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1. Durability of bioprosthetic aortic valve replacement in patients under the age of 60 years-1-year follow-up from the prospective INDURE registry

Author

Meuris, B, Roussel, JC, Borger, MA, Siepe, M, Stefano, P, Laufer, G, Langanay, T, Theron, A, Grabenwöger, M, Binder, K, Demers, P, Pessotto, R, van Leeuwen, W, Bourguignon, T, Canovas, S, Mariscalco, G, Coscioni, E, Dagenais, F, Wendler, O, Polvani, G, Eden, M, Botta, B, Bramlage, P, De Paulis, R, Meuris, B, Roussel, JC, Borger, MA, Siepe, M, Stefano, P, Laufer, G, Langanay, T, Theron, A, Grabenwöger, M, Binder, K, Demers, P, Pessotto, R, van Leeuwen, W, Bourguignon, T, Canovas, S, Mariscalco, G, Coscioni, E, Dagenais, F, Wendler, O, Polvani, G, Eden, M, Botta, B, Bramlage, P, and De Paulis, R

Abstract

OBJECTIVES: We report 1-year safety and clinical outcomes in patients <60 years undergoing bioprosthetic surgical aortic valve intervention. METHODS: The INSPIRIS RESILIA Durability Registry is a prospective, multicentre registry to assess clinical outcomes of patients <60 years. Patients with planned SAVR with or without concomitant replacement of the ascending aorta and/or coronary bypass surgery were included. Time-related valve safety, haemodynamic performance and quality of life (QoL) at 1 year were assessed. RESULTS: A total of 421 patients were documented with a mean age of 53.5 years, 76.5% being male and 27.2% in NYHA class III/IV. Outcomes within 30 days included cardiovascular-related mortality (0.7%), time-related valve safety (VARC-2; 5.8%), thromboembolic events (1.7%), valve-related life-threatening bleeding (VARC-2; 4.3%) and permanent pacemaker implantation (3.8%). QoL was significantly increased at 6 months and sustained at 1 year. Freedom from all-cause mortality at 1 year was 98.3% (95% confidence interval 97.1; 99.6) and 81.8% were NYHA I versus 21.9% at baseline. No patient developed structural valve deterioration stage 3 (VARC-3). The mean aortic pressure gradient was 12.6 mmHg at 1 year and the effective orifice area was 1.9 cm2. CONCLUSIONS: The 1-year data from the INSPIRIS RESILIA valve demonstrate good safety and excellent haemodynamic performance as well as an early QoL improvement. Clinical trial registration: clinicaltrials.gov: NCT03666741.

Published
2023

2. Clinical and Hemodynamic Outcomes of Rapid-Deployment Aortic Bioprostheses

Author

D'Onofrio, A., Tessari, C., Cibin, G., Lorenzoni, G., Martinelli, G. L., Solinas, M., Gerosa, G., Gregori, D., Alamanni, F., Polvani, G., Massetti, M., Eusanio, M. D., Merlo, M., Vendramin, I., Mangino, D., Mignosa, C., Russo, C., Rinaldi, M., De Paulis, R., Pacini, D., Luzi, G., Antona, C., Salvador, L., Musumeci, F., Maselli, D., Colli, A., Portoghese, M., Alfieri, O., De Filippo, C. M., Lorenzoni G., Massetti M. (ORCID:0000-0002-7100-8478), Maselli D., Portoghese M., D'Onofrio, A., Tessari, C., Cibin, G., Lorenzoni, G., Martinelli, G. L., Solinas, M., Gerosa, G., Gregori, D., Alamanni, F., Polvani, G., Massetti, M., Eusanio, M. D., Merlo, M., Vendramin, I., Mangino, D., Mignosa, C., Russo, C., Rinaldi, M., De Paulis, R., Pacini, D., Luzi, G., Antona, C., Salvador, L., Musumeci, F., Maselli, D., Colli, A., Portoghese, M., Alfieri, O., De Filippo, C. M., Lorenzoni G., Massetti M. (ORCID:0000-0002-7100-8478), Maselli D., and Portoghese M.

