Surgical repair of aortic coarctation in pediatric age: A single center two decades experience.

BACKGROUND: To evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in infants and children. METHODS: A retrospective clinical review of patients less than 18 years with CoAo, undergoing surgery between 1995 and 2015. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by bivariate, Cox's, and logistic regression analysis. RESULTS: Three hundred forty-one consecutive patients (male/female: 192/149; the median age at surgery of 25 days; interquartile range [IQR], 10-143 days) were included; 187 patients were less than 1 month (54.9%); 276 underwent extended end-to-end anastomosis (EEEA) (80.9%). Hypoplastic aortic arch (HAA) occurred in 34.6% and bicuspid aortic valve in 21.1%. The isolated type was present in 249 (73.0%). Significant postoperative complications occurred in 5.6%. Thirty-day mortality was 1.4%. At a median follow-up of 10.2 years (IQR, 6-15 years; FU completeness, 91.2%), there were eight late deaths (2.6%), most in the complex type. Among 298 survivors, 284 (95.3%) were in NYHA class I; 10 (3.0%) were on antihypertensive treatment. Reinterventions on aortic arch occurred only in 4.5%, being HAA a significant risk factor for reoperation ( P = 0.00173). Freedom from mortality and reintervention on aorta at 21 years were 93.5% and 93.6%, respectively. CONCLUSIONS: Surgical repair of CoAo by EEEA without CPBP is a safe and low-risk procedure, concerning either early or late outcomes, despite the presence of HAA and neonatal age can influence recoarctation. Most patients are clinically well in the long-term, and only a few require antihypertensive therapy.

Women in thoracic, cardiac and vascular surgery claim for a change in the working situation: an Italian national survey.

Background: Women's participation in the surgical workforce has increased. The aim of the study is to acquire objective data regarding practice, training, satisfaction, and discrimination of women surgeons working in cardiothoracic and vascular surgery in Italy. Methods: An 83-item questionnaire was distributed through social media and sent to e-mails of women surgeons from November through December 2020. A sub-analysis on women working in cardiac, thoracic, and vascular surgery was performed. Results: Overall, 222 respondents were included (48 cardiac, 62 thoracic, and 112 vascular surgeons). Thirty-six percent partially abandoned surgical activities in favor of other professional activities, not including the operating room. On average, our respondents took part in 33% of all surgical cases performed in their units; however, of 12 high complexity surgeries per month, less than one is performed by them. Only 7 female participants who answered the questionnaire were in leadership positions. Many respondents struggle with lack of mentorship and missing opportunities in operating room. A high percentage of women experienced discrimination due to their gender in their professional life, and 59% claimed to have been subject to sexual harassment. Conclusions: In Italy, women thoracic, cardiac, and vascular surgeons face lack of mentorship, opportunities in the operating room, and gender-related issues including some episodes of sexual harassment. Diversity, equity, and inclusion should become strategic priorities in all institutions. Among our respondents, surgical exposure is limited, which may deter a surgical career and play a crucial role in surgeons' dissatisfaction, that also include poor work-life-balance, and a large amount of administrative work. Surgical societies may address these issues by providing structured mentorship programs and networking opportunities. Societies' contributions might substantially impact supporting and retaining women at different stages of their careers.

Conduction disorders after aortic valve replacement with rapid-deployment bioprostheses: early occurrence and one-year evolution.

BACKGROUND: Rapid-deployment bioprostheses represent one of the newest aortic valve substitutes introduced into clinical practice. The aim of this retrospective single-center study was to evaluate the occurrence of conduction disorders (CDs) after rapid-deployment aortic valve implantation at discharge and at 1-year follow-up, and to identify risk factors for CDs and permanent pacemaker implantation (PPI). METHODS: All patients who reached 1-year follow-up after isolated or combined aortic valve replacement (AVR) with rapid-deployment bioprostheses (Intuity Elite, Edwards Lifesciences, Irvine, CA) at our institution were included in this study. Standard 12-lead electrocardiograms (ECGs) were recorded before the procedure (within 24 hours), after the procedure as soon as the patient was moved to the intensive care unit (ICU), every day during in-hospital stay and at 1-year follow-up. The primary endpoint was the incidence of postoperative CDs at discharge and at 1-year follow up. Patients were divided in two groups: those who developed the primary endpoint (Group CD) and those who didn't (Group Non-CD). RESULTS: A total of 98 consecutive patients were included in the study. At discharge, the primary endpoint occurred in 40 patients (40.8%). In particular, new CDs and PPI occurred in 33 (33.7%) and in 7 (7.1%) patients, respectively. Valve size was the only independent predictor of primary endpoint at discharge. At 1-year, 30 patients (31.3%) presented with CDs or pacemaker-induced rhythm. In particular, in 25 patients of Group CD (64.1%), 1-year follow-up ECG revealed the persistence of the same CD as at discharge or pacemaker-induced rhythm, while 14 patients (35.9%) showed recovery of their CD. Age and prosthesis size were identified as independent predictors of CDs/pacemaker-induced rhythm at 1-year follow-up. CONCLUSIONS: According to our data, nearly 40% of patients develop a new CD after rapid-deployment aortic valve implantation. Of these, one third recover after one year. Bioprosthesis size and age were identified as independent risk factors for occurrence of CD after surgery.

