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3. Survival and Durability of Minimally Invasive Mitral Valve Repair: Insights from Different Repair Techniques.

Author

Iaccarino, Alessandra, Giambuzzi, Ilaria, Galbiati, Denise, Cuko, Enea, Droandi, Ginevra, Forcina, Sara, Kushta, Eraldo, Basciu, Alessio, Barbone, Alessandro, Fumero, Andrea, and Torracca, Lucia

Subjects
MITRAL valve, MITRAL valve insufficiency, MINIMALLY invasive procedures, OVERALL survival, SURVIVAL rate
Abstract

This study evaluates the long-term outcomes of minimally invasive mitral valve repair (MIMVR) in patients with degenerative mitral regurgitation, focusing on survival, mitral valve repair failure, and re-operation rates. A cohort of patients undergoing three primary repair techniques—quadrangular resection, edge-to-edge repair, and artificial chordae implantation—was analyzed using time-to-event methods. The overall survival rates at 1, 10, and 20 years were high and comparable among the techniques, indicating effective long-term benefits of MIMVR. However, freedom from recurrence of moderate mitral regurgitation (MR) ≥ 2 was significantly higher in the quadrangular resection and edge-to-edge groups compared to the artificial chordae group. No significant differences were observed for recurrent MR ≥ 3. Re-operation rates were low and similar across all techniques, underscoring the durability of MIMVR. Pre-discharge residual MR ≥ 2 was identified as a strong predictor of long-term repair failure. These findings confirm the effectiveness of MIMVR, with all techniques demonstrating excellent long-term survival and durability. [ABSTRACT FROM AUTHOR]

Published
2024
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5. Similar outcome of tricuspid valve repair and replacement for isolated tricuspid infective endocarditis

Author

Di Mauro, Michele, Bonalumi, Giorgia, Giambuzzi, Ilaria, Dato, Guglielmo Mario Actis, Centofanti, Paolo, Corte, Alessandro Della, Ratta, Ester Della, Cugola, Diego, Merlo, Maurizio, Santini, Francesco, Salsano, Antonio, Rinaldi, Mauro, Mancuso, Samuel, Cappabianca, Giangiuseppe, Beghi, Cesare, De Vincentiis, Carlo, Biondi, Andrea, Livi, Ugolino, Sponga, Sandro, Pacini, Davide, Murana, Giacomo, Scrofani, Roberto, Antona, Carlo, Cagnoni, Giovanni, Nicolini, Francesco, Benassi, Filippo, De Bonis, Michele, Pozzoli, Alberto, Pano, Marco, Nicolardi, Salvatore, Falcetta, Giosuè, Colli, Andrea, Musumeci, Francesco, Gherli, Riccardo, Vizzardi, Enrico, Salvador, Loris, Picichè, Marco, Paparella, Domenico, Margari, Vito, Troise, Giovanni, Villa, Emmanuel, Dossena, Yudit, Lucarelli, Carla, Onorati, Francesco, Faggian, Giuseppe, Mariscalco, Giovanni, Maselli, Daniele, Barili, Fabio, Parolari, Alessandro, and Lorusso, Roberto

Published
2022
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8. Three Logistic Predictive Models for the Prediction of Mortality and Major Pulmonary Complications after Cardiac Surgery

Author

Bignami, Elena, primary, Guarnieri, Marcello, additional, Giambuzzi, Ilaria, additional, Trumello, Cinzia, additional, Saglietti, Francesco, additional, Gianni, Stefano, additional, Belluschi, Igor, additional, Di Tomasso, Nora, additional, Corti, Daniele, additional, Alfieri, Ottavio, additional, and Gemma, Marco, additional

Published
2023
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16. Long Term Results of Reduction Ascending Aortoplasty

Author

Trumello, Cinzia, primary, Giambuzzi, Ilaria, additional, Bargagna, Marta, additional, Tavana, Kevin, additional, Bisogno, Arturo, additional, Ascione, Guido, additional, Calabrese, Mariachiara, additional, Castiglioni, Alessandro, additional, Alfieri, Ottavio, additional, and De Bonis, Michele, additional

Published
2022
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23. Prognostic value of SARS‐CoV‐2 on patients undergoing cardiac surgery

