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Moscarelli M, Sollami G, Lentini E, Prestera R, Pernice V, Milo S, Violante F, Cuffari F, Di Pasquale C, Ferlisi A, La Grutta L, Grassedonio E, Speziale G, Fattouch K. About different localization of hypoattenuated lesions following transcatheter aortic valve replacement. Int J Cardiol 2024; 398:131597. [PMID: 37979790 DOI: 10.1016/j.ijcard.2023.131597] [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: 10/01/2023] [Revised: 10/29/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Subclinical leaflet thrombosis is diagnosed using multidetector computed tomography (MDCT) and is characterised by a meniscal-shaped hypoattenuated lesion of one or more leaflets. Transcatheter aortic self-expandable valves are commonly manufactured with pliable pericardium over a nitinol frame that forms leaflet and extra-leaflet components such as the valve skirt. Little is known about extra-leaflet hypoattenuated lesion localisation, including that at the anatomical sinus level. Thus, the main aim of this study was to describe leaflet and extra-leaflet (anatomic sinus and subvalvular level) hypoattenuated lesions following transcatheter aortic valve replacement with a self-expandable prosthesis. As a secondary aim, we sought to investigate predictors of hypoattenuated lesions. METHODS Fifty patients underwent MDCT at the follow-up. RESULTS At a follow-up of 12 months, hypoattenuated leaflet lesions with mild to severe restricted movement were detected in eight individuals (16%), anatomic sinus lesions were identified in nine patients (18%), with higher prevalence in the non-coronary sinus (16%), and subvalvular lesions with variable extension toward the valve inflow were diagnosed in eight patients (16%). In 4 patients (8%) the anatomic sinus thrombus was 'in overlap' with leaflet thrombus; in 3 patients (6%) was in continuity with subvalvular frame thrombus. Bicuspid valve was the only independent predictor associated with hypoattenuated lesions (adj OR 8.25 (95% CI: 1.38, 49.21), p = 0.02)). CONCLUSIONS This study demonstrated that hypoattenuated lesions could be identified not only at the leaflet but also at the subvalvular and anatomic sinus levels. The clinical relevance of such lesions remains unclear.
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Affiliation(s)
- Marco Moscarelli
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy.
| | - Giulia Sollami
- Dept. of Radiology, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Emanuele Lentini
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Rosa Prestera
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Vincenzo Pernice
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Sabrina Milo
- Dept. of Radiology, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Francesco Violante
- Dept. of Radiology, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Federico Cuffari
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Claudia Di Pasquale
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Angelo Ferlisi
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Ludovico La Grutta
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Emanuele Grassedonio
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Giuseppe Speziale
- Dept. of Cardiovascular Surgery, Anthea Hospital, GVM Care&Research, Bari, Italy
| | - Khalil Fattouch
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy; University of Palermo, DICHIRONS, Palermo, Italy
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Moscarelli M, Zlahoda-Huzior A, Pernice V, Speziale G, Fattouch K. Three-dimensional analysis of subclinical leaflet thrombosis following transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2024:jeae051. [PMID: 38366717 DOI: 10.1093/ehjci/jeae051] [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: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
Affiliation(s)
- Marco Moscarelli
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
- Imperial College, National Heart Lung Institute, London, UK
| | - Adriana Zlahoda-Huzior
- AGH University of Science and Technology, Department of AGH Department of Measurement & Electronics, Krakow, Poland
- Digital Innovations & Robotics Hub, Krakow, Poland
| | - Vincenzo Pernice
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Giuseppe Speziale
- Dept. of Cardiovascular Surgery, Anthea Hospital, GVM Care&Research, Bari, Italy
| | - Khalil Fattouch
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
- University of Palermo, DICHIRONS, Palermo, Italy
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Lancellotti P, Fattouch K, Modine T. Is transcatheter aortic valve implantation for aortic stenosis cost-effective? Acta Cardiol 2024; 79:95-97. [PMID: 37962324 DOI: 10.1080/00015385.2023.2281110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, CHU SartTilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Liège, Belgium
| | - Khalil Fattouch
- Department of Cardiovascular surgery, GVM Care and Research, Maria Eleonora Hospital and Dichirinos University, Palermo, Italy
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Moscarelli M, Prestera R, Fiore C, Pernice V, Milo S, Violante F, Cuffari F, Di Pasquale C, Ferlisi A, Speziale G, Fattouch K. Evaluation of the anatomic sinus after transcatheter aortic valve replacement. Int J Cardiol 2024; 396:131551. [PMID: 37866786 DOI: 10.1016/j.ijcard.2023.131551] [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: 06/15/2023] [Revised: 09/15/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Following transcatheter aortic valve replacement (TAVI), the newly formed 'anatomic sinus'. may contribute to the formation of subclinical leaflet thrombosis (SLT).The evaluation of root geometry after TAVI is generally performed using multi-detector computed tomography (MDCT), and the role of transthoracic echocardiography (2D TTE) requires further validation. Thus, we aimed to test the reproducibility of 2D TTE assessment of the anatomic sinus with MDCT as a reference and its association with SLT. METHODS 2D TTE was performed in 90 patients, and the echocardiograms were analyzed offline. Both sinus of Valsalva (SOV) and prosthesis diameters were assessed in the long- and short-axis parasternal views (PLAX/PSAX), and the anatomic sinus area was calculated. Inter- and intra-observer reproducibility were assessed using the interclass correlation coefficient (ICC). MDCT was performed in 50 individuals to evaluate concordance with 2D TTE and to detect SLT. RESULTS There was excellent correlation regarding the diameter of the SOV and the prosthesis in PLAX (ICC: 0.93 (95% CI: 0.76,0.97); ICC: 0.80 (95% CI: 0.63,0.96)) and PSAX view (ICC: 0.90 (95% CI: 0.68,0.97); ICC: 0.88 (95% CI: 0.63,0.96)). Bland-Altman analysis of 2D TTE and MDCT anatomic sinus areas indicated a high level of agreement. SLT was detected in 8 individuals (16%); 3 patients had severe SLT at the level of 1 cusp. CONCLUSIONS 2D TTE might play a role in the evaluation of the anatomic sinus after TAVI. The importance of this space and its effects on the SLT remain uncertain.
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Affiliation(s)
- Marco Moscarelli
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy.
| | - Rosa Prestera
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Corrado Fiore
- Dept. of Cardiovascular Surgery, Città di Lecce Hospital, GVM Care&Research, Lecce, Italy
| | - Vincenzo Pernice
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Sabrina Milo
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Francesco Violante
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Federico Cuffari
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Claudia Di Pasquale
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Angelo Ferlisi
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Giuseppe Speziale
- Dept. of Cardiovascular Surgery, Anthea Hospital, GVM Care&Research, Bari, Italy
| | - Khalil Fattouch
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy; University of Palermo, DICHIRONS, Palermo, Italy
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Spadaccio C, Rose D, Candura D, Lopez Marco A, Cerillo A, Stefano P, Nasso G, Ramoni E, Fattouch K, Minacapelli A, Oo AY, Speziale G, Shelton K, Berra L, Bose A, Moscarelli M. Effect of Hospital-associated SARS-CoV-2 Infections in Cardiac Surgery: A Multicenter Study. Ann Thorac Surg 2024; 117:213-219. [PMID: 35690139 PMCID: PMC9174100 DOI: 10.1016/j.athoracsur.2022.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/11/2022] [Accepted: 05/22/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The effect of hospital-associated SARS-CoV-2 infections in cardiac surgery patients remains poorly investigated, and current data are limited to small case series with conflicting results. METHODS A multicenter European collaboration was organized to analyze the outcomes of patients who tested positive with hospital-associated SARS-CoV-2 infection after cardiac surgery. The study investigators hypothesized that early infection could be associated with worse postoperative outcomes; hence 2 groups were considered: (1) an early hospital-associated SARS-CoV-2 infection group comprising patients who had a positive molecular test result ≤7 days after surgery, with or without symptoms; and (2) a late hospital-associated SARS-CoV-2 infection group comprising patients whose test positivity occurred >7 days after surgery, with or without symptoms. The primary outcome was 30-day mortality. Secondary outcomes included all-cause mortality or morbidity at early follow-up and SARS-CoV-2-related hospital readmission. RESULTS A total of 87 patients were included in the study. Of those, 30 were in the early group and 57 in the late group. Overall, 30-day mortality was 8%, and in-hospital mortality was 11.5%. The reintubation rate was 11.4%. Early infection was significantly associated with higher mortality (adjusted OR, 26.6; 95% CI, 2, 352.6; P < .01) when compared with the late group. At 6-month follow-up, survival probability was also significantly higher in the late infection group: 91% (95% CI, 83%, 98%) vs 75% (95% CI, 61%, 93%) in the early infection group (P = .036). Two patients experienced COVID-19-related rehospitalization. CONCLUSIONS In this multicenter analysis, hospital-associated SARS-CoV-2 infection resulted in higher than expected postoperative mortality after cardiac surgery, especially in the early infection group.
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Affiliation(s)
- Cristiano Spadaccio
- Department of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - David Rose
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Dario Candura
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ana Lopez Marco
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Alfredo Cerillo
- Department of Cardiothoracic and Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Pierluigi Stefano
- Department of Cardiothoracic and Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
| | - Enrico Ramoni
- Department of Cardiovascular Surgery, GVM Care & Research, Villa Torri Hospital, Bologna, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy
| | - Alberto Minacapelli
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy
| | - Aung Y Oo
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Giuseppe Speziale
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
| | - Kenneth Shelton
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amal Bose
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy.
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Moscarelli M, Sollami G, Lentini E, Prestera R, Pernice V, Violante F, Cuffari F, Di Pasquale C, Speziale G, Giannini F, Vadalà G, Galassi AR, Fattouch K. Stent-frame decoupling following self-expandable transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2024; 18:105-108. [PMID: 37679246 DOI: 10.1016/j.jcct.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Marco Moscarelli
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy.
| | - Giulia Sollami
- Dept. of Radiology, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy; Section of Radiological Sciences, University of Palermo, Palermo, Italy
| | - Emanuele Lentini
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Rosa Prestera
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Vincenzo Pernice
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Francesco Violante
- Dept. of Radiology, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy; Section of Radiological Sciences, University of Palermo, Palermo, Italy
| | - Federico Cuffari
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Claudia Di Pasquale
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy
| | - Giuseppe Speziale
- Dept. of Cardiovascular Surgery, Anthea Hospital, GVM Care&Research, Bari, Italy
| | | | - Giuseppe Vadalà
- Department of Health Promotion, University Hospital Paolo Giaccone, University of Palermo, 90127 Palermo, Italy
| | - Alfredo Ruggero Galassi
- Department of Health Promotion, University Hospital Paolo Giaccone, University of Palermo, 90127 Palermo, Italy
| | - Khalil Fattouch
- Dept. of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research, Palermo, Italy; University of Palermo, DICHIRONS, Italy
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Nasso G, Vignaroli W, Contegiacomo G, Marchese A, Fattouch K, D’Alessandro P, Brigiani MS, Vitobello V, Triggiani V, Demola MA, Tonioni S, Paparella D, Sechi S, Bonifazi R, Santarpino G, Resta F, Bartolomucci F, Lorusso R, Larosa C, Valenti G, Tito A, Moscarelli M, Margari V, Fiore F, Condello I, Speziale G. Emergent Conversion to Open Heart Surgery during Transcatheter Aortic Valve Implantation: The Presence of a Rescue Team Improves Outcomes. J Clin Med 2023; 12:7705. [PMID: 38137774 PMCID: PMC10743555 DOI: 10.3390/jcm12247705] [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: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Transcatheter aortic valve implant (TAVI) is the gold standard for the high-surgical-risk group of patients with aortic valve disease and it is an alternative to surgery in patients at intermediate risk. Lethal complications can occur, and many of these are manageable only with emergent conversion to open heart surgery. We retrospectively evaluate the outcome of all patients undergoing TAVI in our departments and the impact of a complete cardiac rescue team to reduce 30-day mortality. METHODS Data from all patients undergoing TAVI between January 2020 and August 2023 in our center were analyzed. An expert complete rescue was present in catheter laboratory. Primary outcomes were in-hospital and at 30-day mortality and evaluation of all cases needed for emergent conversion to open heart surgery. RESULTS 825 patients were enrolled. The total mortality was 19/825 (2.3%). Eleven of the total patients (1.3%) required emergent conversion to open heart surgery. Among them, eight were alive (73%), with a theoretical decrease of 0.98% in overall mortality. CONCLUSIONS surgical treatment is rare during TAVI. The presence of an expert complete rescue team as support means an increase in survival. Surgery must be used only to restore circulatory and to treat complication while percutaneous approaches should complete the procedure.
