120 results on '"Ascione, Guido"'
Search Results
2. Impact of Mitral Regurgitation Etiology on Mitral Surgery After Transcatheter Edge-to-Edge Repair: From the CUTTING-EDGE Registry
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Zaid, Syed, Avvedimento, Marisa, Vitanova, Keti, Akansel, Serdar, Bhadra, Oliver D., Ascione, Guido, Saha, Shekhar, Noack, Thilo, Tagliari, Ana Paula, Pizano, Alejandro, Donatelle, Marissa, Squiers, John J., Goel, Kashish, Leurent, Guillaume, Asgar, Anita W., Ruaengsri, Chawannuch, Wang, Lin, Leroux, Lionel, Flagiello, Michele, Algadheeb, Muhanad, Werner, Paul, Ghattas, Angie, Bartorelli, Antonio L., Dumonteil, Nicholas, Geirsson, Arnar, Van Belle, Eric, Massi, Francesco, Wyler von Ballmoos, Moritz, Goel, Sachin S., Reardon, Michael J., Bapat, Vinayak N., Nazif, Tamim M., Kaneko, Tsuyoshi, Modine, Thomas, Denti, Paolo, and Tang, Gilbert H.L.
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- 2023
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3. Acute Reduction in Left Ventricular Function Following Transcatheter Mitral Edge‐to‐Edge Repair
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Leor Perl, Mark Kheifets, Ascione Guido, Eustachio Agricola, Paolo Denti, Mirjam Gauri Wild, Fabien Praz, Antonio Popolo Rubbio, Francesco Bedogni, Federico De Marco, Ronen Beeri, Mony Shuvy, Francesco Melillo, Matteo Montorfano, Xavier Freixa, Juan Carlos de la Fuente Mancera, Arturo Giordano, Filippo Finizio, Nicolas M. Van Mieghem, J. F. W. Ooms, Neil Fam, Cormac O'Connor, Stefan Toggweiler, Amos Levi, Yaron Shapira, Shmuel Schwartzenberg, Stefano Pidello, Fabrizio D'Ascenzo, Filippo Angelini, Dan Haberman, Gabriele Crimi, Italo Porto, Ottavia Cozzi, Francesco Giannini, Giuseppe Tarantini, Francesco Maisano, and Ran Kornowski
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afterload mismatch ,left ventricular ejection fraction ,mitral regurgitation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Little is known about the impact of transcatheter mitral valve edge‐to‐edge repair on changes in left ventricular ejection fraction (LVEF) and the effect of an acute reduction in LVEF on prognosis. We aimed to assess changes in LVEF after transcatheter mitral valve edge‐to‐edge repair for both primary and secondary mitral regurgitation (PMR and SMR, respectively), identify rates and predictors of LVEF reduction, and estimate its impact on prognosis. Methods and Results In this international multicenter registry, patients with both PMR and SMR undergoing transcatheter mitral valve edge‐to‐edge repair were included. We assessed rates of acute LVEF reduction (LVEFR), defined as an acute relative decrease of >15% in LVEF, its impact on all‐cause mortality, major adverse cardiac event (composite end point of all‐cause death, mitral valve surgery, and residual mitral regurgitation grade ≥2), and LVEF at 12 months, as well as predictors for LVEFR. Of 2534 patients included (727 with PMR, and 1807 with SMR), 469 (18.5%) developed LVEFR. Patients with PMR were older (79.0±9.2 versus 71.8±8.9 years; P
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- 2023
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4. Bicuspid Aortic Valve, from the Unknown till the Perfection of the Species.
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Bargagna, Marta, Ascione, Guido, Zancanaro, Edoardo, Fioravanti, Francesco, Sala, Alessandra, Trumello, Cinzia, Chang, Guohao, Verzini, Alessandro, Castiglioni, Alessandro, and Maisano, Francesco
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The bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality. Though most often isolated, BAV may be associated with other cardiovascular malformations. BAV-related aortopathy is the most common, sharing genetic alterations and phenotypic heterogeneity characteristics. Sometimes silent for a lifetime, BAV may manifest as aortic valve dysfunction, aortic aneurysm, or more emergent situations, such as endocarditis or aortic dissection. Its embryological origin and the characterization of the genes involved, as well as the histopathological and hemodynamic aspects of its natural history, are becoming increasingly clear. In addition, emerging evidence of rhythm disorders associated with BAV has been identified. A new international nomenclature and classification has been introduced to interpret all the advances made in recent years for the comprehension of this condition. In the guidelines, more attention has been paid to the diagnosis of BAV and related aortopathy, together with surveillance, and family screening. Surgical treatment remains the gold standard, especially in young low-risk patients, and valve repair techniques have been shown to be effective and durable. Finally, the new era of transcatheter techniques is also being applied to dysfunctional BAV, allowing the treatment of patients at high surgical risk, with increasingly promising results, and the possibility of expanding indications through the introduction of more advanced devices. This review aims to comprehensively describe the BAV conundrum, focusing on anatomy, pathophysiology, genetics, diagnosis of BAV-related disorders, and the different treatment options available in the transcatheter era. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Transseptal BATMAN for High-Risk Valve-in-Ring Procedures
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Denti, Paolo, primary, Saccocci, Matteo, additional, Buzzatti, Nicola, additional, Ascione, Guido, additional, Margonato, Davide, additional, Gatto, Pamela, additional, Palloshi, Altin, additional, Sarais, Cristiano, additional, Longoni, Matteo, additional, and Maisano, Francesco, additional
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- 2024
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6. Advances in Mitral Valve Repair for Degenerative Mitral Regurgitation: Philosophy, Technical Details, and Long-Term Results
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Del Forno, Benedetto, Ascione, Guido, and De Bonis, Michele
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- 2021
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7. When annuloplasty is not enough: a case report of ventricular arrhythmias stepwise abolition after mitral valve re-repair.
