54 results on '"Mariscalco, Giovanni"'
Search Results
2. Single-Stage Off-Pump Hybrid Repair of Kommerell's Diverticulum with Right-Sided Aortic Arch Using a Surgeon-Customized Vascular Prosthesis
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Acharya, Metesh, Ahmed, Aamer, Deshpande, Aparna, Vainas, Tryfon, Hadjinikolaou, Leonidas, and Mariscalco, Giovanni
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thoracic endovascular aortic repair ,right aortic arch ,surgical procedures, operative ,cardiovascular system ,Case Report ,Kommerell's diverticulum ,Radiology, Nuclear Medicine and imaging ,Surgery ,Cardiology and Cardiovascular Medicine ,aortic aneurysm ,hybrid approach - Abstract
We report the successful single-stage hybrid management of Kommerell's diverticulum associated with a right-sided aortic arch in a 63-year-old woman. She underwent total aortic arch debranching utilizing a surgeon-customized vascular prosthesis, without cardiopulmonary bypass or deep hypothermic circulatory arrest, and concomitant zone-0 endovascular stent–graft deployment.
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- 2021
3. Effect of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement on All-Cause Mortality in Patients With Aortic Stenosis: A Randomized Clinical Trial
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Toff, William D., Hildick-Smith, David, Kovac, Jan, Mullen, Michael J., Wendler, Olaf, Mansouri, Anita, Rombach, Ines, Abrams, Keith R., Conroy, Simon P., Flather, Marcus D., Gray, Alastair M., MacCarthy, Philip, Monaghan, Mark J., Prendergast, Bernard, Ray, Simon, Young, Christopher P., Crossman, David C., Cleland, John G. F., de Belder, Mark A., Ludman, Peter F., Jones, Stephen, Densem, Cameron G., Tsui, Steven, Kuduvalli, Manoj, Mills, Joseph D., Banning, Adrian P., Sayeed, Rana, Hasan, Ragheb, Fraser, Douglas G. W., Trivedi, Uday, Davies, Simon W., Duncan, Alison, Curzen, Nick, Ohri, Sunil K., Malkin, Christopher J., Kaul, Pankaj, Muir, Douglas F., Owens, W. Andrew, Uren, Neal G., Pessotto, Renzo, Kennon, Simon, Awad, Wael I., Khogali, Saib S., Matuszewski, Maciej, Edwards, Richard J., Ramesh, Bandigowdanapalya C., Dalby, Miles, Raja, Shahzad G., Mariscalco, Giovanni, Lloyd, Clinton, Cox, Ian D., Redwood, Simon R., Gunning, Mark G., and Ridley, Paul D.
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Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Male ,Aortic Valve Insufficiency ,General Medicine ,Aortic Valve Stenosis ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Risk Factors ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Female ,Aged ,Original Investigation - Abstract
IMPORTANCE: Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear. OBJECTIVE: To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk. DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical trial conducted at 34 UK centers, 913 patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk due to age or comorbidity were enrolled between April 2014 and April 2018 and followed up through April 2019. INTERVENTIONS: TAVI using any valve with a CE mark (indicating conformity of the valve with all legal and safety requirements for sale throughout the European Economic Area) and any access route (n = 458) or surgical aortic valve replacement (surgery; n = 455). MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality at 1 year. The primary hypothesis was that TAVI was noninferior to surgery, with a noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI for the absolute between-group difference in mortality. There were 36 secondary outcomes (30 reported herein), including duration of hospital stay, major bleeding events, vascular complications, conduction disturbance requiring pacemaker implantation, and aortic regurgitation. RESULTS: Among 913 patients randomized (median age, 81 years [IQR, 78 to 84 years]; 424 [46%] were female; median Society of Thoracic Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%) completed follow-up and were included in the noninferiority analysis. At 1 year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%) in the surgery group, with an adjusted absolute risk difference of −2.0% (1-sided 97.5% CI, −∞ to 1.2%; P
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- 2022
4. Computational fluid dynamics of a novel perfusion strategy using direct perfusion of a left carotid-subclavian bypass during hybrid thoracic aortic repair
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Mariscalco, Giovanni, Fragomeni, Gionata, Tryfon, Vainas, Hadjinikolaou, Leonidas, Biancari, Fausto, Benedetto, Umberto, Salsano, Antonio, Gaudio, Lina, Biancari, Federica, Mastroroberto, Pasquale, and Serraino, Filiberto
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cerebral perfusion ,Bristol Heart Institute ,aorta and great vessels ,aortic repair ,cardiovascular pathology - Abstract
Objective: We aimed to computationally evaluate the effects of direct cerebral perfusion strategy through a left carotid-subclavian bypass on hemodynamics in a patient-specific thoracic aorta model. Methods: Between July 2016 and March 2019, eleven consecutive patients underwent single-stage frozen elephant trunk operation using the left carotid-subclavian bypass with a side graft anastomosis and a right axillary cannulation for systemic and brain perfusion. A multiscale model realized coupling 3D computational fluid dynamics was developed and validated with in vivo data. A model comparison with direct antegrade cannulation of all epiaortic vessels was performed. Wall shear stress, wall shear stress spatial gradient, and localized normalized helicity were selected as hemodynamic indicators. Four cerebral perfusion flows were tested (6 to 15 ml/kg/min). Results: Direct cerebral perfusion of the left-subclavian bypass resulted in higher flow rates with augmented speeds in all epiaortic vessels in comparison with traditional perfusion model. At the level of left vertebral artery, a speed of 22.5 vs 21 ml/min and mean velocity of 3.07 cm/s vs 2.93 cm/s were registered, respectively. With a cerebral perfusion flow of 15 ml/kg, lower left vertebral artery wall shear stress (1.596 vs 2.030 N/m2) and wall shear stress gradient (1445 vs 5882 N/m3) were observed. A less disturbed flow considering the localized normalized helicity was documented. Similar results persisted at different cerebral perfusion flows. No patients experienced neurological/spinal cord damages. Conclusions: The direct perfusion of a left-carotid bypass proved to be cerebroprotective, resulting in a more physiological and stable anterior and posterior cerebral perfusion.
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- 2020
5. Corrigendum to 'A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE'. [Int. J. Cardiol. 241 (Aug 15 2017) 97–102](S0167527317309877)(10.1016/j.ijcard.2017.03.148)
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Di Mauro, Michele, Dato, Guglielmo Mario Actis, Barili, Fabio, Gelsomino, Sandro, Santè, Pasquale, Corte, Alessandro Della, Carrozza, Antonio, Ratta, Ester Della, Cugola, Diego, Galletti, Lorenzo, Devotini, Roger, Casabona, Riccardo, Santini, Francesco, Salsano, Antonio, Scrofani, Roberto, Antona, Carlo, Botta, Luca, Russo, Claudio, Mancuso, Samuel, Rinaldi, Mauro, De Vincentiis, Carlo, Biondi, Andrea, Beghi, Cesare, Cappabianca, Giangiuseppe, Tarzia, Vincenzo, Gerosa, Gino, De Bonis, Michele, Pozzoli, Alberto, Nicolini, Francesco, Benassi, Filippo, Rosato, Francesco, Grasso, Elena, Livi, Ugolino, Sponga, Sandro, Pacini, Davide, Di Bartolomeo, Roberto, Demartino, Andrea, Bortolotti, Uberto, Onorati, Francesco, Faggian, Giuseppe, Lorusso, Roberto, Vizzardi, Enrico, Di Giammarco, Gabriele, Marinelli, Daniele, Villa, Emmanuel, Troise, Giovanni, Picichè, Marco, Musumeci, Francesco, Paparella, Domenico, Margari, Vito, Tritto, Francesco, Damiani, Girolamo, Scrascia, Giuseppe, Zaccaria, Salvatore, Renzulli, Attilio, Serraino, Giuseppe, Mariscalco, Giovanni, Maselli, Daniele, Foschi, Massimiliano, Parolari, Alessandro, Nappi, Giannantonio, Di Mauro, Michele, Dato, Guglielmo Mario Acti, Barili, Fabio, Gelsomino, Sandro, Santè, Pasquale, Corte, Alessandro Della, Carrozza, Antonio, Ratta, Ester Della, Cugola, Diego, Galletti, Lorenzo, Devotini, Roger, Casabona, Riccardo, Santini, Francesco, Salsano, Antonio, Scrofani, Roberto, Antona, Carlo, Botta, Luca, Russo, Claudio, Mancuso, Samuel, Rinaldi, Mauro, De Vincentiis, Carlo, Biondi, Andrea, Beghi, Cesare, Cappabianca, Giangiuseppe, Tarzia, Vincenzo, Gerosa, Gino, De Bonis, Michele, Pozzoli, Alberto, Nicolini, Francesco, Benassi, Filippo, Rosato, Francesco, Grasso, Elena, Livi, Ugolino, Sponga, Sandro, Pacini, Davide, Di Bartolomeo, Roberto, Demartino, Andrea, Bortolotti, Uberto, Onorati, Francesco, Faggian, Giuseppe, Lorusso, Roberto, Vizzardi, Enrico, Di Giammarco, Gabriele, Marinelli, Daniele, Villa, Emmanuel, Troise, Giovanni, Picichè, Marco, Musumeci, Francesco, Paparella, Domenico, Margari, Vito, Tritto, Francesco, Damiani, Girolamo, Scrascia, Giuseppe, Zaccaria, Salvatore, Renzulli, Attilio, Serraino, Giuseppe, Mariscalco, Giovanni, Maselli, Daniele, Foschi, Massimiliano, Parolari, Alessandro, and Nappi, Giannantonio
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Cardiology and Cardiovascular Medicine - Abstract
The authors regret that the first name and last name of the author Sandro Sponga was published incorrectly in the original version and this has now been corrected.
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- 2018
6. A 3D computational modeling of a novel cerebral perfusion strategy for complex surgery of the aortic arch
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Mariscalco, Giovanni, Serraino, Filiberto, Hadjinikolaou, Leonidas, Vainas, Tryfon, Salsano, Antonio, Biancari, Fausto, Mastroroberto, Pasquale, and Santini, Francesco.
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- 2019
7. Which are the best scores for prediction of severe bleeding after coronary artery bypass surgery?
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Salsano, Antonio, Antonio, Nenna, Raffaele, Barbato, Carmelo, Dominici, Olivieri, GUIDO MARIA, Sportelli, Elena, Natali, Roberto, Miette, Ambra, Soma, Federico, Mariscalco, Giovanni, Massimo, Chello, and Santini, Francesco
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- 2019
8. Prior Percutaneous Coronary Intervention and Mortality in Patients Undergoing Surgical Myocardial Revascularization
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Mariscalco, Giovanni, Rosato, Stefano, Serraino, Giuseppe F., Maselli, Daniele, Dalén, Magnus, Airaksinen, Juhani K. E., Reichart, Daniel, Zanobini, Marco, Onorati, Francesco, De Feo, Marisa, Gherli, Riccardo, Santarpino, Giuseppe, Rubino, Antonino S., Gatti, Giuseppe, Nicolini, Francesco, Santini, Francesco, Perrotti, Andrea, Bruno, Vito D., Ruggieri, Vito G., and Biancari, Fausto
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prior coronary intervention ,adult ,coronary artery bypass grafting ,Cardiology and Cardiovascular Medicine ,adult, coronary artery bypass grafting, mortality, prior coronary intervention, thoracic surgery, Cardiology and Cardiovascular Medicine ,mortality ,thoracic surgery - Published
- 2018
9. Corrigendum to 'A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE'. [Int. J. Cardiol. Aug 15 2017;241:97-102.]
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Di Mauro, Michele, Dato, Guglielmo Mario Actis, Barili, Fabio, Gelsomino, Sandro, Santè, Pasquale, Corte, Alessandro Della, Carrozza, Antonio, Ratta, Ester Della, Cugola, Diego, Galletti, Lorenzo, Devotini, Roger, Casabona, Riccardo, Santini, Francesco, Salsano, Antonio, Scrofani, Roberto, Antona, Carlo, Botta, Luca, Russo, Claudio, Mancuso, Samuel, Rinaldi, Mauro, De Vincentiis, Carlo, Biondi, Andrea, Beghi, Cesare, Cappabianca, Giangiuseppe, Tarzia, Vincenzo, Gerosa, Gino, De Bonis, Michele, Pozzoli, Alberto, Nicolini, Francesco, Benassi, Filippo, Rosato, Francesco, Grasso, Elena, Livi, Ugolino, Sponga, Sandro, Pacini, Davide, Di Bartolomeo, Roberto, Demartino, Andrea, Bortolotti, Uberto, Onorati, Francesco, Faggian, Giuseppe, Lorusso, Roberto, Vizzardi, Enrico, Di Giammarco, Gabriele, Marinelli, Daniele, Villa, Emmanuel, Troise, Giovanni, Picichè, Marco, Musumeci, Francesco, Paparella, Domenico, Margari, Vito, Tritto, Francesco, Damiani, Girolamo, Scrascia, Giuseppe, Zaccaria, Salvatore, Renzulli, Attilio, Serraino, Giuseppe, Mariscalco, Giovanni, Maselli, Daniele, Foschi, Massimiliano, Parolari, Alessandro, and Nappi, Giannantonio
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Cardiology and Cardiovascular Medicine - Published
- 2018
10. Subspecialisation in aortic surgery: The acute type A on call rota
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Mariscalco, Giovanni, Wozniak, M, and Murphy, Gj
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- 2018
11. Aortic Valve Replacement in Redo-Scenarios: A Comparison Between Traditional Aortic Valve Replacement (TAVR) and Transapical-TAVR from Two Real-World Multicenter Registries
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Onorati, Francesco, AUGUSTO D'ONOFRIO, Biancari, Fausto, Salizzoni, Stefano, Feo, Marisa, Agrifoglio, Marco, Mariscalco, Giovanni, Lucchetti, Vincenzo, Messina, Antonio, Musumeci, Francesco, Santarpino, Giuseppe, Esposito, Giampiero, Santini, Francesco, Magagna, Paolo, Beghi, Cesare, Aiello, Marco, Della Ratta, Ester, Savini, Carlo, Troise, Giovanni, Cassese, Mauro, Fischlein, Theodor, Glauber, Mattia, Passerone, Giancarlo, Punta, Giuseppe, Juvonen, Tatu, Alfieri, Ottavio, Gabbieri, Davide, Mangino, Domenico, Agostinelli, Andrea, Livi, Ugolino, Di Gregorio, Omar, Minati, Alessandro, Rinaldi, Mauro, Gino Gerosa, Faggian The Record Ita Investigators, Giuseppe, Onorati, Francesco, D'Onofrio, Augusto, Biancari, Fausto, Salizzoni, Stefano, DE FEO, Marisa, Agrifoglio, Marco, Mariscalco, Giovanni, Lucchetti, Vincenzo, Messina, Antonio, Musumeci, Francesco, Santarpino, Giuseppe, Esposito, Giampiero, Santini, Francesco, Magagna, Paolo, Beghi, Cesare, Aiello, Marco, Della Ratta, Ester, Savini, Carlo, Troise, Giovanni, Cassese, Mauro, Fischlein, Theodor, Glauber, Mattia, Passerone, Giancarlo, Punta, Giuseppe, Juvonen, Tatu, Alfieri, Ottavio, Gabbieri, Davide, Mangino, Domenico, Agostinelli, Andrea, Livi, Ugolino, Di Gregorio, Omar, Minati, Alessandro, Rinaldi, Mauro, Gerosa, Gino, and Faggian The Record Ita Investigators, Giuseppe
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cardiovascular system - Abstract
The study aim was to compare the outcome of transapical transcatheter aortic valve replacement (TaTAVR) and traditional aortic valve replacement (AVR) in redo from two real-world registries.The 30-day and follow up outcome of 462 patients enrolled in two multicenter redo registries, treated with redo-AVR (RAVR; n = 292 patients) or TaTAVR (n = 170 patients), were analyzed according to VARC-2 criteria, stratified also by propensity-matching analysis.TaTAVR-patients were older and sicker than RAVR patients, and reported a higher all-cause 30-day mortality (p0.01), a higher risk for all-cause mortality (p = 0.006) and cardiovascular mortality (p = 0.05) at follow up, but similar 30-day cardiovascular mortality (p = 0.12). Prolonged intubation (p0.01) and Acute Kidney Injury Network (AKIN) 2/3 p = 0.02) prevailed in RAVR. TaTAVR patients reported a higher level of major/life-threatening/disabling bleeding (p0.01) and 'early safety-events' (ES) (p = 0.04). Thirty-day acute myocardial infarction (AMI), stroke, and follow up freedom from acute heart failure (AHF), from stroke and from reinterventions were similar (p = NS). The NYHA class was better after RAVR (p0.01). The intermediate-to-high risk (Logistic EuroSCORE RAVR 17.1 ± 8.5; TaTAVR 16.0 ± 17.0) propensity-matched population demonstrated comparable 30-day and follow up all-cause and cardiovascular mortality, ES, AMI, stroke, prolonged intubation, follow up freedom from AHF, from stroke and from reinterventions and NYHA class. TaTAVR still reported lower levels of AKIN 2/3 (2.2% versus 15.6%, p = 0.03) and shorter hospitalization (9.5 ± 3.4 days versus 12.0 ± 7.0 days, p = 0.03).Outcome differences between RAVR and TaTAVR in redo-scenarios reflect methodological differences and different baseline risk profiles. Propensity-matched patients showed a better renal outcome after TaTAVR. *Drs. Onorati and D'Onofrio contributed equally to this article and should both be considered as first authors.
