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Faggi A, Buzzatti N, Marzi A, Fioravanti F, Denti P, Gatto P, Belluschi I, Agricola E, Godino C, Maisano F. Hisian Lead Electrical Decay After TAVR Intervention. JACC Case Rep 2023; 28:102090. [PMID: 38204541 PMCID: PMC10774790 DOI: 10.1016/j.jaccas.2023.102090] [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: 03/20/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 01/12/2024]
Abstract
We report a case of patient with a single-chamber Hisian pacemaker who developed complete atrioventricular block and significant deterioration of the ventricular threshold and sensing after transcatheter aortic valve replacement. Revision of the implantation was required, with ventricular lead extraction and replacement.
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Affiliation(s)
| | | | | | | | - Paolo Denti
- Vita Salute San Raffaele University, Milan, Italy
| | - Pamela Gatto
- Vita Salute San Raffaele University, Milan, Italy
| | | | | | - Cosmo Godino
- Vita Salute San Raffaele University, Milan, Italy
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2
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Del Forno B, Tavana K, Ruffo C, Carino D, Lapenna E, Ascione G, Bisogno A, Belluschi I, Scarale MG, Nonis A, Monaco F, Alfieri O, Castiglioni A, Maisano F, De Bonis M. Neochordae implantation versus leaflet resection in mitral valve posterior leaflet prolapse and dilated left ventricle: a propensity score matching comparison with long-term follow-up. Eur J Cardiothorac Surg 2023; 64:ezad274. [PMID: 37551944 PMCID: PMC10693437 DOI: 10.1093/ejcts/ezad274] [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: 10/07/2022] [Revised: 07/22/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES Uncorrected severe mitral regurgitation (MR) due to posterior prolapse leads to left ventricular dilatation. At this stage, mitral valve repair becomes mandatory to avoid permanent myocardial injury. However, which technique among neochoardae implantation and leaflet resection provides the best results in this scenario remains unknown. METHODS We selected 332 patients with left ventricular dilatation and severe degenerative MR due to posterior leaflet (PL) prolapse who underwent neochoardae implantation (85 patients) or PL resection (247 patients) at our institution between 2008 and 2020. A propensity score matching analysis was carried on to decrease the differences at baseline. RESULTS Matching yielded 85 neochordae implantations and 85 PL resections. At 10 years, freedom from cardiac death and freedom from mitral valve reoperation were 92.6 ± 6.1% vs 97.8 ± 2.1% and 97.7 ± 2.2% vs 95 ± 3% in the neochordae group and in the PL resection group, respectively. The MR ≥2+ recurrence rate was 23.9 ± 10% in the neochordae group and 20.8 ± 5.8% in the PL resection group (P = 0.834) at 10 years. At the last follow-up, the neochordae group showed a higher reduction of left ventricular end-diastolic diameter (44 vs 48 mm; P = 0.001) and a better ejection fraction (60% vs 55%; P < 0.001) compared to PL resection group. CONCLUSIONS In this subgroup of patients, both neochordae implantation and leaflet resection provide excellent durability of the repair in the long term. Neochordae implantation might have a better effect on dilated left ventricle.
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Affiliation(s)
- Benedetto Del Forno
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Kevin Tavana
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Ruffo
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Carino
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Arturo Bisogno
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Giovanna Scarale
- University Centre of Statistics in Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Nonis
- University Centre of Statistics in Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | - Fabrizio Monaco
- Department of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Maisano
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Bignami E, Guarnieri M, Giambuzzi I, Trumello C, Saglietti F, Gianni S, Belluschi I, Di Tomasso N, Corti D, Alfieri O, Gemma M. Three Logistic Predictive Models for the Prediction of Mortality and Major Pulmonary Complications after Cardiac Surgery. Medicina (Kaunas) 2023; 59:1368. [PMID: 37629658 PMCID: PMC10456464 DOI: 10.3390/medicina59081368] [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] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Pulmonary complications are a leading cause of morbidity after cardiac surgery. The aim of this study was to develop models to predict postoperative lung dysfunction and mortality. Materials and Methods: This was a single-center, observational, retrospective study. We retrospectively analyzed the data of 11,285 adult patients who underwent all types of cardiac surgery from 2003 to 2015. We developed logistic predictive models for in-hospital mortality, postoperative pulmonary complications occurring in the intensive care unit, and postoperative non-invasive mechanical ventilation when clinically indicated. Results: In the "preoperative model" predictors for mortality were advanced age (p < 0.001), New York Heart Association (NYHA) class (p < 0.001) and emergent surgery (p = 0.036); predictors for non-invasive mechanical ventilation were advanced age (p < 0.001), low ejection fraction (p = 0.023), higher body mass index (p < 0.001) and preoperative renal failure (p = 0.043); predictors for postoperative pulmonary complications were preoperative chronic obstructive pulmonary disease (p = 0.007), preoperative kidney injury (p < 0.001) and NYHA class (p = 0.033). In the "surgery model" predictors for mortality were intraoperative inotropes (p = 0.003) and intraoperative intra-aortic balloon pump (p < 0.001), which also predicted the incidence of postoperative pulmonary complications. There were no specific variables in the surgery model predicting the use of non-invasive mechanical ventilation. In the "intensive care unit model", predictors for mortality were postoperative kidney injury (p < 0.001), tracheostomy (p < 0.001), inotropes (p = 0.029) and PaO2/FiO2 ratio at discharge (p = 0.028); predictors for non-invasive mechanical ventilation were kidney injury (p < 0.001), inotropes (p < 0.001), blood transfusions (p < 0.001) and PaO2/FiO2 ratio at the discharge (p < 0.001). Conclusions: In this retrospective study, we identified the preoperative, intraoperative and postoperative characteristics associated with mortality and complications following cardiac surgery.