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Guicciardi, Nicolò Azzola, Ascione, Guido, Alfieri, Ottavio, Maisano, Francesco, and Bonis, Michele De
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ARRHYTHMIA ,VENTRICULAR arrhythmia ,MITRAL valve ,TRICUSPID valve ,PAPILLARY muscles ,TRICUSPID valve surgery - Abstract
Background Some patients affected by mitral valve (MV) prolapse (MVP) are at higher risk of ventricular arrhythmias (VAs), but the underlying pathogenesis, as well as the effects of surgery on VA, remain not fully understood. Mitral valve repair, however, represents a privileged point of view to deepen the understanding of arrhythmogenesis in this context. Hence, we report an interesting case of MV re-repair. Case summary A 52-year-old man was referred to our institution for severe mitral regurgitation (MR) due to P2 prolapse in the context of myxomatous MV degeneration. Pre-operative imaging showed systolic mitral annular disjunction, left ventricular (LV) wall curling, Pickelhaube's sign, and a prolapsing tricuspid valve (TV) with only mild regurgitation. Twenty-four-hour electrocardiogram (ECG) Holter revealed a significant burden of premature ventricular contractions (PVCs), most of them originating from anterior papillary muscle (APM), posterior papillary muscle (PPM), and mitral annulus (MA). Quadrangular resection of P2 and mitral annuloplasty were performed. One year later, relapse of severe MR due to a residual P2M1 prolapse occurred. Twenty-four-hour ECG Holter showed no PVCs from PPM and MA, while those from APM persisted. A central edge-to-edge repair was effectively used to fix the residual prolapse. After 1 year from REDO surgery, a third ECG Holter confirmed the absence of any remaining LV PVCs, but still few ectopic beats originating from TV were recorded. Discussion Here, we report a case of VA resolution after specific, anatomical triggers addressing surgical gestures. Our experience confirms that MV surgery may have a role in MVP patients' arrhythmias correction. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Neochordae implantation versus leaflet resection in mitral valve posterior leaflet prolapse and dilated left ventricle: a propensity score matching comparison with long-term follow-up
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Del Forno, Benedetto, primary, Tavana, Kevin, additional, Ruffo, Claudio, additional, Carino, Davide, additional, Lapenna, Elisabetta, additional, Ascione, Guido, additional, Bisogno, Arturo, additional, Belluschi, Igor, additional, Scarale, Maria Giovanna, additional, Nonis, Alessandro, additional, Monaco, Fabrizio, additional, Alfieri, Ottavio, additional, Castiglioni, Alessandro, additional, Maisano, Francesco, additional, and De Bonis, Michele, additional
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- 2023
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9. The impact of mitral valve surgery on ventricular arrhythmias in patients with Barlow’s disease: preliminary results of a prospective study
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Ascione, Guido, primary, Azzola Guicciardi, Nicolò, additional, Lorusso, Roberto, additional, Boccellino, Antonio, additional, Lapenna, Elisabetta, additional, Del Forno, Benedetto, additional, Carino, Davide, additional, Bisogno, Arturo, additional, Palmisano, Anna, additional, D’Angelo, Giuseppe, additional, Della Bella, Paolo, additional, Esposito, Antonio, additional, Agricola, Eustachio, additional, Alfieri, Ottavio, additional, Castiglioni, Alessandro, additional, Maisano, Francesco, additional, Vergara, Pasquale, additional, and De Bonis, Michele, additional
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- 2023
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10. Mitral Repair With Complete Rings or Posterior Bands in Barlow Disease: Long-term Results
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Del Forno, Benedetto, primary, Carino, Davide, additional, Bisogno, Arturo, additional, Rizzello, Angelica, additional, Lapenna, Elisabetta, additional, Ascione, Guido, additional, Gramegna, Federica, additional, Iaci, Giuseppe, additional, Agricola, Eustachio, additional, Monaco, Fabrizio, additional, Alfieri, Ottavio, additional, Castiglioni, Alessandro, additional, Maisano, Francesco, additional, and De Bonis, Michele, additional
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- 2023
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11. Neochordae implantation versus leaflet resection in mitral valve posterior leaflet prolapse and dilated left ventricle: a propensity score matching comparison with long-term follow-up.
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Forno, Benedetto Del, Tavana, Kevin, Ruffo, Claudio, Carino, Davide, Lapenna, Elisabetta, Ascione, Guido, Bisogno, Arturo, Belluschi, Igor, Scarale, Maria Giovanna, Nonis, Alessandro, Monaco, Fabrizio, Alfieri, Ottavio, Castiglioni, Alessandro, Maisano, Francesco, and Bonis, Michele De
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MITRAL valve ,PROPENSITY score matching ,VENTRICULAR ejection fraction ,PAMPHLETS ,MITRAL valve insufficiency ,MYOCARDIAL injury - Abstract
Open in new tab Download slide OBJECTIVES Uncorrected severe mitral regurgitation (MR) due to posterior prolapse leads to left ventricular dilatation. At this stage, mitral valve repair becomes mandatory to avoid permanent myocardial injury. However, which technique among neochoardae implantation and leaflet resection provides the best results in this scenario remains unknown. METHODS We selected 332 patients with left ventricular dilatation and severe degenerative MR due to posterior leaflet (PL) prolapse who underwent neochoardae implantation (85 patients) or PL resection (247 patients) at our institution between 2008 and 2020. A propensity score matching analysis was carried on to decrease the differences at baseline. RESULTS Matching yielded 85 neochordae implantations and 85 PL resections. At 10 years, freedom from cardiac death and freedom from mitral valve reoperation were 92.6 ± 6.1% vs 97.8 ± 2.1% and 97.7 ± 2.2% vs 95 ± 3% in the neochordae group and in the PL resection group, respectively. The MR ≥2+ recurrence rate was 23.9 ± 10% in the neochordae group and 20.8 ± 5.8% in the PL resection group (P = 0.834) at 10 years. At the last follow-up, the neochordae group showed a higher reduction of left ventricular end-diastolic diameter (44 vs 48 mm; P = 0.001) and a better ejection fraction (60% vs 55%; P < 0.001) compared to PL resection group. CONCLUSIONS In this subgroup of patients, both neochordae implantation and leaflet resection provide excellent durability of the repair in the long term. Neochordae implantation might have a better effect on dilated left ventricle. [ABSTRACT FROM AUTHOR]
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- 2023
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12. Edge-to-Edge Technique Used as a Bailout for Suboptimal Mitral Repair: Long-term Results
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Carino, Davide, primary, Lorusso, Roberto, additional, Del Forno, Benedetto, additional, Lapenna, Elisabetta, additional, Ascione, Guido, additional, Sala, Alessandra, additional, Ruggeri, Stefania, additional, Schavi, Davide, additional, Bargagna, Marta, additional, Maisano, Francesco, additional, Castiglioni, Alessandro, additional, Alfieri, Ottavio, additional, and De Bonis, Michele, additional
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- 2023
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13. Mitral annular calcification in patients with significant mitral valve disease: An old problem with new solutions
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Ascione, Guido, primary and Denti, Paolo, additional
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- 2022
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14. Surgical approach to combined mitral and tricuspid valve disease: good neighbourhood rules
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Ascione, Guido, primary, Carino, Davide, additional, and Alfieri, Ottavio, additional
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- 2022
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15. Long Term Results of Reduction Ascending Aortoplasty
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Trumello, Cinzia, primary, Giambuzzi, Ilaria, additional, Bargagna, Marta, additional, Tavana, Kevin, additional, Bisogno, Arturo, additional, Ascione, Guido, additional, Calabrese, Mariachiara, additional, Castiglioni, Alessandro, additional, Alfieri, Ottavio, additional, and De Bonis, Michele, additional
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- 2022
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16. Fate of moderate secondary mitral regurgitation in patients undergoing aortic valve replacement for severe aortic regurgitation
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Del Forno, Benedetto, primary, Ascione, Guido, additional, Gramegna, Federica, additional, Carino, Davide, additional, Lapenna, Elisabetta, additional, Verzini, Alessandro, additional, Alfieri, Ottavio, additional, Castiglioni, Alessandro, additional, Maisano, Francesco, additional, and De Bonis, Michele, additional
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- 2022
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17. Genetic background of mitral valve prolapse
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Guicciardi, Nicolò Azzola, primary, De Bonis, Michele, primary, Di Resta, Chiara, primary, Ascione, Guido, primary, Alfieri, Ottavio, primary, Maisano, Francesco, primary, and Vergara, Pasquale, primary
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- 2022
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18. New challenges in the era of low-intermediate risk transcatheter aortic valve replacement: surgery for infective endocarditis
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Ascione, Guido, primary and Denti, Paolo, additional
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- 2022
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19. The impact of the SARS-CoV-2 pandemic on healthcare provision in Italy to non-COVID patients: a systematic review
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Ottaviani Matteo Maria, Botta Annarita, Bruschi Alessandro, Lugli Gianmarco, Portaluri Tommaso, Romagnani Paola, Zammarchi Lorenzo, Ascione Guido, and Cagnazzo Federico
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Telemedicine ,Coronavirus disease 2019 (COVID-19) ,business.industry ,COVID-19 ,non-COVID patients ,Italy ,National Health System ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Scopus ,Review Article ,Guideline ,Hematology ,medicine.disease ,Public healthcare ,Infectious Diseases ,Pandemic ,Health care ,medicine ,Diseases of the blood and blood-forming organs ,Medical emergency ,RC633-647.5 ,business - Abstract
BackgroundItaly has been one of the countries most affected by the SARS-CoV-2 pandemic and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. We investigated the management of non-COVID-19 patients across all medical specialties during the pandemic in Italy.MethodsA PRISMA guideline-based systematic review of the available literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from 20 February to 25 June, 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialties in combination with our geographical focus (Italy) and COVID-19.FindingsOf the 4643 potentially eligible studies identified by the search, 247 studies were included in the systematic review. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialties have been affected by the reorganization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine during the pandemic.InterpretationOur work highlights the changes taking place in the Italian public healthcare system in order to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyze future directions for the healthcare system in the case of new pandemic scenarios.
