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1.
Perfusion ; : 2676591241255649, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38756008

RESUMO

Introduction: Adequate cerebral protection for aortic reoperation is challenging and optimal technique is still controversial.Case Report: We report a hybrid cannulation approach to achieve safe cerebral protection during circulatory arrest to repair an aortic root pseudoaneurysm.Conclusion: A multidisciplinary approach combining conventional techniques and interventional expertise could be considered in complex aortic scenario.

2.
J Cardiothorac Vasc Anesth ; 32(5): 2077-2086, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29325843

RESUMO

OBJECTIVE: To support a rational use of preoperative intra-aortic balloon pump (IABP) in cardiac surgery. DESIGN: Retrospective, observational study. SETTING: Single university hospital. PARTICIPANTS: The study included 588 (mean age 68.5 ± 9.6 yr) consecutive patients who received IABP before cardiac surgery from 1999 to 2016. INTERVENTIONS: Coronary surgery was performed in 573 (97.4%) cases. IABP indications were prophylaxis (n = 147), unstable angina (n = 239), and rapid worsening of hemodynamics (n = 202). Baseline characteristics of patients were analyzed with multivariable methods. Comparison of outcomes postsurgery between 74 patients undergoing IABP because of left main coronary artery disease (LMCAD) (stenosis ≥ 50%) and a new series of 1,360 patients experiencing LMCAD but who did not receive an IABP using propensity-score matching. MEASUREMENTS AND MAIN RESULTS: Throughout the study period, the rate of IABP use for prophylaxis and unstable angina increased (p = 0.0029) despite reduction in patient surgical risk (p = 0.0051). Early period of surgery (p = 0.032), rapid worsening of hemodynamics in the operating room (p = 0.0029), renal impairment (p < 0.0001), and ventilation before surgery (p = 0.0032) were predictors of in-hospital mortality. The cumulative rate of IABP-related complications was 6.8%. Current smoking (p = 0.025) and the use of a 9 Fr catheter (p = 0.0017) were predictors of IABP-related vascular complications. No difference was found regarding outcomes postsurgery for 43 pairs of IABP/non-IABP matched patients with LMCAD, even though preoperative IABP was associated with an increased use of bilateral internal thoracic artery grafting. CONCLUSIONS: Preoperative use of IABP in cardiac surgery was shown in this study to be safe, even for high-risk patients. LMCAD is not by itself a sufficient indication for prophylactic IABP.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Doença da Artéria Coronariana/cirurgia , Balão Intra-Aórtico/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Pontuação de Propensão , Medição de Risco , Idoso , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
3.
Infection ; 45(4): 413-423, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28054252

RESUMO

PURPOSE: Risk stratification is of utmost importance for patients with infective endocarditis (IE) who need surgery. However, for these critically ill patients, aspecific scoring systems are used to predict the risk of death after surgery. The aim of this study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE and to create a mortality risk score based on the results of this analysis. METHODS: Outcomes of 138 consecutive patients (mean age 60.6 ± 8.5 years) who had undergone surgery for IE in an Italian cardiac surgery center between 1999 and 2015 were reviewed retrospectively and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver-operating characteristic (ROC) curve analysis. RESULTS: Twenty-eight (20.3%) patients died in hospital following surgery. Anemia [odds ratio (OR) 11.0, p = 0.035), New York Heart Association class IV (OR 2.61, p = 0.09), critical state (OR 4.97, p = 0.016), large intracardiac destruction (OR 6.45, p = 0.0014), and surgery of the thoracic aorta (OR 7.51, p = 0.041) were independent predictors of hospital death. A new scoring system was devised to predict in-hospital death after surgery for IE (area under ROC curve, 0.828, 95% confidence interval, 0.754-0.887). The score outperformed six of seven scoring systems, for early death after cardiac surgery, that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk after surgery for IE. Prospective studies are needed for the score validation.