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Affiliation(s)
- Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy;
| | - Marcello Guarnieri
- Department of Anesthesia and Intensive Care, Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Ilaria Giambuzzi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, 20122 Milan, Italy;
- Department of Clinical and Community Sciences, DISCCO University of Milan, 20126 Milan, Italy
| | - Cinzia Trumello
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.T.); (I.B.); (O.A.)
| | - Francesco Saglietti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy;
| | - Stefano Gianni
- Department of Anesthesia and Intensive Care, Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.T.); (I.B.); (O.A.)
| | - Nora Di Tomasso
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (N.D.T.); (D.C.)
| | - Daniele Corti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (N.D.T.); (D.C.)
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.T.); (I.B.); (O.A.)
| | - Marco Gemma
- Intensive Care Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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Tang GHL, Zaid S, Kleiman NS, Goel SS, Fukuhara S, Marin-Cuartas M, Kiefer P, Abdel-Wahab M, De Backer O, Søndergaard L, Saha S, Hagl C, Wyler von Ballmoos M, Bhadra O, Conradi L, Grubb KJ, Shih E, DiMaio JM, Szerlip M, Vitanova K, Ruge H, Unbehaun A, Kempfert J, Pirelli L, Kliger CA, Van Mieghem N, Hokken TW, Adrichem R, Modine T, Corona S, Wang L, Petrossian G, Robinson N, Meier D, Webb JG, Cheung A, Ramlawi B, Herrmann HC, Desai ND, Andreas M, Mach M, Waksman R, Schults CC, Ahmad H, Goldberg JB, Geirsson A, Forrest JK, Denti P, Belluschi I, Ben-Ali W, Asgar AW, Taramasso M, Rovin JD, Di Eusanio M, Colli A, Kaneko T, Nazif TN, Leon MB, Bapat VN, Mack MJ, Reardon MJ, Sathananthan J. Explant vs Redo-TAVR After Transcatheter Valve Failure: Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry. JACC Cardiovasc Interv 2023; 16:927-941. [PMID: 37100556 DOI: 10.1016/j.jcin.2023.01.376] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [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: 10/28/2022] [Revised: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Valve reintervention after transcatheter aortic valve replacement (TAVR) failure has not been studied in detail. OBJECTIVES The authors sought to determine outcomes of TAVR surgical explantation (TAVR-explant) vs redo-TAVR because they are largely unknown. METHODS From May 2009 to February 2022, 396 patients in the international EXPLANTORREDO-TAVR registry underwent TAVR-explant (181, 46.4%) or redo-TAVR (215, 54.3%) for transcatheter heart valve (THV) failure during a separate admission from the initial TAVR. Outcomes were reported at 30 days and 1 year. RESULTS The incidence of reintervention after THV failure was 0.59% with increasing volume during the study period. Median time from index-TAVR to reintervention was shorter in TAVR-explant vs redo-TAVR (17.6 months [IQR: 5.0-40.7 months] vs 45.7 months [IQR: 10.6-75.6 months]; P < 0.001], respectively. TAVR-explant had more prosthesis-patient mismatch (17.1% vs 0.5%; P < 0.001) as the indication for reintervention, whereas redo-TAVR had more structural valve degeneration (63.7% vs 51.9%; P = 0.023), with a similar incidence of ≥moderate paravalvular leak between groups (28.7% vs 32.8% in redo-TAVR; P = 0.44). There was a similar proportion of balloon-expandable THV failures (39.8% TAVR-explant vs 40.5% redo-TAVR; P = 0.92). Median follow-up was 11.3 (IQR: 1.6-27.1 months) after reintervention. Compared with redo-TAVR, TAVR-explant had higher mortality at 30 days (13.6% vs 3.4%; P < 0.001) and 1 year (32.4% vs 15.4%; P = 0.001), with similar stroke rates between groups. On landmark analysis, mortality was similar between groups after 30 days (P = 0.91). CONCLUSIONS In this first report of the EXPLANTORREDO-TAVR global registry, TAVR-explant had a shorter median time to reintervention, with less structural valve degeneration, more prosthesis-patient mismatch, and similar paravalvular leak rates compared with redo-TAVR. TAVR-explant had higher mortality at 30 days and 1 year, but similar rates on landmark analysis after 30 days.
