoni L, Catanzariti D, Gerosa G, Zanon F. Transvenous lead extraction of lumenless 3830 pacing lead in conduction system pacing: a single-center experience. J Interv Card Electrophysiol 2024; 67:175-182. [PMID: 37365481 PMCID: PMC10769925 DOI: 10.1007/s10840-023-01590-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND The Medtronic SelectSecure Model 3830 lumenless lead (Medtronic, Inc., Minneapolis, MN) is commonly used for conduction system pacing (CSP). However, with this increased use, the potential need for transvenous lead extraction (TLE) also will increase. While extraction of endocardial 3830 leads is rather well described especially in pediatric and adult congenital heart disease population, there is very limited data on extraction of CSP leads. In the present study, we reported our preliminary experience on TLE of CSP leads and provided technical considerations. METHODS The study population comprised 6 consecutive patients (67% male; mean age 70 ± 22 years) with CSP leads (3830 leads), including left bundle branch pacing (LBBP) lead (n = 3) and His pacing lead (n = 3) undergoing TLE. Overall target leads were 17. The mean implant duration time of CSP leads was 97 ± 90 months [range 8-193). RESULTS Manual traction was successful in 2 cases and mechanical extraction tools were required in the remaining cases. Sixteen leads (94%) were completely extracted, whereas incomplete removal was observed in one lead (6%) among 1 patient. Of note, in the only lead incompletely removed, we observed retention of < 1-cm remnant of lead material consisting of the screw of 3830 LBBP lead into the interventricular septum. No failure of lead extraction was reported and no major complications occurred. CONCLUSIONS Our findings demonstrated that at an experienced center the success of TLE of chronically implanted CSP leads is high in the absence of major complications also when mechanical extraction tools are needed.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padova, Italy.
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padova, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padova, Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padova, Italy
| | - Gianni Pastore
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Santa Maria Della Misericordia General Hospital, Rovigo, Italy
| | - Lina Marcantoni
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Santa Maria Della Misericordia General Hospital, Rovigo, Italy
| | | | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padova, Italy
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Santa Maria Della Misericordia General Hospital, Rovigo, Italy
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12
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Gemelli M, Italiano EG, Geatti V, Addonizio M, Cao I, Dimagli A, Dokollari A, Tarzia V, Gallo M, Ferrari E, Slaughter MS, Gerosa G. Optimizing Safety and Success: The Advantages of Bloodless Cardiac Surgery. A Systematic Review and Meta-Analysis of Outcomes in Jehovah's Witnesses. Curr Probl Cardiol 2024; 49:102078. [PMID: 37716536 DOI: 10.1016/j.cpcardiol.2023.102078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Abstract
Transfusions are extremely frequent after cardiac surgery, and they have a considerable economic burden and impact on outcomes. Optimal patient blood management could play a fundamental role in reducing the rate of transfusion and Jehovah's Witnesses (JW) represent the ideal surrogate study population. This meta-analysis compares outcomes of JWs and non-JWs' patients undergoing cardiac surgery, assessing the safety of a bloodless cardiac surgery. A scoping review was conducted using a search strategy for studies assessing outcomes of JW undergoing cardiac surgery. The primary outcome was perioperative mortality, and a random-effects meta-analysis was performed. Ten studies were included in our meta-analysis, involving 780 JW patients refusing any type of transfusion ("JW") and 1182 patients accepting transfusion if needed ("non-JW"). 86% of non-JW patients received at least 1 transfusion. There was no significant difference in terms of perioperative mortality (OR 0.91; 95% CI 0.55-1.52; p = 0.72). The volume blood loss was significantly less in the JW (p = 0.001), while the rate of reoperation for bleeding was also lower, but not statistically significative, in the JW (p = 0.16). Both preoperative and postoperative hemoglobin and hematocrit were significantly higher in the JW. Therefore, we concluded that bloodless cardiac surgery is safe and early outcomes are similar between JW and non-JW patients: optimal patient blood management is fundamental in guarantying these results. Further studies are needed to assess if a limitation of transfusion could have a positive long-term impact on outcomes.
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Affiliation(s)
- Marco Gemelli
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Enrico Giuseppe Italiano
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Veronica Geatti
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Mariangela Addonizio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Irene Cao
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Aleksander Dokollari
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA
| | - Vincenzo Tarzia
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Gallo
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY
| | - Enrico Ferrari
- Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Mark S Slaughter
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, KY
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Cocchio S, Nicoletti M, Zanella F, Gaburro D, Bianco R, Gerosa G, Contessa C, Boschetto M, Stano P, Militello V, Cozzolino C, Martello T, Baldo V. Mycobacterium chimaera Infections in a Unit of Cardio Surgery: Study at a General Hospital in Padua, Italy. Microorganisms 2023; 12:29. [PMID: 38257856 PMCID: PMC10818605 DOI: 10.3390/microorganisms12010029] [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] [Received: 12/05/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Mycobacterium chimaera is a slow-growing non-tuberculous mycobacterium already known for being able to colonize cardio surgery heater-cooler units (HCUs). This study aims to describe the real magnitude of the phenomenon, providing a methodological protocol and the results of a longitudinal survey. In the period 1 January 2017-23 May 2022, over 1191 samples were collected on 35 HCUs of two different manufacturers. Among them, we identified 118 (10.3%) positive results for M. chimaera. We propose our 4-year biosurveillance experience as a practical model to minimize microbiological patients' risk, suggesting the need for new procedures and interventions for a safer and more ecological cardio surgery.
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Affiliation(s)
- Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (M.N.); (G.G.); (C.C.)
| | - Michele Nicoletti
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (M.N.); (G.G.); (C.C.)
| | - Fabio Zanella
- Cardiocirculatory Pathophysiology Unit, Surgery Department, University of Padua, 35131 Padua, Italy; (F.Z.); (D.G.)
| | - Dania Gaburro
- Cardiocirculatory Pathophysiology Unit, Surgery Department, University of Padua, 35131 Padua, Italy; (F.Z.); (D.G.)
| | - Roberto Bianco
- Department of Cardio Surgery, University of Padua, 35131 Padua, Italy;
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (M.N.); (G.G.); (C.C.)
| | - Cristina Contessa
- Department of Directional Hospital Management, University Hospital of Padua, 35128 Padova, Italy; (C.C.); (T.M.)
| | | | - Paola Stano
- Microbiology and Virology Department, University Hospital of Padua, 35128 Padua, Italy; (P.S.); (V.M.)
| | - Valentina Militello
- Microbiology and Virology Department, University Hospital of Padua, 35128 Padua, Italy; (P.S.); (V.M.)
| | - Claudia Cozzolino
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (M.N.); (G.G.); (C.C.)
| | - Tiziano Martello
- Department of Directional Hospital Management, University Hospital of Padua, 35128 Padova, Italy; (C.C.); (T.M.)
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (M.N.); (G.G.); (C.C.)
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14
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Gemelli M, Gallo M, Addonizio M, Van den Eynde J, Pradegan N, Danesi TH, Pahwa S, Dixon LK, Slaughter MS, Gerosa G. Surgical Ablation for Atrial Fibrillation During Mitral Valve Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Cardiol 2023; 209:104-113. [PMID: 37848175 DOI: 10.1016/j.amjcard.2023.09.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/15/2023] [Accepted: 09/24/2023] [Indexed: 10/19/2023]
Abstract
Although surgical ablation has been shown to produce excellent outcomes at follow-up for patients with atrial fibrillation who underwent mitral valve replacement/repair (MVR), this procedure is not commonly performed. Our objective was to conduct a systematic review and meta-analysis to evaluate the outcomes of concomitant surgical ablation during MVR. Three databases were systematically reviewed for randomized clinical trials published by August 2022. The primary outcome was sinus rhythm (SR) at 12 months. Secondary outcomes included SR at discharge and 6 months, all-cause mortality, permanent pacemaker implantation, and stroke and thromboembolic events. A random-effects meta-analysis was performed, calculating odds ratios (ORs) for each outcome. Thirteen studies were included, involving 1,089 patients comparing patients who underwent either isolated MVR ("MVR-only") or concomitant surgical ablation during MVR ("MVR+Ablation"). The odds of SR were significantly higher in the MVR+Ablation group at discharge (OR 9.62, 95% confidence interval [CI] 4.87 to 19.02, I2 = 55%), at 6-month follow-up (OR 7.21, 95% CI 4.30 to 12.11, I2 = 34%), and at 1-year follow-up (OR 8.41, 95% CI 5.14 to 13.77, I2 = 48%). All-cause mortality was not different in the groups, as were stroke and thromboembolic events, whereas the odds of permanent pacemaker implantation were slightly higher in the MVR+Ablation group (OR 1.87, 95% CI 1.11 to 3.17, I2 = 0%). Concomitant surgical ablation during MVR showed excellent outcomes at short-term follow-up, despite a slightly higher rate of permanent pacemaker implantation. Further studies with longer follow-ups are needed to assess if the SR is maintained over the years.
