27 results on '"Zancanaro E"'
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2. P16 ELIGIBILITY COAPT TRIAL IN DAILY PRACTICE: A REAL WORLD EXPERIENCE
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Zancanaro, E, primary, Buzzatti, N, additional, Denti, P, additional, and Maisano, F, additional
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- 2023
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3. Long term outcomes of reoperative tricuspid valve surgery
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Bianchi, G, Zancanaro, E, Sala, A, De Bonis, M, and Solinas, M
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- 2022
4. Developing crop canopy model for irrigation of high-density olive groves by using UAV imagery
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Zancanaro, E., primary, Gertsis, A., additional, Vellidis, G., additional, Marinello, F., additional, and Morari, F., additional
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- 2019
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5. Long-term results of tricuspid annuloplasty with 3-dimensional-shaped rings: effective and durable!
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Maria Chiara Calabrese, Nicola Buzzatti, Edoardo Zancanaro, Alessandra Sala, Michele De Bonis, Ottavio Alfieri, Davide Carino, Simona Nascimbene, Giuseppe Iaci, Alessandro Castiglioni, Elisabetta Lapenna, Stefania Ruggeri, Paolo Denti, Carino, D., Zancanaro, E., Lapenna, E., Ruggeri, S., Denti, P., Iaci, G., Buzzatti, N., Calabrese, M. C., Nascimbene, S., Sala, A., Castiglioni, A., Alfieri, O., and De Bonis, M.
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Tricuspid regurgitation ,030204 cardiovascular system & hematology ,Cardiac Valve Annuloplasty ,03 medical and health sciences ,0302 clinical medicine ,Tricuspid annuloplasty ,Tricuspid valve repair ,Tricuspid Valve Insufficiency ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Tricuspid valve ,Ejection fraction ,business.industry ,Atrial fibrillation ,Retrospective cohort study ,General Medicine ,medicine.disease ,Confidence interval ,3D shaped rings ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Heart Valve Prosthesis ,Cardiology ,Surgery ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES 3-Dimensional (3D)-shaped rings are largely adopted for tricuspid annuloplasty, but evidence about their long-term results is scanty. The goal of this study was to analyse the long-term results of tricuspid annuloplasty with 3D-shaped rings. MATERIALS AND METHODS A retrospective review of our prospectively maintained database was carried out to identify all patients who underwent tricuspid valve repair with 3D-shaped rings between January 2011 and December 2014. Kaplan–Meier methods were used to analyse long-term survival. Cumulative incidence function using death as the competitive outcome was used to estimate cardiac death. RESULTS A total of 168 patients were identified. The median age was 66 years. Eighty-two patients (49%) were in advanced New York Heart Association functional class III–IV. Atrial fibrillation (AF) was present in 101 (60%); the median ejection fraction was 60%. In 82 (49%) patients, a Medtronic 3D Contour annuloplasty ring was employed; in the remaining 86 (51%) patients, an Edwards MC3 ring was used. Cumulative incidence function of cardiac death, with non-cardiac death as a competing risk, was 1.9 ± 1.1%, 95% confidence interval (CI) (0.51–4.95) at 7 years. The cumulative incidence function of recurrence of tricuspid regurgitation (TR) ≥2+ at 7 years was 14 ± 3.17%, 95% CI (8.49–20.82). Recurrence of TR ≥2+ at 7 years was not significantly different between the Medtronic 3D Contour and the Edwards MC3 rings (P = 0.3). AF was identified as the only independent predictor of recurrence of TR ≥2+. CONCLUSIONS 3D-shaped rings are effective and durable. TR recurrence was relatively low at 7 years and usually moderate (2+/4+) without a significant difference between the 2 types of rings. The role of AF as a predictor of TR recurrence was confirmed.
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- 2021
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6. Valve-Sparing vs Bio-Bentall Aortic Root Replacement in Patients Aged 60 to 75 Years: Survival, Reintervention, and Aortic Regurgitation.
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Sala A, Di Mauro M, Zancanaro E, Bargagna M, Grimaldi F, D'Oria V, Menicanti L, Alfieri O, De Bonis M, and de Vincentiis C
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Background: Valve-sparing root replacement (VSRR) with the David technique is an established therapy for aortic root pathology in young patients. This study evaluated short- and long-term outcomes between VSRR and aortic root replacement (ARR) with a biological-valved conduit in sexagenarians., Methods: A multicenter retrospective review from 2002 to 2022 identified 299 sexagenarians undergoing aortic root surgery, among whom 82 (27.4%) underwent VSRR and 217 (72.6%) underwent bio-Bentall. Inverse probability of treatment weighting (IPTW) was applied to balance clinical variables. Median follow-up was 15 years (interquartile range, 12-18 years). Study end points were in-hospital mortality, long-term survival, freedom from reintervention, and recurrence of at least moderate aortic regurgitation (AR)., Results: There were no major differences in baseline characteristics. The incidence of bicuspid valves (VSRR, 4.9%; ARR, 19%), severe AR (42% vs 51%), type A aortic dissection (1.2% vs 6.9%), and reoperation (4% vs 23%) were higher in ARR. After IPTW, there was no difference in in-hospital mortality (VSRR, 1.2%; ARR, 4.6%; P = .3). The incidence of neurologic complications (P = .003) and permanent pacemaker implantation (P = .022) were significantly higher in the bio-Bentall group. After IPTW, 10-year survival did not differ between VSRR (87%) and ARR (80%; P = .176). However, cardiac survival was significantly higher in VSRR patients (98% vs 92%, P = .018), with deaths mainly due to infective endocarditis and end-stage heart failure. No difference was reported in reoperation/recurrence of at least moderate AR among the groups at 10 years, with only 1 patient undergoing reintervention after bio-Bentall (P = .117)., Conclusions: David and bio-Bentall procedures have low in-hospital mortality and good long-term survival in sexagenarians. VSRR is associated with improved long-term cardiac survival, lower rates of infective endocarditis, permanent pacemaker implantation, and heart failure episodes, with similar rates of reintervention/recurrence of moderate AR., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2025 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2025
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7. Personalized management of tricuspid valve regurgitation.