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Affiliation(s)
| | - Syed Zaid
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Sachin S Goel
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | | | | | | | | | - Ole De Backer
- The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Shekhar Saha
- German Centre for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- Ludwig Maximillian University of Munich, Munich, Germany
| | | | - Oliver Bhadra
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lenard Conradi
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Emily Shih
- Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| | - J Michael DiMaio
- Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| | - Molly Szerlip
- Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| | | | | | | | | | | | | | | | | | - Rik Adrichem
- Eramus University Medical Center, Rotterdam, the Netherlands
| | - Thomas Modine
- UMCV Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux, France
| | - Silvia Corona
- UMCV Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux, France
| | - Lin Wang
- St. Francis Hospital, Roslyn, New York, USA
| | | | | | - David Meier
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anson Cheung
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Basel Ramlawi
- Lankanau Heart Institute at Main Line Health, Philadelphia, Pennsylvania, USA
| | | | - Nimesh D Desai
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Markus Mach
- Medical University of Vienna, Vienna, Austria
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Hasan Ahmad
- Westchester Medical Center, Valhalla, New York, USA
| | | | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | | | | | | | | | | | | | | | - Tsuyoshi Kaneko
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tamim N Nazif
- Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Michael J Mack
- Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
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Abdelshafy M, Serruys P, Elkoumy A, Elzomor H, Revaiah PC, Corcione N, Belluschi I, Kim WK, Rück A, Maisano F, Onuma Y, Mylotte D, Soliman O. TCT-503 Objective Quantification of Post-TAVR Aortic Regurgitation in the Real World Using 12 Different Types of Transcatheter Heart Valves: A Multicenter Pooled Analysis. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Elkoumy A, Corcione N, Belluschi I, Abdelshafy M, Elzomor H, Cimmino M, Revaiah PC, Morello A, Albanese M, Maisano F, Serruys P. TCT-368 Core Lab Quantitative Angiographic Assessment of Residual Aortic Regurgitation After Implantation of Portico Transcatheter Aortic Valve. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Igor Belluschi
- Corresponding author. Tel: +39 342 8004482, Fax: +39 02 26437125,
| | - Nicola Buzzatti
- Heart Valve Center, IRCCS San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Paolo Denti
- Heart Valve Center, IRCCS San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco Maisano
- Heart Valve Center, IRCCS San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy
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Belluschi I, Glauber M, Miceli A. Commentary: Beyond the boundaries of left ventricular outflow tract obstruction. JTCVS Open 2021; 8:261-262. [PMID: 36004131 PMCID: PMC9390487 DOI: 10.1016/j.xjon.2021.06.003] [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] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Glauber
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy
- Address for reprints: Antonio Miceli, MD, PhD, Minimally Invasive Cardiac Department, Istituto Clinico Sant'Ambrogio, Via LG Faravelli 16, 20149 Milano, Italy.
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Belluschi I, Buzzatti N, Castiglioni A, De Bonis M, Maisano F, Alfieri O. Aortic and mitral bioprosthetic valve dysfunction: surgical or percutaneous solutions? Eur Heart J Suppl 2021; 23:E6-E12. [PMID: 34650350 PMCID: PMC8503419 DOI: 10.1093/eurheartj/suab083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/12/2022]
Abstract
In the last years, there has been a trend to prefer biological prostheses, especially among young patients, with the aim to avoid anticoagulant treatment. Surgical tissue valves have so far demonstrated their solid long-term durability. However, younger age has been identified as one of the main risk factors for developing structural valve deterioration (SVD). As a consequence, the proportion of subjects at risk for valve dysfunction will constantly rise in the near future. However, while surgical reintervention has always been considered the gold standard for treatment of prosthesis deterioration, the introduction of transcatheter heart valves could offer new therapeutical options, particularly among high-risk patients, aiming a second less invasive chance. The recent standardization of valve durability definitions will soon allow a more comprehensive understanding of the mechanism underlying SVD and guide the choice of prosthesis for patients needing valve replacement.
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Affiliation(s)
- Igor Belluschi
- Cardiac Surgery Department, San Raffaele IRCCS University Hospital-Milan, Italy
| | - Nicola Buzzatti
- Cardiac Surgery Department, San Raffaele IRCCS University Hospital-Milan, Italy
| | | | - Michele De Bonis
- Cardiac Surgery Department, San Raffaele IRCCS University Hospital-Milan, Italy
| | - Francesco Maisano
- Cardiac Surgery Department, San Raffaele IRCCS University Hospital-Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery Department, San Raffaele IRCCS University Hospital-Milan, Italy
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Belluschi I, Glauber M, Miceli A. Commentary: Is Minimally Invasive Mitral Approach After a Previous Sternotomy Still Competitive? Semin Thorac Cardiovasc Surg 2021; 34:1218-1219. [PMID: 34525390 DOI: 10.1053/j.semtcvs.2021.09.005] [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] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Glauber
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy.
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Belluschi I, Miceli A. Commentary: Is There a Second Chance to Treat Mitral Disease After Irradiation? Semin Thorac Cardiovasc Surg 2021; 34:1206-1207. [PMID: 34500072 DOI: 10.1053/j.semtcvs.2021.08.029] [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] [Received: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy.
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Belluschi I, Glauber M, Miceli A. Commentary: What do we still have to learn from surgery? JTCVS Open 2021; 7:109-110. [PMID: 36003714 PMCID: PMC9390765 DOI: 10.1016/j.xjon.2021.06.014] [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] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 06/13/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Glauber
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy
- Address for reprints: Antonio Miceli, MD, Minimally Invasive Cardiac Department, Istituto Clinico Sant'Ambrogio, Via LG Faravelli 16, 20149 Milano, Italy.
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Belluschi I, Glauber M, Miceli A. Commentary: Fate Revealed: How Simulation Predicts False Lumen Evolution. Semin Thorac Cardiovasc Surg 2021; 34:449-450. [PMID: 34116199 DOI: 10.1053/j.semtcvs.2021.06.002] [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] [Received: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Glauber
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy.
