Search

Introduzione: La disfunzione epato-renale costituisce un fattore di rischio per mortalità e morbidità postoperatoria nei candidati a trapianto. Il MELD-XI (Model of End-Stage Liver Disease Excluding INR) score rappresenta un valido strumento per valutare in anticipo i pazienti affetti da scompenso cardiaco avanzato. Scopo della nostra analisi è stato valutare l’impatto, come fattore prognostico, di valori progressivamente maggiori del MELD-XI score nei pazienti sottoposti a trapianto di cuore. Metodi: Fra gennaio 2000 ed agosto 2016 un totale di 425 pazienti consecutivi sono stati sottoposti a trapianto presso la nostra unità operativa. I dati di questa coorte di pazienti, dopo stratificazione in base al MELD-XI score (MELD-XI 18), sono stati analizzati per descrivere i risultati a breve ed a lungo termine. Risultati: I pazienti con MELD-XI score >18 sono caratterizzati da condizioni cliniche preoperatorie critiche, che determinano un rischio di mortalità precoce maggiore (HR 1.45 [1.11-1.67], p 18 è rispettivamente 63% e 47%, contro il 72% e 59% del gruppo di controllo (MELD-XI, Introduction: Preoperative liver and renal dysfunction remain surgical risk factors for both postoperative morbidity and mortality. The ‘Model of End-Stage Liver Disease Excluding INR’ score (MELD-XI) calculation may help as predictor in patients with advanced heart failure. We analyzed the impact of progressive elevated MELD-XI values among heart transplant recipients at our institution. Methods: The data of a total of 425 consecutive adult patients who underwent heart transplantation, between January 2000 and August 2018, have been reviewed and divided into three cohorts according to preoperative MELD-XI calculations (MELD-XI 18). Early and late outcomes have been analyzed. Results: Patients with MELD-XI score >18 had a more critical clinical condition preoperatively and resulted to have a higher risk of early mortality (HR 1.45 [1.11-1.67], p 240 minutes resulted the strongest predictors of early mortality (p0.001). The 5-y and 10-y survival for MELD-XI >18 cohort was 63% and 47% versus 72% and 59% in the control group (MELD-XI

Objectives In this study, a propensity-matching analysis was used to compare biological versus mechanical composite valve graft implantation for early mortality and morbidities and for late complications including the need for aortic reintervention. Methods Between 1978 and 2011, 1112 consecutive patients underwent a complete aortic root replacement using either a biological Bentall (BB, n = 356) or a mechanical Bentall (MB, n = 756) valve conduit. Preoperative data were stratified according to the type of valve graft, and treatment bias was addressed by propensity score analysis. Results Two homogeneous groups of 138 patients were obtained. Hospital mortality between them was comparable (MB = 7.2% and BB = 5.8%, P = 0.6). They also had similar results after a mean follow-up time of 40 ± 38 months. Propensity-adjusted Cox-regression analysis showed no relationship between the type of prosthesis and all-cause mortality at follow-up (hazards ratio: 0.88; 95% confidence interval: 0.50-2.14; P = 0.4). Freedom from proximal aortic reintervention at 1, 5 and 7 years was 99.1 ± 0.9% in the MB group compared with 98.4 ± 1.1%, 93.0 ± 3.2% and 93.0 ± 3.2% in the BB group (long-rank P = 0.07). Conclusions The Bentall procedure is a safe and reproducible treatment for ascending aorta pathologies. The choice of either a mechanical or a biological valve graft seems to have no influence on early and late midterm adverse outcomes including need for aortic reinterventions.

Objectives: Although antegrade selective cerebral perfusion (ASCP) provides good brain protection during aortic arch surgery, the issue of distal organ protection during circulatory arrest remains to be clarified. The aim of the study was to retrospectively evaluate the outcome of aortic arch surgery using ASCP at different temperatures, focusing on visceral functions (VFs). Methods: Three hundred and thirty-four patients underwent elective aortic arch surgery using ASCP from November 1996 to March 2011. Those patients without early postoperative low cardiac output syndrome were included. VFs were evaluated by comparing preoperative and postoperative creatinine, aspartate amino transferase, alanine amino transferase and bilirubin. Univariate and multivariate analysis were performed. Results: Three hundred and four patients represent the cohort of the study. Deeper systemic hypothermia (≤25°C) (Group A) was used in 194 patients (63.8%) and moderate hypothermia (>25°C) (Group B) in 110 patients (36.2%). The 30-day mortality rate was 3.6% in Group B and 5.2% in Group A (P = NS). Permanent neurological deficits occurred in 4 (3.6%) and in 14 patients (7.2%) of Group A and Group B, respectively (P = NS). Postoperative renal insufficiency requiring dialysis occurred in 6 patients (5.4%) in Group A and in 15 patients (7.7%) in Group B, the differences were not statistically significant. Biochemical markers of VFs increased in the postoperative period without differences between groups. At the multivariate analysis, cardiopulmonary bypass time >180 min (odds ratio (OR) = 2.16) was the only significant risk factor for renal dysfunction with or without liver dysfunction, while cardiopulmonary bypass time longer than 180min (OR = 2.28) and hypothermia higher than 25°C (OR = 0.54) were found to be independently related to liver dysfunction. Conclusions: Our results confirmed that ASCP with moderate hypothermia at 26°C is a safe method for brain protection. Moreover, during circulatory arrest, moderate hypothermia also offers good protection of visceral organs and it should be preferred for limited periods (