16 results on '"Margari, V."'
Search Results
2. Mid-term results of endoscopic mitral valve repair and insights in surgical techniques for isolated posterior prolapse.
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Squiccimarro E, Margari V, Kounakis G, Visicchio G, Pascarella C, Rotunno C, Carbone C, and Paparella D
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- Humans, Mitral Valve surgery, Endoscopy, Reoperation, Mitral Valve Insufficiency surgery, Cardiac Surgical Procedures
- Abstract
Background: The adoption of minimally invasive techniques to perform mitral valve repair surgery is increasing. This is enhanced by the compelling evidence of satisfactory short-term results and lower major morbidity. We analyzed mid-term follow-up results of our experience, and further compared two techniques: isolated leaflet resection and neochord implantation for posterior leaflet prolapse., Methods: Data for all consecutive endoscopic mitral valve repairs via video-assisted right anterior mini-thoracotomy were analyzed between December 2012 and September 2021. The early and mid-term follow-up results were ascertained. The main outcome was the incidence of mortality and the recurrence of significant mitral regurgitation during follow-up which were summarized by the Kaplan-Meier estimator and compared between treatment arms using the stratified log-rank test. Secondary outcomes were the early-postoperative results including 30-days mortality and the occurrence of major complications., Results: A total of 309 patients were included. Along with ring annuloplasty, 136 (44.4%) patients received posterior leaflet resection (122 isolated) whereas 97 (31.1%) underwent posterior leaflet chords implantation (88 isolated). Forty-nine patients had annuloplasty alone. In-hospital mortality was 1.0%. Mean follow-up was 28.8 ± 22.0 months (maximum 8.3 years). Kaplan-Meier survival rate at 5 years was 97.3 ± 1.0%, mitral regurgitation ([Formula: see text]3+) or valve reoperation free-survival at 5 years was estimated as 94.5 ± 2.3%. Subgroup time-to-event analysis for the indexed outcomes showed no statistical significance between the techniques., Conclusions: Endoscopic mitral valve repair is safe and associated with excellent short- and mid-term outcomes. No differences were found between leaflet resection and gore-tex chords implantation for posterior leaflet prolapse., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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3. Bilateral mini-thoracotomy for combined minimally invasive direct coronary artery bypass and mitral valve repair.
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Squiccimarro E, Margari V, and Paparella D
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- Coronary Artery Bypass methods, Humans, Minimally Invasive Surgical Procedures methods, Mitral Valve surgery, Thoracotomy methods, Treatment Outcome, Cardiac Surgical Procedures methods, Heart Valve Prosthesis Implantation methods
- Abstract
Consistent evidence recognizes minimally invasive valve surgery as the top-tier surgical approach for heart valve pathology. Conversely, the overall adoption of minimally invasive coronary surgery remains low. Notwithstanding, excellent clinical outcomes have been recently reported, further consolidating a technique that addresses major concerns associated with the traditional approach for the most frequently performed cardiac operation, including sternal dehiscence (i.e sternal sparing) and stroke (i.e. no-touch aorta), but that also guarantees a reduced resort to blood transfusions, diminished pain and faster recovery. More to the point, the suitability of minimally invasive strategies for combined coronary and valve procedures remains debateable. Almost no reports of such combined procedures are available in literature and the very few published experiences appear scarce and heterogeneous about the surgical access (i.e. single versus bilateral mini-thoracotomy). However, bilateral mini-thoracotomy has been proposed as a feasible and safe strategy for different cardiac operations like surgical ablation and left ventricular assist device implantation, but also for isolated multivessel minimally invasive coronary surgery. Here, we describe the feasibility of combined minimally invasive mitral valve and coronary surgery performed through bilateral mini-thoracotomy and we report outcomes of our initial series of 3 cases., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2022
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4. Similar outcome of tricuspid valve repair and replacement for isolated tricuspid infective endocarditis.
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Di Mauro M, Bonalumi G, Giambuzzi I, Dato GMA, Centofanti P, Corte AD, Ratta ED, Cugola D, Merlo M, 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, Pano M, Nicolardi S, Falcetta G, Colli A, Musumeci F, Gherli R, Vizzardi E, Salvador L, Picichè M, Paparella D, Margari V, Troise G, Villa E, Dossena Y, Lucarelli C, Onorati F, Faggian G, Mariscalco G, Maselli D, Barili F, Parolari A, and Lorusso R
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- Humans, Treatment Outcome, Tricuspid Valve diagnostic imaging, Tricuspid Valve surgery, Cardiac Surgical Procedures adverse effects, Endocarditis surgery, Endocarditis, Bacterial surgery
- 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., (Copyright © 2022 Italian Federation of Cardiology - I.F.C. All rights reserved.)
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- 2022
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5. High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality.