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- 2022
20. The impact of the SARS-CoV-2 pandemic on healthcare provision in Italy to non-COVID patients: a systematic review
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Botta, Annarita, primary, Lugli, Gianmarco, additional, Ottaviani, Matteo Maria, additional, Ascione, Guido, additional, Bruschi, Alessandro, additional, Cagnazzo, Federico, additional, Zammarchi, Lorenzo, additional, Romagnani, Paola, additional, and Portaluri, Tommaso, additional
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- 2022
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21. Abstract 12016: Surgical Mitral Valve Repair for Degenerative Mitral Regurgitation: Defining the Benchmark for Trans-Catheter Options
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Del Forno, Benedetto, primary, D’Ovidio, Mariangela, additional, Carino, Davide, additional, Lapenna, Elisabetta, additional, Verzini, Alessandro, additional, Ascione, Guido, additional, Pinnarelli, Luigi, additional, Davoli, Marina, additional, Castiglioni, Alessandro, additional, Maisano, Francesco, additional, Alfieri, Ottavio, additional, and De Bonis, Michele, additional
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- 2021
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22. Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair
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Kaneko, Tsuyoshi, primary, Hirji, Sameer, additional, Zaid, Syed, additional, Lange, Rudiger, additional, Kempfert, Jörg, additional, Conradi, Lenard, additional, Hagl, Christian, additional, Borger, Michael A., additional, Taramasso, Maurizio, additional, Nguyen, Tom C., additional, Ailawadi, Gorav, additional, Shah, Ashish S., additional, Smith, Robert L., additional, Anselmi, Amedeo, additional, Romano, Matthew A., additional, Ben Ali, Walid, additional, Ramlawi, Basel, additional, Grubb, Kendra J., additional, Robinson, Newell B., additional, Pirelli, Luigi, additional, Chu, Michael W.A., additional, Andreas, Martin, additional, Obadia, Jean-Francois, additional, Gennari, Marco, additional, Garatti, Andrea, additional, Tchetche, Didier, additional, Nazif, Tamim M., additional, Bapat, Vinayak N., additional, Modine, Thomas, additional, Denti, Paolo, additional, Tang, Gilbert H.L., additional, Vitanova, Keti, additional, Krane, Markus, additional, Akansel, Serdar, additional, Bhadra, Oliver D., additional, Saha, Shekhar, additional, Bagaev, Erik, additional, Noack, Thilo, additional, Fahr, Florian, additional, Ascione, Guido, additional, Tagliari, Ana Paula, additional, Pizano, Alejandro, additional, Donatelle, Marissa, additional, Goel, Kashish, additional, Squiers, John J., additional, Shah, Pinak B., additional, Leurent, Guillaume, additional, Corbineau, Herve, additional, Asgar, Anita W., additional, Demers, Philippe, additional, Pellerin, Michel, additional, Bouchard, Denis, additional, Ruaengsri, Chawannuch, additional, Wang, Lin, additional, Petrossian, George A., additional, Kliger, Chad A., additional, Leroux, Lionel, additional, Algadheeb, Muhanad, additional, Lavi, Shahar, additional, Werner, Paul, additional, Flagiello, Michele, additional, Bartorelli, Antonio L., additional, Ghattas, Angie, additional, Dumonteil, Nicholas, additional, von Ballmoos, Moritz Wyler, additional, Atkins, Marvin D., additional, D'Onofrio, Augusto, additional, Tessari, Chiara, additional, Geirsson, Arnar, additional, Kaple, Ryan K., additional, Massi, Francesco, additional, Triggiani, Michele, additional, Van Belle, Eric, additional, Vincent, Flavien, additional, Denimal, Tom, additional, Brinkmann, Christina, additional, Schöfer, Joachim, additional, Di Eusanio, Marco, additional, Capestro, Filippo, additional, Estevez-Loureiro, Rodrigo, additional, Pinon, Miguel A., additional, Kleiman, Neal S., additional, Reardon, Michael J., additional, Szerlip, Molly I., additional, DiMaio, J. Michael, additional, Mack, Michael J., additional, Lim, D. Scott, additional, Falk, Volkmar, additional, Maisano, Francesco, additional, George, Isaac, additional, and Hahn, Rebecca T., additional
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- 2021
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23. Transcatheter Mitral Valve Replacement and Thrombosis: A Review
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Ascione, Guido, primary and Denti, Paolo, additional
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- 2021
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24. Long-term fate of moderate aortic regurgitation left untreated at the time of mitral valve surgery
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Del Forno, Benedetto, primary, Ascione, Guido, additional, Bisogno, Arturo, additional, Carino, Davide, additional, Lapenna, Elisabetta, additional, Verzini, Alessandro, additional, Bargagna, Marta, additional, Ruggeri, Stefania, additional, Schiavi, Davide, additional, Meneghin, Roberta, additional, Agricola, Eustachio, additional, Monaco, Fabrizio, additional, Alfieri, Ottavio, additional, Castiglioni, Alessandro, additional, and De Bonis, Michele, additional
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- 2021
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25. Isolated tricuspid valve surgery: first outcomes report according to a novel clinical and functional staging of tricuspid regurgitation
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Sala, Alessandra, primary, Lorusso, Roberto, additional, Bargagna, Marta, additional, Ascione, Guido, additional, Ruggeri, Stefania, additional, Meneghin, Roberta, additional, Schiavi, Davide, additional, Buzzatti, Nicola, additional, Trumello, Cinzia, additional, Monaco, Fabrizio, additional, Agricola, Eustachio, additional, Alfieri, Ottavio, additional, Castiglioni, Alessandro, additional, and De Bonis, Michele, additional
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- 2021
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26. Commissural closure to treat severe mitral regurgitation: standing the test of time.
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Carino, Davide, Lorusso, Roberto, Lapenna, Elisabetta, Forno, Benedetto Del, Sala, Alessandra, Zancanaro, Edoardo, Ruggeri, Stefania, Abboud, Sabrin, Schiavi, Davide, Ascione, Guido, Castiglioni, Alessandro, Alfieri, Ottavio, Maisano, Francesco, and Bonis, Michele De
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MITRAL valve insufficiency ,MITRAL valve ,GENERALIZED estimating equations ,MITRAL stenosis ,CONFIDENCE intervals ,REOPERATION ,HEART valve prosthesis implantation - Abstract
Open in new tab Download slide OBJECTIVES Mitral regurgitation (MR) due to commissural prolapse or flail represents a pattern of valve dysfunction that can be treated, among other techniques, by suturing the margins of the anterior and posterior leaflets in the commissural area (commissural closure). The very long-term results of this technique have not been reported so far and represent the objective of this study. METHODS A retrospective review of our institutional database was carried on querying for patients who underwent commissural closure and ring annuloplasty within the time frame 1997–2007 to provide a robust long-term assessment. Cumulative incidence function (CIF) using death as a competitive outcome was used to estimate cardiac death and reoperation for mitral valve replacement. To describe the time course of MR, we performed a longitudinal analysis using generalized estimating equations with a random intercept for correlated data. RESULTS A total of 125 patients were included. At 15 years, the CIF for cardiac death, with non-cardiac death as a competitive event, was 8.0 ± 2.57% (95% confidence interval [3.88–13.93]). At 15 years, the CIF for reintervention for a mitral valve replacement with death as a competitive event was 5.0 ± 1.98%, 95% confidence interval [2.04–9.89]. No significant predictors of reintervention for mitral valve replacement were identified. At 5 years, the predicted rate of MR ≥3+ recurrence was 2.53% while it was 8.22% at 15 years. In no case a more than mild mitral stenosis was detected. CONCLUSIONS Severe MR due to commissural prolapse/flail can be effectively treated with commissural closure and ring annuloplasty. In our series, the rate of reoperation in the very long term was extremely low. Similarly, longitudinal analysis demonstrated a very low rate of MR ≥3+ recurrence. [ABSTRACT FROM AUTHOR]
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- 2022
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27. Fate of mild‐to‐moderate bicuspid aortic valve disease untreated during ascending aorta replacement
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Verzini, Alessandro, primary, Bargagna, Marta, additional, Ascione, Guido, additional, Sala, Alessandra, additional, Carino, Davide, additional, Del Forno, Benedetto, additional, Blasio, Andrea, additional, Ruggeri, Stefania, additional, Castiglioni, Alessandro, additional, Alfieri, Ottavio, additional, and De Bonis, Michele, additional
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- 2021
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28. Is mitral annuloplasty an effective treatment for severe atrial functional mitral regurgitation?