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Affiliation(s)
- Marco Gemelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiac Surgery Unit, University of Padua, Padua, Italy
| | - Michele Gallo
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky.
| | - Mariangela Addonizio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiac Surgery Unit, University of Padua, Padua, Italy
| | | | - Nicola Pradegan
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiac Surgery Unit, University of Padua, Padua, Italy
| | - Tommaso Hinna Danesi
- Cardiac Surgery Unit, San Bortolo Hospital, Vicenza, Italy; Division of Cardiac Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Siddharth Pahwa
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky
| | - Lauren K Dixon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom
| | - Mark S Slaughter
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiac Surgery Unit, University of Padua, Padua, Italy
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15
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Tarzia V, Ponzoni M, Pittarello D, Gerosa G. Test Bench for Right Ventricular Failure Reversibility: The Hybrid BiVAD Concept. J Clin Med 2023; 12:7604. [PMID: 38137672 PMCID: PMC10744029 DOI: 10.3390/jcm12247604] [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] [Received: 10/29/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND When heart transplantation and myocardial recovery are unlikely, patients presenting with biventricular cardiogenic shock initially treated with extracorporeal membrane oxygenation (ECMO) may benefit from a mechanical support upgrade. In this scenario, a micro-invasive approach is proposed: the combination of the double-lumen ProtekDuo cannula (Livanova, London, UK) and the Impella 5.5 (Abiomed, Danvers, MA) trans-aortic pump that translates into a hybrid BiVAD. METHODS All consecutive ECMO patients presenting with biventricular cardiogenic shock and ineligibility to heart transplantation from August 2022 were prospectively enrolled. The clinical course, procedural details, and in-hospital events were collected via electronic medical records. RESULTS A total of three patients, who were temporarily not eligible for heart transplantation or durable LVAD due to severe acute pneumonia and right ventricular (RV) dysfunction, were implanted with a hybrid BiVAD. This strategy provided high-flow biventricular support while pulmonary function ameliorated. Moreover, by differentially sustaining the systemic and pulmonary circulation, it allowed for a more adequate reassessment of RV function. All the patients were considered eligible for isolated durable LVAD and underwent less invasive LVAD implantation paired with a planned postoperative RVAD. In all cases, RV function gradually recovered and the RVAD was successfully removed. CONCLUSIONS The Hybrid BiVAD represents an up-to-date micro-invasive mechanical treatment of acute biventricular failure beyond ECMO. Its rationale relies on more physiological circulation across the lungs, the complete biventricular unloading, and the possibility of including an oxygenator in the circuit. Finally, the independent and differential control of pulmonary and systemic flows allows for more accurate RV function evaluation for isolated durable LVAD eligibility reassessment.
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Affiliation(s)
- Vincenzo Tarzia
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy; (M.P.); (G.G.)
| | - Matteo Ponzoni
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy; (M.P.); (G.G.)
| | - Demetrio Pittarello
- Institute of Anesthesia and Intensive Care, Padua University Hospital, 35128 Padua, Italy;
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy; (M.P.); (G.G.)
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16
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D'Onofrio A, Salizzoni S, Onorati F, Di Marco L, Gatti G, Luciani GB, Rinaldi M, Pacini D, Mazzaro E, Lorenzoni G, Gregori D, Livi U, Vendramin I, Gerosa G. Impact of Previous Cardiac Operations in Patients Undergoing Surgery for Type A Acute Aortic Dissection. Long-Term Follow Up. Curr Probl Cardiol 2023; 48:101991. [PMID: 37487853 DOI: 10.1016/j.cpcardiol.2023.101991] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
Aim of this multicenter study was to evaluate the impact of reoperative cardiac surgery for type A acute aortic dissection (TAAAD) on early and long-term outcomes. Patients with history of previous cardiac surgery were included in group R while those undergoing first operation where included in group F. Kaplan-Meier analysis was used to evaluate long-term survival in the 2 groups. A total of 1472 patients were included in the analysis. Of these, 85 (5.8%) and 1387 (94.2%) were included in group R and F, respectively. Thirty-day mortality was 24% (20 patients) and 18% (249 patients) in groups R and F, respectively(P = 0.8). Kaplan-Meier survival at 10 and at 20-year was 51.5% and 30.2% in group R and 48% and 32% in group F (P = 0.368). Patients with a history of previous cardiac operations who develop TAAAD can undergo surgery with similar early and long-term outcomes compared to those at their first operation.
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Affiliation(s)
| | | | | | - Luca Di Marco
- Division of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliana Isontina, Trieste, Italy
| | | | - Mauro Rinaldi
- Division of Cardiac Surgery, University of Torino, Torino, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - Enzo Mazzaro
- Division of Cardiac Surgery, Azienda Sanitaria Universitaria Giuliana Isontina, Trieste, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Ugolino Livi
- Division of Cardiac Surgery, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Igor Vendramin
- Division of Cardiac Surgery, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
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17
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Montisci R, Licciardi M, Cecchi R, Kondo T, Gerosa G, Casula R, Cecchetto G, Montisci M. Malpratice claims in cardiology and cardiac surgery: A medico-legal issue. Leg Med (Tokyo) 2023; 65:102319. [PMID: 37696211 DOI: 10.1016/j.legalmed.2023.102319] [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: 04/21/2023] [Revised: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
Medical liability has become a challenge in every physician's modern practice with the consequent loss of the physician's autonomy and an increase in "defensive medicine". From this perspective, the role of Legal Medicine in assessing medical liability has become increasingly specific and a homogenization of the methods of ascertainment is increasingly necessary, since such a process can contribute to strengthening the guarantees in professional liability procedures. Focusing on malpractice claims in the field of cardiology, the complexity of the management of cardiac pathologies and the frequency of severe adverse events implies the importance of a multi-disciplinary approach, together with the application of a shared ascertainment methodology. In particular, it is essential for the forensic pathologist to collaborate with experts in cardio-pathology, cardiology and/or cardiac surgery in cases of alleged medical liability in the cardiologic field and to follow the guidelines which have been produced to assist the expert dealing with deaths reflecting cardiac disease, in order to prevent criticism of case analysis in medico-legal environments and to promote the standardization of the structure of the juridical-legislative medical malpractice lawsuits.
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Affiliation(s)
- R Montisci
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Licciardi
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - R Cecchi
- Institute of Legal Medicine, Department of Medicine and Surgery, University of Parma, Italy.
| | - T Kondo
- Institute of Legal Medicine, Wakayama Medical University School of Medicine Graduate School of Medicine, Japan
| | - G Gerosa
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - R Casula
- Clinical Cardiology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - G Cecchetto
- Legal Medicine and Toxicology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Montisci
- Legal Medicine and Toxicology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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18
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De Lazzari M, Cipriani A, Cecere A, Niero A, De Gaspari M, Giorgi B, De Conti G, Motta R, Rizzo S, Tona F, Cacciavillani L, Tarantini G, Gerosa G, Basso C, Iliceto S, Perazzolo Marra M. Cardiac rupture in acute myocardial infarction: a cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging 2023; 24:1491-1500. [PMID: 37200615 PMCID: PMC10610764 DOI: 10.1093/ehjci/jead088] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/20/2023] Open
Abstract
AIMS We assessed the feasibility of cardiac magnetic resonance (CMR) and the role of myocardial strain in the diagnostic work-up of patients with acute myocardial infarction (AMI) and a clinical suspicion of cardiac rupture (CR). METHODS AND RESULTS Consecutive patients with AMI complicated by CR who underwent CMR were enrolled. Traditional and strain CMR findings were evaluated; new parameters indicating the relative wall stress between AMI and adjacent segments, named wall stress index (WSI) and WSI ratio, were analysed. A group of patients admitted for AMI without CR served as control. 19 patients (63% male, median age 73 years) met the inclusion criteria. Microvascular obstruction (MVO, P = 0.001) and pericardial enhancement (P < 0.001) were strongly associated with CR. Patients with clinical CR confirmed by CMR exhibited more frequently an intramyocardial haemorrhage than controls (P = 0.003). Patients with CR had lower 2D and 3D global radial strain (GRS) and global circumferential strain (in 2D mode P < 0.001; in 3D mode P = 0.001), as well as 3D global longitudinal strain (P < 0.001), than controls. The 2D circumferential WSI (P = 0.010), as well as the 2D and 3D circumferential (respectively, P < 0.001 and P = 0.042) and radial WSI ratio (respectively, P < 0.001 and P: 0.007), were higher in CR patients than controls. CONCLUSION CMR is a safe and useful imaging tool to achieve the definite diagnosis of CR and an accurate visualization of tissue abnormalities associated with CR. Strain analysis parameters can give insights into the pathophysiology of CR and may help to identify those patients with sub-acute CR.