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- 2015
12. Endovascular Treatment of Degenerative Aneurysms Involving Only the Descending Thoracic Aorta : Systematic Review and Meta-analysis
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Biancari, Fausto, Mariscalco, Giovanni, Mariani, Silvia, Saari, Petri, Satta, Jari, Juvonen, Tatu, Clinicum, Department of Surgery, and III kirurgian klinikka
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reintervention ,stent-graft ,VASCULAR COMPLICATIONS ,descending aorta ,thoracic aortic aneurysm ,MULTICENTER ,NATURAL-HISTORY ,OPEN REPAIR ,3126 Surgery, anesthesiology, intensive care, radiology ,mortality ,stroke ,thoracic endovascular aortic repair ,paraplegia ,OPEN SURGERY ,aneurysm ,EXPERIENCE ,TRIAL - Abstract
Purpose: To determine the efficacy of thoracic endovascular aortic repair (TEVAR) for degenerative aneurysm involving only the descending thoracic aorta (DTAA). Methods: An English-language literature review was performed through PubMed, Scopus, and Google Scholar to identify any study evaluating the outcomes of TEVAR for DTAA. The main endpoints of this analysis were all-cause 30-day and late postoperative mortality. Secondary outcome measures were procedure success, vascular access complications, paraplegia, stroke, early endoleaks during the index hospitalization, aneurysm-related death, reinterventions, and conversion to open repair. To control for the anticipated heterogeneity among small observational studies, absolute values and means were pooled using random effects models; the results are expressed as pooled proportions, means, or risk ratio (RR) with 95% confidence intervals (CIs). Results: Eleven studies reporting on 673 patients (mean age 72.6 years, mean aneurysm diameter 62.9 cm) with DTAA were selected for the analysis. Technical success was reported in 91.0% of patients, and vascular access complications requiring repair were encountered in 9.7% of cases. Pooled overall 30-day, 1-year, 2-year, and 3-year survival rates were 96.0%, 80.3%, 77.3%, and 74.0%, respectively. Five studies compared the results of TEVAR after elective (n=151) and urgent/emergent procedure (n=77); the latter was a predictor of 30-day mortality (17.1% vs 1.8%, RR 3.83, 95% CI 1.18 to 12.40, p=0.025). Paraplegia occurred in 3.2% of patients and was permanent in 1.4% of patients. The stroke rate was 2.7%. Early type I endoleak was observed in 7.3%, type II endoleak in 2.0%, and type III in 1.2% of patients. The mean follow-up of 9 studies was 22.3 months. At 3 years, freedom from reintervention was 90.3%. Death secondary to aneurysm rupture and/or fistula was reported in 3.2% of patients. Conclusion: Current results indicate that TEVAR for DTAA can be performed with rather high technical success, low postoperative morbidity, and good 3-year survival.
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- 2016
13. Outcome of Jehovah's Witnesses after adult cardiac surgery: systematic review and meta-analysis of comparative studies
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Vasques, Francesco, Kinnunen, Eeva-Maija, Pol, Marek, Mariscalco, Giovanni, Onorati, Francesco, and Biancari, Fausto
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Treatment Refusal ,Postoperative Complications ,Treatment Outcome ,Cardiac Surgical Procedures ,Humans ,Religion and Medicine ,Jehovah's Witnesses - Abstract
The objective was to evaluate the early outcome after adult cardiac surgery in Jehovah's Witnesses (JWs) compared with controls not refusing blood transfusions.A literature review was performed through PubMed, Scopus, and Google Scholar to identify any comparative study evaluating the outcome of JWs and patients not refusing blood transfusion after adult cardiac surgery.Six studies comparing the outcome of 564 JWs and 903 controls fulfilled the inclusion criteria of this study. All series included a matched control cohort. Baseline characteristics of these two cohorts were similar, but JWs had higher hemoglobin (Hb) levels as reported in three studies. Pooled analysis of postoperative outcomes showed that JWs had higher postoperative levels of Hb (data from four studies: mean, 11.5 g/L vs. 9.8 g/L; p 0.001) and significantly less postoperative blood loss (mean, 402 mL vs. 826 mL; p 0.001) compared to controls. JWs and controls had similar early outcome. However, JWs had a nonsignificant trend toward decreased early mortality (2.6% vs. 3.6%; p = 0.318), reoperation for bleeding (3.2% vs. 4.7%; p = 0.070), atrial fibrillation (9.9% vs. 14.3%; p = 0.056), stroke (2.2% vs. 3.1%; p = 0.439), myocardial infarction (0.4% vs. 1.4%; p = 0.203), and length of stay in the intensive care unit (1.5 days vs. 2.0 days; p = 0.081).JWs undergoing adult cardiac surgery have a nonsignificant trend toward better early outcome than controls receiving or not blood transfusions. The suboptimal quality of available studies prevents conclusive results on the possible benefits of a transfusion-free strategy in patients not refusing blood transfusion.
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- 2016
14. First-time, isolated surgical aortic valve replacement after prior coronary artery bypass surgery: results from the RECORD multicenter registry
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Biancari, Fausto, Onorati, Francesco, Mariscalco, Giovanni, De Feo, Marisa, Messina, Antonio, Santarpino, Giuseppe, Santini, Francesco, Beghi, Cesare, Della Ratta, Ester, Troise, Giovanni, Fischlein, Theodor, Passerone, Giancarlo, Juvonen, Tatu, Mazzucco, Alessandro, Heikkinen, Jouni, Faggian, Giuseppe, Biancari, F, Onorati, F, Mariscalco, G, DE FEO, Marisa, Messina, Antonietta, Santarpino, G, Santini, F, Beghi, C, Della Ratta, E, Troise, G, Fischlein, T, Passerone, G, Juvonen, T, Mazzucco, A, Heikkinen, J, and Faggian, G.
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Male ,Time Factors ,Hypothermia ,Aged, Aged 80 and over, Aortic Valve, Constriction, Female, Heart Arrest Induced, Humans, Hypothermia Induced, Male, Mammary Arteries, Middle Aged, Sternotomy, Survival Rate, Time Factors, Treatment Outcome, Coronary Artery Bypass, Heart Valve Prosthesis Implantation, Registries ,Hypothermia, Induced ,80 and over ,Humans ,Registries ,Coronary Artery Bypass ,Mammary Arteries ,Aged ,Aged, 80 and over ,Aortic Valve ,Constriction ,Female ,Heart Arrest, Induced ,Middle Aged ,Sternotomy ,Survival Rate ,Treatment Outcome ,Heart Valve Prosthesis Implantation ,Cardiology and Cardiovascular Medicine ,Surgery ,Medicine (all) ,Induced ,Heart Arrest ,Aged 80 and over ,Heart Arrest Induced ,Hypothermia Induced - Abstract
This multicenter study was undertaken to determine the immediate and long-term outcomes in patients undergoing a primary surgical aortic valve replacement (AVR) who had a previous coronary artery bypass graft surgery with patent grafts.One hundred and thirteen consecutive patients (mean EuroSCORE II, 10.3 ± 7.7%, median 8.0%) who underwent first-time isolated AVR after coronary artery bypass grafting (CABG) were the subjects of this multicenter study. The procedure was performed through a full sternotomy in 95.7% of cases, a patent internal mammary artery graft was clamped in 76.6% of patients. The temperature of cardioplegia was ≤12 °C in 62.8% of patients and systemic temperature was32 °C in 23.9% of patients.Thirty-day mortality was 4.4%. Stroke was observed in 8.0% of patients, low cardiac output syndrome in 14.1%, prolonged tracheal intubation in 20.8%, and intensive care unit stay was longer than five days in 19.5% of patients. Among patients with a patent internal mammary graft (91 patients), clamping of this graft (5.7% vs. 0%, p = 0.57) was associated with a nonsignificant trend toward increased 30-day mortality. One-, three- and five-year survival rates were 91.5%, 90.4%, and 88.4%, respectively.Patients undergoing isolated AVR after prior CABG have a good immediate and late survival. A history of prior CABG should not be considered an absolute indication for transcatheter AVR.
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- 2014
15. Aneurismi dell’aorta toracica e dissecazioni aortiche
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Piffaretti, Gabriele, Mariscalco, Giovanni, Lomazzi, Chiara, and Riva, Francesca
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- 2011
16. Angiotensin converting-enzyme inhibitors and candesartan have no effects on atrial fibrillation after cardiac surgery Comment on: Mehmet Ozaydin et al. 'Effect of renin-angiotensin aldosteron system blockers on postoperative atrial fibrillation'
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Mariscalco, Giovanni, Dominici, Carmelo, Banach, Maciej, and Sala, Andrea
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Renin-Angiotensin System ,Angiotensin II Type 1 Receptor Blockers ,Angiotensin-Converting Enzyme Inhibitors ,Atrial Fibrillation ,Benzimidazoles ,Cardiac Surgical Procedures ,Humans ,Mineralocorticoid Receptor Antagonists ,Postoperative Complications ,Prospective Studies ,Tetrazoles - Published
- 2010
17. Il reintervento è ancora il tallone d’Achille della metodica?
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Castelli, Patrizio, Piffaretti, Gabriele, Tozzi, Matteo, Rivolta, Nicola, Riva, Francesca, Maida, S, Buscarini, E, Ferrario, M, and Mariscalco, Giovanni
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- 2010
18. Letter by Banach et al regarding article, 'postoperative treatment with carvedilol, a beta-adrenergic blocker, prevents paroxysmal atrial fibrillation after coronary artery bypass grafting'
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Banach, Maciej, Mariscalco, Giovanni, Ugurlucan, Murat, and Rysz, Jacek
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Postoperative Care ,Propanolamines ,Adrenergic beta-Antagonists ,Atrial Fibrillation ,Carbazoles ,Coronary Artery Bypass ,Coronary Stenosis ,Humans ,Research Design ,Treatment Outcome - Published
- 2008
19. Atrial fibrillation after cardiac surgery. An analysis of risk factors, mechanisms, and survival effects
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Mariscalco, Giovanni
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- 2008
20. Atrial fibrillation after cardiac surgery : an analysis of risk factors, mechanisms, and survival effects
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Mariscalco, Giovanni
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histology ,adult ,Kirurgi ,coronary artery bypass grafting ,atrial fibrillation ,Surgery ,cardiopulmonary bypass ,catecholamines ,embolism ,cardiac surgery ,valvular surgery ,mortalilty - Abstract
Background: Despite the recent improvements in surgical techniques and postoperative patient care, atrial fibrillation (AF) remains the most frequent complication after cardiac surgery. Although postoperative AF is often regarded as a benign clinical condition, this arrhythmia has significant adverse effects on patient recovery and postoperative survival. Its exact pathophysiology has not yet been elucidated. The present thesis aims to analyze AF risk factors and their interaction, pre-existing histological explanatory alterations of the atrium, the AF impact on postoperative survival and the compliance of a prophylactic drug regimen. Methods: During a 10-year period, consecutive cardiac surgery cases with complete data on AF occurrence and postoperative survival were extracted. All patients were operated on for coronary or valvular surgery, with cardiopulmonary bypass (CPB). Hospital and long-term survival data were obtained from Swedish population registry. Study I) Isolated coronary artery bypass grafting (CABG, n=7056), aortic valve replacement (n=690) and their combination (n=688) were considered. Independent AF risk factors and AF effects on early and 1 year mortality were investigated. Study II) Patients affected by postoperative AF among isolated CABG patients (n=7621), valvular surgeries (n=995) and their combination (n=879) were studied. Long-term survival was obtained and prognostic factors identified. Study III) Seventy patients were randomized to on-pump (n=35) or off-pump (n=35) CABG. Samples from the right atrial appendage were collected and histology was evaluated by means of light and electronic microscopy with reference to preexistent alterations related to postoperative AF. Study IV) Cardiac surgery patients with complete data on smoking status (n=3245) were reviewed. Effects of smoking on AF development and interaction among variables were explored. Study V) CABG patients without clinical contraindications to receive oral sotalol (80 mg twice daily) and magnesium were prospectively enrolled (n = 49) and compared with a matched contemporary control CABG group (n = 844). The clinical compliance to the AF prophylactic drug regimen was tested. Results: The overall AF incidence was around 26%, subdivided into 23%, 40% and 45% for isolated CABG, valve procedures and their combined surgeries, respectively. Age was the strongest predictor of postoperative AF. Coronary disease superimposed risk factors with reference to myocardial conditions at CPB weaning. Considering the preoperative smoking condition, smokers demonstrated a reduced AF incidence compared to non-smokers (20% versus 27%, p
- Published
- 2008
21. [Left ventricular thrombus in a patient with antiphospholipid antibody syndrome and hyperhomocysteinemia]
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Cattaneo, Paolo, Mariscalco, Giovanni, Blanzola, Claudio, Chelazzi, Paolo, Faeli, Mehran, and Sala, Andrea
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Adult ,Male ,Heart Diseases ,Echocardiography ,Antiphospholipid Syndrome ,Echocardiography, Transesophageal ,Humans ,Hyperhomocysteinemia ,Thrombosis ,Transesophageal - Abstract
This report describes the case of a 39-year-old man, admitted for the occasional finding of left ventricular, irregular and pedicled mass. Because of the elevated risk of thromboembolism, cardiac surgery was performed with complete removal of the mass. Histologic examination showed it to be composed entirely of thrombotic material. Additional laboratory data revealed the simultaneous presence of two thrombophilic disorders: antiphospholipid syndrome and hyperhomocysteinemia. Screening laboratory evaluation for hypercoagulable states is recommended in similar cases.
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- 2003
22. Aortic valve papillary fibroelastoma: A rare cause of angina
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Bruno, Vito D., Mariscalco, Giovanni, Stefano De Vita, Piffaretti, Gabriele, Nassiacos, Daniele, and Sala, Andrea
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Heart Neoplasms ,Treatment Outcome ,Aortic Valve ,Humans ,Female ,Fibroma ,Cardiac Surgical Procedures ,Echocardiography, Transesophageal ,Images in Cardiovascular Medicine ,Aged ,Angina Pectoris - Abstract
WEB SITE FEATURE
23. Late Myocardial Infarction and Repeat Revascularization after Coronary Artery Bypass Grafting in Patients with Prior Percutaneous Coronary Intervention
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Fausto Biancari, Antonio Salsano, Francesco Santini, Marisa De Feo, Magnus Dalén, Qiyao Zhang, Giuseppe Gatti, Enzo Mazzaro, Ilaria Franzese, Ciro Bancone, Marco Zanobini, Tuomas Tauriainen, Timo Mäkikallio, Matteo Saccocci, Alessandra Francica, Stefano Rosato, Zein El-Dean, Francesco Onorati, Giovanni Mariscalco, Biancari, Fausto, Salsano, Antonio, Santini, Francesco, De Feo, Marisa, Dalén, Magnu, Zhang, Qiyao, Gatti, Giuseppe, Mazzaro, Enzo, Franzese, Ilaria, Bancone, Ciro, Zanobini, Marco, Tauriainen, Tuoma, Mäkikallio, Timo, Saccocci, Matteo, Francica, Alessandra, Rosato, Stefano, El-Dean, Zein, Onorati, Francesco, and Mariscalco, Giovanni
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myocardial infarction ,repeat revascularization ,coronary artery bypass grafting ,percutaneous coronary intervention ,prior PCI ,previous PCI ,General Medicine - Abstract
Objectives: The aim of the present study was to evaluate the risk of late mortality and major adverse cardiovascular and cerebral events after coronary artery bypass grafting (CABG) in patients with prior percutaneous coronary intervention (PCI). Methods: A total of 2948 patients undergoing isolated CABGs were included in a prospective multicenter registry. Outcomes were adjusted for multiple covariates in logistic regression, Cox proportional hazards analysis and competing risk analysis. Results: In all, 2619 patients fulfilled the inclusion criteria of this analysis. Of them, 2199 (79.1%) had no history of PCI and 420 (20.9%) had a prior PCI. An adjusted analysis showed that a single prior PCI and multiple prior PCIs did not increase the risk of 30-day and 5-year mortality. Patients with multiple prior PCIs had a significantly higher risk of 5-year myocardial infarction (SHR 2.566, 95%CI 1.379–4.312) and repeat revascularization (SHR 1.774, 95%CI 1.140–2.763). Similarly, 30-day and 5-year mortality were not significantly increased in patients with prior PCI treatment of single or multiple vessels. Patients with multiple vessels treated with PCI had a significantly higher risk of 5-year myocardial infarction (SHR 2.640, 95%CI 1.497–4.658), repeat revascularization (SHR 1.648, 95%CI 1.029–2.638) and stroke (SHR 2.215, 95%CI 1.056–4.646) at 5-year. The risk for repeat revascularization was also increased with a prior single vessel PCI, but not for other outcomes. Conclusions: Among patients undergoing CABGs, multiple prior PCIs seem to increase the risk of late myocardial infarction and the need for repeat revascularization, but not the risk of mortality.