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Carino, Davide, primary, Lapenna, Elisabetta, additional, Ascione, Guido, additional, Ruggeri, Stefania, additional, Del Forno, Benedetto, additional, Castiglioni, Alessandro, additional, Alfieri, Ottavio, additional, and De Bonis, Michele, additional
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- 2021
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29. Fate of mild-to-moderate bicuspid aortic valve disease untreated during ascending aorta replacement
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Verzini, Alessandro, primary, Bargagna, Marta, additional, Ascione, Guido, additional, Sala, Alessandra, additional, Carino, Davide, additional, Forno, Benedetto Del, additional, Blasio, Andrea, additional, Ruggeri, Stefania, additional, Castiglioni, Alessandro, additional, Alfieri, Ottavio, additional, and Bonis, Michele De, additional
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- 2020
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30. Treatment of isolated tricuspid regurgitation in 2020: an update
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Ascione, Guido, primary, Del Forno, Benedetto, additional, Carino, Davide, additional, Lapenna, Elisabetta, additional, Schiavi, Davide, additional, Denti, Paolo, additional, Bisogno, Arturo, additional, Verzini, Alessandro, additional, Iaci, Giuseppe, additional, Alfieri, Ottavio, additional, Castiglioni, Alessandro, additional, and De Bonis, Michele, additional
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- 2020
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31. Is the EuroSCORE II reliable in surgical mitral valve repair? A single-centre validation study
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Carino, Davide, primary, Denti, Paolo, additional, Ascione, Guido, additional, Del Forno, Benedetto, additional, Lapenna, Elisabetta, additional, Ruggeri, Stefania, additional, Agricola, Eustachio, additional, Buzzatti, Nicola, additional, Verzini, Alessandro, additional, Meneghin, Roberta, additional, Scandroglio, Anna Mara, additional, Monaco, Fabrizio, additional, Castiglioni, Alessandro, additional, Alfieri, Ottavio, additional, and De Bonis, Michele, additional
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- 2020
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32. RegenHeart: A Time-Effective, Low-Concentration, Detergent-Based Method Aiming for Conservative Decellularization of the Whole Heart Organ
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Dal Sasso, Eleonora, primary, Menabò, Roberta, additional, Agrillo, Davide, additional, Arrigoni, Giorgio, additional, Franchin, Cinzia, additional, Giraudo, Chiara, additional, Filippi, Andrea, additional, Borile, Giulia, additional, Ascione, Guido, additional, Zanella, Fabio, additional, Fabozzo, Assunta, additional, Motta, Raffaella, additional, Romanato, Filippo, additional, Di Lisa, Fabio, additional, Iop, Laura, additional, and Gerosa, Gino, additional
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- 2020
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33. Reply to Cimciet al.
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Del Forno, Benedetto, primary, Ascione, Guido, additional, Alfieri, Ottavio, additional, and De Bonis, Michele, additional
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- 2020
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34. Optimal versus suboptimal mitral valve repair: late results in a matched cohort study
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De Bonis, Michele, primary, Zancanaro, Edoardo, additional, Lapenna, Elisabetta, additional, Trumello, Cinzia, additional, Ascione, Guido, additional, Giambuzzi, Ilaria, additional, Ruggeri, Stefania, additional, Meneghin, Roberta, additional, Abboud, Sabrin, additional, Agricola, Eustachio, additional, Del Forno, Benedetto, additional, Buzzatti, Nicola, additional, Monaco, Fabrizio, additional, Pappalardo, Federico, additional, Castiglioni, Alessandro, additional, and Alfieri, Ottavio, additional
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- 2020
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35. Is myocardial revascularization really necessary in patients with ≥50% but <70% coronary stenosis undergoing valvular surgery?
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Del Forno, Benedetto, primary, Ascione, Guido, additional, Lapenna, Elisabetta, additional, Trumello, Cinzia, additional, Ruggeri, Stefania, additional, Belluschi, Igor, additional, Verzini, Alessandro, additional, Iaci, Giuseppe, additional, Ferrara, David, additional, Schiavi, Davide, additional, Meneghin, Roberta, additional, Castiglioni, Alessandro, additional, Alfieri, Ottavio, additional, and De Bonis, Michele, additional
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- 2020
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36. The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review.
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Lugli, Gianmarco, Ottaviani, Matteo Maria, Botta, Annarita, Ascione, Guido, Bruschi, Alessandro, Cagnazzo, Federico, Zammarchi, Lorenzo, Romagnani, Paola, and Portaluri, Tommaso
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COVID-19 pandemic ,DISEASE management ,MEDICAL care ,HOSPITAL care ,EMERGENCY management - Abstract
Background: Italy has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of noncommunicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy. Methods: A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19. Results: Of the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine. Conclusions: Our work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios. [ABSTRACT FROM AUTHOR]
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- 2022
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37. Long-term fate of moderate aortic regurgitation left untreated at the time of mitral valve surgery.
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Forno, Benedetto Del, Ascione, Guido, Bisogno, Arturo, Carino, Davide, Lapenna, Elisabetta, Verzini, Alessandro, Bargagna, Marta, Ruggeri, Stefania, Schiavi, Davide, Meneghin, Roberta, Agricola, Eustachio, Monaco, Fabrizio, Alfieri, Ottavio, Castiglioni, Alessandro, and Bonis, Michele De
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AORTIC valve insufficiency , *MITRAL valve surgery , *AORTIC valve transplantation , *MITRAL valve , *TRICUSPID valve surgery ,AORTIC valve surgery - Abstract
Open in new tab Download slide Open in new tab Download slide OBJECTIVES The appropriateness of moderate aortic regurgitation treatment during mitral valve (MV) surgery remains unclear. The goal of this study was to evaluate the immediate and long-term outcomes of patients with moderate aortic regurgitation at the time of MV surgery. METHODS We included 183 patients admitted to our institution for elective treatment of MV disease between 2004 and 2018, in whom moderate aortic regurgitation was diagnosed during preoperative evaluation. One hundred and twenty-two patients underwent isolated MV surgery (study group) whereas 61 patients underwent concomitant MV surgery and aortic valve replacement (control group). RESULTS One death (0.8%) occurred in the study group, and 3 deaths (4.8%) occurred in the control group (P = 0.52). The rate of the most common postoperative complication was similar between the 2 groups. At 12 years, the cumulative incidence function of cardiac death, with non-cardiac death as a competing risk, was 4.7 ± 2.8% in the study group; no cardiac deaths were observed in the control group (P = 0.078). At 6 and 12 years, in the study group, the cumulative incidence function of aortic valve reintervention, with death as a competing risk, was 2.5 ± 1.85% and 19 ± 7.1%, respectively. CONCLUSIONS The appropriate management of moderate aortic regurgitation at the time of MV surgery deserves a careful evaluation by balancing the reintervention rate with the age, the operative risk and the life expectancy of the patient. Our findings suggest that a patient-tailored approach is the key to achieving the best clinical outcome for each individual patient. [ABSTRACT FROM AUTHOR]
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- 2021
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38. Is the EuroSCORE II reliable in surgical mitral valve repair? A single-centre validation study.
