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8. OC69 SURGERY FOR BENTALL ENDOCARDITIS: SHORT AND LONG-TERM OUTCOME FROM A MULTI-CENTRE REGISTRY

Author

Sponga, S., Di Mauro, M., Pacini, D., Murara, G., Di Bartolomeo, R., Cappabianca, G., Beghi, C., Weltert, L., De Paulis, R., De Vincentiis, C., Biondi, A., Santini, F., Salsano, A., Salvador, L., Picichè, M., Mariscalco, G., Maselli, D., Rinaldi, M., Mancuso, S., Scrofani, R., Cagnoni, G., Antona, C., Dato, G.M.A., Centofani, P., De Bonis, M., Pozzoli, A., Cugola, D., Galletti, L., Villa, E., Dossena, Y., Troise, G., Barili, F., Paparella, D., Margari, V., Lorusso, R., Parolari, A., and Livi, U.

Published
2018
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9. OC71 SURGICAL TREATMENT FOR ISOLATED TRICUSPID VALVE INFECTIVE ENDOCARDITIS. 25-YEAR RESULTS

Author

Di Mauro, M., Dato, G. Actis, Barili, F., Corte, A. Della, Ratta, E. Della, Cugola, D., Galletti, L., Centofanti, P., Santini, F., Salsano, A., Rinaldi, M., Mancuso, S., Cappabianca, G., Beghi, C., De Vincentiis, C., Biondi, A., Livi, U., Sponga, S., Pacini, D., Murara, G., Di Bortalomeo, R., Scrofani, R., Cagnoni, G., Antona, C., Nicolini, F., Benassi, F., De Bonis, M., Pozzoli, A., Casali, G., Scrascia, G., Bortolotti, U., Falcetta, G., Musumeci, F., Gherli, R., Vizzardi, E., Salvador, L., Piccichè, M., Paparella, D., Margari, V., Troise, G., Villa, E., Dossena, Y., Lucarelli, C., Onorati, F., Faggian, G., Mariscalco, G., Maselli, D., Foschi, M., Parolari, A., and Lorusso, R.

Published
2018
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12. Abrupt intrinsic and extrinsic responses of southwestern Iberian vegetation to millennial‐scale variability over the past 28 ka

Author

Cutmore, A., Ausín, B., Maslin, M., Eglinton, T., Hodell, D., Muschitiello, F., Menviel, L., Haghipour, N., Martrat, B., Margari, V., Tzedakis, P.C., Cutmore, A., Ausín, B., Maslin, M., Eglinton, T., Hodell, D., Muschitiello, F., Menviel, L., Haghipour, N., Martrat, B., Margari, V., and Tzedakis, P.C.

Abstract

We present new high-resolution pollen records combined with palaeoceanographic proxies from the same samples in deep-sea cores SHAK06-5K and MD01-2444 on the southwestern Iberian Margin, documenting regional vegetation responses to orbital and millennial-scale climate changes over the last 28 ka. The chronology of these records is based on high-resolution radiocarbon dates of monospecific samples of the planktonic foraminifera Globigerina bulloides, measured from SHAK06-5K and MD01-2444 and aligned using an automated stratigraphical alignment method. Changes in temperate and steppe vegetation during Marine Isotope Stage 2 are closely coupled with sea surface temperature (SST) and global ice-volume changes. The peak expansion of thermophilous woodland between ~10.1 and 8.4 cal ka bp lags behind the boreal summer insolation maximum by ~2 ka, possibly arising from residual high-latitude ice-sheets into the Holocene. Rapid changes in pollen percentages are coeval with abrupt transitions in SSTs, precipitation and winter temperature at the onset and end of Heinrich Stadial 2, the ice-rafted debris event and end of Heinrich Stadial 1, and the onset of the Younger Dryas, suggesting extrinsically forced southwestern Iberian ecosystem changes by abrupt North Atlantic climate events. In contrast, the abrupt decline in thermophilous elements at ~7.8 cal ka bp indicates an intrinsically mediated abrupt vegetation response to the gradually declining boreal insolation, potentially resulting from the crossing of a seasonality of precipitation threshold.

Published
2022

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

Author

Di Mauro, M, Foschi, M, Dato, G, Centofanti, P, Barili, F, Corte, A, Ratta, E, Cugola, D, Galletti, L, Santini, F, Salsano, A, Rinaldi, M, Mancuso, S, Cappabianca, G, Beghi, C, De Vincentiis, C, Biondi, A, Livi, U, Sponga, S, Pacini, D, Murana, G, Scrofani, R, Antona, C, Cagnoni, G, Nicolini, F, Benassi, F, De Bonis, M, Pozzoli, A, Casali, G, Scrascia, G, Falcetta, G, Bortolotti, U, Musumeci, F, Gherli, R, Vizzardi, E, Salvador, L, Piciche, M, Paparella, D, Margari, V, Troise, G, Villa, E, Dossena, Y, Lucarelli, C, Onorati, F, Faggian, G, Mariscalco, G, Maselli, D, Parolari, A, Lorusso, R, Di Mauro M., Foschi M., Dato G. M. A., Centofanti P., Barili F., Corte A. D., Ratta E. D., Cugola D., Galletti L., Santini F., Salsano A., Rinaldi M., Mancuso S., Cappabianca G., Beghi C., De Vincentiis C., Biondi A., Livi U., Sponga S., Pacini D., Murana G., Scrofani R., Antona C., Cagnoni G., Nicolini F., Benassi F., De Bonis M., Pozzoli A., Casali G., Scrascia G., Falcetta G., Bortolotti U., Musumeci F., Gherli R., Vizzardi E., Salvador L., Piciche M., Paparella D., Margari V., Troise G., Villa E., Dossena Y., Lucarelli C., Onorati F., Faggian G., Mariscalco G., Maselli D., Parolari A., Lorusso R., Di Mauro, M, Foschi, M, Dato, G, Centofanti, P, Barili, F, Corte, A, Ratta, E, Cugola, D, Galletti, L, Santini, F, Salsano, A, Rinaldi, M, Mancuso, S, Cappabianca, G, Beghi, C, De Vincentiis, C, Biondi, A, Livi, U, Sponga, S, Pacini, D, Murana, G, Scrofani, R, Antona, C, Cagnoni, G, Nicolini, F, Benassi, F, De Bonis, M, Pozzoli, A, Casali, G, Scrascia, G, Falcetta, G, Bortolotti, U, Musumeci, F, Gherli, R, Vizzardi, E, Salvador, L, Piciche, M, Paparella, D, Margari, V, Troise, G, Villa, E, Dossena, Y, Lucarelli, C, Onorati, F, Faggian, G, Mariscalco, G, Maselli, D, Parolari, A, Lorusso, R, Di Mauro M., Foschi M., Dato G. M. A., Centofanti P., Barili F., Corte A. D., Ratta E. D., Cugola D., Galletti L., Santini F., Salsano A., Rinaldi M., Mancuso S., Cappabianca G., Beghi C., De Vincentiis C., Biondi A., Livi U., Sponga S., Pacini D., Murana G., Scrofani R., Antona C., Cagnoni G., Nicolini F., Benassi F., De Bonis M., Pozzoli A., Casali G., Scrascia G., Falcetta G., Bortolotti U., Musumeci F., Gherli R., Vizzardi E., Salvador L., Piciche M., Paparella D., Margari V., Troise G., Villa E., Dossena Y., Lucarelli C., Onorati F., Faggian G., Mariscalco G., Maselli D., Parolari A., and Lorusso R.

Abstract

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

Published
2019

15. Corrigendum to “A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE”. [Int. J. Cardiol. 241 (Aug 15 2017) 97–102](S0167527317309877)(10.1016/j.ijcard.2017.03.148)