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- 2022
24. Failure to achieve a satisfactory cardiac outcome after isolated coronary surgery in low-risk patients
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Till Demal, Francesco Onorati, Daniele Maselli, Magnus Dalén, Andrea Perrotti, Theodor Fischlein, Giuseppe Gatti, Giuseppe Faggian, Tatu Juvonen, Giovanni Mariscalco, Karl Bounader, Francesco Musumeci, Antonino S. Rubino, Giuseppe Santarpino, Tuomas Tauriainen, Carmelo Mignosa, Francesco Nicolini, Sidney Chocron, Francesco Santini, Ciro Bancone, Antonio Salsano, Marco Zanobini, Vito G. Ruggieri, Fausto Biancari, Matteo Saccocci, Marisa De Feo, Biancari, Fausto, Mariscalco, Giovanni, Juvonen, Tatu, Mignosa, Carmelo, Ruggieri, Vito G, Gatti, Giuseppe, Bounader, Karl, Saccocci, Matteo, Zanobini, Marco, Salsano, Antonio, Santini, Francesco, Musumeci, Francesco, Maselli, Daniele, Fischlein, Theodor, Santarpino, Giuseppe, Dalén, Magnu, Chocron, Sidney, Perrotti, Andrea, Bancone, Ciro, Faggian, Giuseppe, Onorati, Francesco, De Feo, Marisa, Demal, Till, Tauriainen, Tuoma, Nicolini, Francesco, and Rubino, Antonino S
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Coronary artery bypass grafting ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,Coronary artery bypass surgery ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Registries ,Coronary Artery Bypass ,Adverse effect ,Aged ,Low risk ,business.industry ,Incidence ,Incidence (epidemiology) ,EuroSCORE ,Odds ratio ,Middle Aged ,medicine.disease ,Comorbidity ,3. Good health ,Cardiac surgery ,Europe ,Survival Rate ,Clinical trial ,Treatment Outcome ,030228 respiratory system ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES This study aims to investigate the incidence and determinants of major early adverse events in low-risk patients undergoing isolated coronary artery bypass grafting (CABG). METHODS The multicentre E-CABG registry included 7352 consecutive patients who underwent isolated CABG from January 2015 to December 2016. Patients with an European System for Cardiac Operative Risk Evaluation (EuroSCORE) II of RESULTS Out of 2397 low-risk patients, 11 (0.46%) died during the index hospitalization or within 30 days from surgery. Five deaths were cardiac related, 4 of which were secondary to technical failures. We estimated that 8 out of 11 deaths were potentially preventable. Logistic regression model identified porcelain aorta [odds ratio (OR) 34.3, 95% confidence interval (CI) 1.3–346.3] and E-CABG bleeding grades 2–3 (OR 30.2, 95% CI 8.3–112.9) as independent predictors of hospital death. CONCLUSIONS Mortality and major complications, although infrequently, do occur even in low-risk patients undergoing CABG. Identification of modifiable causes of postoperative adverse events may be useful to develop preventative strategies to improve the quality of care of patients undergoing cardiac surgery. Clinical Trial Registration NCT02319083 (https://clinicaltrials.gov/ct2/show/NCT02319083).
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- 2020
25. Similar outcome of tricuspid valve repair and replacement for isolated tricuspid infective endocarditis
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Michele Di Mauro, Giorgia Bonalumi, Ilaria Giambuzzi, Guglielmo Mario Actis Dato, Paolo Centofanti, Alessandro Della Corte, Ester Della Ratta, Diego Cugola, Maurizio Merlo, Francesco Santini, Antonio Salsano, Mauro Rinaldi, Samuel Mancuso, Giangiuseppe Cappabianca, Cesare Beghi, Carlo De Vincentiis, Andrea Biondi, Ugolino Livi, Sandro Sponga, Davide Pacini, Giacomo Murana, Roberto Scrofani, Carlo Antona, Giovanni Cagnoni, Francesco Nicolini, Filippo Benassi, Michele De Bonis, Alberto Pozzoli, Marco Pano, Salvatore Nicolardi, Giosuè Falcetta, Andrea Colli, Francesco Musumeci, Riccardo Gherli, Enrico Vizzardi, Loris Salvador, Marco Picichè, Domenico Paparella, Vito Margari, Giovanni Troise, Emmanuel Villa, Yudit Dossena, Carla Lucarelli, Francesco Onorati, Giuseppe Faggian, Giovanni Mariscalco, Daniele Maselli, Fabio Barili, Alessandro Parolari, Roberto Lorusso, CTC, RS: Carim - V04 Surgical intervention, MUMC+: MA Med Staf Spec CTC (9), Di Mauro, Michele, Bonalumi, Giorgia, Giambuzzi, Ilaria, Dato, Guglielmo Mario Acti, Centofanti, Paolo, Corte, Alessandro Della, Ratta, Ester Della, Cugola, Diego, Merlo, Maurizio, Santini, Francesco, Salsano, Antonio, Rinaldi, Mauro, Mancuso, Samuel, Cappabianca, Giangiuseppe, Beghi, Cesare, De Vincentiis, Carlo, Biondi, Andrea, Livi, Ugolino, Sponga, Sandro, Pacini, Davide, Murana, Giacomo, Scrofani, Roberto, Antona, Carlo, Cagnoni, Giovanni, Nicolini, Francesco, Benassi, Filippo, De Bonis, Michele, Pozzoli, Alberto, Pano, Marco, Nicolardi, Salvatore, Falcetta, Giosuè, Colli, Andrea, Musumeci, Francesco, Gherli, Riccardo, Vizzardi, Enrico, Salvador, Lori, Picichè, Marco, Paparella, Domenico, Margari, Vito, Troise, Giovanni, Villa, Emmanuel, Dossena, Yudit, Lucarelli, Carla, Onorati, Francesco, Faggian, Giuseppe, Mariscalco, Giovanni, Maselli, Daniele, Barili, Fabio, Parolari, Alessandro, and Lorusso, Roberto
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MECHANICAL PROSTHESES ,SURGERY ,endocarditis ,tricuspid valve ,tricuspid valve repair ,tricuspid valve replacement ,tricuspid valve, tricuspid repair, tricuspid replacement, endocarditis ,endocarditi ,Tricuspid Valve/diagnostic imaging ,MANAGEMENT ,Humans ,tricuspid replacement ,Cardiac Surgical Procedures ,METAANALYSIS ,Endocarditis, Bacterial/surgery ,Endocarditis ,HEART-VALVE ,MORTALITY ,Endocarditis/surgery ,Bacterial ,Endocarditis, Bacterial ,General Medicine ,Treatment Outcome ,Tricuspid Valve ,Cardiac Surgical Procedures/adverse effects ,tricuspid repair ,Bacterial/surgery ,Cardiology and Cardiovascular Medicine - Abstract
AIMS: To compare early and late mortality of acute isolated tricuspid valve infective endocarditis (TVIE) treated with valve repair or replacement.METHODS: Patients who were surgically treated for TVIE from 1983 to 2018 were retrieved from the Italian Registry for Surgical Treatment of Valve and Prosthesis Infective Endocarditis. All the patients were followed up by means of phone interview or calling patient referral physicians or cardiologists. Kaplan-Meier method was used to assess late survival and survival free from TVIE recurrence with log-rank test for univariate comparison. The primary end points were early mortality (30 days after surgery) and long-term survival free from TVIE recurrence.RESULTS: A total of 4084 patients were included in the registry. Among them, 149 patients were included in the study. Overall, 77 (51.7%) underwent TV repair and 72 (48.3%) TV replacement. Early mortality was 9% (13 patients). Expected early mortality according to EndoSCORE was 12%. The TV repair showed lower mortality and major complication rate (7% and 16%), compared with TV replacement (11% and 25%), but statistical significance was not reached. Median follow-up was 19.1 years (14.3-23.8). Late deaths were 30 and IE recurrences were 5. No difference in cardiac survival free from IE was found between the two groups after 20 years (80 ± 6% Repair Group vs 59 ± 13% Replacement Group, P = 0.3).CONCLUSIONS: Overall results indicate that once surgically addressed, TVIE has a low recurrence rate and excellent survival, apparently regardless of the type of surgery used to treat it.
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- 2022
26. Prognostic impact of hemoglobin concentration at one to three months after coronary surgery
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Fausto, Biancari, Tuomas, Tauriainen, Qiyao, Zhang, Giuseppe, Gatti, Francesco, Santini, Marisa, De Feo, Marco, Zanobini, Timo, Mäkikallio, Francesco, Onorati, Stefano, Rosato, Paola, D'Errigo, Giovanni, Mariscalco, Magnus, Dalén, Biancari, Fausto, Tauriainen, Tuoma, Zhang, Qiyao, Gatti, Giuseppe, Santini, Francesco, De Feo, Marisa, Zanobini, Marco, Mäkikallio, Timo, Onorati, Francesco, Rosato, Stefano, D'Errigo, Paola, Mariscalco, Giovanni, and Dalén, Magnus
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cabg, hemoglobin, infection ,hemoglobin ,cabg ,infection - Published
- 2022
27. Neurological Complications in High-Risk Patients Undergoing Coronary Artery Bypass Surgery
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Björn Sill, Daniele Maselli, Till Demal, Magnus Dalén, Marco Zanobini, Andrea Perrotti, Marisa De Feo, Karl Bounader, Fausto Biancari, Timo Mäkikallio, Hermann Reichenspurner, Francesco Onorati, Giovanni Mariscalco, Giuseppe Gatti, Antonino S. Rubino, Vito G. Ruggieri, Francesco Santini, Tatu Juvonen, Francesco Musumeci, Shiho Naito, Giuseppe Santarpino, Francesco Nicolini, Giuseppe Faggian, Naito, Shiho, J Demal, Till, Sill, Björn, Reichenspurner, Hermann, Onorati, Francesco, Gatti, Giuseppe, Mariscalco, Giovanni, Faggian, Giuseppe, Santini, Francesco, Santarpino, Giuseppe, Zanobini, Marco, Musumeci, Francesco, Rubino, Antonino Salvatore, DE FEO, Marisa, Nicolini, Francesco, Dalén, Magnu, Maselli, Daniele, Bounader, Karl, Mäkikallio, Timo, Juvonen, Tatu, G Ruggieri, Vito, Perrotti, Andrea, and Biancari, Fausto
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,complications ,medicine.medical_treatment ,Revascularization ,law.invention ,cabg, stroke, complications ,Coronary artery bypass surgery ,Postoperative Complications ,Risk Factors ,law ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Cardiopulmonary bypass ,Humans ,cardiovascular diseases ,Coronary Artery Bypass ,Stroke ,Intra-aortic balloon pump ,business.industry ,Percutaneous coronary intervention ,medicine.disease ,cabg ,stroke ,3. Good health ,Stenosis ,Treatment Outcome ,Ischemic Attack, Transient ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Coronary artery bypass grafting (CABG) without cardiopulmonary bypass and minimal or no aortic manipulation may be associated with a lower risk of neurological complications. We investigated this issue in patients with a high risk of perioperative stroke. Methods: Data on 7352 patients who underwent isolated CABG from January 2015 to May 2017 were included in the multicenter study E-CABG (European Coronary Artery Bypass Grafting) registry. Of these, 684 patients had an increased risk of neurological complications, ie, previous stroke or transient ischemic attack, severe carotid artery stenosis or occlusion, or previous carotid artery intervention. In this subgroup, we analyzed the rates of the combined primary endpoint comprising any postoperative stroke or transient ischemic attack. A comparative analysis between CABG with and without aortic cross-clamping was performed. Results: The primary endpoint was more often reached when aortic cross-clamping was used (propensity score matching, without vs with aortic cross-clamp: 0.9% vs 7.2%; P = .016). In comparison with all other revascularization techniques, off-pump CABG with avoidance of aortic manipulation was associated with the lowest rate of neurological complications (0.7%). Conclusions: In patients with increased risk of perioperative stroke, aortic manipulation including the use of cardiopulmonary bypass or partial clamping for central anastomoses is associated with higher rates of postoperative neurological complications. These patients may benefit from off-pump surgery without aortic manipulation if complete revascularization can be ensured.
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- 2022
28. Impact of Surgeon Experience and Centre Volume on Outcome After Off-Pump Coronary Artery Bypass Surgery: Results from the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) Registry
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Shiho Naito, Till J. Demal, Björn Sill, Hermann Reichenspurner, Francesco Onorati, Giuseppe Gatti, Giovanni Mariscalco, Giuseppe Faggian, Antonio Salsano, Francesco Santini, Giuseppe Santarpino, Marco Zanobini, Francesco Musumeci, Antonino S. Rubino, Ciro Bancone, Marisa De Feo, Francesco Nicolini, Magnus Dalén, Giuseppe Speziale, Karl Bounader, Timo Mäkikallio, Tuomas Tauriainen, Vito G. Ruggieri, Andrea Perrotti, Fausto Biancari, Naito, Shiho, Demal, Till J, Sill, Björn, Reichenspurner, Hermann, Onorati, Francesco, Gatti, Giuseppe, Mariscalco, Giovanni, Faggian, Giuseppe, Salsano, Antonio, Santini, Francesco, Santarpino, Giuseppe, Zanobini, Marco, Musumeci, Francesco, Rubino, Antonino S, Bancone, Ciro, De Feo, Marisa, Nicolini, Francesco, Dalén, Magnu, Speziale, Giuseppe, Bounader, Karl, Mäkikallio, Timo, Tauriainen, Tuoma, Ruggieri, Vito G, Perrotti, Andrea, and Biancari, Fausto
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Pulmonary and Respiratory Medicine ,Surgeon volume ,Off-pump coronary bypa ,Centre volume ,Cardiology and Cardiovascular Medicine ,Off-pump coronary bypass ,Individual surgeon - Abstract
Aim: The aim of this study was to assess the impact of surgeon experience and centre volume on early operative outcomes in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. Method: Of 7,352 patients in the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry, 1,549 underwent OPCAB and were included in the present analysis. Using adjusted regression analysis, we compared major early adverse events after procedures performed by experienced OPCAB surgeons (i.e., ≥20 cases per year; n=1,201) to those performed by non-OPCAB surgeons (n=348). Furthermore, the same end points were compared between procedures performed by OPCAB surgeons in high OPCAB volume centres (off-pump technique used in >50% of cases; n=894) and low OPCAB volume centres (n=307). Results: In the experienced OPCAB surgeon group, we observed shorter procedure times (β -43.858, 95% confidence interval [CI] -53.322 to -34.393; p
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- 2022
29. Massive Acute Spinal Subdural Hematoma Causing Sudden Onset Paraplegia in a Patient on Anticoagulation
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Martin H. Pham, Jacob Kosarchuk, Courtney S. Lewis, and Mariscalco, Giovanni
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musculoskeletal diseases ,medicine.medical_specialty ,RD1-811 ,Decompression ,Umbilicus (mollusc) ,Spinal Subdural Hematoma ,Case Report ,Neurodegenerative ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,medicine ,Back pain ,Pharmacology (medical) ,030212 general & internal medicine ,business.industry ,Neurosciences ,Cauda equina ,Hematology ,medicine.disease ,Surgery ,body regions ,medicine.anatomical_structure ,medicine.symptom ,Paraplegia ,business ,030217 neurology & neurosurgery ,Sudden onset - Abstract
Spinal subdural hematoma (SSDH) is a rare but known entity that can cause severe and irreversible motor, sensory, and autonomic dysfunction if not decompressed in a timely manner. We present here a 74-year-old female on anticoagulation who developed sudden onset back pain with rapidly progressive paraplegia. On neurologic exam, she was completely flaccid in the bilateral lower extremities with absent sensation from the umbilicus down. Imaging demonstrated a massive extra-axial spinal hematoma from T12 to S1 that initially was believed to be epidural in origin. She was taken emergently to the operating room for a T11-L5 decompressive laminectomy, and dural opening demonstrated a thick subdural clot encasing the conus and cauda equina confirming the subdural pathology. Despite decompression and partial evacuation of the subdural hematoma, she did not recover neurologic function.
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- 2020
30. Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting
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Marco Zanobini, Riccardo Gherli, Fausto Biancari, Marisa De Feo, Saverio Nardella, Tuomas Tauriainen, Giovanni Mariscalco, Andrea Perrotti, Francesco Onorati, Ciro Bancone, Antonino S. Rubino, Vito G. Ruggieri, Francesco Santini, Giuseppe Santarpino, Francesco Nicolini, Till Demal, Magnus Dalén, Giuseppe Gatti, Biancari, Fausto, Santini, Francesco, Tauriainen, Tuoma, Bancone, Ciro, Ruggieri, Vito G, Perrotti, Andrea, Gherli, Riccardo, Demal, Till, Dalén, Magnu, Santarpino, Giuseppe, Rubino, Antonino S, Nardella, Saverio, Nicolini, Francesco, Zanobini, Marco, De Feo, Marisa, Onorati, Francesco, Mariscalco, Giovanni, and Gatti, Giuseppe
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Cardiac Surgery ,Epiaortic ultrasound ,Coronary artery bypass grafting ,030204 cardiovascular system & hematology ,Lower risk ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Internal medicine ,Ascending aorta ,medicine ,Humans ,Coronary Artery Bypass ,Intraoperative Complications ,Stroke ,Aorta ,Ultrasonography, Interventional ,Ultrasonography ,Aged ,Interventional ,Female ,Middle Aged ,business.industry ,medicine.disease ,Confidence interval ,medicine.anatomical_structure ,030228 respiratory system ,Relative risk ,Cardiology ,Number needed to treat ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Background Epiaortic ultrasonography (EAU) is a valid imaging method to detect atherosclerotic changes of the ascending aorta and to guide surgical strategies for the prevention of cerebral embolism in patients undergoing isolated coronary artery bypass grafting (CABG). However, its use is not widespread. Methods The impact of EAU on the outcome after isolated CABG was investigated in patients from the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry. A systematic review and meta-analysis of the literature was performed to substantiate the findings of this observational study. Results EAU was performed intraoperatively in 673 of 7241 patients (9.3%) from the E-CABG registry. In the overall series, the rates of stroke without and with aortic manipulation were 0.3% and 1.3%, respectively (P = .003). In 660 propensity score–matched pairs, EAU was associated with significantly lower risk of stroke (0.6% vs 2.6%, P = .007). A literature search yielded 5 studies fulfilling the inclusion criteria. These studies, along with the present one, included 11,496 patients, of whom 3026 (25.7%) underwent intraoperative EAU. Their rate of postoperative stroke was significantly lower than in patients not investigated with EAU (pooled rate, 0.6% vs 1.9%; risk ratio, 0.40; 95% confidence interval, 0.24-0.66; I2 = 0%). On the basis of these pooled rates, the number needed to treat to prevent 1 stroke is 76.9. Conclusions Avoiding aortic manipulation is associated with the lowest risk of stroke in patients undergoing CABG. When manipulation of the ascending aorta is planned, EAU is effective in guiding the surgical strategy to reduce the risk for embolic stroke in these patients.