Abstract

Aim of this retrospective, multicenter study was to evaluate early and mid-term clinical and hemodynamic results of patients who underwent surgical aortic valve replacement (SAVR) with Intuity rapid-deployment bioprostheses (RDB) (Edwards Lifesciences, Irvine, CA). We analyzed data from the Italian Registry of Intuity Valve (INTU-ITA registry) that is a national, real-world and independent from the industry registry. Preoperative variables were defined according to EuroSCORE and postoperative outcomes according to Valve Academic Research Consortium (VARC). Survival distribution was evaluated using the Kaplan-Meier approach. A Cox-Proportional Hazard Model was employed to assess the effect of the covariates on patients’ survival. The registry included 1687 patients from 23 centers (June 2012-September 2019). Aortic cross clamp time for isolated SAVR was 55 minutes (IQR: 45–70 minute). Postoperative pace-maker rate was 6.3%. At discharge transaortic peak and mean gradients were: 18 mm Hg (IQR: 14–23 mm Hg) and 10 mmHg (IQR: 8–13 mm Hg), respectively. Indexed effective orifice area was 1.10 cm2/m2 (IQR: 0.91–1.31 cm2/m2) and the incidence of severe patient-prosthesis mismatch was 0.6%. Hemodynamic data for all valve sizes remained stable during follow-up. Thirty-day overall mortality was 1.8% (30 patients), and at follow-up it was 5.3% (89 patients). Kaplan-Meier overall survival was 95.5% (94.3–96.7%); 90.7% (88.3–93.1%); 86.4% (82.6–90.4%) at 1, 3, and 5 years, respectively. Serum creatinine (HR: 1.36; 95%CI: 1.04–1.81; p = 0.0397) and cross-clamp time (HR: 1.01; 95%CI: 1.002–1.017; p = 0.0077) were identified as independent predictors of mortality. According to our data from the INTU-ITA registry, SAVR with RDB provides good early clinical and hemodynamic results that are confirmed at follow-up.

Published
2021

3. Cardiac surgery practice during the COVID-19 outbreak: A multicentre national survey

Author

Rubino, A. S., De Santo, L. S., Pisano, Adelaide, Mauro, M. D., Benussi, S., Borghetti, V., Castiglioni, A., Chiariello, L., Colli, A., De Bellis, Andrea, De Filippo, C. M., De Paulis, R., Di Benedetto, G., Di Eusanio, M., Faggian, G., Fiorani, B., Fratto, P. A., Giuffrida, A. G., Glauber, M., Iannelli, G., Iesu, S., Livi, U., Martinelli, G., Massetti, Massimo, Mastroroberto, P., Menicanti, L., Minniti, G., Miraldi, F., Montesi, G., Musumeci, F., Nicolini, Francesco, Napoleone, C. P., Panisi, P., Pappalardo, A., Patane`, F., Ragni, T., Rinaldi, M., Tribastone, S., Triggiani, M., Tritto, F. P., Zebele, C., Parolari, A., Gerosa, G., De Feo, M., Antonino, S. R., Luca Salvatore, D. S., Antonio, P., Michele, D. M., Stefano, B., Valentino, B., Alessandro, C., Luigi, C., Andrea, C., Antonio, D. B., Carlo Maria, D. F., Ruggero, D. P., Giuseppe, D. B., Marco, D. E., Giuseppe, F., Brenno, F., Pasquale, A. F., Angelo Giuseppe, G., Mattia, Giuseppe, Gabriele, I., Severino, Iolanda, Ugolino, L., Gianluca, M., Massimo, M., Pasquale, M., Lorenzo, M., Giuseppe, M., Fabio, M., Gianfranco, M., Francesco, M., Francesco, N., Carlo Pace, N., Paolo, P., Aniello, P., Francesco, P., Temistocle, R., Mauro, R., Salvatore, T., Michele, T., Francesco Paolo, T., Carlo, Z., Alessandro, P., Gino, G., Marisa, D. F., Pisano A., De Bellis A., Massetti M. (ORCID:0000-0002-7100-8478), Nicolini F., Mattia G., Severino I., Rubino, A. S., De Santo, L. S., Pisano, Adelaide, Mauro, M. D., Benussi, S., Borghetti, V., Castiglioni, A., Chiariello, L., Colli, A., De Bellis, Andrea, De Filippo, C. M., De Paulis, R., Di Benedetto, G., Di Eusanio, M., Faggian, G., Fiorani, B., Fratto, P. A., Giuffrida, A. G., Glauber, M., Iannelli, G., Iesu, S., Livi, U., Martinelli, G., Massetti, Massimo, Mastroroberto, P., Menicanti, L., Minniti, G., Miraldi, F., Montesi, G., Musumeci, F., Nicolini, Francesco, Napoleone, C. P., Panisi, P., Pappalardo, A., Patane`, F., Ragni, T., Rinaldi, M., Tribastone, S., Triggiani, M., Tritto, F. P., Zebele, C., Parolari, A., Gerosa, G., De Feo, M., Antonino, S. R., Luca Salvatore, D. S., Antonio, P., Michele, D. M., Stefano, B., Valentino, B., Alessandro, C., Luigi, C., Andrea, C., Antonio, D. B., Carlo Maria, D. F., Ruggero, D. P., Giuseppe, D. B., Marco, D. E., Giuseppe, F., Brenno, F., Pasquale, A. F., Angelo Giuseppe, G., Mattia, Giuseppe, Gabriele, I., Severino, Iolanda, Ugolino, L., Gianluca, M., Massimo, M., Pasquale, M., Lorenzo, M., Giuseppe, M., Fabio, M., Gianfranco, M., Francesco, M., Francesco, N., Carlo Pace, N., Paolo, P., Aniello, P., Francesco, P., Temistocle, R., Mauro, R., Salvatore, T., Michele, T., Francesco Paolo, T., Carlo, Z., Alessandro, P., Gino, G., Marisa, D. F., Pisano A., De Bellis A., Massetti M. (ORCID:0000-0002-7100-8478), Nicolini F., Mattia G., and Severino I.