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Carino, Davide, Denti, Paolo, Ascione, Guido, Forno, Benedetto Del, Lapenna, Elisabetta, Ruggeri, Stefania, Agricola, Eustachio, Buzzatti, Nicola, Verzini, Alessandro, Meneghin, Roberta, Scandroglio, Anna Mara, Monaco, Fabrizio, Castiglioni, Alessandro, Alfieri, Ottavio, and Bonis, Michele De
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MITRAL valve ,RECEIVER operating characteristic curves ,MITRAL valve insufficiency ,GOODNESS-of-fit tests - Abstract
Open in new tab Download slide Open in new tab Download slide OBJECTIVES The EuroSCORE II is widely used to predict 30-day mortality in patients undergoing open and transcatheter cardiac surgery. The aim of this study is to evaluate the discriminatory ability of the EuroSCORE II in predicting 30-day mortality in a large cohort of patients undergoing surgical mitral valve repair in a high-volume centre. METHODS A retrospective review of our institutional database was carried on to find all patients who underwent mitral valve repair in our department from January 2012 to December 2019. Discrimination of the EuroSCORE II was assessed using receiver operating characteristic curves. The maximum Youden's Index was employed to define the optimal cut-point. Calibration was assessed by generating calibration plot that visually compares the predicted mortality with the observed mortality. Calibration was also tested with the Hosmer–Lemeshow goodness-of-fit test. Finally, the accuracy of the models was tested calculating the Brier score. RESULTS A total of 2645 patients were identified, and the median EuroSCORE II was 1.3% (0.6–2.0%). In patients with degenerative mitral regurgitation (MR), the EuroSCORE II showed low discrimination (area under the curve 0.68), low accuracy (Brier score 0.27) and low calibration with overestimation of the 30-day mortality. In patients with secondary MR, the EuroSCORE II showed a good overall performance estimating the 30-day mortality with good discrimination (area under the curve 0.88), good accuracy (Brier score 0.003) and good calibration. CONCLUSIONS In patients with degenerative MR operated on in a high-volume centre with a high level of expertise in mitral valve repair, the EuroSCORE II significantly overestimates the 30-day mortality. [ABSTRACT FROM AUTHOR]
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- 2021
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39. Is myocardial revascularization really necessary in patients with ≥50% but <70% coronary stenosis undergoing valvular surgery?
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Forno, Benedetto Del, Ascione, Guido, Lapenna, Elisabetta, Trumello, Cinzia, Ruggeri, Stefania, Belluschi, Igor, Verzini, Alessandro, Iaci, Giuseppe, Ferrara, David, Schiavi, Davide, Meneghin, Roberta, Castiglioni, Alessandro, Alfieri, Ottavio, and Bonis, Michele De
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CORONARY artery stenosis , *MYOCARDIAL revascularization , *MINIMALLY invasive procedures , *MITRAL valve surgery , *CORONARY artery bypass ,AORTIC valve surgery - Abstract
Open in new tab Download slide Open in new tab Download slide OBJECTIVES The aim of this study is to evaluate the immediate and mid-term effects of omitting coronary artery bypass grafting in patients with moderate coronary artery stenosis who have a primary indication for valvular surgery. METHODS We included 77 consecutive patients admitted to our Institution for aortic or mitral valve surgery between June 2012 and June 2017 in whom a de novo diagnosis of ≥50%, but <70% coronary stenosis was made. In this cohort, the myocardial revascularization was omitted. All these patients were free from angina and ischaemia on echo and ECG. RESULTS There were no in-hospital deaths. In only 1 patient, acute myocardial infarction occurred postoperatively, which was immediately treated by percutaneous coronary intervention (PCI). The 6-year overall survival was 94.7 ± 2.59%. At 6 years, no cardiac deaths were recorded. At follow-up, 4 patients underwent elective PCI after a positive stress myocardial perfusion test. Only 1 patient underwent urgent PCI due to acute coronary syndrome. At 6 years, the cumulative incidence function of PCI, with death as competing risk, was 8 ± 3.9%. CONCLUSIONS In our experience, moderate coronary stenosis, occasionally discovered at the time of valvular heart surgery, can be safely overlooked and do not need any further treatment at follow-up in the majority of cases. Our results open up the opportunity to apply this 'intentional omission strategy' in different situations, such as minimally invasive heart surgery, percutaneous procedures and complex patients. [ABSTRACT FROM AUTHOR]
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- 2020
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40. Optimal versus suboptimal mitral valve repair: late results in a matched cohort study.
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Bonis, Michele De, Zancanaro, Edoardo, Lapenna, Elisabetta, Trumello, Cinzia, Ascione, Guido, Giambuzzi, Ilaria, Ruggeri, Stefania, Meneghin, Roberta, Abboud, Sabrin, Agricola, Eustachio, Forno, Benedetto Del, Buzzatti, Nicola, Monaco, Fabrizio, Pappalardo, Federico, Castiglioni, Alessandro, and Alfieri, Ottavio
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MITRAL valve ,MITRAL valve insufficiency ,ANGIOTENSIN converting enzyme ,COHORT analysis ,PERCUTANEOUS balloon valvuloplasty - Abstract
Open in new tab Download slide Open in new tab Download slide OBJECTIVES After mitral repair for degenerative mitral regurgitation (MR), no or mild (≤1+/4+) residual MR should remain. Occasionally patients are left with more than mild residual MR (>1+/4+) for a number of reasons. The aim of this study was to assess the late implications of such a suboptimal repair in a matched cohort study. METHODS From 2006 to 2013, a total of 2158 patients underwent mitral repair for degenerative MR in our institution. Fifty patients (2.3%) with residual MR >1+ at hospital discharge (study group) were matched up to 1:2 with 91 patients operated on during the same period who were discharged with MR ≤1+ (control group). The median follow-up was 8 years (interquartile range 6.3–10.1, longest 12.7 years). A comparative analysis of the outcomes in the 2 groups was performed. RESULTS Overall survival at 8 years was 87 ± 8% in the study group and 92 ± 3% in the control group (P = 0.23). There were 3 late deaths (6.0%) in the study group and 6 deaths (6.6%) in the control group. Freedom from reoperation was similar (P = 1.0). At 8 years the prevalence of MR ≥3+ was significantly higher in the study group (15.6% vs 2.1%, P < 0.001) as was the use of diuretics, beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers. Interestingly, even in the control group, a gradual progression of MR was observed because 13.3% of the patients had MR ≥2+ at 8 years with a significant increase over time (P < 0.001). CONCLUSIONS Residual MR more than mild at hospital discharge is associated with lower durability of mitral repair and the need for more medical therapy in the long term. However, even an initial optimal result does not completely arrest the progression of the degenerative process. [ABSTRACT FROM AUTHOR]
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- 2020
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41. Reply to Cimci et al.