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Affiliation(s)
- Manuel De Lazzari
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Science, University Hospital of Padua, Via Giustiniani, 2, 35121 Padua, Italy
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Alberto Cipriani
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Science, University Hospital of Padua, Via Giustiniani, 2, 35121 Padua, Italy
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Annagrazia Cecere
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Science, University Hospital of Padua, Via Giustiniani, 2, 35121 Padua, Italy
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Alice Niero
- Cardiology Unit, Ospedale dell’Angelo, Venice, Italy
| | - Monica De Gaspari
- Cardiovascular Pathology Unit, University Hospital of Padua, Padua, Italy
| | - Benedetta Giorgi
- Radiology Unit, University of Padua—University Hospital of Padua, Padua, Italy
| | - Giorgio De Conti
- Radiology Unit, University of Padua—University Hospital of Padua, Padua, Italy
| | - Raffaella Motta
- Department of Medicine, University of Padua—Azienda Ospedaliera, Padua, Italy
| | - Stefania Rizzo
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
- Cardiovascular Pathology Unit, University Hospital of Padua, Padua, Italy
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Science, University Hospital of Padua, Via Giustiniani, 2, 35121 Padua, Italy
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Luisa Cacciavillani
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Science, University Hospital of Padua, Via Giustiniani, 2, 35121 Padua, Italy
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Science, University Hospital of Padua, Via Giustiniani, 2, 35121 Padua, Italy
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Gino Gerosa
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
- Cardiac Surgery Unit, University Hospital of Padua, Padua, Italy
| | - Cristina Basso
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
- Cardiovascular Pathology Unit, University Hospital of Padua, Padua, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Science, University Hospital of Padua, Via Giustiniani, 2, 35121 Padua, Italy
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Science, University Hospital of Padua, Via Giustiniani, 2, 35121 Padua, Italy
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
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Tarzia V, Pradegan N, Ponzoni M, Parolin M, Gaio P, Meneghesso D, Cananzi M, Benetti E, Battistel M, Zanella F, Gerosa G. The AngioVac System in Childhood and Adolescence: A New Venovenous Extracorporeal Membrane Oxygenation-Like Configuration. ASAIO J 2023; 69:e443-e447. [PMID: 37429015 DOI: 10.1097/mat.0000000000001965] [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: 07/12/2023] Open
Abstract
Intravascular and intracardiac clots, thrombi, and vegetative material can be safely and effectively treated with the AngioVac System (AngioDynamics, Latham, NY) as an alternative to open surgery. However, this technology is still not performed in children or adolescents as a rule. We aimed to present our experience with two cases (a 10 year old girl and a 17 year old male adolescent) with concurrent hypoxemia in whom this device was successfully used in combination with venovenous extracorporeal membrane oxygenation to remove caval thrombi and cavoatrial septic material, respectively. This extracorporeal circuit configuration allowed adequate respiratory support during the procedure. No endovascular recurrence of the pathologic material was found at 2 and 1 year of follow-up, respectively.
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Affiliation(s)
- Vincenzo Tarzia
- From the Cardiac Surgery Unit, Cardiac, Thoracic, Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Nicola Pradegan
- From the Cardiac Surgery Unit, Cardiac, Thoracic, Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Matteo Ponzoni
- From the Cardiac Surgery Unit, Cardiac, Thoracic, Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Mattia Parolin
- Pediatric Nephrology Unit, Department of Woman and Child's Health, Padova University Hospital, Padova, Italy
| | - Paola Gaio
- Pediatric Gastroenterology Unit, Department of Woman and Child's Health, Padova University Hospital, Padova, Italy
| | - Davide Meneghesso
- Pediatric Nephrology Unit, Department of Woman and Child's Health, Padova University Hospital, Padova, Italy
| | - Mara Cananzi
- Pediatric Gastroenterology Unit, Department of Woman and Child's Health, Padova University Hospital, Padova, Italy
| | - Elisa Benetti
- Pediatric Nephrology Unit, Department of Woman and Child's Health, Padova University Hospital, Padova, Italy
| | - Michele Battistel
- Institute of Radiology, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Fabio Zanella
- From the Cardiac Surgery Unit, Cardiac, Thoracic, Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Gino Gerosa
- From the Cardiac Surgery Unit, Cardiac, Thoracic, Vascular and Public Health Department, Padova University Hospital, Padova, Italy
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20
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Pergola V, Mattesi G, Cozza E, Pradegan N, Tessari C, Dellino CM, Savo MT, Amato F, Cecere A, Perazzolo Marra M, Tona F, Guaricci AI, De Conti G, Gerosa G, Iliceto S, Motta R. New Non-Invasive Imaging Technologies in Cardiac Transplant Follow-Up: Acquired Evidence and Future Options. Diagnostics (Basel) 2023; 13:2818. [PMID: 37685356 PMCID: PMC10487200 DOI: 10.3390/diagnostics13172818] [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] [Received: 06/27/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Heart transplantation (HT) is the established treatment for end-stage heart failure, significantly enhancing patients' survival and quality of life. To ensure optimal outcomes, the routine monitoring of HT recipients is paramount. While existing guidelines offer guidance on a blend of invasive and non-invasive imaging techniques, certain aspects such as the timing of echocardiographic assessments and the role of echocardiography or cardiac magnetic resonance (CMR) as alternatives to serial endomyocardial biopsies (EMBs) for rejection monitoring are not specifically outlined in the guidelines. Furthermore, invasive coronary angiography (ICA) is still recommended as the gold-standard procedure, usually performed one year after surgery and every two years thereafter. This review focuses on recent advancements in non-invasive and contrast-saving imaging techniques that have been investigated for HT patients. The aim of the manuscript is to identify imaging modalities that may potentially replace or reduce the need for invasive procedures such as ICA and EMB, considering their respective advantages and disadvantages. We emphasize the transformative potential of non-invasive techniques in elevating patient care. Advanced echocardiography techniques, including strain imaging and tissue Doppler imaging, offer enhanced insights into cardiac function, while CMR, through its multi-parametric mapping techniques, such as T1 and T2 mapping, allows for the non-invasive assessment of inflammation and tissue characterization. Cardiac computed tomography (CCT), particularly with its ability to evaluate coronary artery disease and assess graft vasculopathy, emerges as an integral tool in the follow-up of HT patients. Recent studies have highlighted the potential of nuclear myocardial perfusion imaging, including myocardial blood flow quantification, as a non-invasive method for diagnosing and prognosticating CAV. These advanced imaging approaches hold promise in mitigating the need for invasive procedures like ICA and EMB when evaluating the benefits and limitations of each modality.
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Affiliation(s)
- Valeria Pergola
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Giulia Mattesi
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Elena Cozza
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Nicola Pradegan
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (N.P.); (C.T.); (G.G.)
| | - Chiara Tessari
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (N.P.); (C.T.); (G.G.)
| | - Carlo Maria Dellino
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Maria Teresa Savo
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Filippo Amato
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Annagrazia Cecere
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital “Policlinico” of Bari, 70124 Bari, Italy;
| | | | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (N.P.); (C.T.); (G.G.)
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Raffaella Motta
- Unit of Radiology, Department of Medicine, Medical School, University of Padua, 35122 Padua, Italy;
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Abstract
Heart transplantation is considered the gold standard for the treatment of advanced end-stage heart failure. However, standard donors after brain death are decreasing, whereas patients on the heart transplant waitlist are constantly rising. The introduction of the ex vivo machine perfusion device has been a turning point; in fact, these systems are able to significantly reduce ischemic times and have a potential effect on ischemia-related damage reduction. From a clinical standpoint, these machines show emerging results in terms of heart donor pool expansion, making marginal donors and donor grafts after circulatory death suitable for donation. This article aims to review mechanisms and preclinical and clinical outcomes of currently available ex vivo perfusion systems, and to explore the future fields of application of these technologies.