Abstract

OBJECTIVES: Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak. Accordingly, hospitals had to implement strategies to profoundly reshape both non-COVID-19 medical care and surgical activities. Knowledge about the impact of the COVID-19 pandemic on cardiac surgery practice is pivotal. The goal of the present study was to describe the changes in cardiac surgery practices during the health emergency at the national level. METHODS: A 26-question web-enabled survey including all adult cardiac surgery units in Italy was conducted to assess how their clinical practice changed during the national lockdown. Data were compared to data from the corresponding period in 2019. RESULTS: All but 2 centres (94.9%) adopted specific protocols to screen patients and personnel. A significant reduction in the number of dedicated cardiac intensive care unit beds (-35.4%) and operating rooms (-29.2%), along with healthcare personnel reallocation to COVID departments (nurses-15.4%, anaesthesiologists-7.7%), was noted. Overall adult cardiac surgery volumes were dramatically reduced (1734 procedures vs 3447; P 0.001), with a significant drop in elective procedures [580 (33.4%) vs 2420 (70.2%)]. CONCLUSIONS: This national survey found major changes in cardiac surgery practice as a response to the COVID-19 pandemic. This experience should lead to the development of permanent systems-based plans to face possible future pandemics. These data may effectively help policy decision-making in prioritizing healthcare resource reallocation during the ongoing pandemic and once the healthcare emergency is over. © 2021 The Author(s). Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Published
2021

4. Minimally Invasive vs Conventional Aortic Valve Replacement With Rapid-Deployment Bioprostheses

Author

D'Onofrio, A., Tessari, C., Lorenzoni, G., Cibin, G., Martinelli, G., Alamanni, F., Polvani, G., Solinas, M., Massetti, M., Merlo, M., Vendramin, I., Di Eusanio, M., Mignosa, C., Mangino, D., Russo, C., Rinaldi, M., Pacini, D., Salvador, L., Antona, C., Maselli, D., De Paulis, R., Luzi, G., Alfieri, O., De Filippo, C. M., Portoghese, M., Musumeci, F., Colli, A., Gregori, D., Gerosa, G., Lorenzoni G., Massetti M. (ORCID:0000-0002-7100-8478), Maselli D., Portoghese M., D'Onofrio, A., Tessari, C., Lorenzoni, G., Cibin, G., Martinelli, G., Alamanni, F., Polvani, G., Solinas, M., Massetti, M., Merlo, M., Vendramin, I., Di Eusanio, M., Mignosa, C., Mangino, D., Russo, C., Rinaldi, M., Pacini, D., Salvador, L., Antona, C., Maselli, D., De Paulis, R., Luzi, G., Alfieri, O., De Filippo, C. M., Portoghese, M., Musumeci, F., Colli, A., Gregori, D., Gerosa, G., Lorenzoni G., Massetti M. (ORCID:0000-0002-7100-8478), Maselli D., and Portoghese M.

Abstract

Background: The aim of this multicenter retrospective study was to compare early and midterm clinical and hemodynamic results of aortic valve replacement with rapid-deployment bioprostheses performed through conventional full-sternotomy vs mini-sternotomy. Methods: Data from the Italian multicenter registry of aortic valve replacement with rapid-deployment bioprostheses (INTU-ITA registry) were analyzed. Patients were divided into 2 groups: full sternotomy (FS) and ministernotomy (MS). Primary endpoint was the comparison of early and midterm mortality. Secondary endpoints were: comparison of intraoperative variables, complications, and hemodynamic performance. A propensity score weighting approach was used for data analysis. Results: A total of 1057 patients were analyzed: 435 (41.2%) and 622 (58.8%) in group FS and MS, respectively. Thirty-day mortality was 1.6% and 0.6% in FS and MS groups, respectively (P =.074). cardiopulmonary bypass time was 78.5 minutes and 83 minutes in FS and MS groups, respectively (P =.414). In the overall cohort, the incidence of intraoperative complications and of device success was 3.8% (40 patients) and 95.9% (1014 patients), respectively, with no significant differences between groups. Survival at 1, 3, and 5 years was 94.1%, 98.1%, 88.5% and 91.8%, 85.2%, and 84.8% in FS and MS groups, respectively (P =.412). The 2 groups showed similar postoperative gradients (median mean gradient, FS: 10.0 mm Hg, MS: 11.0 mm Hg; P =.170) and also similar incidence of patient–prosthesis mismatch (FS: 7%, MS: 6.4%, P =.647). Conclusions: According to our data, rapid-deployment bioprostheses allow the performance of minimally invasive aortic valve replacement with similar surgical times and similar clinical and hemodynamic outcomes to conventional surgery and should be considered the first choice in these procedures.