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Forno, Benedetto Del, Ascione, Guido, Alfieri, Ottavio, and Bonis, Michele De
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CORONARY artery bypass , *AORTIC valve transplantation , *MITRAL valve - Abstract
Moderate coronary stenosis, Aortic valve replacement, Mitral valve replacement, Mitral valve repair, Intentional omission strategy, Coronary artery bypass grafting. [Extracted from the article]
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- 2021
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42. Mitral Repair With Complete Rings or Posterior Bands in Barlow Disease: Long-term Results
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Benedetto Del Forno, Davide Carino, Arturo Bisogno, Angelica Rizzello, Elisabetta Lapenna, Guido Ascione, Federica Gramegna, Giuseppe Iaci, Eustachio Agricola, Fabrizio Monaco, Ottavio Alfieri, Alessandro Castiglioni, Francesco Maisano, Michele De Bonis, Del Forno, Benedetto, Carino, Davide, Bisogno, Arturo, Rizzello, Angelica, Lapenna, Elisabetta, Ascione, Guido, Gramegna, Federica, Iaci, Giuseppe, Agricola, Eustachio, Monaco, Fabrizio, Alfieri, Ottavio, Castiglioni, Alessandro, Maisano, Francesco, and De Bonis, Michele
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Complete rings or posterior bands are both commonly used during mitral valve repair, but which one ensures the best long-term outcome in patients with Barlow disease is a topic of debate. This study evaluated whether the type of annuloplasty device affects the long-term durability of the repair.We selected 296 consecutive patients with severe mitral regurgitation due to Barlow disease who underwent edge-to-edge mitral repair at our institution between 2004 and 2013. For the edge-to-edge repair, a complete semirigid ring was used in 151 patients, whereas a posterior flexible band was used in 145 patients. The clinical and echocardiographic outcomes of both groups were compared at long-term follow-up.At 14 years, the overall survival was 87.3% ± 2.79% in the ring group and 94.1% ± 2.30% in the band group (P = .056). The incidence of mitral valve reintervention was 4.9% ± 1.95% in the ring group and 5.5% ± 2.53% in the band group (P = .371) at 14 years. The incidence of recurrence of mitral regurgitation ≥3+ and ≥2+ was 8.3% ± 2.64% in the ring group and 8.7% ± 3.07% in the band group (P = .991) and 26.5% ± 4.23% in the ring group and 17.4% ± 3.26% in the band group (P = .697), respectively. Mitral regurgitation ≥1+ at discharge was the only independent predictor of reoperation and recurrence of mitral regurgitation ≥3+ in the long-term.In patients with Barlow disease undergoing edge-to-edge mitral valve repair, the type of annuloplasty device does not influence the long-term results. Achieving an optimal immediate result remains the key to maintain the stability of the repair at long-term.
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- 2023
43. Is the EuroSCORE II reliable in surgical mitral valve repair? A single-centre validation study
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Alessandro Verzini, Roberta Meneghin, Guido Ascione, Stefania Ruggeri, Michele De Bonis, Nicola Buzzatti, Ottavio Alfieri, Anna Mara Scandroglio, Fabrizio Monaco, Elisabetta Lapenna, Davide Carino, Eustachio Agricola, Paolo Denti, Benedetto Del Forno, Alessandro Castiglioni, Carino, Davide, Denti, Paolo, Ascione, Guido, Del Forno, Benedetto, Lapenna, Elisabetta, Ruggeri, Stefania, Agricola, Eustachio, Buzzatti, Nicola, Verzini, Alessandro, Meneghin, Roberta, Scandroglio, Anna Mara, Monaco, Fabrizio, Castiglioni, Alessandro, Alfieri, Ottavio, and De Bonis, Michele
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Validation study ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Risk Assessment ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Euroscore ii ,Risk Factors ,Risks scores ,Internal medicine ,Humans ,Medicine ,Hospital Mortality ,Cardiac Surgical Procedures ,Retrospective Studies ,Mitral valve repair ,Mitral regurgitation ,Receiver operating characteristic ,business.industry ,Area under the curve ,General Medicine ,EuroSCORE II ,Degenerative mitral regurgitation ,Cardiac surgery ,ROC Curve ,Secondary mitral regurgitation ,030228 respiratory system ,Brier score ,Cardiology ,Mitral Valve ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES The EuroSCORE II is widely used to predict 30-day mortality in patients undergoing open and transcatheter cardiac surgery. The aim of this study is to evaluate the discriminatory ability of the EuroSCORE II in predicting 30-day mortality in a large cohort of patients undergoing surgical mitral valve repair in a high-volume centre. METHODS A retrospective review of our institutional database was carried on to find all patients who underwent mitral valve repair in our department from January 2012 to December 2019. Discrimination of the EuroSCORE II was assessed using receiver operating characteristic curves. The maximum Youden’s Index was employed to define the optimal cut-point. Calibration was assessed by generating calibration plot that visually compares the predicted mortality with the observed mortality. Calibration was also tested with the Hosmer–Lemeshow goodness-of-fit test. Finally, the accuracy of the models was tested calculating the Brier score. RESULTS A total of 2645 patients were identified, and the median EuroSCORE II was 1.3% (0.6–2.0%). In patients with degenerative mitral regurgitation (MR), the EuroSCORE II showed low discrimination (area under the curve 0.68), low accuracy (Brier score 0.27) and low calibration with overestimation of the 30-day mortality. In patients with secondary MR, the EuroSCORE II showed a good overall performance estimating the 30-day mortality with good discrimination (area under the curve 0.88), good accuracy (Brier score 0.003) and good calibration. CONCLUSIONS In patients with degenerative MR operated on in a high-volume centre with a high level of expertise in mitral valve repair, the EuroSCORE II significantly overestimates the 30-day mortality.
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- 2020
44. Commissural closure to treat severe mitral regurgitation: standing the test of time
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Davide Carino, Roberto Lorusso, Elisabetta Lapenna, Benedetto Del Forno, Alessandra Sala, Edoardo Zancanaro, Stefania Ruggeri, Sabrin Abboud, Davide Schiavi, Guido Ascione, Alessandro Castiglioni, Ottavio Alfieri, Francesco Maisano, Michele De Bonis, CTC, MUMC+: MA Med Staf Spec CTC (9), RS: Carim - V04 Surgical intervention, Carino, Davide, Lorusso, Roberto, Lapenna, Elisabetta, Del Forno, Benedetto, Sala, Alessandra, Zancanaro, Edoardo, Ruggeri, Stefania, Abboud, Sabrin, Schiavi, Davide, Ascione, Guido, Castiglioni, Alessandro, Alfieri, Ottavio, Maisano, Francesco, and De Bonis, Michele
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Reoperation ,Pulmonary and Respiratory Medicine ,OUTCOMES ,Mitral Valve Annuloplasty ,Mitral Valve Prolapse ,PROLAPSE ,Mitral Valve Insufficiency ,General Medicine ,LEAFLET ,ANTERIOR ,Treatment Outcome ,POSTERIOR ,Edge to edge mitral repair ,Commissural prolapse ,VALVE REPAIR ,Humans ,Mitral Valve ,Surgery ,Cardiology and Cardiovascular Medicine ,Mitral valve repair ,Retrospective Studies ,Mitral regurgitation - Abstract
OBJECTIVES Mitral regurgitation (MR) due to commissural prolapse or flail represents a pattern of valve dysfunction that can be treated, among other techniques, by suturing the margins of the anterior and posterior leaflets in the commissural area (commissural closure). The very long-term results of this technique have not been reported so far and represent the objective of this study. METHODS A retrospective review of our institutional database was carried on querying for patients who underwent commissural closure and ring annuloplasty within the time frame 1997–2007 to provide a robust long-term assessment. Cumulative incidence function (CIF) using death as a competitive outcome was used to estimate cardiac death and reoperation for mitral valve replacement. To describe the time course of MR, we performed a longitudinal analysis using generalized estimating equations with a random intercept for correlated data. RESULTS A total of 125 patients were included. At 15 years, the CIF for cardiac death, with non-cardiac death as a competitive event, was 8.0 ± 2.57% (95% confidence interval [3.88–13.93]). At 15 years, the CIF for reintervention for a mitral valve replacement with death as a competitive event was 5.0 ± 1.98%, 95% confidence interval [2.04–9.89]. No significant predictors of reintervention for mitral valve replacement were identified. At 5 years, the predicted rate of MR ≥3+ recurrence was 2.53% while it was 8.22% at 15 years. In no case a more than mild mitral stenosis was detected. CONCLUSIONS Severe MR due to commissural prolapse/flail can be effectively treated with commissural closure and ring annuloplasty. In our series, the rate of reoperation in the very long term was extremely low. Similarly, longitudinal analysis demonstrated a very low rate of MR ≥3+ recurrence.