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Lurz P, Zancanaro E, and Kresoja KP
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- 2025
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8. Long-term results of edge-to-edge and neochordal mitral repair for isolated anterior leaflet lesion: a propensity match analysis.
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Zancanaro E, Carino D, Lorusso R, Del Forno B, Lapenna E, Sala A, Ascione G, Scarale MG, Nonis A, Castiglioni A, Alfieri O, Maisano F, and De Bonis M
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- Humans, Male, Female, Retrospective Studies, Middle Aged, Aged, Treatment Outcome, Echocardiography, Recurrence, Follow-Up Studies, Reoperation statistics & numerical data, Mitral Valve Insufficiency surgery, Mitral Valve surgery, Mitral Valve diagnostic imaging, Mitral Valve Annuloplasty methods, Mitral Valve Annuloplasty statistics & numerical data, Mitral Valve Annuloplasty adverse effects, Propensity Score
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Objectives: Mitral regurgitation due to anterior mitral leaflet lesions is associated with an increased risk of mitral regurgitation recurrence after mitral valve repair compared with posterior leaflet-related lesions. Both edge-to-edge (E-to-E) and neochordal repair, associated with ring annuloplasty, have been used in our institution to address isolated anterior mitral leaflet lesions. The aim of this study was to compare the clinical and echocardiographic long-term results of those two approaches for isolated anterior mitral leaflet lesions by means of a propensity match analysis., Methods: An institutional database retrospective review within the time-frame 2000 to 2021 was carried out. The Kaplan-Meier method and cumulative incidence function were employed. Cox regression was used to identify the risk factor for mortality during the follow-up., Results: The estimated freedom from reoperative mitral valve surgery at 20 years was 78% in the E-to-E group and 64% in the neochordae group (P = 0.032). The longitudinal analysis performed to analyse the mitral regurgitation recurrence rate showed a higher rate of mitral regurgitation ≥3+ recurrence in the neochordae group at 5 (5.1% vs 8.7%), -10 (8.2% vs 13.2%), and 15 years (8.8% vs 16.5%) (P < 0.001)., Conclusions: Isolated anterior leaflet pathology can be effectively treated with E-to-E or neochordal repair and ring annuloplasty. In our series, clinical and echocardiographic results were better in E-to-E group. The excellent durability of this technique up to 20 years of follow-up, together with its simplicity and reproducibility, confirms the role the E-to-E techniques as an excellent treatment option for severe mitral regurgitation due anterior mitral leaflets lesions., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
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- 2024
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9. Sutureless Bioprostheses for Aortic Valve Replacement: An Updated Systematic Review with Long-Term Results.
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Chiariello GA, Di Mauro M, Villa E, Koulouroudias M, Bruno P, Mazza A, Pasquini A, D'Avino S, De Angelis G, Corigliano K, Marcolini A, Zancanaro E, Saitto G, Meani P, Massetti M, and Lorusso R
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Background: In recent years, in case of aortic valve replacement (AVR), a significant increase in the use of bioprostheses has been observed. The Perceval sutureless bioprosthesis has proven to be safe and reliable in the short and mid-term, with limited but promising long-term results. An updated systematic review with the long-term results of patients who underwent a sutureless bioprosthesis implantation with a Perceval biological valve is herewith presented. Methods: Studies published between 2015 and 2024, including the long-term outcomes-with clinical as well as echocardiographic information for up to five years-of patients who underwent a Perceval implantation for AVR were selected from the published literature. The Cochrane GRADE system was used to assess the study quality, and the risk of bias in non-randomized studies (ROBINS-I) tool was used to evaluate studies. Results: Ten studies were selected with an overall number of 5221 patients. The long-term survival ranged from 64.8 to 87.9%, freedom from structural valve degeneration (SVD) from 96.1 to 100%, freedom from significant paravalvular leak from 98.5 to 100%, freedom from prosthetic endocarditis from 90.7 to 99%, and freedom from reintervention from 94 to 100%. The long-term mortality ranged from 6.5 to 27.4%. SVD was observed in 0-4.8% patients. Significant paravalvular leak was observed in 0-3.4% patients, and infective endocarditis was observed in 0-3.4%. A bioprosthesis-related reintervention at long-term follow-up was required for 0-4.3% of patients, and 1.7-7.1% of patients required a late new pacemaker implantation. The transprosthetic mean pressure gradient ranged from 9 to 14.7 mmHg, peak pressure gradient ranged from 17.8 to 26.5 mmHg, and EOA ranged from 1.5 to 1.7 cm
2 . Conclusions: This systematic review shows that there is still a paucity of data about sutureless bioprostheses. Nevertheless, the clinical results from prospective studies or retrospective series are encouraging. Medium- and long-term results seem to support the increasing use of this type of prosthesis.- Published
- 2024
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10. Welcome to the exciting world of the right ventricle.