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- 2020
31. Bleeding in Patients Treated with Ticagrelor or Clopidogrel Before Coronary Artery Bypass Grafting
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Marisa De Feo, Juhani Airaksinen, Manne Holm, Daniele Maselli, Marco Zanobini, Stefano Rosato, Sorosh Khodabandeh, Giovanni Mariscalco, Vito G. Ruggieri, Francesco Onorati, Francesco Santini, Giuseppe Santarpino, Fausto Biancari, Riccardo Gherli, Francesco Nicolini, Magnus Dalén, Antonino S. Rubino, Giuseppe Gatti, Eeva-Maija Kinnunen, Daniel Reichart, Andrea Perrotti, Holm, Manne, Biancari, Fausto, Khodabandeh, Sorosh, Gherli, Riccardo, Airaksinen, Juhani, Mariscalco, Giovanni, Gatti, Giuseppe, Reichart, Daniel, Onorati, Francesco, De Feo, Marisa, Santarpino, Giuseppe, Rubino, Antonino S, Maselli, Daniele, Santini, Francesco, Nicolini, Francesco, Zanobini, Marco, Kinnunen, Eeva-Maija, Ruggieri, Vito G, Perrotti, Andrea, Rosato, Stefano, and Dalén, Magnus
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Male ,Pulmonary and Respiratory Medicine ,Ticagrelor ,medicine.medical_specialty ,Postoperative Hemorrhage ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,P2Y12 ,Humans ,Medicine ,Coronary artery bypa ,Prospective Studies ,cardiovascular diseases ,Coronary Artery Bypass ,Prospective cohort study ,Aged ,Bleeding complication ,business.industry ,Perioperative ,Middle Aged ,Clopidogrel ,Surgery ,Discontinuation ,030228 respiratory system ,Preoperative Period ,Propensity score matching ,Dual antiplatelet therapy ,Purinergic P2Y Receptor Antagonists ,Platelet aggregation inhibitor ,Female ,Platelet Aggregation Inhibitors ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background: We evaluated perioperative bleeding after coronary artery bypass grafting (CABG) in patients preoperatively treated with ticagrelor or clopidogrel, stratified by discontinuation of these P2Y₁₂ inhibitors. Methods: All patients from the prospective, European Multicenter Registry on Coronary Artery Bypass Grafting (E-CABG) treated with ticagrelor or clopidogrel undergoing isolated primary CABG were eligible. The primary outcome measure was severe or massive bleeding defined according to the Universal Definition of Perioperative Bleeding, stratified by P2Y₁₂ inhibitor discontinuation. Secondary outcome measures included four additional definitions of major bleeding. Propensity score matching was performed to adjust for differences in preoperative and perioperative covariates. Results: Of 2,311 patients who were included, 1,293 (55.9%) received clopidogrel and 1,018 (44.1%) ticagrelor preoperatively. Mean time between discontinuation and the operation was 4.5 ± 3.2 days for clopidogrel and 4.9 ± 3.0 days for ticagrelor. In the propensity score–matched cohort, ticagrelor-treated patients had a higher incidence of major bleeding according to Universal Definition of Perioperative Bleeding when ticagrelor was discontinued 0 to 2 days compared with 3 days before the operation (16.0% vs 2.7%, p = 0.003). Clopidogrel-treated patients had a higher incidence of major bleeding according to the Universal Definition of Perioperative Bleeding when clopidogrel was discontinued 0 to 3 days compared with 4 to 5 days before the operation (15.6% vs 8.3%, p = 0.031). Conclusions: In patients receiving ticagrelor 2 days before CABG and in those receiving clopidogrel 3 days before CABG, there was an increased rate of severe bleeding. Postponing nonemergent CABG for at least 3 days after discontinuation of ticagrelor and 4 days after clopidogrel should be considered.
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- 2019
32. Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery
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Till Demal, Ilaria Franzese, Marisa De Feo, Magnus Dalén, Tuomas Tauriainen, Andrea Perrotti, Paola D'Errigo, Giovanni Mariscalco, Antonio Salsano, Stefano Rosato, Vito G. Ruggieri, Daniele Maselli, Francesco Onorati, Matteo Saccocci, Antonino S. Rubino, Fausto Biancari, Francesco Nicolini, Giuseppe Santarpino, Eeva-Maija Kinnunen, Giuseppe Gatti, Riccardo Gherli, Biancari, Fausto, Ruggieri, Vito G., Perrotti, Andrea, Gherli, Riccardo, Demal, Till, Franzese, Ilaria, Dalén, Magnu, Santarpino, Giuseppe, Rubino, Antonino S., Maselli, Daniele, Salsano, Antonio, Nicolini, Francesco, Saccocci, Matteo, Gatti, Giuseppe, Rosato, Stefano, D'Errigo, Paola, Kinnunen, Eeva-Maija, De Feo, Marisa, Tauriainen, Tuoma, Onorati, Francesco, and Mariscalco, Giovanni
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Blood transfusion ,medicine.medical_treatment ,Platelet Transfusion ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Plasma ,0302 clinical medicine ,Fresh frozen plasma ,Medicine ,Humans ,030212 general & internal medicine ,Coronary Artery Bypass ,Aged ,Aged, 80 and over ,business.industry ,Prothrombin complex concentrate ,Transfusion ,Bleeding ,Acute kidney injury ,ta3121 ,Cardiac surgery ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Blood Coagulation Factors ,Platelet transfusion ,Anesthesia ,Cohort ,Female ,business ,Cardiology and Cardiovascular Medicine ,Erythrocyte Transfusion ,Kidney disease ,medicine.drug - Abstract
Background Recent studies suggested that prothrombin complex concentrate (PCC) might be more effective than fresh frozen plasma (FFP) to reduce red blood cell (RBC) transfusion requirement after cardiac surgery. Methods This is a comparative analysis of 416 patients who received FFP postoperatively and 119 patients who received PCC with or without FFP after isolated coronary artery bypass grafting (CABG). Results Mixed-effects regression analyses adjusted for multiple covariates and participating centres showed that PCC significantly decreased RBC transfusion (67.2% vs. 87.5%, adjusted OR 0.319, 95%CI 0.136–0.752) and platelet transfusion requirements (11.8% vs. 45.2%, adjusted OR 0.238, 95%CI 0.097–0.566) compared with FFP. The PCC cohort received a mean of 2.7 ± 3.7 (median, 2.0, IQR 4) units of RBC and the FFP cohort received a mean of 4.9 ± 6.3 (median, 3.0, IQR 4) units of RBC (adjusted coefficient, -1.926, 95%CI -3.357–0.494). The use of PCC increased the risk of KDIGO (Kidney Disease: Improving Global Outcomes) acute kidney injury (41.4% vs. 28.2%, adjusted OR 2.300, 1.203–4.400), but not of KDIGO acute kidney injury stage 3 (6.0% vs. 8.0%, OR 0.850, 95%CI 0.258–2.796) when compared with the FFP cohort. Conclusions These results suggest that the use of PCC compared with FFP may reduce the need of blood transfusion after CABG.
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- 2018
33. Outcomes comparison of different surgical strategies for the management of severe aortic valve stenosis: study protocol of a prospective multicentre European registry (E-AVR registry)
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Onorati, F., Gherli, R., Mariscalco, G., Girdauskas, E., Quintana, E., Santini, F., De Feo, M., Sponga, S., Tozzi, P., Bashir, M., Perrotti, A., Pappalardo, A., Ruggieri, V. G., Santarpino, G., Rinaldi, M., Ronaldo, S., Nicolini, F., Livi, Ugolino, All, Et, Onorati, Francesco, Gherli, Riccardo, Mariscalco, Giovanni, Girdauskas, Evalda, Quintana, Eduardo, Santini, Francesco, De Feo, Marisa, Sponga, Sandro, Tozzi, Piergiorgio, Bashir, Mohamad, Perrotti, Andrea, Pappalardo, Aniello, Ruggieri, Vito Giovanni, Santarpino, Giuseppe, Rinaldi, Mauro, Ronaldo, Silva, and Nicolini, Francesco
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Aortic valve ,medicine.medical_specialty ,adult cardiology ,cardiac surgery ,cardiothoracic surgery ,ischaemic heart disease ,valvular heart disease ,Aortic Valve ,Aortic Valve Stenosis ,Cause of Death ,Coronary Artery Disease ,Europe ,Follow-Up Studies ,Heart Valve Prosthesis Implantation ,Humans ,Logistic Models ,Minimally Invasive Surgical Procedures ,Prospective Studies ,Quality of Life ,Registries ,Research Design ,Treatment Outcome ,Medicine (all) ,030204 cardiovascular system & hematology ,Cardiovascular Medicine ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Protocol ,Medicine ,030212 general & internal medicine ,ddc:610 ,Prospective cohort study ,business.industry ,General surgery ,General Medicine ,medicine.disease ,Cardiac surgery ,medicine.anatomical_structure ,Cardiothoracic surgery ,Aortic valve stenosis ,Observational study ,business - Abstract
Traditional and transcatheter surgical treatments of severe aortic valve stenosis (SAVS) are increasing in parallel with the improved life expectancy. Recent randomised controlled trials (RCTs) reported comparable or non-inferior mortality with transcatheter treatments compared with traditional surgery. However, RCTs have the limitation of being a mirror of the predefined inclusion/exclusion criteria, without reflecting the 'real clinical world'. Technological improvements have recently allowed the development of minimally invasive surgical accesses and the use of sutureless valves, but their impact on the clinical scenario is difficult to assess because of the monocentric design of published studies and limited sample size. A prospective multicentre registry including all patients referred for a surgical treatment of SAVS (traditional, through full sternotomy; minimally invasive; or transcatheter; with both 'sutured' and 'sutureless' valves) will provide a 'real-world' picture of available results of current surgical options and will help to clarify the 'grey zones' of current guidelines. Introduction Traditional and transcatheter surgical treatments of severe aortic valve stenosis (SAVS) are increasing in parallel with the improved life expectancy. Recent randomised controlled trials (RCTs) reported comparable or non-inferior mortality with transcatheter treatments compared with traditional surgery. However, RCTs have the limitation of being a mirror of the predefined inclusion/exclusion criteria, without reflecting the 'real clinical world'. Technological improvements have recently allowed the development of minimally invasive surgical accesses and the use of sutureless valves, but their impact on the clinical scenario is difficult to assess because of the monocentric design of published studies and limited sample size. A prospective multicentre registry including all patients referred for a surgical treatment of SAVS (traditional, through full sternotomy; minimally invasive; or transcatheter; with both 'sutured' and 'sutureless' valves) will provide a 'real-world' picture of available results of current surgical options and will help to clarify the 'grey zones' of current guidelines.Methods and analysis European Aortic Valve Registry is a prospective observational open registry designed to collect all data from patients admitted for SAVS, with or without coronary artery disease, in 16 cardiac surgery centres located in six countries (France, Germany, Italy, Spain, Switzerland and UK). Patients will be enrolled over a 2-year period and followed up for a minimum of 5 years to a maximum of 10 years after enrolment. Outcome definitions are concordant with Valve Academic Research Consortium-2 criteria and established guidelines. Primary outcome is 5-year all-cause mortality. Secondary outcomes aim at establishing 'early' 30-day all-cause and cardiovascular mortality, as well as major morbidity, and 'late' cardiovascular mortality, major morbidity, structural and non-structural valve complications, quality of life and echocardiographic results.Ethics and dissemination The study protocol is approved by local ethics committees. Any formal presentation or publication of data will be considered as a joint publication by the participating physician(s) and will follow the recommendations of the International Committee of Medical Journal Editors for authorship.
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- 2018
34. Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting
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Francesco Onorati, Ilaria Franzese, Tuomas Tauriainen, Vito G. Ruggieri, Magnus Dalén, Marco Zanobini, Giuseppe Faggian, Saverio Nardella, Daniel Reichart, Sidney Chocron, Riccardo Gherli, Giuseppe Santarpino, Giovanni Mariscalco, Ciro Bancone, Fausto Biancari, Antonino S. Rubino, Karl Bounader, Marisa De Feo, Andrea Perrotti, Giuseppe Gatti, Juhani Airaksinen, Daniele Maselli, Antonio Salsano, Stefano Rosato, Francesco Nicolini, Sorosh Khodabandeh, Matteo Saccocci, Theodor Fischlein, Santarpino, Giseppe, Nicolini, Francesco, De Feo, Marisa, Dalén, Magnu, Fischlein, Theodor, Perrotti, Andrea, Reichart, Daniel, Gatti, Giuseppe, Onorati, Francesco, Franzese, Ilaria, Faggian, Giuseppe, Bancone, Ciro, Chocron, Sideny, Khodabandeh, Sorosh, Rubino, Antonino S., Maselli, Daniele, Nardella, Saverio, Gherli, Riccardo, Salsano, Antonio, Zanobini, Marco, Saccocci, Matteo, Bounader, Karl, Rosato, Stefano, Tauriainen, Tuoma, Mariscalco, Giovanni, Airaksinen, Juhani, Ruggieri, Vito G., and Biancari, Fausto
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Male ,Bypass grafting ,Coronary artery bypass grafting ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,carotid artery stenosis ,0302 clinical medicine ,Risk Factors ,Medicine ,Carotid Stenosis ,Carotid artery stenosis ,Coronary Artery Bypass ,Endarterectomy, Carotid ,education.field_of_study ,Middle Aged ,Prognosis ,stroke ,Stroke ,Treatment Outcome ,medicine.anatomical_structure ,Adult ,Aged ,Female ,Humans ,Risk Assessment ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Artery ,medicine.medical_specialty ,Population ,Endarterectomy ,Asymptomatic ,03 medical and health sciences ,Internal medicine ,Post-hoc analysis ,In patient ,cardiovascular diseases ,education ,Carotid ,Carotid artery stenosi ,business.industry ,ta3121 ,medicine.disease ,Clinical trial ,Stenosis ,Surgery ,business ,030217 neurology & neurosurgery - Abstract
Objectives: The aim of this study was to evaluate the prognostic impact of untreated asymptomatic carotid artery stenosis (CS) in patients undergoing isolated coronary artery bypass grafting (CABG). Methods: This was a post hoc analysis of data from a prospective multicentre observational study. Patients without history of stroke or transient ischaemic attack from the multicentre E-CABG registry who were screened for CS before isolated CABG were included. Results: Among 2813 patients screened by duplex ultrasound and who did not undergo carotid intervention for asymptomatic CS, 11.1% had a stenosis of 50–59%, 6.0% of 60–69%, 3.1% of 70–79%, 1.4% of 80–89%, 0.5% of 90–99%, and 1.1% had carotid occlusion. In the screened population post-operative stroke occurred in 25 patients (0.9%), with an incidence of 1.5% among patients with CS ≥ 50% (n = 649). Pre-operative screening had not found a relevant CS in 15 of 25 patients suffering stroke after CABG. Brain imaging identified cerebral ischaemic injury in 20 patients, which was bilateral in five patients (25%), ipsilateral to a CS ≥ 50% in six (30%), and ipsilateral to a CS ≥ 70% in three (15%). In univariable analysis, the severity of CS was associated with a significantly increased risk of stroke (CS < 50%, 0.7%; 50–59%, 1.0%; 60–69%, 0.6%; 70–79%, 1.2%; 80–89%, 5.1%; 90–99%, 7.7%; occluded, 6.7%, p < .001). In multivariable analysis, a CS of 90–99% (OR 12.03, 95% CI 1.34–108.23) and the presence of an occluded internal carotid artery (OR 8.783, 95% CI 1.820–42.40) were independent predictors of stroke along with urgency of the procedure, severe massive bleeding according to the E-CABG classification, and the presence of a porcelain ascending aorta. Conclusions: Among screened patients with untreated asymptomatic patients, CS ≥ 90% was an independent predictor of post-operative stroke. As this condition has a low prevalence and when left untreated is associated with a relatively low rate of stroke, pre-operative screening of asymptomatic CS before CABG may not be justified. Clinical Trial registration: https://clinicaltrials.gov. Unique identifier: NCT02319083.