Author

Di Mauro M., Di Mauro, M, Dato, G, Barili, F, Gelsomino, S, Sante, P, Corte, A, Carrozza, A, Ratta, E, Cugola, D, Galletti, L, Devotini, R, Casabona, R, Santini, F, Salsano, A, Scrofani, R, Antona, C, Botta, L, Russo, C, Mancuso, S, Rinaldi, M, De Vincentiis, C, Biondi, A, Beghi, C, Cappabianca, G, Tarzia, V, Gerosa, G, De Bonis, M, Pozzoli, A, Nicolini, F, Benassi, F, Rosato, F, Grasso, E, Livi, U, Sponga, S, Pacini, D, Di Bartolomeo, R, Demartino, A, Bortolotti, U, Onorati, F, Faggian, G, Lorusso, R, Vizzardi, E, Di Giammarco, G, Marinelli, D, Villa, E, Troise, G, Piciche, M, Musumeci, F, Paparella, D, Margari, V, Tritto, F, Damiani, G, Scrascia, G, Zaccaria, S, Renzulli, A, Serraino, G, Mariscalco, G, Maselli, D, Foschi, M, Parolari, A, Nappi, G, Di Mauro M., Dato G. M. A., Barili F., Gelsomino S., Sante P., Corte A. D., Carrozza A., Ratta E. D., Cugola D., Galletti L., Devotini R., Casabona R., Santini F., Salsano A., Scrofani R., Antona C., Botta L., Russo C., Mancuso S., Rinaldi M., De Vincentiis C., Biondi A., Beghi C., Cappabianca G., Tarzia V., Gerosa G., De Bonis M., Pozzoli A., Nicolini F., Benassi F., Rosato F., Grasso E., Livi U., Sponga S., Pacini D., Di Bartolomeo R., DeMartino A., Bortolotti U., Onorati F., Faggian G., Lorusso R., Vizzardi E., Di Giammarco G., Marinelli D., Villa E., Troise G., Piciche M., Musumeci F., Paparella D., Margari V., Tritto F., Damiani G., Scrascia G., Zaccaria S., Renzulli A., Serraino G., Mariscalco G., Maselli D., Foschi M., Parolari A., Nappi G., Di Mauro M., Di Mauro, M, Dato, G, Barili, F, Gelsomino, S, Sante, P, Corte, A, Carrozza, A, Ratta, E, Cugola, D, Galletti, L, Devotini, R, Casabona, R, Santini, F, Salsano, A, Scrofani, R, Antona, C, Botta, L, Russo, C, Mancuso, S, Rinaldi, M, De Vincentiis, C, Biondi, A, Beghi, C, Cappabianca, G, Tarzia, V, Gerosa, G, De Bonis, M, Pozzoli, A, Nicolini, F, Benassi, F, Rosato, F, Grasso, E, Livi, U, Sponga, S, Pacini, D, Di Bartolomeo, R, Demartino, A, Bortolotti, U, Onorati, F, Faggian, G, Lorusso, R, Vizzardi, E, Di Giammarco, G, Marinelli, D, Villa, E, Troise, G, Piciche, M, Musumeci, F, Paparella, D, Margari, V, Tritto, F, Damiani, G, Scrascia, G, Zaccaria, S, Renzulli, A, Serraino, G, Mariscalco, G, Maselli, D, Foschi, M, Parolari, A, Nappi, G, Di Mauro M., Dato G. M. A., Barili F., Gelsomino S., Sante P., Corte A. D., Carrozza A., Ratta E. D., Cugola D., Galletti L., Devotini R., Casabona R., Santini F., Salsano A., Scrofani R., Antona C., Botta L., Russo C., Mancuso S., Rinaldi M., De Vincentiis C., Biondi A., Beghi C., Cappabianca G., Tarzia V., Gerosa G., De Bonis M., Pozzoli A., Nicolini F., Benassi F., Rosato F., Grasso E., Livi U., Sponga S., Pacini D., Di Bartolomeo R., DeMartino A., Bortolotti U., Onorati F., Faggian G., Lorusso R., Vizzardi E., Di Giammarco G., Marinelli D., Villa E., Troise G., Piciche M., Musumeci F., Paparella D., Margari V., Tritto F., Damiani G., Scrascia G., Zaccaria S., Renzulli A., Serraino G., Mariscalco G., Maselli D., Foschi M., Parolari A., and Nappi G.

Abstract

The authors regret that the first name and last name of the author Sandro Sponga was published incorrectly in the original version and this has now been corrected.

Published
2018

17. Surgery for prosthetic valve endocarditis: A retrospective study of a national registry

Author

Corte, A, Di Mauro, M, Dato, G, Barili, F, Cugola, D, Gelsomino, S, Sante, P, Carozza, A, Ratta, E, Galletti, L, Devotini, R, Casabona, R, Santini, F, Salsano, A, Scrofani, R, Antona, C, De Vincentiis, C, Biondi, A, Beghi, C, Cappabianca, G, De Bonis, M, Pozzoli, A, Nicolini, F, Benassi, F, Pacini, D, Di Bartolomeo, R, De Martino, A, Bortolotti, U, Lorusso, R, Vizzardi, E, Di Giammarco, G, Marinelli, D, Villa, E, Troise, G, Paparella, D, Margari, V, Tritto, F, Damiani, G, Scrascia, G, Zaccaria, S, Renzulli, A, Serraino, G, Mariscalco, G, Maselli, D, Parolari, A, Nappi, G, Corte A. D., Di Mauro M., Dato G. A., Barili F., Cugola D., Gelsomino S., Sante P., Carozza A., Ratta E. D., Galletti L., Devotini R., Casabona R., Santini F., Salsano A., Scrofani R., Antona C., De Vincentiis C., Biondi A., Beghi C., Cappabianca G., De Bonis M., Pozzoli A., Nicolini F., Benassi F., Pacini D., Di Bartolomeo R., De Martino A., Bortolotti U., Lorusso R., Vizzardi E., Di Giammarco G., Marinelli D., Villa E., Troise G., Paparella D., Margari V., Tritto F., Damiani G., Scrascia G., Zaccaria S., Renzulli A., Serraino G., Mariscalco G., Maselli D., Parolari A., Nappi G., Corte, A, Di Mauro, M, Dato, G, Barili, F, Cugola, D, Gelsomino, S, Sante, P, Carozza, A, Ratta, E, Galletti, L, Devotini, R, Casabona, R, Santini, F, Salsano, A, Scrofani, R, Antona, C, De Vincentiis, C, Biondi, A, Beghi, C, Cappabianca, G, De Bonis, M, Pozzoli, A, Nicolini, F, Benassi, F, Pacini, D, Di Bartolomeo, R, De Martino, A, Bortolotti, U, Lorusso, R, Vizzardi, E, Di Giammarco, G, Marinelli, D, Villa, E, Troise, G, Paparella, D, Margari, V, Tritto, F, Damiani, G, Scrascia, G, Zaccaria, S, Renzulli, A, Serraino, G, Mariscalco, G, Maselli, D, Parolari, A, Nappi, G, Corte A. D., Di Mauro M., Dato G. A., Barili F., Cugola D., Gelsomino S., Sante P., Carozza A., Ratta E. D., Galletti L., Devotini R., Casabona R., Santini F., Salsano A., Scrofani R., Antona C., De Vincentiis C., Biondi A., Beghi C., Cappabianca G., De Bonis M., Pozzoli A., Nicolini F., Benassi F., Pacini D., Di Bartolomeo R., De Martino A., Bortolotti U., Lorusso R., Vizzardi E., Di Giammarco G., Marinelli D., Villa E., Troise G., Paparella D., Margari V., Tritto F., Damiani G., Scrascia G., Zaccaria S., Renzulli A., Serraino G., Mariscalco G., Maselli D., Parolari A., and Nappi G.

Abstract

OBJECTIVES: We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design. METHODS: Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study. RESULTS: Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P < 0.001), consistent with increasing mean patient age (56 ± 14, 64 ± 15, 65 ± 14 years, respectively, P < 0.001) and median logistic EuroSCORE (14%, 21%, 23%, P = 0.025). Older age, female sex, preoperative serum creatinine > -2 mg/dl, chronic pulmonary disease, low ejection fraction, non-streptococcal aetiology, active endocarditis, preoperative intubation, preoperative shock and triple valve surgery were significantly associated with mortality. In multivariable analysis, age (OR = 1.02; P = 0.03), renal insufficiency (OR = 2.1; P = 0.05), triple valve surgery (OR = 6.9; P = 0.004) and shock (OR = 4.5; P < 0.001) were independently associated with mortality, while streptococcal aetiology, healed endocarditis and ejection fraction with survival. Adjusting for study era, preoperative shock (OR = 3; P < 0.001), Enterococcus (OR = 2.3; P = 0.01) and female sex (OR = 1.5; P = 0.03) independently predicted complications, whereas ejection fraction was protective. CONCLUSIONS: PVE surgery remains a high-risk one. The strongest predictors of early outcome of PVE surgery are related to patient's haemodynamic status an

Published
2017

18. A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE

Author

Di Mauro, M, Dato, G, Barili, F, Gelsomino, S, Sante, P, Corte, A, Carrozza, A, Ratta, E, Cugola, D, Galletti, L, Devotini, R, Casabona, R, Santini, F, Salsano, A, Scrofani, R, Antona, C, Botta, L, Russo, C, Mancuso, S, Rinaldi, M, De Vincentiis, C, Biondi, A, Beghi, C, Cappabianca, G, Tarzia, V, Gerosa, G, De Bonis, M, Pozzoli, A, Nicolini, F, Benassi, F, Rosato, F, Grasso, E, Livi, U, Sandro, S, Pacini, D, Di Bartolomeo, R, De Martino, A, Bortolotti, U, Onorati, F, Faggian, G, Lorusso, R, Vizzardi, E, Di Giammarco, G, Marinelli, D, Villa, E, Troise, G, Piciche, M, Musumeci, F, Paparella, D, Margari, V, Tritto, F, Damiani, G, Scrascia, G, Zaccaria, S, Renzulli, A, Serraino, G, Mariscalco, G, Maselli, D, Foschi, M, Parolari, A, Nappi, G, Di Mauro M., Dato G. M. A., Barili F., Gelsomino S., Sante P., Corte A. D., Carrozza A., Ratta E. D., Cugola D., Galletti L., Devotini R., Casabona R., Santini F., Salsano A., Scrofani R., Antona C., Botta L., Russo C., Mancuso S., Rinaldi M., De Vincentiis C., Biondi A., Beghi C., Cappabianca G., Tarzia V., Gerosa G., De Bonis M., Pozzoli A., Nicolini F., Benassi F., Rosato F., Grasso E., Livi U., Sandro S., Pacini D., Di Bartolomeo R., De Martino A., Bortolotti U., Onorati F., Faggian G., Lorusso R., Vizzardi E., Di Giammarco G., Marinelli D., Villa E., Troise G., Piciche M., Musumeci F., Paparella D., Margari V., Tritto F., Damiani G., Scrascia G., Zaccaria S., Renzulli A., Serraino G., Mariscalco G., Maselli D., Foschi M., Parolari A., Nappi G., Di Mauro, M, Dato, G, Barili, F, Gelsomino, S, Sante, P, Corte, A, Carrozza, A, Ratta, E, Cugola, D, Galletti, L, Devotini, R, Casabona, R, Santini, F, Salsano, A, Scrofani, R, Antona, C, Botta, L, Russo, C, Mancuso, S, Rinaldi, M, De Vincentiis, C, Biondi, A, Beghi, C, Cappabianca, G, Tarzia, V, Gerosa, G, De Bonis, M, Pozzoli, A, Nicolini, F, Benassi, F, Rosato, F, Grasso, E, Livi, U, Sandro, S, Pacini, D, Di Bartolomeo, R, De Martino, A, Bortolotti, U, Onorati, F, Faggian, G, Lorusso, R, Vizzardi, E, Di Giammarco, G, Marinelli, D, Villa, E, Troise, G, Piciche, M, Musumeci, F, Paparella, D, Margari, V, Tritto, F, Damiani, G, Scrascia, G, Zaccaria, S, Renzulli, A, Serraino, G, Mariscalco, G, Maselli, D, Foschi, M, Parolari, A, Nappi, G, Di Mauro M., Dato G. M. A., Barili F., Gelsomino S., Sante P., Corte A. D., Carrozza A., Ratta E. D., Cugola D., Galletti L., Devotini R., Casabona R., Santini F., Salsano A., Scrofani R., Antona C., Botta L., Russo C., Mancuso S., Rinaldi M., De Vincentiis C., Biondi A., Beghi C., Cappabianca G., Tarzia V., Gerosa G., De Bonis M., Pozzoli A., Nicolini F., Benassi F., Rosato F., Grasso E., Livi U., Sandro S., Pacini D., Di Bartolomeo R., De Martino A., Bortolotti U., Onorati F., Faggian G., Lorusso R., Vizzardi E., Di Giammarco G., Marinelli D., Villa E., Troise G., Piciche M., Musumeci F., Paparella D., Margari V., Tritto F., Damiani G., Scrascia G., Zaccaria S., Renzulli A., Serraino G., Mariscalco G., Maselli D., Foschi M., Parolari A., and Nappi G.