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- 2022
45. Is myocardial revascularization really necessary in patients with ≥50% but <70% coronary stenosis undergoing valvular surgery?
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Giuseppe Iaci, Alessandro Castiglioni, Guido Ascione, Davide Schiavi, Stefania Ruggeri, Alessandro Verzini, Michele De Bonis, Ottavio Alfieri, David Ferrara, Elisabetta Lapenna, Roberta Meneghin, Igor Belluschi, Benedetto Del Forno, Cinzia Trumello, Del Forno, Benedetto, Ascione, Guido, Lapenna, Elisabetta, Trumello, Cinzia, Ruggeri, Stefania, Belluschi, Igor, Verzini, Alessandro, Iaci, Giuseppe, Ferrara, David, Schiavi, Davide, Meneghin, Roberta, Castiglioni, Alessandro, Alfieri, Ottavio, and De Bonis, Michele
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Acute coronary syndrome ,Moderate coronary stenosi ,medicine.medical_treatment ,Coronary artery bypass grafting ,030204 cardiovascular system & hematology ,Valvular heart surgery ,Angina ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,Aortic valve replacement ,medicine ,Myocardial infarction ,Mitral valve repair ,business.industry ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Surgery ,030228 respiratory system ,Conventional PCI ,Mitral valve replacement ,Cardiology and Cardiovascular Medicine ,business ,Intentional omission strategy - Abstract
OBJECTIVES The aim of this study is to evaluate the immediate and mid-term effects of omitting coronary artery bypass grafting in patients with moderate coronary artery stenosis who have a primary indication for valvular surgery. METHODS We included 77 consecutive patients admitted to our Institution for aortic or mitral valve surgery between June 2012 and June 2017 in whom a de novo diagnosis of ≥50%, but RESULTS There were no in-hospital deaths. In only 1 patient, acute myocardial infarction occurred postoperatively, which was immediately treated by percutaneous coronary intervention (PCI). The 6-year overall survival was 94.7 ± 2.59%. At 6 years, no cardiac deaths were recorded. At follow-up, 4 patients underwent elective PCI after a positive stress myocardial perfusion test. Only 1 patient underwent urgent PCI due to acute coronary syndrome. At 6 years, the cumulative incidence function of PCI, with death as competing risk, was 8 ± 3.9%. CONCLUSIONS In our experience, moderate coronary stenosis, occasionally discovered at the time of valvular heart surgery, can be safely overlooked and do not need any further treatment at follow-up in the majority of cases. Our results open up the opportunity to apply this ‘intentional omission strategy’ in different situations, such as minimally invasive heart surgery, percutaneous procedures and complex patients.
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- 2020
46. Edge-to-Edge Technique Used as a Bailout for Suboptimal Mitral Repair: Long-term Results
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Davide Carino, Roberto Lorusso, Benedetto Del Forno, Elisabetta Lapenna, Guido Ascione, Alessandra Sala, Stefania Ruggeri, Davide Schavi, Marta Bargagna, Francesco Maisano, Alessandro Castiglioni, Ottavio Alfieri, Michele De Bonis, Carino, Davide, Lorusso, Roberto, Del Forno, Benedetto, Lapenna, Elisabetta, Ascione, Guido, Sala, Alessandra, Ruggeri, Stefania, Schavi, Davide, Bargagna, Marta, Maisano, Francesco, Castiglioni, Alessandro, Alfieri, Ottavio, De Bonis, Michele, CTC, MUMC+: MA Cardiothoracale Chirurgie (3), and RS: Carim - V04 Surgical intervention
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Pulmonary and Respiratory Medicine ,Treatment Outcome ,Mitral Valve Prolapse ,Echocardiography ,Humans ,Mitral Valve Insufficiency ,Mitral Valve ,Surgery ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
For cases of initial suboptimal mitral valve repair, the edge-to-edge (EE) technique has been used as a bailout procedure. However the long-term durability of those rescued mitral valves is currently unknown. With this study we aim to evaluate the long-term clinical and echocardiographic results of the EE technique used to rescue patients with initial suboptimal conventional mitral valve repair.A retrospective review of our institutional database was done to query for patients who had undergone mitral valve repair with the EE technique used as a bailout procedure. The cumulative incidence function using death as a competing event was used to estimate cardiac death and redo for mitral valve replacement. To describe the time course of mitral regurgitation, we performed a longitudinal analysis using generalized estimating equations with random intercept for correlated data.Eighty-one patients were selected. The median follow-up was 9.1 years (interquartile range, 6.7-12.1; maximum, 22.6 years). At 15 years the estimated Kaplan-Meier overall survival was 63.2% ± 8.69% (95% confidence interval, 43.76-77.46) and the predicted rate of moderate to severe mitral regurgitation recurrence was 16.67%. At 15 years the cumulative incidence function for redo for mitral valve replacement with death as a competing event was 2.5% (95% confidence interval, 0.48-7.84). No case of more than mild mitral stenosis was detected.The EE technique can be effectively used as a bailout procedure in patients with suboptimal conventional mitral valve repair with satisfactory long-term results.