Author

Bonalumi, Giorgia, primary, Pilozzi Casado, Alberto, additional, Barbone, Alessandro, additional, Garatti, Andrea, additional, Colli, Andrea, additional, Giambuzzi, Ilaria, additional, Torracca, Lucia, additional, Ravenni, Giacomo, additional, Folesani, Gianluca, additional, Murara, Giacomo, additional, Pantaleo, Antonio, additional, Picichè, Marco, additional, Villa, Emmanuel, additional, Ferraro, Francesco, additional, Vendramin, Igor, additional, Livi, Ugolino, additional, Montalto, Andrea, additional, Musumeci, Francesco, additional, Tarzia, Vincenzo, additional, Trumello, Cinzia, additional, De Bonis, Michele, additional, Margari, Vito, additional, Paparella, Domenico, additional, Salsano, Antonio, additional, Santini, Francesco, additional, Nicolardi, Salvatore, additional, Patanè, Francesco, additional, Mammana, Liborio, additional, Cura Stura, Erik, additional, Rinaldi, Mauro, additional, Massi, Francesco, additional, Triggiani, Michele, additional, Grazioli, Valentina, additional, Giroletti, Laura, additional, Rubino, Antonino, additional, De Feo, Marisa, additional, Audo, Andrea, additional, Regesta, Tommaso, additional, Barili, Fabio, additional, Gerosa, Gino, additional, Di Mauro, Michele, additional, and Parolari, Alessandro, additional

Published
2021
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28. Rheumatic mitral regurgitation: is repair justified by the long-term results?

Author

Trumello, Cinzia, primary, Giambuzzi, Ilaria, additional, Bonalumi, Giorgia, additional, Bargagna, Marta, additional, Naliato, Moreno, additional, Ruggeri, Stefania, additional, Fileccia, Daniele, additional, Castiglioni, Alessandro, additional, Alfieri, Ottavio, additional, Alamanni, Francesco, additional, and De Bonis, Michele, additional

Published
2021
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31. Three Logistic Predictive Models for the Prediction of Mortality and Major Pulmonary Complications after Cardiac Surgery

Author

Bignami, Elena, primary, Guarnieri, Marcello, additional, Giambuzzi, Ilaria, additional, Trumello, Cinzia, additional, Saglietti, Francesco, additional, Gianni, Stefano, additional, Belluschi, Igor, additional, Tomasso, Nora Di, additional, Corti, Daniele, additional, Alfieri, Ottavio, additional, and Gemma, Marco, additional

Published
2021
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34. A call to action becomes practice: cardiac and vascular surgery during the COVID-19 pandemic based on the Lombardy emergency guidelines

Author

Bonalumi, Giorgia, primary, Giambuzzi, Ilaria, additional, Barbone, Alessandro, additional, Ranieri, Camilla, additional, Cavallotti, Laura, additional, Trabattoni, Piero, additional, Naliato, Moreno, additional, Polvani, Gianluca, additional, Torracca, Lucia, additional, Pelenghi, Stefano, additional, Ragni, Franco, additional, Russo, Claudio Francesco, additional, Guerra, Francisco, additional, Trimarchi, Santi, additional, Civilini, Efrem, additional, Romani, Federico, additional, Bellosta, Raffaello, additional, Losa, Sergio, additional, Roberto, Maurizio, additional, and Alamanni, Francesco, additional

Published
2020
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35. Re-repair after previous mitral valve reconstruction: handle with care!

Author

Trumello, Cinzia, primary, Giambuzzi, Ilaria, primary, Del Forno, Benedetto, primary, Bargagna, Marta, primary, Blasio, Andrea, primary, Ruggeri, Stefania, primary, Meneghin, Roberta, primary, Schiavi, Davide, primary, Nascimbene, Simona, primary, Castiglioni, Alessandro, primary, Alfieri, Ottavio, primary, and De Bonis, Michele, primary

Published
2020
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36. Optimal versus suboptimal mitral valve repair: late results in a matched cohort study

Author

De Bonis, Michele, primary, Zancanaro, Edoardo, additional, Lapenna, Elisabetta, additional, Trumello, Cinzia, additional, Ascione, Guido, additional, Giambuzzi, Ilaria, additional, Ruggeri, Stefania, additional, Meneghin, Roberta, additional, Abboud, Sabrin, additional, Agricola, Eustachio, additional, Del Forno, Benedetto, additional, Buzzatti, Nicola, additional, Monaco, Fabrizio, additional, Pappalardo, Federico, additional, Castiglioni, Alessandro, additional, and Alfieri, Ottavio, additional

Published
2020
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37. Prognostic value of SARS‐CoV‐2 on patients undergoing cardiac surgery.