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Devereaux PJ, Lamy A, Chan MTV, Allard RV, Lomivorotov VV, Landoni G, Zheng H, Paparella D, McGillion MH, Belley-Côté EP, Parlow JL, Underwood MJ, Wang CY, Dvirnik N, Abubakirov M, Fominskiy E, Choi S, Fremes S, Monaco F, Urrútia G, Maestre M, Hajjar LA, Hillis GS, Mills NL, Margari V, Mills JD, Billing JS, Methangkool E, Polanczyk CA, Sant'Anna R, Shukevich D, Conen D, Kavsak PA, McQueen MJ, Brady K, Spence J, Le Manach Y, Mian R, Lee SF, Bangdiwala SI, Hussain S, Borges FK, Pettit S, Vincent J, Guyatt GH, Yusuf S, Alpert JS, White HD, and Whitlock RP
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- Aged, Aortic Valve surgery, Biomarkers blood, Cardiac Surgical Procedures mortality, Coronary Artery Bypass adverse effects, Female, Humans, Male, Middle Aged, Myocardial Infarction blood, Myocardial Infarction etiology, Myocardial Infarction mortality, Postoperative Complications blood, Postoperative Complications mortality, Prospective Studies, Reference Values, Cardiac Surgical Procedures adverse effects, Myocardial Infarction diagnosis, Postoperative Complications diagnosis, Troponin I blood
- Abstract
Background: Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations., Methods: We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex)., Results: Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit., Conclusions: The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury. (Funded by the Canadian Institutes of Health Research and others; VISION Cardiac Surgery ClinicalTrials.gov number, NCT01842568.)., (Copyright © 2022 Massachusetts Medical Society.)
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- 2022
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6. Minimally invasive tricuspid valve surgery without caval occlusion: Short and midterm results.
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Margari V, Malvindi PG, De Santis A, Kounakis G, Visicchio G, Mastrototaro G, Dambruoso P, Carbone C, and Paparella D
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- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Minimally Invasive Surgical Procedures, Prospective Studies, Retrospective Studies, Thoracotomy, Treatment Outcome, Tricuspid Valve diagnostic imaging, Tricuspid Valve surgery, Cardiac Surgical Procedures, Heart Valve Prosthesis Implantation, Tricuspid Valve Insufficiency surgery
- Abstract
Objective: The use of minimally invasive or transcatheter interventions rather than standard full sternotomy operations to treat tricuspid valve (TV) disease is increasing. The debate however is still open regarding venous drainage management during cardiopulmonary bypass (CPB) and wheatear or not superior and inferior vena cava should be occluded during the opening of the right atrium to avoid air entrance in the venous line. The aim of the present study is to report operative outcomes and midterm follow-up results of minimally invasive TV surgery performed without caval occlusion., Methods: A retrospective outcome evaluation from institutional records was performed with prospective data entry. Considered were consecutive patients who underwent right mini-thoracotomy TV surgery isolated or combined with mitral valve surgery during the period from June 2013 to February 2020. A telephone and echocardiographic follow-up was performed., Results: During the study period, 68 consecutive patients underwent minimally invasive TV surgery without occlusion of cava veins. The mean age was 69 ± 14 years and 48 (70%) were female. All operations were performed safely without air-lock during CPB. A perioperative cerebral stroke occurred in one patient. The survival at a 5- and 8-year follow-up was 100% and 79%, respectively. No severe tricuspid regurgitation was evident at echocardiographic follow-up., Conclusion: Our results show that performing tricuspid surgery without caval occlusion is safe. The air was captured by the active vacuum drainage system without causing damage. Midterm follow-up data confirm that a minimally invasive approach does not alter the quality of surgery., (© 2021 Wiley Periodicals LLC.)
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- 2021
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7. Right ventricular assessment can improve prognostic value of Euroscore II.