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- 2022
47. Genetic background of mitral valve prolapse
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Pasquale Vergara, Francesco Maisano, Ottavio Alfieri, Guido Ascione, Chiara Di Resta, Michele De Bonis, Nicolò Azzola Guicciardi, Vergara, Pasquale, Maisano, Francesco, Alfieri, Ottavio, Ascione, Guido, Di Resta, Chiara, De Bonis, Michele, and Guicciardi, Nicolò Azzola
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Mitral Valve Prolapse ,Phenotype ,Humans ,General Medicine ,Cardiology and Cardiovascular Medicine ,Genetic Background ,Adaptor Proteins, Signal Transducing ,Genome-Wide Association Study - Abstract
Mitral valve prolapse (MVP) has a prevalence of 2-3% among the population. It involves a heterogeneous group of patients with different expressions and according to the phenotype can be further divided into fibroelastic deficiency, which is mainly considered as a degeneration due to aging, and myxomatous disease, frequently associated with familiar clusters. Thus, MVP can be present in syndromic, when part of a well-defined syndrome, and non-syndromic forms. The latter occurs more often. To the second belong both familiar and isolated or sporadic forms. On one hand, among familial forms, although X-linked transmission related to
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- 2022
48. Fate of moderate secondary mitral regurgitation in patients undergoing aortic valve replacement for severe aortic regurgitation
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Benedetto Del Forno, Guido Ascione, Federica Gramegna, Davide Carino, Elisabetta Lapenna, Alessandro Verzini, Ottavio Alfieri, Alessandro Castiglioni, Francesco Maisano, Michele De Bonis, Del Forno, Benedetto, Ascione, Guido, Gramegna, Federica, Carino, Davide, Lapenna, Elisabetta, Verzini, Alessandro, Alfieri, Ottavio, Castiglioni, Alessandro, Maisano, Francesco, and De Bonis, Michele
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Pulmonary and Respiratory Medicine ,Heart Valve Prosthesis Implantation ,multivalvular heart disease ,Aortic Valve Insufficiency ,Mitral Valve Insufficiency ,aortic regurgitation ,moderate mitral regurgitation ,Death ,Treatment Outcome ,Aortic Valve ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,secondary mitral regurgitation ,functional mitral regurgitation ,Retrospective Studies - Abstract
Moderate secondary mitral regurgitation is common in patients with severe aortic regurgitation, but whether it has to be addressed at the time of aortic valve surgery remains unclear. With this study, we evaluated the long-term fate of moderate secondary mitral regurgitation in this specific scenario.Between January 2004 and January 2018, in 154 patients admitted to our institution for treatment of severe aortic regurgitation, a moderate secondary mitral regurgitation was diagnosed. Ninety-four patients underwent isolated aortic valve replacement (group 1) and 60 patients underwent also concomitant mitral valve annuloplasty (group 2).One death (1.1%) occurred in group 1, whereas two deaths (3.3%) occurred in group 2 (p = .561). At 11 years, the cumulative incidence function of cardiac death, with noncardiac death as a competing risk was 11.5 ± 5.11% in group 1 and 8.3 ± 5.15% in group 2 (p = .731). The cumulative incidence function of mitral valve reintervention, with death as a competing risk, was 3.7 ± 2.61% in group 1 and 4.5 ± 4.35% in group 2 (p = .620) at 11 years. Secondary mitral regurgitation improved to ≤mild in 66% and 76% of the survivors of group 1 and group 2, respectively (p = .67).In our experience, in patients with moderate secondary mitral regurgitation undergoing aortic valve replacement for severe aortic regurgitation, concomitant mitral valve annuloplasty did not improve the long-term survival, the incidence of cardiac death and mitral valve reoperation or the evolution of the mitral valve disease.
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- 2022
49. Long-term fate of moderate aortic regurgitation left untreated at the time of mitral valve surgery
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Michele De Bonis, Ottavio Alfieri, Roberta Meneghin, Benedetto Del Forno, Fabrizio Monaco, Alessandro Castiglioni, Eustachio Agricola, Marta Bargagna, Davide Schiavi, Davide Carino, Elisabetta Lapenna, Guido Ascione, Stefania Ruggeri, Arturo Bisogno, Alessandro Verzini, Del Forno, Benedetto, Ascione, Guido, Bisogno, Arturo, Carino, Davide, Lapenna, Elisabetta, Verzini, Alessandro, Bargagna, Marta, Ruggeri, Stefania, Schiavi, Davide, Meneghin, Roberta, Agricola, Eustachio, Monaco, Fabrizio, Alfieri, Ottavio, Castiglioni, Alessandro, and De Bonis, Michele
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Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,medicine.medical_treatment ,Moderate aortic regurgitation ,Aortic Valve Insufficiency ,Multivalvular heart disease ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Mitral valve ,medicine ,Humans ,030212 general & internal medicine ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Mitral valve repair ,business.industry ,Mitral valve replacement ,Postoperative complication ,Mitral Valve Insufficiency ,General Medicine ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Concomitant ,Aortic Valve ,Heart Valve Prosthesis ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES The appropriateness of moderate aortic regurgitation treatment during mitral valve (MV) surgery remains unclear. The goal of this study was to evaluate the immediate and long-term outcomes of patients with moderate aortic regurgitation at the time of MV surgery. METHODS We included 183 patients admitted to our institution for elective treatment of MV disease between 2004 and 2018, in whom moderate aortic regurgitation was diagnosed during preoperative evaluation. One hundred and twenty-two patients underwent isolated MV surgery (study group) whereas 61 patients underwent concomitant MV surgery and aortic valve replacement (control group). RESULTS One death (0.8%) occurred in the study group, and 3 deaths (4.8%) occurred in the control group (P = 0.52). The rate of the most common postoperative complication was similar between the 2 groups. At 12 years, the cumulative incidence function of cardiac death, with non-cardiac death as a competing risk, was 4.7 ± 2.8% in the study group; no cardiac deaths were observed in the control group (P = 0.078). At 6 and 12 years, in the study group, the cumulative incidence function of aortic valve reintervention, with death as a competing risk, was 2.5 ± 1.85% and 19 ± 7.1%, respectively. CONCLUSIONS The appropriate management of moderate aortic regurgitation at the time of MV surgery deserves a careful evaluation by balancing the reintervention rate with the age, the operative risk and the life expectancy of the patient. Our findings suggest that a patient-tailored approach is the key to achieving the best clinical outcome for each individual patient.
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- 2021
50. Isolated tricuspid valve surgery: first outcomes report according to a novel clinical and functional staging of tricuspid regurgitation
- Author
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Roberto Lorusso, Fabrizio Monaco, Roberta Meneghin, Eustachio Agricola, Alessandra Sala, Cinzia Trumello, Marta Bargagna, Michele De Bonis, Ottavio Alfieri, Nicola Buzzatti, Davide Schiavi, Alessandro Castiglioni, Guido Ascione, Stefania Ruggeri, Sala, Alessandra, Lorusso, Roberto, Bargagna, Marta, Ascione, Guido, Ruggeri, Stefania, Meneghin, Roberta, Schiavi, Davide, Buzzatti, Nicola, Trumello, Cinzia, Monaco, Fabrizio, Agricola, Eustachio, Alfieri, Ottavio, Castiglioni, Alessandro, De Bonis, Michele, CTC, MUMC+: MA Med Staf Spec CTC (9), and RS: Carim - V04 Surgical intervention
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,IMPACT ,SOCIETY ,Regurgitation (circulation) ,Tricuspid regurgitation ,HEART-DISEASE ,030204 cardiovascular system & hematology ,Preoperative care ,RECOMMENDATIONS ,law.invention ,03 medical and health sciences ,Isolated tricuspid valve surgery ,0302 clinical medicine ,Tricuspid Valve Insufficiency ,law ,Tricuspid repair ,MANAGEMENT ,Humans ,Medicine ,Tricuspid replacement ,030212 general & internal medicine ,Stage (cooking) ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,EUROPEAN ASSOCIATION ,Tricuspid valve ,business.industry ,Acute kidney injury ,General Medicine ,medicine.disease ,Intensive care unit ,TRENDS ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,GUIDELINE ,Vomiting ,Tricuspid Valve ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,NATIVE VALVULAR REGURGITATION - Abstract
OBJECTIVES The goal of this study was to assess the applicability of a novel classification of patients with tricuspid regurgitation based on 5 stages and to evaluate outcomes following isolated surgical treatment. METHODS All patients treated with isolated tricuspid valve repair or tricuspid valve replacement (TVR) from March 1997 to January 2020 at a single institution were retrospectively reviewed. Patients were divided according to a novel clinical-functional classification, based on the degree of regurgitation together with symptoms, right ventricular size and function and medical therapy. A total of 195 patients were treated; however, 23/195 were excluded due to lack of sufficient preoperative data. RESULTS A total of 172 patients were considered; of these, 129 (75%) underwent TVR and 43 (25%) had tricuspid valve repair. The distribution of patients showed that 46.5% of patients who underwent tricuspid valve repair were in stage 2, whereas 51.9% who underwent TVR were in stage 3. TVR patients were in more advanced stages of the disease, with dilated right ventricles, more pronounced symptoms and development of organ damage. Hospital mortality was 5.8%, in particular 0% in stages 2 and 3 and 15.3% in stages 4 and 5 (P CONCLUSIONS Patients in more advanced stages had higher hospital mortality and longer hospitalizations. Timely referral is associated with lower mortality, short postoperative course and mostly valve repair.
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- 2021
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