98 results on '"Capestro, F."'
Search Results
2. VD04 AORTIC ROOT REPLACEMENT WITH “FRENCH CUFF” TECHNIQUE: A CHALLENGING REDO CASE
- Author
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Cefarelli, M., Berretta, P., Pierri, M., Capestro, F., D’Alfonso, A., and Di Eusanio, M.
- Published
- 2018
- Full Text
- View/download PDF
3. VD16 SUTURELESS MINIAVR WITH RIGHT ANTERIOR THORACOTOMY AND ULTRA FAST TRACK ANAESTHESIA: OUR MULTIDISCIPLINARY APPROACH IN ANCONA
- Author
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Berretta, P., Cefarelli, M., Zingaro, C., Pierri, M., Capestro, F., and Di Eusanio, M.
- Published
- 2018
- Full Text
- View/download PDF
4. VD14 OPEN SURGICAL TREATMENT OF GIANT CORONARY ARTERY ANEURYSMS
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Matteucci, M.L.S., Cefarelli, M., Pierri, M., Capestro, F., Berretta, P., and Di Eusanio, M.
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- 2018
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- View/download PDF
5. OC06 BUILDING UP A MULTIDISCIPLINARY 360° MINIMALLY INVASIVE PROGRAM FOR AVR: OUR EXPERIENCE
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Berretta, P., Wessella, V., Pierri, M., Fazzi, D., Cefarelli, M., Zingaro, C., Capestro, F., D’alfonso, A., and Di Eusanio, M.
- Published
- 2018
- Full Text
- View/download PDF
6. P50 IMPLEMENTATION OF PROTOCOLS FOR “ENHANCED RECOVERY AFTER CARDIAC SURGERY” IN AORTIC VALVE SURGERY
- Author
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Alfonsi, J, primary, Berretta, P, additional, Malvindi, P, additional, Cefarelli, M, additional, D‘Alfonso, A, additional, Alessandroni, E, additional, Capestro, F, additional, Zingaro, C, additional, and Di Eusanio, M, additional
- Published
- 2022
- Full Text
- View/download PDF
7. C17 SIMPLIFIED MINIMALLY INVASIVE MITRAL VALVE SURGERY THROUGH A DIRECT VISION TRANSAXILLARY APPROACH: PROCEDURAL AND 30–DAYS OUTCOMES
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Malvindi, P, primary, Berretta, P, additional, Alfonsi, J, additional, Galeazzi, M, additional, Bifulco, O, additional, Capestro, F, additional, Zingaro, C, additional, and Di Eusanio, M, additional
- Published
- 2022
- Full Text
- View/download PDF
8. Brady-Tachy Syndrome: What Is the Best Pacing Technique To Reduce the Burden of Atrial Fibrillation?
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Azzolini, P., Altamura, G., Bacca, F., Capestro, F., Dini, P., Del Giudice, G. B., Favale, S., Pavia, L., Pettinati, G., Puglisi, A., and Raviele, Antonio, editor
- Published
- 2002
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9. Surgical Explantation After TAVR Failure: Mid-Term Outcomes From the EXPLANT-TAVR International Registry
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Bapat, V. N., Zaid, S., Fukuhara, S., Saha, S., Vitanova, K., Kiefer, P., Squiers, J. J., Voisine, P., Pirelli, L., von Ballmoos, M. W., Chu, M. W. A., Rodes-Cabau, J., Dimaio, J. M., Borger, M. A., Lange, R., Hagl, C., Denti, P., Modine, T., Kaneko, T., Tang, G. H. L., Sengupta, A., Holzhey, D., Noack, T., Harrington, K. B., Mohammadi, S., Brinster, D. R., Atkins, M. D., Algadheeb, M., Bagur, R., Desai, N. D., Bhadra, O. D., Conradi, L., Shults, C., Satler, L. F., Ramlawi, B., Robinson, N. B., Wang, L., Petrossian, G. A., Andreas, M., Werner, P., Garatti, A., Vincent, F., Van Belle, E., Juthier, F., Leroux, L., Doty, J. R., Goldberg, J. B., Ahmad, H. A., Goel, K., Shah, A. S., Geirsson, A., Forrest, J. K., Grubb, K. J., Hirji, S., Shah, P. B., Bruschi, G., Gelpi, G., Belluschi, I., Ouzounian, M., Ruel, M., Al-Atassi, T., Kempfert, J., Unbehaun, A., Van Mieghem, N. M., Hokken, T. W., Ben Ali, W., Ibrahim, R., Demers, P., Pizano, A., Di Eusanio, M., Capestro, F., Estevez-Loureiro, R., Pinon, M. A., Salinger, M. H., Rovin, J., D'Onofrio, A., Tessari, C., Di Virgilio, A., Taramasso, M., Gennari, M., Colli, A., Whisenant, B. K., Nazif, T. M., Kleiman, N. S., Szerlip, M. Y., Waksman, R., George, I., Nguyen, T. C., Maisano, F., Deeb, G. M., Bavaria, J. E., Reardon, M. J., Mack, M. J., Brinkman, W. T., George, T. J., Potluri, S., Ryan, W. H., Schaffer, J. M., Smith, R. L., Szerlip, M., Nazif, T., Rahim, H., Grubb, K., Atkins, M., Goel, S., Kleiman, N., Reardon, M., Doty, J., Whisenant, B., Salinger, M., Satler, L., Schults, C., Fisher, S., Alexis, S. L., Kliger, C. A., Rutkin, B., P. -J., Yu, Petrossian, G., Robinson, N., Deeb, M., Oakley, J., Bavaria, J., Desai, N., Walsh, L., Nguyen, T., Ahmad, H., Goldberg, J., Spielvogel, D., Forrest, J., Chu, M., Cartier, R., Abois, A. -P., Boodhwani, M., Dick, A., Glover, C., Labinaz, M., Lam, B. -K., Delhaye, C., Delsaux, A., Denimal, T., Gaul, A., Koussa, M., Pamart, T., Sonnabend, S., Krane, M., Munsterer, A., Bhadra, O., Merlanti, B., Russo, C. F., Romagnoni, C., and Pinnon, M.
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TAVR explantation ,TAVR failure ,surgical aortic valve replacement ,transcatheter aortic valve replacement - Published
- 2021
10. [Surgical treatment of aortic valve disease: early results of a 360° minimally invasive approach]
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Eusanio M. D., Berretta P., Alfonsi J., Pierri M. D., Zingaro C., Capestro F., D'Alfonso A., Matteucci M. L. S., Fazzi D., Raffaeli V., Munch C., Vessella W., Cefarelli M., Eusanio M.D., Berretta P., Alfonsi J., Pierri M.D., Zingaro C., Capestro F., D'Alfonso A., Matteucci M.L.S., Fazzi D., Raffaeli V., Munch C., Vessella W., and Cefarelli M.
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Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Male ,Time Factors ,Time Factor ,Aortic valve disease ,Aortic Valve Insufficiency ,Minimally Invasive Surgical Procedure ,Aortic Valve Stenosis ,Middle Aged ,Aortic Valve Stenosi ,Treatment Outcome ,Minimally invasive surgery ,Heart Valve Prosthesis ,Ultra fast-track anesthesia ,Humans ,Minimally Invasive Surgical Procedures ,Female ,Aortic valve surgery ,Human ,Aged - Abstract
Background. Over the years, with the introduction of minimally invasive techniques and technologies aimed at reducing surgical trauma, aortic valve surgery has considerably developed and improved. Our approach includes: reduced incisions (upper “J” ministernomy or anterior right minithoracotomy), “ultra fast-track” anesthesia protocols, sutureless and rapid deployment valve prostheses and miniaturized circuits of extracorporeal circulation. The aim of this study was to evaluate the clinical outcomes associated with this multidisciplinary approach. Methods. Between October 2016 and November 2018, 429 patients underwent isolated aortic valve replacement at the Cardiac Surgery Unit of the “Ospedali Riuniti” of Ancona, Italy. Overall, 91 patients (21.2%) were operated according to our minimally invasive approach. A severe aortic valve stenosis was the indication for surgery in 90.1% of patients, aortic valve insufficiency in the remaining 18.7%. Results. There were neither in-hospital deaths nor major or minor neurological events. Atrial fibrillation was the main postoperative complications (n=26, 28.6%). Four patients (4.4%) underwent permanent pacemaker implantation due to third-degree atrioventricular block, and a surgical bleeding revision was performed in 3.3%. No episodes of respiratory failure were reported. The median length of hospital stay was 6 days (5-8 days). Conclusions. Our initial experience with a 360° minimally invasive approach for the treatment of patients undergoing aortic valve replacement shows encouraging clinical outcomes; this approach may lead to an improved perception of surgery both by patients and their families. However, further clinical studies are needed to evaluate the long-term results.