Published
2021

5. Durability of bioprosthetic aortic valves in patients under the age of 60 years - Rationale and design of the international INDURE registry

Author

Meuris, B. (Bart), Borger, M.A. (Michael), Bourguignon, T. (Thierry), Siepe, M. (Matthias), Grabenwöger, M. (Martin), Laufer, G. (Günther), Binder, K. (Konrad), Polvani, G. (Gianluca), Stefano, P. (Pierluigi), Coscioni, E. (Enrico), Leeuwen, W.J. (Wouter) van, Demers, P. (Philippe), Dagenais, F. (Francois), Cánovas, S.J. (Sergio), Theron, A. (Alexis), Langanay, T. (Thierry), Roussel, J.-C. (Jean-Christian), Wendler, O. (Olaf), Mariscalco, G. (Giovanni), Pessotto, R. (Renzo), Botta, B. (Beate), Bramlage, P. (Peter), De Paulis, R. (Ruggero), Meuris, B. (Bart), Borger, M.A. (Michael), Bourguignon, T. (Thierry), Siepe, M. (Matthias), Grabenwöger, M. (Martin), Laufer, G. (Günther), Binder, K. (Konrad), Polvani, G. (Gianluca), Stefano, P. (Pierluigi), Coscioni, E. (Enrico), Leeuwen, W.J. (Wouter) van, Demers, P. (Philippe), Dagenais, F. (Francois), Cánovas, S.J. (Sergio), Theron, A. (Alexis), Langanay, T. (Thierry), Roussel, J.-C. (Jean-Christian), Wendler, O. (Olaf), Mariscalco, G. (Giovanni), Pessotto, R. (Renzo), Botta, B. (Beate), Bramlage, P. (Peter), and De Paulis, R. (Ruggero)

Abstract

Background: There is an ever-growing number of patients requiring aortic valve replacement (AVR). Limited data is available on the long-term outcomes and structural integrity of bioprosthetic valves in younger patients undergoing surgical AVR. Methods: The INSPIRIS RESILIA Durability Registry (INDURE) is a prospective, open-label, multicentre, international registry with a follow-up of 5 years to assess clinical outcomes of patients younger than 60 years who undergo surgical AVR using the INSP

Published
2020
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6. Durability of bioprosthetic aortic valves in patients under the age of 60years-rationale and design of the international INDURE registry

Author

Meuris, B, Borger, MA, Bourguignon, T, Siepe, M, Grabenwoger, M, Laufer, G, Binder, K, Polvani, G, Di Stefano, P, Coscioni, E, van Leeuwen, Wouter, Demers, P, Dagenais, F, Canovas, S, Theron, A, Langanay, T, Roussel, JC, Wendler, O, Mariscalco, G, Pessotto, R, Botta, B, Bramlage, P, De Paulis, R, Meuris, B, Borger, MA, Bourguignon, T, Siepe, M, Grabenwoger, M, Laufer, G, Binder, K, Polvani, G, Di Stefano, P, Coscioni, E, van Leeuwen, Wouter, Demers, P, Dagenais, F, Canovas, S, Theron, A, Langanay, T, Roussel, JC, Wendler, O, Mariscalco, G, Pessotto, R, Botta, B, Bramlage, P, and De Paulis, R

Published
2020

7. Surgical aortic valve replacement with new-generation bioprostheses: Sutureless versus rapid-deployment

Author

D'Onofrio, Ginevra Federica, Salizzoni, S., Filippini, C., Tessari, C., Bagozzi, L., Messina, A., Troise, Giovanni, Tomba, M. D., Rambaldini, M., Dalen, M., Alamanni, F., Massetti, Massimo, Mignosa, C., Russo, C., Salvador, L., Di Bartolomeo, R., Maselli, Daniele, De Paulis, R., Alfieri, O., De Filippo, C. M., Portoghese, M., Bortolotti, U., Rinaldi, M., Gerosa, G., D'Onofrio A., Troise G., Massetti M. (ORCID:0000-0002-7100-8478), Maselli D., D'Onofrio, Ginevra Federica, Salizzoni, S., Filippini, C., Tessari, C., Bagozzi, L., Messina, A., Troise, Giovanni, Tomba, M. D., Rambaldini, M., Dalen, M., Alamanni, F., Massetti, Massimo, Mignosa, C., Russo, C., Salvador, L., Di Bartolomeo, R., Maselli, Daniele, De Paulis, R., Alfieri, O., De Filippo, C. M., Portoghese, M., Bortolotti, U., Rinaldi, M., Gerosa, G., D'Onofrio A., Troise G., Massetti M. (ORCID:0000-0002-7100-8478), and Maselli D.