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Ancona MB, Toscano E, Moroni F, Ferri LA, Russo F, Bellini B, Sorropago A, Mula C, Festorazzi C, Gamardella M, Vella C, Beneduce A, Romano V, Belluschi I, Buzzatti N, Agricola E, Montorfano M. Patients younger than 70 undergoing transcatheter aortic valve implantation: Procedural outcomes and mid-term survival. Int J Cardiol Heart Vasc 2021; 34:100817. [PMID: 34169142 PMCID: PMC8207181 DOI: 10.1016/j.ijcha.2021.100817] [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: 05/16/2021] [Accepted: 05/31/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Based on recent data, the indication for transcatheter aortic valve implantation (TAVI) is expanding to individuals at lower surgical risk, who are generally younger than subjects historically treated for severe aortic stenosis. Indeed, younger patients have traditionally been under-represented in current TAVI literature. The aim of the present study is to report about clinical features, procedural outcomes and mid-term outcomes of patients younger than 70 who underwent TAVI in a single high-volume center. MATERIALS AND METHODS Consecutive patients younger than 70 years of age who underwent TAVI for severe, symptomatic aortic stenosis between 2007 and 2019 at a single, tertiary referral center have been included in this retrospective study. Procedural and mid-term outcomes were analyzed, comparing 1st generation with 2nd generation devices. RESULTS Between 2007 and 2019, 1740 TAVI procedures were performed in our center. Among these, one hundred twenty-nine (7.4%) patients were younger than 70 years at the time of the intervention and were included in the present analysis. Fifty-eight patients (45%) were implanted with a 1st generation prosthesis while seventy-one patients (55%) were implanted with a 2nd generation device. Reasons which lead to a transcatheter approach in this population were: previous CABG (27.9%); porcelain aorta (24%); severe left ventricular systolic dysfunction (21.7%); prior chest radiation (19.4%); severe lung disease (8.5%); hemodynamic instability (7.0%); advanced liver disease (4.6%) and active cancer (3.9%). Overall device success rate was 89%, with no differences among 1st and 2nd generation devices. Threeyears all-cause mortality was 34%, with no difference among the two groups. Low incidence of aortic-valve re-intervention was observed at mid-term follow-up (late valve re-intervention = 2.3%). CONCLUSIONS TAVI in young patient with appropriate indication for intervention is a safe procedure, associated with low rate of in hospital mortality and low rate of severe complications both with 1st and with 2nd generation devices. When considering long term durability, more data are needed; in our case series long-term follow up shows a good survival and also an extremely low rate of valve re-intervention.
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Affiliation(s)
- Marco B. Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evelina Toscano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Interventional Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Francesco Moroni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca A. Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Sorropago
- Interventional Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Caterina Mula
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Costanza Festorazzi
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Gamardella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ciro Vella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Igor Belluschi
- Heart Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Heart Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Belluschi I, Miceli A. Commentary: Coronary Surgery Goes Virtual! Semin Thorac Cardiovasc Surg 2021; 34:533-534. [PMID: 34000430 DOI: 10.1053/j.semtcvs.2021.04.012] [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] [Received: 03/21/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Miceli
- Department of Minimally Invasive Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy.
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Belluschi I, Alfieri O, Montorfano M, Castiglioni A. Low left main coronary ostium: when surgery is still more appropriate than transcatheter aortic valve implantation. Eur J Cardiothorac Surg 2021; 59:920. [PMID: 33225362 DOI: 10.1093/ejcts/ezaa415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/12/2020] [Accepted: 10/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Department of Interventional Cardiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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17
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Belluschi I, Buzzatti N, Romano V, De Backer O, Søndergaard L, Karady J, Maurovich-Horvat P, Rahgozar K, De Bonis M, Castiglioni A, Colombo A, Alfieri O, Montorfano M, Latib A. Surgical feasibility of ascending aorta manipulation after transcatheter aortic valve implantation: a computed tomography theoretical analysis. EUROINTERVENTION 2021; 16:e1533-e1540. [PMID: 32364502 PMCID: PMC9724966 DOI: 10.4244/eij-d-19-00991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The expansion of TAVI will involve an increase in the frequency of emergent or late cardiac surgery after THV implantation. This study was designed to investigate the anatomical feasibility of surgical cross-clamp and aortotomy after TAVI through a post-TAVI CT-scan assessment. METHODS AND RESULTS We retrospectively analysed 117 CTs acquired after TAVI procedures with high stent prostheses in three high-volume centres between October 2008 and May 2017. The mean distance observed between the innominate artery and the top of the transcatheter heart valve was 45±11 mm, being <30 mm in 8/117 (6.8%) patients and <20 mm in none. The mean distance between the sinotubular junction and the first free site for aortotomy was 22±7 mm (>20 mm in 78/117 [66.7%] cases). A total of 56/117 (47.9%) patients showed a complete continuous contact between the anterior aortic wall and the anterior part of the valve stent. CONCLUSIONS Aortic cross-clamp appears not to be an issue when cardiac surgery is needed after TAVI; however, a careful and possibly higher aortotomy may be required. CT should be performed prior to planned cardiac surgery after TAVI to determine a safe positioning for aortic cross-clamp and aortotomy.