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Affiliation(s)
- Nicola Pradegan
- From the Cardiac Surgery Unit, Heart Transplantation Program, Cardiac, Thoracic, Vascular Sciences and Public Health Department, Padova University Hospital, Padova, Italy
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Migliore F, Pittorru R, Dall'Aglio PB, De Lazzari M, Falzone PV, Sottini S, Dentico A, Ferrieri A, Pradegan N, Bertaglia E, Iliceto S, Gerosa G, Tarzia V, Carretta D. Outcomes of transvenous lead extraction in octogenarians using bidirectional rotational mechanical sheaths. Pacing Clin Electrophysiol 2023; 46:960-968. [PMID: 36951180 DOI: 10.1111/pace.14696] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/01/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, data on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited. The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid-term outcome after TLE. METHODS The study population comprised 83 patients (78.3% male; mean age 85 ± 3 years; [range 80-94 years]) with 181 target leads. All the leads (mean implant duration 112 ± 77 months [range 12-377]) were extracted exclusively using the Evolution RL sheaths (Cook Medical, Bloomington, IN, USA). RESULTS The main indication for TLE was infection in 84.3% of cases. Complete procedural success rate, clinical success rate, per lead were 93.9% and 98.3%, respectively. Failure of lead extraction was seen in 1.7% of leads. The additional use of a snare was required in 8.4% of patients. Major complications occurred in one patient (1.2%). Thirty-day mortality after TLE was 6%. During a mean time follow-up of 22 ± 21 months, 24 patients (29%) died. No procedure-related mortality occurred. Predictors of mortality included ischemic cardiomyopathy (HR 4.35; 95% CI 1.87-10.13; p = .001), left ventricularejection fraction ≤35% (HR 7.89; 95% CI 3.20-19.48; p < .001), and TLE for systemic infection (HR 4.24; 95% CI 1.69-10.66; p = .002). CONCLUSIONS At experienced centers bidirectional rotational mechanical sheaths combined with different mechanical tools and femoral approach allowreasonable success and safety in octogenarian with long lead dwell time. Patient's age should not influence the decision to extract or not the leads, although the 30-day and mid-term mortality are significant, especially in the present of specific comorbidities.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | | | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Pasquale Valerio Falzone
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Simone Sottini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Alessia Dentico
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Alessandra Ferrieri
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Nicola Pradegan
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Domenico Carretta
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
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23
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Giannella M, Huth M, Righi E, Hasenauer J, Marconi L, Konnova A, Gupta A, Hotterbeekx A, Berkell M, Palacios-Baena ZR, Morelli MC, Tamè M, Busutti M, Potena L, Salvaterra E, Feltrin G, Gerosa G, Furian L, Burra P, Piano S, Cillo U, Cananzi M, Loy M, Zaza G, Onorati F, Carraro A, Gastaldon F, Nordio M, Kumar-Singh S, Baño JR, Lazzarotto T, Viale P, Tacconelli E. Using machine learning to predict antibody response to SARS-CoV-2 vaccination in solid organ transplant recipients: the multicentre ORCHESTRA cohort. Clin Microbiol Infect 2023; 29:1084.e1-1084.e7. [PMID: 37150358 PMCID: PMC10212001 DOI: 10.1016/j.cmi.2023.04.027] [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: 12/19/2022] [Revised: 04/05/2023] [Accepted: 04/26/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVES The study aim was to assess predictors of negative antibody response (AbR) in solid organ transplant (SOT) recipients after the first booster of SARS-CoV-2 vaccination. METHODS Solid organ transplant recipients receiving SARS-CoV-2 vaccination were prospectively enrolled (March 2021-January 2022) at six hospitals in Italy and Spain. AbR was assessed at first dose (t0), second dose (t1), 3 ± 1 month (t2), and 1 month after third dose (t3). Negative AbR at t3 was defined as an anti-receptor binding domain titre <45 BAU/mL. Machine learning models were developed to predict the individual risk of negative (vs. positive) AbR using age, type of transplant, time between transplant and vaccination, immunosuppressive drugs, type of vaccine, and graft function as covariates, subsequently assessed using a validation cohort. RESULTS Overall, 1615 SOT recipients (1072 [66.3%] males; mean age±standard deviation [SD], 57.85 ± 13.77) were enrolled, and 1211 received three vaccination doses. Negative AbR rate decreased from 93.66% (886/946) to 21.90% (202/923) from t0 to t3. Univariate analysis showed that older patients (mean age, 60.21 ± 11.51 vs. 58.11 ± 13.08), anti-metabolites (57.9% vs. 35.1%), steroids (52.9% vs. 38.5%), recent transplantation (<3 years) (17.8% vs. 2.3%), and kidney, heart, or lung compared with liver transplantation (25%, 31.8%, 30.4% vs. 5.5%) had a higher likelihood of negative AbR. Machine learning (ML) algorithms showing best prediction performance were logistic regression (precision-recall curve-PRAUC mean 0.37 [95%CI 0.36-0.39]) and k-Nearest Neighbours (PRAUC 0.36 [0.35-0.37]). DISCUSSION Almost a quarter of SOT recipients showed negative AbR after first booster dosage. Unfortunately, clinical information cannot efficiently predict negative AbR even with ML algorithms.
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Affiliation(s)
- Maddalena Giannella
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola, Bologna, Italy.
| | - Manuel Huth
- Faculty of Mathematics and Natural Sciences, University of Bonn, Bonn, Germany; Institute of Computational Biology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Elda Righi
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jan Hasenauer
- Faculty of Mathematics and Natural Sciences, University of Bonn, Bonn, Germany; Institute of Computational Biology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Lorenzo Marconi
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | - Angelina Konnova
- Molecular Pathology Group, Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Akshita Gupta
- Molecular Pathology Group, Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - An Hotterbeekx
- Molecular Pathology Group, Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Matilda Berkell
- Molecular Pathology Group, Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Zaira R Palacios-Baena
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena; Department of Medicine, School of Medicine, University of Seville; and Biomedicine Institute of Seville (IBiS)/CSIC, Seville, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Cristina Morelli
- Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | - Mariarosa Tamè
- Gastroenterology Unit, Department of Digestive, Hepatic and Endocrine-metabolic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | - Marco Busutti
- Nephrology, Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | - Luciano Potena
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | - Elena Salvaterra
- Division of Interventional Pulmonology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | | | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Patrizia Burra
- Unit of Gastroenterology and Multivisceral Transplant, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Mara Cananzi
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Monica Loy
- Thoracic Surgery and Lung Transplant Center, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gianluigi Zaza
- Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italy
| | | | - Amedeo Carraro
- Liver Transplant Unit, Department of Surgery and Dentistry, University and Hospital Trust of Verona, Verona, Italy
| | - Fiorella Gastaldon
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Maurizio Nordio
- Nephrology, Dialysis and Transplantation Unit, Treviso Hospital, Treviso, Italy
| | - Samir Kumar-Singh
- Molecular Pathology Group, Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Jesús Rodríguez Baño
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena; Department of Medicine, School of Medicine, University of Seville; and Biomedicine Institute of Seville (IBiS)/CSIC, Seville, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Tiziana Lazzarotto
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; Microbiology Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Bergonzoni E, D’Onofrio A, Mastro F, Gerosa G. Microinvasive mitral valve repair with transapical mitral neochordae implantation. Front Cardiovasc Med 2023; 10:1166892. [PMID: 37576109 PMCID: PMC10416619 DOI: 10.3389/fcvm.2023.1166892] [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: 02/15/2023] [Accepted: 07/03/2023] [Indexed: 08/15/2023] Open
Abstract
Microinvasive cardiac surgery includes procedures performed off-pump, on the beating heart, with limited or absent skin incision, and those that rely on live imaging techniques. Transapical off-pump beating heart neochordae implantation allows the repair of severe mitral valve regurgitation due to leaflet prolapse or flail with live three-dimensional echo guidance. This procedure has shown good results for up to 5 years and can be considered as a valid alternative to conventional surgery in selected patients with high prediction of success based on clinical and anatomical considerations. The aim of this review is to describe the devices, indications, patient screening process, clinical and echocardiographic results, and future perspectives of this procedure.
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25
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Lucertini G, Rogers MP, Italiano EG, Tarzia V, Pradegan N, Gallo M, Gerosa G. Left ventricular assist device exchange: a review of indications, operative procedure, and outcomes. Indian J Thorac Cardiovasc Surg 2023; 39:143-153. [PMID: 37525708 PMCID: PMC10386995 DOI: 10.1007/s12055-022-01450-y] [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] [Received: 07/22/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 01/18/2023] Open
Abstract
The use of left ventricular assist devices (LVADs) is intended to treat patients with end-stage heart failure. Owing to technological advances, these devices are becoming more durable. However, LVADs may need to be exchanged when complications arise and heart transplantation is not possible. Indications for LVAD exchange (LVADE) include device thrombosis, device infections, and pump component failure. LVADE has historically been associated with a high risk of morbidity and mortality. In this review, we discuss the indications of LVADE, the decisional and technical aspects during surgery, and outcomes.
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Affiliation(s)
- Giovanni Lucertini
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Michael Paul Rogers
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Enrico Giuseppe Italiano
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Vincenzo Tarzia
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Nicola Pradegan
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Michele Gallo
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
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Gerosa G, Ponzoni M, Evangelista G, Tessari C, Tiberio I, Molè A, Zanella F, Pittarello D, Tarzia V. Proof of Concept: Trans-atrial AngioVac Aspiration of Mitral Valve Thrombosis in a COVID-19 Patient. ASAIO J 2023; 69:e342-e345. [PMID: 37018815 PMCID: PMC10296976 DOI: 10.1097/mat.0000000000001910] [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] [Indexed: 04/07/2023] Open
Abstract
In patients with a prohibitive surgical risk, the AngioVac cannula can be used to remove left-sided cardiac masses, as an off-label adaptation of the device. We herein describe a novel micro-invasive approach to gain access to the left atrium for the aspiration of a mitral valve mass in a patient affected by severe coronavirus disease 2019. Through a right anterior mini-thoracotomy, the right superior pulmonary vein was accessed and used to insert the aspiration cannula. A parallel venous-arterial extracorporeal membrane oxygenation (ECMO)-like circuit provided circulatory and respiratory support to ensure proper intra- and postoperative hemodynamic stabilization.