Abstract

Objectives: The aim of this retrospective multicenter study was to compare early clinical and hemodynamic outcomes of Perceval-S sutureless (Livanova, London, United Kingdom) and Intuity rapid-deployment (Edwards Lifesciences, Irvine, Calif) bioprostheses. Methods: Data from patients who underwent isolated or combined aortic valve replacement with Perceval-S and with Intuity bioprostheses at 18 cardiac surgical institutions were analyzed. Propensity matching was performed to identify similar patient cohorts. Results: We included 911 patients from March 2011 until May 2017. Perceval-S and Intuity valves were implanted in 349 (38.3%) and in 562 (61.7%) patients, respectively. Propensity score identified 117 matched pairs. In the matched cohort, device success was 99.1% and 100% in Perceval-S and Intuity group, respectively (P = 1.000). Thirty-day Valve Academic Research Consortium mortality occurred in 2 (1.7%) and 4 (3.4%) patients in the Perceval-S and in Intuity group, respectively (P = .6834). The rate of postoperative new permanent pacemaker implantation was 6% (7 patients) and 6.8% (8 patients) in the Perceval-S and in Intuity group, respectively (P = .7896). Perceval-S valve implantation requires significantly shorter aortic crossclamp and cardiopulmonary bypass times than Intuity valve implantation (aortic crossclamp time for isolated, 52 ± 14 minutes vs 62 ± 24 minutes; P < .0001). Peak transaortic gradients were 22.4 ± 8.1 mm Hg and 19.6 ± 6.7 mm Hg (P = .0144), whereas mean gradients were 11.8 ± 4.7 mm Hg and 10.5 ± 3.9 mm Hg (P = .0388) in the Perceval-S and Intuity groups, respectively. Conclusions: Sutureless Perceval-S and rapid-deployment Intuity bioprostheses provide good and similar early clinical and hemodynamic outcomes. Perceval-S valve implantation requires shorter crossclamp and cardiopulmonary bypass times, whereas Intuity valve implantation provides lower transaortic peak and mean gradients.