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Grapsa J, Zancanaro E, and Enriquez-Sarano M
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- Humans, Heart Ventricles
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- 2024
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11. Bicuspid Aortic Valve, from the Unknown till the Perfection of the Species.
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Bargagna M, Ascione G, Zancanaro E, Fioravanti F, Sala A, Trumello C, Chang G, Verzini A, Castiglioni A, and Maisano F
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The bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality. Though most often isolated, BAV may be associated with other cardiovascular malformations. BAV-related aortopathy is the most common, sharing genetic alterations and phenotypic heterogeneity characteristics. Sometimes silent for a lifetime, BAV may manifest as aortic valve dysfunction, aortic aneurysm, or more emergent situations, such as endocarditis or aortic dissection. Its embryological origin and the characterization of the genes involved, as well as the histopathological and hemodynamic aspects of its natural history, are becoming increasingly clear. In addition, emerging evidence of rhythm disorders associated with BAV has been identified. A new international nomenclature and classification has been introduced to interpret all the advances made in recent years for the comprehension of this condition. In the guidelines, more attention has been paid to the diagnosis of BAV and related aortopathy, together with surveillance, and family screening. Surgical treatment remains the gold standard, especially in young low-risk patients, and valve repair techniques have been shown to be effective and durable. Finally, the new era of transcatheter techniques is also being applied to dysfunctional BAV, allowing the treatment of patients at high surgical risk, with increasingly promising results, and the possibility of expanding indications through the introduction of more advanced devices. This review aims to comprehensively describe the BAV conundrum, focusing on anatomy, pathophysiology, genetics, diagnosis of BAV-related disorders, and the different treatment options available in the transcatheter era., Competing Interests: The authors declare no conflict of interest. Francesco Maisano received a grant and/or institutional research support from Abbott, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific Corporation, NVT, Terumo. He received consulting fees, Honoraria personal and institutional from Abbott, Medtronic, Edwards Lifesciences, Xeltis, Cardiovalve, Occlufit, Simulands, Mtex. He has received royalty income/IP rights from Edwards Lifesciences. He is a shareholder (including share options) of Cardiogard, Magenta, SwissVortex, Transseptal Solutions, Occlufit, 4Tech, Perifect., (Copyright: © 2024 The Author(s). Published by IMR Press.)
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- 2024
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12. Emergent Surgical Replacement of a Tendyne Prosthesis for Bioprosthetic Valve Thrombosis.
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Dohle DS, Pfeiffer P, Ruf T, Gößler T, Ghazy A, Zancanaro E, Lurz P, Treede H, and von Bardeleben RS
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A 66-year-old woman with a complex medical history underwent transcatheter mitral valve replacement (TMVI) owing to mitral insufficiency. Risk factors and noncompliance led to bioprosthetic valve thrombosis (BPVT) within 3 years. Emergent surgery indicated by an ad hoc heart team successfully managed the situation, showcasing challenges in BPVT management after TMVI., Competing Interests: Dr Dohle is a consultant to Artivion, Edwards, Medira and VarmX. Dr Ruf has received consultation fees and proctor, preceptor, and speaker honoraria from Abbott Medical, Edwards Lifesciences, and TRiCares. Dr Lurz has received grants from Abbott Vascular, Edwards Lifesciences, and ReCor Medical. Dr Treede is consultant for Jena Valve Technology. Dr von Bardeleben reports advisory board activity with Abbott, Bioventrix, Boston Scientific, Edwards Lifesciences, and Medtronic and trial steering committee and lecture honoraria from Abbott Cardiovascular and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)
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- 2024
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13. Tricuspid regurgitation and heart failure: the fate of treated vs. untreated cohort in the percutaneous era.
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Zancanaro E, Romeo MR, Nardone A, D'Agostino A, Mariani M, and Berti S
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Aims: Tricuspid regurgitation (TR) is associated with heart failure (HF) and reduced survival. Within a short-time period, transcatheter tricuspid valve repair or replacement (TTVR/TTVr) for TR has evolved from innovation to clinical reality. The present study's aim is to provide 1-year results between TR patients treated with TTVR and TTVr compared with untreated patients, in terms of cardiac survival, rehospitalization, right-side HF symptom development, and New York Heart Association (NYHA) improvement., Methods and Results: Seventy-seven patients (pts) have been prospectively inserted into a dedicated database from January 2020 till January 2023. Twenty-six patients (33.8%) have been treated with TTVR/r [treated group (TG)], and 51 pts (66.2%) have been left untreated with medical therapy optimization [untreated group (UNTG)]. Analysing the cardiac death between the two groups, there was a significant statistical difference since TG has less incidence of exitus in the general population ( P = 0.05). Concerning HF hospitalization, TG has a lower incidence with a P = 0.005. In TG, there was a significant improvement in NYHA class at follow-up (FUP) ( P = 0.001) as well as an improvement in right-side HF symptoms ( P = 0.001)., Conclusion: This study shows that treatment in the case of TR with right-side HF has a positive impact on cardiac death and HF hospitalization at 1 year. And there is a significant improvement in clinical and echocardiographic status at FUP in the TG., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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14. Eligibility to COAPT trial in the daily practice: A real-world experience.
