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2. Cardiac surgery practice during the COVID-19 outbreak: A multicentre national survey

Author

Rubino, A. S., De Santo, L. S., Pisano, Adelaide, Mauro, M. D., Benussi, S., Borghetti, V., Castiglioni, A., Chiariello, L., Colli, A., De Bellis, Andrea, De Filippo, C. M., De Paulis, R., Di Benedetto, G., Di Eusanio, M., Faggian, G., Fiorani, B., Fratto, P. A., Giuffrida, A. G., Glauber, M., Iannelli, G., Iesu, S., Livi, U., Martinelli, G., Massetti, Massimo, Mastroroberto, P., Menicanti, L., Minniti, G., Miraldi, F., Montesi, G., Musumeci, F., Nicolini, Francesco, Napoleone, C. P., Panisi, P., Pappalardo, A., Patane`, F., Ragni, T., Rinaldi, M., Tribastone, S., Triggiani, M., Tritto, F. P., Zebele, C., Parolari, A., Gerosa, G., De Feo, M., Antonino, S. R., Luca Salvatore, D. S., Antonio, P., Michele, D. M., Stefano, B., Valentino, B., Alessandro, C., Luigi, C., Andrea, C., Antonio, D. B., Carlo Maria, D. F., Ruggero, D. P., Giuseppe, D. B., Marco, D. E., Giuseppe, F., Brenno, F., Pasquale, A. F., Angelo Giuseppe, G., Mattia, Giuseppe, Gabriele, I., Severino, Iolanda, Ugolino, L., Gianluca, M., Massimo, M., Pasquale, M., Lorenzo, M., Giuseppe, M., Fabio, M., Gianfranco, M., Francesco, M., Francesco, N., Carlo Pace, N., Paolo, P., Aniello, P., Francesco, P., Temistocle, R., Mauro, R., Salvatore, T., Michele, T., Francesco Paolo, T., Carlo, Z., Alessandro, P., Gino, G., Marisa, D. F., Pisano A., De Bellis A., Massetti M. (ORCID:0000-0002-7100-8478), Nicolini F., Mattia G., Severino I., Rubino, A. S., De Santo, L. S., Pisano, Adelaide, Mauro, M. D., Benussi, S., Borghetti, V., Castiglioni, A., Chiariello, L., Colli, A., De Bellis, Andrea, De Filippo, C. M., De Paulis, R., Di Benedetto, G., Di Eusanio, M., Faggian, G., Fiorani, B., Fratto, P. A., Giuffrida, A. G., Glauber, M., Iannelli, G., Iesu, S., Livi, U., Martinelli, G., Massetti, Massimo, Mastroroberto, P., Menicanti, L., Minniti, G., Miraldi, F., Montesi, G., Musumeci, F., Nicolini, Francesco, Napoleone, C. P., Panisi, P., Pappalardo, A., Patane`, F., Ragni, T., Rinaldi, M., Tribastone, S., Triggiani, M., Tritto, F. P., Zebele, C., Parolari, A., Gerosa, G., De Feo, M., Antonino, S. R., Luca Salvatore, D. S., Antonio, P., Michele, D. M., Stefano, B., Valentino, B., Alessandro, C., Luigi, C., Andrea, C., Antonio, D. B., Carlo Maria, D. F., Ruggero, D. P., Giuseppe, D. B., Marco, D. E., Giuseppe, F., Brenno, F., Pasquale, A. F., Angelo Giuseppe, G., Mattia, Giuseppe, Gabriele, I., Severino, Iolanda, Ugolino, L., Gianluca, M., Massimo, M., Pasquale, M., Lorenzo, M., Giuseppe, M., Fabio, M., Gianfranco, M., Francesco, M., Francesco, N., Carlo Pace, N., Paolo, P., Aniello, P., Francesco, P., Temistocle, R., Mauro, R., Salvatore, T., Michele, T., Francesco Paolo, T., Carlo, Z., Alessandro, P., Gino, G., Marisa, D. F., Pisano A., De Bellis A., Massetti M. (ORCID:0000-0002-7100-8478), Nicolini F., Mattia G., and Severino I.

Abstract

OBJECTIVES: Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak. Accordingly, hospitals had to implement strategies to profoundly reshape both non-COVID-19 medical care and surgical activities. Knowledge about the impact of the COVID-19 pandemic on cardiac surgery practice is pivotal. The goal of the present study was to describe the changes in cardiac surgery practices during the health emergency at the national level. METHODS: A 26-question web-enabled survey including all adult cardiac surgery units in Italy was conducted to assess how their clinical practice changed during the national lockdown. Data were compared to data from the corresponding period in 2019. RESULTS: All but 2 centres (94.9%) adopted specific protocols to screen patients and personnel. A significant reduction in the number of dedicated cardiac intensive care unit beds (-35.4%) and operating rooms (-29.2%), along with healthcare personnel reallocation to COVID departments (nurses-15.4%, anaesthesiologists-7.7%), was noted. Overall adult cardiac surgery volumes were dramatically reduced (1734 procedures vs 3447; P 0.001), with a significant drop in elective procedures [580 (33.4%) vs 2420 (70.2%)]. CONCLUSIONS: This national survey found major changes in cardiac surgery practice as a response to the COVID-19 pandemic. This experience should lead to the development of permanent systems-based plans to face possible future pandemics. These data may effectively help policy decision-making in prioritizing healthcare resource reallocation during the ongoing pandemic and once the healthcare emergency is over. © 2021 The Author(s). Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Published
2021

5. Genotypic categorization of loeys-dietz syndrome based on 24 novel families and literature data

Author

Camerota, L., Ritelli, M., Wischmeijer, A., Majore, S., Cinquina, V., Fortugno, P., Monetta, R., Gigante, L., Sangiuolo, F. C., Novelli, G., Colombi, M., Brancati, F., Ruvolo, G., Bertoldo, F., Donzelli, C., Polisca, P., Salehi, L. B., Mancino, R., di Carlo, E., Bollero, P., Cozza, P., Lagana, G., Farsetti, P., de Maio, F., de Luna, V., Mancini, F., Chini, L., Graziani, S., Floris, R., Sperandio, M., Infante, A., de Stefano, A., Chiariello, L., and Grego, S.

