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1. Surgical treatment of isolated tricuspid valve infective endocarditis: 25-year results from a multicenter registry

Author

Giosuè Falcetta, Ester Della Ratta, Roberto Lorusso, Daniele Maselli, Roberto Scrofani, Vito Margari, Francesco Nicolini, Antonio Salsano, Lorenzo Galletti, Alessandro Parolari, Carla Lucarelli, Davide Pacini, Michele Di Mauro, Giacomo Murana, Francesco Musumeci, Giuseppe Scrascia, Samuel Mancuso, Giuseppe Faggian, Massimiliano Foschi, Francesco Onorati, Mauro Rinaldi, Giovanni Troise, Yudit Dossena, Ugolino Livi, Marco Picichè, Domenico Paparella, Giovanni Mariscalco, Loris Salvador, Giangiuseppe Cappabianca, Cesare Beghi, Uberto Bortolotti, Guglielmo Mario Actis Dato, Carlo Antona, Filippo Benassi, Sandro Sponga, Paolo Centofanti, Enrico Vizzardi, Alessandro Della Corte, Carlo De Vincentiis, Fabio Barili, Alberto Pozzoli, Andrea Biondi, Giovanni Cagnoni, Riccardo Gherli, Michele De Bonis, Emmanuel Villa, Francesco Santini, Diego Cugola, Giovanni Casali, Di Mauro, M, Foschi, M, Dato, G, Centofanti, P, Barili, F, Corte, A, Ratta, E, Cugola, D, Galletti, L, Santini, F, Salsano, A, Rinaldi, M, Mancuso, S, Cappabianca, G, Beghi, C, De Vincentiis, C, Biondi, A, Livi, U, Sponga, S, Pacini, D, Murana, G, Scrofani, R, Antona, C, Cagnoni, G, Nicolini, F, Benassi, F, De Bonis, M, Pozzoli, A, Casali, G, Scrascia, G, Falcetta, G, Bortolotti, U, Musumeci, F, Gherli, R, Vizzardi, E, Salvador, L, Piciche, M, Paparella, D, Margari, V, Troise, G, Villa, E, Dossena, Y, Lucarelli, C, Onorati, F, Faggian, G, Mariscalco, G, Maselli, D, Parolari, A, Lorusso, R, MUMC+: MA Med Staf Spec CTC (9), RS: CARIM - R2.12 - Surgical intervention, CTC, RS: Carim - V04 Surgical intervention, Di Mauro M., Foschi M., Dato G.M.A., Centofanti P., Barili F., Corte A.D., Ratta E.D., Cugola D., Galletti L., Santini F., Salsano A., Rinaldi M., Mancuso S., Cappabianca G., Beghi C., De Vincentiis C., Biondi A., Livi U., Sponga S., Pacini D., Murana G., Scrofani R., Antona C., Cagnoni G., Nicolini F., Benassi F., De Bonis M., Pozzoli A., Casali G., Scrascia G., Falcetta G., Bortolotti U., Musumeci F., Gherli R., Vizzardi E., Salvador L., Piciche M., Paparella D., Margari V., Troise G., Villa E., Dossena Y., Lucarelli C., Onorati F., Faggian G., Mariscalco G., Maselli D., Parolari A., Lorusso R., Di Mauro, M., Foschi, M., Dato, G. M. A., Centofanti, P., Barili, F., Della Corte, A., Ratta, E. D., Cugola, D., Galletti, L., Santini, F., Salsano, A., Rinaldi, M., Mancuso, S., Cappabianca, G., Beghi, C., De Vincentiis, C., Biondi, A., Livi, U., Sponga, S., Pacini, D., Murana, G., Scrofani, R., Antona, C., Cagnoni, G., Nicolini, F., Benassi, F., De Bonis, M., Pozzoli, A., Casali, G., Scrascia, G., Falcetta, G., Bortolotti, U., Musumeci, F., Gherli, R., Vizzardi, E., Salvador, L., Piciche, M., Paparella, D., Margari, V., Troise, G., Villa, E., Dossena, Y., Lucarelli, C., Onorati, F., Faggian, G., Mariscalco, G., Maselli, D., Parolari, A., Lorusso, R., and Corte, A. D.