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Di Mauro M, Scrofani R, Antona C, Nicolò F, Cappabianca G, Beghi C, Santarpino G, Gregorini R, Di Marco L, Pacini D, Salsano A, Santini F, Weltert L, De Paulis R, Pano M, Zaccaria S, D'Alfonso A, Di Eusanio M, Massi F, Portoghese M, Stura EC, Rinaldi M, Margari V, Foschi M, Parolari A, and Paparella D
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- Adult, Aged, Aged, 80 and over, Dilatation, Pathologic, Female, Humans, Male, Middle Aged, Preoperative Period, Prognosis, Prospective Studies, Risk, Ventricular Dysfunction, Right, Young Adult, Cardiac Surgical Procedures mortality, Heart Ventricles pathology, Outcome Assessment, Health Care methods, Research Design, Ventricular Function, Right
- Abstract
Background: The aim of this multicenter prospective study was to evaluate the prognostic weight of preoperative right ventricular assessment on early mortality in cardiac surgery., Methods: This is a multicenter prospective observational study performed by the Italian Group of Research for Outcome in Cardiac Surgery (GIROC) including 11 centers. From October 2017 to March 2019, out of 923 patients undergoing cardiac surgery, 28 patients with some missing data were excluded and 895 patients were enrolled in the study right ventricular dilatation was defined as a basal end-diastolic diameter >42 mm. The right ventricle (RV) function was assessed using the combination of three parameters: fractional area changing (FAC), tricuspid annular plane systolic excursion (TAPSE), and S'-wave using tissue Doppler imaging (TDI-S'); RV dysfunction was defined as the presence of at least two of the following cutoffs: FAC <35%, TAPSE <17 mm, and TDI S' <9.5 mm RESULTS: Among the entire cohort, 624 (70%) showed normal RV, 92 (10%) isolated RV dilatation, 154 (17%) isolated RV dysfunction, and 25 (3%) both RV dilatation and dysfunction. Non-surviving patients showed a significantly higher rate of RV alteration at multivariable analysis, RV status was found to be an independent predictor for higher in-hospital mortality beside Euroscore II., Conclusions: This prospective multicenter observation study shows the importance to assess RV preoperatively and to include both RV function and dimension in a risk score model such as Euroscore II to implement its predictivity, since PH cannot always mirror the status of the right ventricle., (© 2020 Wiley Periodicals LLC.)
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- 2020
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8. Prevalence and Clinical Impact of Systemic Inflammatory Reaction After Cardiac Surgery.
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Squiccimarro E, Labriola C, Malvindi PG, Margari V, Guida P, Visicchio G, Kounakis G, Favale A, Dambruoso P, Mastrototaro G, Lorusso R, and Paparella D
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- Aged, Cardiovascular Diseases surgery, Female, Follow-Up Studies, Humans, Italy epidemiology, Male, Middle Aged, Postoperative Complications etiology, Prevalence, Prognosis, Propensity Score, Retrospective Studies, Risk Factors, Survival Rate trends, Systemic Inflammatory Response Syndrome etiology, Cardiac Surgical Procedures adverse effects, Postoperative Complications epidemiology, Risk Assessment methods, Systemic Inflammatory Response Syndrome epidemiology
- Abstract
Objectives: Cardiac surgery induces a systemic inflammatory reaction that has been associated with postoperative mortality and morbidity. Many studies have characterized this reaction through laboratory biomarkers while clinical studies generally are lacking. This study aimed to assess the incidence of postoperative systemic inflammation after cardiac surgery, and the association of postoperative systemic inflammation with preoperative patients' characteristics and postoperative outcomes., Design: Retrospective analysis of prospectively collected data. Analysis of the overall population and of propensity-matched subgroups., Setting: Cardiac surgery intensive care unit., Patients: Adult patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) between June 2016 and June 2017., Interventions: Mixed cardiac surgery operations on CPB., Measurements and Main Results: During the study period, 502 patients underwent cardiac surgery with CPB. One hundred forty-two patients (28.3%) fulfilled SIRS criteria at 24 hours. After performing a multivariate analysis to adjust for the procedure type and preoperative systemic inflammatory reaction syndrome (SIRS) parameters, the occurrence of SIRS was associated inversely with age and extracardiac arteriopathy, and it was associated positively with preoperative white blood cell count. Vasopressors were used more frequently in SIRS patients who further experienced longer mechanical ventilation time and length of stay in the intensive care unit (ICU). The incidence of a composite outcome including death, transient ischemic attack/stroke, renal replacement therapy, bleeding, postoperative intra-aortic balloon pump insertion, and a length of stay in ICU >96 hours was more frequent in SIRS-positive patients. There was no difference between overall and matched subgroups for in-hospital mortality., Conclusion: In this retrospective study, the clinical signs of SIRS were detected in a substantial percentage of patients who underwent cardiac surgery. The postoperative SIRS criteria were associated with a more complicated postoperative course and higher postoperative morbidity., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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9. A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE.