Author

Bonalumi, Giorgia, Pilozzi Casado, Alberto, Barbone, Alessandro, Garatti, Andrea, Colli, Andrea, Giambuzzi, Ilaria, Torracca, Lucia, Ravenni, Giacomo, Folesani, Gianluca, Murara, Giacomo, Pantaleo, Antonio, Picichè, Marco, Villa, Emmanuel, Ferraro, Francesco, Vendramin, Igor, Livi, Ugolino, Montalto, Andrea, Musumeci, Francesco, Tarzia, Vincenzo, and Trumello, Cinzia

Subjects
SARS-CoV-2, COVID-19, CARDIAC surgery, CORONARY artery bypass, PROGNOSIS
Abstract

Objective: To analyze Italian Cardiac Surgery experience during the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) identifying risk factors for overall mortality according to coronavirus disease 2019 (COVID‐19) status. Methods: From February 20 to May 31, 2020, 1354 consecutive adult patients underwent cardiac surgery at 22 Italian Centers; 589 (43.5%), patients came from the red zone. Based on COVID‐19 status, 1306 (96.5%) were negative to SARS‐CoV‐2 (COVID‐N), and 48 (3.5%) were positive to SARS‐CoV‐2 (COVID‐P); among the COVID‐P 11 (22.9%) and 37 (77.1%) become positive, before and after surgery, respectively. Surgical procedures were as follows: 396 (29.2%) isolated coronary artery bypass grafting (CABG), 714 (52.7%) isolated non‐CABG procedures, 207 (15.3%) two associate procedures, and three or more procedures in 37 (2.7%). Heart failure was significantly predominant in group COVID‐N (10.4% vs. 2.5%, p =.01). Results: Overall in‐hospital mortality was 1.6% (22 cases), being significantly higher in COVID‐P group (10 cases, 20.8% vs. 12, 0.9%, p <.001). Multivariable analysis identified COVID‐P condition as a predictor of in‐hospital mortality together with emergency status. In the COVID‐P subgroup, the multivariable analysis identified increasing age and low oxygen saturation at admission as risk factors for in‐hospital mortality. Conclusion: As expected, SARS‐CoV‐2 infection, either before or soon after cardiac surgery significantly increases in‐hospital mortality. Moreover, among COVID‐19‐positive patients, older age and poor oxygenation upon admission seem to be associated with worse outcomes. [ABSTRACT FROM AUTHOR]

Published
2022
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38. Additional file 1: of Positive end-expiratory pressure (PEEP) level to prevent expiratory flow limitation during cardiac surgery: study protocol for a randomized clinical trial (EFLcore study)

Author

Bignami, Elena, Spadaro, Savino, Saglietti, Francesco, Lullo, Antonio Di, Corte, Francesca, Guarnieri, Marcello, Simone, Giulio De, Giambuzzi, Ilaria, Zangrillo, Alberto, and Volta, Carlo

Abstract

Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Checklist. (DOC 123 kb)

Published
2018
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40. Optimal versus suboptimal mitral valve repair: late results in a matched cohort study.

Author

Bonis, Michele De, Zancanaro, Edoardo, Lapenna, Elisabetta, Trumello, Cinzia, Ascione, Guido, Giambuzzi, Ilaria, Ruggeri, Stefania, Meneghin, Roberta, Abboud, Sabrin, Agricola, Eustachio, Forno, Benedetto Del, Buzzatti, Nicola, Monaco, Fabrizio, Pappalardo, Federico, Castiglioni, Alessandro, and Alfieri, Ottavio

Subjects
MITRAL valve, MITRAL valve insufficiency, ANGIOTENSIN converting enzyme, COHORT analysis, PERCUTANEOUS balloon valvuloplasty
Abstract

Open in new tab Download slide Open in new tab Download slide 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. [ABSTRACT FROM AUTHOR]

Published
2020
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41. Mid‐term outcomes (up to 5 years) of percutaneous edge‐to‐edge mitral repair in the real‐world according to regurgitation mechanism: A single‐center experience