Subjects
Male, Time Factors, SURGERY, medicine.medical_treatment, Heart Valve Diseases, 030204 cardiovascular system & hematology, Prosthesis, 0302 clinical medicine, Tricuspid Valve Insufficiency, Tricuspid valve, 80 and over, Acute infective endocarditis, Cardiac implantable electronic device, Intravenous drug use, Tricuspid valve, Registries, 030212 general & internal medicine, Acute infective endocarditis, Aged, 80 and over, OUTCOMES, Endocarditis, Cardiac implantable electronic device, Hazard ratio, Middle Aged, medicine.anatomical_structure, Italy, Infective endocarditis, HEART, Female, Cardiology and Cardiovascular Medicine, Adult, medicine.medical_specialty, Adolescent, Intravenous drug use, Young Adult, 03 medical and health sciences, MANAGEMENT, medicine, Humans, Dialysis, Aged, business.industry, MORTALITY, Acute infective endocarditi, Odds ratio, medicine.disease, TRENDS, Surgery, INVASIVENESS, business
Abstract

Background: To assess early and late mortality in patients with isolated acute tricuspid valve infective endocarditis (TVIE) using data from a multicenter registry.Methods: From 1983 to 2018, isolated acute TVIE was surgically treated in 157 (3.8%) patients [mean age 47 +/- 16 years (range 15-86 years), 25% females]. Of these, 142 (90%) had native tricuspid regurgitation, 7 (5%) native tricuspid valve (TV) steno-regurgitation, and 8 (5%) prosthetic TVIE. Intravenous drug use (IVDU) was recorded in 38% of patients, infection involved cardiac implantable electronic device leads in 21%, and vascular catheters for dialysis in 1%; in the remaining cases, the cause was unknown. The primary endpoint was in-hospital outcome, long-term freedom from recurrence and overall survival.Results: Overall, 77 (49%) patients underwent TV repair, 72 (46%) TV replacement, and 8 (5%) prosthetic TV replacement. Early mortality was 11% (n = 17). Expected early mortality according to EndoSCORE was 12%, with age (odds ratio 1.06) and redo (odds ratio 6.64) as risk factors. Late deaths occurred in 31 patients and TVIE recurrences in 4. Survival rates at 10, 20, and 25 years were 66%, 60%, and 44%, respectively. Risk factors were age [hazard ratio (HR) 1.06], mycotic TVIE (HR 4.2), IVDU (HR 4.90), infected prosthesis replacement (HR 4.4), and presence of cardiac implantable electronic device leads (HR 3.0). No significant difference was found in valve repair vs. replacement and in IVDUs vs. non-IVDUs.Conclusions: Patients with isolated acute TVIE undergoing surgical treatment show acceptable early and late outcomes. TVIE recurrence was low, and repair of the affected valve does not seem to confer any advantage either at early or long term up to 25 years. (C) 2019 Elsevier B.V. All rights reserved.

Published
2019
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2. Beating vs Arrested Heart Isolated Tricuspid Valve Surgery: Long-term Outcomes

Author

Sandro Sponga, Ugolino Livi, Michele Di Mauro, Antonio Lio, Maurizio Taramasso, Francesco Maisano, Alfred Kocher, Marco Solinas, Paolo Berretta, Martin Andreas, Paul Werner, Ernesto Greco, Ester Della Ratta, Guglielmo Saitto, Carlo Antona, Dror B. Leviner, Fabio Miraldi, Roberto Scrofani, Andrea Biondi, Giacomo Bianchi, Francesco Musumeci, Marco Di Eusanio, Matteo Saccocci, Marco Russo, Alessandro Della Corte, Erez Sharoni, Guenther Laufer, Carlo De Vincentiis, Giovanni Troise, Antonio M. Calafiore, Russo, Marco, Di Mauro, Michele, Saitto, Guglielmo, Lio, Antonio, Berretta, Paolo, Taramasso, Maurizio, Scrofani, Roberto, Della Corte, Alessandro, Sponga, Sandro, Greco, Ernesto, Saccocci, Matteo, Calafiore, Antonio, Bianchi, Giacomo, Leviner, Dror B, Biondi, Andrea, Della Ratta, Ester, Livi, Ugolino, Sharoni, Erez, Werner, Paul, De Vincentiis, Carlo, Di Eusanio, Marco, Kocher, Alfred, Antona, Carlo, Miraldi, Fabio, Troise, Giovanni, Solinas, Marco, Maisano, Francesco, Laufer, Guenther, Musumeci, Francesco, Andreas, Martin, RS: Carim - V04 Surgical intervention, CTC, Russo, M, Di Mauro, M, Saitto, G, Lio, A, Berretta, P, Taramasso, M, Scrofani, R, Della Corte, A, Sponga, S, Greco, E, Saccocci, M, Calafiore, A, Bianchi, G, Leviner, D, Biondi, A, Della Ratta, E, Livi, U, Sharoni, E, Werner, P, De Vincentiis, C, Di Eusanio, M, Kocher, A, Antona, C, Miraldi, F, Troise, G, Solinas, M, Maisano, F, Laufer, G, Musumeci, F, and Andreas, M