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Di Mauro M, Dato GMA, Barili F, Gelsomino S, Santè P, Corte AD, Carrozza A, Ratta ED, Cugola D, Galletti L, Devotini R, Casabona R, Santini F, Salsano A, Scrofani R, Antona C, Botta L, Russo C, Mancuso S, Rinaldi M, De Vincentiis C, Biondi A, Beghi C, Cappabianca G, Tarzia V, Gerosa G, De Bonis M, Pozzoli A, Nicolini F, Benassi F, Rosato F, Grasso E, Livi U, Sponga S, Pacini D, Di Bartolomeo R, De Martino A, Bortolotti U, Onorati F, Faggian G, Lorusso R, Vizzardi E, Di Giammarco G, Marinelli D, Villa E, Troise G, Picichè M, Musumeci F, Paparella D, Margari V, Tritto F, Damiani G, Scrascia G, Zaccaria S, Renzulli A, Serraino G, Mariscalco G, Maselli D, Foschi M, Parolari A, and Nappi G
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- Adult, Aged, Aged, 80 and over, Cardiac Surgical Procedures trends, Female, Humans, Logistic Models, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Treatment Outcome, Cardiac Surgical Procedures mortality, Endocarditis diagnosis, Endocarditis mortality, Heart Valve Prosthesis microbiology, Prosthesis-Related Infections diagnosis, Prosthesis-Related Infections mortality
- Abstract
Background: The aim of this large retrospective study was to provide a logistic risk model along an additive score to predict early mortality after surgical treatment of patients with heart valve or prosthesis infective endocarditis (IE)., Methods: From 2000 to 2015, 2715 patients with native valve endocarditis (NVE) or prosthesis valve endocarditis (PVE) were operated on in 26 Italian Cardiac Surgery Centers. The relationship between early mortality and covariates was evaluated with logistic mixed effect models. Fixed effects are parameters associated with the entire population or with certain repeatable levels of experimental factors, while random effects are associated with individual experimental units (centers)., Results: Early mortality was 11.0% (298/2715); At mixed effect logistic regression the following variables were found associated with early mortality: age class, female gender, LVEF, preoperative shock, COPD, creatinine value above 2mg/dl, presence of abscess, number of treated valve/prosthesis (with respect to one treated valve/prosthesis) and the isolation of Staphylococcus aureus, Fungus spp., Pseudomonas Aeruginosa and other micro-organisms, while Streptococcus spp., Enterococcus spp. and other Staphylococci did not affect early mortality, as well as no micro-organisms isolation. LVEF was found linearly associated with outcomes while non-linear association between mortality and age was tested and the best model was found with a categorization into four classes (AUC=0.851)., Conclusions: The following study provides a logistic risk model to predict early mortality in patients with heart valve or prosthesis infective endocarditis undergoing surgical treatment, called "The EndoSCORE"., (Copyright © 2017. Published by Elsevier B.V.)
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- 2017
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10. Surgery for prosthetic valve endocarditis: a retrospective study of a national registry.
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Della Corte A, Di Mauro M, Actis Dato G, Barili F, Cugola D, Gelsomino S, Santè P, Carozza A, Della 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, and Nappi G
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- Aged, Endocarditis, Bacterial epidemiology, Female, Follow-Up Studies, Hospital Mortality trends, Humans, Italy epidemiology, Male, Middle Aged, Prognosis, Prosthesis-Related Infections epidemiology, Retrospective Studies, Risk Factors, Survival Rate trends, Time Factors, Cardiac Surgical Procedures methods, Endocarditis, Bacterial surgery, Heart Valve Prosthesis adverse effects, Prosthesis-Related Infections surgery, Registries, Risk Assessment
- 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 < 0.001), consistent with increasing mean patient age (56 ± 14, 64 ± 15, 65 ± 14 years, respectively, P < 0.001) and median logistic EuroSCORE (14%, 21%, 23%, P = 0.025). Older age, female sex, preoperative serum creatinine >-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 < 0.001) were independently associated with mortality, while streptococcal aetiology, healed endocarditis and ejection fraction with survival. Adjusting for study era, preoperative shock (OR = 3; P < 0.001), Enterococcus (OR = 2.3; P = 0.01) and female sex (OR = 1.5; P = 0.03) independently predicted complications, whereas ejection fraction was protective., 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., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2017
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11. The Effects of Steroids on Coagulation Dysfunction Induced by Cardiopulmonary Bypass: A Steroids in Cardiac Surgery (SIRS) Trial Substudy.