Author

Buzzatti, Nicola, primary, Denti, Paolo, additional, Scarfò, Iside Stella, additional, Giambuzzi, Ilaria, additional, Schiavi, Davide, additional, Ruggeri, Stefania, additional, Castiglioni, Alessandro, additional, De Bonis, Michele, additional, La Canna, Giovanni, additional, and Alfieri, Ottavio, additional

Published
2018
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43. Second cross-clamping after mitral valve repair for degenerative disease in contemporary practice†

Author

De Bonis, Michele, primary, Lapenna, Elisabetta, additional, Giambuzzi, Ilaria, additional, Meneghin, Roberta, additional, Affronti, Giovanni, additional, Pappalardo, Federico, additional, Castiglioni, Alessandro, additional, Trumello, Cinzia, additional, Buzzatti, Nicola, additional, Giacomini, Andrea, additional, Raimondi Lucchetti, Marcello, additional, and Alfieri, Ottavio, additional

Published
2018
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44. Long-term results (up to 14 years) of the clover technique for the treatment of complex tricuspid valve regurgitation†

Author

De Bonis, Michele, primary, Lapenna, Elisabetta, additional, Di Sanzo, Stefania, additional, Del Forno, Benedetto, additional, Pappalardo, Federico, additional, Castiglioni, Alessandro, additional, Vicentini, Luca, additional, Pozzoli, Alberto, additional, Giambuzzi, Ilaria, additional, Latib, Azeem, additional, Schiavi, Davide, additional, La Canna, Giovanni, additional, and Alfieri, Ottavio, additional

Published
2017
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46. Mycobacterium chimaera in heater–cooler units: new technical approach for treatment, cleaning and disinfection protocol.

Author

Colangelo, Nicola, Giambuzzi, Ilaria, Moro, Matteo, Pasqualini, Neva, Aina, Alessandro, De Simone, Francesco, Blasio, Andrea, Alfieri, Ottavio, Castiglioni, Alessandro, and De Bonis, Michele

Subjects
*HEATING equipment, *MYCOBACTERIAL diseases, *ACETIC acid, *AEROSOLS, *PREVENTION of communicable diseases, *CARDIAC surgery, *MEDICAL protocols, *MUCOUS membranes, *OPERATING rooms, *RESPIRATORY organs, *STERILIZATION (Disinfection), *VENTILATION, *MEDICAL equipment contamination, *PREVENTION
Abstract

Mycobacterium chimaera infections have mainly been associated with the heater-cooler unit (HCU) and, ultimately, linked to contaminated aerosols in the operation room. The contamination status of HCUs seems to be influenced by the maintenance, therefore, according to the manufacturer's recommendations, peracetic acid (Puristeril) was introduced to increase HCU cleaning and disinfection protocol maintenance. Aerosol dispersion from Puristeril during maintenance can cause adverse effects to nearby workers. We aim to describe our technique to reduce the impact of Puristeril on operating room staff and to limit dispersion of its aerosol in the environment by performing the cleaning procedure through a closed circuit. [ABSTRACT FROM AUTHOR]

Published
2019
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47. Similar outcome of tricuspid valve repair and replacement for isolated tricuspid infective endocarditis