- Published
- 2019
11. IMPROVED EARLY OUTCOMES IN WOMEN UNDERGOING AORTIC VALVE INTERVENTIONS
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Bifulco, O, Malvindi, P, Berretta, P, Alfonsi, J, Cefarelli, M, Zingaro, C, Capestro, F, D‘Alfonso, A, and Di Eusanio, M
- Abstract
Surgical aortic valve replacement (SAVR) in female patients has been associated with higher mortality (up to 3.3–8.9%) and postoperative complication rates when compared with their male counterparts. In recent years, TAVI has been shown to provide a greater benefit than SAVR in women. We sought to assess the early outcomes of the contemporary aortic valve intervention practice (surgical and transcatheter) in patients referred to our cardiac surgery unit. The data of consecutive patients who underwent isolated aortic valve intervention for aortic valve stenosis during the 2018–2022 period were retrieved from our internal database. Several preoperative, intraoperative, and postoperative variables were analyzed, including the predicted risk of a prosthesis–patient mismatch. Nine hundred and fifty–five consecutive patients—514 women and 441 men—were included. Among them, 480 patients—276 female and 204 male—received a transcatheter procedure, and 475—238 women and 237 men—had conventional SAVR. The women were older and had higher EuroSCORE II, while the male patients presented a higher incidence of cardiovascular comorbidities. There was no difference in mortality or major postoperative complication rates after either the surgical or transcatheter procedures between the female and male populations. The availability and targeted use of different techniques and technologies have enabled the safe and effective treatment of female patients treated for severe symptomatic aortic valve stenosis with similar results when compared with their male counterparts.
- Published
- 2024
- Full Text
- View/download PDF
12. Absorption of carbon dioxide during endoscopic vein harvest
- Author
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Zingaro, C., primary, Pierri, M. D., additional, Massi, F., additional, Matteucci, M. L. S., additional, Capestro, F., additional, D'Alfonso, A., additional, Aratari, C., additional, and Torracca, L., additional
- Published
- 2012
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13. ITALIAN MULTICENTER CLINICAL-EXPERIENCE WITH ENDOCARDIAL DEFIBRILLATION - ACUTE AND LONG-TERM RESULTS IN 307 PATIENTS
- Author
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Raviele, A, Gasparini, G, Capestro, F, Renzi, R, Favale, S, Rizzon, P, Capucci, A, Boriani, G, Marchini, A, Verlato, R, Corrado, Domenico, Carli, L, Abbate, M, Calcaterra, V, Leone, G, Paparella, N, Alboni, P, Derosa, F, Plastina, F, Daulerio, M, Tirella, G, Benedini, G, Musso, G, Mureddu, R, Brignole, M, Oddone, D, Arlotti, M, Lotto, A, Lunati, M, Gasparini, M, Marzegalli, M, Bernasconi, M, Vincenti, A, Ciro, A, Musto, B, Donofrio, A, Renzulli, A, Cotrufo, M, Occhetta, E, Plebani, L, Deponti, R, Salerno, Ja, Bongiorni, Mg, Biagini, A, Pulitano, G, Adornato, E, Pennisi, V, Dini, P, Adinolfi, E, Bellocci, F, Zecchi, P, Auricchio, A, Scafuri, A, Potenza, D, Fanelli, R, Fazzari, M, Pistis, G, Libero, L, Giustetto, C, Vergara, G, Furlanello, F, Petz, E, Morgera, T, Proclemer, A, Feruglio, Ga, Onofri, M, Caico, S, Vicentini, A, Peranzoni, G, and Ometto, R.
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medicine.medical_specialty ,Ejection fraction ,business.industry ,Defibrillation ,medicine.medical_treatment ,General Medicine ,Ventricular tachycardia ,medicine.disease ,Sudden death ,Defibrillation threshold ,Internal medicine ,Shock (circulatory) ,Multicenter trial ,Ventricular fibrillation ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
This study presents the acute and long-term results of 307 patients (267 men, mean age 57.5 years, 205 suffering from coronary artery disease, mean left ventricular ejection fraction 33.3%) with malignant ventricular tachyarrhythmias who underwent attempted transvenous ICD implantation with the CPI Endotak lead system in 37 Italian centers. Transvenous ICD implantation was ultimately accomplished in 306 (99.7%) patients. These included 19 subjects with high (< 10 J below output energy of implanted device) defibrillation threshold (DFT) at implant. One hundred sixty-four patients (53%) were implanted with the endocardial lead alone, while 142 also received an SQ patch or SQ array. The mean DFT (not always step-down DFT) at implant was 16.9 +/- 5.7 joules; 15.3 +/- 5.2 joules with biphasic shock and 19.6 +/- 5.4 joules with monophasic shock; P < 0.0001. A significantly higher percentage of patients tested with a biphasic shock could be implanted with adequate safety margin and without an additional SQ patch or SQ array (98% and 81%, respectively). No perioperative deaths occurred. During the mean follow-up of 14.5 +/- 10.2 months, 140 patients (52%) received at least one appropriate shock. An inappropriate shock was observed in 26% of episodes. The 1- and 3-year actuarial incidence of sudden death was 2% and 4%, respectively, and that of total death was 10% and 20%, respectively. A pocket infection requiring ICD explantation occurred in 4 patients (1.4%) and an endocardial lead dislodgment in 11 patients (3.6%). Two patients (0.3%) showed a sensing pin disconnection and six patients (2.3%) had a lead insulation break. The results of this Italian multicenter trial indicate that the CPI Endotak lead system is a simple, safe, and reliable system for endocardial defibrillation. When compared to epicardial leads, it clearly reduces the perioperative mortality and morbidity, while maintaining a similar efficacy in preventing sudden death and terminating ventricular arrhythmias.
- Published
- 1995
14. MEDICAL SCIENCE. GISSI-2: A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12 490 patients with acute myocardial infarction
- Author
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Feruglio, G. A., Lotto, A., Rovelli, F., Solinas, P., Tavazzi, L., Tognoni, G., De Vita, C., Franzosi, M. G., Maggiom, A. P., Mauri, F., Volpi, A., Selvini, A., Donato, L., Garattmi, S., Loi, U., Sirchia, G., Ambrosioni, E., Camerini, F., Campolo, L., Donati, M. B., Ferrari, M., Farchi, G., Geraci, E., Mannucci, P. M., Marubini, E., Neri Semeri, G. G., Peto, R., Prati, P. L., Specchia, G., Vecchio, C., Visani, L., Yusuf, S., Mezzanotte, G., Santoro, E., Bruno, M., Cappello, T., Coppini, A., Fincati, F., Mantovani, G., Pangrazzi, J., Pogna, M., Turazza, F. M., Ansehni, M., Barbonaglia, L., Bigi, R., Cavalli, A., Frigerio, M., Giordano, A., Gualtierotti, C., Torta, D., Vinci, P., Bossi, M., Furlanello, F., Braito, E., Giulia, V., Palmieri, M., Majoimo, P., Pinelli, G., Papi, L., Nardelli, A., Capestro, F., Rossi, A., Ricci, D., Mininni, N., Bianco, G., Barbuzzi, S., Plastina, F., Di Giovanna, F., Mereu, D., Giordano, F., Barlotti, R., Loparco, G., Boscarino, S., Ruggeri, G., Anastasi, R., Paciaroni, E., Tomassini, P. F., Purcaro, A., Francesconi, M., Figliolia, S., Tesse, S., Devoti, G., Giometti, R., Teoni, P., Burali, A., Zucconelli, V., Iervoglini, A., Amabili, S., Caratti, C. A., Zola, G., Ferraguto, P., Sagci, G., Rotiroti, D., Genovese, M., Da€™amato, N., Taurino, L., Colonna, L., Bovenzi, F., Messina, D., Sarcina, G., Compostella, L., Cucchini, F., Malacrida, R., Gradel, C., Bridda, A., Pellegrini, P., Acone, L., Bruno, A., Tespili, M., Guaghurrii, G., Casari, A., Bobba, F., Scaramuzzino, G., Berardi, C., De Castro, U., Fulvi, M., Lintner, W., Erlicher, A., Pitscheider, W., Scola Gagliardi, R., Bonizzato, G., Roggero, C., Perrini, A., Tsialtas, D., Straneo, U., Storelli, A., Verrienti, A., Albonico, B., Corradi, L., De Petra, V., Villani, C., Maxia, P., Bianco, A., Crabu, E., Centamore, G., Di Stefano, G., Vancheri, F., Amico, C., Baldini, F., Santopuoli, G., Pantaleoni, A., Contessotto, F., Terlizzi, R., Turchi, E., Teglio, V., Pignatti, F., Aletto, C., Gozzelino, G., Pettinati, G., De Santis, F., Correale, E., Romano, S., Perrotta, R., Tritto, C., May, L., Achilli, G., Suzzi, G., Cemetti, C., Longobardi, R., Somma, G., Palumbo, C., Gallone, P., Sorrentino, F., Dato, A., Della Monica, R., Pagano, L., Alberti, A., Orselli, L., Negrini, M., De Ponti, C., Acito, P., Capelletti, D., Bortolini, F., Coppola, V., Ciglia, C., De Cesare, M., De Lio, U., Maiolino, P., Giannini, R., Niccolini, A., Marinoni, C., Guasconi, C., Sonnino, S., Pagliei, M., Ferrari, G., Politi, A., Galli, M., De Rinaldis, G., Calcagnile, A., Bendinelli, S., Lusetti, L., Mollaioli, M., Cosmi, F., Venneri, N., Feraco, E., Lauro, A., Catelli, P., Poluzzi, C., Distante, S., Pedroni, P., Zampaglione, G., Lumare, R., Bruna, C., De