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Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Vittorio Romano
- Department of Interventional Cardiology, San Raffaele University Hospital, Milan, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagan, Denmark
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagan, Denmark
| | - Julia Karady
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Kusha Rahgozar
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Michele De Bonis
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Antonio Colombo
- Department of Cardiology, Maria Cecilia Hospital, Cotignola, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Matteo Montorfano
- Department of Interventional Cardiology, San Raffaele University Hospital, Milan, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA
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Belluschi I, Buzzatti N, Denti P, Romano V, Miceli A, Alfieri O, De Bonis M, Glauber M, Castiglioni A, Montorfano M. First-in-man Valve-in-Valve with the new balloon-expandable Myval transcatheter heart valve in a failed sutureless Perceval bioprosthesis. J Card Surg 2021; 36:2546-2548. [PMID: 33797811 DOI: 10.1111/jocs.15533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/25/2021] [Indexed: 11/26/2022]
Abstract
Sutureless aortic bioprostheses were introduced more than ten years ago, with the aim of decreasing cross-clamp time and thus becoming the first choice in older patients for many surgeons. However, published data are limited to a 5-year follow-up, and some cases of deterioration have already been described. High-risk patients who once have benefitted from a fast sutureless aortic replacement and now are experiencing a prosthesis dysfunction, could take advantage of a percutaneous Valve-in-Sutureless technique. Furthermore, thanks to technological improvement, new transcatheter prostheses have been designed, allowing a more precise positioning. In this report, we described the first Myval-in-Perceval case, which resulted in a safe and effective procedure.
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Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Vittorio Romano
- Department of Interventional Cardiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Miceli
- Department of Minimally Invasive Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Glauber
- Department of Minimally Invasive Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Department of Interventional Cardiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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19
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Belluschi I, Lapenna E, Carino D, Trumello C, Cireddu M, Ruggeri S, Schiavi D, Monaco F, Pozzoli A, Agricola E, Alfieri O, De Bonis M, Benussi S. Long-term results of thoracoscopic ablation of paroxysmal atrial fibrillation: is the glass half full or half empty? Eur J Cardiothorac Surg 2021; 60:850-856. [PMID: 33778846 DOI: 10.1093/ejcts/ezab138] [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: 09/13/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Previous series showed the outcomes of thoracoscopic ablation of stand-alone symptomatic paroxysmal atrial fibrillation (AF) for up to 7 years of follow-up. The goal of this study was to assess the long-term durability of surgical pulmonary vein isolation (PVI) beyond 7 years. METHODS Fifty consecutive patients {mean age 55 [standard deviation (SD): 11.2] years, previous catheter ablation in 56%, left ventricular ejection fraction 60% (SD: 4.6), left atrium volume 65 ml (SD: 17)} with stand-alone symptomatic paroxysmal AF underwent PVI through bilateral thoracoscopy ablation between 2005 and 2014. The CHA2DS2-VASc score was ≥2 in 12 patients (24%). RESULTS No hospital deaths occurred. At hospital discharge all patients but 1 (2%) were in sinus rhythm (SR). Follow-up was 100% complete [mean 8.4 years (SD: 2.3), max 15]. The 8-year cumulative incidence function of AF recurrence, with death as a competing risk, on or off class I/III antiarrhythmic drugs (AADs)/electrocardioversion/re-transcatheter ablation (TCA) was 20% (SD: 5; 95% confidence interval: 10, 32); and off class I/III AADs/electrocardioversion/re-TCA was 52% (SD: 7; 95% confidence interval: 0.83, 8.02). At 8 years, the predicted prevalence of patients in SR was 87% and 53% were off class I/III AADs/electrocardioversion/re-TCA. The recurrent arrhythmia was AF in all patients except 2, who had atypical atrial flutter (4%). No predictors of AF recurrence were identified. At the last follow-up, 76% of the patients showed European Heart Rhythm Association class I. No strokes or thromboembolic events were documented and 76% of the subjects were off anticoagulation therapy. CONCLUSIONS Despite a considerable AF recurrence rate, our single-centre, long-term outcome of surgical PVI showed encouraging data, with the majority of patients remaining in SR, although many of them were on antiarrhythmic therapy.
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Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Carino
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Cinzia Trumello
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Manuela Cireddu
- Department of Cardiac Electrophysiology and Arrhythmia, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefania Ruggeri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Schiavi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabrizio Monaco
- Department of Cardiothoracic Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Pozzoli
- Heart Surgery Unit, Zurich University Hospital, Zurich, Switzerland
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Benussi
- Department of Cardiac Surgery, Spedali Civili di Brescia, University Hospital, Brescia, Italy
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20
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Belluschi I, Miceli A. Commentary: The Phoenix Arises From Its Own Ashes. Semin Thorac Cardiovasc Surg 2021; 33:986-987. [PMID: 33600979 DOI: 10.1053/j.semtcvs.2021.01.014] [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] [Received: 12/05/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy.