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Affiliation(s)
- Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Walter Vignaroli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
| | - Gaetano Contegiacomo
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Alfredo Marchese
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Khalil Fattouch
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
| | - Pasquale D’Alessandro
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Mario Siro Brigiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Vincenza Vitobello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Vera Triggiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Maria Antonietta Demola
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Stefano Tonioni
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
| | - Domenico Paparella
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Stefano Sechi
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
| | - Raffaele Bonifazi
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Fabrizio Resta
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Francesco Bartolomucci
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6229 HX Maastricht, The Netherlands;
| | - Claudio Larosa
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Giovanni Valenti
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Antonio Tito
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Marco Moscarelli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Vito Margari
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Flavio Fiore
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Ignazio Condello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
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8
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Moscarelli M, Sollami G, Lentini E, Prestera R, Pernice V, Violante F, Cuffari F, Pasquale CD, La Grutta L, Grassedonio E, Speziale G, Fattouch K. Self-Expandable Prosthesis Valve Adaptation: Non-Uniform Expansion and Stent Frame Decoupling. Am J Cardiol 2023; 207:93-99. [PMID: 37734306 DOI: 10.1016/j.amjcard.2023.08.130] [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: 08/01/2023] [Revised: 08/20/2023] [Accepted: 08/20/2023] [Indexed: 09/23/2023]
Abstract
The incidence of non-uniform expansion in the context of the self-expandable transcatheter heart valve (THV) is little investigated, along with stent-frame decoupling, which is a form of stent adaptation, in which the lower part of the THV stent conforms to both the ellipticity of the left ventricle outflow tract and the native annulus while maintaining the higher part of the valve more circular. We analyzed post-implant multi-detector computed tomography scans in 50 patients. Prosthesis non-uniform expansion was assessed by computing the prosthesis eccentricity on 6 prespecified levels: (1) frame inflow, (2) native annulus, (3) leaflet inflow, (4) prosthesis waist, (5) leaflet outflow, and (6) frame outflow. Stent-frame decoupling was assessed by comparing the mean eccentricity on 6 different prosthesis levels. Implantation depth, leaflet expansion and alignment, and residual anatomic sinus area ratios were also calculated. Subclinical leaflet thrombosis was defined as hypoattenuated lesion of a meniscal shape. At a 12-month follow-up, non-uniform expansion was consistently detected at each valvular level. Highest eccentricity was measured at the native annulus level (eccentricity: 0.54 ± 0.12), while the lowest index at the frame outflow level (0.23 ± 0.11). Similar results were observed in the subgroup analyses of sizes 23, 26, 29, and 34. Eccentricity significantly decreased from the annulus level to the prosthesis frame outflow (p <0.001). Notably, the incidence of mild-to-severe subclinical leaflet thrombosis was relevant (16%). In conclusion, prosthesis non-uniform expansion and stent frame decoupling frequently occur after self-expandable THV replacement. The clinical and hemodynamic implications remain uncertain.
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Affiliation(s)
- Marco Moscarelli
- Departments of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy.
| | - Giulia Sollami
- Departments of Radiology, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Emanuele Lentini
- Departments of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Rosa Prestera
- Departments of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Vincenzo Pernice
- Departments of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Francesco Violante
- Departments of Radiology, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Federico Cuffari
- Departments of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Claudia Di Pasquale
- Departments of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Ludovico La Grutta
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Emanuele Grassedonio
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Giuseppe Speziale
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Khalil Fattouch
- Departments of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy; Department of Surgical, Oncological and Stomatological Sciences (DICHIRONS), University of Palermo, Palermo, Italy
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9
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Moscarelli M, Prestera R, Pernice V, Milo S, Violante F, Cuffari F, Di Pasquale C, Ferlisi A, Speziale G, Angelini GD, Fattouch K. Subclinical Leaflet Thrombosis Following Surgical and Transcatheter Aortic Valve Replacement: A Meta-Analysis. Am J Cardiol 2023; 204:171-177. [PMID: 37544140 DOI: 10.1016/j.amjcard.2023.07.089] [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: 05/18/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Abstract
Subclinical leaflets valve thrombosis (SLT) is a recently identified phenomenon with multidetector computer tomography after tissue aortic valve replacement. Whether SLT is more frequent after transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) is currently not known. Thus, the aim of this pairwise meta-analysis was to investigate the incidence of SLT after both TAVR and SAVR, the association with anticoagulation therapy, and the risk for neurological events. We searched PubMed, Google Scholar, and Ovid MEDLINE/Embase (January 02, 2023, last update) (PROSPERO registration: CRD42022383295). Statistical analysis was performed according to a prespecified statistical analysis plan. Time-to-event outcomes were summarized as incidence rate ratios (IRR). Pooled estimates were calculated using inverse variance method and random effect model. Overall, 2 registries, 2 randomized trials, and 1 observational study (1,593 patients) were included in this meta-analysis. There was a statistically significant difference in the incidence rate at follow-up of SLT between patients who underwent TAVR and SAVR (IRR 2.07, 95% confidence interval [CI]: [1.06; 4.03], I2 79%, 95% CI: [44; 92], p = 0.03). Oral anticoagulation therapy was associated with a reduced incidence of SLT (IRR 7.51, 95% CI: [3.24; 17.37], I2 62%, 95% CI: [0; 87], p <0.001). However, the incidence of later neurological events did not differ between patients with or without SLT (IRR 1.05, 95% CI: [0.32; 3.47], p = 0.93). In conclusion, SLT was more frequently detected after TAVR than SAVR. However, it was not associated with an increased risk for neurological events. Oral anticoagulation therapy seemed to reduce the incidence of SLT.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy.
| | - Rosa Prestera
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Vincenzo Pernice
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Sabrina Milo
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Francesco Violante
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Federico Cuffari
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Claudia Di Pasquale
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Angelo Ferlisi
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Giuseppe Speziale
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, United Kingdom
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy; DICHIRONS, Discipline Chirurgiche, Oncologiche e Stomatologiche, University of Palermo, Palermo, Italy
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10
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Nasso G, Santarpino G, Di Bari N, Fattouch K, Condello I, Moscarelli M, Del Giglio M, Paparella D, Lamarra M, Savini C, Coppola R, Fiorani V, Speziale G. Cardiac Surgery in Nonagenarians Following the TAVI/TMVI Era: A Multicenter 23-Year Comparative Analysis. J Clin Med 2023; 12:jcm12062177. [PMID: 36983179 PMCID: PMC10054800 DOI: 10.3390/jcm12062177] [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: 12/26/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Studies reporting on the outcome of 90-year-old patients undergoing cardiac surgery are scant in literature; and currently, those regarding the implementation of trans-catheter techniques number even fewer. Methods: We compared patients aged >89 years operated on between 1998 and 2008 at 8 Italian cardiac surgery centers, with patients of the same age operated on between 2009 and 2021. All of the patients were operated on with “open” surgery, with the exclusion of percutaneous valve repair/implantation procedures. Results: The patients of the two groups (group 98-08—127 patients, and group 09-21—101 patients) had comparable preoperative risk factors in terms of the LogEuroSCORE (98-08: 21.3 ± 6.1 vs. 09-21: 20.9 ± 11.1, p = 0.12). There was a considerable difference in the type of surgery (isolated valve, isolated coronary, and combined surgery, 46.5, 38.5, and 15% vs. 52, 13, and 35% in 98-08 and 09-21, respectively, p = 0.01). Analogous operating durations were recorded (cross-clamp time: 98-08: 46 ± 28 min vs. 09-21: 51 ± 28 min, p = 0.06). The number of packed bypasses was lower in 09-21 (1.3 ± 0.6 vs. 2.4 ± 1.2, p = 0.001). In the postoperative period, there was a statistically significant difference in the 30-day survival in favor of the “more recent” patients (98-08: 17 deaths (13.4%) versus 09-21: 6(5.9%); p = 0.001), also confirmed in the subgroups (12.2% vs. 0% in isolated coronary surgery, p < 0.001; and 12.3% vs. 0% in isolated valve surgery, p < 0.001). Conclusions: Accurate pre-, intra-, and post-operative evaluation/management to reduce biological impacts facilitate significant improvements in the outcomes in nonagenarian patients when compared to the results recorded in previous years.
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Affiliation(s)
- Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70100 Bari, Italy
- Correspondence: ; Tel.: +39-080-564-4168; Fax: +39-080-564-4678
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, 73100 Lecce, Italy
- Department of Cardiac Surgery, Paracelsus Medical University, 40100 Nuremberg, Germany
- Department of Experimental and Clinical Medicine, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Nicola Di Bari
- Department of Cardiac Surgery, “Aldo Moro” University, 70100 Bari, Italy
| | - Khalil Fattouch
- Department of Cardiac Surgery, Maria Eleonora Hospital, GVM Care & Research, 90121 Palermo, Italy
| | - Ignazio Condello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70100 Bari, Italy
| | - Marco Moscarelli
- Department of Cardiac Surgery, Maria Eleonora Hospital, GVM Care & Research, 90121 Palermo, Italy
| | - Mauro Del Giglio
- Department of Cardiac Surgery, Maria Pia Hospital, GVM Care & Research, 10024 Torino, Italy
| | - Domenico Paparella
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70100 Bari, Italy
- Department of Cardiac Surgery, University of Foggia, 71121 Foggia, Italy
| | - Mauro Lamarra
- Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, 40100 Cotignola, Italy
- Department of Cardiac Surgery, Villa Torri Hospital, GVM Care & Research, 40100 Bologna, Italy
| | - Carlo Savini
- Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, 40100 Cotignola, Italy
| | - Roberto Coppola
- Department of Cardiac Surgery, ICLAS Hospital, GVM Care & Research, 16135 Rapallo, Italy
| | - Vinicio Fiorani
- Department of Cardiac Surgery, Salus Hospital, GVM Care & Research, 40100 Reggio Emilia, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70100 Bari, Italy
- Department of Cardiac Surgery, San Carlo di Nancy Hospital, GVM Care & Research, 00042 Rome, Italy
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11
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Milo SM, Toia P, Midiri F, D'Alessandro L, Sollami G, Panci A, Pernice V, Violante F, Fattouch K, Cutaia G, Salvaggio G, Lo Re G, Grassedonio E, Galia M, La Grutta L. Aortic valve and vascular calcium score in pre-TAVI CT: correlation with early post-procedural complications. Radiol Med 2023; 128:299-306. [PMID: 36786969 PMCID: PMC10020291 DOI: 10.1007/s11547-023-01603-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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE The aim of our study was to evaluate the prevalence of early complications after Transcatheter Aortic Valve Implantation (TAVI) and their correlation with the Calcium Score (CS) of the aortic valve, aorta and ilio-femoral arteries derived from pre-procedural computed tomography (CT). MATERIALS AND METHODS We retrospectively reviewed 226 patients (100 males, mean age 79.4 ± 6.7 years) undergoing 64-slice CT for pre-TAVI evaluation from January 2018 to April 2021. The population was divided into CS quartiles. RESULTS Overall, 173 patients underwent TAVI procedure, of whom 61% presented paravalvular leak after the procedure, 28% presented bleeding or vascular complications, 25% presented atrioventricular block, and 8% developed acute kidney injury. The prevalence of paravalvular leak and vascular complications was higher in the upper CS quartiles for aortic valve and ilio-femoral arteries. CONCLUSIONS Aortic valve and vascular CS could help to predict post-TAVI early complications.