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Zancanaro E, Buzzatti N, Denti P, Guicciardi NA, Melillo E, Monaco F, Agricola E, Ancona F, Alfieri O, De Bonis M, and Maisano F
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- Humans, Retrospective Studies, Female, Male, Aged, Treatment Outcome, Time Factors, Aged, 80 and over, Risk Factors, Clinical Decision-Making, Recovery of Function, Risk Assessment, Middle Aged, Heart Valve Prosthesis, Ventricular Function, Left, Patient Selection, Mitral Valve Insufficiency surgery, Mitral Valve Insufficiency physiopathology, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency mortality, Eligibility Determination, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Mitral Valve surgery, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Cardiac Catheterization adverse effects, Cardiac Catheterization mortality, Cardiac Catheterization instrumentation
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Background: The COAPT Trial was the first ever to demonstrate a survival benefit in treating functional mitral regurgitation (FMR). That was achieved through transcatheter mitral repair in selected patients. The exact proportion of patients fulfilling COAPT selection criteria in the real-world is unknown., Aims: To assess the applicability of COAPT criteria in real world and its impact on patients' survival., Methods: We assessed the clinical data and follow-up results of all consecutive patients admitted for FMR at our Department between January 2016 and May 2021 according to COAPT eligibility. COAPT eligibility was retrospectively assessed by a cardiac surgeon and a cardiologist., Results: Among 394 patients, 56 (14%) were COAPT eligible. The most frequent reasons for exclusion were MR ≤ 2 (22%), LVEF < 20% or >50% (19%), and non-optimized GDMT (21.3%). Among Non-COAPT patients, weighted 4-year survival was higher in patients who received MitraClip compared to those who were left in optimized medical therapy (91.5% confidence interval [CI: 0.864, 0.96] vs. 71.8% [CI: 0.509, 0.926], respectively, p = 0.027)., Conclusions: Only a minority (14%) of real-world patients with FMR referred to a tertiary hospital fulfilled the COAPT selection criteria. Among Non-COAPT patients, weighted 4-year survival was higher in patients who received MitraClip compared to those who were left in optimized medical therapy (91.5% [0.864, 0.96] vs. 71.8% [0.509, 0.926], respectively, p = 0.027)., (© 2024 The Author(s). Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)
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- 2024
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15. First-in-human implantation of a customised balloon-expandable valve into a dysfunctional Tendyne valve.
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Denti P, Saccocci M, Buzzatti N, Zancanaro E, and Maisano F
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- Aged, Humans, Balloon Valvuloplasty, Cardiac Catheterization instrumentation, Cardiac Catheterization methods, Treatment Outcome, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation methods, Prosthesis Design
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- 2024
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16. Sex Differences in Short- and Long-Term Survival after Acute Type A Aortic Dissection.
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Pfeiffer P, Brendel L, Rösch RM, Probst C, Ghazy A, Zancanaro E, El Beyrouti H, Treede H, and Dohle DS
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- Humans, Male, Female, Retrospective Studies, Sex Characteristics, Treatment Outcome, Risk Factors, Acute Disease, Aortic Dissection surgery, Blood Vessel Prosthesis Implantation
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Background and Objectives : Acute type A aortic dissection (AAD) is a life-threatening disease. No differences between men and women have been made in the treatment of AAD so far and knowledge about sex differences regarding long-term outcomes is limited. Materials and Methods : Between 01/2004 and 12/2021, 874 patients were operated on for AAD, including 313 (35.8%) women and 561 (64.2%) men. Clinical and surgical records, including long-term follow-up information, were obtained and analyzed retrospectively. To account for differences in the outcome determined by different preoperative life expectancies, a subgroup analysis for a set of patients matched according to their remaining life expectancy was performed. Results : At the time of AAD, women were older than men (69.1 ± 13.0 vs. 61.8 ± 13.3 years, p < 0.001) and had a shorter remaining statistical life expectancy (18.6 ± 10.8 vs. 21.4 ± 10.4 years, p < 0.001). Significantly more DeBakey type II AAD was found in women (37.1% vs. 25.7%, p < 0.001). Comorbidities and preoperative status at the time of presentation were similar in women and men. More hemiarch procedures (63.3% vs. 52.0%, p < 0.001) and less arch replacements (8.6% vs. 16.6%, p < 0.001) were performed in women, resulting in shorter cross-clamp times for women (92 ± 39 vs. 102 ± 49 min, p < 0.001). The in-hospital mortality was similar in women and men (11.5% vs. 12.7%, p = 0.618). Long-term survival was significantly shorter in women compared to men (9.8 [8.1-11.5] vs. 15.1 [11.9-18.4] years, p = 0.011). A matched subgroup analysis revealed that when comparing groups with a similar remaining life expectancy, the long-term survival showed no significant differences between women and men (9.8 [7.9-11.6] vs. 12.4 [10.1-14.7] years, p = 0.487). Conclusions : There are sex differences in AAD, with DeBakey type II dissection being more frequent in women. The seemingly worse long-term outcome can mostly be attributed to the shorter remaining statistical life expectancy at the time of presentation.