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Paparella D, Parolari A, Rotunno C, Vincent J, Myasoedova V, Guida P, De Palo M, Margari V, Devereaux PJ, Lamy A, Alamanni F, Yusuf S, and Whitlock R
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- Administration, Intravenous, Aged, Aged, 80 and over, Biomarkers blood, Blood Coagulation Tests, Double-Blind Method, Drug Administration Schedule, Female, Fibrinolysis drug effects, Glucocorticoids adverse effects, Humans, Italy, Male, Methylprednisolone adverse effects, Middle Aged, Ontario, Platelet Activation drug effects, Platelet Function Tests, Postoperative Hemorrhage blood, Postoperative Hemorrhage etiology, Risk Factors, Thrombin metabolism, Time Factors, Treatment Outcome, Blood Coagulation drug effects, Blood Loss, Surgical prevention & control, Cardiac Surgical Procedures adverse effects, Cardiopulmonary Bypass adverse effects, Glucocorticoids administration & dosage, Methylprednisolone administration & dosage, Postoperative Hemorrhage prevention & control
- Abstract
Cardiopulmonary bypass (CPB) surgery, despite heparin administration, elicits activation of coagulation system resulting in coagulopathy. Anti-inflammatory effects of steroid treatment have been demonstrated, but its effects on coagulation system are unknown. The primary objective of this study is to assess the effects of methylprednisolone on coagulation function by evaluating thrombin generation, fibrinolysis, and platelet activation in high-risk patients undergoing cardiac surgery with CPB. The Steroids In caRdiac Surgery study is a double-blind, randomized, controlled trial performed on 7507 patients worldwide who were randomized to receive either intravenous methylprednisolone, 250 mg at anesthetic induction and 250 mg at initiation of CPB (n = 3755), or placebo (n = 3752). A substudy was conducted in 2 sites to collect blood samples perioperatively to measure prothrombin fragment 1.2 (PF1+2, thrombin generation), plasmin-antiplasmin complex (PAP, fibrinolysis), platelet factor 4 (PF4 platelet activation), and fibrinogen. Eighty-one patients were enrolled in the substudy (37 placebo vs 44 in treatment group). No difference in clinical outcome was detected, including postoperative bleeding and need for blood products transfusion. All patients showed changes of all plasma biomarkers with greater values than baseline in both groups. This reaction was attenuated significantly in the treatment group for PF1.2 (P = 0.040) and PAP (P = 0.042) values at the first intraoperative measurement. No difference between groups was detected for PF4. Methylprednisolone treatment attenuates activation of coagulation system in high-risk patients undergoing CPB surgery. Reduction of thrombin generation and fibrinolysis activation may lead to reduced blood loss after surgery., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2017
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12. Effect of methylprednisolone on acute kidney injury in patients undergoing cardiac surgery with a cardiopulmonary bypass pump: a randomized controlled trial
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Garg, Amit X, Chan, Matthew TV, Cuerden, Meaghan S, Devereaux, PJ, Abbasi, Seyed Hesameddin, Hildebrand, Ainslie, Lamontagne, Francois, Lamy, Andre, Noiseux, Nicolas, Parikh, Chirag R, Perkovic, Vlado, Quantz, Mackenzie, Rochon, Antoine, Royse, Alistair, Sessler, Daniel I, Shah, Pallav J, Sontrop, Jessica M, Tagarakis, Georgios I, Teoh, Kevin H, Vincent, Jessica, Walsh, Michael, Yared, Jean-Pierre, Yusuf, Salim, Whitlock, Richard P, Whitlock, R, Semelhago, L, Chu, V, Dyub, A, Cybulsky, I, Van Oosteen, R, Cordova, G, Quantz, MA, McKenzie, FN, Fox, S, Chase, L, Stevens, LM, Prieto, I, Basile, F, Finegan, BA, Bryden, C, Meyer, S, Chappell, A, Mazer, CD, Dixon, J, Yagnik, S, Crescini, C, Verma, S, Legare, JF, Greentree, D, Coutu, M, Teijeira, J, Wiley, W, Peniston, C, Teng, C, Rochon, AG, Lamarche, Y, Deschamps, A, Voisine, P, Dagenais, F, Singal, RK, Brown, CD, Kieser, TM, Robinson, R, Fremes, SE, Christakis, GT, Melvin, KN, Parsons, M, Zheng, H, Yu, J, Xu, W, Zhang, Q, Chen, C, Yu, H, Zeng, J, Zuo, Y, Liu, J, Zhang, T, Sun, Y, Song, D, Dong, H, Chen, M, Zhao, J, Tao, L, Huang, W, Cheng, Y, Long, YS, Lei, W, Zhang, W, Xu, MY, Qing, E, Xiao, YB, Karunakaran, J, Pillai, VV, Reddy, PB, Kundan, S, Jain, AR, Mallya, SS, Mehta, CB, Shukla, V, Kuruvila, K, Karthikeyan, G, Devagourou, V, Hote, MP, Airan, B, Padmanabhan, C, Srinivasan, M, Agarwal, SK, Pande, S, Rao, P