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Affiliation(s)
- Sabrina Maria Milo
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
- GVM Care and Research, Department of Diagnostic Imaging, Maria Eleonora Hospital, Palermo, Italy
| | - Patrizia Toia
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Federico Midiri
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Luigi D'Alessandro
- GVM Care and Research, Department of Diagnostic Imaging, Maria Eleonora Hospital, Palermo, Italy
| | - Giulia Sollami
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Aldo Panci
- GVM Care and Research, Department of Diagnostic Imaging, Maria Eleonora Hospital, Palermo, Italy
| | - Vincenzo Pernice
- GVM Care and Research, Department of Hemodynamics and Interventional Cardiac and Vascular, Maria Eleonora Hospital, Palermo, Italy
| | - Francesco Violante
- GVM Care and Research, Department of Diagnostic Imaging, Maria Eleonora Hospital, Palermo, Italy
| | - Khalil Fattouch
- GVM Care and Research, Department of Cardiovascular Surgery, Maria Eleonora Hospital, Palermo, Italy
| | - Giuseppe Cutaia
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Giuseppe Salvaggio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Giuseppe Lo Re
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Emanuele Grassedonio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Massimo Galia
- Department of Biomedicine, Neurosciences and Advanced Diagnostics-BIND, University of Palermo, Via del Vespro 127, 90100, Palermo, Italy
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties - ProMISE, University of Palermo, Via Del Vespro 12790100, Palermo, Italy.
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12
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Nogara A, Minacapelli A, Zambelli G, V LC, Fattouch K. Functional anatomy and echocardiographic assessment in secondary mitral regurgitation. J Card Surg 2022; 37:4103-4111. [PMID: 35998280 DOI: 10.1111/jocs.16863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mitral valve apparatus is complex and involves the mitral annulus, the leaflets, the chordae tendinae, the papillary muscles as well as the left atrial and ventricular myocardium. Secondary mitral regurgitation is a consequence of regional or global left ventricle remodeling due to an acute myocardial infarction (75% of cases) or idiopathic dilated cardiomyopathy (25% of cases). It is associated with an increase in mortality and poor outcome. There is a potential survival benefit deriving from the reduction in the degree of severity of mitral regurgitation. So the correction of the valve defect can change the clinical course and prognosis of the patient. The rationale for mitral valve treatment depends on the mitral regurgitation mechanism. Therefore, it is essential to identify and understand the pathophysiology of mitral valve regurgitation. AIM OF THE STUDY The aim of this review is to describe the crucial role of transthoracic and trans-esophageal echocardiography, in particular with three-dimensional echocardiography, for the assessment of the severity of secondary mitral regurgitation, anatomy, and hemodynamic changes in the left ventricle. Moreover, the concept that the mitral valve has no organic lesions has been abandoned. The echocardiography must allow a complete anatomical and functional evaluation of each component of the mitral valve complex, also useful to the surgeon in choosing the best surgical approach to repair the valve. CONCLUSIONS Echocardiography is the first-line imaging modality for a better selection of patients, according to geometrical modifications of mitral apparatus and left ventricle viability, especially in preoperative phase.
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Affiliation(s)
- Angela Nogara
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Alberto Minacapelli
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Giulia Zambelli
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Lo Coco V
- Department of Cardiac Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
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13
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Guccione F, Moscarelli M, Sampognaro R, Salardino M, Bacarella D, Angela N, Fattouch K. Subannular procedures on papillary muscles for secondary mitral valve regurgitation repair. J Card Surg 2022; 37:5434-5438. [PMID: 36515261 DOI: 10.1111/jocs.16968] [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] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Francesco Guccione
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Roberta Sampognaro
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Massimo Salardino
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Daniela Bacarella
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Nogara Angela
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
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14
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Fattouch K, Calafiore AM. Mitral valve repair: Regulatory or ethical problem? J Card Surg 2022; 37:4094-4096. [PMID: 35916157 DOI: 10.1111/jocs.16823] [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: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 01/06/2023]
Abstract
The long-term outcome of patients undergoing mitral valve repair (MVr) is based on what happens during the more or less 60 min of aortic cross-clamping necessary to transform a leaking valve into a well-functioning one. As a consequence, the experience of the surgeon performing the procedure is the only determinant of the success rate that deserves to be taken into account. It is clear from the literature that the number of cases/year is inversely related to the number of early and late deaths, repair failures, and reoperations. However, there is no agreement on the minimum caseload/year that represents the threshold to identify surgeons that can perform or not MVr. This problem then cannot be regulated by specific guidelines of Scientific Societies, but only by the ethical perception, we have of our profession.
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Affiliation(s)
- Khalil Fattouch
- Department of Surgical, Oncologic and Stomatological Disciplines, GVM Care and Research, Maria Eleonora Hospital, University of Palermo, Palermo, Italy
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15
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Calafiore AM, Prapas S, Totaro A, Guarracini S, Cargoni M, Katsavrias K, Fattouch K, Di Mauro M. Cutting the second order chords during mitral valve repair. J Card Surg 2022; 37:4072-4078. [PMID: 36378871 DOI: 10.1111/jocs.17194] [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: 07/04/2022] [Revised: 08/15/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022]
Abstract
The chordae tendinae connect the papillary muscles (PMs) to the mitral valve. While the first-order chordae serve to secure the leaflets to maintain valve closure and prevent mitral valve prolapse, the second-order chordae are believed to play a role in maintaining normal left ventricle size and geometry. The PMs, from where the chordae tendinae originate, function as shock absorbers that compensate for the geometric changes of the left ventricular wall. The second-order chordae connect the PMs to both trigons under tension. The tension distributed towards the second-order chordae has been demonstrate to be more than threefold that in their first-order counterpart. Cutting the second-order chordae puts all the tension on the first-order chordae, which are then closer to their rupture point. However, it has been experimentally demonstrated that the tension at which the first-order chordae break is 6.8 newtons (N), by far higher than the maximal tension reached, that is 0.4 N. Even if the clinical reports have been favorable, the importance of cutting the second-order chordae to recover curvature of the anterior leaflet and increase the coaptation length between the mitral valve leaflets has been slowly absorbed by the surgical world. Nevertheless, there are progressive demonstrations that chordal tethering affects the anterior leaflet not only in secondary, but also in primary mitral regurgitation, having a not negligible role in the long-term outcome of mitral repair.
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Affiliation(s)
| | - Sotirios Prapas
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | - Antonio Totaro
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | | | - Marco Cargoni
- Department of Surgical, Oncologic and Stomatological Disciplines, GVM Care & Research, Maria Eleonora Hospital, University of Palermo, Palermo, Italy
| | - Kostas Katsavrias
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | - Khalil Fattouch
- Department of Cardiac Anesthesia, Mazzini Hospital, Teramo, Italy
| | - Michele Di Mauro
- Departmente of Cardio-Thoracic and Vascular Surgery, Heart and Vascular Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
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16
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Moscarelli M, Paparella D, Angelini GD, Giannini F, Contegiacomo G, Marchese A, Nasso G, Albertini A, Fattouch K, Speziale G. The influence of metabolic syndrome in heart valve intervention. A multi-centric study. J Card Surg 2022; 37:5063-5072. [PMID: 36413686 DOI: 10.1111/jocs.17204] [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: 09/14/2022] [Accepted: 10/29/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The effect of metabolic syndrome (MetS), defined as insulin resistance along with two or more of: obesity, atherogenic dyslipidaemia and elevated blood pressure, on postoperative complications after isolated heart valve intervention remains controversial. We hypothesized that MetS may negatively influence the postoperative course in these patients. METHODS Patients from 10 cardiac units who underwent isolated valve intervention (mitral± $\pm $ tricuspid repair/replacement (mitral valve surgery [MVS]) or surgical aortic valve replacement (SAVR), or transcatheter aortic valve replacement (TAVR) were included. MetS was defined according to the World Health Organization criteria. Primary outcome was in-hospital mortality and overall postoperative length of stay (LOS). Relevant postoperative complications were also recorded. RESULTS From 2010 to 2019, 17,283 patients underwent valve intervention. The MVS, SVAR, and TAVR accounted for the 39.4%, 48.2%, and 12.3% respectively of the whole. MetS compared to no-MetS was associated to higher mortality in the MVS group (6.5% vs. 2%, p < .001), but not in the SAVR and TAVR group. In both surgical cohorts, MetS was associated with increased complications including red blood cells transfusion, renal failure, mechanical ventilation time, intensive care and overall postoperative LOS (11 (9) vs. 10 (6), p < .001 and 10 (6) versus 10 (5) days, p = .002, MVS and [SAVR]). No differences were found in the TAVR cohort, with similar mortality and complications. CONCLUSION MetS was associated to more postoperative complications, with higher mortality in the MVS group. In the TAVR cohort, postoperative complications and mortality rate did not differ between patients with and without MetS, however LOS was longer in the MetS group.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
| | - Domenico Paparella
- Department of Cardiovascular Surgery, GVM Care & Research, Santa Maria Hospital, Bari, Italy
| | | | - Francesco Giannini
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Gaetano Contegiacomo
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
| | - Alfredo Marchese
- Department of Cardiovascular Surgery, GVM Care & Research, Santa Maria Hospital, Bari, Italy
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
| | - Alberto Albertini
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy
| | - Giuseppe Speziale
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
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Moscarelli M, Fattouch K. No need to treat atrial fibrillation. An unexpected perspective. J Card Surg 2022; 37:3607-3608. [DOI: 10.1111/jocs.16932] [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: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery GVM Care and Research, Eleonora Hospital Palermo Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery GVM Care and Research, Eleonora Hospital Palermo Italy
- Department of Cardiovascular Surgery University of Palermo Palermo Italy
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18
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Moscarelli M, Fattouch K. Commentary to: "Comparing midterm outcomes" of Cox-Maze procedure and pulmonary vein isolation for atrial fibrillation after concomitant mitral valve surgery: A "systematic review". J Card Surg 2022; 37:3811-3812. [PMID: 36040719 DOI: 10.1111/jocs.16886] [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: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
There is no solid evidence from the literature that compare Cox-Maze with pulmonary vein isolation techniques for atrial fibrillation in the context of concomitant mitral valve surgery. Although the first is perhaps more effective and linked to higher freedom from atrial fibrillation, it is more invasive compared to the pulmonary isolation.
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Affiliation(s)
- Marco Moscarelli
- Deparment of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Khalil Fattouch
- Deparment of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
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19
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Novo G, Almeida A, Nobile D, Morreale P, Fattouch K, Lisi DD, Manno G, Lancellotti P, Pinto FJ. RIGHT VENTRICLE FUNCTION IN PATIENTS WITH ANTERIOR MYOCARDIAL INFARCTION: ARE WE SURE IT IS NOT INVOLVED? Curr Probl Cardiol 2022; 47:101277. [PMID: 35661811 DOI: 10.1016/j.cpcardiol.2022.101277] [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: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
The right and left ventricle of heart are intimately connected by anatomical and functional links. Hence, acute changes in cardiac geometry and function can modify the performance and physiology of both sides of the heart, influencing each other. After a brief overview of the anatomy and related imaging techniques for the study of right ventricular function, we report a review on the interesting correlation of acute anterior myocardial infarction and right ventricular function, very often underestimated.
