99 results on '"Mazzaro E"'
Search Results
2. Outcome of Patients undergoing Surgery for Acute Type A Aortic Dissection after Cardiopulmonary Resuscitation.
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Al-Hafez, B., Demal, T.J., Detter, C., Mariscalco, G., Gatti, G., Mazzaro, E., Acharya, M., Peterss, S., Buech, J., Herve, A., Folliguet, T., Pettinari, M., Dell, A. A., Wisniewski, K., Pol, M., Piani, D., Jormalainen, M., Rodriguez, L. J., Pinto, AG., and Quintana, E.
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AORTIC dissection ,CARDIOPULMONARY resuscitation ,DISSECTION ,MULTIPLE regression analysis ,SURGERY - Abstract
This article examines the outcomes of patients with acute type A aortic dissection (ATAD) who underwent surgery after receiving preoperative cardiopulmonary resuscitation (CPR). The study analyzed data from the European registry of type A aortic dissection (ERTAAD) and included 2,266 ATAD patients from 19 European centers. The results showed that patients who required CPR before surgery had higher rates of postoperative complications, including stroke, heart failure, and the need for dialysis. They also had a higher 30-day mortality rate. However, when additional risk factors such as low ejection fraction, advanced age, and myocardial ischemia were present, the analysis did not indicate a significant increase in mortality, suggesting that surgery may still be a viable option for these patients. [Extracted from the article]
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- 2024
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3. OC38 LONG-TERM OUTCOME AFTER BENTALL OPERATION AND VALVE SPARING AORTIC ROOT REPLACEMENT IN ELECTIVE PATIENTS: A SINGLE CENTRE EXPERIENCE
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Meneguzzi, M., Lechiancole, A., Piani, D., Vendramin, I., Sponga, S., Mazzaro, E., Spagna, E., Tursi, V., and Livi, U.
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- 2018
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4. Late myocardial infarction and repeat revascularization after coronary artery bypass grafting in patients with prior percutaneous coronary intervention
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Biancari, F. (Fausto), Salsano, A. (Antonio), Santini, F. (Francesco), De Feo, M. (Marisa), Dalén, M. (Magnus), Zhang, Q. (Qiyao), Gatti, G. (Giuseppe), Mazzaro, E. (Enzo), Franzese, I. (Ilaria), Bancone, C. (Ciro), Zanobini, M. (Marco), Tauriainen, T. (Tuomas), Mäkikallio, T. (Timo), Saccocci, M. (Matteo), Francica, A. (Alessandra), Rosato, S. (Stefano), El-Dean, Z. (Zein), Onorati, F. (Francesco), Mariscalco, G. (Giovanni), Biancari, F. (Fausto), Salsano, A. (Antonio), Santini, F. (Francesco), De Feo, M. (Marisa), Dalén, M. (Magnus), Zhang, Q. (Qiyao), Gatti, G. (Giuseppe), Mazzaro, E. (Enzo), Franzese, I. (Ilaria), Bancone, C. (Ciro), Zanobini, M. (Marco), Tauriainen, T. (Tuomas), Mäkikallio, T. (Timo), Saccocci, M. (Matteo), Francica, A. (Alessandra), Rosato, S. (Stefano), El-Dean, Z. (Zein), Onorati, F. (Francesco), and Mariscalco, G. (Giovanni)
- Abstract
Objectives: The aim of the present study was to evaluate the risk of late mortality and major adverse cardiovascular and cerebral events after coronary artery bypass grafting (CABG) in patients with prior percutaneous coronary intervention (PCI). Methods: A total of 2948 patients undergoing isolated CABGs were included in a prospective multicenter registry. Outcomes were adjusted for multiple covariates in logistic regression, Cox proportional hazards analysis and competing risk analysis. Results: In all, 2619 patients fulfilled the inclusion criteria of this analysis. Of them, 2199 (79.1%) had no history of PCI and 420 (20.9%) had a prior PCI. An adjusted analysis showed that a single prior PCI and multiple prior PCIs did not increase the risk of 30-day and 5-year mortality. Patients with multiple prior PCIs had a significantly higher risk of 5-year myocardial infarction (SHR 2.566, 95%CI 1.379–4.312) and repeat revascularization (SHR 1.774, 95%CI 1.140–2.763). Similarly, 30-day and 5-year mortality were not significantly increased in patients with prior PCI treatment of single or multiple vessels. Patients with multiple vessels treated with PCI had a significantly higher risk of 5-year myocardial infarction (SHR 2.640, 95%CI 1.497–4.658), repeat revascularization (SHR 1.648, 95%CI 1.029–2.638) and stroke (SHR 2.215, 95%CI 1.056–4.646) at 5-year. The risk for repeat revascularization was also increased with a prior single vessel PCI, but not for other outcomes. Conclusions: Among patients undergoing CABGs, multiple prior PCIs seem to increase the risk of late myocardial infarction and the need for repeat revascularization, but not the risk of mortality.