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- 2024
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17. Ten-year experience with sutureless Perceval bioprosthesis: single-centre analysis in 1157 implants.
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Concistrè G, Bianchi G, Margaryan R, Zancanaro E, Chiaramonti F, Kallushi E, Gasbarri T, Murzi M, Varone E, Simeoni S, Leone A, Santarelli F, Farneti P, and Solinas M
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- Humans, Aged, Aged, 80 and over, Prosthesis Design, Treatment Outcome, Aortic Valve diagnostic imaging, Aortic Valve surgery, Bioprosthesis, Heart Valve Prosthesis Implantation methods, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Aortic Valve Stenosis complications, Heart Valve Prosthesis
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Aims: We describe long-term clinical and echocardiographic outcomes in the largest single-centre cohort of patients who underwent aortic valve replacement (AVR) with sutureless Perceval (CorCym, Italy) bioprosthesis., Methods: Between March 2011 and March 2021, 1157 patients underwent AVR with Perceval bioprosthesis implantation. Mean age was 77 ± 6 years (range: 46-89 years) and mean EuroSCORE II was 6.7 ± 3.2% (range: 1.7-14.2%). Concomitant procedures were performed in 266 patients (23%)., Results: Thirty-day mortality was 1.38% (16/1157). Eight hundred and twenty of 891 (92%) isolated AVRs underwent minimally invasive surgery with a ministernotomy ( n = 196) or right minithoracotomy ( n = 624) approach. Cardiopulmonary bypass and aortic cross-clamp times were 81.1 ± 24.3 and 50.6 ± 11.7 min for isolated AVR and 144.5 ± 34.7 and 96.4 ± 21.6 min for combined procedures. At mean follow-up of 53.08 ± 6.7 months (range: 1-120.5 months), survival was 96.5% and mean transvalvular pressure gradient was 13.7 ± 5.8 mmHg. Left ventricular mass decreased from 152.8 to 116.1 g/m 2 ( P < 0.001) and moderate paravalvular leakage occurred in three patients without haemolysis not requiring any treatment. Freedom from reoperation was 97.6%. Eight patients required surgical reintervention and 19 patients transcatheter valve-in-valve procedure for structural prosthesis degeneration at a mean of 5.6 years after first operation (range: 2-9 years)., Conclusion: AVR with a Perceval bioprosthesis is associated with good clinical results and excellent haemodynamic performance in our 10-year experience. Structural degeneration rate of Perceval is comparable with other bioprosthetic aortic valves. Sutureless technology may reduce operative time especially in combined procedures and enable minimally invasive AVR., (Copyright © 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.)
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- 2023
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18. Impact of Social Media and Multimedia Platforms: View From the JACC: Case Reports SoMe Editors.
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Oliveros E, Brailovsky Y, Beneduce A, Bakhshi H, Zancanaro E, Sukmawati I, Shetty M, and Lundberg G
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Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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- 2023
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19. TRI-SCORE: a single-centre validation study.
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Sala A, Carino D, Lorusso R, Zancanaro E, Bargagna M, Del Forno B, Trumello C, Denti P, Ruggeri S, Nonis A, Scarale MG, Schiavi D, Castiglioni A, Maisano F, Alfieri O, and De Bonis M
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Objectives: The TRI-SCORE is a recently published risk score for predicting in-hospital mortality in patients undergoing isolated tricuspid valve surgery (ITVS). The aim of this study is to externally validate the ability of the TRI-SCORE in predicting in-hospital and long-term mortality following ITVS., Methods: A retrospective review of our institutional database was carried out to identify all patients undergoing isolated tricuspid valve repair or replacement from March 1997 to March 2021. The TRI-SCORE was calculated for all patients. Discrimination of the TRI-SCORE was assessed using receiver operating characteristic curves. Accuracy of the models was tested calculating the Brier score. Finally, a COX regression was employed to evaluate the relationship between the TRI-SCORE value and long-term mortality., Results: A total of 176 patients were identified and the median TRI-SCORE was 3 (1-5). The cut-off value identified for increased risk of isolated ITVS was 5. Regarding in-hospital outcomes, the TRI-SCORE showed high discrimination (area under the curve 0.82), and high accuracy (Brier score 0.054). This score showed also very good performance in predicting long-term mortality (at 10 years, hazard ratio: 1.47, 95% confidence interval [1.31-1.66], P < 0.001), with high discrimination (area under the curve >0.80 at 1-5 and 10 years) and high accuracy values (Brier score 0.179)., Conclusions: This external validation confirms the good performance of the TRI-SCORE in predicting in-hospital mortality. Moreover, the score showed also very good performance in predicting the long-term mortality., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
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- 2023
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20. Hamartoma of mature cardiomyocytes presenting with atypical angina, 18 F-fluorodeoxyglucose positron emission tomography uptake, and myocardial bridging: a case report.