Benedictis, N., Ziacchi, V., Lomanto, B., Riva, D., Bertocchi, P., Tirella, G., Tessitori, M., Bini, A., Peruzzi, F., Maresta, A., Pirazzini, L., Gaggi, S., Frausini, G., Malacame, C., Codeca, L., Cappato, R., Andreoli, L., Bastoni, L. A., Pucci, P., Sarro, F., Vergassola, R., Barchielli, M., De Matteis, D., Carrone, M., Liberati, R., Meniconi, L., Radogna, M., Tallone, M., Ieri, A., Ferreri, A., Guidali, P., Canziani, R., Mariello, F., Minelli, C., Muzio, L., Rota Baldini, M., Lupi, G., Cecchi, A., Giuliano, G., Bellotti, S., Livi, S., Corti, E., Rossi, P., Delfino, R., Iannetti, M., Pastorini, C., Pennesi, A., Di Giacinto, N., Bertolo, L., Slomp, L., Cresti, A., Svetoni, N., Distefano, S., Veneri, L., Moretti, S., Palermo, R., Giovanelli, N., Parchi, C., Dethomads, M., Paparella, N., Carrino, C., Aquaro, G., Idone, P., Marsili, P., Sideri, F., Valerio, A., Tullio, D., Ragazzini, G., Gramenzi, S., De Pasquale, B., Gelfo, P. G., Rosselli, P., De Marchi, E., Greco, M. R., Fazio, A. M., Savoia, M. T., Gerosa, C., Barbiero, M., Barbaresi, F., Volta, G., Da€™urbano, M., Passoni, F., Parola, G., Lanzini, A., Baldini, U., Del Bene, P., Orlandi, M., Oddone, A., Lazzari, M., Ballerini, B., Bozzi, L., Moccetti, T., Bemasconi, E., Sanguinetti, M., Tognoli, T., Bardelli, G., Maggi, A., Turato, R., Piva, M., Izzo, A., Tantalo, L., Rizzi, A., Scilabra, G., Varvaro, F., Colombo, G., Grieco, A., Dovico, E., Belluzzi, F., Casellato, F., Lecchi, G., Maugeri Sacci, C., Consolo, A., Piccolo, E., Zuin, G., Zappa, C., Sanna, G. P., Dossena, M. G., Corsini, C., Lettino, M., Marconi, M., Mafrici, A., Leonardi, G., Moreo, A., Seregni, R., Pastine, I., Casazza, F., Regalia, F., Maggiolini, S., Benenati, P. M., Rigo, R., Pascotto, P., Zanocco, A., Artusi, L., Cappelli, C., Bernardi, C., Pahnieri, M., Zilio, G., Sandri, R., Neri, G., Valagussa, F., Osculati, G., Cira, A., Da€™aniello, L., Piantadosi, F. R., Improta, M., Severino, S., Bisconti, C., Mostacci, M., Randon, L., Boschello, M., Allegri, M., Freggiaro, V., Mureddu, V., Soro, F., Marras, E., Marchi, S. M., De Luca, C., Manetta, M., Dalla Volta, S., Maddalena, F., Donzelli, M., Vitrano, M. G., Canonico, A., Ledda, A., Bellomare, D., Carrubba, A., Da€™antonio, E., Scardulla, C., Raineri, A., Traina, M., La Calce, C., Cirincione, V., Montanar, F., Strizzolo, L., Di Gregorio, D., Mantini, L., Chiriatti, G., Gazzola, U., Rosi, A., Mellini, M., Piazza, R., Micheli, G., Bechi, S., Martines, C., Marchese, D., Bigalli, A., Davini, P., Boem, A., Del Citerna, F., Giomi, A., Codeluppi, P., Negrelli, M., Brieda, M., Charmet, P. A., Petrella, A., Bardazzi, L., Bianco, G. A., Marco, A., Licitra, R., Lettica, G. V., Tumiotto, G., Bosi, S., Spitali, G., Casali, G., Bottoni, N., Parenti, G. F., Triulzi, E., Brighi, F., Benati, A., De Sanctis, A., Mene, A., Pesaresi, A., Bologna, F., Lumia, F., Barbato, G., Milazzotto, F., Proietti, F., Angrisani, G., Azzolini, P., Coppola, E., Trani, Carlo, Masini, V., Rocchi, M., Borgia, M. C., Luciani, C., Vitucci, N. C., Giuliani, P., Tugnoli, F., Vetta, C., Altieri, T., Gimigliano, F., Striano, U., Salituri, S., Zanazzi, G., Zonzin, P., Bugatti, U., Ravera, B., Allemano, P., Reynaud, S., Sanson, A., Milani, L., De Simone, M. V., Villella, A., Grazzini, M., Amidei, S., Ansehni, L., Benza, G., Tagliamonte, A., Messina, V., Etro, M. D., Vivaldi, F., Cortese, R., Ibba, G. V., Sannia, L., Pedrazzini, F., Gazzotti, G. L., Pizzuti, A., Antonielli, E., Becchi, G., Filice, A., Salmoiraghi, A., Caramanno, G., Caporicci, D., Brun, M., Ferrario, G., Giani, P., Ronconi, G., Douglas, S., Bianchi, C., Cucchi, G., Marieni, M., Marcellini, G., Speca, G., Beato, E., Serabni, N., Bazzucchi, M., Coronelli, R., Rossi, L., Basso, G., Presbitero, P., Bevilacqua, R., Pallisco, O., Di Leo, M., Golzio, P. G., Parigi, A., Belli, R., Trinchero, R., Gaschino, G., Barenghi, M., Poggio, G. L., Braschi, G. B., Sciacca, R., Sammartano, A., Braito, G., Cuzzato, V., Frigo, G., Perissinono, F., Galati, A., Accogli, M., Morgera, T., Barbieri, L., Slavich, G. A., Fresco, C., Cuda, A., Liguori, A., Cozzi, A., Caico, S., Alberio, M., Di Marco, G., De Vito, G., Valente, S., Zagatti, G., Zardini, P., Nidasio, G. P., Girardi, P., Mazzini, C., Nava, S., Achilli, A., Bisogno, A., Pasotti, C., Ballestra, A. M., and Giustarini, C.
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Aspirin ,medicine.medical_specialty ,business.industry ,Streptokinase ,acute myocardial infarction ,General Medicine ,Heparin ,medicine.disease ,Atenolol ,Surgery ,Anistreplase ,Anesthesia ,Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,medicine ,Myocardial infarction ,business ,Stroke ,medicine.drug ,Killip class - Abstract
A multicentre, randomised, open trial with a 2 x 2 factorial design was conducted to compare the benefits and risks of two thrombolytic agents, streptokinase (SK, 1·5 MU infused intravenously over 30-60 min) and alteplase (tPA, 100 mg infused intravenously over 3 h) in patients with acute myocardial infarction admitted to coronary care units within 6 h from onset of symptoms. The patients were also randomised to receive heparin (12 500 U subcutaneously twice daily until discharge from hospital, starting 12 h after beginning the tPA or SK infusion) or usual therapy. All patients without specific contraindications were given atenolol (5-10 mg iv) and aspirin (300-325 mg a day). The end-point of the study was the combined estimate of death plus severe left ventricular damage. 12 490 patients were randomised to four treatment groups (SK alone, SK plus heparin, tPA alone, tPA plus heparin). No specific differences between the two thrombolytic agents were detected as regards the combined end-point (tPA 23·1%; SK 22·5%; relative risk 1·04, 95% Cl 0·95-1·13), nor after the addition of heparin to the aspirin treatment (hep 22·7%, no hep 22·9%; RR 0·99, 95% Cl 0·91-1·08). The outcome of patients allocated to the four treatment groups was similar with respect to baseline risk factors such as age, Killip class, hours from onset of symptoms, and site and type of infarct. The rates of major in-hospital cardiac complications (reinfarction, post-infarction angina) were also similar. The incidence of major bleeds was significantly higher in SK and heparin treated patients (respectively, tPA 0·5%, SK 1·0%, RR 0·57, 95% Cl 0·38-0·85; hep 1·0%, no hep 0·6%, RR 1·64, 95% Cl 1·09-2·45), whereas the overall incidence of stroke was similar in all groups. SK and tPA appear equally effective and safe for use in routine conditions of care, in all infarct patients who have no contraindications, with or without post-thrombolytic heparin treatment. The 8·8% hospital mortality of the study population (compared with approximately 13% in the control cohort of the GISSI-1 trial) indicates the beneficial impact of the proven acute treatments for AMI.
- Published
- 1990
15. 196 The innovative fully digital pacemakers: may they improve our patients management?
- Author
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Scipione, P., primary, Capestro, F., additional, Cecchetti, p., additional, Misiani, A., additional, and Trombetti, M., additional
- Published
- 2005
- Full Text
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16. 557 Reverse neurohormonal remodeling by biventricular pacing in patients with congestive heart failure
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GABRIELLI, D, primary, SCIPIONE, P, additional, CAPESTRO, F, additional, MISIANI, A, additional, MORACA, A, additional, RUGA, O, additional, CESARI, G, additional, CECCONI, M, additional, and PERNA, G, additional
- Published
- 2003
- Full Text
- View/download PDF
17. A semi-automatic algorithm for reducing the time spent on routine follow-up of cardioverter defibrillators
- Author
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Boriani, G., primary, Biffi, M., additional, Renzi, R., additional, Capestro, F., additional, Pierantozzi, A., additional, Sgarbi, E., additional, Scarfó, S., additional, Alboni, P., additional, Migani, L., additional, Sallusti, L., additional, Frabetti, L., additional, and Branzi, A., additional
- Published
- 2001
- Full Text
- View/download PDF
18. ICD Implantation in patients withidiopathic ventricular fibrillation: Follow-up and results
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Scipione, P., primary, Renzi, R., additional, Capestro, F., additional, and Perna, G. P., additional
- Published
- 2001
- Full Text
- View/download PDF
19. Atrial tachycardia assosciated with A-V nodal reentrant tachycardia involving several retrograde pathways: A case report
- Author
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Scipione, P., primary, Renzi, R., additional, Ricciotti, R., additional, Capestro, F., additional, and Perna, G. P., additional
- Published
- 2001
- Full Text
- View/download PDF
20. Impact of Closed-Loop Stimulation, overdrive pacing, DDDR pacing mode on atrial tachyarrhythmia burden in Brady-Tachy Syndrome.