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- 2018
35. Prognostic Impact of Prolonged Cross-Clamp Time in Coronary Artery Bypass Grafting
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Riccardo Gherli, Giuseppe Santarpino, Francesco Onorati, Jean Philippe Verhoye, Matteo Saccocci, Karl Bounader, Fausto Biancari, Giuseppe Gatti, Daniel Reichart, Marisa De Feo, Sidney Chocron, Giuseppe Faggian, Antonio Salsano, Vito G. Ruggieri, Peter Svenarud, Tuomas Tauriainen, Magnus Dalén, Antonino S. Rubino, Tiziano Gherli, Andrea Perrotti, Giovanni Mariscalco, Francesco Nicolini, Daniele Maselli, Juhani Airaksinen, Ruggieri, Vito G., Bounader, Karl, Verhoye, Jean Philippe, Onorati, Francesco, Rubino, Antonino S., Gatti, Giuseppe, Tauriainen, Tuoma, De Feo, Marisa, Reichart, Daniel, Dalã©n, Magnu, Svenarud, Peter, Faggian, Giuseppe, Santarpino, Giuseppe, Maselli, Daniele, Gherli, Riccardo, Mariscalco, Giovanni, Salsano, Antonio, Nicolini, Francesco, Gherli, Tiziano, Saccocci, Matteo, Airaksinen, Juhani K. E., Chocron, Sidney, Perrotti, Andrea, and Biancari, Fausto
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Male ,Inotrope ,Time Factors ,medicine.medical_treatment ,Myocardial Ischemia ,Coronary artery bypass ,030204 cardiovascular system & hematology ,Myocardial ischaemia ,law.invention ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,law ,Hospital Mortality ,Prospective Studies ,CABG ,Incidence ,Atrial fibrillation ,Cardiac surgery ,Prognosis ,Intensive care unit ,Europe ,Survival Rate ,Treatment Outcome ,medicine.anatomical_structure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Cross clamp ,Cross-clamping ,Pulmonary and Respiratory Medicine ,Artery ,medicine.medical_specialty ,03 medical and health sciences ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Coronary artery bypa ,Propensity Score ,Adverse effect ,Aged ,business.industry ,ta3121 ,medicine.disease ,CABG, Cardiac surgery, Coronary artery bypass, Cross clamp, Cross-clamping, Myocardial ischaemia ,030228 respiratory system ,Propensity score matching ,business ,Follow-Up Studies - Abstract
Background: The prognostic impact of cross-clamp time (XCT) in patients undergoing isolated coronary artery bypass grafting (CABG) has not been thoroughly investigated. Material and Methods: 2957 patients who underwent on-pump isolated CABG from the prospective multicentre E-CABG study were the subjects of this analysis. Results: The mean XCT in this series was 58 ± 25 minutes Cross-clamp time was >60 minutes in 1134 patients (38.3%), >75 minutes in 619 patients (20.9%) and >90 minutes in 296 patients (10.0%). Multivariate analysis showed that XCT was an independent predictor of 30-day mortality (p < 0.0001, OR 1.027, 95%CI 1.015–1.039) along with age (p < 0.0001), female gender (p = 0.001), pulmonary disease (p = 0.001), poor mobility (p = 0.002), urgency status (p = 0.007), critical preoperative status (p = 0.002) and participating centres (p = 0.015). Adjusted risk of 30-day mortality was highest for XCT >75 minutes (2.9% vs. 1.7%, p = 0.002, OR 3.479, 95%CI 1.609–7.520). Analysis of 428 propensity score matched pairs showed that XCT >75 minutes was associated with significantly increased risk of early mortality, prolonged use of inotropes, postoperative use of intra-aortic balloon pump, use of extracorporeal membrane oxygenation, atrial fibrillation, prolonged stay in the intensive care unit and of composite major adverse events. Conclusions: Isolated CABG is currently performed with prolonged XCT in a significant number of patients and this seems to be a determinant of poor early outcome.
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- 2018
36. Outcome in Patients Having Salvage Coronary Artery Bypass Grafting
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Sidney Chocron, Ciro Bancone, Giovanni Mariscalco, Giuseppe Santarpino, Eeva-Maija Kinnunen, Vito G. Ruggieri, Francesco Onorati, Angelo M. Dell’Aquila, Aniello Pappalardo, Antonino S. Rubino, Cesare Beghi, Francesco Musumeci, Giuseppe Faggian, Marisa De Feo, Fausto Biancari, Giuseppe Gatti, Andrea Perrotti, Riccardo Gherli, Karl Bounader, Carmelo Mignosa, Magnus Dalén, Theodor Fischlein, Peter Svenarud, Santarpino, Giuseppe, Ruggieri, Vito G., Mariscalco, Giovanni, Bounader, Karl, Beghi, Cesare, Fischlein, Theodor, Onorati, Francesco, Faggian, Giuseppe, Gatti, Giuseppe, Pappalardo, Aniello, DE FEO, Marisa, Bancone, Ciro, Perrotti, Andrea, Chocron, Sidney, Dalen, Magnu, Svenarud, Peter, Rubino, Antonino S., Mignosa, Carmelo, Gherli, Riccardo, Musumeci, Francesco, Dell'Aquila, Angelo M., Kinnunen, Eeva Maija, and Biancari, Fausto
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Shock, Cardiogenic ,Salvage therapy ,Extracorporeal Membrane Oxygenation ,Retrospective Studie ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Hospital Mortality ,Cardiopulmonary resuscitation ,Coronary Artery Bypass ,Survival rate ,Aged ,Retrospective Studies ,Salvage Therapy ,business.industry ,Coronary Artery Bypa ,Cardiogenic shock ,Percutaneous coronary intervention ,EuroSCORE ,Length of Stay ,Middle Aged ,medicine.disease ,Cardiac surgery ,Surgery ,Europe ,Survival Rate ,Aged, Coronary Artery Bypass, Europe, Extracorporeal Membrane Oxygenation, Female, Hospital Mortality, Humans, Length of Stay, Male, Middle Aged, Retrospective Studies, Salvage Therapy, Shock Cardiogenic, Survival Rate, Treatment Outcome ,Treatment Outcome ,surgical procedures, operative ,Cardiology ,Shock Cardiogenic ,Female ,Cardiology and Cardiovascular Medicine ,business ,Human - Abstract
Salvage coronary artery bypass grafting (CABG) is often performed for cardiogenic shock on compassionate basis without clinical data justifying this aggressive approach. The aim of this study was to analyze early and intermediate outcomes after salvage CABG. We retrospectively reviewed the data of 85 patients who underwent salvage CABG at 11 European cardiac surgery centers. Salvage CABG was defined according to the EuroSCORE criteria, that is, a procedure performed in patients requiring cardiopulmonary resuscitation (external cardiac massage) en route to the operating theater or before induction of anesthesia. A percutaneous coronary intervention procedure preceded salvage CABG in 55 patients (64.7%). Thirty patients (35.3%) died during the inhospital stay. The mean EuroSCORE II was 32.0% and the observed-to-expected ratio was 1.08. Salvage CABG was associated with high rates of postoperative stroke (9.4%), resternotomy for bleeding (23.5%), resternotomy for hemodynamic instability (15.3%), dialysis (18.8%), severe gastrointestinal complications (12.9%), and deep sternal wound infection (10.6%). Survival at 1, 3, and 5 years was 58.6%, 49.8%, and 40.9%, respectively. Twenty patients (23.5%) were postoperatively treated with extracorporeal membrane oxygenation (ECMO). The rates of adverse events after ECMO were particularly high (stroke 40%, resternotomy for bleeding 60%, dialysis 35%, gastrointestinal complications 30%, and deep sternal wound infection 30%). Of patients treated with ECMO, 8 (40%) survived to discharge, and 1-year survival was 29.2%. Salvage CABG is associated with high risk of immediate mortality and severe adverse events. However, the observed immediate and intermediate outcome justify coronary surgery in these critically ill patients. A number of these patients are currently treated by ECMO, and its results are encouraging.
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- 2015
37. Prior Percutaneous Coronary Intervention and Mortality in Patients Undergoing Surgical Myocardial Revascularization: Results From the E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) With a Systematic Review and Meta-Analysis
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Giovanni Mariscalco, Stefano Rosato, Giuseppe F. Serraino, Daniele Maselli, Magnus Dalén, Juhani K.E. Airaksinen, Daniel Reichart, Marco Zanobini, Francesco Onorati, Marisa De Feo, Riccardo Gherli, Giuseppe Santarpino, Antonino S. Rubino, Giuseppe Gatti, Francesco Nicolini, Francesco Santini, Andrea Perrotti, Vito D. Bruno, Vito G. Ruggieri, Fausto Biancari, Aamer Ahmed, Nicola Masala, Carmelo Dominici, Saverio Nardella, Sorosh Khodabandeh, Peter Svenarud, Helmut Gulbins, Matteo Saccocci, Giuseppe Faggian, Ilaria Franzese, Ciro Bancone, Ester E. Della Ratta, Francesco Musumeci, Laszlo Gazdag, Theodor Fischlein, Carmelo Mignosa, Aniello Pappalardo, Tiziano Gherli, Antonio Salsano, Guido Olivieri, Karl Bounader, Jean P. Verhoye, Sidney Chocron, Tuomas Tauriainen, Eeva-Maija Kinnunen, Mariscalco, Giovanni, Rosato, Stefano, Serraino, Giuseppe F, Maselli, Daniele, Dalén, Magnu, Airaksinen, Juhani K. E, Reichart, Daniel, Zanobini, Marco, Onorati, Francesco, De Feo, Marisa, Gherli, Riccardo, Santarpino, Giuseppe, Rubino, Antonino S, Gatti, Giuseppe, Nicolini, Francesco, Santini, Francesco, Perrotti, Andrea, Bruno, Vito D, Ruggieri, Vito G, and Biancari, Fausto
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prior coronary intervention ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,coronary artery bypass grafting ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Cochrane Library ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Postoperative Complications ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,cardiovascular diseases ,Hospital Mortality ,Prospective Studies ,Registries ,Coronary Artery Bypass ,Aged ,ta3126 ,business.industry ,adult ,Percutaneous coronary intervention ,Odds ratio ,Middle Aged ,mortality ,thoracic surgery ,Confidence interval ,Clinical trial ,Europe ,surgical procedures, operative ,Treatment Outcome ,Cardiothoracic surgery ,Meta-analysis ,Conventional PCI ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background— The clinical impact of prior percutaneous coronary intervention (PCI) in patients requiring coronary artery bypass grafting (CABG) remains unsettled. We sought to determine whether prior PCI is associated with adverse outcome after CABG. Methods and Results— Data from the prospective E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) conducted between January 2015 and March 2016 at 16 European centres were analyzed using propensity weighted methodology to adjust for confounding. A parallel systematic review/meta-analysis (MEDLINE, Embase, SCOPUS, and Cochrane Library) through September 2017 was accomplished. Of a total of 3641 adult patients included in the E-CABG study, 685 (19%) patients had a history of PCI. At multivariable level, prior PCI was not associated with an increased hospital mortality in both unweighted and weighted patient groups (odds ratio, 0.73; 95% confidence interval, 0.29–1.38; P =0.33 and odds ratio, 0.90; 95% confidence interval, 0.39–2.08; P =0.81, respectively). Subgroup analyses confirmed that prior PCI had no impact on hospital mortality and morbidity, including reexploration for bleeding, blood transfusion, hospital resource use, and neurological, renal, and cardiac complications. The systematic review provided a total of 71 366 individuals and showed a trend toward higher in-hospital/30-day mortality (adjusted odds ratio, 1.30; 95% confidence interval, 0.99–1.70; I 2 =43.1%) in patients with prior PCI. Conclusions— Our prospective multicenter study showed that prior PCI was not associated with an increased risk of mortality or other adverse outcomes in patients undergoing CABG. In light of a trend toward increased mortality observed in the meta-analysis, further studies are needed to ascertain the prognostic impact of prior PCI in the outcome after CABG. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT02319083.
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- 2017
38. Hospital Outcome and Risk Indices of Mortality after redo-mitral valve surgery in Potential Candidates for Transcatheter Procedures: Results From a European Registry
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Giuseppe Santarpino, Christian Detter, Daniel Reichart, Fausto Biancari, Francesco Santini, Giovanni Mariscalco, Giuseppe Gatti, Marisa De Feo, Giuseppe Faggian, Andrea Perrotti, Antonino S. Rubino, Francesco Onorati, Onorati, Francesco, Mariscalco, Giovanni, Reichart, Daniel, Perrotti, Andrea, Gatti, Giuseppe, De Feo, Marisa, Rubino, Antonio, Santarpino, Giuseppe, Biancari, Fausto, Detter, Christian, Santini, Francesco, and Faggian, Giuseppe
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redo ,Male ,Reoperation ,medicine.medical_specialty ,valve-in-valve ,valve-in-ring ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Myocardial infarction ,Hospital Mortality ,Prospective Studies ,Registries ,mitral ,Stroke ,Dialysis ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Ejection fraction ,Receiver operating characteristic ,business.industry ,failed bioprosthesi ,Age Factors ,Mitral Valve Insufficiency ,Odds ratio ,Perioperative ,Middle Aged ,medicine.disease ,Confidence interval ,Europe ,failed bioprosthesis, mitral ,redo, trans-catheter valve, valve-in-ring, valve-in-valve ,Anesthesiology and Pain Medicine ,Treatment Outcome ,030228 respiratory system ,trans-catheter valve ,failed bioprosthesis ,Cardiology and Cardiovascular Medicine ,Cardiology ,Female ,business - Abstract
Transcatheter mitral valve-in-valve/valve-in-ring procedures (TM-VIVoR) are increasing. The authors aimed to identify independent predictors for hospital mortality in redo mitral valve surgery as possible future selection criteria for TM-VIVoR. Objective: Transcatheter mitral valve-in-valve/valve-in-ring procedures (TM-VIVoR) are increasing. The authors aimed to identify independent predictors for hospital mortality in redo mitral valve surgery as possible future selection criteria for TM-VIVoR.Design: Retrospective multicenter registry.Setting: Tertiary university and community hospitals.Participants: Two-hundred and sixty patients (out of 920 enrolled) who are potentially candidates for TM-VIVoR undergoing redo-surgery.Interventions: Redo mitral surgery.Measurements and Main Results: Regression analyzes and receiver operating characteristic (ROC) curves identified independent predictors of death. Patients potentially candidates for TM-VIVoR reported significant hospital mortality (9.2%; EuroSCORE II: 13.2 +/- 13.1, Society of Thoracic Surgeons [STS] score: 6.2 +/- 3.1) and major morbidity (3.8% acute myocardial infarction, 5% stroke, 16.9% perioperative respiratory failure, 16.5% acute renal insufficiency, 25% massive transfusions). EuroSCORE II (odds ration [OR] 1.06; confidence interval [CI] 1.01-1.10; p = 0.005), STS score (OR 1.58; CI 1.27-1.97; p = 0.001), age at surgery (OR 1.05; CI 1.00-1.15; p = 0.05), preoperative dialysis (OR 2.5; CI 1.8-12.6; p = 0.042), left ventricular ejection fraction (LVEF) < 30% (OR 4.8; CI 1.12-37.1; p = 0.021), severe pulmonary hypertension (OR 7.5; CI 1.9-29.4; p = 0.003), and previous coronary artery bypass grafting (CABG) (OR 11.8; CI 1.7-36.9; p = 0.002) were independent predictors of hospital mortality. ROC analyses reported good prediction for EuroSCORE II (AUC: 0.76; cut-off value: > 13.1; 70.8% sensitivity and 68.2% specificity) and better prediction for STS score (AUC: 0.81; cut-off value: 7.4; 75.0% sensitivity and 66.2% specificity). Quintiles stratification identified EuroSCORE II >= 18.7 (5th quintile, observed mortality: 19.3%) and STS score > 9.1 as strong predictors of death within each risk-categorization (OR 5.9 and 12.1, respectively).Conclusions: High EuroSCORE II and STS scores, advanced age at surgery, LVEF < 30%, previous CABG, severe pulmonary hypertension or preoperative dialysis might represent in the future preferred indications for TM-VIVoR in the redo-mitral surgery scenario. (c) 2017 Elsevier Inc. All rights reserved.
