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4 results on '"Demal T"'

1. Perioperative bleeding in patients with acute coronary syndrome treated with fondaparinux versus low-molecular-weight heparin before coronary artery bypass grafting

Author

Khodabandeh, S. (Sorosh), Biancari, F. (Fausto), Kinnunen, E.-M. (Eeva-Maija), Mariscalco, G. (Giovanni), Airaksinen, J. (Juhani), Gherli, R. (Riccardo), Gatti, G. (Giuseppe), Demal, T. (Till), Onorati, F. (Francesco), Faggian, G. (Giuseppe), De Feo, M. (Marisa), Santarpino, G. (Giuseppe), Rubino, A. S. (Antonino S.), Maselli, D. (Daniele), Salsano, A. (Antonio), Nicolini, F. (Francesco), Zanobini, M. (Marco), Ruggieri, V. G. (Vito G.), Bounader, K. (Karl), Perrotti, A. (Andrea), Dalén, M. (Magnus), Khodabandeh, S. (Sorosh), Biancari, F. (Fausto), Kinnunen, E.-M. (Eeva-Maija), Mariscalco, G. (Giovanni), Airaksinen, J. (Juhani), Gherli, R. (Riccardo), Gatti, G. (Giuseppe), Demal, T. (Till), Onorati, F. (Francesco), Faggian, G. (Giuseppe), De Feo, M. (Marisa), Santarpino, G. (Giuseppe), Rubino, A. S. (Antonino S.), Maselli, D. (Daniele), Salsano, A. (Antonio), Nicolini, F. (Francesco), Zanobini, M. (Marco), Ruggieri, V. G. (Vito G.), Bounader, K. (Karl), Perrotti, A. (Andrea), and Dalén, M. (Magnus)

Abstract

The perioperative bleeding risk in patients receiving fondaparinux versus low-molecular weight heparin before coronary artery bypass grafting has not been reported. We evaluated perioperative coronary artery bypass grafting -related bleeding in patients with acute coronary syndrome preoperatively treated with fondaparinux or low-molecular weight heparin. All patients with acute coronary syndrome from the prospective, European multicenter registry on Coronary Artery Bypass Grafting (E-CABG) preoperatively treated with fondaparinux or lowmolecular weight heparin undergoing isolated primary CABG were eligible. The primary outcome measure was severe or massive bleeding defined according to the Universal Definition of Perioperative Bleeding stratified by P2Y12 inhibitor discontinuation. Secondary outcome measures included three additional definitions of major bleeding used in cardiac surgery trials. Propensity score matching was performed to adjust for differences in pre- and perioperative covariates. 1525 patients were included, of whom 276 (18.1%) received fondaparinux and 1249 (81.9%) low-molecular weight heparin preoperatively. In the propensity score-matched cohort (245 pairs), the risk of major bleeding according to the Universal Definition of Perioperative Bleeding severe or massive bleeding (11.8 versus 9.0%, p = 0.285) and the three other major bleeding definitions was similar between the fondaparinux and low-molecular weight heparin cohorts. In conclusion, preoperative treatment with fondaparinux compared to low-molecular weight heparin was associated with similar incidence of perioperative bleeding in patients with acute coronary syndrome undergoing coronary artery bypass grafting.

Published
2019

2. Diameter and dissection of the abdominal aorta and the risk of distal aortic reoperation after surgery for type A aortic dissection.

Author

Biancari F, Perrotti A, Juvonen T, Mariscalco G, Pettinari M, Lega JR, Di Perna D, Mäkikallio T, Onorati F, Wisniewki K, Demal T, Pol M, Gatti G, Vendramin I, Rinaldi M, Quintana E, Peterss S, Field M, and Fiore A

Subjects
Humans, Aorta, Abdominal diagnostic imaging, Aorta, Abdominal surgery, Reoperation, Risk Factors, Treatment Outcome, Retrospective Studies, Aortic Aneurysm surgery, Blood Vessel Prosthesis Implantation adverse effects, Aortic Dissection diagnostic imaging, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Azides, Deoxyglucose analogs & derivatives
Abstract

Background: Surgery for Stanford type A aortic dissection (TAAD) is associated with an increased risk of late aortic reoperations due to degeneration of the dissected aorta., Methods: The subjects of this analysis were 990 TAAD patients who survived surgery for acute TAAD and had complete data on the diameter and dissection status of all aortic segments., Results: After a mean follow-up of 4.2 ± 3.6 years, 60 patients underwent 85 distal aortic reoperations. Ten-year cumulative incidence of distal aortic reoperation was 9.6%. Multivariable competing risk analysis showed that the maximum preoperative diameter of the abdominal aorta (SHR 1.041, 95%CI 1.008-1.075), abdominal aorta dissection (SHR 2.133, 95%CI 1.156-3.937) and genetic syndromes (SHR 2.840, 95%CI 1.001-8.060) were independent predictors of distal aortic reoperation. Patients with a maximum diameter of the abdominal aorta >30 mm and/or abdominal aortic dissection had a cumulative incidence of 10-year distal aortic reoperation of 12.0% compared to 5.7% in those without these risk factors (adjusted SHR 2.076, 95%CI 1.062-4.060)., Conclusion: TAAD patients with genetic syndromes, and increased size and dissection of the abdominal aorta have an increased the risk of distal aortic reoperations. A policy of extensive surgical or hybrid primary aortic repair, completion endovascular procedures for aortic remodeling and tight surveillance may be justified in these patients., Trial Registration: ClinicalTrials.gov Identifier: NCT04831073., Competing Interests: Conflict of interest statement None declared., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Published
2024
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4. Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting.

Author

Biancari F, Santini F, Tauriainen T, Bancone C, Ruggieri VG, Perrotti A, Gherli R, Demal T, Dalén M, Santarpino G, Rubino AS, Nardella S, Nicolini F, Zanobini M, De Feo M, Onorati F, Mariscalco G, and Gatti G

Subjects
Aged, Aorta, Female, Humans, Male, Middle Aged, Coronary Artery Bypass, Intraoperative Complications prevention & control, Stroke prevention & control, Ultrasonography, Interventional
Abstract

Background: Epiaortic ultrasonography (EAU) is a valid imaging method to detect atherosclerotic changes of the ascending aorta and to guide surgical strategies for the prevention of cerebral embolism in patients undergoing isolated coronary artery bypass grafting (CABG). However, its use is not widespread., Methods: The impact of EAU on the outcome after isolated CABG was investigated in patients from the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry. A systematic review and meta-analysis of the literature was performed to substantiate the findings of this observational study., Results: EAU was performed intraoperatively in 673 of 7241 patients (9.3%) from the E-CABG registry. In the overall series, the rates of stroke without and with aortic manipulation were 0.3% and 1.3%, respectively (P = .003). In 660 propensity score-matched pairs, EAU was associated with significantly lower risk of stroke (0.6% vs 2.6%, P = .007). A literature search yielded 5 studies fulfilling the inclusion criteria. These studies, along with the present one, included 11,496 patients, of whom 3026 (25.7%) underwent intraoperative EAU. Their rate of postoperative stroke was significantly lower than in patients not investigated with EAU (pooled rate, 0.6% vs 1.9%; risk ratio, 0.40; 95% confidence interval, 0.24-0.66; I 2  = 0%). On the basis of these pooled rates, the number needed to treat to prevent 1 stroke is 76.9., Conclusions: Avoiding aortic manipulation is associated with the lowest risk of stroke in patients undergoing CABG. When manipulation of the ascending aorta is planned, EAU is effective in guiding the surgical strategy to reduce the risk for embolic stroke in these patients., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Published
2020
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