- Author
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Puglisi, A., Altamura, G., Capestro, F., Castaldi, B., Critelli, G., Favale, S., Pavia, L., and Pettinati, G.
- Abstract
Aims Atrial overdrive pacing algorithms increase Atrial Pacing Percentage (APP) to reduce Atrial Tachyarrhythmia (AT) recurrences in patients with Brady-Tachy Syndrome (BTS). This study aimed to compare AT burden and APP in BTS patients treated with conventional DDDR pacing, DDD+ overdrive or Closed-Loop Stimulation (CLS).Methods and results One hundred and forty-nine BTS patients were included (72 male, mean age 74±9), who received a dual chamber pacemaker (Philos DR or Inos 2+CLS, Biotronik GmbH, Berlin, Germany) programmed in DDD at 70min−1. At 1-month follow-up, DDDR, DDD+ or CLS algorithms were activated according to randomization. Follow-up visits for data collection were performed at 4 and 7 months. Non parametric statistical tests (Kruskal–Wallis H-test, Dunn test, Spearman coefficient) were used to analyse not-normally-distributed samples. At 7 months, AT burden was significantly lower in CLS group (20.3±63.1min/day, P<0.01) compared to DDDR (56.0±184.0min/day) and DDD+ group (63.1±113.8min/day). APP was higher in CLS (89.0±13.2%) and in DDD+ group (97.9±2.7%) than in DDDR group (71.1±26.7%, P<0.001). The correlation found between AT burden and APP was very weak: at 7-month follow-up the Spearman coefficient was −0.29 (P=NS) in CLS, −0.52 (P<0.01) in DDD+, −0.22 (P=NS) in DDDR.Conclusions CLS pacing was associated with a significantly lower AT burden,compared to the other pacing algorithms. Moreover APP was significantly higher in DDD+ and in CLS mode, than in DDDR. APP weakly correlated with AT burden only in DDD+ mode, though the lowest AT burden level was obtained in the CLS group where no significant correlation was found. [ABSTRACT FROM PUBLISHER]
- Published
- 2003
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21. Aortic Arch Patch Aortoplasty for Ortner's Syndrome in the Age of Endovascular Stented Grafts
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Matteucci, M. L. S., Rescigno, G., Capestro, F., and Lucia Torracca
- Subjects
Male ,Hoarseness ,Aortic Aneurysm, Thoracic ,Recurrent Laryngeal Nerve ,Nerve Compression Syndromes ,Accidents, Traffic ,Endoscopy ,Case Reports ,Syndrome ,Vascular System Injuries ,Aortography ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,cardiovascular system ,otorhinolaryngologic diseases ,Humans ,Tomography, X-Ray Computed ,Vocal Cord Paralysis ,Aged - Abstract
We present a case of hoarseness in a 68-year-old man with a post-traumatic saccular aortic arch aneurysm, effort dyspnea, and dysphonia. Oropharyngeal examination and flexible nasal endoscopy revealed left vocal fold palsy, with the left fold lying in the paramedian position. On account of these and other findings, we made the diagnosis of Ortner's syndrome. We treated the patient surgically by endoluminal repair with a Dacron patch. The postoperative course was uneventful. No additional procedure was necessary on the vocal folds, since he showed prompt postoperative speech improvement.We believe that an accurate evaluation should be made before switching a patient to endovascular treatment. Our case shows that careful preoperative planning, coupled with the most recent cerebral protection techniques, can enable a safe and straightforward surgical solution to a complex anatomic problem.
22. Minimal influence of traditional surgical risk factors on mortality in contemporary aortic valve replacement
- Author
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Rescigno, G., Aratari, C., D Alfonso, A., Matteucci, S., Capestro, F., Pierri, M. D., and Lucia Torracca
23. 557 Reverse neurohormonal remodeling by biventricular pacing in patients with congestive heart failure
- Author
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Gabrielli, D., Scipione, P., Capestro, F., Misiani, A., Moraca, A., Ruga, O., Cesari, G.P., Cecconi, M., and Perna, G.P.
- Subjects
CONGESTIVE heart failure ,CARDIAC pacing - Abstract
An abstract of the study "Reverse Neurohormonal Remodeling by Biventricular Pacing in Patients with Congestive Heart Failure," by D. Gabrielli and A. Moraca, is presented.
- Published
- 2004
24. ICD Implantation in patients withidiopathic ventricular fibrillation: Follow-up and results.
- Author
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Scipione, P., Renzi, R., Capestro, F., and Perna, G. P.
- Published
- 2000
25. Atrial tachycardia assosciated with A-V nodal reentrant tachycardia involving several retrograde pathways: A case report.
- Author
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Scipione, P., Renzi, R., Ricciotti, R., Capestro, F., and Perna, G. P.
- Published
- 2000
26. Conduction disorders after aortic valve replacement: what is the real impact of sutureless and rapid deployment valves?
- Author
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Fabio Vagnarelli, Paolo Berretta, Mariano Cefarelli, Luca Montecchiani, Michele Danilo Pierri, Alessandro D'Alfonso, Marco Di Eusanio, Jacopo Alfonsi, Carlo Zingaro, Filippo Capestro, Berretta P., Montecchiani L., Vagnarelli F., Cefarelli M., Alfonsi J., Zingaro C., Capestro F., Pierri M.D., D'alfonso A., and Eusanio M.D.
- Subjects
medicine.medical_specialty ,Conduction disorders ,Subgroup analysis ,030204 cardiovascular system & hematology ,rapid deployment aortic valve replacement ,conduction disorder ,New onset ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Internal medicine ,medicine ,Left bundle branch block ,business.industry ,Incidence (epidemiology) ,Right bundle branch block ,Featured Article ,medicine.disease ,030228 respiratory system ,aortic valve replacement (AVR) ,Cardiology ,Sutureless aortic valve replacement ,Surgery ,Left anterior fascicular block ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Although sutureless and rapid deployment aortic valve replacement (SURD-AVR) has been associated with an increased rate of permanent pacemaker (PPM) implantation compared to conventional AVR (c-AVR), the predictors of new conduction abnormalities remain to be clarified. This study aimed to identify risk factors for conduction disorders in patients undergoing AVR surgery. Methods: Data from 243 patients receiving minimally invasive AVR were prospectively collected. SURD-AVR was performed in 103 (42.4%) patients and c-AVR in 140 (57.6%). The primary endpoint was the occurrence of new-onset conduction disorders, defined as first degree atrioventricular (AV) block, advanced AV block requiring PPM implantation, left anterior fascicular block (LAFB), left bundle branch block (LBBB) and right bundle branch block (RBBB). Results: The unadjusted comparison revealed that SURD-AVR was associated with a higher rate of advanced AV block requiring PPM when compared with c-AVR (10.5% vs. 2.1%, P=0.01). After adjusting for other measured covariates (OR: 1.6, P=0.58) and for the estimated propensity of SURD-AVR (OR: 5.1, P=0.1), no significant relationship between type of AVR and PPM implantation emerged. On multivariable analysis, preoperative first-degree AV block (OR: 6.9, P=0.04) and RBBB (OR: 6.9, P=0.03) were independent risk factors for PPM. Subgroup analysis of patients with normal preoperative conduction revealed similar incidence of PPM between SURD-AVR and c-AVR (1.3% vs. 1.9%, P=0.6). When compared with c-AVR, SURD-AVR was associated with a greater incidence of postoperative new onset LBBB (18.1% vs. 3.2%, P
- Published
- 2020
27. Transcatheter cerebral embolic protection in open heart surgery: our initial experience in Ancona, Italy
- Author
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Luca, Montecchiani, Jacopo, Alfonsi, Mariano, Cefarelli, Paolo, Berretta, Filippo, Capestro, Marco, Di Eusanio, Montecchiani L., Alfonsi J., Cefarelli M., Berretta P., Capestro F., and Di Eusanio M.
- Subjects
Aged, 80 and over ,Male ,Extracorporeal Circulation ,Aortic Diseases ,Calcinosis ,Heart Valves ,Embolic Protection Devices ,Treatment Outcome ,Intracranial Embolism ,Italy ,Aortic Valve ,Preoperative Care ,Humans ,Mitral Valve ,Female ,Cardiac Surgical Procedures ,Intraoperative Complications ,Tomography, X-Ray Computed ,transcatheter cerebral protection systems ,Aged - Abstract
BACKGROUND: Neurological events after cardiac surgery or transcatheter aortic valve implantation (TAVI) have a dramatic effect on patients' prognosis. Recent development of transcatheter cerebral protection systems aims to reduce their incidence, even if their use is currently limited to TAVI. Here we report our initial experience with transcatheter cerebral protection devices used in patients at high brain embolic risk undergoing cardiac surgery. METHODS: Between December 2018 and March 2020, at the Cardiac Surgery Unit of Lancisi Cardiovascular Center in Ancona, Italy, 9 patients (mean age 77 years; median EuroSCORE II: 2.2%) underwent cardiac surgery using a transcatheter cerebral protection system (Sentinel, Claret Medical, Santa Rosa, CA, USA). In all cases, a preoperative computed tomography scan highlighted the presence of severely calcified ascending aorta. RESULTS: The brain protection system was successfully implanted in all patients. Total time for device implantation and removal was less than 10 min in all cases. Four patients underwent aortic valve replacement, 2 mitral surgery, whereas 3 received combined valve surgery. Calcified debris were found within filters in 100% of patients. Postoperatively, there were neither neurological events nor major complications. CONCLUSIONS: In our experience, transferring transcatheter brain protection techniques and technologies to cardiac surgery allowed us (with excellent results) to avoid palliative percutaneous or medical management in patients with severe aortic calcifications. Waiting for more solid evidence, we believe that our example supports the concept of hybrid surgery as a therapeutic approach capable of extending traditional surgical indications with improved patients' outcomes.