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- 2022
5. STERNAL WOUND INFECTION AFTER CARDIAC SURGERY: LOOKING FOR INTERACTIONS BETWEEN PERIOPERATIVE VARIABLES AND PATHOGEN AGENTS
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Gatti, G, Radesich, C, Savonitto, G, Rizzi, J, Munaretto, L, Maurel, C, Costantino, V, Gripshi, F, Franzese, I, Barbati, G, Rodriguez Garcia, A, Busetti, M, Luzzati, R, Sinagra, G, and Mazzaro, E
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- 2024
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6. OC38 LONG-TERM OUTCOME AFTER BENTALL OPERATION AND VALVE SPARING AORTIC ROOT REPLACEMENT IN ELECTIVE PATIENTS
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Meneguzzi, M., Lechiancole, A., Piani, D., Vendramin, I., Sponga, S., Mazzaro, E., Spagna, E., Tursi, V., and Livi, U.
- Published
- 2018
7. Familiar hypocalciurIc hypercalcemia: treatment with cinacalcet
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Bosco, M.B., primary, Pasqualini, T., additional, Galich, A.M., additional, Diehl, M., additional, Mazzaro, E., additional, Jaen, A., additional, and Plantalech, L., additional
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- 2017
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8. CryoLife O'Brien aortic stentless prosthesis reoperations: clinical results and morphologic findigs
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Ius, F, Basso, C, Della Barbera, M, Mazzaro, E, Thiene, G, Valente, M, and Livi, Ugolino
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- 2013
9. Alterations of Brain-Derived Neurotrophic Factor Serum Levels in Patients with Alcohol Dependence
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Zanardini, R, Fontana, A, Pagano, R, Mazzaro, E, Bergamasco, F, Romagnosi, G, Gennarelli, Massimo, and Bocchio Chiavetto, L.
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- 2011
10. Freedom Solo stentless aortic valve prosthesis: 4-year experience and hemodynamic results
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Ius, F, Badano, Lp, Pavoni, D, Mazzaro, E, Tursi, V, Spagna, E, Bassi, F, and Livi, Ugolino
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- 2009
11. Clinical results of minimally invasive mitral valve surgery: endoclamp versus external aortic clamp techniques
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Ius, F, Mazzaro, E, Tursi, V, Guzzi, G, Spagna, E, Vetrugno, L, Bassi, F, and Livi, Ugolino
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- 2009
12. Clinical results of minimally invasive mitral valve surgery: endoclamp vs. external aortic clamp technique
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Ius, F, Pavoni, D, Badano, Lp, Mazzaro, E, Tursi, V, Guzzi, G, Vetrugno, L, Spagna, E, and Livi, Ugolino
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- 2008
13. CryoLife O’Brien stentless valve reoperation: a low risk procedure with satisfactory long-term results
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Pavoni, D, Ius, F, Badano, Lp, Vendramin, I, Mazzaro, E, Tursi, V, Thiene, G, and Livi, Ugolino
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- 2008
14. Long-term survival after valve replacement for active infective endocarditis: comparison between native and prosthetic valve disease
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Mazzaro, E, Pavoni, D, Masullo, G, Vendramin, I, Guzzi, G, Frassani, R, Tursi, V, and Livi, Ugolino
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- 2007
15. Twelve-year results of aortic valve replacement with the CryoLife O’Brien stentless bioprostheses
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Pavoni, D, Badano, Lp, Ius, F, Musumeci, Sf, Vendramin, I, Frassani, R, Mazzaro, E, Tursi, V, and Livi, Ugolino
- Published
- 2006
16. 299 * SURGICAL MANAGEMENT OF DESTRUCTIVE AORTIC ENDOCARDITIS: LEFT VENTRICULAR OUTFLOW RECONSTRUCTION WITH SORIN PERICARBON FREEDOM STENTLESS BIOPROSTHESIS