Subjects
0301 basic medicine, Adult, Connective Tissue Disorder, Adolescent, lcsh:QH426-470, Receptor, Transforming Growth Factor-beta Type I, 030105 genetics & heredity, Bioinformatics, Loeys–Dietz syndrome, Article, 03 medical and health sciences, Transforming Growth Factor beta2, tgfbr1, TGFB3, Genotype, Genetics, Arterial aneurysms, Ehlers-Danlos syndrome, Hereditary connective tissue disorders, Loeys-Dietz syndrome, SMAD2, SMAD3, TGFB2, TGFBR1, TGFBR2, ehlers-danlos syndrome, arterial aneurysms, Medicine, Humans, loeys-dietz syndrome, smad3, smad2, Smad3 Protein, Craniofacial, Child, tgfbr2, Genetics (clinical), business.industry, Genetic heterogeneity, Receptor, Transforming Growth Factor-beta Type II, Infant, Middle Aged, medicine.disease, Penetrance, Pedigree, lcsh:Genetics, 030104 developmental biology, Settore MED/03 - Genetica Medica, Ehlers–Danlos syndrome, Child, Preschool, tgfb3, hereditary connective tissue disorders, Age of onset, tgfb2, business
Abstract

Loeys-Dietz syndrome (LDS) is a connective tissue disorder first described in 2005 featuring aortic/arterial aneurysms, dissections, and tortuosity associated with craniofacial, osteoarticular, musculoskeletal, and cutaneous manifestations. Heterozygous mutations in 6 genes (TGFBR1/2, TGFB2/3, SMAD2/3), encoding components of the TGF-&beta, pathway, cause LDS. Such genetic heterogeneity mirrors broad phenotypic variability with significant differences, especially in terms of the age of onset, penetrance, and severity of life-threatening vascular manifestations and multiorgan involvement, indicating the need to obtain genotype-to-phenotype correlations for personalized management and counseling. Herein, we report on a cohort of 34 LDS patients from 24 families all receiving a molecular diagnosis. Fifteen variants were novel, affecting the TGFBR1 (6), TGFBR2 (6), SMAD3 (2), and TGFB2 (1) genes. Clinical features were scored for each distinct gene and matched with literature data to strengthen genotype-phenotype correlations such as more severe vascular manifestations in TGFBR1/2-related LDS. Additional features included spontaneous pneumothorax in SMAD3-related LDS and cervical spine instability in TGFB2-related LDS. Our study broadens the clinical and molecular spectrum of LDS and indicates that a phenotypic continuum emerges as more patients are described, although genotype-phenotype correlations may still contribute to clinical management.

Published
2019

7. Shock II

Author

Wolbink, G. J., Baars, J. W., Wagstaff, J., Eerenberg, A., Hack, C. E., Faint, R. W., Mythen, M., Mackie, I. J., Machin, S. J., Routsi, C., Zakynthinos, S., Haviaras, B., Mavromatis, A., Armaganidis, A., Kadas, B., Roussos, Ch., Annane, D., Jars-Guincestre, M. C., Paraire, F., Raphaël, J. C., Lind, L., Mälstam, J., Skoog, G., Teboul, J. -L., Depret, J., Leger, N., Douguet, D., Zelter, M., Mercat, A., Richard, Ch., Saulnier, F., Durocher, A., Cadelis, G., Herengt, F., Wattel, F., Kugler B., Träger K., Holland M., Schricker Th., Georgieff M., Westendorp, R. G. J., Roos, A. N., Simons, R., Frölich, M., Meinders, A. E., Lichtwarck-Aschoff, M., Aschenbrenner, J., Zimmermann, G., Senekowitsch, R., Pfeiffer, U. J., Blümel, G., Lovell, A. T., Hanson, G. C., Jensen, P. J., Andersen, P. K., Thøgersen, C., Poelaert, J. I., Everaert, J. A., Vogelaers, D. P., Decruyenaere, J. M., Colardyn, F. A., Timmins, A. C., Giles, M., Hinds, C. J., Maynard, N., Bihari, D., Mason, R., Baldock, G., McColl, I., Mathieu, D., Neviere, R., Fleyfel, M., Zaknun, J., Fridrich, L., Heute, D., Dyrk, S., Stoeger, A., Seyr, M., Mutz, N., Riccabona G., Lefrant, J. Y., Aya, G., de la Coussaye, J. E., Bassoul, B., Auffray, J. P., Eledjam, J. J., Leucht, S., Kisch, H. W., Goller, R., Belot, J. P., Valtier, B., Mottin, D., Payen, D., Rubini, A., Monte, Del, Attar, I., Catena, E., Rattazzi, G., Alati, G. L., Polisca P., Turani F., Pierri M. D., Sommariva L., de Penta Peppo A., Colella D. F., Zupancich E., Gioffrè P. A., Chiariello L., Descorps-Declère, A., Hollande, J., Beaussier, M., Mimoz, O., Duranteau, J., Edouard, A., Samii, K., Saulnier, F., Drault, J. N., Marzollo, P., Sebastiano, P., Mariotti, M., Burnier, P., Chioléro, R., Goy, J. -J., Schütz, Y., Gombotz, H., Metzler, H., Plaza, J., Berger, J., List, W. F., Angus, D. C., Lidsky, N. M., Dotterweich, L. M., Pinsky, M. R., Evrard, P., de Ruyter, B., Dive, A., Gonzalez, M., Jacquet, L., and Installé, E.

