Search

Heart failure is a serious and challenging medical condition characterized by the inability of the heart to pump blood effectively, leading to reduced blood flow to organs and tissues. Several underlying causes may be linked to this, including coronary artery disease, hypertension, or previous heart attacks. Therefore, it is a chronic condition that requires ongoing management and medical attention. HF affects >64 million individuals worldwide. Heart transplantation remains the gold standard of treatment for patients with end-stage cardiomyopathy. The recruitment of marginal donors may be considered an asset at the age of cardiac donor organ shortage. Primary graft dysfunction (PGD) is becoming increasingly common in the new era of heart transplantations. PGD is the most common cause of death within 30 days of cardiac transplantation. Mechanical Circulatory Support (MCS), particularly venoarterial extracorporeal membrane oxygenation (V-A ECMO), is the only effective treatment for severe PGD. VA-ECMO support ensures organ perfusion and provides the transplanted heart with adequate rest and recovery. In the new era of heart transplantation, early use allows for increased patient survival and careful management reduces complications. [ABSTRACT FROM AUTHOR]

Objective: To analyze the data of the psychological assessment, focusing attention on the quality of life and the psychological status of patients who are listed for heart transplant. Methods: All heart failure patients listed for heart transplant at the Cardiac Surgery Unit of Bari University, Italy, were evaluated from September to November 2023, by administering the Symptom Checklist‐90‐R (SCL‐90‐R) and the Short Form Health Survey 36 (SF‐36). Results: Overall, 27 patients were studied. Mean age was 60 years, 88% were males. One third of the patients showed a clinically significant overall mental distress. The symptoms leading to domains such as somatization (55.55%), anxiety (40.74%) and depression (33.33%) were frequently observed. The majority of the population studied (96.30%) showed low levels of perceived physical health status, while 59,62% of them presented levels of perceived physical health status below normal ranges. Conclusions: Heart transplant candidates show elements of overall mental distress and low quality of life related to physical health status. [ABSTRACT FROM AUTHOR]

Background: Measuring the chordae tendineae for mitral valve reconstruction is feasible with various techniques. However, the effect of different strategies on the durability of plastics at follow-up is unknown. The study aims to compare a conventional surgical technique for measuring artificial chordae length with our new approach, defined “track technique”. Methods: We compared the results of patients with anterior leaflet prolapse/flail who underwent mitral valve reconstruction by implanting artificial chordae from January 2020 to January 2022; 22 patients were operated on with a conventional technique, and 25 with our new alternative, “track technique”. Clinical and transesophageal echocardiography data were collected postoperatively and at 2 years of follow-up. The primary outcome was freedom from mitral regurgitation. Secondary outcomes were presentation with New York Heart Association (NYHA) class <2 and leaflet coaptation length ≥10 mm. Results: The patients of the 2 groups had comparable preoperative risk factors regarding the LogEuroSCORE (p = 0.33). Moreover, no difference was observed in terms of the mechanism of mitral valve insufficiency. No hospital or follow-up deaths were recorded for either group. At discharge, no echocardiographic differences were observed in the regarding degree of residual mitral regurgitation, but the measurement of coaptation length was in favor of the alternative group (8.6 ± 1.8 vs. 11 ± 1.4; p = 0.04). At 2 years of follow-up (25 ± 9; range 13–37), the NYHA class was not different; however, the number of patients with 1–2+ recurrent mitral regurgitation was significantly higher in the conventional group (8 vs. 4 patients; p = 0.02), and the coaptation length was in favor of the alternative group (8.8 ± 1.7 vs. 11 ± 1.7; p = 0.04). Conclusions: We devised both techniques to prove effective in achieving good valvular continence, but a significantly greater coaptation length was obtained with our track technique at the 2 years follow-up. [ABSTRACT FROM AUTHOR]

Background: Insufflation of carbon dioxide (CO2) into the operative field to prevent cerebral or myocardial damage by air embolism is a well known strategy in open-heart surgery. However, here is no general consensus on the best delivery approach.Methods: From January 2018 to November 2021, we retrospectively collected data of one hundred consecutive patients undergoing minimally invasive mitral valve repair (MIMVR). Of these, fifty patients were insufflated with continuous CO2 1 min before opening the left atrium and ended after its closure, and fifty patients were insufflated with one shot CO2 10 min before the start of left atrium closure. The primary outcome of the study was the incidence of transient post-operative cognitive disorder, in particular agitation and delirium at discontinuation of anesthesia, mechanical ventilation (MV) duration and intensive care unit (ICU) length of stay.Results: In all patients that received continuous field flooding CO2, correction of ventilation for hypercapnia during cardiopulmonary bypass (CPB) was applied with an increase of mean sweep gas air (2.5 L) and monitoring of VCO2 changes. One patient vs. 9 patients of control group reported agitation at discontinuation of anesthesia (p = 0.022). MV duration was 14 ± 3 h vs. 27 ± 4 h (p = 0.016) and ICU length of stay was 33 ± 4 h vs. 42 ± 5 h (p = 0.029). A significant difference was found in the median number of total micro-emboli recorded from release of cross-clamp until 20 min after end of CPB (154 in the continuous CO2 group vs. 261 in the one-shot CO2 control group; p < 0.001). Total micro-emboli from the first 15 min after the release of cross-clamp was 113 in the continuous CO2 group vs. 310 in the control group (p < 0.001). In the continuous CO2 group, the median number of detectable micro-emboli after CPB fell to zero 9 ± 5 min after CPB vs. 19 ± 3 min in the control group (p = 0.85).Conclusion: Continuous field flooding insufflation of CO2 in MIMVR is associated with a lower incidence of micro-emboli and of agitation at discontinuation of anesthesia, along with improved MV duration and ICU length of stay. [ABSTRACT FROM AUTHOR]