Assuntos
Endocardite/cirurgia , Mortalidade Hospitalar , Complicações Pós-Operatórias/mortalidade , Idoso , Análise Fatorial , Feminino , Humanos , Itália/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/etiologia , Curva ROC , Estudos Retrospectivos , Fatores de Risco
4.
Ann Thorac Surg ; 115(3): e67-e69, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-35367435

RESUMO

Cardiac hamartoma is a rare benign tumor of the heart, and the vascular type is an extremely rare histologic diagnosis. A small number of cases have previously been described in childhood. We report the case of a 63-year-old woman with an incidentally detected cardiac mass that was finally diagnosed as vascular hamartoma. Approval for publication was obtained from the patient.


Assuntos
Hamartoma , Procedimentos de Cirurgia Plástica , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Coração , Tomografia Computadorizada por Raios X , Hamartoma/diagnóstico , Tórax
5.
Acta Biomed ; 93(2): e2022049, 2022 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-35546025

RESUMO

Coronary artery bypass grafting is the gold standard strategy for obtaining complete coronary revascularization in patients with multivessel coronary artery disease. The recent AHA and EACTS guidelines on myocardial revascularization recommend total arterial revascularization, especially in younger patients, whenever possible. However, the use of saphenous vein grafts in association with single or bilateral internal thoracic artery (SITA, BITA) instead of arterial grafts (radial arteries, right gastroepiploic artery and inferior epigastric artery) is widespread. We analyzed literature from the last ten years (January 2010 to December 2020) looking for evidence in favour of the use of a radial artery compared to a saphenous vein in association with BITA. We identified nine studies (4 Systematic Reviews and Meta-analyses and 6 large cohort observational studies with propensity score-matching) that compared arterial with saphenous grafts as third conduit. The main finding of the review is the higher rate of freedom from any cardiac adverse event in the population which reached Total Arterial myocardial Revascularization (TAR). A probable reason for the limited application of TAR as a strategy is the shortage of Randomized Controlled Trials (RCTs).


Assuntos
Doença da Artéria Coronariana , Artéria Radial , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Humanos , Artéria Radial/transplante , Veia Safena/transplante , Resultado do Tratamento
6.
Acta Biomed ; 93(S1): e2022115, 2022 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-35674476

RESUMO

Redo surgical aortic valve replacement has been the gold standard for the treatment of degenerated bioprostheses; however it carries an inherent risk associated with a reoperative open heart surgery. Valve-in-Valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as an alternative approach. Few articles in literature review transcatheter aortic valve replacement's failure rates, complications (i.e., valve dislocation, paravalvular leaks) and their surgical management. The rate of reoperations after a percutaneous approach is expected to increase, with the currently rising number of transcatheter procedures worldwide even in patients with a longer life expectancy. Valve dislocation is a rare but serious complication that can severely impact on the outcome of patients. Paravalvular leaks and structural valve degeneration are the most common causes of surgical re-intervention. We present the case of a complex patient with previous surgical aortic valve and ascending aorta replacement who underwent a transfemoral valve-in-valve TAVI for bioprosthesis degeneration, complicated by valve dislocation requiring surgical reoperation.


Assuntos
Bioprótese , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Humanos , Desenho de Prótese , Falha de Prótese , Reoperação/métodos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento
7.
J Clin Med ; 10(19)2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34640374

RESUMO

BACKGROUND: Long-term outcomes of patients with infective endocarditis (IE) who received either a mechanical (MP) or biological prosthesis (BP) are conflicting. A meta-analysis of observational studies comparing the long-term outcomes of left-side IE with the use of MP versus BP was performed. METHODS: Electronic databases from January 2000 to June 2021 were screened. Studies reporting long-term mortality were analyzed. The primary endpoint was long-term overall mortality. Secondary endpoints were in-hospital/.30-day mortality and freedom from both prosthesis reinfection and reintervention. The pooled hazard ratio (HR) with 95% confidence interval (CI) was calculated for survival according to the random effect model. RESULTS: Thirteen retrospective observational studies reporting on 8645 patients (MP: 4688; BP: 4137) were included for comparison. Twelve studies reported data of long-term survival for a total of 8285 patients (MP: 4517; BP: 3768). The pooled analysis revealed that the use of MP was statistically associated with longer benefits compared to BP (HR 0.74; 95% CI 0.63-0.86; p < 0.0001). The median follow-up time ranged from 1 to 15.3 years. The pooled analysis of five studies reporting data on prosthesis reinfection in 4491 patients (MP: 2433; BP: 2058) did not reveal significant differences (HR 0.60; 95% CI 0.30-1.21; p = 0.15). Five studies reported data on prosthesis reintervention in 4401 patients (MP: 2307; BP: 2094). The meta-analysis revealed a significant difference in favor of MP (HR 0.40; 95% CI 0.29-0.55; p < 0.0001). Meta-regression reported no effect of male gender (p = 0.09) and age (p = 0.77) on long-term survival. CONCLUSIONS: In a meta-analysis of retrospective observational studies comparing the long-term outcome of patients who underwent surgery for left-sided IE, the use of MP compared to BP is associated with a significant longer-term survival and with a reduced incidence of late reoperation. The incidence of late reinfection is comparable between the two prostheses.