- Published
- 2020
28. Mitral Valve Damage After an Aortic Balloon Valvuloplasty in an Infant
- Author
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Marco Pozzi, Filippo Capestro, Andrea Quarti, Capestro F., Quarti A., and Pozzi M.
- Subjects
Balloon valvuloplasty ,medicine.medical_specialty ,Aortography ,Aortic valve stenosi ,Catheterization ,Diagnosis, Differential ,Internal medicine ,Mitral valve ,medicine ,Humans ,cardiovascular diseases ,Mitral regurgitation ,Surgical repair ,medicine.diagnostic_test ,Mitral valve damage ,business.industry ,Mitral Valve Insufficiency ,Aortic Valve Stenosis ,Cardiac surgery ,Vascular surgery ,medicine.disease ,medicine.anatomical_structure ,Echocardiography ,Child, Preschool ,Aortic valve stenosis ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Cardiology ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business - Abstract
The case of a 2-year-old infant admitted to our Institution with a diagnosis of severe aortic valve stenosis is presented. After a balloon valvuloplasty with no results in terms of gradient reduction, an echocardiogram showed a moderate mitral regurgitation. The patient underwent surgical repair of both the aortic and mitral valves. Inspection of the mitral valve showed a 5-mm hole in the posterior leaflet at the P2 scallop. Probably, the dilation tore a secondary cord, pulling away a piece of the leaflet. A quadrangular resection was performed with good results. © Springer Science+Business Media, LLC 2011.
- Published
- 2011
29. Normothermic frozen elephant trunk without circulatory arrest.
- Author
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Berretta P, Galeazzi M, Malvindi PG, Bifulco O, Buratto B, Cefarelli M, Alfonsi J, Capestro F, Gatta E, and Di Eusanio M
- Abstract
We describe our technique for total aortic arch replacement with stenting of the descending thoracic aorta allowing normothermic cardiopulmonary bypass and avoiding hypothermic circulatory arrest., Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-023-01536-1., Competing Interests: Conflict of interestAll authors have no conflicts of interest or financial conflicts to disclose., (© The Author(s) 2023.)
- Published
- 2023
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30. Improved Early Outcomes in Women Undergoing Aortic Valve Interventions.
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Malvindi PG, Bifulco O, Berretta P, Alfonsi J, Cefarelli M, Zingaro C, Capestro F, D'Alfonso A, and Di Eusanio M
- Abstract
Surgical aortic valve replacement (SAVR) in female patients has been associated with higher mortality (up to 3.3-8.9%) and postoperative complication rates when compared with their male counterparts. In recent years, TAVI has been shown to provide a greater benefit than SAVR in women. We sought to assess the early outcomes of the contemporary aortic valve intervention practice (surgical and transcatheter) in patients referred to our cardiac surgery unit. The data of consecutive patients who underwent isolated aortic valve intervention for aortic valve stenosis during the 2018-2022 period were retrieved from our internal database. Several preoperative, intraoperative, and postoperative variables were analyzed, including the predicted risk of a prosthesis-patient mismatch. Nine hundred and fifty-five consecutive patients-514 women and 441 men-were included. Among them, 480 patients-276 female and 204 male-received a transcatheter procedure, and 475-238 women and 237 men-had conventional SAVR. The women were older and had higher EuroSCORE II, while the male patients presented a higher incidence of cardiovascular comorbidities. There was no difference in mortality or major postoperative complication rates after either the surgical or transcatheter procedures between the female and male populations. The availability and targeted use of different techniques and technologies have enabled the safe and effective treatment of female patients treated for severe symptomatic aortic valve stenosis with similar results when compared with their male counterparts.
- Published
- 2023
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31. Results and insights after 413 TAVI procedures performed by cardiac surgeons on their own.
- Author
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Malvindi PG, Berretta P, Capestro F, Bifulco O, Alfonsi J, Cefarelli M, Pierri MD, and Di Eusanio M
- Abstract
Objectives: Current evidence on transcatheter aortic valve implantation (TAVI) has been generated exclusively by cardiology studies and no operative data from cardiac surgeons are available. Here, we describe the development of our TAVI programme and report the results of transfemoral (TF) TAVI done by cardiac surgeons on their own., Methods: This study included all the TAVI procedures on native valve performed at Cardiac Surgery Unit, Ospedali Riuniti di Ancona, during the period October 2018 to July 2022. Relevant prospectively collected preoperative, intraprocedural and postoperative data were retrieved from the Institutional database., Results: A total of 413 patients were included in the study. Mean patients' age was 82 years and among them 44% (180/413) were male. STS score was 3.1% (2.2-4.4). Eighty patients underwent transapical TAVI and 333 patients had a TF approach. We progressively moved from transapical TAVI towards TF procedures that are now routinely performed on conscious sedation and using a fully percutaneous approach. After TF TAVI, 30-day mortality rate was 1%, cerebral stroke occurred in 2% of the cases, permanent pacemaker implantation was necessary in 23% of the patients and in 6% of the cases there was a moderate/severe degree of aortic regurgitation. There was no association between operators performing TAVI and 30-day mortality., Conclusions: The acquisition of catheter-based skills and an adequate training allowed cardiac surgeons to perform on their own awake and fully percutaneous TF TAVI with similar results when compared with major randomized clinical trials and registries' experiences., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
- Published
- 2023
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- View/download PDF
32. Minimally invasive approach: is this the future of aortic surgery?
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Berretta P, Galeazzi M, Cefarelli M, Alfonsi J, De Angelis V, Pierri MD, Matteucci SML, Alessandroni E, Zingaro C, Capestro F, D'Alfonso A, and Di Eusanio M
- Abstract
Median sternotomy incision has shown to be a safe and efficacious approach in patients who require thoracic aortic interventions and still represents the gold-standard access. Nevertheless, over the last decade, less invasive techniques have gained wider clinical application in cardiac surgery becoming the first-choice approach to treat heart valve diseases, in experienced centers. The popularization of less invasive techniques coupled with an increased patient demand for less invasive therapies has motivated aortic surgeons to apply minimally invasive approaches to more challenging procedures, such as aortic root replacement and arch repair. However, technical demands and the paucity of available clinical data have still limited the widespread adoption of minimally invasive thoracic aortic interventions. This review aimed to assess and comment on the surgical techniques and the current evidence on mini thoracic aortic surgery., Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-021-01258-2., Competing Interests: Conflict of interestThe authors declare no competing interests., (© The Author(s) 2021.)
- Published
- 2022
- Full Text
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33. [Transcatheter cerebral embolic protection in open heart surgery: our initial experience in Ancona, Italy].
- Author
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Montecchiani L, Alfonsi J, Cefarelli M, Berretta P, Capestro F, and Di Eusanio M
- Subjects
- Aged, Aged, 80 and over, Aortic Diseases complications, Aortic Diseases diagnostic imaging, Aortic Valve, Calcinosis complications, Calcinosis diagnostic imaging, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures instrumentation, Extracorporeal Circulation methods, Female, Humans, Italy, Male, Mitral Valve surgery, Preoperative Care, Tomography, X-Ray Computed, Treatment Outcome, Cardiac Surgical Procedures methods, Embolic Protection Devices, Heart Valves surgery, Intracranial Embolism prevention & control, Intraoperative Complications prevention & control
- Abstract
Background: Neurological events after cardiac surgery or transcatheter aortic valve implantation (TAVI) have a dramatic effect on patients' prognosis. Recent development of transcatheter cerebral protection systems aims to reduce their incidence, even if their use is currently limited to TAVI. Here we report our initial experience with transcatheter cerebral protection devices used in patients at high brain embolic risk undergoing cardiac surgery., Methods: Between December 2018 and March 2020, at the Cardiac Surgery Unit of Lancisi Cardiovascular Center in Ancona, Italy, 9 patients (mean age 77 years; median EuroSCORE II: 2.2%) underwent cardiac surgery using a transcatheter cerebral protection system (Sentinel, Claret Medical, Santa Rosa, CA, USA). In all cases, a preoperative computed tomography scan highlighted the presence of severely calcified ascending aorta., Results: The brain protection system was successfully implanted in all patients. Total time for device implantation and removal was less than 10 min in all cases. Four patients underwent aortic valve replacement, 2 mitral surgery, whereas 3 received combined valve surgery. Calcified debris were found within filters in 100% of patients. Postoperatively, there were neither neurological events nor major complications., Conclusions: In our experience, transferring transcatheter brain protection techniques and technologies to cardiac surgery allowed us (with excellent results) to avoid palliative percutaneous or medical management in patients with severe aortic calcifications. Waiting for more solid evidence, we believe that our example supports the concept of hybrid surgery as a therapeutic approach capable of extending traditional surgical indications with improved patients' outcomes.
- Published
- 2020
- Full Text
- View/download PDF
34. Conduction disorders after aortic valve replacement: what is the real impact of sutureless and rapid deployment valves?