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Bianchi G, Zancanaro E, Pucci A, and Solinas M
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Aim: Hamartoma of mature cardiomyocytes is a rare tumor and the present case shows a complex diagnostic pathway to understand its nature and treatment options in a young patient. The myocardial bridge was also part of the clinical evaluation discovered during the diagnostic workout., Methods and Results: A 27-year-old woman with atypical chest pain and a normal electrocardiogram received the diagnosis of neoformation of the interventricular septum with
18 F-fluorodeoxyglucose (18 F-FDG) uptake, and evidence of myocardial bridging on coronary angiography. On suspicion of malignancy, coronary unroofing and surgical biopsy was performed. The final diagnosis was hamartoma of mature cardiomyocytes., Conclusion: This case offers great insight into medical reasoning and decision-making process. Given the history of chest pain, the patient was evaluated for possible ischemic, embolic, or vascular causes. Given a left ventricular wall thickness ≥15 mm, hypertrophic cardiomyopathy (HCM) should always be suspected; nuclear magnetic resonance imaging is essential to distinguish between HCM. The magnetic resonance imaging is also critical in distinguishing HCM itself from tumoral phenocopies. To rule out a neoplastic process,18 F-FDG positron emission tomography (PET) was used. A surgical biopsy was performed, and the final diagnosis was completed after the immune-histochemistry study. A myocardial bridge was found during preoperative coronagraphy and was treated accordingly., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)- Published
- 2023
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21. Outcomes of Emergent Isolated Coronary Bypass Grafting in Heart Failure Patients.
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Bianchi G, Zancanaro E, Margaryan R, Concistré G, Varone E, Simeoni S, and Solinas M
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Patients with previously diagnosed HF are at greater risk for subsequent morbidity and mortality when hospitalized for an Acute Myocardial Infarction (AMI). The purpose of our study was to describe the time trend of the incidence of emergent CABG in patients with and without HF, the clinical characteristics, outcomes, and the risk factors for mortality of surgical revascularization in the short and medium term. This was a single-center retrospective observational study of patients who underwent isolated emergency CABG from January 2009 to January 2020. A propensity-score matching analysis yielded two comparable groups (n = 430) of patients without (n = 215) and with (n = 215) heart failure. In-hospital mortality did not differ in the two groups (2.8%; p > 0.9); the patients with heart failure presented more frequently with cardiogenic shock, and there was an association with mortality and mechanical circulatory support (OR 16.7−95% CI 3.31−140; p = 0.002) and postoperative acute renal failure (OR 15.9−95% CI 0.66−203; p = 0.036). In the early- and mid-term, heart failure and NSTEMI were associated with mortality (HR 3.47−95% CI 1.15−10.5; p = 0.028), along with age (HR 1.28−95% CI 1.21−1.36; p < 0.001). Surgical revascularization offers an excellent solution for patients with acute coronary syndrome, leading to a good immediate prognosis even in those with chronic heart failure.
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- 2022
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22. Surgical treatment of tricuspid valve regurgitation in patients with cardiac implantable electronic devices: long-term results.
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Carino D, Sala A, Zancanaro E, Ruggeri S, Lapenna E, Del Forno B, Verzini A, Schiavi D, Castiglioni A, Alfieri O, Maisano F, and De Bonis M
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- Electronics, Humans, Retrospective Studies, Risk Factors, Treatment Outcome, Tricuspid Valve surgery, Cardiac Surgical Procedures methods, Tricuspid Valve Insufficiency etiology, Tricuspid Valve Insufficiency surgery
- Abstract
Objectives: With the expanding use of cardiac implantable electronic devices (CIEDs), lead interference with the tricuspid valve (TV) causing significant tricuspid regurgitation (TR) has gained increasing recognition. However, current knowledge about the long-term results of the surgical treatment of TR in this setting is scanty. Therefore, increasing this information was the goal of this study., Methods: A retrospective review of our institutional database was carried out to select all patients with previously implanted CIEDs who underwent tricuspid valve repair and replacement from 2000 through 2019. Kaplan-Meier methods were used to analyse long-term survival. To describe the time course of TR, we performed a longitudinal analysis using generalized estimating equations., Results: A total of 151 patients were identified. Mechanical interference with leaflet mobility and coaptation was detected in 103 patients (68%) (CIED-induced group); in the remaining 48 patients (32%), the lead was associated with TR without being the cause of it (CIED-associated group). A total of 105 patients underwent TV repair; in the remaining 46, a TV replacement was necessary. In patients who underwent TV repair, no significant difference in moderate TR recurrence rate was highlighted between CIED-induced and CIED-associated TR., Conclusions: In patients with CIEDs and surgically treated tricuspid regurgitation, TR is CIED-induced in about two-thirds of the cases and CIED-associated in one-third of them. In our experience, TV repair was still possible in 63% of the cases, with good long-term results and no significant durability difference between CIED-induced and CIED-associated TR., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2022
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23. Mid-term outcomes of isolated tricuspid valve surgery according to preoperative clinical and functional staging.
