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Background: The aim of this multicenter retrospective study was to compare early and midterm clinical and hemodynamic results of aortic valve replacement with rapid-deployment bioprostheses performed through conventional full-sternotomy vs mini-sternotomy., Methods: Data from the Italian multicenter registry of aortic valve replacement with rapid-deployment bioprostheses (INTU-ITA registry) were analyzed. Patients were divided into 2 groups: full sternotomy (FS) and ministernotomy (MS). Primary endpoint was the comparison of early and midterm mortality. Secondary endpoints were: comparison of intraoperative variables, complications, and hemodynamic performance. A propensity score weighting approach was used for data analysis., Results: A total of 1057 patients were analyzed: 435 (41.2%) and 622 (58.8%) in group FS and MS, respectively. Thirty-day mortality was 1.6% and 0.6% in FS and MS groups, respectively (P = .074). cardiopulmonary bypass time was 78.5 minutes and 83 minutes in FS and MS groups, respectively (P = .414). In the overall cohort, the incidence of intraoperative complications and of device success was 3.8% (40 patients) and 95.9% (1014 patients), respectively, with no significant differences between groups. Survival at 1, 3, and 5 years was 94.1%, 98.1%, 88.5% and 91.8%, 85.2%, and 84.8% in FS and MS groups, respectively (P = .412). The 2 groups showed similar postoperative gradients (median mean gradient, FS: 10.0 mm Hg, MS: 11.0 mm Hg; P = .170) and also similar incidence of patient-prosthesis mismatch (FS: 7%, MS: 6.4%, P = .647)., Conclusions: According to our data, rapid-deployment bioprostheses allow the performance of minimally invasive aortic valve replacement with similar surgical times and similar clinical and hemodynamic outcomes to conventional surgery and should be considered the first choice in these procedures., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this multicenter study was to evaluated whether cold or warm cardioplegia are associated with postoperative atrial fibrillation (POAF) and the prognostic role of the latter on early stroke and neurological mortality., Method: This was a retrospective analysis of prospective collected data from 9 cardiac centers in Italy and the United States including patients undergoing surgery between 2010 and 2018. From the 9 institutional databases, 17,231 patients underwent isolated CABG on-pump, using either warm cardioplegia (n = 7730) or cold cardioplegia (n = 9501); among the latter group blood and crystalloid cardioplegia were used in 691 and 8810 patients, respectively. After matching, two pairs of 4162 patients (overall cohort 8324) were analyzed., Results: In matched population, the rate of POAF was 18% (1472 cases), 15% (608) in warm group versus 21% (864) in cold group (p < 0.001). Multivariable analysis confirmed that cold cardioplegia was associated with higher rate of POAF, along with age, hypercholesterolemia, LVEF, reoperation, preoperative IABP, previous stroke, cardiopulmonary and cross-clamp. Moreover, cold cardioplegia as well as POAF increased the rate of postoperative stroke as well as early mortality and neurological mortality Propensity-weighted cohort included 11,830 (70%) patients out of 17,231. After adjustment, both cold blood and cold crystalloid cardioplegia negatively influenced POAF, stroke and neurological mortality., Conclusions: Warm cardioplegia may reduce the rate of POAF in CABG patients with respect to cold cardioplegia, either blood or crystalloid. This has a prognostic impact on postoperative stroke and neurological mortality., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Our aim was to assess gender differences in variables associated with the emotional and physical burdens of tension-type headache (TTH). Participants with TTH diagnosed according to the ICHD-III were recruited from three university-based hospitals (in Spain, Italy, Denmark) between January 2015 and June 2017. The physical/emotional headache burden was assessed with the Headache Disability Inventory (HDI-P/HDI-E, respectively). Headache features were collected with a four-week diary. Sleep quality was assessed with Pittsburgh Sleep Quality Index. The Hospital Anxiety and Depression Scale evaluated anxiety and depressive symptom levels. Trait and state anxiety levels were evaluated with the State-Trait Anxiety Inventory. Two hundred and twelve (28% men) participants (aged 41-48 years old) participated. Multiple regression models revealed that sleep quality explained 36.7% of the variance of HDI-E and 31.1% of the variance of HDI-P in men, whereas headache intensity, depressive levels, and younger age explained 37.5% of the variance of HDI-E and 32.8% of the variance of HDI-P in women (all p < .001). This study observed gender differences in variables associated with headache burden in TTH. Management of men with TTH should focus on interventions targeting sleep quality, whereas the management of women with TTH should combine psychological approaches and interventions targeting pain mechanisms.

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., (Copyright © 2019 Elsevier B.V. All rights reserved.)