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Affiliation(s)
- Giuseppina Novo
- Cardiology Unit, Department of Excellence of Sciences for Health Promotion and Mothernal-Child Care, Internal Medicine and Specialities (ProMISE), University of Palermo, University Hospital Paolo Giaccone, Palermo, Italy.
| | - Ana Almeida
- Centro Cardiovascular da Universidade de Lisboa - CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Portugal; Serviço de Cardiologia, Hospital Universitário de Santa Maria, CHULN, Portugal
| | - Domenico Nobile
- Cardiology Unit, Department of Excellence of Sciences for Health Promotion and Mothernal-Child Care, Internal Medicine and Specialities (ProMISE), University of Palermo, University Hospital Paolo Giaccone, Palermo, Italy
| | - Pierluigi Morreale
- Cardiology Unit, Department of Excellence of Sciences for Health Promotion and Mothernal-Child Care, Internal Medicine and Specialities (ProMISE), University of Palermo, University Hospital Paolo Giaccone, Palermo, Italy
| | - Khalil Fattouch
- Maria Eleonora Hospital, Department of Cardiac Surgery, GVM Care & Research, Palermo, Italy
| | - Daniela Di Lisi
- Cardiology Unit, Department of Excellence of Sciences for Health Promotion and Mothernal-Child Care, Internal Medicine and Specialities (ProMISE), University of Palermo, University Hospital Paolo Giaccone, Palermo, Italy
| | - Girolamo Manno
- Cardiology Unit, Department of Excellence of Sciences for Health Promotion and Mothernal-Child Care, Internal Medicine and Specialities (ProMISE), University of Palermo, University Hospital Paolo Giaccone, Palermo, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, Groupe Interdisciplinaire de Genoproteomique Appliquee Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Fausto J Pinto
- Centro Cardiovascular da Universidade de Lisboa - CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Portugal; Serviço de Cardiologia, Hospital Universitário de Santa Maria, CHULN, Portugal
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20
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Calafiore AM, Haverich A, Gaudino M, Di Mauro M, Fattouch K, Prapas S, Zilla P. Immunoreaction to xenogenic tissue in cardiac surgery: alpha-Gal and beyond. Eur J Cardiothorac Surg 2022; 62:6535925. [PMID: 35211732 DOI: 10.1093/ejcts/ezac115] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Michele Di Mauro
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Khalil Fattouch
- Department of Surgical, Oncologic and Stomatological Disciplines, University of Palermo, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy
| | - Sotirios Prapas
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | - Peter Zilla
- Christian Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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21
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Moscarelli M, Lorusso R, Angelini GD, Di Bari N, Paparella D, Fattouch K, Albertini A, Nasso G, Fiorentino F, Speziale G. Sex-specific differences and postoperative outcomes of minimally invasive and sternotomy valve surgery. Eur J Cardiothorac Surg 2022; 61:695-702. [PMID: 34392335 PMCID: PMC8858592 DOI: 10.1093/ejcts/ezab369] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Female sex is an established risk factor for postoperative complications after heart surgery, but the influence of sex on outcomes after minimally invasive cardiac surgery (MICS) for valvular replacement/repair remains controversial. We examined whether the role of sex as a risk factor varies by surgical approach [MICS vs conventional sternotomy (ST)] and further assessed outcomes among female patients including in-hospital mortality and postoperative complications by surgical approach. METHODS We analysed data from a multicentre registry for patients who underwent isolated aortic valve and mitral surgery with MICS or ST. The primary outcome was in-hospital mortality. Propensity score matching was used to minimize between-group differences. RESULTS Among the 15 155 patients included in the study, 7674 underwent MICS (50.6%). Female sex was equally distributed in the MICS and ST groups (47.3% vs 47.6%, respectively). Risk for surgery was higher in the ST group than in the MICS group {EuroSCORE II: 4.0 [standard deviation (SD): 6.8] vs 3.7 [SD: 6.4]; P = 0.005}, including among female patients only [ST vs MICS 4.6 (SD: 6.9) vs 4.2 (SD: 6.3); P = 0.04]. Mortality did not significantly vary by procedure among women [MICS vs ST, 2.4% vs 2.8%; hazard ratio 1.09, 95% confidence interval 0.71-1.73; P (surgical approach × sex) = 0.51]. The results also did not vary after adjusting for confounders. CONCLUSIONS Female sex was associated with higher mortality in patients undergoing valve surgery, regardless of surgical approach. In female patients, MICS did not provide any benefits over ST in terms of in-hospital deaths or postoperative complications. SUBJECT COLLECTION 117, 125.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Gianni D Angelini
- Department of Cardiovascular Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Nicola Di Bari
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
| | - Domenico Paparella
- Department of Cardiovascular Surgery, GVM Care & Research, Santa Maria Hospital, Bari, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy
| | - Alberto Albertini
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
| | - Francesca Fiorentino
- Department of Surgery and Cancer and Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Giuseppe Speziale
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
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22
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Fattouch K, Moscarelli M. Shedding some light on tricuspid intervention. J Card Surg 2021; 37:336-338. [PMID: 34775649 DOI: 10.1111/jocs.16133] [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: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND More than 1.6 million Americans have at least moderate to severe valvular tricuspid regurgitation, yet fewer than 8000 tricuspid valve operations are performed annually in the USA. The undertreatment for isolated tricuspid regurgitation might be related to the fact that in the past years no clear guidelines on 'how' and 'when' to treat tricuspid regurgitation were issued. AIMS Sarris-Michopoulos and colleagues carried out a meta-analysis with the aim to investigate the role of tricuspid valve repair versus tricuspid valve replacement in patients with isolated tricuspid valve regurgitation. MATERIAL AND METHODS Outcomes of patients with first-time surgery for isolated tricuspid valve regurgitation without previous left-sided valve surgery were reviewed. Ten studies were included with a total of 1407 patients. RESULTS Authors concluded that patients who underwent tricuspid valve repair showed less 30-days mortality than replacement along with a reduced need for post-operaitve permanent pacemaker implantation rate. DISCUSSION Decision on whether to treat or not tricuspid valve is demanding, particularly in the context of the newest percutaneous technologies. Before intervention, careful evaluation of both tricuspid valve and right ventricle must be performed. Nevertheless, intervention, should not be deferred when clinically indicated. CONCLUSIONS The findings form this meta-analysis suggest that reparative surgery, perhaps in an early stage, may be beneficial in selected cohort of patients.
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Affiliation(s)
- Khalil Fattouch
- Dicronis, Department of Cardiovascular Surgery, University of Palermo, Palermo, Italy
| | - Marco Moscarelli
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
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23
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Santarpino G, Lorusso R, Moscarelli M, Mikus E, Wisniewski K, Dell'Aquila AM, Margari V, Carrozzo A, Barbato L, Fiorani V, Lamarra M, Fattouch K, Squeri A, Giannini F, Marchese A, Farahani K, Gregorini R, Comoglio C, Martinelli L, Calvi S, Avolio M, Paparella D, Albertini A, Speziale G. Sutureless versus transcatheter aortic valve replacement: A multicenter analysis of "real-world" data. J Cardiol 2021; 79:121-126. [PMID: 34518075 DOI: 10.1016/j.jjcc.2021.08.022] [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: 04/09/2021] [Revised: 08/08/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recent data suggested that transcatheter aortic valve replacement (TAVR) may be indicated also for low-risk patients. However, robust evidence is still lacking, particularly regarding valve performance at follow-up that confers a limitation to its use in young patients. Moreover, a literature gap exists in terms of 'real-world' data analysis. The aim of this study is to compare the cost-effectiveness of sutureless aortic valve replacement (SuAVR) versus transfemoral TAVR. METHODS Prospectively collected data were retrieved from a centralized database of nine cardiac surgery centers between 2010 and 2018. Follow-up was completed in June 2019. A propensity score matching (PSM) analysis was performed. RESULTS Patients in the TAVR group (n=1002) were older and with more comorbidities than SuAVR patients (n=443). The PSM analysis generated 172 pairs. No differences were recorded between groups in 30-day mortality [SuAVR vs TAVR: n=7 (4%) vs n=5 (2.9%); p=0.7] and need for pacemaker implant [n=10 (5.8%) vs n=20 (11.6%); p=0.1], but costs were lower in the SuAVR group (20486.6±4188€ vs 24181.5±3632€; p<0.01). Mean follow-up was 1304±660 days. SuAVR patients had a significantly higher probability of survival than TAVR patients (no. of fatal events: 22 vs 74; p<0.014). Median follow-up was 2231 days and 2394 days in the SuAVR and TAVR group, respectively. CONCLUSION The treatment of aortic valve stenosis with surgical sutureless or transcatheter prostheses is safe and effective. By comparing the two approaches, patients who can undergo surgery after heart team evaluation show longer lasting results and a more favorable cost ratio.
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Affiliation(s)
- Giuseppe Santarpino
- Città di Lecce Hospital, Department of Cardiac Surgery, GVM Care & Research, Lecce, Italy; Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany; Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University "Magna Graecia", Catanzaro (CZ), Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Hospital, Maastricht, the Netherlands
| | - Marco Moscarelli
- Anthea Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari (BA), Italy
| | - Elisa Mikus
- Maria Cecilia Hospital, Department of Cardiac Surgery, GVM Care & Research, Cotignola (RA), Italy
| | - Konrad Wisniewski
- Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany.