8.
J Clin Med ; 10(17)2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34501308

RESUMO

Since the advent of TAVR (transcatheter aortic valve replacement), the transapical surgical approach has been affirmed as a safe and effective alternative access for patients with unsuitable peripheral arteries. With the improvement of devices for transfemoral approach and the development of other alternative accesses, the number of transapical procedures has decreased significantly worldwide. The left ventricular apex, however, has proved to be a safe and valid alternative access for various other structural heart procedures such as mitral valve repair, mitral valve-in-valve or valve-in-ring replacement, transcatheter mitral valve replacement (TMVR), transcatheter mitral paravalvular leak repair, and thoracic aorta endovascular repair (TEVAR). We review the literature and our experience of various hybrid transcatheter structural heart procedures using the transapical surgical approach and discuss pros and cons.

9.
Ann Thorac Surg ; 107(4): 1166-1173, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30444991

RESUMO

BACKGROUND: To minimize aortic manipulation and maximize use of arterial conduits are aims of modern coronary surgery. METHODS: From March 2012 to October 2016, 890 consecutive patients with multivessel coronary disease underwent isolated coronary operations using both internal thoracic arteries (ITAs). In 205 (23%; mean age, 67.6 ± 9.2 years), the right ITA was proximally transected and used as a free graft, while its in situ stump was elongated with a saphenous vein graft. The new arteriovenous I conduit was directed to the inferolateral cardiac wall. Operative data and early outcomes of these patients (I group) were compared with the remaining 685 patients (control [C] group). Early and late outcomes were also compared in 184 pairs identified with propensity score matching. RESULTS: Between the I and C groups there was no significant difference in expected operative risk (European System for Cardiac Operative Risk Evaluation II, p = 0.28), although diseased ascending aorta (p < 0.0001) and critical preoperative state (p = 0.027) were more frequent in the I group. Despite a higher number of coronary anastomoses (mean, 4 ± 0.9 vs 3.7 ± 1, p < 0.0001), cardiopulmonary bypass time was shorter in the I group both in overall (86.7 ± 23.7 vs 105.7 ± 34.2 minutes, p < 0.0001) and matched series (86.8 ± 24.1 vs 108.8 ± 31.9 minutes, p < 0.0001). In-hospital mortality (1% vs 1.9%, p = 0.54) and the rates of postoperative complications were similar. During the follow-up period, no intergroup difference was found in matched patients in the nonparametric estimates of freedom from all-cause death (p = 0.39) and major adverse cardiac and cerebrovascular events (p = 0.44). CONCLUSIONS: Surgery using this arteriovenous I conduit is safe, minimizes aortic manipulation, shortens cardiopulmonary bypass time, and aids complete revascularization.


Assuntos
Fístula Anastomótica/prevenção & controle , Ponte de Artéria Coronária/métodos , Estenose Coronária/cirurgia , Mortalidade Hospitalar , Anastomose de Artéria Torácica Interna-Coronária/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Feminino , Seguimentos , Humanos , Itália , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular/fisiologia
10.
Eur J Prev Cardiol ; 25(1_suppl): 59-65, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29708031