Background and Aim of the Study: The debate on the usefulness of the minimally invasive approach in mitral valve surgery is still open. The aim of this study is to describe a single‐center case series of all comers undergoing minimally invasive mitral valve reconstruction. Methods: From 2010 to 2019, all the data recorded in the medical records of 893 consecutive patients undergoing mitral valve reconstruction through a right mini‐thoracotomy were retrospectively collected. All patients were contacted by telephone for remote evaluation and integration of echocardiographic information on surgical results. Results: Mean age was 62.2 ± 14.5; 447 (50%) were female and mean log EuroSCORE was 2.5 ± 2.8%. At a mean follow‐up of 4.1 ± 2.2 years (median 3.9), a total of 24 deaths (2.68%) were recorded. Twenty‐four patients required rehospitalization for cardiac causes, 13 (1.4%) patients had at least moderate mitral insufficiency on follow‐up echocardiography and, of these, seven patients underwent reoperation (0.8%). The cumulative hazard showed that 8.3% of patients experienced at least one event at 5 years. NYHA class improved significantly with 874 patients in NYHA class I, 13 in NYHA class II, 6 in NYHA class III, and 0 in NYHA class IV at last follow‐up (p <.001 from baseline as reference point). Conclusions: In a high‐volume center, mitral valve surgery using a minimally invasive approach is a feasible treatment option for all‐comers and is associated with excellent results that are maintained at clinical and echocardiographic follow‐up. [ABSTRACT FROM AUTHOR]

Background: We sought to determine if a modified technique for ascending aorta replacement with sinotubular junction reduction and stabilization was safe. Methods: This technique was performed by suspension of the three commissures, invagination of the aortic Dacron graft and advancing the graft into the ventricles. We included patients with dilatation of the ascending aorta, normal sinuses of Valsalva dimension (<45 mm), with or without aortic annulus enlargement (>25 mm) and with various degree of aortic insufficiency (from grade 1 to 3). Results: From April to October 2019, 20 patients were recruited from two centers; mean age was 66.9 ± 12.8 years, 13 were male; grade 1, 2 and 3 was present in 12, 2 and 6 patients, respectively. All patients underwent ascending aorta replacement with modified technique; an additional open subvalvular ring was used in 8 patients with aortic insufficiency ≥ 2; cusps repair was performed in 6 patients (5 plicating central stitches/1 shaving); concomitant coronary artery bypass grafting was performed in 10 patients. There was no 30-day mortality. One patient was re-explored for bleeding. All patients completed six-month follow-up; at the transthoracic echocardiography, there was no aortic insufficiency ≥ 1 except one patient with aortic insufficiency grade 1 who underwent ascending aorta replacement and subvalvular ring; no patients underwent reintervention. Conclusions: This modified technique for ascending aorta replacement and sinotubular junction stabilization was safe. It could be associated with other aortic valve sparing techniques. However, such remodeling approach has to be validated in a larger cohort of patients with longer follow-up. [ABSTRACT FROM AUTHOR]

Background: Pilonidal sinus disease is a chronic condition of adolescents and young adults and is rare after the age of 40 years with a reported incidence rate of 26/10.000 people per year. Over the years many surgical approaches have been proposed but to date an ideal treatment has not yet been developed. The aim of this prospective observational study was to evaluate the short and long-term results obtained with this minimally surgical trephine technique for the treatment of pilonidal disease. Material and Methods: From November 2017 to November 2019 we treated 70 consecutive patients with minimally trephines technique. All patients were evaluated in terms of operation time, perioperative and postoperative complications, postoperative pain, patient satisfaction and recurrence at 6 months. Results: We prospectly observed 49 males and 21 females with an average age of 27.86 years (range: 17-36), finding a low operative time, a high cure rate (95.71%) and a low recurrence rate (4.28%). Differently from the Gips technique we suture the trephine-made openings, and this in our opinion reduces even more the healing time (19.14 days). Conclusion: Trephine operation is a simple outpatient approach for treating pilonidal sinus disease, with quick recovery, and appealing aesthetic outcome. Patients undergoing minimal excision with trephines had reduced number of sick days, shorter time to activity and fewer days requiring analgesia, and in cases of recurrence, the same treatment can be repeated as needed. [ABSTRACT FROM AUTHOR]