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- 2017
39. Validation of Bleeding Classifications in Coronary Artery Bypass Grafting
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Francesco Nicolini, Ciro Bancone, Tiziano Gherli, Daniel Reichart, Francesco Santini, Francesco Onorati, Marisa De Feo, Tuomas Tauriainen, Magnus Dalén, Andrea Perrotti, Theodor Fischlein, Giuseppe Faggian, Giovanni Mariscalco, Vito G. Ruggieri, Daniele Maselli, Antonino S. Rubino, Debora Brascia, Karl Bounader, Carmelo Dominici, Matteo Saccocci, Giuseppe Gatti, Fausto Biancari, Stefano Rosato, Riccardo Gherli, Eeva-Maija Kinnunen, Giuseppe Santarpino, Jean Philippe Verhoye, Brascia, Debora, Reichart, Daniel, Onorati, Francesco, Perrotti, Andrea, Ruggieri, Vito G., Bounader, Karl, Verhoye, Jean Philippe, Santarpino, Giuseppe, Fischlein, Theodor, Maselli, Daniele, Dominici, Carmelo, Mariscalco, Giovanni, Gherli, Riccardo, Rubino, Antonino S., DE FEO, Marisa, Bancone, Ciro, Gatti, Giuseppe, Santini, Francesco, Dalén, Magnu, Saccocci, Matteo, Faggian, Giuseppe, Tauriainen, Tuoma, Kinnunen, Eeva Maija, Nicolini, Francesco, Gherli, Tiziano, Rosato, Stefano, and Biancari, Fausto
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Hemorrhage ,Postoperative Hemorrhage ,030204 cardiovascular system & hematology ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,Registries ,030212 general & internal medicine ,cardiovascular diseases ,Coronary Artery Bypass ,Mammary Arteries ,Intraoperative Complications ,Stroke ,Aged ,business.industry ,Coronary Stenosis ,Acute Kidney Injury ,Anticoagulants ,Female ,Logistic Models ,Middle Aged ,Multivariate Analysis ,Platelet Aggregation Inhibitors ,ROC Curve ,Cardiology and Cardiovascular Medicine ,Percutaneous coronary intervention ,EuroSCORE ,Perioperative ,Clopidogrel ,medicine.disease ,Mediastinitis ,Surgery ,Transplantation ,surgical procedures, operative ,Cardiology ,Platelet aggregation inhibitor ,Acute Kidney Injury, Aged ,Anticoagulants, Coronary Artery Bypass, Coronary Stenosis, Female, Hemorrhage, Humans, Intraoperative Complications, Logistic Models, Male, Mammary Arteries, Middle Aged, Multivariate Analysis, Platelet Aggregation Inhibitors, Postoperative Hemorrhage, Prospective Studies, ROC Curve, Risk Factors, Severity of Illness Index, Stroke, Registries ,business ,medicine.drug - Abstract
Perioperative bleeding is a determinant of poor outcome in patients undergoing coronary artery bypass grafting (CABG), but there is a lack of adequate stratification of its severity. The ability of the European registry of Coronary Artery Bypass Grafting (E-CABG), Universal Definition of Perioperative Bleeding (UDPB), Study of Platelet Inhibition and Patient Outcomes (PLATO), Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent,Events Seventh Organization to Assess Strategies in Ischemic Syndromes (CURRENT-OASIS 7), Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q Wave Coronary Events (ESSENCE), and SafeTy and Efficacy of Enoxaparin in Percutaneous coronary intervention patients, an internationaL randomized Evaluation (STEEPLE) bleeding classifications to predict early mortality, stroke, acute kidney injury (AKI) stage 3, and deep sternal wound infection/mediastinitis was investigated in 3,730.patients from the prospective, multicentre E-CABG registry. Increasing grades of the E-CABG, UDPB, PLATO, and CURRENT-OASIS 7 classifications were associated with increasing risks of early mortality, had similar receiver-operating characteristic area under the curves (>0.7), and were predictive also when adjusted for EuroSCORE II. The E-CABG and UDPB classifications had satisfactory area under the curves (>0.6) in pre,dicting stroke, AKI stage 3, and deep sternal wound infection/mediastinitis even when adjusted for EuroSCORE II. The PLATO and CURRENT-OASIS 7 classifications had similar predictive ability for stroke and AKI stage 3 as confirmed by multivariate analysis adjusted for EuroSCORE II but showed inferior ability in predicting severe wound infection compared to the E-CABG and UDPB classifications. The STEEPLE and ESSENCE classifications had a poor ability of predicting all these adverse events. Decision curve analysis showed a benefit of the ECABG bleeding classification over the other classifications in predicting all adverse events. In conclusion, the E-CABG, UDPB, PLATO, and CURRENT-OASIS 7 bleeding classifications have a satisfactory ability in predicting adverse events after CABG. Decision curve analysis showed that the E-CABG bleeding classification had the best predictive performance. (C) 2016 Elsevier Inc. All rights reserved.
- Published
- 2017
40. Surgery for prosthetic valve endocarditis: a retrospective study of a national registry
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Pasquale Santè, Roberto Di Bartolomeo, Alberto Pozzoli, Carlo De Vincentiis, Attilio Renzulli, Sandro Gelsomino, Lorenzo Galletti, Alessandro Parolari, Giuseppe Filiberto Serraino, Francesco Santini, Riccardo Casabona, Carlo Antona, Enrico Vizzardi, Roberto Lorusso, Francesco Paolo Tritto, Antonio Salsano, Diego Cugola, Giangiuseppe Cappabianca, Daniele Maselli, Giovanni Troise, Daniele Marinelli, Andrea De Martino, Giuseppe Scrascia, Domenico Paparella, Cesare Beghi, Michele Di Mauro, Giovanni Mariscalco, Roger Devotini, Salvatore Zaccaria, Ester Della Ratta, Alessandro Della Corte, Antonio Carozza, Uberto Bortolotti, Fabio Barili, Andrea Biondi, Girolamo Damiani, G. Nappi, Michele De Bonis, Emmanuel Villa, Roberto Scrofani, Guglielmo Mario Actis Dato, Filippo Benassi, Gabriele Di Giammarco, Vito Margari, Francesco Nicolini, Davide Pacini, Della Corte, Alessandro, Di Mauro, Michele, Actis Dato, Guglielmo, Barili, Fabio, Cugola, Diego, Gelsomino, Sandro, Santè, Pasquale, Carozza, Antonio, Della Ratta, Ester, Galletti, Lorenzo, Devotini, Roger, Casabona, Riccardo, Santini, Francesco, Salsano, Antonio, Scrofani, Roberto, Antona, Carlo, De Vincentiis, Carlo, Biondi, Andrea, Beghi, Cesare, Cappabianca, Giangiuseppe, DE BONIS, Michele, Pozzoli, Alberto, Nicolini, Francesco, Benassi, Filippo, Pacini, Davide, Di Bartolomeo, Roberto, De Martino, Andrea, Bortolotti, Uberto, Lorusso, Roberto, Vizzardi, Enrico, Di Giammarco, Gabriele, Marinelli, Daniele, Villa, Emmanuel, Troise, Giovanni, Paparella, Domenico, Margari, Vito, Tritto, Francesco, Damiani, Girolamo, Scrascia, Giuseppe, Zaccaria, Salvatore, Renzulli, Attilio, Serraino, Giuseppe, Mariscalco, Giovanni, Maselli, Daniele, Parolari, Alessandro, Nappi, Giannantonio, CTC, RS: CARIM - R2.12 - Surgical intervention, MUMC+: MA Med Staf Spec CTC (9), Corte, A, Di Mauro, M, Dato, G, Barili, F, Cugola, D, Gelsomino, S, Sante, P, Carozza, A, Ratta, E, Galletti, L, Devotini, R, Casabona, R, Santini, F, Salsano, A, Scrofani, R, Antona, C, De Vincentiis, C, Biondi, A, Beghi, C, Cappabianca, G, De Bonis, M, Pozzoli, A, Nicolini, F, Benassi, F, Pacini, D, Di Bartolomeo, R, De Martino, A, Bortolotti, U, Lorusso, R, Vizzardi, E, Di Giammarco, G, Marinelli, D, Villa, E, Troise, G, Paparella, D, Margari, V, Tritto, F, Damiani, G, Scrascia, G, Zaccaria, S, Renzulli, A, Serraino, G, Mariscalco, G, Maselli, D, Parolari, A, Nappi, G, De Bonis, Michele, Dato, Guglielmo Acti, Santã, Pasquale, and Ratta, Ester Della
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Male ,Time Factors ,medicine.medical_treatment ,Early outcomes ,Infective endocarditis ,Predictors ,Prosthetic valve endocarditis ,Surgery ,Pulmonary and Respiratory Medicine ,Cardiology and Cardiovascular Medicine ,Infective endocarditi ,030204 cardiovascular system & hematology ,Aged ,Cardiac Surgical Procedures ,Endocarditis, Bacterial ,Female ,Follow-Up Studies ,Heart Valve Prosthesis ,Hospital Mortality ,Humans ,Italy ,Middle Aged ,Prognosis ,Prosthesis-Related Infections ,Retrospective Studies ,Risk Factors ,Survival Rate ,Registries ,Risk Assessment ,0302 clinical medicine ,Epidemiology ,Intubation ,EPIDEMIOLOGY ,030212 general & internal medicine ,Early outcomes, Infective endocarditis, Predictors, Prosthetic valve endocarditis, Surgery ,Ejection fraction ,Endocarditis ,Bacterial ,General Medicine ,medicine.medical_specialty ,Preoperative care ,03 medical and health sciences ,Prosthetic valve endocarditi ,medicine ,MANAGEMENT ,INTERNATIONAL-COLLABORATION ,business.industry ,MORTALITY ,Retrospective cohort study ,medicine.disease ,Early outcome ,Etiology ,business ,Predictor - Abstract
OBJECTIVES: We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design.METHODS: Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study.RESULTS: Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P -2 mg/dl, chronic pulmonary disease, low ejection fraction, non-streptococcal aetiology, active endocarditis, preoperative intubation, preoperative shock and triple valve surgery were significantly associated with mortality. In multivariable analysis, age (OR = 1.02; P = 0.03), renal insufficiency (OR = 2.1; P = 0.05), triple valve surgery (OR = 6.9; P = 0.004) and shock (OR = 4.5; P CONCLUSIONS: PVE surgery remains a high-risk one. The strongest predictors of early outcome of PVE surgery are related to patient's haemodynamic status and microbiological factors.
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- 2017
41. The impact of minor blood transfusion on the outcome after coronary artery bypass grafting
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Francesco Nicolini, Karl Bounader, Marisa De Feo, Marco Zanobini, Daniel Reichart, Francesco Santini, Giuseppe Faggian, Francesco Onorati, Carmelo Mignosa, Antonio Salsano, Fausto Biancari, Tiziano Gherli, Daniele Maselli, Giuseppe Santarpino, Andrea Perrotti, Antonino S. Rubino, Debora Brascia, Eeva-Maija Kinnunen, Vito G. Ruggieri, Riccardo Gherli, Matteo Saccocci, Ilaria Franzese, Helmut Gulbins, Magnus Dalén, Francesco Musumeci, Saverio Nardella, Giuseppe Gatti, Giovanni Mariscalco, Kinnunen, Eeva Maija, Zanobini, Marco, Onorati, Francesco, Brascia, Debora, Mariscalco, Giovanni, Franzese, Ilaria, Ruggieri, Vito G, Bounader, Karl, Perrotti, Andrea, Musumeci, Francesco, Santarpino, Giuseppe, Maselli, Daniele, Nardella, Saverio, Gulbins, Helmut, Gherli, Riccardo, Rubino, Antonino S, Mignosa, Carmelo, DE FEO, Marisa, Gatti, Giuseppe, Santini, Francesco, Salsano, Antonio, Dalén, Magnu, Saccocci, Matteo, Reichart, Daniel, Faggian, Giuseppe, Gherli, Tiziano, Nicolini, Francesco, and Biancari, Fausto
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Male ,medicine.medical_specialty ,Blood transfusion ,medicine.medical_treatment ,Coronary artery bypass grafting ,Hemorrhage ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,bleeding , cardiac surgery, coronary artery bypass grafting ,red blood cell, transfusion ,Intraoperative Period ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Humans ,Surgical Wound Infection ,Medicine ,Blood Transfusion ,Prospective Studies ,Registries ,Coronary Artery Bypass ,Propensity Score ,Adverse effect ,Stroke ,Aged ,business.industry ,Transfusion ,Bleeding ,Acute kidney injury ,Perioperative ,Acute Kidney Injury ,Cardiac surgery ,medicine.disease ,Surgery ,Europe ,Intensive Care Units ,Red blood cell ,Treatment Outcome ,Bleeding, Cardiac surgery, Coronary artery bypass grafting, Red blood cell, Transfusion ,medicine.anatomical_structure ,030228 respiratory system ,Propensity score matching ,Female ,business ,Artery - Abstract
To investigate the impact of minor perioperative bleeding requiring transfusion of 1-2 red blood cell (RBC) units on the outcome after coronary artery bypass grafting (CABG). Purpose: To investigate the impact of minor perioperative bleeding requiring transfusion of 1-2 red blood cell (RBC) units on the outcome after coronary artery bypass grafting (CABG).Methods: Sixteen cardiac surgical centers contributed to the prospective European CABG registry (E-CABG). 1014 patients receiving 1-2 RBC units during or after isolated CABG were compared to 2264 patients not receiving RBCs.Results: In 827 propensity score matched pairs, transfusion of 1-2 RBC units did not affect the risk of in-hospital/30-day death (p = 0.523) or stroke (p = 0.804). However, RBC transfusion was associated with an increased risk of acute kidney injury (p = 0.008), sternal wound infection (p = 0.001), postoperative use of antibiotics (p = 0.001), prolonged use of inotropes (p < 0.0001), use of intra-aortic balloon pump (p = 0.012), length of intensive care unit stay (p < 0.0001) and length of in-hospital stay (p < 0.0001). Matched paired analysis excluding pre- and postoperative critical hemodynamic conditions showed that RBC transfusion was associated with an increased risk of major complications except in-hospital/30-day death.Conclusion: Minor perioperative bleeding and subsequent transfusion of 1-2 RBC units did not affect the risk of early death, but increased the risk of other major adverse events. Minimizing perioperative bleeding and prevention of even low-volume RBC transfusion may improve the outcome after CABG. (C) 2017 Elsevier Inc. All rights reserved.
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- 2017
42. Prediction of severe bleeding after coronary surgery: the WILL-BLEED Risk Score
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Daniel Reichart, Paola D'Errigo, Matteo Saccocci, Antonino S. Rubino, Debora Brascia, Giuseppe Gatti, Daniele Maselli, Stefano Rosato, Francesco Santini, Juhani Airaksinen, Francesco Nicolini, Fausto Biancari, Vito G. Ruggieri, Francesco Onorati, Giovanni Mariscalco, Magnus Dalén, Marisa De Feo, Andrea Perrotti, Giuseppe Santarpino, Riccardo Gherli, Eeva-Maija Kinnunen, Biancari, Fausto, Brascia, Debora, Onorati, Francesco, Reichart, Daniel, Perrotti, Andrea, Ruggieri, Vito G., Santarpino, Giuseppe, Maselli, Daniele, Mariscalco, Giovanni, Gherli, Riccardo, Rubino, Antonino S., DE FEO, Marisa, Gatti, Giuseppe, Santini, Francesco, Dalén, Magnu, Saccocci, Matteo, Kinnunen, Eeva Maija, Airaksinen, Juhani K. E., D’Errigo, Paola, Rosato, Stefano, and Nicolini, Francesco
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Male ,medicine.medical_specialty ,Time Factors ,Clinical Decision-Making ,Bleeding ,CABG ,cardiac surgery ,coronary artery bypass grafting ,risk score ,Aged ,Area Under Curve ,Coronary Artery Bypass ,Coronary Artery Disease ,Europe ,Female ,Humans ,Middle Aged ,Postoperative Hemorrhage ,Predictive Value of Tests ,Prospective Studies ,ROC Curve ,Registries ,Reproducibility of Results ,Risk Assessment ,Risk Factors ,Severity of Illness Index ,Treatment Outcome ,Decision Support Techniques ,030204 cardiovascular system & hematology ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Severity of illness ,medicine ,030212 general & internal medicine ,Prospective cohort study ,Cardiac surgery ,Coronary artery bypass grafting ,Risk Score ,Hematology ,Framingham Risk Score ,business.industry ,Perioperative ,Bleed ,bleeding ,medicine.disease ,Surgery ,Predictive value of tests ,business - Abstract
SummarySevere perioperative bleeding after coronary artery bypass grafting (CABG) is associated with poor outcome. An additive score for prediction of severe bleeding was derived (n=2494) and validated (n=1250) in patients from the E-CABG registry. Severe bleeding was defined as E-CABG bleeding grades 2–3 (transfusion of >4 units of red blood cells or reoperation for bleeding). The overall incidence of severe bleeding was 6.4 %. Preoperative anaemia (3 points), female gender (2 points), eGFR 6: 24.6 % vs 24.2 %, both pClinical Trial Registration: NCT02319083 (https://clinicaltrials.gov/ct2/show/NCT02319083)
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- 2016
43. Impact of failed mitral valve repair on hospital outcome of redo mitral valve procedures
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Carmelo Mignosa, Fausto Biancari, Paola D'Errigo, Christian Detter, Sidney Chocron, Giovanni Mariscalco, Antonio Salsano, Theodor Fischlein, Marisa De Feo, Aniello Pappalardo, Francesco Santini, Antonio Rubino, Giuseppe Faggian, Daniel Reichart, Ester Della Ratta, Giuseppe Gatti, Aldo Domenico Milano, Cesare Beghi, Giuseppe Santarpino, Andrea Perrotti, Francesco Onorati, Onorati, Francesco, Gatti, Giuseppe, Perrotti, Andrea, Mariscalco, Giovanni, Reichart, Daniel, Milano, Aldo, Della Ratta, Ester, Rubino, Antonio, Santarpino, Giuseppe, Salsano, Antonio, Biancari, Fausto, Detter, Christian, Chocron, Sidney, Beghi, Cesare, DE FEO, Marisa, Mignosa, Carmelo, Fischlein, Theodor, Pappalardo, Aniello, D'Errigo, Paola, Santini, Francesco, and Faggian, Giuseppe
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Pulmonary and Respiratory Medicine ,Male ,Reoperation ,medicine.medical_specialty ,Mitral, Mitral repair, Outcome, Redo ,Mitral ,Outcome ,Redo ,repair ,Surgery ,Cardiology and Cardiovascular Medicine ,medicine.medical_treatment ,Context (language use) ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Aged ,Female ,Hospital Mortality ,Humans ,Middle Aged ,Mitral Valve ,Mitral Valve Insufficiency ,Retrospective Studies ,Treatment Outcome ,Heart Valve Prosthesis Implantation ,Internal medicine ,Mitral valve ,medicine ,Myocardial infarction ,Dialysis ,Mitral valve repair ,business.industry ,Mitral repair ,Mortality rate ,General Medicine ,Perioperative ,medicine.disease ,Obstructive lung disease ,medicine.anatomical_structure ,030228 respiratory system ,Cardiology ,business - Abstract
The prognostic impact of failed mitral valve repair (FMR) on in-hospital outcome after redo mitral valve surgery has not been thoroughly investigated. OBJECTIVES: The prognostic impact of failed mitral valve repair (FMR) on in-hospital outcome after redo mitral valve surgery has not been thoroughly investigated.METHODS: Hospital outcomes after redo mitral valve surgery because of an FMR in patients from nine European centres were reported. Logistic regressions identified predictors of mortality in combined or isolated redo mitral valve operations. Hospital outcome was compared between propensity-matched cohorts with FMR and native mitral valves in the context of redo surgery and FMR versus failed prostheses.RESULTS: A total of 246 patients with FMR yielded a 6.5% mortality rate at redo surgery. FMR per se did not impact mortality at multivariable analysis (P = 0.64). A preoperative Global Initiative for Chronic Obstructive Lung Disease (GOLD) score >= 2 chronic obstructive lung disease (COPD) (OR 15.2, P < 0.01), left ventricular ejection fraction = 2 COPD (OR 12.3, P = 0.049), age at surgery (OR 1.15 for each incremental year, P = 0.049) and cardiopulmonary bypass duration (OR 1.02, P = 0.022) predicted mortality in isolated redo mitral valve surgery for FMR. The fourth (> 68 years = 13.8% mortality) and the fifth quintiles of age (>= 73.4 years = 14.8%) reported the highest mortality (OR 3.8 and 4.2 respectively, P = 0.002) in this subgroup. Propensity-matched cohorts of FMR and native mitral valves in the context of redo surgery showed no differences in terms of mortality (P = 0.69) and major morbidity (acute myocardial infarction P = 0.31, stroke P = 0.65, acute kidney injury P = 1.0), whereas more perioperative dialysis (P = 0.04) and transfusions (P = 0.02) were noted in propensity-matched failed prostheses compared to FMR.CONCLUSIONS: A failed mitral repair does not impact hospital outcome of redo surgery. Given the role of severe left ventricular dysfunction and advanced age on hospital mortality rates, an early indication for redo surgery may improve outcome.