| | | | - Vito Margari
- Santa Maria Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari (BA), Italy
| | - Alessandro Carrozzo
- ICLAS, Department of Cardiac Surgery, GVM Care & Research, Rapallo (GE), Italy
| | - Luciano Barbato
- Maria Pia Hospital, Department of Cardiac Surgery, GVM Care & Research, Turin, Italy
| | - Vinicio Fiorani
- Salus Hospital, Department of Cardiac Surgery, GVM Care & Research, Reggio Emilia, Italy
| | - Mauro Lamarra
- Villa Torri, Department of Cardiac Surgery, GVM Care & Research, Bologna, Italy
| | - Khalil Fattouch
- Maria Eleonora Hospital, Department of Cardiac Surgery, GVM Care & Research, Palermo, Italy
| | - Angelo Squeri
- Maria Cecilia Hospital, Department of Cardiology, GVM Care & Research, Cotignola (RA), Italy
| | - Francesco Giannini
- Maria Cecilia Hospital, Department of Cardiology, GVM Care & Research, Cotignola (RA), Italy
| | - Alfredo Marchese
- Santa Maria Hospital, Department of Cardiology, GVM Care & Research, Bari, Italy
| | - Kia Farahani
- Città di Lecce Hospital, Department of Cardiology, GVM Care & Research, Lecce, Italy
| | - Renato Gregorini
- Città di Lecce Hospital, Department of Cardiac Surgery, GVM Care & Research, Lecce, Italy
| | - Chiara Comoglio
- Maria Pia Hospital, Department of Cardiac Surgery, GVM Care & Research, Turin, Italy
| | - Luigi Martinelli
- ICLAS, Department of Cardiac Surgery, GVM Care & Research, Rapallo (GE), Italy
| | - Simone Calvi
- Maria Cecilia Hospital, Department of Cardiac Surgery, GVM Care & Research, Cotignola (RA), Italy
| | - Maria Avolio
- Clinical Data Management, GVM Care & Research, Rome, Italy
| | - Domenico Paparella
- Santa Maria Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari (BA), Italy; Department of Emergency and Organ Transplant, Aldo Moro University of Bari, Bari, Italy
| | - Alberto Albertini
- Maria Cecilia Hospital, Department of Cardiac Surgery, GVM Care & Research, Cotignola (RA), Italy
| | - Giuseppe Speziale
- Anthea Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari (BA), Italy
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24
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Moscarelli M, Santarpino G, Athanasiou T, Mastroroberto P, Fattouch K, Nasso G, Speziale G. A pooled analysis of pacemaker implantation after Perceval sutureless aortic valve replacement. Interact Cardiovasc Thorac Surg 2021; 33:501-509. [PMID: 34000013 DOI: 10.1093/icvts/ivab137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/10/2020] [Revised: 02/15/2021] [Accepted: 03/31/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We performed a literature meta-analysis to estimate the rate of pacemaker implantation after Perceval sutureless aortic valve replacement. METHODS Pertinent articles were identified from the PubMed, Google Scholar, Ovid MEDLINE and Ovid EMBASE databases. Eligible studies reported the de novo incidence of postoperative pacemaker implantation after Perceval valve surgery. Among 394 articles retrieved, 26 studies including 9492 patients met the inclusion criteria. RESULTS The pooled event rate for postoperative pacemaker implantation was 7% [95% confidence interval (CI) 6-9%]; however, significant heterogeneity was observed across studies. In a sub-analysis, there was no difference between the rates of pacemaker implantation calculated from multicentre and registry studies (8 studies, 6845 patients; 7%, 95% CI 5-10%) and single-centre studies (18 studies, 2647 patients; 7%, 95% CI 5-9%; P = 0.75). Implantation rates were similar in high-volume studies (16 studies, 9121 patients; 7%, 95% CI 5-8%) than in low-volume studies (10 studies, 371 patients; pooled rate: 7%, 95% CI 4-14%; P = 0.5). Postoperative pacemaker implantation rates tended to decrease over time. CONCLUSIONS With a pooled event rate of 7%, postoperative pacemaker implantation remains an important limitation of Perceval sutureless valve surgery, although we observed a degree of variability across included studies. The resultant findings provide a useful estimate for physicians and patients and can serve as a benchmark for future comparative studies. PROSPERO REGISTRATION NUMBER CRD42020188397.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Imperial College, NHLI, Hammersmith Hospital, London, UK
| | - Giuseppe Santarpino
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy.,Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | | | - Pasquale Mastroroberto
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
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25
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Paparella D, Santarpino G, Moscarelli M, Guida P, De Santis A, Fattouch K, Martinelli L, Coppola R, Mikus E, Albertini A, Del Giglio M, Gregorini R, Speziale G. Minimally invasive aortic valve replacement: short-term efficacy of sutureless compared with stented bioprostheses. Interact Cardiovasc Thorac Surg 2021; 33:188-194. [PMID: 33984125 DOI: 10.1093/icvts/ivab070] [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: 12/16/2020] [Revised: 01/23/2021] [Accepted: 01/24/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Sutureless aortic valve prostheses have been introduced to facilitate the implant process, speed up the operating time and improve haemodynamic performance. The goal of this study was to assess the potential advantages of using sutureless prostheses during minimally invasive aortic valve replacement in a large multicentre population. METHODS From 2011 to 2019, a total of 3402 patients in 11 hospitals underwent isolated aortic valve replacement with minimal access approaches using a bioprosthesis. A total of 475 patients received sutureless valves; 2927 received standard valves. The primary outcome was the incidence of 30-day deaths. Secondary outcomes were the occurrence of major complications following procedures performed with sutureless or standard bioprostheses. Propensity matched comparisons was performed based on a multivariable logistic regression model. RESULTS The annual number of sutureless valve implants increased over the years. The matching procedure paired 430 sutureless with 860 standard aortic valve replacements. A total of 0.7% and 2.1% patients with sutureless and standard prostheses, respectively, died within 30 days (P = 0.076). Cross-clamp times [48 (40-62) vs 63 min (48-74); P = 0.001] and need for blood transfusions (27.4% vs 33.5%; P = 0.022) were lower in patients with sutureless valves. No difference in permanent pacemaker insertions was observed in the overall population (3.3% vs 4.4% in the standard and sutureless groups; P = 0.221) and in the matched groups (3.6% vs 4.7% in the standard and sutureless groups; P = 0.364). CONCLUSIONS The use of sutureless prostheses is advantageous and facilitates the adoption of a minimally invasive approach, reducing cardiac arrest time and the number of blood transfusions. No increased risk of permanent pacemaker insertion was observed.
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Affiliation(s)
- Domenico Paparella
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy.,Dipartimento Scienze Medice e Chirurgiche, Università di Foggia, Foggia, Italy
| | - Giuseppe Santarpino
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy.,Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Marco Moscarelli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Pietro Guida
- Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Italy
| | - Adriano De Santis
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Khalil Fattouch
- Department of Cardiac Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Luigi Martinelli
- Department of Cardiac Surgery, ICLAS, GVM Care & Research, Rapallo, Italy
| | - Roberto Coppola
- Department of Cardiac Surgery, ICLAS, GVM Care & Research, Rapallo, Italy
| | - Elisa Mikus
- Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Alberto Albertini
- Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Mauro Del Giglio
- Department of Cardiac Surgery, Villa Torri Hospital, GVM Care & Research, Bologna, Italy
| | - Renato Gregorini
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
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26
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Moscarelli M, Nasso G, Fattouch K, Di Bari N, Bonifazi R, Speziale G. A modified technique for performing proximal anastomosis of a supracoronary graft. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 34019746 DOI: 10.1510/mmcts.2021.028] [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: 06/12/2023]
Abstract
An aortic aneurysm may cause loss of the sinotubular junction. Reduction in the diameter of the sinotubular junction may reestablish aortic valve competence in patients with an ascending aortic aneurysm and aortic valve regurgitation with normal aortic cusps. With this video tutorial we describe an alternative technique for replacing the ascending aorta with restoration of the sinotubular junction.
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Affiliation(s)
- Marco Moscarelli
- GVM Care & Research, Department of Cardiovascular Surgery, Anthea Hospital, Bari, Italy
| | - Giuseppe Nasso
- GVM Care & Research, Department of Cardiovascular Surgery, Anthea Hospital, Bari, Italy
| | | | - Nicola Di Bari
- GVM Care & Research, Department of Cardiovascular Surgery, Anthea Hospital, Bari, Italy
| | - Raffaele Bonifazi
- GVM Care & Research, Department of Cardiovascular Surgery, Anthea Hospital, Bari, Italy
| | - Giuseppe Speziale
- GVM Care & Research, Department of Cardiovascular Surgery, Anthea Hospital, Bari, Italy
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27
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Moscarelli M, Di Bari N, Nasso G, Fattouch K, Athanasiou T, Bonifazi R, Speziale G. Early safety performance of a modified technique of aorta replacement with sinotubular stabilization. Asian Cardiovasc Thorac Ann 2021; 30:171-176. [PMID: 33947228 DOI: 10.1177/02184923211015094] [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: 11/17/2022]
Abstract
BACKGROUND We sought to determine if a modified technique for ascending aorta replacement with sinotubular junction reduction and stabilization was safe. METHODS This technique was performed by suspension of the three commissures, invagination of the aortic Dacron graft and advancing the graft into the ventricles. We included patients with dilatation of the ascending aorta, normal sinuses of Valsalva dimension (<45 mm), with or without aortic annulus enlargement (>25 mm) and with various degree of aortic insufficiency (from grade 1 to 3). RESULTS From April to October 2019, 20 patients were recruited from two centers; mean age was 66.9 ± 12.8 years, 13 were male; grade 1, 2 and 3 was present in 12, 2 and 6 patients, respectively. All patients underwent ascending aorta replacement with modified technique; an additional open subvalvular ring was used in 8 patients with aortic insufficiency ≥ 2; cusps repair was performed in 6 patients (5 plicating central stitches/1 shaving); concomitant coronary artery bypass grafting was performed in 10 patients. There was no 30-day mortality. One patient was re-explored for bleeding. All patients completed six-month follow-up; at the transthoracic echocardiography, there was no aortic insufficiency ≥ 1 except one patient with aortic insufficiency grade 1 who underwent ascending aorta replacement and subvalvular ring; no patients underwent reintervention. CONCLUSIONS This modified technique for ascending aorta replacement and sinotubular junction stabilization was safe. It could be associated with other aortic valve sparing techniques. However, such remodeling approach has to be validated in a larger cohort of patients with longer follow-up.
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Affiliation(s)
| | | | | | - Khalil Fattouch
- GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy
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28
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Moscarelli M, Rahouma M, Nasso G, di Bari N, Speziale G, Bartolomucci F, Pepe M, Fattouch K, Lau C, Gaudino M. Minimally invasive approaches to primary cardiac tumors: A systematic review and meta-analysis. J Card Surg 2020; 36:483-492. [PMID: 33259109 DOI: 10.1111/jocs.15224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Cardiac tumors are rare conditions. The vast majority of them are benign yet they may lead to serious complications. Complete surgical resection is the gold standard treatment and should be performed as soon as the diagnosis is made. Median sternotomy (MS) is the standard approach and provides excellent early outcomes and durable results at follow-up. However, minimally invasive (MI) is gaining popularity and its role in the treatment of cardiac tumors needs further clarification. METHODS A systematic literature review identified 12 candidate studies; of these, 11 met the meta-analysis criteria. We analyzed outcomes of 653 subjects (294 MI and 359 MS) with random effects modeling. Each study was assessed for heterogeneity. The primary endpoints were mortality at follow-up and tumor relapse. Secondary endpoints included relevant intraoperative and postoperative outcomes; tumor size was also considered. RESULTS There were no significant between-group differences in terms of late mortality (incidence rate ratio [IRR]: MI vs. MS, 0.98 [95% confidence interval [CI]: 0.25-3.82], p = .98). Few relapses (IRR: 1.13; CI: 0.26-4.88; p = .87) and redo surgery (IRR: 1.92; 95% CI: 0.39-9.53; p = .42) were observed in both groups; MI approach resulted in prolonged operation time but that did not influence the clinical outcomes. Tumor size did not significantly differ between groups. CONCLUSION Both MI and MS are associated with excellent early and late outcomes with acceptable survival rate and low incidence of recurrences. This study confirms that cardiac tumor may be approached safely and radically with a MI approach.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Mohamed Rahouma
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | | | - Giuseppe Speziale
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | | | - Martino Pepe
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Christopher Lau
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, New York, USA
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Moscarelli M, Lorusso R, Abdullahi Y, Varone E, Marotta M, Solinas M, Casula R, Parlanti A, Speziale G, Fattouch K, Athanasiou T. The Effect of Minimally Invasive Surgery and Sternotomy on Physical Activity and Quality of Life. Heart Lung Circ 2020; 30:882-887. [PMID: 33191139 DOI: 10.1016/j.hlc.2020.09.936] [Citation(s) in RCA: 9] [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: 03/29/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
AIM The aim of this study was to compare minimally invasive surgery (MI) and median sternotomy (MS) in terms of post-procedure health-related quality of life (HRQoL) and functional outcome. METHOD We conducted a multicentre prospective cohort study that enrolled patients from January 2015 until February 2017. Combined cardiac procedures were performed with MS and isolated valve procedures with either MS or MI, depending on patient preference and surgeon experience. HRQoL was measured using the five-level version of the EQ-5D (EQ-5D-5L) and physical activity before and after surgery was evaluated using a wearable accelerometer. Activity patterns and intensity recorded by the accelerometer in each period were classified as "sedentary", "light physical activity", "moderate physical activity", and "vigorous physical activity" for each patient. We also conducted a sub-analysis of frail patients in each group, as identified by the Reported Edmonton Frail Scale (>10 points). Patients were followed for 1 year. RESULTS The study included 100 consecutive patients who underwent MI (n=50) or MS (n=50) during the study period. Patients in the MI group showed a faster recovery of physical activity in the immediate postoperative period and superior HRQoL in the first 3 months (both p<0.001) versus the MS group. Differences between the MI and MS group were indistinguishable over a longer follow-up. A similar correlation was observed in the frailty subanalysis. Overall, the MS group had a higher cumulative incidence of events than the MI group (p<0.001). CONCLUSIONS Compared to conventional MS, MI was associated with better HRQoL and early functional outcome, even in frail patients.