Published
1992
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13. 1-year outcomes after transfemoral transcatheter or surgical aortic valve replacement: Results from the Italian OBSERVANT study

Author

Tamburino, C, Barbanti, M, D'Errigo, P, Ranucci, M, Onorati, F, Covello, R, Santini, F, Rosato, S, Santoro, G, Fusco, D, Grossi, C, Seccareccia, F, Marra, S, D'Amico, M, Gaita, F, Moretti, C, De Benedictis, M, Aranzulla, T, Pistis, G, Reale, M, Bedogni, F, Brambilla, N, Ferrario, M, Ferrero, L, Vicinelli, P, Colombo, A, Chieffo, A, Ferrari, A, Inglese, L, Casilli, F, Ettori, F, Frontini, M, Antona, C, Piccaluga, E, Klugmann, S, De Marco, F, Tespili, M, Saino, A, Leonzi, O, Rizzi, A, Grisolia, E, Franceschini Grisolia, E, Isabella, G, Fraccaro, C, Bernardi, G, Bisceglia, T, Armellini, I, Vischi, M, Parodi, E, Vignali, L, Ardissimo, D, Marzocchi, A, Marrozzini, C, Cremonesi, A, Colombo, F, Giannini, C, Pierli, C, Iadanza, A, Meucci, F, Berti, S, Mariani, M, Tomai, F, Ghini, A, Violini, R, Confessore, P, Crea, F, Giubilato, S, Sardella, G, Mancone, M, Ribichini, F, Vassanelli, C, Dandale, R, Giudice, P, Vigorito, F, Liso, A, Specchia, L, Indolfi, C, Spaccarotella, C, Stabile, A, Gandolfo, C, Ussia, G, Comoglio, C, Dyrda, O, Rinaldi, M, Salizzoni, S, Micalizzi, E, Di Gregorio, O, Scoti, P, Costa, R, Casabona, R, Del Ponte, S, Panisi, P, Spira, G, Troise, G, Messina, A, Viganò, M, Aiello, M, Alfieri, O, Denti, P, Menicanti, L, Agnelli, B, Donatelli, F, Muneretto, C, Rambaldini, M, Gamba, A, Tasca, G, Ferrazzi, P, Terzi, A, Gelpi, G, Martinelli, L, Bruschi, G, Graffigna, A, Mazzucco, A, Pappalardo, A, Gatti, G, Livi, U, Pompei, E, Coppola, R, Gucciardo, M, Albertini, A, Caprili, L, Ghidoni, I, Gabbieri, D, La Marra, M, Aquino, T, Gherli, T, Policlinico, S, Di Bartolomeo, R, Savini, C, Popoff, G, Innocenti, D, Bortolotti, U, Pratali, S, Stefano, P, Blanzola, C, Glauber, M, Cerillo, A, Chiaramonti, F, Pardini, A, Fioriello, F, Torracca, L, Rescigno, G, De Paulis, R, Nardella, S, Musumeci, F, Luzi, G, Possati, G, Bonalumi, G, Covino, E, Pollari, F, Sinatra, R, Roscitano, A, Chiariello, L, Nardi, P, Lonobile, T, Baldascino, F, Di Benedetto, G, Mastrogiovanni, G, Piazza, L, Marmo, J, Vosa, C, De Amicis, V, Speziale, G, Visicchio, G, Spirito, R, Gregorini, R, Villani, M, Pano, M, Bortone, A, De Luca Tupputi Schinosa, L, De Cillis, E, Gaeta, R, Di Natale, M, Cassese, M, Antonazzo, A, Argano, V, Santaniello, E, Patanè, L, Gentile, M, Tribastone, S, Follis, F, Montalbano, G, Pilato, M, Stringi, V, Patanè, F, Salamone, G, Ruvolo, G, Pisano, C, Mignosa, C, Bivona, A, Cirio, E, Lixi, G, Maraschini, A, Badoni, G, Onorato, F, De Palma, R, Scandotto, S, Orlando, A, Copello, F, Borgia, P, Marchetta, F, and Porcu, R

Subjects
aortic stenosis, implantation, intermediate risk, transcatheter aortic valve, Settore MED/23 - Chirurgia Cardiaca
Published
2015

14. Five-year clinical outcome and patency rate of device-dependent venous grafts after clampless OPCAB with PAS-port automated proximal anastomosis: the PAPA Study

Author

Bassano, C, Bovio, E, Sperandio, M, Uva, F, Farinaccio, A, Prati, P, and Chiariello, L

Subjects
Male, Time Factors, Anastomosis, Surgical, Settore MED/23 - Chirurgia Cardiaca, Middle Aged, Coronary Angiography, Cerebrovascular Disorders, Postoperative Complications, Treatment Outcome, Cardiovascular Diseases, Humans, Female, Saphenous Vein, Coronary Artery Bypass, Pancreatitis, Graft, Tomography, X-Ray Computed, Aorta, Vascular Patency, Aged, Follow-Up Studies
Abstract