RESUMO

Background The effects of fat microembolization due to cardiopulmonary bypass are well known in cardiac surgery. Our aim is to evaluate the use of the RemoweLL device (Eurosets, Medolla, Italy) during elective aortic valve replacement in elderly patients (>70 years old) to rate its biochemical and clinical effects. The RemoweLL device is an oxygenator-integrated reservoir which combines two strategies for fat emboli and leucocytes removal: filtration and supernatant elimination. Methods Forty-four elderly patients were enrolled and assigned randomly to a Group A (standard device) and a Group B (RemoweLL). Biochemical effects were evaluated by blood samples, which were tested for white blood cells, neutrophils, protein SP-100 and interleukin 6 besides standard lab tests. Our clinical endpoints were any type of neurological, cardiac, respiratory, gastrointestinal or renal complications, and length of stay in the intensive care unit. Statistical analysis was carried out with chi square test for non-parametric data; t test and analysis of variance for repeated measures were used for parametric data. Results Group B showed lower levels of white blood cells, neutrophils, interleukin 6 and protein SP-100 immediately and 24 hours after the operation. Group B also showed a lower amount of neurocognitive type II dysfunction even if the length of stay in the ICU did not change. Conclusions The RemoweLL system is safe and effective in reducing inflammatory response to cardiopulmonary bypass and it could be a useful tool in minimizing negative effects of cardiopulmonary bypass; however, it does not seem to have any effect on elderly patients' hospital stay.


Assuntos
Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Procedimentos de Redução de Leucócitos/instrumentação , Oxigenadores , Complicações Pós-Operatórias/prevenção & controle , Idoso , Citocinas/sangue , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Contagem de Leucócitos , Masculino , Complicações Pós-Operatórias/sangue , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
11.
G Ital Cardiol (Rome) ; 18(12): 875-877, 2017 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-29189832

RESUMO

Papillary fibroelastoma, a benign cardiac tumor, is a rare clinical condition. Before the echocardiography era, the diagnosis was often occasional, especially during other cardiac procedures; but nowadays it has improved with the advent of higher-resolution imaging technology. The clinical presentation can vary from asymptomatic to severe complications such as cerebrovascular or ischemic events due to tumor embolization.We present the case of a 33-year-old female with a papillary fibroelastoma on the anterior leaflet of the mitral valve undergoing clinical examination for claudicatio intermittens. An occlusion of the left common femoral artery was present. The diagnosis was made posteriorly after embolectomy. All cardiac imaging investigations were negative. The heart team decided a strict echocardiographic follow-up every 3 months, and after the first visit a pedunculated mass was detected on the anterior mitral leaflet. The surgical management included urgent resection of the tumor on cardiopulmonary bypass using a minimally invasive approach via a right anterior minithoracotomy. The postoperative course was uneventful. We emphasize the need for surgical treatment given the potential risk of relapse. When no mass is detected on imaging, a strict echocardiographic follow-up and antiplatelet therapy are mandatory.


Assuntos
Neoplasias Cardíacas/patologia , Células Neoplásicas Circulantes , Adulto , Embolectomia , Feminino , Artéria Femoral , Neoplasias Cardíacas/cirurgia , Humanos , Fatores de Tempo
12.
J Cardiovasc Med (Hagerstown) ; 17 Suppl 2: e146-e148, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28482352

RESUMO

: In this report, we present a rare case of cardiac echinococcosis presenting with cerebral haemorrhage due to rupture of a mycotic aneurysm in a peripheral branch of the media cerebral artery. Further investigations lead to discovery of multiple cysts in the heart and liver. The complementary use of transthoracic and transoesophageal echocardiography, MRI and computed tomography lead to the final diagnosis of disseminated echinococcosis and allowed precise evaluation of the anatomical and structural characteristics of the cardiac mass, its boundaries and its relationship with the surrounding anatomic structures.


Assuntos
Aneurisma Infectado/parasitologia , Aneurisma Roto/parasitologia , Hemorragia Cerebral/parasitologia , Equinococose Hepática/parasitologia , Equinococose/parasitologia , Cardiopatias/parasitologia , Aneurisma Intracraniano/parasitologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/terapia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Angiografia Cerebral/métodos , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/terapia , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Equinococose/diagnóstico por imagem , Equinococose/terapia , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/terapia , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Cardiopatias/diagnóstico por imagem , Cardiopatias/terapia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Imageamento por Ressonância Magnética , Masculino , Imagem Multimodal/métodos , Resultado do Tratamento , Adulto Jovem
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