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Affiliation(s)
- Marco Moscarelli
- Imperial College, National Heart and Lung Institute, London, UK; Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy.
| | - Roberto Lorusso
- Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Yusuf Abdullahi
- Imperial College, National Heart and Lung Institute, London, UK
| | | | | | | | - Roberto Casula
- Imperial College, National Heart and Lung Institute, London, UK
| | | | - Giuseppe Speziale
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Khalil Fattouch
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
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Fattouch K, Corrao S, Augugliaro E, Minacapelli A, Nogara A, Zambelli G, Argano C, Moscarelli M. Cardiac surgery outcomes in patients with coronavirus disease 2019 (COVID-19): A case-series report. J Thorac Cardiovasc Surg 2020; 163:1085-1092.e3. [PMID: 33220960 PMCID: PMC7581347 DOI: 10.1016/j.jtcvs.2020.09.138] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/23/2022]
Abstract
Objective The impact of coronavirus disease 2019 (COVID-19) on the postoperative course of patients after cardiac surgery is unknown. We experienced a major severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in our cardiac surgery unit, with several patients who tested positive early after surgery. Here we describe the characteristics, postoperative course, and laboratory findings of these patients, along with the fate of the health care workers. We also discuss how we reorganize and reallocate hospital resources to resume the surgical activity without further positive patients. Methods After diagnosis of the first symptomatic patient, surgery was suspended. Nasopharyngeal swabs were performed in all patients and health care workers. Patients who were positive for SARS-CoV-2 were isolated and monitored throughout the in-hospital stay and followed up after discharged until death or clinical recovery. Results Twenty patients were found to be positive for SARS-CoV-2 sometime after cardiac surgery (mean age 69 ± 10.4 years; median European System for Cardiac Operative Risk Evaluation II score 3 [interquartile range, 5.1]); the median time from surgery to diagnosis was 15 days (interquartile range, 11). Among the patients, 18 had undergone cardiac surgery and 2 of them transcatheter aortic valve replacement. Overall mortality was 15%. Specific COVID-19–related symptoms were identified in 7 patients (35%). Among the 12 health care workers infected, 1 developed a bilateral mild-grade interstitial pneumonia. Conclusions COVID-19 infection after cardiac surgery, regardless the time of the onset, is a serious condition. The systemic inflammatory state that follows extracorporeal circulation may mask the typical COVID-19 laboratory findings, making the diagnosis more difficult. A strict reorganization of the hospital resources is necessary to safely resume the cardiac surgical activity.
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Affiliation(s)
- Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy; GVM Care & Research, Maria Cecilia Hospital, Cotignola (RA), Italy
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy; Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", PROMISE, University of Palermo School of Medicine, Palermo, Italy
| | - Ettore Augugliaro
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy
| | - Alberto Minacapelli
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy
| | - Angela Nogara
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy
| | - Giulia Zambelli
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy
| | - Christiano Argano
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy; GVM Care & Research, Maria Cecilia Hospital, Cotignola (RA), Italy.
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Moscarelli M, Di Bari N, Fattouch K, Brigiani MS, Bonifazi R, Nasso G, Speziale G. Minimally Invasive Mitral Valve Repair for Standalone Secondary Mitral Regurgitation. Heart Lung Circ 2020; 30:431-437. [PMID: 32896484 DOI: 10.1016/j.hlc.2020.08.002] [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: 03/24/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic secondary mitral valve regurgitation is associated with a poor prognosis. Yet, in contrast to primary mitral regurgitation, there is no clear evidence that a reduction in regurgitation improves survival. The limited availability of data regarding secondary mitral regurgitation has resulted in a low level of evidence for treatment recommendations. We evaluated the influence of minimally invasive mitral valve annuloplasty on survival, freedom from recurrent regurgitation, and other echocardiographic parameters in patients with "standalone" secondary mitral valve regurgitation. METHODS The analysis included patients with severe secondary mitral regurgitation, left ventricular function <40%, and persistent symptoms, despite optimal medical therapy. We excluded patients who were eligible for coronary artery revascularisation or cardiac resynchronisation therapy (i.e., not standalone mitral regurgitation). After discharge, patients were scheduled for outpatient clinic follow-up at 1, 3, 6, and 12 months. RESULTS From 2012 to 2018, 54 consecutive patients underwent minimally invasive mitral valve annuloplasty for severe standalone secondary mitral regurgitation. All patients were discharged with no or trivial residual regurgitation. The mean duration of follow-up was 33.5±16.8 months. Overall survival was 90% at 4 years postprocedure. Freedom from moderate regurgitation or reintervention was 89% at the 4-year follow-up. There was a low incidence of readmission for heart failure and patients showed consistent improvements in left ventricular function and symptoms. CONCLUSIONS Mitral valve repair with reduction and stabilisation of the annulus may be beneficial for symptomatic patients with secondary stand-alone mitral regurgitation.
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Affiliation(s)
- Marco Moscarelli
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy; Imperial College, National Heart and Lung Institute, London, UK.
| | - Nicola Di Bari
- Cardiothoracic and Vascular Department, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Khalil Fattouch
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Mario Siro Brigiani
- Cardiothoracic and Vascular Department, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Raffaele Bonifazi
- Cardiothoracic and Vascular Department, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Nasso
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Speziale
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
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Calafiore AM, Di Mauro M, Bonatti J, Centofanti P, Di Eusanio M, Faggian G, Fattouch K, Gaudino M, Kofidis T, Lorusso R, Menicanti L, Prapas S, Sarkar K, Stefano P, Tabata M, Zenati M, Paparella D. An observational, prospective study on surgical treatment of secondary mitral regurgitation: The SMR study. Rationale, purposes, and protocol. J Card Surg 2020; 35:2489-2494. [PMID: 32789993 DOI: 10.1111/jocs.14924] [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: 11/27/2022]
Abstract
The natural history of secondary mitral regurgitation (MR) is unfavorable. Nevertheless, there are no evidence that its correction can improve the outcome. If from one side the original cause of secondary MR can be such to limit the possibilities of improvement, from the other side it is possible that the surgical technique widely applied to repair, restrictive mitral annuloplasty, is not adequate to correct the regurgitation. The addition of valvular and/or subvalvular techniques has been considered a possible technical solution. However, we do not know the prevalence of each technique, how many times mitral replacement is used to correct secondary MR. This aspect is of particular importance, as we know that a successful mitral repair causes a better left ventricular systolic remodeling than a unsuccessful repair or replacement. This study is a prospective, observational registry, conceived to understand what is done in the real world. Any surgeon will use the technique he thinks the most suitable for the patient. Every year, for 5 years, patients will have a clinical and echocardiographic follow-up, to evaluate the risk factors for a worse result (death, rehospitalization for heart failure, reoperation for MR return, moderate, or more MR return). This knowledge will give us the possibility to understand which is the technique, or the strategy, more efficient to treat this disease and the real efficacy of the surgical treatment.
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Affiliation(s)
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, Italy
| | - Johannes Bonatti
- Department of Cardiac Surgery, Wien North Hospital, Wien, Austria
| | - Paolo Centofanti
- Department of Cardiac Surgery, Ospedale Mauriziano, Torino, Italy
| | - Marco Di Eusanio
- Department of Cardiac Surgery, Ospedali Riuniti Torrette, Ancona, Italy
| | - Giuseppe Faggian
- Department of Cardiac Surgery, Ospedale Universitario di Verona, Verona, Italy
| | - Khalil Fattouch
- Department of Cardiac Surgery, Villa Maria Eleonora, Palermo, Italy
| | - Mario Gaudino
- Department of Cardiac Surgery, Weill Cornell Medicine, New York, New York
| | - Thoedoros Kofidis
- Department of Cardiac Surgery, National University Heart Center, Singapore
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, IRCCS, Policlinico San Donato, San Donato Milanese, Italy
| | - Sotirios Prapas
- Department of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece
| | - Kunal Sarkar
- Department of Cardiac Surgery, Medica Superspecialty Hospital, Kolkata, India
| | - Pierluigi Stefano
- Department of Cardiac Surgery, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Minoru Tabata
- Department of Cardiac Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Tokyo, Japan
| | - Marco Zenati
- Department of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Harvard Medical School, Bosto, Massachusetts
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Moscarelli M, Fattouch K, Speziale G. Tailor-Made Aortic Root Reconstruction. Ann Thorac Surg 2020; 111:1097-1098. [PMID: 32712096 DOI: 10.1016/j.athoracsur.2020.05.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Marco Moscarelli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy; Anthea Hospital, GVM Care & Research, Via Camillo Rosalba, 35/38, Bari 70124, Italy.
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Condello I, Moscarelli M, Santarpino G, Fattouch K, Nasso G, Speziale G. Water condensation from gas outlet of oxygenator. J Card Surg 2020; 35:2039-2040. [PMID: 32652821 DOI: 10.1111/jocs.14841] [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: 06/23/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
Condensation and water loss from gas output of the cardiopulmonary bypass (CPB) oxygenator has been the study object of several research. However, little is known about the propagation of the condensation formed at the level of oxygenator and how potentially it can contaminate the surrounding environment. We aimed to document the moment of formation of the 'gas steam' derived from the CPB oxygenator during cardiac surgery with thermography imaging. Thermographic camera is a device that creates an image using infrared radiation, similar to a common camera that forms an image using visible light. The brightest (warmest) parts of the image are customarily colored white, the intermediate temperatures reds and yellows, and the dimmest (coolest) parts black. Thermal image captures the condensation phenomenon around the oxygenator perimeter with the same color/temperature code (yellow) of gas outlet. The use of aspiration at the level of the gas outlet could also favor the elimination of the condensation, improve gas exchanges, and potentially reduce the spread of hazardous substances in the operating room.
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Affiliation(s)
- Ignazio Condello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Marco Moscarelli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany.,Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Khalil Fattouch
- Department of Cardiac Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
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Vinciguerra M, Romiti S, Fattouch K, De Bellis A, Greco E. Atherosclerosis as Pathogenetic Substrate for Sars-Cov2 Cytokine Storm. J Clin Med 2020; 9:E2095. [PMID: 32635302 PMCID: PMC7408959 DOI: 10.3390/jcm9072095] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 05/24/2020] [Revised: 06/21/2020] [Accepted: 07/01/2020] [Indexed: 01/08/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) outbreak is a public health emergency affecting different regions around the world. The lungs are often damaged due to the presence of Sars-CoV-2 binding receptor ACE2 on epithelial alveolar cells. Severity of infection varies from complete absence of symptomatology to more aggressive symptoms, characterized by sudden acute respiratory distress syndrome (ARDS), multiorgan failure, and sepsis, requiring treatment in intensive care unit (ICU). It is not still clear why the immune system is not able to efficiently suppress viral replication in a small percentage of patients. It has been documented as pathological conditions affecting the cardiovascular system, strongly associated to atherosclerotic progression, such as heart failure (HF), coronary heart disease (CHD), hypertension (HTN) and diabetes mellitus (DM), could serve as predictive factors for severity and susceptibility during Sars-CoV-2 infection. Atherosclerotic progression, as a chronic inflammation process, is characterized by immune system dysregulation leading to pro-inflammatory patterns, including interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), and IL-1β. Reviewing immune system and inflammation profiles in atherosclerosis and laboratory results reported in severe COVID-19 infections, we hypothesized a pathogenetic correlation. Atherosclerosis may be an ideal pathogenetic substrate for high viral replication ability, leading to adverse outcomes, as reported in patients with cardiovascular factors. The level of atherosclerotic progression may affect a different degree of severe infection; in a vicious circle, feeding itself, Sars-CoV-2 may exacerbate atherosclerotic evolution due to excessive and aberrant plasmatic concentration of cytokines.
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Affiliation(s)
- Mattia Vinciguerra
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.V.); (S.R.); (E.G.)
| | - Silvia Romiti
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.V.); (S.R.); (E.G.)
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, 90135 Palermo, Italy
| | - Antonio De Bellis
- Department of Cardiology and Cardiac Surgery, Casa di Cura “S. Michele”, Maddaloni, 81024 Caserta, Italy;
| | - Ernesto Greco
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.V.); (S.R.); (E.G.)