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21
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Belluschi I, Lapenna E, Blasio A, Del Forno B, Giacomini A, Ruggeri S, Schiavi D, Castiglioni A, Alfieri O, De Bonis M. Excellent long-term results with minimally invasive edge-to-edge repair in myxomatous degenerative mitral valve regurgitation. Interact Cardiovasc Thorac Surg 2021; 31:28-34. [PMID: 32221590 DOI: 10.1093/icvts/ivaa048] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/13/2020] [Accepted: 01/29/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Previous series of minimally invasive mitral valve repairs showed excellent results at up to 10 years of follow-up. The goal of this study was to assess the long-term durability beyond 10 years of the edge-to-edge repair for myxomatous degeneration performed through a minimally invasive approach. METHODS Ninety-seven consecutive patients (mean age 35 ± 9 years; left ventricular ejection fraction 63 ± 6%) with severe myxomatous mitral regurgitation (MR) underwent mitral valve repair through a right minithoracotomy between 1999 and 2006. MR was due to lesions involving the posterior leaflet (7.2% of patients), anterior leaflet (12.4%) and both leaflets (80.4%). RESULTS No hospital deaths occurred. At hospital discharge all patients had no or trivial MR. Follow-up was 100% complete (median 15.5 years; interquartile range 13.6-17.0, max 19.3 years). The 16-year overall survival rate was 95.9 ± 2.02% [95% confidence interval (CI) 89.39-98.43]. At 16 years, the cumulative incidence function of cardiac death, with non-cardiac death as a competing risk, was 3.1 ± 1.75 (95% CI 0.83-8.02). Only 3 patients (4.1%) had redo operations for recurrent severe MR. At 16 years, the cumulative incidence functions of reoperation for and recurrence of MR ≥3+, with death as a competing risk, were 3.1 ± 1.76% (95% CI 0.83-8.02) and 5.6 ± 2.47% (95% CI 2.06-11.83), respectively. No predictors of recurrence of MR ≥3+ were identified. At the last follow-up, moderate MR (2+/4+) was detected in 17 patients (17.5%); most of the patients were in New York Heart Association functional class I-II (97%) and in sinus rhythm (90%). CONCLUSIONS Minimally invasive mitral valve edge-to-edge repair through a right minithoracotomy for myxomatous degeneration appears to be an effective and durable approach even in the long-term follow-up (up to 19 years).
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Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Blasio
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Giacomini
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefania Ruggeri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Schiavi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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22
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Abstract
Patients with severe symptomatic mitral regurgitation, if left untreated, have a poor prognosis. In those patients not eligible for mitral valve (MV) surgery, percutaneous repair may improve clinical outcomes. In the past 15 years several devices have been developed to address different MV lesions. This manuscript will review the advancement of transcatheter MV repair through the years, focusing on technologies for which consistent clinical data is available.
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Affiliation(s)
- Paolo Denti
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Alessandra Sala
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Igor Belluschi
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
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23
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Belluschi I, Buzzatti N, Castiglioni A, De Bonis M, Montorfano M, Alfieri O. Severe aortic stenosis in the young, with or without bicuspid valve: is transcatheter aortic valve implantation the first choice? Eur Heart J Suppl 2020; 22:L1-L5. [PMID: 33654459 PMCID: PMC7904077 DOI: 10.1093/eurheartj/suaa123] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 11/14/2022]
Abstract
During the last decade, transcatheter aortic valve implantation (TAVI) has represented a valid alternative to surgical aortic valve replacement in patients with aortic stenosis and elevated surgical risk. Recent randomized clinical trials reported excellent results also for patients at low surgical risk, but in clinical practice, the mean age of the patients treated remain over 75 years, and the presence of a bicuspid aortic valve still represents an important exclusion criteria. Today, aortic valve replacement with a mechanical prosthesis remains the treatment of choice for young adults with aortic stenosis, although the desire to avoid oral anticoagulants drives more patients younger than 65 years of age towards biological prostheses. Furthermore, despite the follow-up of patients after TAVI is still limited to a few years, the opportunity of a second percutaneous treatment (TAVI-in-TAVI), extends the scope of percutaneous strategy. In the next few years, TAVI has to face many challenges to become a valid alternative to surgery in the younger patients as well.
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Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Department of Interventional Cardiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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24
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Belluschi I, De Bonis M, Alfieri O, Del Forno B, Alamanni F, Polvani G, Pompilio G, Roberto M, Merlino LG, Troise G, Triboldi A, Di Credico G, Odinolfi FE, Giamberti A, Frigiola A, De Vincentiis C, Menicanti L, Monaco F, Melisurgo G, Scandroglio AM, Ambrosio A, Bottinelli E, Castiglioni A. First reorganization in Europe of a regional cardiac surgery system to deal with the coronavirus-2019 pandemic. Eur J Cardiothorac Surg 2020; 58:25-29. [PMID: 32437514 PMCID: PMC7314078 DOI: 10.1093/ejcts/ezaa185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiac Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Giulio Pompilio
- Department of Cardiac Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Maurizio Roberto
- Department of Cardiac Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | | | - Giovanni Troise
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | | | | | - Alessandro Giamberti
- Department of Pediatric Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Alessandro Frigiola
- Department of Pediatric Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Carlo De Vincentiis
- Department of Adult Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Lorenzo Menicanti
- Department of Adult Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Fabrizio Monaco
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulio Melisurgo
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Mara Scandroglio
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Belluschi I, Redaelli P, Iaci G, Verzini A, Alfieri O, Castiglioni A. Surgery from the future: Performing a safe valve-in-valve explantation. Multimed Man Cardiothorac Surg 2020; 2020. [PMID: 32459076 DOI: 10.1510/mmcts.2020.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As the number of young and relatively low-risk patients undergoing transcatheter aortic valve implantation increases, the number who will require open heart surgery months or years later will also increase. Only a few cases of late transcatheter heart valve explantation (without root replacement) have been reported in the literature, and this rare procedure can be surgically very challenging. In this video tutorial we present the case of a patient with a valve-in-valve subacute thrombosis, and we describe the surgical technique for valve explantation.