Published
2020

8. Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe†‡

Author

De Paulis, Ruggero, Czerny, Martin, Weltert, Luca, Bavaria, Joseph, Borger, Michael A., Carrel, Thierry P., Etz, Christain D., Grimm, Michael, Loubani, Mahmoud, Pacini, Davide, Resch, Timothy, Urbanski, Paul P., Weigang, Ernst, Grimm, M., Grabenwöger, M., Schepens, M., Maatouk, M., Van Ruyssevelt, P., Rodrigus, I., Van Nooten, G., Panayotov, P., Papantchev, V., Medved, I., Sutlic, Z., Ilkjaer, L., Skov Olsen, P., Hippelainen, M., Deleuze, P., Collart, F., Camilleri, L., Caus, T., Villemot, JP, Schmoeckel, M., Iversen, S., Matschke, K., Moritz, A., Fischlein, T., Hammel, D., Doll, KN, Warnecke, H., Reichenspurner, H., Beyesdorf, F., Boning, A., Liebold, A., Asfour, B., Mohr, W., Diegeler, A., Charitos, C., Khouri, M., Palatianos, G., Bairaktaris, A., Sivitanidis, E., Gregorini, R., Torracca, L., Cirio, EM, Mercogliano, D., Esposito, G., Cassese, M., Caparrotti, S., Mazzei, V., De Paulis, R., Mazzola, A., Menicanti, L., Tarelli, G., Glauber, M., Murzi, B., Antona, C., Casabona, R., Di Bartolomeo, R., Muneretto, C., Gherli, T., Lamarra, M., Stradiņš, P., Klautz, R., Grandjean, JG, Stooker, W., Bogers, JJ, Geiran, O., Hirnle, T., Rogowski, J., Brykczynski, M., Jemielity, M., Antunes, M., Tinica, G., Gaspar, M., Priktov, V., Maksimov, A., Belash, S., Boldyrev, S., Barbuchatti, K., Nikolishin, A., Abdulaev, M., Izhbuldin, R., Yunusov, V., Bikbulatov, R., Dzemeshkevich, S., Podoksenov, A., Shipulin, V., Zotov, A., Lockowandt, U., Castellanos, E., Sádaba, R., Mosquera Rodriguez, V., Silva, J., Nistal, JF, Galiñanes Hernández, M., Porras, C., Llorens, R., Saenz Berbejillo, A., Prêtre, R., Carrel, T., Senay, S., Orhan Veli, D., Ruçhan, A., Bülent, K., Sener, E., Katrancioglu, N., Apaydin, AZ, Battaloğlu, B., Yilik, L., Özeren, M., Aykut Aka, S., Tuygun, AK, Ketenci, B., Dağsali, S., Kaplan, M., Akçevin, A., Nashef, S., De Paulis, Ruggero, Czerny, Martin, Weltert, Luca, Bavaria, Joseph, Borger, Michael A., Carrel, Thierry P., Etz, Christain D., Grimm, Michael, Loubani, Mahmoud, Pacini, Davide, Resch, Timothy, Urbanski, Paul P., Weigang, Ernst, Grimm, M., Grabenwöger, M., Schepens, M., Maatouk, M., Van Ruyssevelt, P., Rodrigus, I., Van Nooten, G., Panayotov, P., Papantchev, V., Medved, I., Sutlic, Z., Ilkjaer, L., Skov Olsen, P., Hippelainen, M., Deleuze, P., Collart, F., Camilleri, L., Caus, T., Villemot, JP, Schmoeckel, M., Iversen, S., Matschke, K., Moritz, A., Fischlein, T., Hammel, D., Doll, KN, Warnecke, H., Reichenspurner, H., Beyesdorf, F., Boning, A., Liebold, A., Asfour, B., Mohr, W., Diegeler, A., Charitos, C., Khouri, M., Palatianos, G., Bairaktaris, A., Sivitanidis, E., Gregorini, R., Torracca, L., Cirio, EM, Mercogliano, D., Esposito, G., Cassese, M., Caparrotti, S., Mazzei, V., De Paulis, R., Mazzola, A., Menicanti, L., Tarelli, G., Glauber, M., Murzi, B., Antona, C., Casabona, R., Di Bartolomeo, R., Muneretto, C., Gherli, T., Lamarra, M., Stradiņš, P., Klautz, R., Grandjean, JG, Stooker, W., Bogers, JJ, Geiran, O., Hirnle, T., Rogowski, J., Brykczynski, M., Jemielity, M., Antunes, M., Tinica, G., Gaspar, M., Priktov, V., Maksimov, A., Belash, S., Boldyrev, S., Barbuchatti, K., Nikolishin, A., Abdulaev, M., Izhbuldin, R., Yunusov, V., Bikbulatov, R., Dzemeshkevich, S., Podoksenov, A., Shipulin, V., Zotov, A., Lockowandt, U., Castellanos, E., Sádaba, R., Mosquera Rodriguez, V., Silva, J., Nistal, JF, Galiñanes Hernández, M., Porras, C., Llorens, R., Saenz Berbejillo, A., Prêtre, R., Carrel, T., Senay, S., Orhan Veli, D., Ruçhan, A., Bülent, K., Sener, E., Katrancioglu, N., Apaydin, AZ, Battaloğlu, B., Yilik, L., Özeren, M., Aykut Aka, S., Tuygun, AK, Ketenci, B., Dağsali, S., Kaplan, M., Akçevin, A., and Nashef, S.

Abstract

OBJECTIVES To conduct a survey across European cardiac centres to evaluate the methods used for cerebral protection during aortic surgery involving the aortic arch. METHODS All European centres were contacted and surgeons were requested to fill out a short, comprehensive questionnaire on an internet-based platform. One-third of more than 400 contacted centres completed the survey correctly. RESULTS The most preferred site for arterial cannulation is the subclavian-axillary, both in acute and chronic presentation. The femoral artery is still frequently used in the acute condition, while the ascending aorta is a frequent second choice in the case of chronic presentation. Bilateral antegrade brain perfusion is chosen by the majority of centres (2/3 of cases), while retrograde perfusion or circulatory arrest is very seldom used and almost exclusively in acute clinical presentation. The same pumping system of the cardio pulmonary bypass is most of the time used for selective cerebral perfusion, and the perfusate temperature is usually maintained between 22 and 26°C. One-third of the centres use lower temperatures. Perfusate flow and pressure are fairly consistent among centres in the range of 10-15 ml/kg and 60 mmHg, respectively. In 60% of cases, barbiturates are added for cerebral protection, while visceral perfusion still receives little attention. Regarding cerebral monitoring, there is a general tendency to use near-infrared spectroscopy associated with bilateral radial pressure measurement. CONCLUSIONS These data represent a snapshot of the strategies used for cerebral protection during major aortic surgery in current practice, and may serve as a reference for standardization and refinement of different approaches

Published
2017

9. The Italian study of the Mitroflow postoperative results (ISTHMUS): a 20-year, multicenter evaluation of Mitroflow pericardial bioprosthesis