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Paparella D, Malvindi PG, Santarpino G, Moscarelli M, Guida P, Fattouch K, Margari V, Martinelli L, Albertini A, Speziale G. Full sternotomy and minimal access approaches for surgical aortic valve replacement: a multicentre propensity-matched study. Eur J Cardiothorac Surg 2020; 57:709-716. [PMID: 31647535 DOI: 10.1093/ejcts/ezz286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/31/2019] [Accepted: 09/11/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Surgical aortic valve replacement (AVR) can be performed via a full sternotomy or a minimal access approach (mini-AVR). Despite long-term experience with the procedure, mini-AVR is not routinely adopted. Our goal was to compare contemporary outcomes of mini-AVR and conventional AVR in a large multi-institutional national cohort. METHODS A total of 5801 patients from 10 different centres who had a mini-AVR (2851) or AVR (2950) from 2011 to 2017 were evaluated retrospectively. Standard aortic prostheses were used in all cases. The use of the minimally invasive approach has increased over the years. The primary outcome is the incidence of 30-day deaths following mini-AVR and AVR. Secondary outcomes are the occurrence of major complications following both procedures. Propensity-matched comparisons were performed based on the multivariable logistic regression model. RESULTS In the overall population patients who had AVR had an increased surgical risk based on the EuroSCORE, and the 30-day mortality rate was higher (1.5% and 2.3% in mini-AVR and AVR, respectively; P = 0.048). Propensity scores identified 2257 patients per group with similar baseline profiles. In the matched groups, patients who had mini-AVR, despite longer cardiopulmonary bypass (81 ± 32 vs 76 ± 28 min; P = 0.004) and cross-clamp (64 ± 24 vs 59 ± 21 min; P ≤ 0.001) times, had lower 30-day mortality rates (1.2% vs 2.0%; P = 0.036), reduced low cardiac output (0.8% vs 1.4%; P = 0.046) and reduced postoperative length of stay (9 ± 8 vs 10 ± 7 days; P = 0.004). Blood transfusions (36.4% vs 30.8%; P ≤ 0.001) and atrial fibrillation (26.0% vs 21.5%, P ≤ 0.001) were higher in patients who had the mini-AVR. CONCLUSIONS In a large multi-institutional recent cohort, minimal access approach aortic valve replacement is associated with reduced 30-day mortality rates and shorter postoperative lengths of stay compared to standard sternotomy. A prospective randomized trial is needed to overcome the possible biases of a retrospective study.
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Affiliation(s)
- Domenico Paparella
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy.,Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
| | | | - Giuseppe Santarpino
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy.,Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Marco Moscarelli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Piero Guida
- Maugeri Foundation, Cassano delle Murge, Bari, Italy
| | - Khalil Fattouch
- Department of Cardiac Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Vito Margari
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Luigi Martinelli
- Department of Cardiac Surgery, ICLAS, GVM Care & Research, Rapallo, Italy
| | - Alberto Albertini
- Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
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Martinez C, Cicenia M, Sprynger M, Postolache A, Ilardi F, Dulgheru R, Radermecker M, Esposito G, Marechal P, Marechal V, Donis N, Tridetti J, Nguyen Trung ML, Sugimoto T, Tsugu T, Go YY, Coisne A, Montaigne D, Fattouch K, Nchimi A, Oury C, Lancellotti P. Myocardial Function in Patients With Radiation-Associated Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Layer-Specific Strain Analysis Study. JACC Cardiovasc Imaging 2020; 13:1450-1452. [PMID: 32199837 DOI: 10.1016/j.jcmg.2020.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/28/2022]
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38
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Moscarelli M, Fattouch K, Gaudino M, Nasso G, Paparella D, Punjabi P, Athanasiou T, Benedetto U, Angelini GD, Santarpino G, Speziale G. Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis. Ann Thorac Surg 2020; 109:737-744. [DOI: 10.1016/j.athoracsur.2019.07.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 12/31/2022]
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Lancellotti P, Magne J, Dulgheru R, Clavel MA, Donal E, Vannan MA, Chambers J, Rosenhek R, Habib G, Lloyd G, Nistri S, Garbi M, Marchetta S, Fattouch K, Coisne A, Montaigne D, Modine T, Davin L, Gach O, Radermecker M, Liu S, Gillam L, Rossi A, Galli E, Ilardi F, Tastet L, Capoulade R, Zilberszac R, Vollema EM, Delgado V, Cosyns B, Lafitte S, Bernard A, Pierard LA, Bax JJ, Pibarot P, Oury C. Outcomes of Patients With Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics. JAMA Cardiol 2019; 3:1060-1068. [PMID: 30285058 DOI: 10.1001/jamacardio.2018.3152] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance The natural history and the management of patients with asymptomatic aortic stenosis (AS) have not been fully examined in the current era. Objective To determine the clinical outcomes of patients with asymptomatic AS using data from the Heart Valve Clinic International Database. Design, Setting, and Participants This registry was assembled by merging data from prospectively gathered institutional databases from 10 heart valve clinics in Europe, Canada, and the United States. Asymptomatic patients with an aortic valve area of 1.5 cm2 or less and preserved left ventricular ejection fraction (LVEF) greater than 50% at entry were considered for the present analysis. Data were collected from January 2001 to December 2014, and data were analyzed from January 2017 to July 2018. Main Outcomes and Measures Natural history, need for aortic valve replacement (AVR), and survival of asymptomatic patients with moderate or severe AS at entry followed up in a heart valve clinic. Indications for AVR were based on current guideline recommendations. Results Of the 1375 patients included in this analysis, 834 (60.7%) were male, and the mean (SD) age was 71 (13) years. A total of 861 patients (62.6%) had severe AS (aortic valve area less than 1.0 cm2). The mean (SD) overall survival during medical management (mean [SD] follow up, 27 [24] months) was 93% (1%), 86% (2%), and 75% (4%) at 2, 4, and 8 years, respectively. A total of 104 patients (7.6%) died under observation, including 57 patients (54.8%) from cardiovascular causes. The crude rate of sudden death was 0.65% over the duration of the study. A total of 542 patients (39.4%) underwent AVR, including 388 patients (71.6%) with severe AS at study entry and 154 (28.4%) with moderate AS at entry who progressed to severe AS. Those with severe AS at entry who underwent AVR did so at a mean (SD) of 14.4 (16.6) months and a median of 8.7 months. The mean (SD) 2-year and 4-year AVR-free survival rates for asymptomatic patients with severe AS at baseline were 54% (2%) and 32% (3%), respectively. In those undergoing AVR, the 30-day postprocedural mortality was 0.9%. In patients with severe AS at entry, peak aortic jet velocity (greater than 5 m/s) and LVEF (less than 60%) were associated with all-cause and cardiovascular mortality without AVR; these factors were also associated with postprocedural mortality in those patients with severe AS at baseline who underwent AVR (surgical AVR in 310 patients; transcatheter AVR in 78 patients). Conclusions and Relevance In patients with asymptomatic AS followed up in heart valve centers, the risk of sudden death is low, and rates of overall survival are similar to those reported from previous series. Patients with severe AS at baseline and peak aortic jet velocity of 5.0 m/s or greater or LVEF less than 60% have increased risks of all-cause and cardiovascular mortality even after AVR. The potential benefit of early intervention should be considered in these high-risk patients.
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Affiliation(s)
- Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Julien Magne
- Cardiology Department, Centre Hospitalier Universitaire de Limoges, Hôpital Dupuytren, Pôle Coeur-Poumon-Rein, Limoges, France
| | - Raluca Dulgheru
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium
| | - Marie-Annick Clavel
- Québec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Québec, Canada
| | - Erwan Donal
- Cardiologie and LTSI INSERM U 1099, Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, Rennes, France
| | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - John Chambers
- Guy's and St Thomas Hospitals, London, United Kingdom
| | - Raphael Rosenhek
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Gilbert Habib
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Marseille, France.,Assistance Publique-Hopitaux Marseille, La Timone Hospital, Cardiology Department, Marseille, France
| | - Guy Lloyd
- Barts Heart Centre Echo Lab, St Bartholomew's Hospital, London, United Kingdom
| | - Stefano Nistri
- Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina, Italy
| | - Madalina Garbi
- King's Health Partners, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Stella Marchetta
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.,Department of Surgery and Cancer, University of Palermo, Palermo, Italy
| | - Augustin Coisne
- Centre Hospitalier Universitaire de Lille, Departments of Clinical Physiology and Echocardiography and Cardiovascular Surgery, Lille, France
| | - David Montaigne
- Centre Hospitalier Universitaire de Lille, Departments of Clinical Physiology and Echocardiography and Cardiovascular Surgery, Lille, France
| | - Thomas Modine
- Centre Hospitalier Universitaire de Lille, Departments of Clinical Physiology and Echocardiography and Cardiovascular Surgery, Lille, France
| | - Laurent Davin
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium
| | - Olivier Gach
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium
| | - Marc Radermecker
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium
| | - Shizhen Liu
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Linda Gillam
- Morristown Medical Center, Morristown, New Jersey
| | - Andrea Rossi
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Elena Galli
- Cardiologie and LTSI INSERM U 1099, Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, Rennes, France
| | - Federica Ilardi
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium
| | - Lionel Tastet
- Québec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Québec, Canada
| | - Romain Capoulade
- Québec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Québec, Canada
| | - Robert Zilberszac
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - E Mara Vollema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bernard Cosyns
- Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel and In Vivo Cellular and Molecular Imaging Laboratory, Brussels, Belgium
| | - Stephane Lafitte
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Cardiologique Haut-Lévêque, Pessac, France
| | - Anne Bernard
- Cardiology Department, University of Tours Hospital, Tours, France.,University François Rabelais, Tours, France
| | - Luc A Pierard
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Québec, Canada
| | - Cécile Oury
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium
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Chang CC, Veen KM, Hahn RT, Bogers AJJC, Latib A, Oei FBS, Abdelghani M, Modolo R, Ho SY, Abdel-Wahab M, Fattouch K, Bosmans J, Caliskan K, Taramasso M, Serruys PW, Bax JJ, van Mieghem NMDA, Takkenberg JJM, Lurz P, Modine T, Soliman O. Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review. Eur Heart J 2019; 41:1932-1940. [DOI: 10.1093/eurheartj/ehz614] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/04/2019] [Accepted: 08/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Tricuspid regurgitation (TR) is a frequent and complex problem, commonly combined with left-sided heart disease, such as mitral regurgitation. Significant TR is associated with increased mortality if left untreated or recurrent after therapy. Tricuspid regurgitation was historically often disregarded and remained undertreated. Surgery is currently the only Class I Guideline recommended therapy for TR, in the form of annuloplasty, leaflet repair, or valve replacement. As growing experience of transcatheter therapy in structural heart disease, many dedicated transcatheter tricuspid repair or replacement devices, which mimic well-established surgical techniques, are currently under development. Nevertheless, many aspects of TR are little understood, including the disease process, surgical or interventional risk stratification, and predictors of successful therapy. The optimal treatment timing and the choice of proper surgical or interventional technique for significant TR remain to be elucidated. In this context, we aim to highlight the current evidence, underline major controversial issues in this field and present a future roadmap for TR therapy.