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Affiliation(s)
- Igor Belluschi
- Cardiac Surgery Department San Raffaele University Hospital Milan, Italy
| | - Paola Redaelli
- School of Medicine, Vita-Salute San Raffaele University - Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Iaci
- School of Medicine, Vita-Salute San Raffaele University - Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Verzini
- School of Medicine, Vita-Salute San Raffaele University - Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Redaelli P, Belluschi I, Bertoglio L, Verzini A, Chiesa R, Castiglioni A. Frozen elephant trunk: debranch first technique. Ann Cardiothorac Surg 2020; 9:257-258. [PMID: 32551266 DOI: 10.21037/acs.2020.03.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Paola Redaelli
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Bertoglio
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Verzini
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Del Forno B, Ascione G, Lapenna E, Trumello C, Ruggeri S, Belluschi I, Verzini A, Iaci G, Ferrara D, Schiavi D, Meneghin R, Castiglioni A, Alfieri O, De Bonis M. Is myocardial revascularization really necessary in patients with ≥50% but <70% coronary stenosis undergoing valvular surgery? Eur J Cardiothorac Surg 2020; 58:343-349. [DOI: 10.1093/ejcts/ezaa047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study is to evaluate the immediate and mid-term effects of omitting coronary artery bypass grafting in patients with moderate coronary artery stenosis who have a primary indication for valvular surgery.
METHODS
We included 77 consecutive patients admitted to our Institution for aortic or mitral valve surgery between June 2012 and June 2017 in whom a de novo diagnosis of ≥50%, but <70% coronary stenosis was made. In this cohort, the myocardial revascularization was omitted. All these patients were free from angina and ischaemia on echo and ECG.
RESULTS
There were no in-hospital deaths. In only 1 patient, acute myocardial infarction occurred postoperatively, which was immediately treated by percutaneous coronary intervention (PCI). The 6-year overall survival was 94.7 ± 2.59%. At 6 years, no cardiac deaths were recorded. At follow-up, 4 patients underwent elective PCI after a positive stress myocardial perfusion test. Only 1 patient underwent urgent PCI due to acute coronary syndrome. At 6 years, the cumulative incidence function of PCI, with death as competing risk, was 8 ± 3.9%.
CONCLUSIONS
In our experience, moderate coronary stenosis, occasionally discovered at the time of valvular heart surgery, can be safely overlooked and do not need any further treatment at follow-up in the majority of cases. Our results open up the opportunity to apply this ‘intentional omission strategy’ in different situations, such as minimally invasive heart surgery, percutaneous procedures and complex patients.
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Affiliation(s)
- Benedetto Del Forno
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Cinzia Trumello
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefania Ruggeri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Verzini
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Iaci
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Davide Schiavi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Meneghin
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Belluschi I, Buzzatti N, Blasio A, Romano V, De Bonis M, Castiglioni A, Montorfano M, Alfieri O. Self-expandable valve-in-valve treatment for failing sutureless aortic bioprosthesis. J Card Surg 2019; 35:477-479. [PMID: 31765015 DOI: 10.1111/jocs.14365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aortic valve replacement still represents the gold standard treatment for severe symptomatic aortic stenosis. Sutureless bioprostheses have been so far developed to enhance the minimally invasive approach, resulting in a reduction of cross-clamp time. Even if the first implantation was carried out more than 10 years ago, some cases of valve degeneration treated with balloon-expandable valve-in-valve procedures have been previously described in the literature. Here, we present a case of early sutureless valve degeneration resulting in severe aortic regurgitation. After careful evaluation of the patient's comorbidities, a successful valve-in-valve was finally performed using a self-expandable transcatheter prosthesis. A wide discussion of the Heart Team decision-making process and of the technical aspects has been addressed.