Abstract

Background The aim of this large retrospective study was to provide a logistic risk model along an additive score to predict early mortality after surgical treatment of patients with heart valve or prosthesis infective endocarditis (IE). Methods From 2000 to 2015, 2715 patients with native valve endocarditis (NVE) or prosthesis valve endocarditis (PVE) were operated on in 26 Italian Cardiac Surgery Centers. The relationship between early mortality and covariates was evaluated with logistic mixed effect models. Fixed effects are parameters associated with the entire population or with certain repeatable levels of experimental factors, while random effects are associated with individual experimental units (centers). Results Early mortality was 11.0% (298/2715); At mixed effect logistic regression the following variables were found associated with early mortality: age class, female gender, LVEF, preoperative shock, COPD, creatinine value above 2 mg/dl, presence of abscess, number of treated valve/prosthesis (with respect to one treated valve/prosthesis) and the isolation of Staphylococcus aureus, Fungus spp., Pseudomonas Aeruginosa and other micro-organisms, while Streptococcus spp., Enterococcus spp. and other Staphylococci did not affect early mortality, as well as no micro-organisms isolation. LVEF was found linearly associated with outcomes while non-linear association between mortality and age was tested and the best model was found with a categorization into four classes (AUC = 0.851). Conclusions The following study provides a logistic risk model to predict early mortality in patients with heart valve or prosthesis infective endocarditis undergoing surgical treatment, called “The EndoSCORE”.

Published
2017

19. MID–TERM OUTCOMES OF ENDOSCOPIC MITRAL VALVE REPAIR VIA RIGHT ANTERIOR MINI–THORACOTOMY

Author

Squiccimarro, E, Margari, V, Kounakis, G, Visicchio, G, Pascarella, C, Carbone, C, and Paparella, D

Abstract

The adoption of less–invasive mitral repair (MVr) surgery is increasing, backed by evidence of satisfactory short–term results and lower major morbidity. We assessed mid–term follow–up results of our experience, and compared two techniques: isolated leaflet resection and neochord implantation for posterior leaflet (PML) prolapse. Between 2012–2021, 700+ operations were performed with a video–assisted right mini–thoracotomy (RMT) approach. We report 309 consecutive patients who had endoscopic MVr, including those receiving concomitant tricuspid repair, ablation for atrial fibrillation, closure of patent foramen ovale and/or left atrial appendage. The early and mid–term follow–up results were ascertained. Primary outcome was the incidence of mortality and significant mitral regurgitation (MR) during follow–up which were summarized by Kaplan–Meier estimator and compared between treatment arms via log–rank test. Secondary outcomes were the early–postoperative results including 30–days mortality and major complications. All patients had endoscopic MVr via RMT at the 3rd/4th intercostal space (IS). A soft–tissue retractor is used, accompanied or not by a rib spreader, and two ports in the fourth and sixth IS are used for 3D thoracoscopy and carbon dioxide insufflation. Femoral vessels exposure through a right groin incision and echo–guided cannulation sec. Seldinger is achieved post–heparinization. Thoracic fascia bisection is performed during single–lung ventilation using a double–lumen endotracheal tube, integral to our anesthetic management, including percutaneous right internal jugular vein cannulation. The pericardium is opened and an aortic root cannula for cardioplegia delivery and venting is placed via working incision. After establishing cardiopulmonary bypass, a Chitwood clamp is passed through the second IS and cardioplegia is delivered. Endoaortic balloon clamping is primarily used in redo cases. With ring annuloplasty, 136 (44%) patients received PML resection (122 isolated) and 97 (31%) PML chords implantation (88 isolated). Forty–nine patients had annuloplasty alone. In–hospital mortality was 1.0%. Mean follow–up was 29±22 months (max 8.3 years). Kaplan–Meier 5–year survival was 97.3±1.0%. MR (3/4+) free–survival at 5 years was 94.5±2.3%. Subgroup time–to–event analysis for the indexed outcomes showed no statistical significance between techniques. In conclusion, endoscopic MVr is safe with excellent mid–term outcomes.

Published
2024
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20. Effect of methylprednisolone on acute kidney injury in patients undergoing cardiac surgery with a cardiopulmonary bypass pump: a randomized controlled trial

Author

Garg, Amit X, Chan, Matthew TV, Cuerden, Meaghan S, Devereaux, PJ, Abbasi, Seyed Hesameddin, Hildebrand, Ainslie, Lamontagne, Francois, Lamy, Andre, Noiseux, Nicolas, Parikh, Chirag R, Perkovic, Vlado, Quantz, Mackenzie, Rochon, Antoine, Royse, Alistair, Sessler, Daniel I, Shah, Pallav J, Sontrop, Jessica M, Tagarakis, Georgios I, Teoh, Kevin H, Vincent, Jessica, Walsh, Michael, Yared, Jean-Pierre, Yusuf, Salim, Whitlock, Richard P, Whitlock, R, Semelhago, L, Chu, V, Dyub, A, Cybulsky, I, Van Oosteen, R, Cordova, G, Quantz, MA, McKenzie, FN, Fox, S, Chase, L, Stevens, LM, Prieto, I, Basile, F, Finegan, BA, Bryden, C, Meyer, S, Chappell, A, Mazer, CD, Dixon, J, Yagnik, S, Crescini, C, Verma, S, Legare, JF, Greentree, D, Coutu, M, Teijeira, J, Wiley, W, Peniston, C, Teng, C, Rochon, AG, Lamarche, Y, Deschamps, A, Voisine, P, Dagenais, F, Singal, RK, Brown, CD, Kieser, TM, Robinson, R, Fremes, SE, Christakis, GT, Melvin, KN, Parsons, M, Zheng, H, Yu, J, Xu, W, Zhang, Q, Chen, C, Yu, H, Zeng, J, Zuo, Y, Liu, J, Zhang, T, Sun, Y, Song, D, Dong, H, Chen, M, Zhao, J, Tao, L, Huang, W, Cheng, Y, Long, YS, Lei, W, Zhang, W, Xu, MY, Qing, E, Xiao, YB, Karunakaran, J, Pillai, VV, Reddy, PB, Kundan, S, Jain, AR, Mallya, SS, Mehta, CB, Shukla, V, Kuruvila, K, Karthikeyan, G, Devagourou, V, Hote, MP, Airan, B, Padmanabhan, C, Srinivasan, M, Agarwal, SK, Pande, S, Rao, P Simha Mohan, Math, R, Shankar, BPR, Vaijyanath, PH, Nair, SK, Ayapati, DR, Kurz, A, Awais, A, Panjasawatwong, K, Kashy, BK, Huffmyer, JL, Scalzo, DC, Kazemi, A, Huang, KF, Parvathaneni, SV, Gardner, JC, Malik, MR, Eshraghi, Y, Kramer, RS, Essandoh, MK, Portillo, J, Ayad, SS, Akhtar, Z, Castresana, MR, Collard, CD, Rodriguez-Blanco, YF, Eaton, MP, Villar, JC, Umana, JP, Dominguez, CL, Alvarado, PA, Zuluaga, D, Abello, M, Sarquis, T, Vaquiro, E, Oliveros, CA, Manrique, EJ, Vasquez, S, Ortiz, LM, Holliday, J, Griffin, R, Royse, AG, Royse, CF, Williams, Z, Paparella, D, Rotunno, C, De Palo, M, Margari, V, Alfieri, O, Ferrara, D, Schiavi, D, Parolari, A, Myasoedova, VA, Daprati, A, De Feo, M, Bancone, C, Di Bartolomeo, R, Pacini, D, Ribezzo, M, Karimi, A, Salehiomran, A, Hajighasemi, A, Bina, P, Straka, Z, Hlavicka, J, Lukac, P, Vik, K, Mosna, F, Tsilimingas, NB, Simopoulos, VN, Tsolaki, F, Rivilla, MT, Galan, J, Nunez, JAF, Gonzalez, A, Ruiz, D, Orts Rodriguez, M, Issa, M, Vila Nova, DC, Maia, LN, Nakazone, MA, Lico e Cividanes, GV, Hajjar, LA, Neto, V Avila, Lucchese, FA, Stolf, NA, Hutschala, D, Ruetzler, K, Sima, B, Engelen, S, Borms, S, Van De Velde, M, Rex, S, De Hert, SG, Ho, AMH, Chan, MTV, Underwood, MJ, Deluca Bisurgi, D, Torres, D, and Buggy, DJ