Simha Mohan, Math, R, Shankar, BPR, Vaijyanath, PH, Nair, SK, Ayapati, DR, Kurz, A, Awais, A, Panjasawatwong, K, Kashy, BK, Huffmyer, JL, Scalzo, DC, Kazemi, A, Huang, KF, Parvathaneni, SV, Gardner, JC, Malik, MR, Eshraghi, Y, Kramer, RS, Essandoh, MK, Portillo, J, Ayad, SS, Akhtar, Z, Castresana, MR, Collard, CD, Rodriguez-Blanco, YF, Eaton, MP, Villar, JC, Umana, JP, Dominguez, CL, Alvarado, PA, Zuluaga, D, Abello, M, Sarquis, T, Vaquiro, E, Oliveros, CA, Manrique, EJ, Vasquez, S, Ortiz, LM, Holliday, J, Griffin, R, Royse, AG, Royse, CF, Williams, Z, Paparella, D, Rotunno, C, De Palo, M, Margari, V, Alfieri, O, Ferrara, D, Schiavi, D, Parolari, A, Myasoedova, VA, Daprati, A, De Feo, M, Bancone, C, Di Bartolomeo, R, Pacini, D, Ribezzo, M, Karimi, A, Salehiomran, A, Hajighasemi, A, Bina, P, Straka, Z, Hlavicka, J, Lukac, P, Vik, K, Mosna, F, Tsilimingas, NB, Simopoulos, VN, Tsolaki, F, Rivilla, MT, Galan, J, Nunez, JAF, Gonzalez, A, Ruiz, D, Orts Rodriguez, M, Issa, M, Vila Nova, DC, Maia, LN, Nakazone, MA, Lico e Cividanes, GV, Hajjar, LA, Neto, V Avila, Lucchese, FA, Stolf, NA, Hutschala, D, Ruetzler, K, Sima, B, Engelen, S, Borms, S, Van De Velde, M, Rex, S, De Hert, SG, Ho, AMH, Chan, MTV, Underwood, MJ, Deluca Bisurgi, D, Torres, D, and Buggy, DJ
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Anti-Inflammatory Agents ,030204 cardiovascular system & hematology ,Methylprednisolone ,Drug Administration Schedule ,law.invention ,03 medical and health sciences ,Medicine, General & Internal ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,General & Internal Medicine ,Cardiopulmonary bypass ,SIRS ,Medicine ,Humans ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Glucocorticoids ,Dialysis ,Aged ,Science & Technology ,Cardiopulmonary Bypass ,business.industry ,STEROIDS ,Research ,Acute kidney injury ,General Medicine ,Perioperative ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Cardiac surgery ,HIGH-DOSE DEXAMETHASONE ,Anesthesia ,Female ,business ,Life Sciences & Biomedicine ,Kidney disease ,medicine.drug - Abstract
BACKGROUND: Perioperative corticosteroid use may reduce acute kidney injury. We sought to test whether methylprednisolone reduces the risk of acute kidney injury after cardiac surgery. METHODS: We conducted a prespecified substudy of a randomized controlled trial involving patients undergoing cardiac surgery with cardiopulmonary bypass (2007-2014); patients were recruited from 79 centres in 18 countries. Eligibility criteria included a moderate-to-high risk of perioperative death based on a preoperative score of 6 or greater on the European System for Cardiac Operative Risk Evaluation I. Patients (n = 7286) were randomly assigned (1:1) to receive intravenous methylprednisolone (250 mg at anesthetic induction and 250 mg at initiation of cardiopulmonary bypass) or placebo. Patients, caregivers, data collectors and outcome adjudicators were unaware of the assigned intervention. The primary outcome was postoperative acute kidney injury, defined as an increase in the serum creatinine concentration (from the preoperative value) of 0.3 mg/dL or greater (≥ 26.5 μmol/L) or 50% or greater in the 14-day period after surgery, or use of dialysis within 30 days after surgery. RESULTS: Acute kidney injury occurred in 1479/3647 patients (40.6%) in the methylprednisolone group and in 1426/3639 patients (39.2%) in the placebo group (adjusted relative risk 1.04, 95% confidence interval 0.96 to 1.11). Results were consistent across several definitions of acute kidney injury and in patients with preoperative chronic kidney disease. INTERPRETATION: Intraoperative corticosteroid use did not reduce the risk of acute kidney injury in patients with a moderate-to-high risk of perioperative death who had cardiac surgery with cardiopulmonary bypass. Our results do not support the prophylactic use of steroids during cardiopulmonary bypass surgery. Trial registration: ClinicalTrials.gov, no. NCT00427388. ispartof: CANADIAN MEDICAL ASSOCIATION JOURNAL vol:191 issue:9 pages:E247-E256 ispartof: location:Canada status: published
- Published
- 2019
13. Right ventricular assessment can improve prognostic value of Euroscore II