Author

Michele Di Mauro, Giorgia Bonalumi, Ilaria Giambuzzi, Guglielmo Mario Actis Dato, Paolo Centofanti, Alessandro Della Corte, Ester Della Ratta, Diego Cugola, Maurizio Merlo, Francesco Santini, Antonio Salsano, Mauro Rinaldi, Samuel Mancuso, Giangiuseppe Cappabianca, Cesare Beghi, Carlo De Vincentiis, Andrea Biondi, Ugolino Livi, Sandro Sponga, Davide Pacini, Giacomo Murana, Roberto Scrofani, Carlo Antona, Giovanni Cagnoni, Francesco Nicolini, Filippo Benassi, Michele De Bonis, Alberto Pozzoli, Marco Pano, Salvatore Nicolardi, Giosuè Falcetta, Andrea Colli, Francesco Musumeci, Riccardo Gherli, Enrico Vizzardi, Loris Salvador, Marco Picichè, Domenico Paparella, Vito Margari, Giovanni Troise, Emmanuel Villa, Yudit Dossena, Carla Lucarelli, Francesco Onorati, Giuseppe Faggian, Giovanni Mariscalco, Daniele Maselli, Fabio Barili, Alessandro Parolari, Roberto Lorusso, CTC, RS: Carim - V04 Surgical intervention, MUMC+: MA Med Staf Spec CTC (9), Di Mauro, Michele, Bonalumi, Giorgia, Giambuzzi, Ilaria, Dato, Guglielmo Mario Acti, Centofanti, Paolo, Corte, Alessandro Della, Ratta, Ester Della, Cugola, Diego, Merlo, Maurizio, Santini, Francesco, Salsano, Antonio, Rinaldi, Mauro, Mancuso, Samuel, Cappabianca, Giangiuseppe, Beghi, Cesare, De Vincentiis, Carlo, Biondi, Andrea, Livi, Ugolino, Sponga, Sandro, Pacini, Davide, Murana, Giacomo, Scrofani, Roberto, Antona, Carlo, Cagnoni, Giovanni, Nicolini, Francesco, Benassi, Filippo, De Bonis, Michele, Pozzoli, Alberto, Pano, Marco, Nicolardi, Salvatore, Falcetta, Giosuè, Colli, Andrea, Musumeci, Francesco, Gherli, Riccardo, Vizzardi, Enrico, Salvador, Lori, Picichè, Marco, Paparella, Domenico, Margari, Vito, Troise, Giovanni, Villa, Emmanuel, Dossena, Yudit, Lucarelli, Carla, Onorati, Francesco, Faggian, Giuseppe, Mariscalco, Giovanni, Maselli, Daniele, Barili, Fabio, Parolari, Alessandro, and Lorusso, Roberto

Subjects
MECHANICAL PROSTHESES, SURGERY, endocarditis, tricuspid valve, tricuspid valve repair, tricuspid valve replacement, tricuspid valve, tricuspid repair, tricuspid replacement, endocarditis, endocarditi, Tricuspid Valve/diagnostic imaging, MANAGEMENT, Humans, tricuspid replacement, Cardiac Surgical Procedures, METAANALYSIS, Endocarditis, Bacterial/surgery, Endocarditis, HEART-VALVE, MORTALITY, Endocarditis/surgery, Bacterial, Endocarditis, Bacterial, General Medicine, Treatment Outcome, Tricuspid Valve, Cardiac Surgical Procedures/adverse effects, tricuspid repair, Bacterial/surgery, Cardiology and Cardiovascular Medicine
Abstract

AIMS: To compare early and late mortality of acute isolated tricuspid valve infective endocarditis (TVIE) treated with valve repair or replacement.METHODS: Patients who were surgically treated for TVIE from 1983 to 2018 were retrieved from the Italian Registry for Surgical Treatment of Valve and Prosthesis Infective Endocarditis. All the patients were followed up by means of phone interview or calling patient referral physicians or cardiologists. Kaplan-Meier method was used to assess late survival and survival free from TVIE recurrence with log-rank test for univariate comparison. The primary end points were early mortality (30 days after surgery) and long-term survival free from TVIE recurrence.RESULTS: A total of 4084 patients were included in the registry. Among them, 149 patients were included in the study. Overall, 77 (51.7%) underwent TV repair and 72 (48.3%) TV replacement. Early mortality was 9% (13 patients). Expected early mortality according to EndoSCORE was 12%. The TV repair showed lower mortality and major complication rate (7% and 16%), compared with TV replacement (11% and 25%), but statistical significance was not reached. Median follow-up was 19.1 years (14.3-23.8). Late deaths were 30 and IE recurrences were 5. No difference in cardiac survival free from IE was found between the two groups after 20 years (80 ± 6% Repair Group vs 59 ± 13% Replacement Group, P = 0.3).CONCLUSIONS: Overall results indicate that once surgically addressed, TVIE has a low recurrence rate and excellent survival, apparently regardless of the type of surgery used to treat it.

Published
2022

48. Re-repair after previous mitral valve reconstruction: handle with care!

Author

Benedetto Del Forno, Davide Schiavi, Andrea Blasio, Stefania Ruggeri, Alessandro Castiglioni, Simona Nascimbene, Marta Bargagna, Ilaria Giambuzzi, Michele De Bonis, Roberta Meneghin, Ottavio Alfieri, Cinzia Trumello, Trumello, Cinzia, Giambuzzi, Ilaria, Del Forno, Benedetto, Bargagna, Marta, Blasio, Andrea, Ruggeri, Stefania, Meneghin, Roberta, Schiavi, Davide, Nascimbene, Simona, Castiglioni, Alessandro, Alfieri, Ottavio, and De Bonis, Michele