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Anti-Inflammatory Agents, 030204 cardiovascular system & hematology, Methylprednisolone, Drug Administration Schedule, law.invention, 03 medical and health sciences, Medicine, General & Internal, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, General & Internal Medicine, Cardiopulmonary bypass, SIRS, Medicine, Humans, 030212 general & internal medicine, Cardiac Surgical Procedures, Glucocorticoids, Dialysis, Aged, Science & Technology, Cardiopulmonary Bypass, business.industry, STEROIDS, Research, Acute kidney injury, General Medicine, Perioperative, Acute Kidney Injury, Middle Aged, medicine.disease, Cardiac surgery, HIGH-DOSE DEXAMETHASONE, Anesthesia, Female, business, Life Sciences & Biomedicine, Kidney disease, medicine.drug
Abstract

BACKGROUND: Perioperative corticosteroid use may reduce acute kidney injury. We sought to test whether methylprednisolone reduces the risk of acute kidney injury after cardiac surgery. METHODS: We conducted a prespecified substudy of a randomized controlled trial involving patients undergoing cardiac surgery with cardiopulmonary bypass (2007-2014); patients were recruited from 79 centres in 18 countries. Eligibility criteria included a moderate-to-high risk of perioperative death based on a preoperative score of 6 or greater on the European System for Cardiac Operative Risk Evaluation I. Patients (n = 7286) were randomly assigned (1:1) to receive intravenous methylprednisolone (250 mg at anesthetic induction and 250 mg at initiation of cardiopulmonary bypass) or placebo. Patients, caregivers, data collectors and outcome adjudicators were unaware of the assigned intervention. The primary outcome was postoperative acute kidney injury, defined as an increase in the serum creatinine concentration (from the preoperative value) of 0.3 mg/dL or greater (≥ 26.5 μmol/L) or 50% or greater in the 14-day period after surgery, or use of dialysis within 30 days after surgery. RESULTS: Acute kidney injury occurred in 1479/3647 patients (40.6%) in the methylprednisolone group and in 1426/3639 patients (39.2%) in the placebo group (adjusted relative risk 1.04, 95% confidence interval 0.96 to 1.11). Results were consistent across several definitions of acute kidney injury and in patients with preoperative chronic kidney disease. INTERPRETATION: Intraoperative corticosteroid use did not reduce the risk of acute kidney injury in patients with a moderate-to-high risk of perioperative death who had cardiac surgery with cardiopulmonary bypass. Our results do not support the prophylactic use of steroids during cardiopulmonary bypass surgery. Trial registration: ClinicalTrials.gov, no. NCT00427388. ispartof: CANADIAN MEDICAL ASSOCIATION JOURNAL vol:191 issue:9 pages:E247-E256 ispartof: location:Canada status: published

Published
2019

21. OC69 SURGERY FOR BENTALL ENDOCARDITIS

Author

Sponga, S., Di Mauro, M., Pacini, D., Murara, G., Di Bartolomeo, R., Cappabianca, G., Beghi, C., Weltert, L., De Paulis, R., De Vincentiis, C., Biondi, A., Santini, F., Salsano, A., Salvador, L., Picichè, M., Mariscalco, G., Maselli, D., Rinaldi, M., Mancuso, S., Scrofani, R., Cagnoni, G., Antona, C., Dato, G. M. A., Centofani, P., De Bonis, M., Pozzoli, A., Cugola, D., Galletti, L., Villa, E., Dossena, Y., Troise, G., Barili, F., Paparella, D., Margari, V., Lorusso, R., Parolari, A., and Livi, U.

Published
2018

23. Enhanced climate instability in the North Atlantic and southern Europe during the Last Interglacial

Author

Tzedakis, PC, Drysdale, RN, Margari, V, Skinner, LC, Menviel, L, Rhodes, RH, Taschetto, AS, Hodell, DA, Crowhurst, SJ, Hellstrom, JC, Fallick, AE, Grimalt, JO, McManus, JF, Martrat, B, Mokeddem, Z, Parrenin, F, Regattieri, E, Roe, K, Zanchetta, G, Tzedakis, PC, Drysdale, RN, Margari, V, Skinner, LC, Menviel, L, Rhodes, RH, Taschetto, AS, Hodell, DA, Crowhurst, SJ, Hellstrom, JC, Fallick, AE, Grimalt, JO, McManus, JF, Martrat, B, Mokeddem, Z, Parrenin, F, Regattieri, E, Roe, K, and Zanchetta, G

Abstract

Considerable ambiguity remains over the extent and nature of millennial/centennial-scale climate instability during the Last Interglacial (LIG). Here we analyse marine and terrestrial proxies from a deep-sea sediment sequence on the Portuguese Margin and combine results with an intensively dated Italian speleothem record and climate-model experiments. The strongest expression of climate variability occurred during the transitions into and out of the LIG. Our records also document a series of multi-centennial intra-interglacial arid events in southern Europe, coherent with cold water-mass expansions in the North Atlantic. The spatial and temporal fingerprints of these changes indicate a reorganization of ocean surface circulation, consistent with low-intensity disruptions of the Atlantic meridional overturning circulation (AMOC). The amplitude of this LIG variability is greater than that observed in Holocene records. Episodic Greenland ice melt and runoff as a result of excess warmth may have contributed to AMOC weakening and increased climate instability throughout the LIG.

Published
2018

24. Corrigendum to “A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE”. [Int. J. Cardiol. 241 (Aug 15 2017) 97–102](S0167527317309877)(10.1016/j.ijcard.2017.03.148)

Author

Di Mauro, M, Di Mauro, M, Dato, G, Barili, F, Gelsomino, S, Sante, P, Corte, A, Carrozza, A, Ratta, E, Cugola, D, Galletti, L, Devotini, R, Casabona, R, Santini, F, Salsano, A, Scrofani, R, Antona, C, Botta, L, Russo, C, Mancuso, S, Rinaldi, M, De Vincentiis, C, Biondi, A, Beghi, C, Cappabianca, G, Tarzia, V, Gerosa, G, De Bonis, M, Pozzoli, A, Nicolini, F, Benassi, F, Rosato, F, Grasso, E, Livi, U, Sponga, S, Pacini, D, Di Bartolomeo, R, DeMartino, A, Bortolotti, U, Onorati, F, Faggian, G, Lorusso, R, Vizzardi, E, Di Giammarco, G, Marinelli, D, Villa, E, Troise, G, Piciche, M, Musumeci, F, Paparella, D, Margari, V, Tritto, F, Damiani, G, Scrascia, G, Zaccaria, S, Renzulli, A, Serraino, G, Mariscalco, G, Maselli, D, Foschi, M, Parolari, A, Nappi, G, Di Mauro, M, Di Mauro, M, Dato, G, Barili, F, Gelsomino, S, Sante, P, Corte, A, Carrozza, A, Ratta, E, Cugola, D, Galletti, L, Devotini, R, Casabona, R, Santini, F, Salsano, A, Scrofani, R, Antona, C, Botta, L, Russo, C, Mancuso, S, Rinaldi, M, De Vincentiis, C, Biondi, A, Beghi, C, Cappabianca, G, Tarzia, V, Gerosa, G, De Bonis, M, Pozzoli, A, Nicolini, F, Benassi, F, Rosato, F, Grasso, E, Livi, U, Sponga, S, Pacini, D, Di Bartolomeo, R, DeMartino, A, Bortolotti, U, Onorati, F, Faggian, G, Lorusso, R, Vizzardi, E, Di Giammarco, G, Marinelli, D, Villa, E, Troise, G, Piciche, M, Musumeci, F, Paparella, D, Margari, V, Tritto, F, Damiani, G, Scrascia, G, Zaccaria, S, Renzulli, A, Serraino, G, Mariscalco, G, Maselli, D, Foschi, M, Parolari, A, and Nappi, G

Abstract

The authors regret that the first name and last name of the author Sandro Sponga was published incorrectly in the original version and this has now been corrected.