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Affiliation(s)
- Gino Gerosa
- From the Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Matteo Ponzoni
- From the Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Evangelista
- From the Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Chiara Tessari
- From the Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Ivo Tiberio
- Anaesthesia and Intensive Care Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Angelo Molè
- From the Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Fabio Zanella
- From the Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Demetrio Pittarello
- Anaesthesia and Intensive Care Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Vincenzo Tarzia
- From the Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
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Cattapan C, Testolin L, Caprioglio F, Cerrito LF, Basso C, Rizzo S, Gerosa G. Preoperative Transcatheter Diagnosis of Right Atrial Hemangioma. JACC Case Rep 2023; 15:101857. [PMID: 37283831 PMCID: PMC10240270 DOI: 10.1016/j.jaccas.2023.101857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/31/2023] [Indexed: 06/08/2023]
Abstract
A 34-year-old man with unremarkable past medical history presents with night sweats and a recent diagnosis of intracardiac mass. The initial diagnostic workup did not provide a definitive diagnosis, so a cardiac biopsy under intracardiac echocardiography guidance was performed, revealing a hemangioma, which was then successfully resected. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Claudia Cattapan
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Luca Testolin
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | | | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Gerosa G, D’Onofrio A, Evangelista G, Vida VL, Pradegan N. Sternal-Sparing Transapical, Beating Heart Mitral Valve Repair in an Adult With Repaired Tetralogy of Fallot. JACC Case Rep 2023; 14:101818. [PMID: 37152707 PMCID: PMC10157101 DOI: 10.1016/j.jaccas.2023.101818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 05/09/2023]
Abstract
We present the case of a 60-year-old male patient who underwent tetralogy of Fallot repair at 7 years of age and then developed severe degenerative mitral regurgitation during adulthood. Given the increased surgical risk (obesity, obstructive sleep apnea syndrome, and reoperation), the patient underwent a successful microinvasive mitral valve repair with neochordae implantation. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Gino Gerosa
- Cardiac Surgery Unit, Cardiac, Thoracic, Vascular Sciences and Public Health Department, Padova University Hospital, Padova, Italy
- Address for correspondence: Dr Gino Gerosa, Cardiac Surgery Unit, Adult Congenital Heart Disease Section, Cardiac, Thoracic, Vascular Sciences and Public Health Department, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy.
| | - Augusto D’Onofrio
- Cardiac Surgery Unit, Cardiac, Thoracic, Vascular Sciences and Public Health Department, Padova University Hospital, Padova, Italy
| | - Giuseppe Evangelista
- Cardiac Surgery Unit, Cardiac, Thoracic, Vascular Sciences and Public Health Department, Padova University Hospital, Padova, Italy
| | - Vladimiro L. Vida
- Pediatric Cardiac Surgery Unit, Women’s and Children's Health Department, Padova University Hospital, Padova, Italy
| | - Nicola Pradegan
- Cardiac Surgery Unit, Cardiac, Thoracic, Vascular Sciences and Public Health Department, Padova University Hospital, Padova, Italy
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Fiocco A, Pittarello D, D’Onofrio A, Mastro F, Gerosa G, Colli A. First in human neochordae retensioning for recurrence of mitral regurgitation after neochord procedure. Front Cardiovasc Med 2023; 10:1120323. [PMID: 37255710 PMCID: PMC10225496 DOI: 10.3389/fcvm.2023.1120323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/10/2023] [Indexed: 06/01/2023] Open
Abstract
The Neochord procedure is a viable option to treat degenerative mitral valve regurgitation in selected patients. Left ventricle reverse remodeling can cause neochord-relative elongation and reprolapse of the treated leaflet, leading to failure. We present a clinical case of extensive ventricle reverse remodeling after neochord implantation and the first-in-man off-pump surgical retensioning of the previously implanted artificial chords.
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Affiliation(s)
- Alessandro Fiocco
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Demetrio Pittarello
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Augusto D’Onofrio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Florinda Mastro
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea Colli
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Saldan A, Mengoli C, Sgarabotto D, Fedrigo M, Angelini A, Feltrin G, Gambino A, Gerosa G, Barzon L, Abate D. Human cytomegalovirus and Epstein-Barr virus infections occurring early after transplantation are risk factors for antibody-mediated rejection in heart transplant recipients. Front Immunol 2023; 14:1171197. [PMID: 37256129 PMCID: PMC10225529 DOI: 10.3389/fimmu.2023.1171197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/25/2023] [Indexed: 06/01/2023] Open
Abstract
Background Antibody-mediated rejection (AMR) is a serious complication affecting the survival of patients receiving transplantation. Human cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are common viral infections that occur after transplantation, frequently emerging as viral reactivation in donor grafts or transplant recipients. The present study aimed to investigate the association between CMV and EBV infections and early-onset AMR. Materials and methods This study was conducted at the Heart Transplantation Center of Padova General Hospital and included a cohort of 47 heart transplant recipients (HTxs), including 24 HTxs diagnosed with AMR and 23 control HTxs with no episodes of AMR. Only early cases of CMV and/or EBV infections (1-90 days after transplantation) were considered. Fisher's exact test and logistic regression analysis were used to statistically analyze the correlation and association between AMR and CMV or EBV infection. Results We observed a positive statistical association between CMV and EBV infections (two-sided Fisher's exact test, p = 0.0136) and between EBV infection and AMR (two-sided Fisher's exact test, p = 0.0034). Logistic regression analysis revealed a direct statistical association between CMV and EBV infections and AMR risk (p = 0.037 and 0.006 and odds ratio = 1.72 and 2.19, respectively). AMR occurrence was associated with increased viral loads of both CMV and EBV early after transplantation. Discussion These findings suggest the role of CMV and EBV infections as relevant risk factors for AMR in HTxs for the first time.
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Affiliation(s)
- Alda Saldan
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Carlo Mengoli
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Dino Sgarabotto
- Transplant Infectious Disease Unit, Padova General Hospital, Padova, Italy
| | - Marny Fedrigo
- Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Annalisa Angelini
- Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Antonio Gambino
- Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Davide Abate
- Department of Molecular Medicine, University of Padova, Padova, Italy
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Civieri G, Masiero G, Osto E, Gambino A, Angelini A, Fraiese A, Fedrigo M, Toscano G, Bottio T, Perazzolo Marra M, Iliceto S, Gerosa G, Tona F. Coronary Collateral Circulation: A New Predictor of Mortality in Heart Transplant Recipients With Allograft Vasculopathy. Transplant Direct 2023; 9:e1470. [PMID: 37090121 PMCID: PMC10118324 DOI: 10.1097/txd.0000000000001470] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 04/25/2023] Open
Abstract
Coronary collateral arteries (CCAs) are anastomotic channels between vessels; although beneficial in atherosclerosis, their role in heart transplantation (HT) recipients is underinvestigated. CCAs initially develop as microcirculation and cardiac allograft vasculopathy (CAV), promoting immune-dependent proliferative angiogenic response, and play a role in their development. In our hypothesis, ischemia induced by coronary microvascular dysfunction (CMD) triggers the development of CCAs, which are, in turn, less functional as affected by CAV themselves. Methods One hundred twenty-one patients receiving HT at our institution were retrospectively evaluated and were included if transthoracic echocardiography with coronary flow velocity reserve (CFVR) assessment and coronary angiography were performed. CMD was defined as CFVR of ≤2.5. Patients with CAV were enrolled, and their angiograms were reviewed to evaluate the presence of CCAs. Cardiovascular mortality was assessed as the main clinical outcome. Results Forty patients were found to have CCAs. Patients with CCAs have lower CFVR than those without CCAs (2.22 ± 0.72 versus 2.69 ± 0.92;P = 0.003), reflecting in different rates of CMD in the 2 groups (72.5% versus 37%; P < 0.001). CMD is associated with higher CAV grades (P < 0.001), which are also associated with CCAs (P < 0.001). Patients with poorly developed CCAs have lower CFVR (P < 0.001). At multivariable analysis, CMD (P = 0.008) and higher CAV grades (P = 0.005) are independent predictors of CCAs. During the median follow-up time of 10.2 (6.6-13.3) y, patients with CCAs have been found to have higher mortality than those without CCAs (57.5% versus 32.1%; P = 0.007). CCAs are associated with a lower probability of survival also in patients with CMD (P < 0.001) and are independent predictors of mortality (P < 0.001). Conclusions Our results demonstrate an interplay between CAV, CMD, and CCAs. We confirm that CAV is associated with CMD, and we show, for the first time, that CMD is associated with CCAs. CCAs are pathophysiologically associated with more severe graft vasculopathy and independently predict mortality after HT.