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Antonio Salsano, Alessandro D'Alfonso, Luca Weltert, Marco Di Eusanio, Luca Di Marco, Marco Pano, Francesca Nicolò, Roberto Scrofani, Massimiliano Foschi, Michele Di Mauro, C. Beghi, Erik Cura Stura, Salvatore Zaccaria, Domenico Paparella, Francesco Massi, Carlo Antona, Alessandro Parolari, Francesco Santini, Ruggero De Paulis, Vito Margari, Giangiuseppe Cappabianca, Giuseppe Santarpino, Mauro Rinaldi, Renato Gregorini, Davide Pacini, Michele Portoghese, Di Mauro M., Scrofani R., Antona C., Nicolo F., Cappabianca G., Beghi C., Santarpino G., Gregorini R., Di Marco L., Pacini D., Salsano A., Santini F., Weltert L., De Paulis R., Pano M., Zaccaria S., D'Alfonso A., Di Eusanio M., Massi F., Portoghese M., Stura E.C., Rinaldi M., Margari V., Foschi M., Parolari A., Paparella D., RS: Carim - V04 Surgical intervention, and CTC
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Male ,Ventricular Dysfunction, Right ,right ventricle ,030204 cardiovascular system & hematology ,Doppler imaging ,Heart Ventricle ,0302 clinical medicine ,Outcome Assessment, Health Care ,Cardiac Surgical Procedure ,Prospective Studies ,Young adult ,Prospective cohort study ,Aged, 80 and over ,dysfunction ,Framingham Risk Score ,Middle Aged ,Prognosis ,Euroscore II ,Cardiac surgery ,medicine.anatomical_structure ,Research Design ,Preoperative Period ,Cohort ,Cardiology ,right ventricular dysfunction ,Female ,Cardiology and Cardiovascular Medicine ,Human ,Dilatation, Pathologic ,Adult ,Risk ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,SPECKLE-TRACKING ,Prognosi ,Heart Ventricles ,doppler ,right ventricular dilatation ,ECHOCARDIOGRAPHIC-ASSESSMENT ,Young Adult ,03 medical and health sciences ,Euroscore ii ,Internal medicine ,medicine ,Humans ,plane systolic excursion ,Cardiac Surgical Procedures ,Aged ,heart-failure ,business.industry ,MORTALITY ,Prospective Studie ,cardiac-surgery ,030228 respiratory system ,Ventricle ,Ventricular Function, Right ,Surgery ,MITRAL-VALVE REPAIR ,business - Abstract
Background: The aim of this multicenter prospective study was to evaluate the prognostic weight of preoperative right ventricular assessment on early mortality in cardiac surgery. Methods: This is a multicenter prospective observational study performed by the Italian Group of Research for Outcome in Cardiac Surgery (GIROC) including 11 centers. From October 2017 to March 2019, out of 923 patients undergoing cardiac surgery, 28 patients with some missing data were excluded and 895 patients were enrolled in the study right ventricular dilatation was defined as a basal end-diastolic diameter >42 mm. The right ventricle (RV) function was assessed using the combination of three parameters: fractional area changing (FAC), tricuspid annular plane systolic excursion (TAPSE), and S'-wave using tissue Doppler imaging (TDI-S'); RV dysfunction was defined as the presence of at least two of the following cutoffs: FAC
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- 2020
14. Prognostic value of SARS-CoV-2 on patients undergoing cardiac surgery
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Valentina Grazioli, Michele Triggiani, Antonio Pantaleo, Mauro Rinaldi, Marisa De Feo, Giacomo Murara, Fabio Barili, Marco Picichè, Ilaria Giambuzzi, Tommaso Regesta, Erik Cura Stura, Francesco Musumeci, Andrea Colli, Liborio Mammana, Igor Vendramin, Domenico Paparella, Andrea Garatti, Alessandro Barbone, Michele De Bonis, Ugolino Livi, Gianluca Folesani, Lucia Torracca, Francesco Ferraro, Emmanuel Villa, Cinzia Trumello, Andrea Audo, Laura Giroletti, Salvatore Nicolardi, Antonio Salsano, Giorgia Bonalumi, Francesco Patanè, Vincenzo Tarzia, Gino Gerosa, Michele Di Mauro, Giacomo Ravenni, Alberto Pilozzi Casado, Alessandro Parolari, Antonino S. Rubino, Francesco Massi, Francesco Santini, Andrea Montalto, Vito Margari, RS: Carim - V04 Surgical intervention, CTC, Bonalumi, G., Pilozzi Casado, A., Barbone, A., Garatti, A., Colli, A., Giambuzzi, I., Torracca, L., Ravenni, G., Folesani, G., Murara, G., Pantaleo, A., Piciche, M., Villa, E., Ferraro, F., Vendramin, I., Livi, U., Montalto, A., Musumeci, F., Tarzia, V., Trumello, C., De Bonis, M., Margari, V., Paparella, D., Salsano, A., Santini, F., Nicolardi, S., Patane, F., Mammana, L., Cura Stura, E., Rinaldi, M., Massi, F., Triggiani, M., Grazioli, V., Giroletti, L., Rubino, A., De Feo, M., Audo, A., Regesta, T., Barili, F., Gerosa, G., Di Mauro, M., and Parolari, A.