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Mitral Valve Annuloplasty, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Group A, Group B, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Recurrence, Mitral valve, Hospital discharge, medicine, Humans, Mitral regurgitation, Mitral valve repair, Mitral valve repair failure, business.industry, Mitral valve replacement, Mitral Valve Insufficiency, Middle Aged, Surgery, Echocardiography, Doppler, Color, medicine.anatomical_structure, Treatment Outcome, 030228 respiratory system, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business, Redo surgery, Follow-Up Studies
Abstract

OBJECTIVES Patients with recurrent mitral regurgitation after surgical repair are currently treated with a re-repair procedure or valve replacement. The aim of this study was to compare outcomes of our series of patients who underwent re-repair versus replacement in this setting. METHODS From 2003 to 2017, a total of 79 patients with recurrent mitral regurgitation underwent re-repair, group A (39), or replacement, group B (40). Mean follow-up was 7.4 ± 3.27 years (max 14.4). Inverse Probability of Treatment Weighting was used to create comparable distributions of the covariates; the Kaplan–Meier method was used for survival and competing risk analysis for time to cardiac death, time to recurrence of MR ≥3+ and MR ≥2+. RESULTS A re-repair was possible in 49.4% of patients (39/79). At hospital discharge, residual MR ≥2+ was present in 5 patients in group A, and none in group B (P CONCLUSIONS Recurrent significant mitral regurgitation after re-repair is not rare already at 8 years, but the survival tends to be worse after replacement. This finding calls for a very selective approach in pursuing a re-repair only when the intraoperative findings and the immediate results are very reassuring as far as long-term durability is concerned.

Published
2020

49. Mid‐term outcomes (up to 5 years) of percutaneous edge‐to‐edge mitral repair in the real‐world according to regurgitation mechanism: A single‐center experience

Author

Michele De Bonis, Ottavio Alfieri, Paolo Denti, Davide Schiavi, Nicola Buzzatti, Alessandro Castiglioni, Stefania Ruggeri, Iside Scarfò, Ilaria Giambuzzi, Giovanni La Canna, Buzzatti, Nicola, Denti, Paolo, Scarfò, Iside Stella, Giambuzzi, Ilaria, Schiavi, Davide, Ruggeri, Stefania, Castiglioni, Alessandro, De Bonis, Michele, La Canna, Giovanni, and Alfieri, Ottavio

Subjects
Male, Radiology, Nuclear Medicine and Imaging, Cardiac Catheterization, medicine.medical_specialty, Time Factors, Percutaneous, Alfieri, Regurgitation - mechanism, 030204 cardiovascular system & hematology, Single Center, Ventricular Function, Left, Nyha class, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, MitraClip, Humans, Medicine, Outpatient clinic, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Cardiac Surgical Procedures, Ventricular remodeling, Aged, Retrospective Studies, Aged, 80 and over, Mitral regurgitation, Ventricular Remodeling, business.industry, Hemodynamics, Mitral Valve Insufficiency, General Medicine, Middle Aged, medicine.disease, Progression-Free Survival, transcatheter, Cardiology, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business, Hospitals, High-Volume
Abstract

Objectives: To report mid-term results after MitraClip repair, according to mitral regurgitation (MR) mechanism, in a real-world single-center experience. Background: Mid-term outcomes of percutaneous edge-to-edge mitral repair in the real world are still limited. Methods: We assessed the follow-up results of patients treated with MitraClip at a single high-volume mitral center from 2008 to 2016. All patients underwent Heart-Team discussion, prospective data collection and enrolment in a dedicated outpatient clinic. Functional (FMR, n = 242, 68.6%) and degenerative (DMR, n = 97, 27.5%) MR patients were separately analyzed. Results: 5-Year survival was 53.5 ± 4.5% in FMR vs 57.1 ± 7.5% in DMR (P = 0.18). Reduced survival was strongly associated with worse left ventricle remodeling (ESV HR 1.01, CI 1.01–1.02, P < 0.001) in FMR, and with worse symptoms (New York Heart Association IV HR 6.72, CI 1.78–25.45, P = 0.005) in DMR. 5-Year cumulative incidence function for MR ≥ 3 was 23.7 ± 3.4% in FMR vs 27.9 ± 5.9% in DMR (P = 0.39), being associated with residual MR = 2 both in FMR (HR 4.67, CI 2.49–8.74, P < 0.001) and DMR (HR 7.15, CI 2.72–18.75, P < 0.001). At 5-year, patients in NYHA class I-II increased from 17.9% to 45.3% in FMR (P < 0.001) and from 33.3% to 51.3% in DMR (P < 0.001). Conclusions: In this single-center real-world experience, 5-year after MitraClip, half of the patients were alive and 3/4 were free from MR, both in FMR and DMR. Symptoms benefit was sustained in both groups. Advanced ventricular remodeling, advanced symptoms, and suboptimal MR reduction were associated with worse results. Refined patient selection, improved efficacy and more data will be all required to improve long-term outcomes.