Evaluation of Conduction Disorders After Aortic Valve Replacement With Rapid Deployment Bioprostheses.

OBJECTIVE: The aim of this retrospective, single-center study was to evaluate the occurrence of conduction disorders after rapid deployment aortic bioprosthesis implantation. METHODS: Electrocardiograms of patients undergoing INTUITY (Edwards Lifesciences, Irvine, CA USA) bioprosthesis implantation were collected at admission, during postoperative course, and at discharge. Primary end point was the occurrence of new-onset conduction disorders, defined as complete left bundle branch block, complete right bundle branch block, permanent pacemaker implantation, and worsening of pre-existing rhythm abnormalities. Secondary end points were the assessment of preoperative and postoperative QRS duration and the identification of transitory conduction disorders. RESULTS: Forty-four patients (July 2015-December 2016) were included in the analysis. Preoperatively, patients with normal conduction and with already existing disorders were 25 (56.8%) and 19 (43.2%), respectively. Primary end point occurred in 14 patients (31.8%). Two patients (4.5%) received pacemaker implantation. In patients with normal preoperative conduction, new abnormalities were found in eight cases (32%): all left bundle branch blocks with one pacemaker implantation. Worsening of pre-existing conduction disorders was found in six patients (31.6%) with one pacemaker implantation. QRS duration increased in 20 patients (45.4%), and average increase was 37 milliseconds. Overall, we observed a significant increase of QRS (96 ± 21 milliseconds vs. 111 ± 28 milliseconds, P < 0.001). Three patients experienced a new-onset temporary left bundle branch block. CONCLUSIONS: New-onset conduction disorders or worsening of pre-existing rhythm abnormalities occur in one third of patients after rapid deployment aortic bioprosthesis implantation. Although the incidence of postoperative pacemaker implantation before discharge is low, strict follow-up is mandatory to identify a potential need for pacemaker implantation in a timely manner.

Acute DeBakey Type I aortic dissection without intimal tear in the arch: is total arch replacement the right choice?

OBJECTIVES: Surgical management of acute DeBakey Type I aortic dissection without intimal tear in the aortic arch is controversial. This study compared short- and long-term outcomes of total arch replacement (TAR) versus limited ascending aorta/hemiarch replacement (no-TAR) in a consecutive series of patients. METHODS: Between January 1998 and December 2015, 220 consecutive patients were operated for DeBakey Type I acute aortic dissection; 135 cases did not exhibit an intimal entry tear in the aortic arch and were subsequently selected to comprise the primary study cohort. A secondary subgroup analysis was made within these 135 cases, which comprised patients who received antegrade cerebral perfusion as the neuroprotective strategy of choice (n = 45). RESULTS: Mean follow-up period was 5 ± 4 years. Among the patients selected, 21 (16%) underwent TAR. Thirty-day mortality was higher in the TAR group (38% vs 21%, P = 0.04). Postoperative complication rates were similar between the groups (61% vs 73%, P = 0.31). Long-term mortality and late aortic reintervention rates were also similar (7% vs 30%, P = 0.36 and 27% vs 14%, P = 0.32, respectively). From the subgroup of patients with antegrade cerebral perfusion, 14 (31%) underwent TAR and 31 (69%) had no-TAR. Mean follow-up-time was 3 ± 2 years. Thirty-day mortality was higher in the TAR group (50% vs 16%, P < 0.01), postoperative complications, long-term mortality and late aortic reintervention rates were similar (64% vs 69%, P = 0.73; 0% vs 19%, P = 0.22; 29% vs 8%, P = 0.17, respectively). CONCLUSIONS: TAR was associated with higher 30-day mortality compared with the less extensive hemiarch replacement. In the long term, TAR showed a trend of improved survival and higher reintervention rate.