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- 2016
44. Bleeding, transfusion and the risk of stroke after coronary surgery: A prospective cohort study of 2357 patients
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Marco Zanobini, Giovanni Mariscalco, Luca Maschietto, Fausto Biancari, Tiziano Gherli, Francesco Santini, Vito G. Ruggieri, Saverio Nardella, Daniele Maselli, Tuomas Tauriainen, Paola D'Errigo, Daniel Reichart, Francesco Musumeci, Antonino S. Rubino, Giuseppe Santarpino, Francesco Onorati, Sidney Chocron, Antonio Salsano, Marisa De Feo, Ciro Bancone, Riccardo Gherli, Tamas Püski, Karl Bounader, Theodor Fischlein, Andrea Perrotti, Carmelo Mignosa, Matteo Saccocci, Giuseppe Faggian, Helmut Gulbins, Giuseppe Gatti, Carmelo Dominici, Francesco Nicolini, Peter Svenarud, Eeva-Maija Kinnunen, Ilaria Franzese, Magnus Dalén, Oulu University Hospital [Oulu], Service de Chirurgie Cardiaque [CHU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Karolinska Institutet [Stockholm], University Hospital of Verona, CHU Pontchaillou [Rennes], University Heart Center Hamburg, Karolinska University Hospital [Stockholm], Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), St Anna Hospital, S. Camillo-Forlanini Hospital, Morgagni-Pierantoni Hospital, Università degli studi di Napoli Federico II, Ospedali Riuniti, University of Genoa (UNIGE), University of Parma = Università degli studi di Parma [Parme, Italie], Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Superiore di Sanita [Rome], Biancari, Fausto, Tauriainen, Tuoma, Perrotti, Andrea, Dalén, Magnu, Faggian, Giuseppe, Franzese, Ilaria, Chocron, Sidney, Ruggieri, Vito G., Bounader, Karl, Gulbins, Helmut, Reichart, Daniel, Svenarud, Peter, Santarpino, Giuseppe, Fischlein, Theodor, Puski, Tama, Maselli, Daniele, Dominici, Carmelo, Nardella, Saverio, Mariscalco, Giovanni, Gherli, Riccardo, Musumeci, Francesco, Rubino, Antonino S., Mignosa, Carmelo, DE FEO, Marisa, Bancone, Ciro, Gatti, Giuseppe, Maschietto, Luca, Santini, Francesco, Salsano, Antonio, Nicolini, Francesco, Gherli, Tiziano, Zanobini, Marco, Saccocci, Matteo, D'Errigo, Paola, Kinnunen, Eeva Maija, Onorati, Francesco, University of Naples Federico II = Università degli studi di Napoli Federico II, Università degli studi di Genova = University of Genoa (UniGe), Università degli studi di Parma = University of Parma (UNIPR), and Istituto Superiore di Sanità (ISS)
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Registrie ,Male ,Blood transfusion ,medicine.medical_treatment ,Coronary artery bypass grafting ,030204 cardiovascular system & hematology ,law.invention ,Coronary artery bypass surgery ,0302 clinical medicine ,law ,Risk Factors ,Prospective Studies ,Registries ,Coronary Artery Bypass ,Prospective cohort study ,Stroke ,Bleeding ,Cardiac surgery ,Transfusion ,Aged ,Cardiopulmonary Bypass ,Female ,Hemorrhage ,Heparin ,Humans ,Middle Aged ,Postoperative Hemorrhage ,Surgery ,Cardiopulmonary Bypa ,General Medicine ,3. Good health ,Human ,Cohort study ,medicine.medical_specialty ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,03 medical and health sciences ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Cardiopulmonary bypass ,medicine ,business.industry ,Coronary Artery Bypa ,Risk Factor ,Bleeding, Cardiac surgery, Coronary artery bypass grafting, Coronary artery bypass surgery, Stroke, Transfusion, Aged, Cardiopulmonary Bypass, Coronary Artery Bypass, Female, Hemorrhage, Heparin, Humans, Male, Middle Aged, Postoperative Hemorrhage, Prospective Studies, Registries, Risk Factors, Stroke ,Perioperative ,medicine.disease ,Prospective Studie ,030228 respiratory system ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business - Abstract
International audience; INTRODUCTION: This study was planned to investigate the impact of severe bleeding and blood transfusion on the development of stroke after coronary surgery.METHODS: This cohort study includes 2357 patients undergoing isolated CABG from the prospective European Coronary Artery Bypass Grafting (E-CABG) registry. Severity of bleeding was categorized according to the Universal Definition of Perioperative Bleeding (UDPB), E-CABG and PLATO definitions.RESULTS: Thirty patients (1.3%) suffered postoperative stroke. The amount of transfused red blood cell (RBC) (OR 1.10, 95%CI 1.03-1.18), preoperative use of unfractioned heparin (OR 4.49, 95%CI 1.91-10.60), emergency operation (OR 3.97, 95%CI 1.47-10.74), diseased ascending aorta (OR 4.62, 95%CI 1.37-15.65) and use of cardiopulmonary bypass (p = 0.043, OR 4.85, 95%CI 1.05-22.36) were independent predictors of postoperative stroke. Adjusted analysis showed that UDPB classes 3-4 (crude rate: 3.6% vs. 1.0%; adjusted OR 2.66, 95%CI 1.05-6.73), E-CABG bleeding grades 2-3 (crudes rate: 6.3% vs. 0.9%; adjusted OR 5.91, 95%CI 2.43-14.36), and PLATO life-threatening bleeding (crude rate: 2.5% vs. 0.6%, adjusted OR 3.70, 95%CI 1.59-8.64) were associated with an increased risk of stroke compared with no or moderate bleeding.CONCLUSIONS: Bleeding and blood transfusion are associated with an increased risk of stroke after CABG, which is highest in patients with severe bleeding.
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- 2016
45. Results of surgical aortic valve replacement and transapical transcatheter aortic valve replacement in patients with previous coronary artery bypass grafting
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Davide Gabbieri, Marco Agrifoglio, Alessandro Minati, Ugolino Livi, Fausto Biancari, Francesco Musumeci, Giampiero Esposito, Marisa De Feo, Andrea Agostinelli, Carlo Savini, Francesco Onorati, Mauro Rinaldi, Giovanni Mariscalco, Mauro Cassese, Francesco Santini, Giuseppe Santarpino, Vincenzo Lucchetti, Ottavio Alfieri, Augusto D'Onofrio, Domenico Mangino, Omar Di Gregorio, Stefano Salizzoni, Giuseppe Punta, Giuseppe Faggian, Giovanni Troise, Marco Aiello, Ester Dalla Ratta, Paolo Magagna, Antonio Messina, Theodor Fischlein, Gino Gerosa, Tatu Juvonen, Giancarlo Passerone, Mattia Glauber, Cesare Beghi, Onorati, Francesco, D'Onofrio, Augusto, Biancari, Fausto, Salizzoni, Stefano, DE FEO, Marisa, Agrifoglio, Marco, Mariscalco, Giovanni, Lucchetti, Vincenzo, Messina, Antonio, Musumeci, Francesco, Santarpino, Giuseppe, Esposito, Giampiero, Santini, Francesco, Magagna, Paolo, Beghi, Cesare, Aiello, Marco, Ratta, Ester Dalla, Savini, Carlo, Troise, Giovanni, Cassese, Mauro, Fischlein, Theodor, Glauber, Mattia, Passerone, Giancarlo, Punta, Giuseppe, Juvonen, Tatu, Alfieri, Ottavio, Gabbieri, Davide, Mangino, Domenico, Agostinelli, Andrea, Livi, Ugolino, Di Gregorio, Omar, Minati, Alessandro, Rinaldi, Mauro, Gerosa, Gino, Faggian, Giuseppe, Onorati, F, D'Onofrio, A, Biancari, F, Salizzoni, S, De Feo, M, Agrifoglio, M, Mariscalco, G, Lucchetti, V, Messina, A, Musumeci, F, Santarpino, G, Esposito, G, Santini, F, Magagna, P, Beghi, C, Aiello, M, Ratta, Ed, Savini, C, Troise, G, Cassese, M, Fischlein, T, Glauber, M, Passerone, G, Punta, G, Juvonen, T, Gabbieri, D, Mangino, D, Agostinelli, A, Livi, U, Di Gregorio, O, Minati, A, Rinaldi, M, Gerosa, G, and Faggian, G.
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Aortic valve disease ,Aortic valve replacement ,Bioprosthesis malfunction ,Redo ,Transapical transcatheter aortic valve replacement ,Aged ,Aortic Valve ,Aortic Valve Stenosis ,Coronary Artery Disease ,Female ,Humans ,Incidence ,Italy ,Male ,Postoperative Complications ,Risk Factors ,Sternotomy ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Coronary Artery Bypass ,Heart Valve Prosthesis ,Surgery ,Pulmonary and Respiratory Medicine ,Cardiology and Cardiovascular Medicine ,Aortic valve ,Bypass grafting ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Coronary artery disease ,0302 clinical medicine ,Valve replacement ,medicine.anatomical_structure ,Aortic valve stenosis ,Cardiology ,Artery ,medicine.medical_specialty ,03 medical and health sciences ,Incidence Italy ,Internal medicine ,medicine ,Aortic valve disease, Aortic valve replacement, Bioprosthesis malfunction, Redo, Transapical transcatheter aortic valve replacement, Aged, Aortic Valve, Aortic Valve Stenosis, Coronary Artery Disease, Female, Humans, Incidence Italy, Male, Postoperative Complications, Risk Factors, Sternotomy, Transcatheter Aortic Valve Replacement, Treatment Outcome, Coronary Artery Bypass, Heart Valve Prosthesis ,In patient ,business.industry ,medicine.disease ,030228 respiratory system ,ORIGINAL ARTICLES ,business - Abstract
OBJECTIVES To evaluate the results of aortic valve replacement through sternotomic approach in redo scenarios (RAVR) vs transapical transcatheter aortic valve replacement (TAVR), in patients in the eighth decade of life or older already undergone previous coronary artery bypass grafting (CABG). METHODS One hundred and twenty-six patients undergoing RAVR were compared with 113 patients undergoing TaTAVR in terms of 30-day mortality and Valve Academic Research Consortium-2 outcomes. The two groups were also analysed after propensity-matching. RESULTS TaTAVR patients demonstrated a higher incidence of 30-day mortality (P = 0.03), stroke (P = 0.04), major bleeding (P = 0.03), worse 'early safety' (P = 0.04) and lower permanent pacemaker implantation (P = 0.03). TaTAVR had higher follow-up hazard in all-cause mortality [hazard ratio (HR) 3.15, 95% confidence interval (CI) 1.28-6.62; P < 0.01] and cardiovascular mortality (HR 1.66, 95% CI 1.02-4.88; P = 0.04). Propensity-matched patients showed comparable 30-day outcome in terms of survival, major morbidity and early safety, with only a lower incidence of transfusions after TaTAVR (10.7% vs RAVR: 57.1%; P < 0.01). A trend towards lower Acute Kidney Injury Network Classification 2/3 (3.6% vs RAVR 21.4%; P = 0.05) and towards a lower freedom from all-cause mortality at follow-up (TaTAVR: 44.3 ± 21.3% vs RAVR: 86.6 ± 9.3%; P =. 08) was demonstrated after TaTAVR, although cardiovascular mortality was comparable (TaTAVR: 86.5 ± 9.7% vs RAVR: 95.2 ± 4.6%; P = 0.52). Follow-up freedom from stroke, acute heart failure, reintervention on AVR and thrombo-embolisms were comparable (P = NS). EuroSCORE II (P = 0.02), perioperative stroke (P = 0.01) and length of hospitalization (P = 0.02) were the determinants of all-cause mortality at follow-up, whereas perioperative stroke (P = 0.03) and length of hospitalization (P = 0.04) impacted cardiovascular mortality at follow-up. CONCLUSIONS Reported differences in mortality and morbidity after TaTAVR and RAVR reflect differences in baseline risk profiles. Given the lower trend for renal complications, patients at higher perioperative renal risk might be better served by TaTAVR.
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- 2016
46. Venoarterial extracorporeal membrane oxygenation for acute fulminant myocarditis in adult patients: A 5-year multi-institutional experience
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Fabio Barili, Roberto Di Bartolomeo, Sandro Gelsomino, Ugolino Livi, Roberto Bianco, Michele De Bonis, Enrico Vizzardi, Ottavio Alfieri, Giovanni Casali, Federico Pappalardo, Carlo Pellegrini, Roberto Lorusso, Giuseppe Coletti, Riccardo Casabona, Emanuele Pilato, Mattia Glauber, Massimo Massetti, Francesco Musumeci, Paolo Centofanti, Sandro Sponga, Giovanni Mariscalco, Luca Botta, Claudio Russo, Giuseppe Marinelli, Federica Caldaroni, Cesare Beghi, Parise Orlando, Davide Pacini, Sandro Mazzola, Guglielmo Mario Actis Dato, Antonio Miceli, Gino Gerosa, Rinaldi Mauro, Michele Di Mauro, Filippo Milazzo, Alberto Zangrillo, MUMC+: MA Med Staf Spec CTC (9), RS: CARIM - R2.12 - Surgical intervention, CTC, Lorusso, Roberto, Centofanti, Paolo, Gelsomino, Sandro, Barili, Fabio, Di Mauro, Michele, Orlando, Parise, Botta, Luca, Milazzo, Filippo, Actis Dato, Guglielmo, Casabona, Riccardo, Casali, Giovanni, Musumeci, Francesco, De Bonis, Michele, Zangrillo, Alberto, Alfieri, Ottavio, Pellegrini, Carlo, Mazzola, Sandro, Coletti, Giuseppe, Vizzardi, Enrico, Bianco, Roberto, Gerosa, Gino, Massetti, Massimo, Caldaroni, Federica, Pilato, Emanuele, Pacini, Davide, DI BARTOLOMEO, Roberto, Marinelli, Giuseppe, Sponga, Sandro, Livi, Ugolino, Mauro, Rinaldi, Mariscalco, Giovanni, Beghi, Cesare, Miceli, Antonio, Glauber, Mattia, Pappalardo, Federico, Russo, Claudio Francesco, Lorusso, R, Centofanti, P, Gelsomino, S, Barili, F, Di Mauro, M, Orlando, P, Botta, L, Milazzo, F, Actis Dato, G, Casabona, R, Casali, G, Musumeci, F, De Bonis, M, Zangrillo, A, Alfieri, O, Pellegrini, C, Mazzola, S, Coletti, G, Vizzardi, E, Bianco, R, Gerosa, G, Massetti, M, Caldaroni, F, Pilato, E, Pacini, D, Di Bartolomeo, R, Marinelli, G, Sponga, S, Livi, U, Mauro, R, Mariscalco, G, Beghi, C, Miceli, A, Glauber, M, Pappalardo, F, and Russo, Cf
- Subjects
Male ,Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Myocarditis ,Time Factors ,medicine.medical_treatment ,Fulminant ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Extracorporeal Membrane Oxygenation ,Refractory ,Internal medicine ,Extracorporeal membrane oxygenation ,medicine ,Humans ,Acute Fulminant Myocarditis ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Surgery ,Settore MED/23 - CHIRURGIA CARDIACA ,Survival rate ,Retrospective Studies ,Heart transplantation ,Acute Disease ,Female ,Follow-Up Studies ,Italy ,Survival Rate ,Treatment Outcome ,Medicine (all) ,business.industry ,PERCUTANEOUS CARDIOPULMONARY SUPPORT ,MECHANICAL CIRCULATORY SUPPORT ,CARDIOGENIC-SHOCK PATIENTS ,Cardiogenic shock ,Retrospective cohort study ,medicine.disease ,Cardiology ,business - Abstract
Background Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidly progressive cardiac compromise that ultimately leads to refractory cardiogenic shock or cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in this circumstance, but few clinical series are available about early and long-term results. Data from a multicenter study group are reported which analyzed subjects affected by AFM and treated with VA-ECMO during a 5-year period. Method From hospital databases, 57 patients with diagnoses of AFM treated with VA-ECMO in the past 5 years were found and analyzed. Mean age was 37.6 ± 11.8 years; 37 patients were women. At VA-ECMO implantation, cardiogenic shock was present in 38 patients, cardiac arrest in 12, and severe hemodynamic instability in 7. A peripheral approach was used with 47 patients, whereas 10 patients had a central implantation or other access. Results Mean VA-ECMO support was 9.9 ± 19 days (range, 2 to 24 days). Cardiac recovery with ECMO weaning was achieved in 43 patients (75.5%), major complications were observed in 40 patients (70.1%), and survival to hospital discharge occurred in 41 patients (71.9%). After hospital discharge (median follow-up, 15 months) there were 2 late deaths. The 5-year actual survival was 65.2% ± 7.9%, with recurrent self-recovering myocarditis observed in 2 patients (at 6 and 12 months from the first AFM event), and 1 heart transplantation. Conclusions Cardiopulmonary support with VA-ECMO provides an invaluable tool in the treatment of AFM, although major complications may characterize the hospital course. Long-term outcome appears favorable with rare episodes of recurrent myocarditis or cardiac-related events.