To evaluate long-term clinical performance and angiographic patency of automated proximal venous anastomoses following clampless coronary artery bypass (C-CAB).Observational study in patients submitted for isolated C-CAB and at least one proximal aortosaphenous anastomosis performed with an automated connector (Cardica PAS-Port) including 152 consecutive patients (165 devices and 199 device-dependent distal anastomoses), with LVEF 30% and saphenous vein diameter of 4-6 mm. Clinical follow-up was 96% complete (4101/4269 pt-months). Graft patency rate was assessed with 64-slice CT-scan or coronary angiography. Freedom from major adverse cardiac and cerebrovascular events (MACCE) was reported as actuarial probability with 95% confidence limits and venous graft patency as actual rate at every year interval.Early operative mortality was 1.9%; incidence of neurologic injury was zero. Freedom from MACCE was 92.7 ± 2.1 at one year and 85.2 ± 4.8 at five years. The actual patency rate of device-dependent venous grafts was 90%, 85%, 84%, 84%, and 93% for one-, two-, three-, four-, and five-year-old grafts, respectively.The device is a well-performing system for proximal anastomoses. The incidence of neurologic complications seems to be reduced with this clampless approach. The high patency rate is stable over time.

Published
2014

18. Mitral valve repair for the treatment of degenerative mitral valve disease with or without prosthetic ring annuloplasty: long-term outcomes

Author

Paolo NARDI, Pellegrino, A., Olevano, C., Scafuri, A., Lio, A., Polisca, P., and Chiariello, L.

Subjects
Male, Mitral Valve Annuloplasty, Mitral Valve Insufficiency, Aluminum Hydroxide, Settore MED/23 - Chirurgia Cardiaca, Middle Aged, Survival Rate, Risk Factors, Cause of Death, Heart Valve Prosthesis, Humans, Mitral Valve, Female, Aged
Abstract

Aim of the study was to evaluate late outcomes of mitral valve repair with and without the use of prosthetic ring annuloplasty and standardized techniques for the treatment of degenerative mitral regurgitation (MR).Three hundred and five patients (mean age 62 ± 12 years) underwent mitral valve repair between January 1992 and February 2010 for degenerative MR. In the last five years, all repair techniques were performed routinely using prosthetic ring annuloplasty, with or without quadrangular or triangular resection of posterior leaflet and/or edge-to-edge technique. Mean follow-up (99% complete) was 78 ± 46 (2-220) months.Operative mortality was 0.9% (3/305), 15-year actuarial survival 82% ± 4%. At 15 years freedom from cardiac death was 89% ± 3.7%, from reoperation 84% ± 5.8%, from endocarditis 100%. Independent predictors of all-causes mortality were advanced age at operation (P=0.0006) and mitral valve repair without reductive prosthetic annuloplasty (P=0.0019). Death for cardiac causes was significantly higher when reductive annuloplasty was performed without the use of prosthetic ring (P0.01). Late progression to moderate or severe MR was observed in 23/299 patients (7.7%). Independent predictors of progression to moderate or severe MR was annuloplasty without the use of prosthetic ring (P=0.0053) and postoperative residual mild MR (P=0.0014). Reoperation was required in 13/299 patients (4.4%). At 10 years freedom from moderate or severe MR was 86% ± 6% and 92% ± 4% in patients with postoperative absent or trivial residual MR, respectively, as compared to 38% ± 15% in those with postoperative residual mild MR (P0.0001), freedom from reoperation 94% ± 4% and 90% ± 14% vs. 56% ± 16% (P0.0001).Prosthetic annuloplasty in association with standardized techniques confers over 10 years survival advantage and better durability.

Published
2013

19. [Aortocoronary bypass in severe left ventricular dysfunction: 9 years of clinical experience and mid-term results]

Author

NARDI P, DE PAULIS R, FORLANI S, TOMAI F, SCAFURI A, PELLEGRINO A, POLISCA P, CHIARIELLO L., PENTA DE PEPPO, Alfonso, Nardi, P, DE PAULIS, R, PENTA DE PEPPO, Alfonso, Forlani, S, Tomai, F, Scafuri, A, Pellegrino, A, Polisca, P, and Chiariello, L.

Subjects
Male, Ventricular Dysfunction, Left, Time Factors, Treatment Outcome, Humans, Female, Coronary Artery Bypass, Middle Aged, Severity of Illness Index, Follow-Up Studies, Retrospective Studies
Abstract

Compared with medical therapy alone, coronary artery bypass surgery improves survival in patients with coronary disease and left ventricular dysfunction. Many of these patients have a hibernating myocardium secondary to chronic ischemia with the potential for improvement in left ventricular function and heart failure symptoms following revascularization therapy. Cardiac transplantation remains the treatment of choice for patients with severe congestive heart failure.From January 1992 to June 2000, 351 consecutive patients (318 men, 33 women, mean age 62.8 +/- 8.9 years) with a left ventricular ejection fraction (EF)or = 35% and with multivessel coronary artery disease underwent isolated coronary artery bypass grafting. Preoperatively 226 patients were in CCS class III-IV and 113 in NYHA class III-IV. The mean number of grafts was 3.4 +/- 0.8/patient and complete revascularization was achieved in 98.6% of cases. The internal mammary artery was used in 341 patients (97.2%) and in 328 (96%) as a graft for the left anterior descending artery. Follow-up was obtained in 97% of the patients and on average lasted 42 +/- 28 months.The hospital mortality was 5.9%. At multivariate analysis urgent operation (p0.01) and a lower EF (25.9% in deaths vs 29.1%, p0.05) were predictors of an increased operative mortality. EF (assessed postoperatively at transthoracic echocardiography in survivors) improved from 28.9 +/- 5.7 to 34.4 +/- 7.7% (p0.0001). At 1, 3, 5, 7, and 9 years respectively, the all-cause survival was 93 +/- 1.5, 85 +/- 2.2, 77 +/- 3.1, 69 +/- 4.9, and 60 +/- 7.3% and the freedom from cardiac death was 94 +/- 1.4, 89 +/- 1.9, 88 +/- 2, 80 +/- 4.7, and 76 +/- 5.7% with an improvement in the anginal and congestive heart failure status (p0.0001).In patients with coronary artery disease and severe left ventricular dysfunction, after evaluation of the clinical presentation, of the usefulness of vessels as grafts and of the presence of myocardial viability, 1) coronary artery bypass grafting can be performed with a low mortality and a good mid-term survival, 2) improvement in left ventricular function can be documented after coronary bypass surgery, 3) the internal mammary artery can be safely used as a graft, 4) the quality of life is improved as demonstrated by the improvement in the anginal and congestive heart failure status.