Author

Isthmus, I, Lorusso, R, Gelsomino, S, De Cicco, G, Vizzardi, E, Faggiano, P, Carella, R, Billè, G, Teodori, G, Caimmi, P, Dato, G, Casabona, R, Welter, L, De Paulis, R, Calafiore, A, Di Mauro, M, Di Credico, G, Leva, C, Messina, A, Villa, E, Troise, G, Borghetti, V, Pardini, A, Medici, D, Sala, A, Citterio, E, Barbone, A, Vitali, E, Tarelli, G, Formica, F, Paolini, G, ISTHMUS Investigators, Dato, GA, Calafiore, AM, FORMICA, FRANCESCO, PAOLINI, GIOVANNI, Isthmus, I, Lorusso, R, Gelsomino, S, De Cicco, G, Vizzardi, E, Faggiano, P, Carella, R, Billè, G, Teodori, G, Caimmi, P, Dato, G, Casabona, R, Welter, L, De Paulis, R, Calafiore, A, Di Mauro, M, Di Credico, G, Leva, C, Messina, A, Villa, E, Troise, G, Borghetti, V, Pardini, A, Medici, D, Sala, A, Citterio, E, Barbone, A, Vitali, E, Tarelli, G, Formica, F, Paolini, G, ISTHMUS Investigators, Dato, GA, Calafiore, AM, FORMICA, FRANCESCO, and PAOLINI, GIOVANNI

Abstract

Objective: A multicentre experience with the Mitroflow pericardial bioprosthesis has been evaluated longitudinally over a 20-year period. Methods: From 1988 through 2008, 1591 patients (mean age, 75.3 ± 6.8 years, and 60.1% female) from 12 centres had a Mitroflow in the aortic position. Concomitant coronary artery bypass was performed in 41.9% (n = 666) of patients, urgency/emergency surgery in 9.5% (n = 152) and replacement of degenerated prosthesis in 2.3% (n = 36). Follow-up (7.447 patient-years) was 99.2% complete. Median follow-up was 61.9 months (interquartile range (IQR) 30.8-90.9 months). The study was carried out following American Association for Thoracic Surgery/Society for Thoracic Surgeons/European Association for Cardio-Thoracic Surgery (AATS/STS/EACTS) Guidelines for reporting valve morbidity and mortality. Results: The early (30-day) mortality was 6.5% (n = 104). Actuarial survival rates at 10, 15 and 18 years were 53%, 34% and 27%, respectively (2.2 patient/year). Re-operation was required in 96 patients (5.9%), of whom 59 patients (3.7%) for structural valve degeneration. Actuarial freedom from prosthetic valve degeneration at 18 years was 65.5% (78% in patients >70 years) with a linearised rate of 1.4 patient/year (0.8 patient/year in patients >70 years). At 18 years, freedom from embolism was 82% (0.9 patient/year), freedom from valve endocarditis was 89% (0.6 patient/year) and freedom from bleeding episodes was 95% (0.2 patient/year), respectively. Conclusions: This independent multicentre study indicates that the Mitroflow pericardial bioprosthesis provides favourable long-term postoperative results with a low rate of valve-related events and need of re-intervention, particularly in patients older than 70 years.

