Clinical outcomes for patients with cardiovascular diseases before, during, and after the COVID19 pandemic. A pooled analysis of 600.000 patients.

BACKGROUND: The unexpected virulence of the COVID19 pandemic brought to significant changes of generally accepted therapeutic approaches. The consequences of these changes were difficult to define during the pandemic period. METHODS: We analyzed the National Registries including 97% of hospital admissions in Italy, regarding data describing number of operations for aortic valve implantation or repair, carotid and coronary revascularization, AAA repair, and lower limb arterial reconstruction performed in the period 2015 to 2019 and in the pandemic years 2020, 2021, and 2022. Primary outcomes were number and type of surgical procedures, 30-days operative mortality. RESULTS: During the three years of the pandemic there was a statistically significant increase of the number of all-causes deaths in comparison with the mean of the previous five years (2015-2019). In Italy there was a total increase of all causes-deaths of 251.911 (+105900 in 2020; +66929 in 2021; and +79082 in 2022), and 73% of the excess of deaths was related with COVID19 infection and 27% occurred in COVID 19 negative patients. During the first year of the pandemic, worse clinical outcomes for hospitalized patients with CVD were registered. The medical system responded adequately and in the following two pandemic years clinical outcomes for hospitalized patients were similar with those of the pre-pandemic period. CONCLUSIONS: The unexpected virulence of COVID19 pandemic determined worse clinical outcomes for patients with CVD during the first year. The adopted preventive measures allowed in the following two pandemic years improved clinical outcomes, similar with those of the pre-pandemic period.

Trends towards increase of Cardiovascular diseases mortality in USA: A comparison with Europe and the importance of preventive care.

BACKGROUND: the aim of our study was to analyze exposure of the general population to established risk factors for cardiovascular disease (CVD), which might have determined the trend towards increased mortality rates related with CVD from 2015 to 2019 in USA. MATERIAL AND METHODS: We Analyzed epidemiological of data from the US National Health and Nutrition Examination Survey and from the European Health Interview Survey to determine trends for exposure to several established risk factors for CVD from 2000 to 2018-2019. Trends of prevalence of obesity, arterial hypertension, cigarettes smoking, high cholesterol level, diabetes in the period 2000 to 2018-2019 in USA were correlated with age adjusted mortality and burden related with CVD. We correlated these trends also with educational attainment, family income and national expenditure for preventive care. RESULTS: Cardiovascular Diseases Related Mortality And Burden Decreased Significantly In Usa In The Period 2000-2015; In The Period 2015-2019 there was a trend towards increasing mortality rates. The trend in the period 2015-2019 was associated with increased exposure to several established risk factors for CVD: obesity, diabetes, cigarettes smoking and arterial hypertension. Level of education attainment and family income, and national health expenditure for information, education and counseling were statistically correlated with reduced exposure to established risk factors. Similar trends were present in Western European countries. CONCLUSIONS: Attention is required to improve education and communication, health access and care for people with poor economic conditions, homeless, minorities, to reduce CVD related mortality and burden.

Femoro-femoral crossover graft and simultaneous reconstruction of the proximal deep femoral artery.

BACKGROUND: The goal of this study was to describe and review the results of a technique in which reconstruction of the common and profunda femoral arteries is combined with a femoro-femoral crossover graft using the same synthetic graft. A synthetic bifurcated graft (such as the ones used for aortobifemoral reconstruction), in which one limb is cut off, is used, leaving an enlarging patch at the end where the proximal anastomosis will be fashioned. METHODS: From January 1972 to January 2000, 6 patients underwent this reconstruction for severe limb ischemia. Patients were followed up in the outpatient clinic every 6 months. RESULTS: No postoperative mortality and no major complications were seen. One patient had a superficial wound infection, which resolved with conservative treatment. Five patients had a patent graft at an average follow-up of 39 months. CONCLUSIONS: Using the same synthetic graft allows angioplasty of the common and profunda femoral arteries of the donor side and revascularization of the opposite lower limb, with good short- and long-term results.

Worsening of preoperative foot ischemia after occlusion of polytetrafluoroethylene femorotibial grafts: a comparison with saphenous vein grafts.

BACKGROUND: The aim of this study was to determine the hemodynamic and clinical changes after occlusion of polytetrafluoroethylene (PTFE) femorotibial grafts. METHODS: Twenty-seven patients were randomly selected from all patients who underwent femorotibial bypass grafting in our department. In 10 patients, the reversed autologous saphenous vein was used as graft, and in 17 patients a PTFE prosthesis was used. Out of the latter 17 patients, 10 began long-term aspirin therapy and 7 began oral anticoagulation with warfarin. RESULTS: Nine out of the 10 patients with occluded PTFE grafts and who received only aspirin therapy had a critical ischemia after occlusion of the graft, and 4 underwent major amputation. Among the 10 patients with occluded autologous vein bypass, critical ischemia was present in only 4 patients, and only 2 required some form of surgical therapy with no case of major amputation. CONCLUSIONS: After occlusion of a PTFE femorotibial graft, there is a condition of critical ischemia that is less common after occlusion of a vein graft. Oral anticoagulation seems to prevent these negative changes.

How to avoid a difficult groin in redo arterial surgery: eversion endarterectomy of the proximal superficial femoral artery versus profunda femoris artery as inflow for distal bypass.

BACKGROUND: The aim of the study was to describe and analyze the results of a technique in which the inflow for distal bypasses is provided by the proximal superficial femoral artery, reopened through an eversion endarterectomy, to avoid a "difficult groin." MATERIAL AND METHODS: Twenty-one patients who underwent distal bypass for severe lower-limb ischemia and in whom the proximal superficial femoral artery was reopened with an eversion endarterectomy to provide inflow for the bypass itself were included in the study. As a comparison group, 20 patients in whom the inflow for a distal bypass was obtained by the distal deep femoral artery were randomly selected. In all 41 patients, the groin was considered "difficult" because of multiple previous operations. RESULTS: Five-year cumulative patency rates were 53% for femoropopliteal bypasses and 40% for femorotibial bypasses. Similar patency rates were obtained when the distal deep femoral artery was used as inflow. CONCLUSIONS: Eversion endarterectomy of the proximal superficial femoral artery provides a valid source of inflow for distal bypasses, and it should be kept in the armamentarium of the vascular surgeon, to be used in selected cases.

Eversion endarterectomy of the proximal superficial femoral artery: a source of inflow for distal bypass in case of hostile groin.

BACKGROUND: In selected patients, eversion endarterectomy of the proximal superficial femoral artery can represent a valid inflow for a distal bypass to avoid a "hostile" groin. MATERIAL AND METHODS: Patency rates and limb salvage rates were retrospectively analysed for 21 consecutive patients who underwent distal bypass for severe lower limb ischemia and in whom the proximal superficial femoral artery was reopened with an eversion endarterectomy. In all patients, this technique was used to avoid a hostile groin. RESULTS: Five-year cumulative patency rates were 53% for femoropopliteal bypasses and 40% for femorotibial bypasses. Overall 5-y cumulative limb salvage was 72%. CONCLUSIONS: In case of hostile groin, eversion endarterectomy of the proximal superficial femoral artery is a valid solution to provide inflow for a distal bypass.