Published
2018

25. EARLY RESULTS OF MINIMALLY INVASIVE CORONARY ARTERY BYPASS GRAFTING

Author

Squiccimarro, E, Margari, V, Kounakis, G, Visicchio, G, Pascarella, C, Carbone, C, and Paparella, D

Abstract

Coronary artery bypass grafting (CABG) is the benchmark in elective revascularization for Coronary Artery Disease (CAD), particularly for complex or multivessel CAD, left main coronary involvement, diabetes, or impaired heart function. Traditional CABG, via median sternotomy using cardiopulmonary bypass (CPB), has limitations like CPB–related morbidity and sternal complications. Alternatives like Minimally Invasive Cardiac Surgery (MICS CABG) and Hybrid Revascularization (HR) aim to address these drawbacks. We present a series of 215 consecutive patients (mean age 67±9 years, 27.9% females, EuroSCORE II 1.5±1.3%) between 2017–2023 who underwent elective minimally invasive surgical revascularization. Among the cohort, 164 (76.3%) had Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) via anterolateral left mini–thoracotomy (ALMT) at the fifth intercostal space (IS), with 140 (85.4%) receiving a single left internal thoracic artery (LITA) graft to the left anterior descending (LAD) artery and 24 (14.6%) an additional distal anastomosis. Thirty–four (20.7%) had HR via percutaneous coronary intervention (PCI) on the right coronary artery (RCA). Of the total cohort, 35/215 patients (16.3%) underwent multivessel MICS CABG via ALMT, with mean 2.3±0.5 distal anastomoses using LITA, right ITA, radial artery, or saphenous vein. Heart manipulation was via a subxiphoid device. Four MICS CABG patients (11.4%) had HR. More than half of MICS CABG cases were performed with planned peripheral CPB, without cross–clamping the Aorta. Of the total cohort, 16/215 patients (7.4%) received MICS CABG in an endoscopic fashion, using 3D thoracoscopy for LITA and RITA harvesting via bilateral ports in the 2nd, 3rd, and 4th IS, employing peripheral CPB and aortic clamping by Chitwood clamp at the second IS, with cardioplegia delivery via a 4 cm right anterior MT. Distal anastomoses were performed via left anterior MT, with easy subxiphoid manipulation of the emptied heart. Transit time flowmetry was used in all cases. Conversion to sternotomy was needed in 3 cases, all were MIDCAB. Thirty–day mortality was 1.4%, median ventilation was 4 [2–5] hours, and Intensive Care Unit–stay was 1 [1–2] days. All patients received graft evaluation via computerized tomography before hospital discharge. Mean follow–up was 2.9±1.9 years (max 5 years), with no deaths and 4 (1.9%) requiring follow–up PCI. MICS CABG is a promising future technique for heart revascularization by dedicated teams.

Published
2024
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26. COMBINED ENDOSCOPIC MITRAL REPAIR AND DIRECT CORONARY ARTERY BYPASS VIA BILATERAL MINI–THORACOTOMY

Author

Squiccimarro, E, Margari, V, Kounakis, G, Visicchio, G, Pascarella, C, Carbone, C, and Paparella, D

Abstract

Emerging evidence upholds minimally invasive approaches as the foremost surgical intervention for heart valve diseases, addressing detriments associated with traditional cardiac surgery. Yet, the comprehensive adoption of minimally invasive coronary surgery is disproportionately low, not to mention concurrent coronary and valve procedures. Bilateral mini–thoracotomy (MT) has been suggested as a feasible and safe technique for diverse isolated cardiac procedures. In 2021–2023, 7 patients were treated with minimally invasive mitral repair (MVr) and direct coronary artery bypass (MIDCAB): age was 66±4 years, 5 were males, and EuroSCORE II (%) was 2.6±1.2. For the procedure, a double–lumen endotracheal tube was employed, and heparin was administered. The right internal jugular vein was cannulated percutaneously. The MIDCAB involved a anterolateral left MT at the fifth intercostal space (IS). The left internal thoracic artery (LITA) was harvested under direct vision using a retractor. Mini–pericardiectomy was performed to facilitate off–pump anastomoses on the left anterior descending artery using a stabilizer, along with intracoronary shunts. Transit time flowmetry was performed. A right groin incision exposed the femoral vessels for echo–guided cannulation as per Seldinger. Endoscopic MVr was accomplished via a right MT above the nipple, at the fourth IS. A soft–tissue retractor and trocars at the fourth and sixth IS enabled 3D thoracoscopy and CO2 insufflation. After adjusting for selective ventilation, the chest was accessed for pericardiectomy. An aortic needle inserted via the main incision facilitated cardioplegia delivery and aortic venting. Cardiopulmonary bypass was established and aortic clamping achieved by Chitwood clamp at the second IS. Cardioplegia was delivered with the LITA graft temporarily closed. All patients received ring annuloplasty, 4 had posterior leaflet resection, 3 neochordal repair, and 2 had concomitant monopolar ablation and linear left atrial appendage closure. All patients were discharged healthy, after graft evaluation via computerized tomography. We report favorable outcome, satisfactory surgical times, early mechanical ventilation discontinuation (4±2 hours) and discharge from intensive care unit (3±1 days). No patient died at follow–up (maximum 2 years). In conclusion, minimally invasiveness should be embraced to ensure acceptance among patients and favorable long–term results, even when facing multifactorial pathology.

Published
2024
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27. The RESET project: Constructing a European tephra lattice for refined synchronisation of environmental and archaeological events during the last c. 100 ka

Author

Lowe, John J, Ramsey, Christopher Bronk, Housley, Rupert A., Lane, Christine S., Tomlinson, Emma L., Stringer, Chris, Davies, William, Barton, Nick, Pollard, Mark, Gamble, Clive, Menzies, Martin, Rohling, Eelco, Roberts, Andrew, Blockley, Simon, Cullen, Victoria, Grant, Katharine, Lewis, Mark, Macleod, Alison, White, Dustin, Albert, Paul, Hardiman, Mark, Lee, Sharen, Anna, Oh, Satow, Christopher, Cross, Joanna K., Law, Cassian Bramham, Todman, Anna, Bourne, Anna, Matthews, Ian, Müller, Wolfgang, Smith, Victoria, Wulf, Sabine, Anghelinu, M., Antl Weiser, W., Bar Yosef, O., Boric, D., Boscato, P., Ronchitelli, A., Chabai, V., Veselsky, A., Uthmeier, T., Farrand, W., Gjipali, I., Ruka, R., Güleç, E., Karavanic, I., Karkanas, P., King, T., Komšo, D., Koumouzelis, M., Kyparissi, N., Lengyel, G., Mester, Z., Neruda, P., Panagopoulou, E., Shalamanov Korobar, L., Tolevski, I., Sirakov, N., Guadelli, A., Guadelli, J. L., Ferrier, C., Skrdla, P., Slimak, L., Soler, N., Soler, J., Soressi, M., Tushabramishvilii, N., Zilhão, J., Angelucci, D., Albert, P., Bramham Law, C., Cullen, V. L., Lincoln, P., Staff, R., Flower, K., Aouadi Abdeljaouad, N., Belhouchet, L., Barker, G., Bouzouggar, A., Van Peer, P., Kindermann, K., Gerken, K., Niemann, H., Tipping, R., Saville, A., Ward, T., Clausen, I., Weber, M. J., Kaiser, K., Torksdorf, J. F., Turner, F., Veil, S., Nygaard, N., Pyne O'Donnell, S. D. F., Masojc, M., Nalepka, D., Jurochnik, A., Kabacinski, J., Antoine, P., Olive, M., Christensen, M., Bodu, P., Debout, G., Orliac, M., De Bie, M., Van Gils, M., Paulissen, E., Brou, L., Leesch, D., Hadorn, P., Thew, N., Riede, F., Heinen, M., Joris, O., Richter, J., Knipping, M., Stika, H. P., Friedrich, M., Conard, N., Malina, M., Kind, C. J., Beutelspacher, T., Mortensen, M. F., Burdukiewicz, J. M., Szynkiewicz, A., Poltowicz Bobak, M., Bobak, D., Wisniewski, A., Przezdziecki, M., Valde Nowak, P., Muzyczuk, A., Davies, L., Macleod, A., Morgan, P., Aydar, Erkan, Çubukçu, Evren, Brown, Richard, Coltelli, Mauro, Castro, Deborah Lo, Cioni, Raffaello, Derosa, Rosanna, Donato, Paola, Roberto, Alessio Di, Gertisser, Ralf, Giordano, Guido, Branney, Mike, Jordan, Nina, Keller, Jörg, Kinvig, Helen, Gottsman, Jo, Blundy, Jon, Marani, Michael, Orsi, Giovanni, Civetta, Lucia, Arienzo, Ilenia, Carandente, Antonio, Rosi, Mauro, Zanchetta, Giovanni, Seghedi, Ioan, Szakacs, Alex, Sulpizio, Roberto, Thordarson, Thor, Trincardi, Fabio, Vigliotti, Luigi, Asioli, Alesssandra, Piva, Andrea, Andric, M., Brauer, A., de Klerk, P., Filippi, M. L., Finsinger, W., Galovic, L., Jones, T., Lotter, A., Müller, U., Pross, J., Mangerud, J., Lohne, Ø., Pyne O'Donnell, S., Markovic, S., Pini, R., Ravazzi, C., Theuerkauf, M., Tzedakis, C., Margari, V., Veres, D., Wastegård, S., Ortiz, J. E., Torres, T., Díaz Bautista, A., Moreno, A., Valero Garcés, B., Lowick, S., Ottolini, Lusia, John J. Lowe a,, Christopher Bronk Ramsey, B, A, Rupert A. Housley, B, Christine S. Lane, C, Emma L. Tomlinson, Team, Reset, and Giordano, Guido

Subjects
Archeology, Environmental change, Evolution, Dansgaard–Oeschger and Heinrich events, Abrupt environmental transitions (AETs), Dansgaard-Oeschger and Heinrich events, Last Glacial stage, Middle to Upper Palaeolithic, Tephra database, Tephra geochemistry, Volcanic ash isochrons, Geology, Global and Planetary Change, Ecology, Evolution, Behavior and Systematics, Archeology (arts and humanities), Behavior and Systematics, Glacial period, Tephra, Holocene, Isochron dating, Ecology, Volcanic ash isochron, Tephra geochemistr, Quaternary science, Archaeology, Ecology, Evolution, Behavior and Systematic, Dansgaard-Oeschger and Heinrich event, Mainland, Physical geography
Abstract