Published
2001

31. Coronary-artery bypass surgery in patients with left ventricular dysfunction

Author

Velazquez, E, Lee, K, Deja, Ma:, J, A, Sopko, G, Marchenko, A, Ali, I, Pohost, G, Gradinac, S, Abraham, W, Yii, M, Prabhakaran, D, Szwed, H, Ferrazzi, P, Petrie, M, O'Connor, C, Panchavinnin, P, She, L, Bonow, R, Rankin, G, Jones, R, Rouleau, J, Cherniavsky, A, Romanov, A, Wos, S, Deja, M, Golba, K, Malinowski, M, Kosevic, D, Vukovic, M, Djokovic, L, Krzeminska Pakula, M, Jaszewski, R, Drozdz, J, Chrzanowski, L, Rajda, M, Howlett, J, Macfarlane, M, Jain, A, Shah, H, Rakshak, D, Saxena, A, Zembala, M, Przybylski, R, Kukulski, T, Wasilewski, J, Wiechowski, S, Brykczynski, M, Kurowski, M, Mokrzycki, K, Sadowski, J, Kapelak, B, Sobczyk, D, Plicner, D, Wrobel, K, Piegas, L, Paulista, P, Farsky, P, Veiga Kantorowitz, C, Sadowski, Z, Juraszynski, Z, Dabrowski, R, Rogowski, J, Pawlaczyk, R, Rynkiewicz, A, Betlejewski, P, Siepe, M, Geibel Zehender, A, Cuerten, C, Higgins, R, Crestanello, J, Binkley, P, Jones, D, Sun, B, Smith, P, Milano, C, Adams, P, Hill, J, Beaver, T, Leach, D, Airan, B, Das, S, Prior, D, Mack, J, Rao, V, Iwanochko, R, Renton, J, Phuangkaew, N, Bochenek, A, Krejca, M, Trusz Gluza, M, Wita, K, Gavazzi, A, Senni, M, Natarajan, S, Padmanabhan, C, Racine, N, Bouchard, D, Ducharme, A, Brown, H, Alotti, N, Lupkovics, G, Kumar, S, Agarwal, S, Sinha, N, Rai, H, Andersson, B, Janssen, A, Lamy, A, Demers, C, Rizzo, T, Doenst, T, Garbade, J, Thiele, H, Richter, M, Murday, A, Shaw, M, Raju, K, Mannam, G, Reddy, G, Rao, K, Nicolau, J, Stolf, N, Vieira, A, Chua, Y, Lim, C, Kwok, B, Gan, Y, Cleland, J, Cale, A, Thackray, S, Lammiman, M, Michler, R, Swayze, R, Maurer, G, Grimm, M, Lang, I, Adlbrecht, C, Daly, R, Rodeheffer, R, Nelson, S, Larbalestier, R, Wang, X, Haddad, H, Hendry, P, Donaldson, J, Menicanti, L, Di Donato, M, Castelvecchio, S, Sirvydis, V, Voluckiene, E, Di Benedetto, G, Attisano, T, Favaloro, R, Favaloro, L, Diez, M, Riccitelli, M, Picone, V, Koslowski, P, Gaito, M, Al mohammad, A, Braidley, P, Steele, H, Nawarawong, W, Woragidpoonpol, S, Kuanprasert, S, Mekara, W, Kon, N, Hammon, J, Wells, G, Tilley, W, Drazner, M, Di Maio, M, Peschka, S, Pasquale, D, Knight, C, J, Aylward, P, Thomas, C, Gullestad, L, Sorensen, G, Kaul, U, Gupta, R, Schmedtje, Jj, Arnold, S, Wilson, V, Grayburn, P, Hamman, B, Hebeler, R, Aston, S, Birjiniuk, V, Harrington, M, Dupree, C, Sheridan, B, Schuler, C, Helou, J, Denis, I, Bigalli, D, Gutierrez, F, Russo, N, Batlle, C, White, H, Alison, P, Stewart, R, Borthwick, L, Philippides, G, Shemin, R, Fitzgerald, C, Dagenais, F, Dussault, G, Kamath, P, Busmann, C, Ferrari, G, Botto, M, Horkay, F, Hartyanszky, I, Bartha, E, Simor, T, Papp, L, Toth, L, Varga Szemes, A, Szekely, L, Keltai, M, Edes, I, Szathmarine, V, Yakub, M, Sarip, S, Maitland, A, Isaac, D, Holland, M, Bogats, G, Csepregi, L, Maia, L, Soares, M, Mouco, O, Souza, A, da Rocha, A, Brito, J, Pitella, F, Camara, A, Horowitz, J, Knight, J, Rose, J, Mcrae, Rj, Geiss, D, Clemson, B, Pierson, M, Kron, I, Kern, J, Bergin, J, Phillips, J, Rich, J, Herre, J, Pine, L, Chin, D, Spyt, T, Logtens, E, Amuchastegui, L, Bracco, D, Ruengsakulrach, P, Pitiguagool, V, Sukhum, P, Srinualta, D, Hayward, C, Herrera, C, Zimmermann, R, Patterson, G, Stephens, W, Dignan, R, French, J, Sequalino, N, Vaishnav, S, Panda, R, Chavan, A, Benetis, R, Jankauskiene, L, Kalil, R, Nesralla, I, Santos, M, de Moraes, M, Friedrich, I, Buerke, M, Paraforos, A, Konda, S, Leone, C, Murphy, E, Ravichandran, P, Avalos, K, Hetzer, R, Knosalla, C, Hoffmann, K, Landolfo, K, Landolfo, C, Park, M, Chiariello, L, Nardi, P, Stapleton, D, Hoey, K, Hasaniya, N, Wang, N, Bijou, R, Naka, Y, Ascheim, D, Mikati, I, Arnold, M, Mckenzie, N, Smith, J, Gheorghiade, M, Fullerton, D, Roberts, L, Carson, P, Miller, A, Pina, I, Selzman, C, Wertheimer, J, Goldstein, S, Cohn, F, Hlatky, M, Kennedy, K, Rankin, S, Robbins, R, Zaret, B, Barfield, T, Desvigne Nickens, P, Oh, J, Panza, J, Apte, P, Doyle, M, Forder, J, Ocon, M, Pai, R, Reddy, V, Santos, N, Tripathi, R, Varadarajan, P, Pellikka, P, Miller, Fj, Lin, G, Borgeson, D, Ommen, S, Casaclang Verzosa, G, Miller, D, Springer, R, Blahnik, F, Manahan, B, Welper, J, Wiste, H, Mark, D, Anstrom, K, Baloch, K, Burnette, A, Cowper, P, Davidson Ray, N, Drew, L, Harding, T, Hunt, V, Knight, D, Patterson, A, Redick, T, Sanderford, B, Feldman, A, Bristow, M, Chan, T, Maisel, A, Mann, D, Mcnamara, D, Holly, T, Berman, D, Leonard, S, Helmer, D, Woods, M, Mcnulty, M, Asch, F, Rumsey, M, Bieganski, S, Roberts, B, Handschumacher, M, Mccormick, A, Albright, J, Dandridge, R, Rittenhouse, L, Wagstaff, D, Williams, M, Bailey, D, Glover, D, Parrish, L, Wakeley, N, Jackson, V, Nicholson, B, Mcdaniel, A, Al Khalidi, H, Greene, D, and Moore, V