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Sala A, Lorusso R, Zancanaro E, Carino D, Bargagna M, Bisogno A, Lapenna E, Ruggeri S, Meneghin R, Schiavi D, Buzzatti N, Denti P, Monaco F, Agricola E, Maisano F, Alfieri O, Castiglioni A, and De Bonis M
- Subjects
- Death, Humans, Retrospective Studies, Treatment Outcome, Tricuspid Valve surgery, Heart Valve Prosthesis Implantation adverse effects, Tricuspid Valve Insufficiency etiology
- Abstract
Objectives: This study aimed at assessing mid-term outcomes of patients undergoing isolated tricuspid valve (TV) surgery based on a preoperative baseline clinical and functional classification., Methods: All patients treated with isolated TV repair or replacement from March 1997 to May 2020 at a single institution were retrospectively reviewed and assessed for mid-term postoperative outcome according to a novel classification [stages 1-5 related to the absence or presence and extent of right heart failure (RHF)]. Kaplan-Meier survival curves were used to estimate mid-term survival. Competing risk analysis for time to cardiac death and hospitalizations for RHF were also carried out., Results: Among the 172 patients included, 129 (75%) underwent TV replacement and 43 (25%) TV repair. At follow-up (median 4.2 years [2.1-7.5]), there were 23 late deaths. At 5 years, overall survival was 100% in stage 2, 88 ± 4% in stage 3 and 60 ± 8% in stages 4-5 (P = 0.298 and P = 0.001, respectively). Cumulative incidence function of cardiac death at 5 years was 0%, 8.6 ± 3.76% and 13.2 ± 5% for stages 2, 3 and 4 and 5, respectively. At follow-up, cumulative incidence function of re-hospitalizations for RHF was 0% for stage 2, 20 ± 5% for stage 3 and 20 ± 6.7% for stages 4 and 5 (P = 0.118 and P = 0.039, respectively)., Conclusions: Both short- and mid-term outcomes support early referral for surgery in isolated TV disease, with excellent survival at 5 years and no further hospitalizations for RHF., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2022
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24. Commissural closure to treat severe mitral regurgitation: standing the test of time.
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Carino D, Lorusso R, Lapenna E, Del Forno B, Sala A, Zancanaro E, Ruggeri S, Abboud S, Schiavi D, Ascione G, Castiglioni A, Alfieri O, Maisano F, and De Bonis M
- Subjects
- Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Prolapse, Reoperation adverse effects, Retrospective Studies, Treatment Outcome, Mitral Valve Annuloplasty adverse effects, Mitral Valve Annuloplasty methods, Mitral Valve Insufficiency, Mitral Valve Prolapse complications, Mitral Valve Prolapse surgery
- Abstract
Objectives: Mitral regurgitation (MR) due to commissural prolapse or flail represents a pattern of valve dysfunction that can be treated, among other techniques, by suturing the margins of the anterior and posterior leaflets in the commissural area (commissural closure). The very long-term results of this technique have not been reported so far and represent the objective of this study., Methods: A retrospective review of our institutional database was carried on querying for patients who underwent commissural closure and ring annuloplasty within the time frame 1997-2007 to provide a robust long-term assessment. Cumulative incidence function (CIF) using death as a competitive outcome was used to estimate cardiac death and reoperation for mitral valve replacement. To describe the time course of MR, we performed a longitudinal analysis using generalized estimating equations with a random intercept for correlated data., Results: A total of 125 patients were included. At 15 years, the CIF for cardiac death, with non-cardiac death as a competitive event, was 8.0 ± 2.57% (95% confidence interval [3.88-13.93]). At 15 years, the CIF for reintervention for a mitral valve replacement with death as a competitive event was 5.0 ± 1.98%, 95% confidence interval [2.04-9.89]. No significant predictors of reintervention for mitral valve replacement were identified. At 5 years, the predicted rate of MR ≥3+ recurrence was 2.53% while it was 8.22% at 15 years. In no case a more than mild mitral stenosis was detected., Conclusions: Severe MR due to commissural prolapse/flail can be effectively treated with commissural closure and ring annuloplasty. In our series, the rate of reoperation in the very long term was extremely low. Similarly, longitudinal analysis demonstrated a very low rate of MR ≥3+ recurrence., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2022
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25. Durability of suture versus ring tricuspid annuloplasty: Looking at very long term (18 years).
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Carino D, Zancanaro E, Sala A, Ruggeri S, Lapenna E, Forno BD, Verzini A, Schiavi D, Castiglioni A, Alfieri O, and Bonis M
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- Death, Humans, Retrospective Studies, Sutures, Treatment Outcome, Tricuspid Valve diagnostic imaging, Tricuspid Valve surgery, Cardiac Valve Annuloplasty methods, Heart Valve Prosthesis Implantation adverse effects, Tricuspid Valve Insufficiency diagnostic imaging, Tricuspid Valve Insufficiency surgery
- Abstract
Background: Several papers already reported better outcomes of tricuspid valve repair with ring annuloplasty compared to suture techniques. However, the follow-up is usually limited to 10 years. With this study, we aim to analyze the results of tricuspid valve repair according to the technique employed when the follow-up is extended to more than 15 years., Materials and Methods: A retrospective review of our institutional database was carried on to find all patients who underwent tricuspid valve repair between January 1998 and December 2004. Kaplan-Meier method was employed to estimate survival and log-rank test was used to make intergroup comparison. Cox regression was employed to identify risk factor for mortality. Cumulative incidence function using death as competitive outcome was used to estimate cardiac death. To describe the time course of tricuspid regurgitation, a longitudinal analysis using generalized estimating equations with random intercept for correlated data was performed., Results: One hundred forty-six patients were identified: 89 in the suture group and 57 in the ring group. No difference in term of long-term survival and cardiac death was evident between the two groups. A significant higher rate of tricuspid regurgitation ≥2+ and ≥3+ recurrence was evident in the suture group during the whole follow-up (p < 0.001)., Conclusion: Our results corroborate the better results of tricuspid valve repair by means of ring implantation compared to suture techniques also when the follow-up is extended up to 18 years. Ring annuloplasty should be considered the first option for tricuspid valve repair due to a better durability.