In the past years, the Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae sequence type 258 (ST258) became an important worldwide spread nosocomial pathogen. Recent evidence shows that the global epidemiology is changing, with the rise of new lineages. In this study we report the microbiological and genomic features of two VIM-1-producing K. pneumoniae isolates belonging to the emerging ST307. Two extensively drug-resistant K. pneumoniae strains, collected between May and June 2017, were confirmed as bla VIM positive by GeneXpert system. The whole-genome sequencing revealed that both KpV&#95;S&#95;1 and KpV&#95;S&#95;2 isolates harbored bla VIM-1 and bla CTX-M-15 genes, besides qnrS1 and qnrB1 , strB, mphA, tetR clones in a hospital setting should alert on the changing of the epidemiological situation in Italy, usually endemic reservoir of KPC enzyme.tetA determinants. KpV&#95;S&#95;1 and KpV&#95;S&#95;2 isolates belonged to ST661 and ST307, respectively. Both STs have been recently reported as responsible of outbreaks in several European countries. The detection of bla VIM-1 gene in nonpredominant K. pneumoniae clones in a hospital setting should alert on the changing of the epidemiological situation in Italy, usually endemic reservoir of KPC enzyme.

Background: Rapid deployment bioprostheses (RDBs) have been recently introduced into clinical practice for the treatment of severe aortic valve stenosis. The aim of this retrospective multicenter study was to assess early and mid-term clinical and hemodynamic outcomes of patients undergoing RDB implantation., Methods: Data from a national registry that included patients who underwent isolated or combined aortic valve replacement with RDB in Italy were analyzed. Definitions of the European System for Cardiac Operative Risk Evaluation were used for preoperative variables and updated definitions from the Valve Academic Research Consortium were used for postoperative outcomes assessment. Univariable and multivariable analyses were performed to identify independent predictors of mortality. Follow-up was performed with clinical and echocardiographic examinations at each study site and, if this was not possible, through telephonic interviews. The Kaplan-Meier method was used for survival analysis., Results: A total of 902 patients (December 2012 through November 2017) from 20 national centers were included in the registry. Device success was 95.9%, and 30-day all-cause mortality was 2.8%. Postoperative pacemaker implantation was needed in 63 patients (6.9%). At discharge, peak and mean transaortic gradients were 19 ± 7 mm Hg and 11 ± 4 mm Hg, respectively. Mild and moderate aortic regurgitation were found in 71 patients (8.2%) and in 10 patients (1.2%), respectively. Median follow-up time was 357 days (interquartile range: 103 to 638 days). Survival at 4 years was 86% ± 1%. Preoperative conduction disturbances and history of previous myocardial infarction were independently associated with mortality., Conclusions: Aortic RDBs provide good early and mid-term clinical and hemodynamic outcomes. These devices may be considered as a reasonable alternative to conventional bioprostheses, especially in minimally invasive and combined operations., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: Changes in the incidence, clinical features and microbiology of infective endocarditis (IE) observed in a single center in Italy were compared between the period 2003-2010 and 2011-2015., Methods: All cases of IE, defined as definite or possible according to the modified Duke criteria, observed at the 'L. Sacco' Hospital in Milan, Italy between 2003 and 2015 were retrospectively reviewed., Results: 366 episodes of IE were identified in 325 patients. The mean number of incident IE over the period 2003-2015 was 1.43 (range: 0.6-2.1) cases per 1000 admissions, with a significantly increasing trend from a mean of 1.28-1.72 cases per 1000 admissions/year in 2003-2010 and 2011-2015, respectively (+34%; p = .04). Staphylococci remain the leading pathogens causing IE (29%) with a relative increase of methicillin-resistant Staphylococcus aureus between the two periods. Streptococci and enterococci account for 26% and 18% of IE, respectively. We found an increase in the proportion of cases due to enterococci (from 14% in 2003-2010 to 22% in 2011-2015). The rate of in-hospital mortality was 19%, similar in the two periods studied., Conclusion: The incidence of IE continuously increased in our cohort over the past decade and, along with the aging of the population, a raise in the incidence of health care-associated infections and a change in the distribution of prevalent pathogens were observed. Surgery was independently associated with higher in-hospital survival (AOR, 95% CI: 0.38, 0.19-0.74; p = .005). A constant surveillance is required to guide the optimal management of the changing epidemiology of IE.

We investigated an Italian OXA-181-producing Escherichia coli clinical isolate (ECS1&#95;14) by whole-genome sequencing. The strain coharbored bla CTX-M-15 , bla CMY-2 , and qnrS1 genes; it belonged to ST410(Achtman)/ST692(Pasteur) and phylogroup A. The bla OXA-181 gene was harbored on a plasmid highly similar (99% identity) to the pOXA181&#95;EC14828 plasmid, recently reported in China.