Subjects
Male, Reoperation, Pulmonary and Respiratory Medicine, Isolated tricuspid valve disease, medicine.medical_specialty, Time Factors, Tricuspid Valve Surgery, REGURGITATION, survival, beating heart, surgery, Postoperative Complications, Risk Factors, Tricuspid valve, medicine, Humans, Propensity Score, Survival rate, Stroke, Retrospective Studies, FORGOTTEN, Heart Valve Prosthesis Implantation, REPAIR, Ejection fraction, business.industry, Incidence, Mortality rate, EuroSCORE, Retrospective cohort study, Perioperative, Middle Aged, medicine.disease, Tricuspid Valve Insufficiency, Surgery, Europe, Survival Rate, medicine.anatomical_structure, Heart Arrest, Induced, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

BACKGROUND Isolated tricuspid valve (TV) surgery is a rare procedure generally considered at high risk for perioperative mortality and poor long-term outcomes. Surgical treatment can be performed with either an arrested heart (AH) or beating heart (BH) technique. The aim of this study was to compare the outcomes of isolated tricuspid surgery with 2 different approaches.METHODS The Surgical-Tricuspid Study is a multicenter international retrospective study enrolling adult patients who un- derwent isolated TV procedures (n = 406; age 56 +/- 16 years; 56% female) at 13 international sites. The AH and BH strategies were performed in 253 and 153 patients, respectively. Propensity score-matched analysis was used to compare groups.RESULTS After matching, 129 pairs were obtained and analyzed. The 30-day mortality rate was 6.2% versus 5.0% in the AH and BH groups, respectively (P = .9). The rates of acute renal failure requiring replacement therapy (10% versus 3%; P = .02) and stroke (1.6% versus 0%; P = .08) were numerically higher in the AH group. The 6-year survival rate was 67% +/- 6% versus 78% +/- 5% in the AH and BH groups, respectively (P = .18), whereas freedom from cardiac death was 75% +/- 5% versus 84% +/- 4% (P = .21). The 6-year composite cardiac end point of cardiac death and reoperation rate was 60% +/- 9% versus 86% +/- 5% (P - .024) comparing AH-TV replacement and BH-TV repair groups.CONCLUSIONS Isolated TV surgery performed with a BH strategy is a safe option and resulted in a trend of increased long-term survival and freedom from reoperation compared with the standard AH technique. Patients undergoing BH valve repair had the best long-term outcome. (C) 2022 by The Society of Thoracic Surgeons

Published
2022

3. Surgical factors and complications affecting hospital outcome in redo mitral surgery: insights from a multicentre experience

Author

Marisa De Feo, Christian Detter, Giuseppe Santarpino, Francesco Onorati, Francesco Santini, Theodor Fischlein, Cesare Beghi, Andrea Perrotti, Aniello Pappalardo, Sidney Chocron, Ester Della Ratta, Fausto Biancari, Daniel Reichart, Antonio Salsano, Giovanni Mariscalco, Antonio Rubino, Giuseppe Faggian, Carmelo Mignosa, Giuseppe Gatti, Onorati, F, Perrotti, A, Reichart, D, Mariscalco, G, Della Ratta, E, Santarpino, G, Salsano, A, Rubino, A, Biancari, F, Gatti, G, Beghi, C, De Feo, M, Mignosa, C, Pappalardo, A, Fischlein, T, Chocron, S, Detter, C, Santini, F, and Faggian, G.