- Author
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Berretta P, Montecchiani L, Vagnarelli F, Cefarelli M, Alfonsi J, Zingaro C, Capestro F, Pierri MD, D'alfonso A, and Di Eusanio M
- Abstract
Background: Although sutureless and rapid deployment aortic valve replacement (SURD-AVR) has been associated with an increased rate of permanent pacemaker (PPM) implantation compared to conventional AVR (c-AVR), the predictors of new conduction abnormalities remain to be clarified. This study aimed to identify risk factors for conduction disorders in patients undergoing AVR surgery., Methods: Data from 243 patients receiving minimally invasive AVR were prospectively collected. SURD-AVR was performed in 103 (42.4%) patients and c-AVR in 140 (57.6%). The primary endpoint was the occurrence of new-onset conduction disorders, defined as first degree atrioventricular (AV) block, advanced AV block requiring PPM implantation, left anterior fascicular block (LAFB), left bundle branch block (LBBB) and right bundle branch block (RBBB)., Results: The unadjusted comparison revealed that SURD-AVR was associated with a higher rate of advanced AV block requiring PPM when compared with c-AVR (10.5% vs. 2.1%, P=0.01). After adjusting for other measured covariates (OR: 1.6, P=0.58) and for the estimated propensity of SURD-AVR (OR: 5.1, P=0.1), no significant relationship between type of AVR and PPM implantation emerged. On multivariable analysis, preoperative first-degree AV block (OR: 6.9, P=0.04) and RBBB (OR: 6.9, P=0.03) were independent risk factors for PPM. Subgroup analysis of patients with normal preoperative conduction revealed similar incidence of PPM between SURD-AVR and c-AVR (1.3% vs. 1.9%, P=0.6). When compared with c-AVR, SURD-AVR was associated with a greater incidence of postoperative new onset LBBB (18.1% vs. 3.2%, P<0.001). This finding was confirmed after adjusting for the estimated propensity of SURD-AVR (OR: 6.3, P=0.009)., Conclusions: Our study revealed that the risk of PPM implantation in patients receiving surgical AVR is heavily influenced by the presence of pre-existing conduction disturbances rather than the type of valve prosthesis. Conversely, SURD-AVR emerged as an independent predictor for LBBB and was associated with an increased risk of PPM in patients presenting with RBBB., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2020 Annals of Cardiothoracic Surgery. All rights reserved.)
- Published
- 2020
- Full Text
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35. Catheter-based cerebral protection system in open cardiac surgery: An example of true hybrid surgery.
- Author
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Capestro F, Berretta P, Alfonsi J, Cefarelli M, Pierri M, and Di Eusanio M
- Subjects
- Aged, Female, Humans, Male, Postoperative Complications etiology, Stroke etiology, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement methods, Treatment Outcome, Aortic Valve Stenosis surgery, Postoperative Complications prevention & control, Stroke prevention & control, Transcatheter Aortic Valve Replacement instrumentation
- Abstract
Postoperative stroke after cardiac surgery is an ominous complication. Clinical manifestations range from cognitive disturbances and altered states of consciousness to focal neurological deficits. Stroke is also a well-documented risk of catheter-based cardiac interventions. Recently, the growth of transcatheter procedures has led to the increasing development of devices that are designed to minimize neurological events during valve implantation. In this video tutorial we demonstrate how to transfer a catheter-based cerebral protection technology into an open cardiac surgical intervention. The operation shown in this tutorial was an aortic valve replacement and the cerebral protection device implanted was the Sentinel Cerebral Protection System (Boston Scientific, Marlborough, MA, USA)., (© The Author 2016. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
36. Minimally invasive aortic valve replacement with a catheter-based cerebral protection system: transferring percutaneous technologies into a surgical intervention.
- Author
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Di Eusanio M, Cefarelli M, Berretta P, and Capestro F
- Subjects
- Aged, Catheters, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation methods, Humans, Male, Minimally Invasive Surgical Procedures methods, Transcatheter Aortic Valve Replacement instrumentation, Aortic Valve surgery, Cerebrovascular Circulation physiology, Heart Valve Prosthesis Implantation instrumentation, Minimally Invasive Surgical Procedures instrumentation
- Abstract
Patients with severe aortic valve stenosis are currently treated with 2 different interventional techniques: surgical aortic valve replacement or transcatheter aortic valve implantation (TAVI). Both have strengths and limitations. On the one hand, TAVI represents a valuable option in high- and intermediate-risk patients and is commonly preferred over surgical aortic valve replacement in subjects with porcelain or severely calcified aorta, on the other, the lack of data on valve durability raises concerns on its use in young, low-risk patients. We present herein the case of a low-risk 71-year-old patient with a severely calcified ascending aorta. We successfully combined our minimally invasive surgical approach with the use of a percutaneous cerebral protection system commonly employed during TAVI procedures. We believe that cardiac surgeons could adopt transcatheter technology to improve operative results., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
37. [Surgical treatment of aortic valve disease: early results of a 360° minimally invasive approach].
- Author
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Di Eusanio M, Berretta P, Alfonsi J, Pierri MD, Zingaro C, Capestro F, D'Alfonso A, Fazzi D, Raffaeli V, Munch C, Vessella W, and Cefarelli M
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Minimally Invasive Surgical Procedures, Time Factors, Treatment Outcome, Aortic Valve Insufficiency surgery, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation methods
- Abstract
Background: Over the years, with the introduction of minimally invasive techniques and technologies aimed at reducing surgical trauma, aortic valve surgery has considerably developed and improved. Our approach includes: reduced incisions (upper "J" ministernomy or anterior right minithoracotomy), "ultra fast-track" anesthesia protocols, sutureless and rapid deployment valve prostheses and miniaturized circuits of extracorporeal circulation. The aim of this study was to evaluate the clinical outcomes associated with this multidisciplinary approach., Methods: Between October 2016 and November 2018, 429 patients underwent isolated aortic valve replacement at the Cardiac Surgery Unit of the "Ospedali Riuniti" of Ancona, Italy. Overall, 91 patients (21.2%) were operated according to our minimally invasive approach. A severe aortic valve stenosis was the indication for surgery in 90.1% of patients, aortic valve insufficiency in the remaining 18.7%., Results: There were neither in-hospital deaths nor major or minor neurological events. Atrial fibrillation was the main postoperative complications (n=26, 28.6%). Four patients (4.4%) underwent permanent pacemaker implantation due to third-degree atrioventricular block, and a surgical bleeding revision was performed in 3.3%. No episodes of respiratory failure were reported. The median length of hospital stay was 6 days (5-8 days)., Conclusions: Our initial experience with a 360° minimally invasive approach for the treatment of patients undergoing aortic valve replacement shows encouraging clinical outcomes; this approach may lead to an improved perception of surgery both by patients and their families. However, further clinical studies are needed to evaluate the long-term results.
- Published
- 2019
- Full Text
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38. Mini Bentall operation: technical considerations.
- Author
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Di Eusanio M, Cefarelli M, Zingaro C, Capestro F, Matteucci SML, D'alfonso A, Pierri MD, Aiello ML, and Berretta P
- Abstract
Bentall operation via median sternotomy has been largely shown to be safe and long-term efficacious and currently represents the "gold standard" intervention in patients presenting with aortic valve and root disease. However, over the last years, minimally invasive techniques have gained wider clinical application in cardiac surgery. In particular, minimally invasive aortic valve replacement through ministernotomy has shown excellent outcomes and becomes the first choice approach in numerous experienced centers. Based on these favorable results, ministernotomy approach has also been proposed for complex cardiac procedures such as aortic root replacement and arch surgery. Herein, we present our technique for minimally invasive Bentall operation using a ministernotomy approach., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Indian Association of Cardiovascular-Thoracic Surgeons 2018.)
- Published
- 2019
- Full Text
- View/download PDF
39. Ultra fast-track minimally invasive aortic valve replacement: going beyond reduced incisions.
- Author
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Di Eusanio M, Vessella W, Carozza R, Capestro F, D'Alfonso A, Zingaro C, Munch C, and Berretta P
- Subjects
- Humans, Operative Time, Surgical Wound prevention & control, Transcatheter Aortic Valve Replacement, Aortic Valve surgery, Heart Valve Prosthesis Implantation methods, Minimally Invasive Surgical Procedures methods, Sternotomy methods
- Abstract
Aortic valve replacement (AVR) via a median sternotomy approach has been largely reported to be safe and long-term efficacious, and currently represents the 'gold standard' approach for aortic stenosis treatment. However, aortic valve surgery has undergone continuous development over the last years, involving less invasive techniques and new technologies to reduce the traumatic impact of the intervention and extend the operability toward increasingly high-risk patients. Indeed, minimally invasive AVR and transcatheter aortic valve replacement caseload have steadily increased leading to a paradigm shift in the treatment of aortic valve disease. In this setting, we have established a multidisciplinary minimally invasive programme to treat patients who require AVR. Herein, we present our approach including (i) reduced chest incision (through a J ministernotomy), aiming to reduce the traumatic impact of the surgical procedure, to decrease blood loss, postoperative pain and wound complications and to increase patient's satisfaction; (ii) rapid-deployment AVR, to reduce operative times, to facilitate minimally invasive approach and to improve haemodynamic outcomes; (iii) minimal invasive extracorporeal circulation system, to improve end-organ protection, to decrease systemic inflammatory response and to promote fast-track anaesthesia and (iv) ultra fast-track anaesthesia, to decrease the rate of postoperative complications and assure better and earlier recovery.