Published
2011

10. Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe†‡

Author

De Paulis, Ruggero, Czerny, Martin, Weltert, Luca, Bavaria, Joseph, Borger, Michael A., Carrel, Thierry P., Etz, Christain D., Grimm, Michael, Loubani, Mahmoud, Pacini, Davide, Resch, Timothy, Urbanski, Paul P., Weigang, Ernst, Grimm, M., Grabenwöger, M., Schepens, M., Maatouk, M., Van Ruyssevelt, P., Rodrigus, I., Van Nooten, G., Panayotov, P., Papantchev, V., Medved, I., Sutlic, Z., Ilkjaer, L., Skov Olsen, P., Hippelainen, M., Deleuze, P., Collart, F., Camilleri, L., Caus, T., Villemot, JP, Schmoeckel, M., Iversen, S., Matschke, K., Moritz, A., Fischlein, T., Hammel, D., Doll, KN, Warnecke, H., Reichenspurner, H., Beyesdorf, F., Boning, A., Liebold, A., Asfour, B., Mohr, W., Diegeler, A., Charitos, C., Khouri, M., Palatianos, G., Bairaktaris, A., Sivitanidis, E., Gregorini, R., Torracca, L., Cirio, EM, Mercogliano, D., Esposito, G., Cassese, M., Caparrotti, S., Mazzei, V., De Paulis, R., Mazzola, A., Menicanti, L., Tarelli, G., Glauber, M., Murzi, B., Antona, C., Casabona, R., Di Bartolomeo, R., Muneretto, C., Gherli, T., Lamarra, M., Stradiņš, P., Klautz, R., Grandjean, JG, Stooker, W., Bogers, JJ, Geiran, O., Hirnle, T., Rogowski, J., Brykczynski, M., Jemielity, M., Antunes, M., Tinica, G., Gaspar, M., Priktov, V., Maksimov, A., Belash, S., Boldyrev, S., Barbuchatti, K., Nikolishin, A., Abdulaev, M., Izhbuldin, R., Yunusov, V., Bikbulatov, R., Dzemeshkevich, S., Podoksenov, A., Shipulin, V., Zotov, A., Lockowandt, U., Castellanos, E., Sádaba, R., Mosquera Rodriguez, V., Silva, J., Nistal, JF, Galiñanes Hernández, M., Porras, C., Llorens, R., Saenz Berbejillo, A., Prêtre, R., Carrel, T., Senay, S., Orhan Veli, D., Ruçhan, A., Bülent, K., Sener, E., Katrancioglu, N., Apaydin, AZ, Battaloğlu, B., Yilik, L., Özeren, M., Aykut Aka, S., Tuygun, AK, Ketenci, B., Dağsali, S., Kaplan, M., Akçevin, A., Nashef, S., De Paulis, Ruggero, Czerny, Martin, Weltert, Luca, Bavaria, Joseph, Borger, Michael A., Carrel, Thierry P., Etz, Christain D., Grimm, Michael, Loubani, Mahmoud, Pacini, Davide, Resch, Timothy, Urbanski, Paul P., Weigang, Ernst, Grimm, M., Grabenwöger, M., Schepens, M., Maatouk, M., Van Ruyssevelt, P., Rodrigus, I., Van Nooten, G., Panayotov, P., Papantchev, V., Medved, I., Sutlic, Z., Ilkjaer, L., Skov Olsen, P., Hippelainen, M., Deleuze, P., Collart, F., Camilleri, L., Caus, T., Villemot, JP, Schmoeckel, M., Iversen, S., Matschke, K., Moritz, A., Fischlein, T., Hammel, D., Doll, KN, Warnecke, H., Reichenspurner, H., Beyesdorf, F., Boning, A., Liebold, A., Asfour, B., Mohr, W., Diegeler, A., Charitos, C., Khouri, M., Palatianos, G., Bairaktaris, A., Sivitanidis, E., Gregorini, R., Torracca, L., Cirio, EM, Mercogliano, D., Esposito, G., Cassese, M., Caparrotti, S., Mazzei, V., De Paulis, R., Mazzola, A., Menicanti, L., Tarelli, G., Glauber, M., Murzi, B., Antona, C., Casabona, R., Di Bartolomeo, R., Muneretto, C., Gherli, T., Lamarra, M., Stradiņš, P., Klautz, R., Grandjean, JG, Stooker, W., Bogers, JJ, Geiran, O., Hirnle, T., Rogowski, J., Brykczynski, M., Jemielity, M., Antunes, M., Tinica, G., Gaspar, M., Priktov, V., Maksimov, A., Belash, S., Boldyrev, S., Barbuchatti, K., Nikolishin, A., Abdulaev, M., Izhbuldin, R., Yunusov, V., Bikbulatov, R., Dzemeshkevich, S., Podoksenov, A., Shipulin, V., Zotov, A., Lockowandt, U., Castellanos, E., Sádaba, R., Mosquera Rodriguez, V., Silva, J., Nistal, JF, Galiñanes Hernández, M., Porras, C., Llorens, R., Saenz Berbejillo, A., Prêtre, R., Carrel, T., Senay, S., Orhan Veli, D., Ruçhan, A., Bülent, K., Sener, E., Katrancioglu, N., Apaydin, AZ, Battaloğlu, B., Yilik, L., Özeren, M., Aykut Aka, S., Tuygun, AK, Ketenci, B., Dağsali, S., Kaplan, M., Akçevin, A., and Nashef, S.

Abstract

OBJECTIVES To conduct a survey across European cardiac centres to evaluate the methods used for cerebral protection during aortic surgery involving the aortic arch. METHODS All European centres were contacted and surgeons were requested to fill out a short, comprehensive questionnaire on an internet-based platform. One-third of more than 400 contacted centres completed the survey correctly. RESULTS The most preferred site for arterial cannulation is the subclavian-axillary, both in acute and chronic presentation. The femoral artery is still frequently used in the acute condition, while the ascending aorta is a frequent second choice in the case of chronic presentation. Bilateral antegrade brain perfusion is chosen by the majority of centres (2/3 of cases), while retrograde perfusion or circulatory arrest is very seldom used and almost exclusively in acute clinical presentation. The same pumping system of the cardio pulmonary bypass is most of the time used for selective cerebral perfusion, and the perfusate temperature is usually maintained between 22 and 26°C. One-third of the centres use lower temperatures. Perfusate flow and pressure are fairly consistent among centres in the range of 10-15 ml/kg and 60 mmHg, respectively. In 60% of cases, barbiturates are added for cerebral protection, while visceral perfusion still receives little attention. Regarding cerebral monitoring, there is a general tendency to use near-infrared spectroscopy associated with bilateral radial pressure measurement. CONCLUSIONS These data represent a snapshot of the strategies used for cerebral protection during major aortic surgery in current practice, and may serve as a reference for standardization and refinement of different approaches

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