This paper introduces the aims and scope of the RESET project (. RESponse of humans to abrupt Environmental Transitions), a programme of research funded by the Natural Environment Research Council (UK) between 2008 and 2013; it also provides the context and rationale for papers included in a special volume of Quaternary Science Reviews that report some of the project's findings. RESET examined the chronological and correlation methods employed to establish causal links between the timing of abrupt environmental transitions (AETs) on the one hand, and of human dispersal and development on the other, with a focus on the Middle and Upper Palaeolithic periods. The period of interest is the Last Glacial cycle and the early Holocene (c. 100-8 ka), during which time a number of pronounced AETs occurred. A long-running topic of debate is the degree to which human history in Europe and the Mediterranean region during the Palaeolithic was shaped by these AETs, but this has proved difficult to assess because of poor dating control. In an attempt to move the science forward, RESET examined the potential that tephra isochrons, and in particular non-visible ash layers (cryptotephras), might offer for synchronising palaeo-records with a greater degree of finesse. New tephrostratigraphical data generated by the project augment previously-established tephra frameworks for the region, and underpin a more evolved tephra 'lattice' that links palaeo-records between Greenland, the European mainland, sub-marine sequences in the Mediterranean and North Africa. The paper also outlines the significance of other contributions to this special volume: collectively, these illustrate how the lattice was constructed, how it links with cognate tephra research in Europe and elsewhere, and how the evidence of tephra isochrons is beginning to challenge long-held views about the impacts of environmental change on humans during the Palaeolithic. © 2015 Elsevier Ltd., RESET was funded through Consortium Grants awarded by the Natural Environment Research Council, UK, to a collaborating team drawn from four institutions: Royal Holloway University of London (grant reference NE/E015905/1), the Natural History Museum, London (NE/E015913/1), Oxford University (NE/E015670/1) and the University of Southampton, including the National Oceanography Centre (NE/01531X/1). The authors also wish to record their deep gratitude to four members of the scientific community who formed a consultative advisory panel during the lifetime of the RESET project: Professor Barbara Wohlfarth (Stockholm University), Professor Jørgen Peder Steffensen (Niels Bohr Institute, Copenhagen), Dr. Martin Street (Romisch-Germanisches Zentralmuseum, Neuwied) and Professor Clive Oppenheimer (Cambridge University). They provided excellent advice at key stages of the work, which we greatly valued. We also thank Jenny Kynaston (Geography Department, Royal Holloway) for construction of several of the figures in this paper, and Debbie Barrett (Elsevier) and Colin Murray Wallace (Editor-in-Chief, QSR) for their considerable assistance in the production of this special volume.

Published
2015

28. Interglacials of the last 800,000 years

Author

Berger, A., Crucifix, M., Hodell, D. A., Mangili, C., Mcmanus, J. F., Otto-bliesner, B., Pol, K., Raynaud, D., Skinner, L. C., Tzedakis, P. C., Wolff, E. W., Yin, Q. Z., Abe-ouchi, A., Barbante, C., Brovkin, V., Cacho, I., Capron, E., Ferretti, P., Ganopolski, A., Grimalt, J. O., Hoenisch, B., Kawamura, K., Landais, A., Margari, V., Martrat, B., Masson-delmotte, V., Mokeddem, Zohra, Parrenin, F., Prokopenko, A. A., Rashid, H., Schulz, M., Riveiros, N. Vazquez, Berger, A., Crucifix, M., Hodell, D. A., Mangili, C., Mcmanus, J. F., Otto-bliesner, B., Pol, K., Raynaud, D., Skinner, L. C., Tzedakis, P. C., Wolff, E. W., Yin, Q. Z., Abe-ouchi, A., Barbante, C., Brovkin, V., Cacho, I., Capron, E., Ferretti, P., Ganopolski, A., Grimalt, J. O., Hoenisch, B., Kawamura, K., Landais, A., Margari, V., Martrat, B., Masson-delmotte, V., Mokeddem, Zohra, Parrenin, F., Prokopenko, A. A., Rashid, H., Schulz, M., and Riveiros, N. Vazquez

Abstract

Interglacials, including the present (Holocene) period, are warm, low land ice extent (high sea level), end-members of glacial cycles. Based on a sea level definition, we identify eleven interglacials in the last 800,000years, a result that is robust to alternative definitions. Data compilations suggest that despite spatial heterogeneity, Marine Isotope Stages (MIS) 5e (last interglacial) and 11c (similar to 400ka ago) were globally strong (warm), while MIS 13a (similar to 500ka ago) was cool at many locations. A step change in strength of interglacials at 450ka is apparent only in atmospheric CO2 and in Antarctic and deep ocean temperature. The onset of an interglacial (glacial termination) seems to require a reducing precession parameter (increasing Northern Hemisphere summer insolation), but this condition alone is insufficient. Terminations involve rapid, nonlinear, reactions of ice volume, CO2, and temperature to external astronomical forcing. The precise timing of events may be modulated by millennial-scale climate change that can lead to a contrasting timing of maximum interglacial intensity in each hemisphere. A variety of temporal trends is observed, such that maxima in the main records are observed either early or late in different interglacials. The end of an interglacial (glacial inception) is a slower process involving a global sequence of changes. Interglacials have been typically 10-30ka long. The combination of minimal reduction in northern summer insolation over the next few orbital cycles, owing to low eccentricity, and high atmospheric greenhouse gas concentrations implies that the next glacial inception is many tens of millennia in the future.

Published
2016
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31. The 'Shackleton Site' (IODP Site U1385) on the Iberian Margin

Author

Hodell, D.A., Lourens, L., Stow, D.A.V., Hernández-Molina, F.J., Alvarez-Zarikian, C.A., Abrantes, F., Acton, G.D., Bahr, A., Balestra, B., Llave Barranco, E., Carrara, G., Crowhurst, S., Ducassou, E., Flood, R., Flores, J.-A., Furota, S., Grimalt, J., Grunert, P., Jimenez-Espejo, F.J., Kim, J.K., Konijnendijk, T., Krissek, L., Kuroda, J., Li, B., Lofi, J., Margari, V., Martrat, B., Miller, M.D., Nanayama, F., Nishida, N., Richter, C., Rodrigues, T., Rodríguez-Tovar, F.J., Freixo Roque, A.C., Sanchez Goñi, M.F., Sierro, F.J., Singh, A.D., Skinner, L., Sloss, C.R., Takashimizu, Y., Tjallingii, R., Tzanova, A., Tzedakis, C., Voelker, A., Xuan, C., Williams, T., NWO-VICI: Evolution of astronomically paced climate changes from Greenhouse to Icehouse world, and Stratigraphy and paleontology

Published
2013

36. The 'Shackleton Site' (IODP Site U1385) on the Iberian Margin

Author

NWO-VICI: Evolution of astronomically paced climate changes from Greenhouse to Icehouse world, Stratigraphy and paleontology, Hodell, D.A., Lourens, L., Stow, D.A.V., Hernández-Molina, F.J., Alvarez-Zarikian, C.A., Abrantes, F., Acton, G.D., Bahr, A., Balestra, B., Llave Barranco, E., Carrara, G., Crowhurst, S., Ducassou, E., Flood, R., Flores, J.-A., Furota, S., Grimalt, J., Grunert, P., Jimenez-Espejo, F.J., Kim, J.K., Konijnendijk, T., Krissek, L., Kuroda, J., Li, B., Lofi, J., Margari, V., Martrat, B., Miller, M.D., Nanayama, F., Nishida, N., Richter, C., Rodrigues, T., Rodríguez-Tovar, F.J., Freixo Roque, A.C., Sanchez Goñi, M.F., Sierro, F.J., Singh, A.D., Skinner, L., Sloss, C.R., Takashimizu, Y., Tjallingii, R., Tzanova, A., Tzedakis, C., Voelker, A., Xuan, C., Williams, T., NWO-VICI: Evolution of astronomically paced climate changes from Greenhouse to Icehouse world, Stratigraphy and paleontology, Hodell, D.A., Lourens, L., Stow, D.A.V., Hernández-Molina, F.J., Alvarez-Zarikian, C.A., Abrantes, F., Acton, G.D., Bahr, A., Balestra, B., Llave Barranco, E., Carrara, G., Crowhurst, S., Ducassou, E., Flood, R., Flores, J.-A., Furota, S., Grimalt, J., Grunert, P., Jimenez-Espejo, F.J., Kim, J.K., Konijnendijk, T., Krissek, L., Kuroda, J., Li, B., Lofi, J., Margari, V., Martrat, B., Miller, M.D., Nanayama, F., Nishida, N., Richter, C., Rodrigues, T., Rodríguez-Tovar, F.J., Freixo Roque, A.C., Sanchez Goñi, M.F., Sierro, F.J., Singh, A.D., Skinner, L., Sloss, C.R., Takashimizu, Y., Tjallingii, R., Tzanova, A., Tzedakis, C., Voelker, A., Xuan, C., and Williams, T.