- Published
- 2018
- Full Text
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40. [Early and mid-term results of the transapical aortic valve Symetis Acurate TA: a viable solution in high-risk patients with severe vascular disease].
- Author
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Rescigno G, Fratesi MG, Aratari C, Moretti S, Capestro F, Serenelli M, Piangerelli L, Delca A, Perna GP, Capucci A, and Di Eusanio M
- Subjects
- Aged, Female, Humans, Male, Prosthesis Design, Risk Assessment, Severity of Illness Index, Time Factors, Treatment Outcome, Aortic Valve surgery, Aortic Valve Stenosis complications, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation methods, Vascular Diseases complications
- Abstract
Background: Aortic valve stenosis is the most common valvular disease in the elderly. Transcatheter aortic valve implantation represents a viable alternative to conventional aortic valve replacement. In our Department, the transapical approach is the preferred method in patients with severe peripheral vascular disease. The aim of this study was to analyze the early and midterm results of Symetis Acurate TA implantation in our series., Methods: From June 2013 to January 2017, 21 patients with severe peripheral vascular disease (11 male, mean age 78 ± 2.8 years) underwent transapical implantation of the Symetis Acurate TA device. Mean logistic EuroSCORE I was 21.9 ± 8.6, mean left ventricular ejection fraction was 51.9 ± 12.2%, and mean aortic gradient was 46.7 ± 12.3 mmHg. Valve implantation was performed through a left anterior minithoracotomy. Patients were followed up on a regular basis. Cardiac echocardiographic assessment was performed at 6 months post-implantation., Results: Valve implantation was successful in all patients. Valve sizes were as follows: 7 size S, 6 size M, and 8 size L. Two patients died before hospital discharge (9.5%). Among survivors, 2 patients showed more than mild aortic regurgitation at discharge. Mean aortic gradient was 13.1 ± 4.3 mmHg (p<0.01). Median follow-up was 11.3 months. Mean NYHA class at follow-up was 1.9 ± 0.4 (p<0.05). Mean actuarial survival was 80%., Conclusions: Our series, even if small, demonstrates that transapical implantation of the Symetis Acurate TA device represents a viable solution in patients with severe peripheral vascular disease carrying a high operative risk. The relatively high operative mortality may be attributable to the learning curve of our team.
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- 2017
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41. Cardiac Paraganglioma Arising From the Right Atrioventricular Groove in a Paraganglioma-Pheochromocytoma Family Syndrome With Evidence of SDHB Gene Mutation: An Unusual Presentation.
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Del Forno B, Zingaro C, Di Palma E, Capestro F, Rescigno G, and Torracca L
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- Adrenal Gland Neoplasms genetics, Adrenal Gland Neoplasms surgery, Cardiopulmonary Bypass methods, Female, Heart Atria, Heart Neoplasms diagnostic imaging, Heart Neoplasms genetics, Humans, Magnetic Resonance Imaging, Cine methods, Middle Aged, Paraganglioma, Extra-Adrenal diagnostic imaging, Paraganglioma, Extra-Adrenal genetics, Pedigree, Pheochromocytoma complications, Pheochromocytoma diagnostic imaging, Pheochromocytoma genetics, Rare Diseases, Risk Assessment, Sternotomy methods, Syndrome, Treatment Outcome, Adrenal Gland Neoplasms diagnostic imaging, Cardiac Surgical Procedures methods, Heart Neoplasms surgery, Paraganglioma, Extra-Adrenal surgery, Positron-Emission Tomography methods, Succinate Dehydrogenase genetics
- Abstract
Primary cardiac paragangliomas are extremely rare. Recently this neoplasm has been associated with a familiar syndrome as a result of mutation of genes that encode proteins in the mitochondrial complex II. We report a case of a 46-year-old woman having cases of vertebral paraganglioma in her family showing an unusual anatomic and clinical presentation of cardiac paraganglioma and expressing a genetic mutation never associated before with cardiac localization of this neoplasm., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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42. Prevention of atrial fibrillation and inflammatory response after on-pump coronary artery bypass using different statin dosages: a randomized, controlled trial.
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Pierri MD, Crescenzi G, Zingaro C, D'Alfonso A, Capestro F, Scocco V, Brugia M, and Torracca L
- Subjects
- Adult, Aged, Aged, 80 and over, Atorvastatin therapeutic use, Atrial Fibrillation epidemiology, Atrial Fibrillation etiology, Biomarkers blood, C-Reactive Protein metabolism, Dose-Response Relationship, Drug, Drug Administration Schedule, Elective Surgical Procedures, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Incidence, Inflammation blood, Inflammation epidemiology, Inflammation etiology, Interleukin-6 blood, Male, Middle Aged, Postoperative Complications blood, Postoperative Complications epidemiology, Prospective Studies, Treatment Outcome, Atorvastatin administration & dosage, Atrial Fibrillation prevention & control, Coronary Artery Bypass methods, Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage, Inflammation prevention & control, Postoperative Complications prevention & control, Preoperative Care methods
- Abstract
Background: This randomized controlled trial aimed to evaluate the effects of seven-day preoperative treatment with two different dosages of atorvastatin on the incidence of postoperative atrial fibrillation (POAF) and release of inflammatory markers such as high-sensitive C-reactive protein (hsCRP) and interleukin-6 in patients undergoing elective first-time on-pump coronary artery bypass grafting (CABG)., Methods: The cohort study comprised 212 consecutive patients, already taking statins, who underwent elective first-time CABG with cardiopulmonary bypass without history of atrial fibrillation (AF). Patients were randomly divided into two groups: those who received atorvastatin 40 mg (TOR40 group, 111 patients) and those who received 80 mg (TOR80 group, 101 patients) once a day for 7 days before the planned operation. The primary endpoint was the incidence of AF. The secondary endpoints were the postoperative variations of inflammatory markers, hospital length of stay, and the incidence of major adverse cardiac and clinical events., Results: A total of 26 patients (23.6 %) pretreated with atorvastatin 40 mg and 16 (15.8 %) patients pretreated with atorvastatin 80 mg had postoperative AF but the difference did not reach the statistical significance (p = 0.157). Median values of interleukin-6 and hsCRP at 12 and 24 h did not have differences between the two groups. No statistically significant differences in the other secondary endpoints were detected., Conclusions: According to our result, 7-day preoperative treatment with a high dose of atorvastatin is associated with a trend to a decrease in the incidence of POAF compared with treatment at a lower dose, although it does not impact on the level of inflammatory markers., Clinical Trial Registration: European Clinical Trials Database (EudraCT: 2006-005757-30).
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- 2016
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43. Risk Factors and Impact on Clinical Outcome of Multidrug-Resistant Acinetobacter Baumannii Acquisition in Cardiac Surgery Patients.
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Pierri MD, Crescenzi G, Capestro F, Recanatini C, Manso E, D'errico MM, Prospero E, Barbadoro P, and Torracca L
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- Acinetobacter baumannii drug effects, Aged, Aged, 80 and over, Cohort Studies, Drug Resistance, Multiple, Bacterial, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Acinetobacter baumannii isolation & purification, Cardiac Surgical Procedures mortality
- Abstract
Objectives: Acinetobacter baumannii recently has emerged as an important nosocomial pathogen. The aim of this study was to assess the impact on mortality of multidrug-resistant A. baumannii (MDR-AB) infection/colonization in patients undergoing cardiac surgery and to investigate microbiologic characteristics, epidemiologic spread of this pathogen, and the relative containment measures., Design: Single-center, retrospective cohort study of prospectively collected data., Setting: Cardiac surgery tertiary-care center., Participants: Patients with positive MDR-AB cultures from September 1, 2009 to December 31, 2011., Interventions: Bivariate and multivariate analyses were performed to individualize the risk factors for MDR-AB-infections in cardiac surgery patients. To evaluate the MDR-AB attributable mortality, a retrospective matched cohort study was performed. Incidence density ratio (IDR) was calculated to compare the MDR-AB infection/colonization before and after the introduction of preventive measures adopted following the first cases., Measurements and Main Results: MDR-AB acquisition occurred in 14 patients (0,6%) of 2385 patients. At the multivariate analyses, preoperative use of inotropic drugs (OR 18.2, 95% CI 4.6-71.9) and logistic EuroSCORE (OR 1.09, 95% CI 1.06-1.13) were found as independent risk factors. Patients with MDR-AB had 57% cumulative in-hospital mortality; no statistical differences in mortality were observed in the matched group. IDR revealed a significantly decreased incidence of infection/colonization (0.3 per 1,000 days of stay compared with 0.03/1,000 days of stay, p = 0.0001) after the containment measures became effective., Conclusions: Sicker patients are more susceptible to be infected by A. baumannii, but mortality is not significantly higher compared with other patients with similar characteristics. Adequate measures are fundamental to control the spread of the infection., (Copyright © 2016 Elsevier Inc. All rights reserved.)
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- 2016
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44. Sutureless aortic valve prosthesis in a calcified homograft.
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Capestro F, Massaccesi S, Matteucci ML, and Torracca L
- Subjects
- Aged, Allografts, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Insufficiency diagnosis, Aortic Valve Insufficiency physiopathology, Calcinosis diagnosis, Calcinosis physiopathology, Echocardiography, Transesophageal, Heart Valve Prosthesis Implantation adverse effects, Humans, Male, Prosthesis Design, Prosthesis Failure, Reoperation, Tomography, X-Ray Computed, Treatment Outcome, Aortic Valve surgery, Aortic Valve Insufficiency surgery, Bioprosthesis, Calcinosis surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation
- Published
- 2015
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45. Left ventricular function after mitral surgery: Time to focus on intraoperative management?