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Affiliation(s)
- Giovanni Civieri
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulia Masiero
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Elena Osto
- Department of Cardiology, Heart Center, University Hospital Zurich and University of Zürich, Zurich, Switzerland
- Institute for Clinical Chemistry, University Hospital Zurich and University of Zürich, Zurich, Switzerland
| | - Antonio Gambino
- Division of Cardiac Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Annalisa Angelini
- Cardiac Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Angela Fraiese
- Department of Cardiology, Heart Center, University Hospital Zurich and University of Zürich, Zurich, Switzerland
| | - Marny Fedrigo
- Cardiac Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Toscano
- Department of Cardiology, Heart Center, University Hospital Zurich and University of Zürich, Zurich, Switzerland
| | - Tomaso Bottio
- Department of Cardiology, Heart Center, University Hospital Zurich and University of Zürich, Zurich, Switzerland
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gino Gerosa
- Department of Cardiology, Heart Center, University Hospital Zurich and University of Zürich, Zurich, Switzerland
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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D'Onofrio A, Tessari C, Tarantini G, Cibin G, Lorenzoni G, Pesce R, Fraccaro C, Napodano M, Gregori D, Gerosa G. Transapical TAVI: Survival, Hemodynamics, Devices and Machine Learning. Lessons Learned After 10-Year Experience. Curr Probl Cardiol 2023; 48:101734. [PMID: 37044271 DOI: 10.1016/j.cpcardiol.2023.101734] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/14/2023]
Abstract
Aim of this single-center, retrospective study was to assess early and long-term clinical and hemodynamic results of transapical aortic valve implantation (TA-TAVI), and to identify predictors of survival at follow-up. All patients undergoing TA-TAVI for severe aortic valve stenosis at our institution were reviewed. A hybrid approach based on machine-learning techniques was employed to identify survival predictors, using a Bagging-Decision-Tree algorithm and a Random-Forest algorithm, respectively. Two-hundred-thirty-four consecutive patients underwent TA-TAVI (March 2009-May 2019). All-cause 30-day mortality was 5.1%. Device success was 95.7%. Median follow-up time was 35.2 months. Kaplan-Meier overall survival rates at 2, 5, and 8 years were 75%, 44%, and 15%, respectively. Structural-valve-deterioration occurred in 25 patients (11.3%) overall. The strongest predictors of survival at follow-up were age, body-mass-index, and ejection fraction. TA-TAVI provided valid early and long-term outcomes. These data support its choice as an optimal alternative access whenever the transfemoral route is not feasible.
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Affiliation(s)
- Augusto D'Onofrio
- Division of Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova.
| | - Chiara Tessari
- Division of Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Giuseppe Tarantini
- Division of Biostatistics, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Giorgia Cibin
- Division of Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Giulia Lorenzoni
- Division of Interventional Cardiology, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Rita Pesce
- Division of Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Chiara Fraccaro
- Division of Biostatistics, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Massimo Napodano
- Division of Biostatistics, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Dario Gregori
- Division of Interventional Cardiology, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
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Barison I, Giarraputo A, Rossi E, Vedovelli L, Minuzzo S, Fedrigo M, Castellani C, Tona F, Bottio T, Toscano G, Basso C, Gerosa G, Mandruzzato S, Abate D, Gregori D, Angelini A. MicroRNA Microarray Analysis in Infections Post Heart-Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1310] [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: 04/05/2023] Open
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Tarzia V, Bagozzi L, Ponzoni M, Pradegan N, Banchelli F, Bortolussi G, Bellanti E, Bianco R, Zanella F, Bottio T, Gregori D, Gerosa G. Prognosticating Mortality of Primary Cardiogenic Shock Requiring Extracorporeal Life Support: The RESCUE Score. Curr Probl Cardiol 2023; 48:101554. [PMID: 36529235 DOI: 10.1016/j.cpcardiol.2022.101554] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
We aimed to identify prognostic laboratory markers during extracorporeal life support (ECLS) in patients with primary refractory cardiogenic shock (RCS) and to create a preliminary specific mortality score. All 208 consecutive subjects admitted for primary RCS and treated with ECLS between January-2009 and December-2018 were retrospectively analyzed. Multivariate regression analysis on laboratory markers during the first nine days of ECLS was used to develop a "Refractory End-stage Shock CUred with Ecls" (RESCUE) score. Serum creatinine (OR = 3.72, 95%CI: 2.01-6.88), direct bilirubin (OR = 1.40, 95%CI: 1.05-1.8), and platelet count (OR = 0.62, 95%CI: 0.42-0.94) were independent predictors of in-hospital mortality and were included in the score. The mean AUC was 0.763 (95%CI: 0.698-0.828) in the development cohort and 0.729 (95%CI: 0.664-0.794) in the bootstrap internal validation cohort. The RESCUE score represents a novel promising instrument to predict early mortality during the first critical days of ECLS and to help in properly guiding the therapeutic decision-making process.
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Affiliation(s)
- Vincenzo Tarzia
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy.
| | - Lorenzo Bagozzi
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Matteo Ponzoni
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Nicola Pradegan
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Federico Banchelli
- Statistics Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giacomo Bortolussi
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Ermanno Bellanti
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Roberto Bianco
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Fabio Zanella
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Tomaso Bottio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
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Squizzato F, Spertino A, Lupia M, Grego F, Gerosa G, Tarantini G, Piazza M, Antonello M. Prevalence, risk factors, and clinical effect of coronary artery disease in patients with asymptomatic bilateral carotid stenosis. J Vasc Surg 2023; 77:1182-1191.e1. [PMID: 36464015 DOI: 10.1016/j.jvs.2022.11.063] [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: 10/05/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE In the present report, we have described the prevalence, risk factors, and clinical effects of coronary artery disease (CAD) for patients with asymptomatic bilateral carotid stenosis. METHODS We conducted a single-center, retrospective cohort study of consecutive patients referred for bilateral carotid stenosis >70% (2014-2021). All the patients had undergone systematic coronary angiography. Depending on the anatomic and clinical characteristics, the patients had undergone combined carotid endarterectomy (CEA) plus coronary artery bypass grafting, coronary percutaneous intervention followed by CEA or carotid artery stenting (CAS), or staged bilateral CEA with cardiac best medical therapy. The cumulative 30-day stroke/myocardial infarction (MI) rate after cardiac and bilateral carotid interventions and long-term survival and freedom from cardiovascular mortality were assessed. RESULTS A total of 167 patients with bilateral carotid stenosis >70% had undergone preoperative coronary angiography, identifying severe CAD in 108 patients (65.1%). Echocardiographic abnormalities (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.03-5.78; P = .04) and prior coronary intervention (OR, 11.94; 95% CI, 2.99-63.81; P = .001) were significantly associated with severe CAD. CAD was treatable in 91 patients (84%) and untreatable in 17 (16%). The cumulative MI rate was 4.8%; 5.6% for the patients with severe CAD and 1.7% for those without severe CAD (P = .262). The cumulative stroke rate was 1.8%; 1.8% for those with severe CAD and 1.7% for those without severe CAD (P = 1.00). The overall stroke/MI rate was 6.6%; 8.3% for those with severe CAD and 3.3% for patients without severe CAD (P = .33). Patients with severe CAD deemed untreatable for coronary bypass or percutaneous intervention had a higher risk of perioperative stroke/MI (OR, 1.24; 95% CI, 1.00-2.83; P = .04). At 10 years, overall survival was 67.1% (95% CI, 57%-79%), and freedom from cardiovascular mortality was 78.5% (95% CI, 69%-89%). Patients with untreatable CAD maintained a higher risk of 10-year mortality (hazard ratio, 5.5; 95% CI, 1.6-19.9; P < .01). CONCLUSIONS In the present study, the prevalence of CAD in patients with bilateral carotid stenosis was high, especially for those with abnormal echocardiographic findings. CAD was potentially treatable in 80% of patients, and staged or simultaneous CAD treatment was performed with an acceptable stroke/MI complication rate for these patients. The presence of untreatable CAD was associated with worsened early and long-term outcomes, questioning the benefit of carotid interventions for this subset of patients.
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Affiliation(s)
- Francesco Squizzato
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Andrea Spertino
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Mario Lupia
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Franco Grego
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Piazza
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Antonello
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Pradegan N, Evangelista G, Tessari C, Guerra G, Ciccarelli G, Gallo M, Toscano G, Feltrin G, Tarzia V, Gerosa G. Uncontrolled Cardiac Arrest of Donor Heart Before Donation Does Not Affect Heart Transplant Recipient Outcomes: Proof of Concept for DCD Long-Term Outcomes. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.637] [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: 04/05/2023] Open
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Italiano E, Pradegan N, Tessari C, Toscano G, Marinello S, Gerosa G. Successful Management of Massive Brain Nocardiosis in a Heart Transplant Recipient. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.662] [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: 04/05/2023] Open
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Tarzia V, Ponzoni M, Tessari C, Evangelista G, Zanella F, Pittarello D, Gerosa G. Navigating the Heart. The Evolution of the AngioVac System in a Single-center Experience. Curr Probl Cardiol 2023; 48:101543. [PMID: 36529227 DOI: 10.1016/j.cpcardiol.2022.101543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
We investigated the efficacy, safety, and versatility of the AngioVac (AngioDynamics, Latham, NY) system for the treatment of intravascular and intracardiac masses of different origins. We prospectively enrolled all consecutive patients treated with the AngioVac system between July-2016 and November-2021 at our institution. Three configurations of the device were adopted in 44 patients: a venous-venous circuit in 21 cases (47.7%), a venous-arterial ECMO-like configuration in 20 (45.5%), and a venous-arterial-arterial circuit with 2 centrifugal pumps for left-sided cardiac masses in 3 (6.8%). Successful removal of the mass was achieved in 41 patients (93.2%), while in the other cases conversion to full sternotomy was necessary. Intraoperative complications occurred in 3 cases (6.8%), including 1 death, 1 pulmonary embolization, and 1 cardiac perforation. The AngioVac system is a valid, safe, and versatile option for the treatment of intravascular masses also in patients with prohibitive surgical risk.