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Pulmonary and Respiratory Medicine ,Adult ,medicine.medical_specialty ,Bypass grafting ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,cardiac surgical procedure ,SARS‐CoV‐2 ,COVID‐19 ,Internal medicine ,INFECTION ,Medicine ,Humans ,Coronary Artery Bypass ,cardiac surgical procedures ,COVID-19 ,emergent cardiac surgery ,SARS-CoV-2 ,Aged ,Prognosis ,Adult patients ,business.industry ,Oxygenation ,medicine.disease ,Cardiac surgery ,medicine.anatomical_structure ,Heart failure ,Surgery ,Original Article ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Objective To analyze Italian Cardiac Surgery experience during the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) identifying risk factors for overall mortality according to coronavirus disease 2019 (COVID‐19) status. Methods From February 20 to May 31, 2020, 1354 consecutive adult patients underwent cardiac surgery at 22 Italian Centers; 589 (43.5%), patients came from the red zone. Based on COVID‐19 status, 1306 (96.5%) were negative to SARS‐CoV‐2 (COVID‐N), and 48 (3.5%) were positive to SARS‐CoV‐2 (COVID‐P); among the COVID‐P 11 (22.9%) and 37 (77.1%) become positive, before and after surgery, respectively. Surgical procedures were as follows: 396 (29.2%) isolated coronary artery bypass grafting (CABG), 714 (52.7%) isolated non‐CABG procedures, 207 (15.3%) two associate procedures, and three or more procedures in 37 (2.7%). Heart failure was significantly predominant in group COVID‐N (10.4% vs. 2.5%, p = .01). Results Overall in‐hospital mortality was 1.6% (22 cases), being significantly higher in COVID‐P group (10 cases, 20.8% vs. 12, 0.9%, p
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- 2022
15. High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality
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P J, Devereaux, Andre, Lamy, Matthew T V, Chan, René V, Allard, Vladimir V, Lomivorotov, Giovanni, Landoni, Hong, Zheng, Domenico, Paparella, Michael H, McGillion, Emilie P, Belley-Côté, Joel L, Parlow, Malcolm J, Underwood, Chew Yin, Wang, Nazari, Dvirnik, Marat, Abubakirov, Evgeny, Fominskiy, Stephen, Choi, Stephen, Fremes, Fabrizio, Monaco, Gerard, Urrútia, Marialuz, Maestre, Ludhmila A, Hajjar, Graham S, Hillis, Nicholas L, Mills, Vito, Margari, Joseph D, Mills, J Stephen, Billing, Emily, Methangkool, Carisi A, Polanczyk, Roberto, Sant'Anna, Dmitry, Shukevich, David, Conen, Peter A, Kavsak, Matthew J, McQueen, Katheryn, Brady, Jessica, Spence, Yannick, Le Manach, Rajibul, Mian, Shun Fu, Lee, Shrikant I, Bangdiwala, Sara, Hussain, Flavia K, Borges, Shirley, Pettit, Jessica, Vincent, Gordon H, Guyatt, Salim, Yusuf, Joseph S, Alpert, Harvey D, White, Richard P, Whitlock, Allison, Serra, Devereaux, P. J., Lamy, A., Chan, M. T. V., Allard, R. V., Lomivorotov, V. V., Landoni, G., Zheng, H., Paparella, D., Mcgillion, M. H., Belley-Cote, E. P., Parlow, J. L., Underwood, M. J., Wang, C. Y., Dvirnik, N., Abubakirov, M., Fominskiy, E., Choi, S., Fremes, S., Monaco, F., Urrutia, G., Maestre, M., Hajjar, L. A., Hillis, G. S., Mills, N. L., Margari, V., Mills, J. D., Billing, J. S., Methangkool, E., Polanczyk, C. A., Sant'Anna, R., Shukevich, D., Conen, D., Kavsak, P. A., Mcqueen, M. J., Brady, K., Spence, J., Le Manach, Y., Mian, R., Lee, S. F., Bangdiwala, S. I., Hussain, S., Borges, F. K., Pettit, S., Vincent, J., Guyatt, G. H., Yusuf, S., Alpert, J. S., White, H. D., and Whitlock, R. P.
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Male ,heart infarction ,adverse event ,Myocardial Infarction ,surgery ,Postoperative Complications ,blood ,coronary artery bypass graft ,Reference Values ,Humans ,postoperative complication ,human ,Prospective Studies ,Cardiac Surgical Procedures ,Coronary Artery Bypass ,Aged ,Troponin I ,reference value ,clinical trial ,General Medicine ,Middle Aged ,biological marker ,mortality ,heart surgery ,multicenter study ,Aortic Valve ,Female ,Biomarkers ,prospective study - Abstract
BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to >= 70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury. (Funded by the Canadian Institutes of Health Research and others; VISION Cardiac Surgery ClinicalTrials.gov number, NCT01842568.)
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- 2022
16. 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.
- Published
- 2017
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