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Crescenzi G, Capestro F, and Torracca L
- Subjects
- Female, Humans, Male, Cardiac Surgical Procedures adverse effects, Mitral Valve surgery, Mitral Valve Insufficiency surgery, Ventricular Dysfunction, Left etiology, Ventricular Function, Left
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- 2015
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46. 'Early' and 'late' timing for renal replacement therapy in acute kidney injury after cardiac surgery: a prospective, interventional, controlled, single-centre trial.
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Crescenzi G, Torracca L, Pierri MD, Rosica C, Munch C, and Capestro F
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- Acute Kidney Injury etiology, Aged, Cardiac Surgical Procedures methods, Female, Follow-Up Studies, Hospital Mortality trends, Humans, Intensive Care Units, Italy, Kaplan-Meier Estimate, Kidney Function Tests, Male, Middle Aged, Postoperative Complications mortality, Postoperative Complications physiopathology, Postoperative Complications therapy, Prospective Studies, Renal Replacement Therapy mortality, Risk Assessment, Severity of Illness Index, Statistics, Nonparametric, Survival Analysis, Time Factors, Treatment Outcome, Acute Kidney Injury mortality, Acute Kidney Injury therapy, Cardiac Surgical Procedures adverse effects, Cause of Death, Renal Replacement Therapy methods
- Abstract
Objectives: Acute kidney injury after cardiac surgery (CS-AKI) is strongly associated with in-hospital mortality and morbidity. We aimed to investigate whether 'early' or 'late' initiation of renal replacement therapy (RRT) in patients with CS-AKI is associated with a survival benefit or more favourable outcomes., Methods: All patients who had undergone cardiac surgery at 'Ospedali Riuniti' of Ancona from July 2011 to February 2013 were prospectively enrolled and divided into two treatment groups: the 'early' approach was used during the first 10 months, and the 'late' approach during the next 10 months. 'Early' RRT was started after 6 h of urine output less than 0.5 ml/kg/h, whereas in the 'late' group, therapy started on the basis of persistent (>12 h) oliguria. A total of 1658 patients were enrolled in the trial. The primary outcome was operative mortality, and the secondary outcomes were length of intensive care unit and hospital stay., Results: The total number of patients treated with RRT was 59 (3.6%): 46 (5.5%) in the 'early' group and 13 (1.6%) in the 'late' group (P < 0.0001). Although RRT was significantly less utilized in the 'late' group, no significant difference in the primary and secondary outcomes was found, but a trend towards a better outcome in the 'late' group was observed. Furthermore, we found a significant difference in mortality between the two approaches in the subgroups of patients with preoperative renal dysfunction and in patients suffering from CS-AKI with a clear advantage of the late strategy., Conclusions: Our results do not support the use of early RRT in CS-AKI., Clinical Trial Registration: This trial is registered in the clinicaltrial.gov registry: NCT01961999., (© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2015
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47. Sternal wrapping: developments and results.
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Aratari C, Capestro F, Massi F, Magnano D, Manché A, and Lamarra M
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- Aged, Blood Loss, Surgical prevention & control, Blood Transfusion, Female, Hospital Mortality, Humans, Italy, Male, Mediastinitis prevention & control, Middle Aged, Osteomyelitis prevention & control, Postoperative Complications diagnosis, Postoperative Complications mortality, Risk Factors, Surgical Wound Infection prevention & control, Time Factors, Treatment Outcome, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures mortality, Hemostatic Techniques adverse effects, Hemostatic Techniques mortality, Postoperative Complications prevention & control, Sternotomy adverse effects, Sternotomy mortality, Wound Healing
- Abstract
Background: Postoperative sternal wound complications are infrequent events that negatively affect recovery and may have serious consequences. Sternal wrapping, a technique of sternal care, has hemostatic properties without bone wax, and offers mechanical and microbiologic protection., Methods: From February 1998 to December 2011, 258 patients in 2 Italian institutions underwent various cardiac surgery procedures with sternal wrapping in place, and were followed up for no less then 6 months., Results: Two (0.8%) extremely compromised patients with ischemic sternal osteonecrosis and deep sternal wound infection required a sternal stabilizing procedure. Four (2%) other patients developed sternal wound complications that were treated entirely medically; 3 of them were very trivial, and 1 was an atypical mediastinitis without sternal involvement. Overall, 46.1% of patients (45.3% of isolated coronary artery bypass, 49.3% of isolated on-pump coronary artery bypass, and 18.2% of off-pump coronary artery bypass patients) were transfused. None of the complications was related to sternal wrapping, bleeding from the sternal edge, or sternal wound problems., Conclusions: Sternal wrapping showed a very low incidence and severity of sternal wound complications, with good prevention of sternal osteomyelitis. Hemostatic properties were satisfactory, with transfusion rates within an acceptable range.
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- 2013
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48. Pulmonary pseudoaneurysm: uncommon complication after total aortic arch operation.
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Matteucci ML, Rescigno G, Aratari C, Massi F, Capestro F, and Torracca L
- Subjects
- Aged, Aneurysm, False diagnostic imaging, Diagnosis, Differential, Female, Follow-Up Studies, Humans, Tomography, X-Ray Computed, Aneurysm, False etiology, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects, Postoperative Complications, Pulmonary Artery
- Abstract
Pulmonary pseudoaneurysms are an uncommon but life-threatening condition of congenital or acquired cause, most commonly involving the branch pulmonary arteries and generally requiring emergent intervention. We describe a case of postoperative main pulmonary artery pseudoaneurysm after a complex aortic arch procedure, in which thoracic computed tomography provided full information for its definition before surgical correction., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
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49. Allogenic blood transfusion in cardiac surgery.
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Crescenzi G, Torracca L, Capestro F, Matteucci ML, and Rossi M
- Subjects
- Adult, Blood Loss, Surgical mortality, Cardiac Surgical Procedures methods, Cardiac Surgical Procedures mortality, Erythrocyte Transfusion adverse effects, Erythrocyte Transfusion methods, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Selection, Risk Assessment, Severity of Illness Index, Survival Rate, Transfusion Reaction, Transplantation, Homologous, Treatment Outcome, Blood Loss, Surgical prevention & control, Blood Transfusion methods, Cardiac Surgical Procedures adverse effects
- Abstract
Blood transfusion carries benefits and risks. Adult cardiac surgery accounts for a significant proportion of all red blood cells transfusions. However, the identification of the patient, who will truly benefit from transfusions, is still controversial. This review provides an overview on allogenic blood transfusions in adult cardiac surgery., (© 2012 Wiley Periodicals, Inc.)
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- 2012
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50. Ten years' follow-up of single-surgeon minimally invasive reparative surgery for degenerative mitral valve disease.
- Author
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D'Alfonso A, Capestro F, Zingaro C, Matteucci S, Rescigno G, and Torracca L
- Subjects
- Adolescent, Adult, Aged, Algorithms, Cohort Studies, Endocarditis diagnosis, Follow-Up Studies, Humans, Italy, Middle Aged, Mitral Valve Insufficiency diagnosis, Mitral Valve Prolapse diagnosis, Retrospective Studies, Secondary Prevention, Treatment Outcome, Endocarditis surgery, Heart Valve Prosthesis Implantation, Minimally Invasive Surgical Procedures methods, Mitral Valve Annuloplasty methods, Mitral Valve Insufficiency surgery, Mitral Valve Prolapse surgery
- Abstract
Objective: Granted that minimally invasive mitral valve (MV) surgery short-term results were found to be equivalent to those achieved with traditional sternotomy with respect to perioperative morbidity and echocardiographic outcomes, little is known about the long-term efficacy of this approach. This report analyzes a 10-year single-surgeon experience with minimally invasive MV surgery through a right minithoracotomy with peripheral cannulation and external aortic cross-clamping and MV repair (MVR) by direct vision., Methods: We studied 179 patients (48% female) who underwent MVR between December 1999 and December 2010. Mean age was 40.2 ± 10.1 years (range, 15-67 years). One hundred seventy patients (95.0%) had degenerative diseases, and nine patients (5.0%) had endocarditic diseases. Repair techniques for degenerative disease with posterior leaflet prolapse (74 patients, 43.5%) consisted of quadrangular resection (QR) and annuloplasty (AP) combined with sliding plasty (49 patients, 58.1%); for anterior leaflet prolapse (28 patients, 16.5%) and bileaflet prolapse (66 patients, 38.8%), edge-to-edge repair (EE) and AP; in 2 patients (1.2%), annular dilatation alone consisting of AP. Repair techniques for endocarditic disease consisted of EE in six patients (66.7%), perforation closure in two patients (22.2%), and QR combined with AP in one patient (11.1%)., Results: All patients survived the operation and were discharged with MV regurgitation (MR) less than 2+/4+. At 10 years' follow-up, overall survival was 98.7% ± 1.2%, freedom from redo was 98.5% ± 1.1%, freedom from MR recurrence (>2+/4+) in QR and in EE repair were, respectively, 91.7% ± 2.2% and 90.0% ± 2.4% (P = not significant). The linearized rates of overall mortality, MR recurrence (>2+/4+), and redo at follow-up are 0.10% ± 0.10% per year, 0.63% ± 0.26% per year, and 0.21% ± 0.15% per year, respectively., Conclusions: Minimally invasive MVR can be performed with very good perioperative and long-term results. Freedom from MR greater than 2+/4+ recurrence for patients with QR is equivalent to that with EE repair in our patient cohort.
- Published
- 2012
- Full Text
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