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Affiliation(s)
- Vincenzo Tarzia
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy.
| | - Matteo Ponzoni
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Chiara Tessari
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Evangelista
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Fabio Zanella
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Demetrio Pittarello
- Anesthesia and Intensive Care Unit, University of Padua, Padua, Italy; From the Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
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Pradegan N, Evangelista G, Tessari C, Fabozzo A, Guerra G, Ciccarelli G, Gallo M, Toscano G, Angelini A, Gerosa G. A Very 37-Year Heart Transplantation Single-Center Experience: The Impact of Donor-Recipient Age Mismatch on Long-Term Outcomes. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1612] [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: 04/05/2023] Open
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Gemelli M, Gallo M, Addonizio M, Pahwa S, Van den Eynde J, Trivedi J, Slaughter MS, Gerosa G. Venous External Support in Coronary Artery Bypass Surgery: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101687. [PMID: 36931334 DOI: 10.1016/j.cpcardiol.2023.101687] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES Neointimal hyperplasia and lumen irregularities are major contributors to vein graft failure and the use of VEST(R) should prevent this. In this review, we aim to evaluate the angiographic outcomes of externally supported vein grafts. METHODS Medline, Embase and Cochrane Library were systematically reviewed for randomized clinical trials published by August 2022. The primary outcome was graft failure. Secondary outcomes included graft ectasia, intimal hyperplasia area and thickness, and graft non-uniformity. Odds ratios (OR) for dichotomous variables and mean difference (MD) for continuous variables with 95% confidence intervals (CI) were pooled using a fixed-effects model. RESULTS Three randomized controlled trials with a total of 437 patients were included with follow-up ranging from 1 to 2 years. The odds of graft failure were similar in the two groups (OR 1.22; 95%CI 0.88 to 1.71; I²=0%). Intimal hyperplasia area [MD -0.77 mm2; 95%CI -1.10 to -0.45; I2=0%] and thickness [MD -0.06 mm; 95%CI -0.08 to -0.04; I2=0%] were significantly lower in the VEST group. Fitzgibbon Patency Scale of II or III (representing angiographic conduit non-uniformity; OR 0.67; 95%CI 0.48 to 0.94; I2=0%) and graft ectasia (OR 0.53; 95%CI 0.32 to 0.88; I2=33%) were also significantly lower in the VEST group. CONCLUSIONS At short-term follow-up, VEST does not seem to reduce the incidence of graft failure, although it is associated with attenuation of intimal hyperplasia and non-uniformity. Longer angiographic follow-up is warranted to determine whether these positive effects might translate into a positive effect in graft failure and in long-term clinical outcomes.
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Affiliation(s)
- Marco Gemelli
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Michele Gallo
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky, USA.
| | - Mariangela Addonizio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Siddharth Pahwa
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky, USA
| | | | - Jaimin Trivedi
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Mark S Slaughter
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
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Gerosa G, Pradegan N. Wrapped Ross: Oldies, but goldies…. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00016-8. [PMID: 36914517 DOI: 10.1016/j.jtcvs.2023.01.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/05/2023] [Indexed: 03/16/2023]
Affiliation(s)
| | - Nicola Pradegan
- Cardiac Surgery Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, Padova, Italy
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D'Onofrio A, Gerosa G. Author Reply to Commentary: Let's fill in the glass! J Thorac Cardiovasc Surg 2023; 165:1049. [PMID: 35764461 DOI: 10.1016/j.jtcvs.2022.04.042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Augusto D'Onofrio
- Division of Cardiac Surgery, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Pergola V, Tarzia V, Baroni G, Iliceto S, Gerosa G, Mele D. Utilization of an Ultrasound-Enhancing Agent Improves the Evaluation of the Right Ventricle in Patients With Left Ventricular Assist Device. J Am Soc Echocardiogr 2023; 36:337-339. [PMID: 36460213 DOI: 10.1016/j.echo.2022.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Valeria Pergola
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Vincenzo Tarzia
- Division of Cardiac Surgery, University of Padua, Padua, Italy
| | - Giulia Baroni
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padua, Padua, Italy
| | - Donato Mele
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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D'Onofrio A, Fiocco A, Nadali M, Mastro F, Aruta P, Lorenzoni G, Pittarello D, Gerosa G. Outcomes of transapical mitral valve repair with neochordae implantation. J Thorac Cardiovasc Surg 2023; 165:1036-1046.e4. [PMID: 35624055 DOI: 10.1016/j.jtcvs.2022.02.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Transapical off-pump beating-heart neochord implantation (NC) has shown encouraging early results in patients with degenerative mitral regurgitation. The aim of this study was to evaluate clinical and echocardiographic 5-year outcomes of patients who underwent NC. METHODS All patients who underwent NC at our institution from November 2013 to March 2016 were included. Indications were severe symptomatic degenerative mitral regurgitation due to leaflet prolapse/flail. Patients were classified as having favorable anatomy (FA) and unfavorable anatomy (UA) on the basis of the extent and severity of mitral valve disease. All patients underwent clinical and echocardiographic follow-up at 1, 3, 6, and 12 months, and annually thereafter. Data were prospectively collected and retrospectively analyzed. Outcomes were on the basis of the Mitral Valve Academic Research Consortium guidelines. RESULTS One hundred consecutive patients were included in the analysis (FA: 81%; UA: 19%). Median age was 66 years (interquartile range, 58-76) and median European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was 1.4% (interquartile range, 0.7-2.3). Technical and procedural success were 98% and 94%, respectively. Thirty-day mortality was 2%. Device success was 94%, 92%, and 78%, at 30 days, 1-year, and 5 years, respectively. Patient success at 1 year was 92%. Median follow-up was 5.1 years. At 5 years, overall survival was 83% with no difference between FA and UA patients. Cumulative incidence of severe mitral regurgitation recurrence at 5 years was 14% (95% CI, 6.5%-22.8%) in FA patients and 63% (95% CI, 39.7%-86.2%) in UA patients, respectively (P < .001). Patients with FA compared with UA had a lower incidence of reintervention (14.7% vs 43.4%; P < .001). CONCLUSIONS Transapical off-pump beating heart NC might represent an acceptable option in patients with degenerative mitral valve disease and FA.