Subjects
Male, medicine.medical_specialty, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, law.invention, Coronary artery disease, 03 medical and health sciences, Coronary artery bypass surgery, Ventricular Dysfunction, Left, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Clinical endpoint, Humans, 03.02. Klinikai orvostan, cardiovascular diseases, 030212 general & internal medicine, Coronary Artery Bypass, Aged, Proportional Hazards Models, Heart Failure, Intention-to-treat analysis, Proportional hazards model, business.industry, Hazard ratio, Settore MED/23 - Chirurgia Cardiaca, General Medicine, Middle Aged, medicine.disease, Combined Modality Therapy, 3. Good health, Surgery, Intention to Treat Analysis, Hospitalization, surgical procedures, operative, Cardiovascular Diseases, Heart failure, Cardiology, Female, business
Abstract

The role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established.Between July 2002 and May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes.The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86; 95% confidence interval [CI], 0.72 to 1.04; P=0.12). A total of 201 patients (33%) in the medical-therapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81; 95% CI, 0.66 to 1.00; P=0.05). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74; 95% CI, 0.64 to 0.85; P

Published
2011

33. Myocardial viability and survival in ischemic left ventricular dysfunction

Author

Bonow, R, Maurer, G, Lee, K, Holly, T, Binkley, P, Desvigne Nickens, P, Drozdz, J, Farsky, P, Feldman, A, Doenst, T, Michler, R, Berman, D, Nicolau, J, Pellikka, P, Wrobel, K, Alotti, N, Asch, F, Favaloro, L, She, L, Velazquez, E, Jones, R, Panza, J, Cherniavsky, A, Marchenko, A, Romanov, A, Wos, S, Deja, M, Golba, K, Malinowski, M, Gradinac, S, Kosevic, D, Vukovic, M, Djokovic, L, Krzeminska Pakula, M, Jaszewski, R, Chrzanowski, L, Rajda, M, Ali, I, Howlett, J, Macfarlane, M, Jain, A, Shah, H, Rakshak, D, Saxena, A, Zembala, M, Przybylski, R, Kukulski, T, Wasilewski, J, Wiechowski, S, Brykczynski, M, Kurowski, M, Mokrzycki, K, Sadowski, J, Kapelak, B, Sobczyk, D, Plicner, C, Piegas, L, Paulista, P, Veiga Kantorowitz, C, Sadowski, Z, Juraszynski, Z, Szwed, H, Dabrowski, R, Rogowski, J, Pawlaczyk, R, Rynkiewicz, A, Betlejewski, P, Siepe, M, Geibel Zehender, A, Cuerten, C, Higgins, R, Crestanello, J, Jones, D, Sun, B, Smith, P, Milano, C, Adams, P, Hill, J, Beaver, T, Leach, D, Airan, B, Das, S, Yii, M, Prior, D, Mack, J, Rao, V, Iwanochko, R, Renton, J, Panchavinnin, P, Phuangkaew, N, Bochenek, A, Krejca, M, Trusz Gluza, M, Wita, K, Ferrazzi, P, Gavazzi, A, Senni, M, Natarajan, S, Padmanabhan, C, Racine, N, Bouchard, D, Ducharme, A, Brown, H, Lupkovics, G, Kumar, S, Agarwal, S, Sinha, N, Rai, H, Andersson, B, Janssen, A, Lamy, A, Demers, C, Rizzo, T, Garbade, J, Thiele, H, Richter, M, Petrie, M, Murday, A, Shaw, M, Raju, K, Mannam, G, Reddy, G, Rao, K, Stolf, N, Vieira, A, Chua, Y, Lim, C, Kwok, B, Gan, Y, Cleland, J, Cale, A, Thackray, S, Lammiman, M, Swayze, R, Grimm, M, Lang, I, Adlbrecht, C, Daly, R, Rodeheffer, R, Nelson, S, Larbalestier, R, Wang, X, Haddad, H, Hendry, P, Donaldson, J, Menicanti, L, Di