Subjects
Reoperation, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Blood transfusion, medicine.medical_treatment, Heart Valve Diseases, Outcomes, 030204 cardiovascular system & hematology, Valve disease, law.invention, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, law, Mitral valve, Cardiopulmonary bypass, Humans, Medicine, Myocardial infarction, Cardiac Surgical Procedures, Stroke, Outcome, Redo, Retrospective Studies, Mitral repair, Mitral surgery, Hospitalization, Mitral Valve, Treatment Outcome, Surgery, Cardiology and Cardiovascular Medicine, business.industry, Medicine (all), Retrospective cohort study, General Medicine, Odds ratio, Perioperative, medicine.disease, Mitral repair, Mitral surgery, Mitral valve, Outcomes, Redo, Valve disease, Heart Valve Diseases, Hospitalization, Humans, Mitral Valve, Postoperative Complications, Retrospective Studies, Risk Factors, Treatment Outcome, Cardiac Surgical Procedures, Reoperation, medicine.anatomical_structure, 030228 respiratory system, business
Abstract

OBJECTIVES: Several single-centre experiences have reported significant operative mortality and morbidity after mitral valve surgery in redo scenarios (ReMVS). Several preoperative risk factors outlining 'high-risk' categories have been reported, but scanty data on the impact of different operative techniques for these major challenging procedures have been analysed to date. The aim of the study is to investigate those intraoperative factors and postoperative events affecting early survival after redo mitral procedures.METHODS: Operative mortality and major morbidity events from a large multicentre registry enrolling 832 consecutive redo mitral procedures were analysed. Intraoperative technical issues and postoperative complications impacting operative mortality were identified.RESULTS: ReMVS was associated with significant operative mortality (12.5%), acute myocardial infarction (AMI; 5.9%), stroke (4.9%), acute respiratory insufficiency (14.8%), pneumonia (7.0%), acute renal insufficiency (16.1%) and failure (12.6%), reintervention for bleeding (7.6%), massive transfusion (28.0%), need for permanent pacemaker (10.1%). Injury of a previous patent left internal mammary artery (LIMA) graft [odds ratio (OR) 4.2, 95% confidence interval (CI): 1.6-11.5; P = 0.005], major cardiovascular iatrogenic lesions at re-entry (OR 19.2, 95% CI: 9.2-39.9; P < 0.001), extracellular crystalloid cardioplegia (OR 7.3, 95% CI: 1.4-37.8; P = 0.018), and incremental cardiopulmonary bypass time (OR 1.1, 95% CI: 1.0-1.2; P = 0.001) independently predicted operative mortality, whereas combined antegrade + retrograde cardioplegia (OR 0.2, 95% CI: 0.09-0.4; P = 0.001) was the only protective factor against mortality. Among complications, AMI (OR 4.1, 95% CI: 1.8-9.6; P = 0.001), need for intra-aortic balloon pumping (IABP; OR 3.1, 95% CI: 1.5-6.1; P = 0.001), prolonged intubation >48 h (OR 5.3, 95% CI: 2.9-9.4; P = 0.001) and massive (>6 units) transfusions (OR 4.4, 95% CI: 2.4-8.0; P = 0.001) also predicted operative mortality.CONCLUSIONS: ReMVS still carries the risk of significant early mortality and major morbidity. Major lesion to cardiovascular structures is the most dreadful iatrogenic complication, and injury of a previous LIMA graft identifies patients at higher risk of operative mortality. Prolonged cross-clamp times, extracellular crystalloid cardioplegia and massive transfusions have profound impact on early outcome, as well as the development of perioperative AMI, eventually requiring IABP and prolonged intubation. The combination of antegrade and retrograde cardioplegia seems to offer a better myocardial protection in these high-risk patients.

Published
2016
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4. Surgery for prosthetic valve endocarditis: a retrospective study of a national registry

Author

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

Subjects
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.

Published
2017

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