Background: For coronary surgery we often use the radial artery (RA) instead of the saphenous vein, trying to exploit the advantages offered by this conduit. To eliminate the problems regarding alteration of upper-extremity function after RA procurement related to the standard conventional harvesting technique, we started using the less invasive harvesting technique with surprisingly good preliminary results. To compare the outcomes of open versus less invasive harvesting procedures, a prospective, nonrandomized study was developed by 2 centers., Methods: From January 2001 to March 2003, there were 87 consecutive patients in the less invasive radial artery harvesting (LIRAH) group and 90 patients in the conventional radial artery harvesting (CRAH) group. Patient characteristics and demographics were similar in the groups. Data collection was made to evaluate possible benefits of the LIRAH technique in terms of fewer forearm and hand complications, better aesthetics, and improved patient satisfaction., Results: Between January 11, 2001, and March 30, 2003, 177 patients underwent either primary or redo coronary artery revascularizations with procurement of the RA for use as a conduit with the less invasive harvesting technique. The mean follow-up was 2 months. Four patients died, and overall mortality was 2.26%. One hundred seventy-three patients were successfully examined during the first postoperative control, 85 in the LIRAH group and 88 patients in the CRAH group. Objective and subjective data were collected from the consultant. The overall average age was 60.5 years (range, 40-77 years). In the LIRAH group, the mean overall incision length (when 2 incisions were necessary, both incision lengths were measured) was 5.6 cm (range, 4-10 cm), and the mean vessel length was 16 cm (range, 10-19 cm). Eighteen patients (20.6%) necessitated double incision. Mean harvesting time (from incision to skin closure) was 43.3 min (range, 25-70 min). Fourteen patients (16.4%) presented some kind of complication during the study. There were no cases with acute ischemia, bleeding, or re-exploration. Seventy-five patients (88.2%) found the cosmetic result excellent. Ten patients (11.8%) found it good, and none considered it mediocre. In the CRAH group, the mean incision length was 20 cm (range, 18-22 cm), and the mean vessel length was 18 cm (range, 17-20 cm ). Mean harvesting time (from incision to skin closure) was 30.8 min (range, 14-45 min). Thirty-four patients (38.6%) presented some kind of complication during the study. Three patients (3.5%) found the cosmetic result excellent. Forty-three (48.8%) found it good, and 42 (47.7%) considered it mediocre., Conclusions: A potential of fewer neurological forearm postoperative complications, better aesthetics, and improved patient satisfaction can be achieved by the LIRAH technique.

Between 1984 and 1995, 183 patients underwent an ascending aorta procedure at our institution. Their mean age was 60 +/- 12.3 years; 116 (63.4%) patients were male, 35 (19.1%) had a history of congestive heart failure, 72 (39.3%) presented acute type A dissection, 23 (12.6%) were redos and 63 (34.4%) were operated on an emergency basis. In-hospital mortality was 10% (12/120) in elective procedures and 36.5% (23/63) in emergency operations (p < 0.0001). Multivariate stepwise logistic regression analysis identified cardiopulmonary by-pass time, emergency operation, arch replacement and the need for femoral vein cannulation at surgery as independent predictors of in-hospital death. Mean follow-up time was 54 +/- 30 months (median 50 months), with a Kaplan-Meier survival of 69 +/- 4% and of 60 +/- 5% at 5 and 7 years, respectively. Cox regression analysis identified arch replacement, perioperative myocardial infarction, preoperative NYHA class, acute type A aortic dissection, the need for femoral vein cannulation at intervention and redo operations as independent predictors of reduced survival at follow-up. When this kind of analysis was performed on hospital survivors only, postoperative tracheostomy, reexploration for bleeding, and the occurrence of postoperative ventricular arrhythmias emerged as risk factors. In conclusion, multiple factors affect both early and long-term outcome following ascending aorta surgery. Preoperative clinical status of patients, priority of surgery and aortic dissection are the main determinants of the short-term results. Otherwise, in hospital survivors, the main determinant for long-term outcome seems to be the immediate postoperative course.

From December 1983 to March 1992, of 1650 patients who underwent a cardiac valve procedure 41 (2.5%) underwent reoperation on prosthetic heart valves. The indications for reoperation were: structural degeneration (13 patients, 32%), non-structural dysfunction (nine patients, 22%), prosthetic valve endocarditis (seven patients, 17%), valve thrombosis (four patients, 10%), native valve pathology (three patients, 7%), aortic ascending pathology (five patients, 12%). The hospital mortality rate for mitral valve reoperation was 12% (two of 17) and for reoperation on the aortic prosthesis 26% (five of 19). No deaths occurred for associated mitral and aortic replacement (zero of five). The mortality rate for associated procedures was 24% (four of 17) versus 12% (three of 24) for isolated procedures. Preoperative and operative variables were analysed to determine risk factors for hospital mortality. New York Heart Association functional class, ascites, endocarditis and surgical timing had a univariate influence on operative mortality. The pulmonary capillary wedge pressure and preoperative creatinine level were also higher in non-survivors. Elective reoperation had a mortality rate of 7%, while that for emergency procedures was 38%. Multivariable analysis indicated a longer extracorporeal circulation time and the urgent-emergency status as predictors of mortality. Reoperation before severe haemodynamic impairment occurs is recommended.