Donato, M, Castelvecchio, S, Sirvydis, V, Voluckiene, E, Di Benedetto, G, Attisano, T, Favaloro, R, Diez, M, Riccitelli, M, Picone, V, Koslowski, P, Gaito, M, Al mohammad, A, Braidley, P, Steele, H, Nawarawong, W, Woragidpoonpol, S, Kuanprasert, S, Mekara, W, Kon, N, Hammon, J, Wells, G, Tilley, W, Drazner, M, Dimaio, M, Peschka, S, De Pasquale, C, Knight, J, Aylward, P, Thomas, C, Gullestad, L, Sorensen, G, Kaul, U, Gupta, R, Schmedtje, Jr, J, Arnold, S, Wilson, V, Grayburn, P, Hamman, B, Hebeler, R, Aston, S, Birjiniuk, V, Harrington, M, Dupree, C, Sheridan, B, Schuler, C, Helou, J, Denis, I, Bigalli, D, Gutierrez, F, Russo, N, Batlle, C, White, H, Alison, P, Stewart, R, Borthwick, L, Philippides, G, Shemin, R, Fitzgerald, C, Dagenais, F, Dussault, G, Kamath, P, Busmann, C, Ferrari, G, Botto, M, Horkay, F, Hartyanszky, I, Bartha, E, Simor, T, Papp, L, Toth, L, Varga Szemes, A, Szekely, L, Keltai, M, Edes, I, Szathmarine, V, Yakub, M, Sarip, S, Maitland, A, Isaac, D, Holland, M, Bogats, G, Csepregi, L, Maia, L, Soares, M, Mouco, O, Souza, A, da Rocha, A, Brito, J, Pitella, F, Camara, A, Horowitz, J, Rose, J, Mcrae, Rj, Geiss, D, Clemson, B, Pierson, M, Kron, I, Kern, J, Bergin, J, Phillips, J, Rich, J, Herre, J, Pine, L, Chin, D, Spyt, T, Logtens, E, Amuchastegui, L, Bracco, D, Ruengsakulrach, P, Pitiguagool, V, Sukhum, P, Srinualta, D, Hayward, C, Herrera, C, Zimmermann, R, Patterson, G, Stephens, W, Dignan, R, French, J, Sequalino, N, Vaishnav, S, Panda, R, Chavan, A, Benetis, R, Jankauskiene, L, Kalil, R, Nesralla, I, Santos, M, Moraes, D, M, Friedrich, I, Buerke, M, Paraforos, A, Konda, S, Leone, C, Murphy, E, Ravichandran, P, Avalos, K, Hetzer, R, Knosalla, C, Hoffmann, K, Landolfo, K, Landolfo, C, Park, M, Chiariello, L, Nardi, P, Stapleton, D, Hoey, K, Hasaniya, N, Wang, N, Bijou, R, Naka, Y, Ascheim, D, Mikati, I, Arnold, M, Mckenzie, N, Smith, J, Gheorghiade, M, Fullerton, D, Roberts, L, Carson, P, Miller, A, Pina, I, Selzman, C, Wertheimer, J, Goldstein, S, Cohn, F, Hlatky, M, Kennedy, K, Rankin, S, Robbins, R, Zaret, B, Rouleau, J, Barfield, T, O'Connor, C, Oh, J, Rankin, G, Sopko, G, Pohost, G, Apte, P, Doyle, M, Forder, J, Ocon, M, Pai, R, Reddy, V, Santos, N, Tripathi, R, Varadarajan, P, Miller, Fj, Lin, G, Borgeson, D, Ommen, S, Casaclang Verzosa, G, Miller, D, Springer, R, Blahnik, F, Manahan, B, Welper, J, Wiste, H, Mark, D, Anstrom, K, Baloch, K, Burnette, A, Cowper, P, Davidson Ray, N, Drew, L, Harding, T, Hunt, V, Knight, D, Patterson, A, Redick, T, Sanderford, B, Bristow, M, Chan, T, Maisel, A, Mann, D, Mcnamara, D, Leonard, S, Helmer, D, Woods, M, Mcnulty, M, Rumsey, M, Bieganski, S, Roberts, B, Handschumacher, M, Mccormick, A, Albright, J, Dandridge, R, Rittenhouse, L, Wagstaff, D, Williams, M, Bailey, D, Glover, D, Parrish, L, Wakeley, N, Jackson, V, Nicholson, B, Mcdaniel, A, Al Khalidi, H, Greene, D, and Moore, V

Subjects
Settore MED/23 - Chirurgia Cardiaca
Published
2011

34. Left ventricular pseudoaneurysm and mitral valve regurgitation. Conservative surgical therapy

Author

Ruggero De Paulis, Zeitani, J., Bognolo, G., Fratini, S., Peppo, A. P., Chiariello, L., DE PAULIS, R, Zeitani, J, Bognolo, G, Fratini, S, PENTA DE PEPPO, Alfonso, and Chiariello, L.