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Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Andrea Blasio
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Vittorio Romano
- Department of Interventional Cardiology, San Raffaele University Hospital, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Matteo Montorfano
- Department of Interventional Cardiology, San Raffaele University Hospital, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
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Belluschi I, Verzini A, Bertoglio L, Castiglioni A. Emergency aortic arch replacement using the debranch‐first technique with a custom‐made prosthesis. J Card Surg 2019; 35:229-231. [DOI: 10.1111/jocs.14285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Igor Belluschi
- Department Cardiac Surgery San Raffaele University Hospital Milan Italy
| | | | - Luca Bertoglio
- Department Vascular Surgery San Raffaele University Hospital Milan Italy
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Bargagna M, Belluschi I, Alfieri O. Controversies in cardiac surgery: do multivessel arterial revascularization and beating heart bypass operations improve prognosis? Eur Heart J Suppl 2019; 21:B3-B4. [PMID: 30948932 PMCID: PMC6439897 DOI: 10.1093/eurheartj/suz004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Marta Bargagna
- Department of Cardiac Surgery, San Raffaele Hospital, Milano, Italy
| | - Igor Belluschi
- Department of Cardiac Surgery, San Raffaele Hospital, Milano, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele Hospital, Milano, Italy
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Belluschi I, Blasio A, Pozzoli A, Vicentini L, Alfieri O. Surgical correction of anomalous origin of the right coronary artery from the left sinus of Valsalva: How, where, and when. Multimed Man Cardiothorac Surg 2019; 2019. [PMID: 30990579 DOI: 10.1510/mmcts.2019.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anomalous origin of the right coronary artery from the left sinus of Valsalva has a very low prevalence in the general population. Although the vast majority of patients are asymptomatic, the clinical consequence of this heart disorder can be sudden death. In many of these sudden death cases the right coronary artery is running between the anterior aspect of the aorta and behind the common trunk of the pulmonary artery, where systolic compression may have an impact on myocardial perfusion. Asymptomatic patients with this malignant course present the surgeon with a difficult decision, and they should be carefully evaluated in order to facilitate a tailored surgical approach. In this video tutorial we present a patient with this anomalous course of the right coronary artery, which was documented by coronary computed tomography angiography using a 3D reconstruction. The patient received an off-pump coronary artery bypass graft using an original surgical technique that prevents any type of flow competition. The case had an excellent final outcome, with good results at follow-up. Finally, a systematic review of the literature with a discussion of the different treatment modalities is provided.
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Affiliation(s)
- Igor Belluschi
- Cardiac Surgery Department San Raffaele University Hospital Milan, Italy
| | - Andrea Blasio
- Cardiac Surgery Department San Raffaele University Hospital Milan, Italy
| | | | - Luca Vicentini
- Cardiac Surgery Department San Raffaele University Hospital Milan, Italy
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Lapenna E, Cireddu M, Del Forno B, Monaco F, Nisi T, Bargagna M, Ajello S, Gulletta S, Melisurgo G, Belluschi I, D’Angelo G, Giacomini A, Pappalardo F, Alfieri O, Castiglioni A, Bella PD, De Bonis M. OC67 STAGED HYBRID EPICARDIAL-ENDOCARDIAL PROCEDURE IN PATIENTS WITH REFRACTORY PERSISTENT/LONG-STANDING PERSISTENT ATRIAL FIBRILLATION AND SEVERE LEFT ATRIAL DILATATION. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549934.61949.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Belluschi I, Del Forno B, Lapenna E, Nisi T, Iaci G, Ferrara D, Castiglioni A, Alfieri O, De Bonis M. Surgical Techniques for Tricuspid Valve Disease. Front Cardiovasc Med 2018; 5:118. [PMID: 30234129 PMCID: PMC6127626 DOI: 10.3389/fcvm.2018.00118] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/10/2018] [Indexed: 11/17/2022] Open
Abstract
Tricuspid valve disease affects millions of patients worldwide. It has always been considered less relevant than the left-side valves of the heart, but this “forgotten valve” still represents a great challenge for the cardiac surgeons, especially in the most difficult symptomatic scenarios. In this review we analyze the wide spectrum of surgical techniques for the treatment of a diseased tricuspid valve.
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Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Teodora Nisi
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Giuseppe Iaci
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - David Ferrara
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | | | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Milan, Italy
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Belluschi I, Moriggia S, Giacomini A, Del Forno B, Di Sanzo S, Blasio A, Scafuri A, Alfieri O. Can Perceval sutureless valve reduce the rate of patient-prosthesis mismatch?†. Eur J Cardiothorac Surg 2018; 51:1093-1099. [PMID: 28329177 DOI: 10.1093/ejcts/ezx009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/17/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study is to compare the theoretical incidence of patient-prosthesis mismatch (PPM) in patients undergoing a sutureless or a sutured aortic valve replacement using an exact statistical matching. METHODS Between May 2012 and March 2016, 65 patients with severe symptomatic aortic stenosis underwent a sutureless aortic valve replacement with the Perceval bioprosthesis in 2 centres. Moreover, 177 aortic valve replacements with conventional sutured bioprosthesis were performed between August 2003 and September 2015. Perceval and sutured patients were 1:1 exactly matched for sex and body surface area (BSA), resulting in 62 couples (sutureless: BSA 1.77 ± 0.16 m 2 , female 62.9% vs sutured: BSA 1.77 ± 0.15 m 2 , female 62.9%). RESULTS After matching, the indexed effective orifice area was 1.50 ± 0.18 cm 2 /m 2 and 0.81 ± 0.19 cm 2 /m 2 in the sutureless and the sutured group, respectively ( P < 0.001). No PPM occurred in patients who received a Perceval bioprosthesis ( n = 62). In the sutured group ( n = 62), 38 patients (61.3%) developed a PPM, which was moderate in 41.9% ( n = 26) and severe in 19.4% ( n = 12) ( P < 0.001). CONCLUSIONS The indexed effective orifice area of the sutureless group was significantly larger than in the sutured one. The incidence of PPM with the conventional sutured biprosthesis was 61.3%, while it decreases to 0% in the sutureless group. No PPM was reported in the sutureless valve group. Therefore, the Perceval sutureless valve provides larger effective orifice areas compared to the sutured conventional bioprosthesis and could be considered as a good option to reduce the risk of a PPM.
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Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Stefano Moriggia
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Andrea Giacomini
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Stefania Di Sanzo
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Andrea Blasio
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Antonio Scafuri
- Department of Cardiac Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
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