Published
2018
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50. Positive end-expiratory pressure (PEEP) level to prevent expiratory flow limitation during cardiac surgery: study protocol for a randomized clinical trial (EFLcore study)

Author

Alberto Zangrillo, Elena Bignami, Savino Spadaro, Francesco Saglietti, Giulio de Simone, Carlo Alberto Volta, Marcello Guarnieri, Antonio Di Lullo, Francesca Dalla Corte, Ilaria Giambuzzi, Bignami, Elena, Spadaro, Savino, Saglietti, Francesco, Di Lullo, Antonio, Corte, Francesca Dalla, Guarnieri, Marcello, de Simone, Giulio, Giambuzzi, Ilaria, Zangrillo, Alberto, and Volta, Carlo Alberto

Subjects
Lung Diseases, Time Factors, medicine.medical_treatment, Medicine (miscellaneous), 030204 cardiovascular system & hematology, Respiratory failure, law.invention, Positive-Pressure Respiration, Study Protocol, 0302 clinical medicine, 030202 anesthesiology, law, Medicine, Single-Blind Method, Pharmacology (medical), Continuous positive airway pressure, Protective ventilation, Cardiopulmonary bypass, Respiratory failure, Low tidal volume, Continuous positive airway pressure, Postoperative pulmonary complications, Lung, Randomized Controlled Trials as Topic, lcsh:R5-920, Postoperative pulmonary complications, Respiration, Cardiopulmonary bypass, Low tidal volume, respiratory system, Cardiac surgery, Treatment Outcome, surgical procedures, operative, Italy, Elective Surgical Procedures, Anesthesia, Breathing, Protective ventilation, Cardiopulmonary bypass, Respiratory failure, Low tidal volume, Continuous positive airway pressure, Postoperative pulmonary complication, lcsh:Medicine (General), Protective ventilation, circulatory and respiratory physiology, medicine.medical_specialty, NO, 03 medical and health sciences, Humans, Cardiac Surgical Procedures, Positive end-expiratory pressure, Mechanical ventilation, business.industry, respiratory tract diseases, business, Abdominal surgery
Abstract

Background Lung dysfunction commonly occurs after cardiopulmonary bypass (CPB). Randomized evidence suggests that the presence of expiratory flow limitation (EFL) in major abdominal surgery is associated with postoperative pulmonary complications. Appropriate lung recruitment and a correctly set positive end-expiratory pressure (PEEP) level may prevent EFL. According to the available data in the literature, an adequate ventilation strategy during cardiac surgery is not provided. The aim of this study is to assess whether a mechanical ventilation strategy based on optimal lung recruitment with a best PEEP before and after CPB and with a continuous positive airway pressure (CPAP) during CPB would reduce the incidence of respiratory complications after cardiac surgery. Methods/design This will be a single-center, single-blind, parallel-group, randomized controlled trial. Using a 2-by-2 factorial design, high-risk adult patients undergoing elective cardiac surgery will be randomly assigned to receive either a best PEEP (calculated with a PEEP test) or zero PEEP before and after CPB and CPAP (equal to the best PEEP) or no ventilation (patient disconnected from the circuit) during CPB. The primary endpoint will be a composite endpoint of the incidence of EFL after the weaning from CPB and postoperative pulmonary complications. Discussion This study will help to establish a correct ventilatory strategy before, after, and during CPB. The main purpose is to establish if a ventilation based on a simple and feasible respiratory test may preserve lung function in cardiac surgery. Trial registration ClinicalTrials.gov, ID: NCT02633423. Registered on 6 December 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3046-0) contains supplementary material, which is available to authorized users.

Published
2018
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