Subjects
Heart Failure, Male, Electrocardiography, Heart Ventricles, Myocardial Infarction, Humans, Mitral Valve Insufficiency, Radiography, Thoracic, Cardiac Surgical Procedures, Heart Aneurysm, Aneurysm, False, Echocardiography, Transesophageal, Aged
Abstract

A patient with posterolateral left ventricular pseudoaneurysm, severe mitral regurgitation and coronary artery disease is reported. Mitral valve insufficiency was almost completely cured by simple closure of the left ventricular defect by edge to edge apposition along the long axis of the heart.

Published
1999

35. Mid-term results of conventional bypass surgery for complex proximal left anterior descending coronary artery stenoses

Author

FORLANI S, BASSANO C, TOMAI F, DE PAULIS R, COLAGRANDE L, BURATTA MM, CHEN LW, MATTEUCCI ML, CHIARIELLO L., PENTA DE PEPPO, Alfonso, Forlani, S, Bassano, C, Tomai, F, DE PAULIS, R, PENTA DE PEPPO, Alfonso, Colagrande, L, Buratta, Mm, Chen, Lw, Matteucci, Ml, and Chiariello, L.

Subjects
Adult, Aged, 80 and over, Male, Treatment Outcome, Humans, Coronary Disease, Female, Coronary Artery Bypass, Middle Aged, Aged, Follow-Up Studies, Retrospective Studies
Abstract

The significant involvement of proximal left anterior descending (LAD) coronary artery affects patient prognosis and must be treated. Recently, as alternative methods to conventional coronary bypass (CABG), minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous transluminal coronary angioplasty with stent implantation (PTCA/S) have been proposed to reduce costs and patient discomfort. The aim of this study was to obtain early and medium-term results of CABG in patients with complex LAD disease in whom the expected results with PTCA/S or MIDCAB would have been suboptimal.We retrospectively examined one hundred consecutive patients subjected to isolated CABG who received either a single graft to LAD or several grafts to LAD and diagonal branches. The choice of CABG was due to poor expectable results with PTCA/S or MIDCAB because of anatomical characteristics of the lesion, inclusion in ongoing randomized study comparing surgical versus non-surgical revascularization, or preference on the part of the cardiologist or patient.Left internal mammary artery (LIMA) was grafted to LAD in 99 (99%) patients; 65 (65%) patients received at least one saphenous graft to the diagonal branches. No death was observed within 30 days from the operation. One (1%) patient had a perioperative non-Q myocardial infarction (MI). At a mean follow-up time of 38 +/- 16 months (range 2-60), there were no cardiac deaths and no new MI. Six patients complained of recurrent angina: in all cases but one (vein graft failure to a diagonal branch), there were no clinical or diagnostic signs suggesting other graft failures. The probability of freedom from early and late events, including cardiac death, MI and recurrence of angina regardless of site, was 99% at 1 year and 86% at 5 years.At present, conventional CABG seems to be the "gold standard palliation" of LAD disease in most cases. It can be performed safely with excellent early and medium-term results in terms of freedom from cardiac events. Its comparison with percutaneous transluminal techniques and MIDCAB needs to be addressed in further prospective studies.

Published
1999

48. Surgical treatment of femoral artery pseudoaneurysms after cardiac catheterization

Author

Borioni, R., Garofalo, M., Ruggero De Paulis, Albano, P., Caprara, E., Fratticci, L., and Chiariello, L.

Subjects
Adult, Aged, 80 and over, Femoral Artery, Male, Cardiac Catheterization, Humans, Female, Settore MED/23 - Chirurgia Cardiaca, Middle Aged, Aneurysm, False, Aged, Retrospective Studies
Abstract

To report a clinical experience about surgical treatment of iatrogenic peripheral artery pseudoaneurysms (FPA).This is a retrospective review of 90 consecutive patients (46 males, 44 females, mean age 66.2 years, range 33-86) with FPA complicating coronary angiography or angioplasty, observed between October 1990 through June 2006.A 3 cm pseudoaneurysm or larger was confirmed by duplex ultrasound scanning in 90 out of 21 454 cardiac patients (0.42%), occurring more frequently in interventional (59/3 983) rather than diagnostic (31/17 471) procedures (1.48% vs 0.17%). The surgical treatment consisted in direct closure with polypropilene suture and occasionally, patch angioplasty or bypass. No limb loss occurred. There were 4 wound complications (4.4%), one pulmonary embolism (1.1%), 3 deaths (3.3%).Classical results reported in literature demonstrate that the surgical repair of femoral pseudoaneurysms following cardiac catheterization is safe, effective and durable. In these series, although low major morbidity (1.1%) and no cases of limb loss were reported, the authors observed 3 death (4.4%), resulting from the severity of cardiac disease in 2 cases and from the vascular repair itself in one case (femoral endoarteritis). These results substantiate the common observation that patients who actually require invasive coronary diagnosis and treatment are often affected by advanced cardiovascular disease and suffer the occurrence of complications, having a high risk of death. Therefore, any surgical treatment should be performed with strict adherence to sound vascular surgical principles.

Published
2008

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