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Affiliation(s)
| | | | - Matteo Nadali
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Florinda Mastro
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Patrizia Aruta
- Division of Cardiology, University of Padova, Padova, Italy
| | | | | | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
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Migliore F, Pittorru R, Dall'Aglio PB, De Lazzari M, Rovaris G, Piazzi E, Dentico A, Ferrieri A, D'Angelo G, Marzi A, Sawaf BE, Bertaglia E, Iliceto S, Gerosa G, Tarzia V, Carretta D, Mazzone P. Outcomes of transvenous lead extraction of very old leads using bidirectional rotational mechanical sheaths: Results of a multicentre study. J Cardiovasc Electrophysiol 2023; 34:728-737. [PMID: 36477909 DOI: 10.1111/jce.15767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Lead dwell time >10 years is a recognized predictor for transvenous lead extraction (TLE) failure and complications. Data on the efficacy and safety of TLE using the bidirectional rotational mechanical sheaths in patients with very old leads are lacking. In this multicenter study, we reported the outcomes of transvenous rotational mechanical lead extraction in patients with leads implanted for ≥10 years. METHODS A total of 441 leads (median: 159 months [135-197]; range: 120-487) in 189 consecutive patients were removed with the Evolution RL sheaths (Cook Medical, Bloomingtom, IN, USA) and mechanical ancillary tools supporting the procedures. RESULTS The main indication for TLE was infection in 74% of cases. Complete procedural success rate, clinical success rate, per lead were 94.8% and 98.2%, respectively. Failure of lead extraction was seen in 1.8% of leads. The additional use of a snare via the femoral approach was required in 9% of patients. Lead dwell time was the only predictor of incomplete led removal (odds ratio: 1.009; 95% confidence interval [CI]: 1.003-1.014; p = .002). Four major complication (2%) were encountered. During a mean time follow-up of 31 ± 27 months, 21 patients (11%) died. No procedure-related mortality occurred. Predictors of mortality included severe left ventricular systolic dysfunction (hazard ratio [HR]: 8.06; 95% CI: 2.99-21.73; p = .001), TLE for infection (HR: 8.0; 95% CI: 1.04-62.5; p = .045), diabetes (HR: 3.7; 95% CI: 1.48-9.5; p = .005), and previous systemic infection (HR: 3.1; 95% CI: 1.17-8.24; p = .022). Incomplete lead removal or failure lead extraction did not impact on survival during follow-up. CONCLUSION Our findings demonstrated that the use of bidirectional rotational TLE mechanical sheaths combined with different mechanical tools and femoral approach allows reasonable success and safety in patients with very old leads at experienced specialized centers.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Pietro Bernardo Dall'Aglio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Elena Piazzi
- Department of Cardiology, San Gerardo Hospital, Monza, Italy
| | - Alessia Dentico
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Alessandra Ferrieri
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Giuseppe D'Angelo
- Departement of Cardiac Electrophysiology and Arrhythmology, San Raffaele Hospital, Milano, Italy
| | - Alessandra Marzi
- Departement of Cardiac Electrophysiology and Arrhythmology, San Raffaele Hospital, Milano, Italy
| | - Basma El Sawaf
- Departement of Cardiac Electrophysiology and Arrhythmology, San Raffaele Hospital, Milano, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Domenico Carretta
- Division of Cardiovascular Diseases, Azienda Ospedaliera Universitaria, Ospedale Policlinico Consorziale, Bari, Italy
| | - Patrizio Mazzone
- Departement of Cardiac Electrophysiology and Arrhythmology, San Raffaele Hospital, Milano, Italy
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Tarzia V, Tessari C, Bagozzi L, Bottigliengo D, Fagan D, Fabozzo A, Mastro FR, Pagnin C, Bottio T, Gregori D, Gerosa G. Anticoagulation alone as an effective and safe antithrombotic therapy in LVAD: When less is more. Curr Probl Cardiol 2023; 48:101506. [PMID: 36402214 DOI: 10.1016/j.cpcardiol.2022.101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
To evaluate the safety and effectiveness of anticoagulation alone in HeartMate3 patients. According to antithrombotic regimen, patients were divided into 2 groups: Group-1(warfarin+aspirin) and Group-2(warfarin). A comparison of hemocompatibility-related adverse events (HRAEs), hemocompatibility score (HCS), and hemocoagulative laboratory markers, both qualitative and quantitative, between the 2 groups were performed. Fifty patients were enrolled, 28 (56%) in Group-1 and 22 in Group-2 (44%), without statistical differences at baseline. Median time of follow-up was 590 days (IQR: 410.25-1007.50). Eighteen HRAEs (36.0%) occurred: 17 in Group-1 (34%) and 1 in Group-2 (2%) (P < 0.001). The net HCS for Group-1 versus Group-2 was 24 points and 1 point (OR 12.116[2.034-233.226], P = 0.023), respectively. Hemocoagulative values turned into the normality and remained stable during follow-up, without differences between groups, except for ASPI-test (P = 0.003). HeartMate3 showed a high hemocompatibility independently from antithrombotic therapy. Aspirin avoidance resulted a safe and effective strategy since it reduced hemorrhagic events, without increasing thrombotic risk.
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Affiliation(s)
- Vincenzo Tarzia
- Cardiac-Surgery-Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Chiara Tessari
- Cardiac-Surgery-Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Lorenzo Bagozzi
- Cardiac-Surgery-Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Daniele Bottigliengo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Davide Fagan
- Cardiac-Surgery-Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Assunta Fabozzo
- Cardiac-Surgery-Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Florinda Rosaria Mastro
- Cardiac-Surgery-Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Pagnin
- Cardiac-Surgery-Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Tomaso Bottio
- Cardiac-Surgery-Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gino Gerosa
- Cardiac-Surgery-Unit, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Pradegan N, Lorenzoni G, Gregori D, Gerosa G. Early coronavirus disease 2019 impact on cardiac surgical emergencies in northeast Italy: hidden collateral damage? J Cardiovasc Med (Hagerstown) 2023; 24:141-142. [PMID: 36583983 DOI: 10.2459/jcm.0000000000001402] [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: 12/31/2022]
Affiliation(s)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy
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Mastro F, Angelini A, D'Onofrio A, Gerosa G. A journey from resect to respect to restore: aiming at optimal physiological surgical mitral valve repair. J Cardiovasc Med (Hagerstown) 2023; 24:1-11. [PMID: 36484280 DOI: 10.2459/jcm.0000000000001390] [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: 12/13/2022]
Abstract
The concept of 'repairing' a degenerated mitral valve in order to restore the native competence means achieving the best physiological result coupled with the least invasive approach: this represents an interesting challenge for cardiac surgeons. The evolution of cardiac surgery through the years has involved techniques and technologies in every field of interest. From 'resect', to 'respect', to 'restore': the micro-invasive approach based on Neochord implant implies a transapical beating heart surgery which is based on the concept of implanting artificial chordae, preserving the physiological dynamics of the mitral annulus and avoiding the disadvantages of cardiopulmonary bypass and cardioplegic arrest of the heart.
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Affiliation(s)
- Florinda Mastro
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova
| | - Annalisa Angelini
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Augusto D'Onofrio
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova
| | - Gino Gerosa
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova
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Pittorru R, Dall´aglio PB, Migliore F, Micciolo M, D´onofrio A, Iliceto S, Gerosa G. 322 TRICUSPID VALVE REGURGITATION AFTER TRANSVENOUS LEAD EXTRACTION: WE NEED TO KNOW MORE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.743] [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: 12/23/2022]
Abstract
Abstract
Since 2003 a 73-year-old man was submitted to a pacemaker implantation because of atrio-ventricular block. After fourteen years, upgrading to CRT-D was made due to recovery for acute heart failure in a dilated cardiomyopathy with severe left ventricular systolic dysfunction. In 2019 and 2020 he presented pocket erosion therefore underwent to a submuscular reimplantation. After one year, he came to Arrhythmology outpatient appointment with inflammatory signs of the CRT-D pocket. The patient was started on Meropenem and Vancomicin. Transthoracic (TTE) and transesophageal echocardiogram didn't reveal any vegetation on valvular apparatus or on leads. The patient was submitted to transvenous lead extraction (TLE) with bidirectional rotational mechanical sheats and a epicardial lead on postero-lateral left ventricular wall was implanted. The post-procedural TTE showed a moderate to severe organic tricuspid valve regurgitation with annular dilatation despite the patient was asymptomatic. There weren't flail leaflets or tricuspid valve damage. The reimplantation of right atrial and ventricular leads was hindered by complex venous anatomy documented by intraprocedural phlebography. After Heart Team discussion, we agreed to tricuspid valve repair with annuloplasty ring and other two epicardial leads - right atrial and ventricular - was implanted. We achieve a successful result without complications. The patients was discharged without symptoms; the device interrogation showed good assessment of lead impedances, sensing thresholds, and capture thresholds.
Conclusion
The mechanisms of tricuspid valve regurgitation following TLE are complex. There isn't a standardized best practice to approach this phenomenon. It's important after TLE to assess tricuspid valve structure and function with TTE in order to understand the incidence of underlying potential mechanism and how to prevent it. Complex venous anatomy could direct the choice toward epicardial leads implantation.
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Affiliation(s)
- Raimondo Pittorru
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
| | | | - Federico Migliore
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
| | - Matteo Micciolo
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
| | - Augusto D´onofrio
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
| | - Sabino Iliceto
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
| | - Gino Gerosa
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
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Pittorru R, Migliore F, Arturi F, Tona F, Tarzia V, Iliceto S, Gerosa G. 20 LEAD-RELATED SUPERIOR VENA CAVA SYNDROME IN A PACEMAKER-DEPENDENT PATIENT: A HYBRID PROCEDURE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.571] [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: 12/23/2022]
Abstract
Abstract
We report a case of a 77-years-old man admitted to our department because of facial plethora, prominent venous collateral over the anterior chest wall, marked swelling of the head and upper extremities. His medical history was notable diabetes, non-Hodgkin lymphoma (NHL), eradicated HCV, AV block, for which he underwent placement of a dual-chamber pacemaker 4 years earlier. A superior vena cava (SVC) syndrome lead-related was documented on angio-CT scan and phlebography. After a multidisciplinary team discussion, a treatment strategy was designed to consist of transvenous lead extraction, SVC reconstruction and epicardial pacing placement. At 5 months follow-up, he was completely relieved of symptoms.
Conclusion
Lead-associated SVC syndrome is a rare condition and there is no standard management protocol. Data are lacking and we need at least a registry to make the treatment homogeneous. In this specific patient, a hybrid procedure based on lead extraction and reconstruction of superior vena cava was safe and effective for the relief of symptoms and maintenance of SVC patency. Heparin alone will not lead to the resolution of the disease if the disease is at an advanced stage.
Learning outcomes
Patients with lead-induced superior vena cava syndrome often required a multidisciplinary approach. A hybrid procedure based on transvenous lead extraction and reconstruction of superior vena cava is safe and effective to achieve relief of symptoms, maintenance of SVC patency, and adequate pacing.
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Affiliation(s)
- Raimondo Pittorru
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
| | - Federico Migliore
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
| | - Federico Arturi
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
| | - Francesco Tona
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
| | - Vincenzo Tarzia
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
| | - Sabino Iliceto
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
| | - Gino Gerosa
- Universita’ Degli Studi Di Padova - Dipartimento Di Scienze Cardio-Toraco-Vascolari
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