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- 2016
47. Safety of Preoperative Use of Ticagrelor With or Without Aspirin Compared With Aspirin Alone in Patients With Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting
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Giuseppe Gatti, Marisa De Feo, Theodor Fischlein, Marco Zanobini, Francesco Santini, Francesco Onorati, Carmelo Dominici, Sidney Chocron, Daniel Reichart, Luca Maschietto, Peter Svenarud, Francesco Nicolini, Ciro Bancone, Fausto Biancari, Giuseppe Santarpino, Riccardo Gherli, Antonino S. Rubino, Giovanni Mariscalco, Eeva-Maija Kinnunen, Jean Philippe Verhoye, Francesco Musumeci, Giuseppe Faggian, Stefano Rosato, Carmelo Mignosa, Andrea Perrotti, Helmut Gulbins, Tiziano Gherli, Daniele Maselli, Vito G. Ruggieri, Magnus Dalén, Gherli, Riccardo, Mariscalco, Giovanni, Dalén, Magnu, Onorati, Francesco, Perrotti, Andrea, Chocron, Sidney, Verhoye, Jean Philippe, Gulbins, Helmut, Reichart, Daniel, Svenarud, Peter, Faggian, Giuseppe, Santarpino, Giuseppe, Fischlein, Theodor, Maselli, Daniele, Dominici, Carmelo, Musumeci, Francesco, Rubino, Antonino S, Mignosa, Carmelo, DE FEO, Marisa, Bancone, Ciro, Gatti, Giuseppe, Maschietto, Luca, Santini, Francesco, Nicolini, Francesco, Gherli, Tiziano, Zanobini, Marco, Kinnunen, Eeva Maija, Ruggieri, Vito G, Rosato, Stefano, and Biancari, Fausto
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Adult ,medicine.medical_specialty ,Adenosine ,Antiplatelet drug ,medicine.medical_treatment ,Postoperative Hemorrhage ,030204 cardiovascular system & hematology ,Preoperative care ,EUROPEAN MULTICENTER ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,80 and over ,medicine ,MANAGEMENT ,Humans ,Prospective Studies ,ASSOCIATION TASK-FORCE ,Acute Coronary Syndrome ,Coronary Artery Bypass ,Aged ,Aspirin ,business.industry ,ELEVATION MYOCARDIAL-INFARCTION ,Aged, 80 and over ,Female ,Middle Aged ,Platelet Aggregation Inhibitors ,Cardiology and Cardiovascular Medicine ,Perioperative ,ELEVATION MYOCARDIAL-INFARCTION, ACCF/AHA FOCUSED UPDATE, ASSOCIATION TASK-FORCE, BLEEDING COMPLICATIONS, EUROPEAN MULTICENTER, PLATELET INHIBITION, PRACTICE GUIDELINES, CARDIAC-SURGERY, CLOPIDOGREL ,BLEEDING COMPLICATIONS ,Surgery ,Cardiac surgery ,Platelet transfusion ,030228 respiratory system ,PRACTICE GUIDELINES ,CLOPIDOGREL ,PLATELET INHIBITION ,ACCF/AHA FOCUSED UPDATE ,business ,Ticagrelor ,medicine.drug ,CARDIAC-SURGERY - Abstract
The optimal timing of discontinuation of ticagrelor before cardiac surgery is controversial. Importance: The optimal timing of discontinuation of ticagrelor before cardiac surgery is controversial.Objective: To evaluate the safety of preoperative use of ticagrelor with or without aspirin in patients with acute coronary syndromes (ACS) undergoing isolated coronary artery bypass grafting (CABG) compared with aspirin alone.Design, Setting, and Participants: This prospective, multicenter clinical trial was performed at 15 European centers of cardiac surgery. Participants were patients with ACS undergoing isolated CABG from the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry between January and September 2015.Exposures: Before surgery, patients received ticagrelor with or without aspirin or aspirin alone.Main Outcomes and Measures: Severe bleeding as defined by the Universal Definition of Perioperative Bleeding (UDPB) and E-CABG bleeding classification criteria. A propensity score-matched analysis was performed to adjust for differences in baseline and operative covariates.Results: Of 2482 patients from the E-CABG registry, the study cohort included 786 (31.7%) consecutive patients with ACS (mean [SD] age, 67.1 [9.3] years; range, 32-88 years), and 132 (16.8%) were female. One-to-one propensity score matching provided 215 pairs, whose baseline and operative covariates had a standardized difference of less than 10%. Preoperative use of ticagrelor was associated with a similar risk of bleeding according to the UDPB and E-CABG bleeding classifications, but the incidence of platelet transfusion was higher in the ticagrelor group (13.5% [29 of 215] vs 6.0% [13 of 215]). Compared with those receiving aspirin alone, continuing ticagrelor up to the time of surgery or discontinuing its use less than 2 days before surgery was associated with a higher risk of platelet transfusion (22.7% [5 of 22] vs 6.4% [12 of 187]) and E-CABG bleeding grades 2 and 3 (18.2% [4 of 22] vs 5.9% [11 of 187]) and tended to have an increased risk of UDPB grades 3 and 4 (22.7% [5 of 22] vs 9.6% [18 of 187]). Among patients in whom antiplatelet drug use was discontinued at least 2 days before surgery, the incidence of platelet transfusion was 12.4% (24 of 193) in the ticagrelor group and 3.6% (1 of 28) in the aspirin-alone group.Conclusions and Relevance: In propensity score-matched analyses among patients with ACS undergoing CABG, the use of preoperative ticagrelor with or without aspirin compared with aspirin alone was associated with more platelet transfusion but similar degree of bleeding; in patients receiving ticagrelor 1 day before or up until surgery, there was an increased rate of severe bleeding.
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- 2016
48. Validation of a New Classification Method of Postoperative Complications in Patients Undergoing Coronary Surgery
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Vito G. Ruggieri, Francesco Musumeci, Tatu Juvonen, Daniele Maselli, Fausto Biancari, Sidney Chocron, Giovanni Mariscalco, Saverio Nardella, Nicola Masala, Magnus Dalén, Ciro Bancone, Alessandro Della Corte, Andrea Perrotti, Giuseppe Faggian, Carmelo Dominici, Francesco Onorati, Marisa De Feo, Carmelo Mignosa, Antonino S. Rubino, Peter Svenarud, Matti aleksi Mosorin, Giuseppe Gatti, Riccardo Gherli, Eeva-Maija Kinnunen, Giuseppe Santarpino, Oulu University Hospital [Oulu], CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Karolinska University Hospital [Stockholm], University Hospital of Verona, Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), St Anna Hospital, S. Camillo-Forlanini Hospital, University Hospitals Leicester, Morgagni-Pierantoni Hospital, Università degli studi di Napoli Federico II, University of Naples Federico II = Università degli studi di Napoli Federico II, Kinnunen, Eeva Maija, Mosorin, Matti Aleksi, Perrotti, Andrea, Ruggieri, Vito G., Svenarud, Peter, Dalén, Magnu, Onorati, Francesco, Faggian, Giuseppe, Santarpino, Giuseppe, Maselli, Daniele, Dominici, Carmelo, Nardella, Saverio, Musumeci, Francesco, Gherli, Riccardo, Mariscalco, Giovanni, Masala, Nicola, Rubino, Antonino S., Mignosa, Carmelo, DE FEO, Marisa, DELLA CORTE, Alessandro, Bancone, Ciro, Chocron, Sidney, Gatti, Giuseppe, Juvonen, Tatu, and Biancari, Fausto
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Male ,medicine.medical_specialty ,Endpoint Determination ,[SDV]Life Sciences [q-bio] ,coronary artery bypass grafting ,complication ,030204 cardiovascular system & hematology ,law.invention ,Coronary artery disease ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Predictive Value of Tests ,law ,medicine ,Humans ,Cardiac Surgical Procedures ,Coronary Artery Bypass ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Postoperative complication ,Retrospective cohort study ,Middle Aged ,Cardiac surgery ,Prognosis ,medicine.disease ,Coronary Vessels ,Intensive care unit ,Confidence interval ,3. Good health ,Surgery ,Anesthesiology and Pain Medicine ,Aged 80 and over ,030228 respiratory system ,classification ,Predictive value of tests ,Female ,cardiac surgery, classification, complication, coronary artery bypass grafting, Aged, Aged 80 and over, Cardiac Surgical Procedures, Coronary Artery Bypass, Coronary Vessels, Endpoint Determination, Female, Humans, Male, Middle Aged, Postoperative Complications, Predictive Value of Tests, Prognosis, Retrospective Studies, Algorithms ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Algorithms - Abstract
Objective: The authors aimed to validate the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) classification of postoperative Complications in patients undergoing coronary artery bypass grafting (CABG).Design: Retrospective, observational study.Setting: University hospital.Participants: A total of 2,764 patients with severe coronary artery disease. Complete baseline, operative, and postoperative data were available for patients who underwent isolated CABG.Interventions: Isolated CABG.Measurements and Main Results: The E-CABG complication classification was used to stratify the severity and prognostic impact of adverse postoperative events. Primary outcome endpoints were 30-day, 90-day, and long-term all cause mortality. The secondary outcome endpoints was the length of intensive care unit stay. Both the E-CABG complication grades and additive score were predictive of 30-day (area under the receiver operating characteristics curve 0.866, 95% confidence interval [CI] 0.829-0.903; and 0.876; 95% CI 0.844-0.908, respectively) and 90-day (area under the receiver operating characteristics curve 0.850, 95% CI 0.812-0.887; and 0.863, 95% CI 0.829-0.897, respectively) all-cause mortality. The complication grades were independent predictors of increased mortality at actuarial (log-rank: p < 0.0001) and adjusted analysis (p < 0.0001; grade 1: hazard ratio [HR] 1.757, 95% CI 1.111-2.778; grade 2: HR 2.704, 95% CI 1.664-4.394; grade 3: HR 5.081, 95% CI 3.148-8.201). When patients who died within 30 days were excluded from the analysis, this grading method still was associated with late mortality (p < 0.0001). The grading method (p < 0.0001) and the additive score (rho, 0.514; p < 0.0001) were predictive of the length of intensive care unit stay.Conclusions: The E-CABG postoperative complication classification seems to be a promising tool for stratifying the severity and prognostic impact of postoperative complications in patients undergoing cardiac surgery. (C) 2016 Elsevier Inc. All rights reserved.
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- 2015
49. European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG registry): Study Protocol for a Prospective Clinical Registry and Proposal of Classification of Postoperative Complications
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Daniele Maselli, Vito G. Ruggieri, Alessandro Della Corte, Magnus Dalén, Tatu Juvonen, Giuseppe Faggian, Giuseppe Santarpino, Peter Svenarud, Riccardo Gherli, Saverio Nardella, Fausto Biancari, Francesco Onorati, Eeva-Maija Kinnunen, Carmelo Dominici, Francesco Musumeci, Giuseppe Gatti, Andrea Perrotti, Carmelo Mignosa, Giovanni Mariscalco, Marisa De Feo, Nicola Masala, Sidney Chocron, Ciro Bancone, Antonino S. Rubino, Tiziano Gherli, Biancari, Fausto, Ruggieri, Vito G., Perrotti, Andrea, Svenarud, Peter, Dalén, Magnu, Onorati, Francesco, Faggian, Giuseppe, Santarpino, Giuseppe, Maselli, Daniele, Dominici, Carmelo, Nardella, Saverio, Musumeci, Francesco, Gherli, Riccardo, Mariscalco, Giovanni, Masala, Nicola, Rubino, Antonino, Mignosa, Carmelo, DE FEO, Marisa, DELLA CORTE, Alessandro, Bancone, Ciro, Chocron, Sidney, Gatti, Giuseppe, Gherli, Tiziano, Kinnunen, Eeva Maija, Juvonen, Tatu, Oulu University Hospital [Oulu], CHU Pontchaillou [Rennes], Karolinska University Hospital [Stockholm], University Hospital of Verona, Paracelsus Medical University, St Anna Hospital, S. Camillo-Forlanini Hospital, University Hospitals Leicester, Morgagni-Pierantoni Hospital, Università degli studi di Napoli Federico II, Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( PCVP / CARDIO ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), University of Naples Federico II = Università degli studi di Napoli Federico II, and Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO)
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Registrie ,Time Factors ,[SDV]Life Sciences [q-bio] ,Myocardial Infarction ,Coronary artery bypass grafting ,030204 cardiovascular system & hematology ,law.invention ,Study Protocol ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,Risk Factors ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,Prospective Studies ,Registries ,E-CABG ,Coronary Artery Bypass ,Prospective cohort study ,Stroke ,CABG ,Incidence ,General Medicine ,Middle Aged ,3. Good health ,Cardiac surgery ,Survival Rate ,Europe ,Treatment Outcome ,Cardiothoracic surgery ,Middle Aged Myocardial Infarction ,Cardiology and Cardiovascular Medicine ,Human ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,complications ,Time Factor ,complication ,03 medical and health sciences ,Risk Factors Survival Rate ,Humans ,Adverse effect ,Survival rate ,[ SDV ] Life Sciences [q-bio] ,business.industry ,Coronary Artery Bypa ,Risk Factor ,medicine.disease ,Surgery ,Prospective Studie ,Coronary Artery Bypass, Europe, Humans, Incidence, Middle Aged Myocardial Infarction, Postoperative Complications, Prospective Studies, Risk Factors Survival Rate, Time Factors, Treatment Outcome, Registries ,Emergency medicine ,Postoperative Complication ,business - Abstract
International audience; BACKGROUND: Clinical evidence in coronary surgery is usually derived from retrospective, single institutional series. This may introduce significant biases in the analysis of critical issues in the treatment of these patients. In order to avoid such methodological limitations, we planned a European multicenter, prospective study on coronary artery bypass grafting, the E-CABG registry. DESIGN: The E-CABG registry is a multicenter study and its data are prospectively collected from 13 centers of cardiac surgery in university and community hospitals located in six European countries (England, Italy, Finland, France, Germany, Sweden). Data on major and minor immediate postoperative adverse events will be collected. Data on late all-cause mortality, stroke, myocardial infarction and repeat revascularization will be collected during a 10-year follow-up period. These investigators provided a score from 0 to 10 for any major postoperative adverse events and their rounded medians were used to stratify the severity of these complications in four grades. The sum of these scores for each complication/intervention occurring after coronary artery bypass grafting will be used as an additive score for further stratification of the prognostic importance of these events. DISCUSSION: The E-CABG registry is expected to provide valuable data for identification of risk factors and treatment strategies associated with suboptimal outcome. These information may improve the safety and durability of coronary artery bypass grafting. The proposed classification of postoperative complications may become a valuable research tool to stratify the impact of such complications on the outcome of these patients and evaluate the burden of resources needed for their treatment. CLINICAL TRIALS NUMBER: NCT02319083
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- 2015
50. Outcome of emergency coronary artery bypass grafting
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Giuseppe Faggian, Francesco Onorati, Carmelo Mignosa, Carlo Mariani, Marzia Cottini, Giovanni Mariscalco, Antonino S. Rubino, Fausto Biancari, Cesare Beghi, Naseer Ahmed, M. Mosorin, Tatu Juvonen, Biancari, Fausto, Onorati, Francesco, Rubino, A, Mosorin, Matti-Aleksi, Juvonen, Tatu, Ahmed, Naseer, Faggian, Giuseppe, Mariani, Carlo, Mignosa, Carmelo, Cottini, Marzia, Beghi, Cesare, and Mariscalco, Giovanni
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Male ,medicine.medical_specialty ,Bypass grafting ,Referral ,medicine.medical_treatment ,Psychological intervention ,Coronary Artery Bypass, Off-Pump ,counterpulsation ,Outcome Assessment (Health Care) ,Postoperative Complications ,Outcome Assessment, Health Care ,medicine ,Off-Pump ,Humans ,Hospital Mortality ,CABG ,Finland ,Intra-aortic balloon pump ,Aged ,Retrospective Studies ,Intra-Aortic Balloon Pumping ,business.industry ,emergency ,Retrospective cohort study ,Perioperative ,coronary artery bypass ,intra-aortic balloon pump ,Length of Stay ,University hospital ,Coronary Artery Bypass ,Female ,Italy ,Survival Rate ,Cardiology and Cardiovascular Medicine ,Anesthesiology and Pain Medicine ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,business ,Artery - Abstract
OBJECTIVES: The aim of this study was to evaluate the immediate and late outcome of emergency coronary artery bypass grafting (CABG) in a multicenter setting. DESIGN: Multicenter, retrospective study. SETTING: Four university hospitals. PARTICIPANTS: 596 patients were included in this study. INTERVENTIONS: Included patients underwent isolated, emergency CABG. MEASUREMENTS AND MAIN RESULTS: Sixty patients (absolute rate: 10.1%, pooled rate: 8.7%) died during the in-hospital stay period. Increasing emergency CABG classes (p
- Published
- 2015
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