Published
2013

37. The 'Shackleton Site' (IODP Site U1385) on the Iberian Margin

Author

Hodell, D., Lourens, L., Hernandez-Molina, F., Alvarez-Zarikian, C., Abrantes, F., Acton, G., Bahr, A., Balestra, B., Llave Baranco, E., Carrara, G., Crowhurst, S., Ducassou, E., Flood, R., Flores, J.-A., Furota, S., Grimalt, J., Grunert, P., Jimenez-Espejo, F., Kyoung Kim, J., Konijnendijk, T., Krissek, Lawrence, Kuroda, J., Li, B., Lofi, J., Margari, V., Martrat, B., Miller, M., Nanayama, F., Nishida, Naohisa, Richter, C., Rodrigues, T., Rodriguez-Tovar, Francisco, Roque, C., Fernanda Sanchez Goni, M., Sierro, F.J., Singh, A., Skinner, L., Sloss, Craig, Takashimizu, Y., Tjallingii, R., Tzanova, A., Tzedakis, C., Voelker, A., Xuan, C., Williams, T., Hodell, D., Lourens, L., Hernandez-Molina, F., Alvarez-Zarikian, C., Abrantes, F., Acton, G., Bahr, A., Balestra, B., Llave Baranco, E., Carrara, G., Crowhurst, S., Ducassou, E., Flood, R., Flores, J.-A., Furota, S., Grimalt, J., Grunert, P., Jimenez-Espejo, F., Kyoung Kim, J., Konijnendijk, T., Krissek, Lawrence, Kuroda, J., Li, B., Lofi, J., Margari, V., Martrat, B., Miller, M., Nanayama, F., Nishida, Naohisa, Richter, C., Rodrigues, T., Rodriguez-Tovar, Francisco, Roque, C., Fernanda Sanchez Goni, M., Sierro, F.J., Singh, A., Skinner, L., Sloss, Craig, Takashimizu, Y., Tjallingii, R., Tzanova, A., Tzedakis, C., Voelker, A., Xuan, C., and Williams, T.

Abstract

Nick Shackleton’s research on piston cores from the Iberian margin highlighted the importance of this region for providing high-fidelity records of millennial-scale climate variability, and for correlating climate events from the marine environment to polar ice cores and European terrestrial sequences. During the Integrated Ocean Drilling Program (IODP) Expedition 339, we sought to extend the Iberian margin sediment record by drilling with the D/V JOIDES Resolution. Five holes were cored at Site U1385 using the advanced piston corer (APC) system to a maximum depth of ∼ 155.9 m below sea floor (m b.s.f.). Immediately after the expedition, cores from all holes were analyzed by core scanning X-ray fluorescence (XRF) at 1 cm spatial resolution. Ca/Ti data were used to accurately correlate from hole-to-hole and construct a composite spliced section, containing no gaps or disturbed intervals to 166.5 m composite depth (mcd). A low-resolution (20 cm sample spacing) oxygen isotope record confirms that Site U1385 contains a continuous record of hemipelagic sedimentation from the Holocene to 1.43 Ma (Marine Isotope Stage 46). The sediment profile at Site U1385 extends across the middle Pleistocene transition (MPT) with sedimentation rates averaging ∼ 10 cm kyr−1. Strongprecession cycles in colour and elemental XRF signals provide a powerful tool for developing an orbitally tuned reference timescale. Site U1385 is likely to become an important type section for marine–ice–terrestrial core correlations and the study of orbital- and millennial-scale climate variability.

Published
2013

42. Coupled ocean-land millennial-scale changes 1.26 million years ago, recorded at Site U1385 off Portugal

Author

Tzedakis, P. C., Margari, V., and Hodell, D. A.

Subjects
sub-01
Abstract

While a growing body of evidence indicates that North Atlantic millennial-scale climate variability extends to the Early Pleistocene, its impact on terrestrial ecosystems has not been established. Here we present ultra-high resolution (70–140 year) joint foraminiferal isotopic and pollen analyses from IODP Site U1385 off Portugal, focusing on a short glacial section of Marine Isotope Stage 38, ~ 1.26 million years ago. Our records reveal the presence of millennial-scale variability in the coupled ocean–atmosphere–land system in the North Atlantic and provide the first direct evidence for the response of western Iberian vegetation to abrupt climate changes in the Early Pleistocene. The magnitude and pacing of changes bear significant similarities to Dansgaard–Oeschger variability of the last two glacials.

43. Abrupt intrinsic and extrinsic responses of southwestern Iberian vegetation to millennial-scale variability over the past 28 ka

Author

Cutmore, A, Ausín, B, Maslin, M, Eglinton, T, Hodell, D, Muschitiello, F, Menviel, L, Haghipour, N, Martrat, B, Margari, V, and Tzedakis, PC

Subjects
Holocene, 13. Climate action, pollen, Marine Isotope Stage 2, southwest Iberia, 15. Life on land, abrupt climate change
Abstract

We present new high‐resolution pollen records combined with palaeoceanographic proxies from the same samples in deep‐sea cores SHAK06‐5K and MD01‐2444 on the southwestern Iberian Margin, documenting regional vegetation responses to orbital and millennial‐scale climate changes over the last 28 ka. The chronology of these records is based on high‐resolution radiocarbon dates of monospecific samples of the planktonic foraminifera Globigerina bulloides, measured from SHAK06‐5K and MD01‐2444 and aligned using an automated stratigraphical alignment method. Changes in temperate and steppe vegetation during Marine Isotope Stage 2 are closely coupled with sea surface temperature (SST) and global ice‐volume changes. The peak expansion of thermophilous woodland between ~10.1 and 8.4 cal ka bp lags behind the boreal summer insolation maximum by ~2 ka, possibly arising from residual high‐latitude ice‐sheets into the Holocene. Rapid changes in pollen percentages are coeval with abrupt transitions in SSTs, precipitation and winter temperature at the onset and end of Heinrich Stadial 2, the ice‐rafted debris event and end of Heinrich Stadial 1, and the onset of the Younger Dryas, suggesting extrinsically forced southwestern Iberian ecosystem changes by abrupt North Atlantic climate events. In contrast, the abrupt decline in thermophilous elements at ~7.8 cal ka bp indicates an intrinsically mediated abrupt vegetation response to the gradually declining boreal insolation, potentially resulting from the crossing of a seasonality of precipitation threshold.

44. Fast and slow components of interstadial warming in the North Atlantic during the last glacial

Author

Margari, V, Skinner, LC, Menviel, L, Capron, E, Rhodes, RH, Mleneck-Vautravers, MJ, Ezat, MM, Martrat, B, Grimalt, JO, Hodell, DA, and Tzedakis, PC

Subjects
13 Climate Action, 13. Climate action, 37 Earth Sciences, 3705 Geology, 14. Life underwater, 3709 Physical Geography and Environmental Geoscience
Abstract

The abrupt nature of warming events recorded in Greenland ice-cores during the last glacial has generated much debate over their underlying mechanisms. Here, we present joint marine and terrestrial analyses from the Portuguese Margin, showing a succession of cold stadials and warm interstadials over the interval 35–57 ka. Heinrich stadials 4 and 5 contain considerable structure, with a short transitional phase leading to an interval of maximum cooling and aridity, followed by slowly increasing sea-surface temperatures and moisture availability. A climate model experiment reproduces the changes in western Iberia during the final part of Heinrich stadial 4 as a result of the gradual recovery of the Atlantic meridional overturning circulation. What emerges is that Greenland ice-core records do not provide a unique template for warming events, which involved the operation of both fast and slow components of the coupled atmosphere–ocean–sea-ice system, producing adjustments over a range of timescales.

45. Enhanced climate instability in the North Atlantic and southern Europe during the Last Interglacial

Author

Tzedakis, PC, Drysdale, RN, Margari, V, Skinner, LC, Menviel, L, Rhodes, RH, Taschetto, AS, Hodell, DA, Crowhurst, SJ, Hellstrom, JC, Fallick, AE, Grimalt, JO, McManus, JF, Martrat, B, Mokeddem, Z, Parrenin, F, Regattieri, E, Roe, K, and Zanchetta, G

Subjects
13. Climate action, 14. Life underwater, 0405 Oceanography, 0406 Physical Geography and Environmental Geoscience
Abstract

Considerable ambiguity remains over the extent and nature of millennial/centennial-scale climate instability during the Last Interglacial (LIG). Here we analyse marine and terrestrial proxies from a deep-sea sediment sequence on the Portuguese Margin and combine results with an intensively dated Italian speleothem record and climate-model experiments. The strongest expression of climate variability occurred during the transitions into and out of the LIG. Our records also document a series of multi-centennial intra-interglacial arid events in southern Europe, coherent with cold water-mass expansions in the North Atlantic. The spatial and temporal fingerprints of these changes indicate a reorganization of ocean surface circulation, consistent with low-intensity disruptions of the Atlantic meridional overturning circulation (AMOC). The amplitude of this LIG variability is greater than that observed in Holocene records. Episodic Greenland ice melt and runoff as a result of excess warmth may have contributed to AMOC weakening and increased climate instability throughout the LIG.