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Affiliation(s)
- Chun Chin Chang
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Rebecca T Hahn
- Structural Heart & Valve Center, New York Presbyterian Hospital, Columbia University Medical Center,161 Fort Washington Avenue, New York, NY 10032, USA
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 3400 Bainbridge Ave, The Bronx, New York, NY, USA
| | - Frans B S Oei
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Mohammad Abdelghani
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas- SP, 13083-970, Brazil
| | - Siew Yen Ho
- Brompton Cardiac Morphology Unit, Royal Brompton Hospital, Imperial College London, London, SW7 2AZ UK
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Viale Regione Siciliana 1571, 90100 Palermo, Italy
- GVM Care and Research, Maria Cecilia Hospital, Via Madonna di Genova, 1, 48033, Cotignola, Italy
| | - Johan Bosmans
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Kadir Caliskan
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Patrick W Serruys
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Nicolas M D A van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Philip Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Thomas Modine
- Department of Cardiovascular Surgery, Hopital Cardiologique CHRU de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
| | - Osama Soliman
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
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Moscarelli M, Nasso G, Fattouch K, Di Bari N, Speziale G. Redo mitral valve repair with complete ring implantation over an open band. J Card Surg 2019; 34:614-616. [PMID: 31111518 DOI: 10.1111/jocs.14081] [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: 04/01/2019] [Revised: 04/18/2019] [Accepted: 04/28/2019] [Indexed: 11/27/2022]
Abstract
We present a case of redo mitral valve surgery after failed repair that consisted of implantation of a complete ring over an open band implanted several years prior. The patient presented with severe central mitral regurgitation. During surgical intervention, the open band was identified consolidated with the native annulus. We elected not to remove the posterior annulus given the presence of calcification. Instead, a new complete ring was secured with single sutures posteriorly over the band and anterior to the native annulus. This approach was safe, fast, and achieved a significant reduction in annulus circumference with no residual mitral regurgitation.
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Affiliation(s)
- Marco Moscarelli
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Giuseppe Nasso
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care & Research, Palermo, Italy
| | - Nicola Di Bari
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Giuseppe Speziale
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
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42
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Paparella D, Santarpino G, Malvindi PG, Moscarelli M, Marchese A, Guida P, Carbone C, Gregorini R, Martinelli L, Comoglio C, Coppola R, Albertini A, Cremonesi A, Liso A, Fattouch K, Avolio M, Brunetti ND, Speziale G. Minimally invasive surgical versus transcatheter aortic valve replacement: A multicenter study. Int J Cardiol Heart Vasc 2019; 23:100362. [PMID: 31061875 PMCID: PMC6487354 DOI: 10.1016/j.ijcha.2019.100362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/07/2019] [Accepted: 04/08/2019] [Indexed: 11/28/2022]
Abstract
Objectives Treatment of aortic valve stenosis is evolving, indications for transcatheter approach (TAVI) have increased but also surgical valve replacement has changed with the use of minimally invasive approaches. Comparisons between TAVI and surgery have rarely been done with minimally invasive techniques (mini-SAVR) in the surgical arm. Aim of the present study is to compare mini-SAVR and TAVI in a multicenter recent cohort. Methods Evaluated were 2904 patients undergone mini-SAVR (2407) or TAVI (497) in 10 different centers in the period 2011–2016. The Heart Team approved treatment for complex cases. The primary outcome is the incidence of 30-day mortality following mini-SAVR and TAVI. Secondary outcomes are the occurrence of major complications following both procedures. Propensity matched comparisons was performed based on multivariable logistic regression model. Results In the overall population TAVI patients had increased surgical risk (median EuroSCORE II 3.3% vs. 1.7%, p ≤ 0.001) and 30-day mortality was higher (1.5% and 2.8% in mini-SAVR and TAVI respectively, p = 0.048). Propensity score identified 386 patients per group with similar baseline profile (median EuroSCORE II ~3.0%). There was no difference in 30-day mortality (3.4% in mini-SAVR and 2.3% in TAVI; p = 0.396) and stroke, surgical patients had more blood transfusion, kidney dysfunction and required longer ICU and hospital length of stay while TAVI patients had more permanent pace maker insertion. Conclusions Mini-SAVR and TAVI are both safe and effective to treat aortic stenosis in elderly patients with comorbidities. A joint evaluation by the heart-team is essential to direct patients to the proper approach. A comparison between TAVI and minimally invasive techniques has rarely been done In a propensity-matched comparison from 10 different hospitals, TAVI and mini-SAVR provided optimal short-term outcome. 30-day mortality was 3.4% in mini-SAVR and 2.3% in TAVI (p = 0.396) Mini-SAVR and TAVI are both safe and effective to treat aortic stenosis in elderly patients with comorbidities.
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Affiliation(s)
- Domenico Paparella
- Santa Maria Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari, Italy
- Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Italy
- Corresponding author at: Department of Emergency and Organ Transplant – University of Bari Aldo Moro, Santa Maria Hospital, Department of Cardiac Surgery, Via de Ferrariis 22, 70124 Bari, Italy.
| | - Giuseppe Santarpino
- Città di Lecce Hospital, Department of Cardiac Surgery, GVM Care & Research, Lecce, Italy
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | | | - Marco Moscarelli
- Anthea Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari, Italy
| | - Alfredo Marchese
- Santa Maria Hospital, Department of Cardiology, GVM Care & Research, Bari, Italy
| | - Pietro Guida
- Maugeri Foundation, Cassano delle Murge, Bari, Italy
| | - Carmine Carbone
- Santa Maria Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari, Italy
| | - Renato Gregorini
- Città di Lecce Hospital, Department of Cardiac Surgery, GVM Care & Research, Lecce, Italy
| | - Luigi Martinelli
- ICLAS, Department of Cardiac Surgery, GVM Care & Research, Rapallo, Italy
| | - Chiara Comoglio
- Maria Pia Hospital, Department of Cardiac Surgery, GVM Care & Research, Torino, Italy
| | - Roberto Coppola
- ICLAS, Department of Cardiac Surgery, GVM Care & Research, Rapallo, Italy
| | - Alberto Albertini
- Maria Cecilia Hospital, Department of Cardiac Surgery, GVM Care & Research, Cotignola, Italy
| | - Alberto Cremonesi
- Maria Cecilia Hospital, Department of Cardiology, GVM Care & Research, Cotignola, Italy
| | - Armando Liso
- Città di Lecce Hospital, Department of Cardiology, GVM Care & Research, Lecce, Italy
| | - Khalil Fattouch
- Maria Eleonora Hospital, Department of Cardiac Surgery, GVM Care & Research, Palermo, Italy
| | - Maria Avolio
- Clinical Data Management, GVM Care & Research, Rome, Italy
| | | | - Giuseppe Speziale
- Anthea Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari, Italy
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43
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Modine T, Fattouch K, Overtchouk P. Hybrid strategy-the future of cardiac therapies! A myth or galloping reality? Interact Cardiovasc Thorac Surg 2019; 28:331-332. [PMID: 30689899 DOI: 10.1093/icvts/ivy354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thomas Modine
- Institut Cœur-Poumon, Service de Chirurgie Cardiovaculaire, Hôpital Cardiologique, CHRU de Lille, Lille, France
| | - Khalil Fattouch
- Institut Cœur-Poumon, Service de Chirurgie Cardiovaculaire, Hôpital Cardiologique, CHRU de Lille, Lille, France.,GVM Care and Research, Cardiovascular Department, Surgery, Maria Eleonora Hospital, Palermo, Italy
| | - Pavel Overtchouk
- Institut Cœur-Poumon, Service de Chirurgie Cardiovaculaire, Hôpital Cardiologique, CHRU de Lille, Lille, France.,Department of Cardiology, Bern University Hospital, Bern, Switzerland
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44
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Moscarelli M, Devito F, Fattouch K, Lancellotti P, Ciccone MM, Rizzo P, Gaudino M, Marchese A, Angelini G, Speziale G. The effect of surgical versus transcatheter aortic valve replacement on endothelial function. An observational study. Int J Surg 2019; 63:1-7. [DOI: 10.1016/j.ijsu.2019.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 12/19/2022]
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45
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Moscarelli M, Fattouch K, Speziale G, Nasso G, Santarpino G, Gaudino M, Athanasiou T. A meta-analysis of the performance of small tissue versus mechanical aortic valve prostheses. Eur J Cardiothorac Surg 2019; 56:510-517. [DOI: 10.1093/ejcts/ezz056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/15/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Small aortic prosthetic valves have been associated with suboptimal performance due to patient–prosthesis mismatch (PPM). This meta-analysis compared the outcomes of patients with a small root who received tissue versus mechanical aortic valves.
METHODS
A systematic literature review identified 7 candidate studies; of these, 5 met the meta-analysis criteria. We analysed outcomes for a total of 680 patients (227 tissue valves and 453 mechanical valves) using random effects modelling. Each study was assessed for heterogeneity and quality. The primary end point was mortality at follow-up. Secondary end points included intraoperative and postoperative outcomes, the rate of PPM and left ventricle mass regression and major cardiac and prosthesis-related adverse events at follow-up.
RESULTS
There was no between-group difference in mortality at follow-up [incidence rate ratio 1, 95% confidence interval (CI) 0.50–2.01; P = 0.99]. The tissue group had a higher rate of PPM (odds ratio 17.19, 95% CI 8.6–25.78; P = 0.002) and significantly less reduction in ventricular mass (weighted mean difference 40.79, 95% CI 4.62–76.96; P = 0.02). There were no significant differences in the incidence of structural valve disease at follow-up compared to that in the mechanical valve group. There was also no between-group difference in aggregated adverse events at follow-up (P = 0.68).
CONCLUSIONS
Tissue and mechanical valves were associated with similar mortality rates; however, patients receiving tissue valves had a higher rate of PPM and significantly less left ventricle mass regression. These findings indicate that patients receiving small tissue valves may require closer clinical surveillance than those receiving mechanical valves.
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Affiliation(s)
- Marco Moscarelli
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Khalil Fattouch
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Giuseppe Nasso
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College, Paddington, London, UK
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46
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Bardaro L, Carrozzo A, Albertini A, Fattouch K, Martinelli L. RF87 TRANSAPICAL OFF-PUMP MITRAL VALVE REPAIR WITH PTFE CHORD IMPLANTATION. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550016.11743.e0] [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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47
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Lancellotti P, Fattouch K, Go YY. Secondary tricuspid regurgitation in patients with left ventricular systolic dysfunction: cause for concern or innocent bystander? Eur Heart J 2018; 39:3593-3595. [PMID: 30169626 DOI: 10.1093/eurheartj/ehy522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Khalil Fattouch
- Gruppo Villa Maria Care and Research, Maria Eleonora Hospital Palermo, Italy
| | - Yun Yun Go
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
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48
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Domenico Nobile, Fattouch K, Bongiovanni M, Soraci E. TCT-398 Evaluation of microvascular dysfunction in patients with Takotsubo syndrome. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1557] [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: 11/29/2022]
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Overtchouk P, Alqdeimat I, Coisne A, Fattouch K, Modine T. Transcarotid approach for TAVI: an optimal alternative to the transfemoral gold standard. Ann Cardiothorac Surg 2017; 6:555-557. [PMID: 29062754 DOI: 10.21037/acs.2017.08.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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)
- Pavel Overtchouk
- Interventional Cardiology and Cardiovascular Surgery Centre Hospitalier Regional, Universitaire de Lille (CHRU de Lille), Lille, France
| | - Ibrahim Alqdeimat
- Interventional Cardiology and Cardiovascular Surgery Centre Hospitalier Regional, Universitaire de Lille (CHRU de Lille), Lille, France
| | - Augustin Coisne
- Interventional Cardiology and Cardiovascular Surgery Centre Hospitalier Regional, Universitaire de Lille (CHRU de Lille), Lille, France
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.,Department of Surgery and Cancer, University of Palermo, Palermo, Italy
| | - Thomas Modine
- Interventional Cardiology and Cardiovascular Surgery Centre Hospitalier Regional, Universitaire de Lille (CHRU de Lille), Lille, France
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Fattouch K, Moscarelli M, Castrovinci S, Murana G, Dioguardi P, Guccione F, Nasso G, Speziale G, Lancellotti P. Mid-term results of bicuspid aortic valve repair guided by morphology and function assessment. Interact Cardiovasc Thorac Surg 2017; 25:83-88. [DOI: 10.1093/icvts/ivx027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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