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- 2022
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26. Hypertrophic cardiomyopathy with moderate septal thickness and mitral regurgitation: long-term surgical results.
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Lapenna E, Nisi T, Carino D, Bargagna M, Ruggeri S, Zancanaro E, Del Forno B, Schiavi D, Agricola E, Castiglioni A, Alfieri O, and De Bonis M
- Subjects
- Heart Septum diagnostic imaging, Heart Septum surgery, Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Treatment Outcome, Cardiomyopathy, Hypertrophic diagnostic imaging, Cardiomyopathy, Hypertrophic surgery, Mitral Valve Insufficiency surgery
- Abstract
Objectives: The aim of this study was to assess the long-term outcomes of different surgical strategies in patients with hypertrophic obstructive cardiomyopathy (HOCM) with septal thickness ≤18 mm and systolic anterior motion (SAM)-related moderate-to-severe mitral regurgitation (MR)., Methods: Seventy-six HOCM patients with septal thickness 17 [16; 18] mm, resting left ventricle outflow tract gradient 60 [41; 85] mmHg and SAM-related MR ≥2+/4+, underwent septal myectomy alone (54%) or mitral valve (MV) surgery ± myectomy (46%)., Results: No hospital death and no ventricular septal defect occurred. Patients undergoing MV surgery ± myectomy had longer cardiopulmonary bypass and X-clamp times (77 [60-106] vs 51 [44-62] min, P < 0.001 and 56 [45-77] vs 32 [28-41] min, P < 0.001) and higher incidence of low output syndrome (11% vs 0%, P = 0.04). Follow-up was 98.6% complete, median 8 years [3-11]. There were no statistically significant differences in overall survival (P = 0.069) with survival rates at 9 years of 96 ± 4% in the myectomy alone group and 81 ± 8% in the MV surgery ± myectomy one. At 9 years, cumulative incidence function of cardiac death was 12 ± 6% in the MV surgery ± myectomy group vs 0% in the myectomy one, P = 0.06. Multivariable analysis identified age and previous septal alcoholization as predictors of cardiac death (hazard ratio (HR) = 1.1, 95% confidence interval (CI) 1.0-1.1, P = 0.004 and HR = 2.9, 95% CI 1.0-8.3, P = 0.042). The 9-year cumulative incidence function of recurrence of MR ≥2+, with death as competing risk, was 3 ± 2.8% in the MV surgery ± myectomy group vs 25 ± 6.9% in the myectomy one, P = 0.005., Conclusions: In HOCM patients with moderate septal thickness and SAM-related MR, as the degree of septal hypertrophy decreases, addressing the abnormalities of the MV apparatus may become necessary to provide a durable resolution of left ventricle outflow tract obstruction and SAM-related MR. However, performing myectomy alone, whenever possible, seems to be associated to a better postoperative course and a trend towards lower cardiac mortality at follow-up, despite a higher rate of residual moderate MR., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2021
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27. Optimal versus suboptimal mitral valve repair: late results in a matched cohort study.
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De Bonis M, Zancanaro E, Lapenna E, Trumello C, Ascione G, Giambuzzi I, Ruggeri S, Meneghin R, Abboud S, Agricola E, Del Forno B, Buzzatti N, Monaco F, Pappalardo F, Castiglioni A, and Alfieri O
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- Cohort Studies, Follow-Up Studies, Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Recurrence, Reoperation, Retrospective Studies, Treatment Outcome, Mitral Valve Annuloplasty, Mitral Valve Insufficiency surgery
- Abstract
Objectives: After mitral repair for degenerative mitral regurgitation (MR), no or mild (≤1+/4+) residual MR should remain. Occasionally patients are left with more than mild residual MR (>1+/4+) for a number of reasons. The aim of this study was to assess the late implications of such a suboptimal repair in a matched cohort study., Methods: From 2006 to 2013, a total of 2158 patients underwent mitral repair for degenerative MR in our institution. Fifty patients (2.3%) with residual MR >1+ at hospital discharge (study group) were matched up to 1:2 with 91 patients operated on during the same period who were discharged with MR ≤1+ (control group). The median follow-up was 8 years (interquartile range 6.3-10.1, longest 12.7 years). A comparative analysis of the outcomes in the 2 groups was performed., Results: Overall survival at 8 years was 87 ± 8% in the study group and 92 ± 3% in the control group (P = 0.23). There were 3 late deaths (6.0%) in the study group and 6 deaths (6.6%) in the control group. Freedom from reoperation was similar (P = 1.0). At 8 years the prevalence of MR ≥3+ was significantly higher in the study group (15.6% vs 2.1%, P < 0.001) as was the use of diuretics, beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers. Interestingly, even in the control group, a gradual progression of MR was observed because 13.3% of the patients had MR ≥2+ at 8 years with a significant increase over time (P < 0.001)., Conclusions: Residual MR more than mild at hospital discharge is associated with lower durability of mitral repair and the need for more medical therapy in the long term. However, even an initial optimal result does not completely arrest the progression of the degenerative process., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2020
- Full Text
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