46. The Ceprano basin and its prehistoric evidence

Author

Biddittu, I., Maria Rita Palombo, Donatella Magri, Salvatore Milli, Barbieri, M. R., Maurizio Barbieri, Celiberti, V., Margari, V., Melis, R. T., Ruffo, M., Saracino, B., and Giorgio Manzi

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

Author

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

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

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

Published
2019

48. Right ventricular assessment can improve prognostic value of Euroscore II

Author

Antonio Salsano, Alessandro D'Alfonso, Luca Weltert, Marco Di Eusanio, Luca Di Marco, Marco Pano, Francesca Nicolò, Roberto Scrofani, Massimiliano Foschi, Michele Di Mauro, C. Beghi, Erik Cura Stura, Salvatore Zaccaria, Domenico Paparella, Francesco Massi, Carlo Antona, Alessandro Parolari, Francesco Santini, Ruggero De Paulis, Vito Margari, Giangiuseppe Cappabianca, Giuseppe Santarpino, Mauro Rinaldi, Renato Gregorini, Davide Pacini, Michele Portoghese, Di Mauro M., Scrofani R., Antona C., Nicolo F., Cappabianca G., Beghi C., Santarpino G., Gregorini R., Di Marco L., Pacini D., Salsano A., Santini F., Weltert L., De Paulis R., Pano M., Zaccaria S., D'Alfonso A., Di Eusanio M., Massi F., Portoghese M., Stura E.C., Rinaldi M., Margari V., Foschi M., Parolari A., Paparella D., RS: Carim - V04 Surgical intervention, and CTC

Subjects
Male, Ventricular Dysfunction, Right, right ventricle, 030204 cardiovascular system & hematology, Doppler imaging, Heart Ventricle, 0302 clinical medicine, Outcome Assessment, Health Care, Cardiac Surgical Procedure, Prospective Studies, Young adult, Prospective cohort study, Aged, 80 and over, dysfunction, Framingham Risk Score, Middle Aged, Prognosis, Euroscore II, Cardiac surgery, medicine.anatomical_structure, Research Design, Preoperative Period, Cohort, Cardiology, right ventricular dysfunction, Female, Cardiology and Cardiovascular Medicine, Human, Dilatation, Pathologic, Adult, Risk, Pulmonary and Respiratory Medicine, medicine.medical_specialty, SPECKLE-TRACKING, Prognosi, Heart Ventricles, doppler, right ventricular dilatation, ECHOCARDIOGRAPHIC-ASSESSMENT, Young Adult, 03 medical and health sciences, Euroscore ii, Internal medicine, medicine, Humans, plane systolic excursion, Cardiac Surgical Procedures, Aged, heart-failure, business.industry, MORTALITY, Prospective Studie, cardiac-surgery, 030228 respiratory system, Ventricle, Ventricular Function, Right, Surgery, MITRAL-VALVE REPAIR, business
Abstract

Background: The aim of this multicenter prospective study was to evaluate the prognostic weight of preoperative right ventricular assessment on early mortality in cardiac surgery. Methods: This is a multicenter prospective observational study performed by the Italian Group of Research for Outcome in Cardiac Surgery (GIROC) including 11 centers. From October 2017 to March 2019, out of 923 patients undergoing cardiac surgery, 28 patients with some missing data were excluded and 895 patients were enrolled in the study right ventricular dilatation was defined as a basal end-diastolic diameter >42 mm. The right ventricle (RV) function was assessed using the combination of three parameters: fractional area changing (FAC), tricuspid annular plane systolic excursion (TAPSE), and S'-wave using tissue Doppler imaging (TDI-S'); RV dysfunction was defined as the presence of at least two of the following cutoffs: FAC

Published
2020

49. Prognostic value of SARS-CoV-2 on patients undergoing cardiac surgery

Author

Valentina Grazioli, Michele Triggiani, Antonio Pantaleo, Mauro Rinaldi, Marisa De Feo, Giacomo Murara, Fabio Barili, Marco Picichè, Ilaria Giambuzzi, Tommaso Regesta, Erik Cura Stura, Francesco Musumeci, Andrea Colli, Liborio Mammana, Igor Vendramin, Domenico Paparella, Andrea Garatti, Alessandro Barbone, Michele De Bonis, Ugolino Livi, Gianluca Folesani, Lucia Torracca, Francesco Ferraro, Emmanuel Villa, Cinzia Trumello, Andrea Audo, Laura Giroletti, Salvatore Nicolardi, Antonio Salsano, Giorgia Bonalumi, Francesco Patanè, Vincenzo Tarzia, Gino Gerosa, Michele Di Mauro, Giacomo Ravenni, Alberto Pilozzi Casado, Alessandro Parolari, Antonino S. Rubino, Francesco Massi, Francesco Santini, Andrea Montalto, Vito Margari, RS: Carim - V04 Surgical intervention, CTC, Bonalumi, G., Pilozzi Casado, A., Barbone, A., Garatti, A., Colli, A., Giambuzzi, I., Torracca, L., Ravenni, G., Folesani, G., Murara, G., Pantaleo, A., Piciche, M., Villa, E., Ferraro, F., Vendramin, I., Livi, U., Montalto, A., Musumeci, F., Tarzia, V., Trumello, C., De Bonis, M., Margari, V., Paparella, D., Salsano, A., Santini, F., Nicolardi, S., Patane, F., Mammana, L., Cura Stura, E., Rinaldi, M., Massi, F., Triggiani, M., Grazioli, V., Giroletti, L., Rubino, A., De Feo, M., Audo, A., Regesta, T., Barili, F., Gerosa, G., Di Mauro, M., and Parolari, A.

Subjects
Pulmonary and Respiratory Medicine, Adult, medicine.medical_specialty, Bypass grafting, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cardiac surgical procedure, SARS‐CoV‐2, COVID‐19, Internal medicine, INFECTION, Medicine, Humans, Coronary Artery Bypass, cardiac surgical procedures, COVID-19, emergent cardiac surgery, SARS-CoV-2, Aged, Prognosis, Adult patients, business.industry, Oxygenation, medicine.disease, Cardiac surgery, medicine.anatomical_structure, Heart failure, Surgery, Original Article, Cardiology and Cardiovascular Medicine, business, Artery
Abstract

Objective To analyze Italian Cardiac Surgery experience during the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) identifying risk factors for overall mortality according to coronavirus disease 2019 (COVID‐19) status. Methods From February 20 to May 31, 2020, 1354 consecutive adult patients underwent cardiac surgery at 22 Italian Centers; 589 (43.5%), patients came from the red zone. Based on COVID‐19 status, 1306 (96.5%) were negative to SARS‐CoV‐2 (COVID‐N), and 48 (3.5%) were positive to SARS‐CoV‐2 (COVID‐P); among the COVID‐P 11 (22.9%) and 37 (77.1%) become positive, before and after surgery, respectively. Surgical procedures were as follows: 396 (29.2%) isolated coronary artery bypass grafting (CABG), 714 (52.7%) isolated non‐CABG procedures, 207 (15.3%) two associate procedures, and three or more procedures in 37 (2.7%). Heart failure was significantly predominant in group COVID‐N (10.4% vs. 2.5%, p = .01). Results Overall in‐hospital mortality was 1.6% (22 cases), being significantly higher in COVID‐P group (10 cases, 20.8% vs. 12, 0.9%, p

Published
2022

50. High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality

Author

P J, Devereaux, Andre, Lamy, Matthew T V, Chan, René V, Allard, Vladimir V, Lomivorotov, Giovanni, Landoni, Hong, Zheng, Domenico, Paparella, Michael H, McGillion, Emilie P, Belley-Côté, Joel L, Parlow, Malcolm J, Underwood, Chew Yin, Wang, Nazari, Dvirnik, Marat, Abubakirov, Evgeny, Fominskiy, Stephen, Choi, Stephen, Fremes, Fabrizio, Monaco, Gerard, Urrútia, Marialuz, Maestre, Ludhmila A, Hajjar, Graham S, Hillis, Nicholas L, Mills, Vito, Margari, Joseph D, Mills, J Stephen, Billing, Emily, Methangkool, Carisi A, Polanczyk, Roberto, Sant'Anna, Dmitry, Shukevich, David, Conen, Peter A, Kavsak, Matthew J, McQueen, Katheryn, Brady, Jessica, Spence, Yannick, Le Manach, Rajibul, Mian, Shun Fu, Lee, Shrikant I, Bangdiwala, Sara, Hussain, Flavia K, Borges, Shirley, Pettit, Jessica, Vincent, Gordon H, Guyatt, Salim, Yusuf, Joseph S, Alpert, Harvey D, White, Richard P, Whitlock, Allison, Serra, Devereaux, P. J., Lamy, A., Chan, M. T. V., Allard, R. V., Lomivorotov, V. V., Landoni, G., Zheng, H., Paparella, D., Mcgillion, M. H., Belley-Cote, E. P., Parlow, J. L., Underwood, M. J., Wang, C. Y., Dvirnik, N., Abubakirov, M., Fominskiy, E., Choi, S., Fremes, S., Monaco, F., Urrutia, G., Maestre, M., Hajjar, L. A., Hillis, G. S., Mills, N. L., Margari, V., Mills, J. D., Billing, J. S., Methangkool, E., Polanczyk, C. A., Sant'Anna, R., Shukevich, D., Conen, D., Kavsak, P. A., Mcqueen, M. J., Brady, K., Spence, J., Le Manach, Y., Mian, R., Lee, S. F., Bangdiwala, S. I., Hussain, S., Borges, F. K., Pettit, S., Vincent, J., Guyatt, G. H., Yusuf, S., Alpert, J. S., White, H. D., and Whitlock, R. P.

Subjects
Male, heart infarction, adverse event, Myocardial Infarction, surgery, Postoperative Complications, blood, coronary artery bypass graft, Reference Values, Humans, postoperative complication, human, Prospective Studies, Cardiac Surgical Procedures, Coronary Artery Bypass, Aged, Troponin I, reference value, clinical trial, General Medicine, Middle Aged, biological marker, mortality, heart surgery, multicenter study, Aortic Valve, Female, Biomarkers, prospective study
Abstract

BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to >= 70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury. (Funded by the Canadian Institutes of Health Research and others; VISION Cardiac Surgery ClinicalTrials.gov number, NCT01842568.)

Published
2022

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