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Sponga, S., primary, Pavoni, D., additional, Nucifora, G., additional, Vendramin, I., additional, Mazzaro, E., additional, and Livi, U., additional
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- 2014
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17. CryoLife O'Brien aortic stentless prosthesis reoperations: clinical results and morphologic findings
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Ius, F., primary, Basso, C., additional, Della Barbera, M., additional, Mazzaro, E., additional, Thiene, G., additional, Valente, M., additional, and Livi, U., additional
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- 2013
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18. Early and late outcome after reoperation for prosthetic valve dysfunction: analysis of 549 patients during a 26-year period
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Bortolotti, U., Aldo Domenico MILANO, Mossuto, E., Mazzaro, E., Thiene, G., and Casarotto, D.
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- 1994
19. Use of 2D longitudinal strain to monitor myocardial recovery during biventricular assistance in patients with fulminant myocarditis
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MIANI, D, primary, BADANO, L, additional, PAVONI, D, additional, GIANFAGNA, P, additional, GUZZI, G, additional, TURSI, V, additional, MAZZARO, E, additional, and LIVI, U, additional
- Published
- 2008
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20. 568 Redo cardiac surgery: is there an impact on heart transplantation outcome? A single centre experience
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GUZZI, G, primary, SPAGNA, E, additional, TURSI, V, additional, ALBANESE, M, additional, MIANI, D, additional, MAZZARO, E, additional, AUCI, E, additional, and LIVI, U, additional
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- 2007
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21. Extracorporeal membrane oxygenation in emergency resuscitation from deep hypothermia
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Irone, M, primary, Mazzaro, E, additional, Zamperetti, N, additional, Dan, M, additional, Fabbri, A, additional, and Mazzucco, A, additional
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- 1998
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22. Haemolysis due to active venous drainage during cardiopulmonary bypass: comparison of two different techniques.
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Cirri, S., Negri, L., Babbini, M., Latis, G., Khlat, B., Tarelli, G., Panisi, P., Mazzaro, E., Bellisario, A., Borghetti, B., Bordignon, F., Ferrara, M., Pavan, H., and Meco, M.
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HEMOLYSIS & hemolysins ,CARDIAC surgery ,CENTRIFUGAL pumps ,HEMORRHAGE - Abstract
To facilitate mini-access for cardiac surgery, two different methods of active venous drainage are used: vacuum assisted drainage and centrifugal pump aspiration on the venous line. The aim of this study was to compare the haemolysis produced using these two techniques. From June to December 1999, 50 consecutive patients were operated on using a ministernotomy. All of these patients had valvular surgery for either valve repair or valve replacement (9 MVRepair, 11 MVR, 29 AVR, 1 AVR 1 MVR). They were randomized into two groups: Group A, 25 patients who underwent surgery where vacuum assisted drainage was used, and Group B, 25 patients where kinetic asssisted venous drainage with centrifugal pump venous aspiration was used. Patient characteristics of both groups were similar for age, gender, body weight, body surface area, height, cardiopulmonary bypass (CPB) time, aortic crossclamp time, priming volume, cardioplegia volume, haemoglobin concentration, haematocrit, serum creatinine, bilirubin, lactate dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (sGOT), serum glutamic pyruvic transaminase (sGPT), aptoglobin, reticulocytes, and platelet count. We checked all these laboratory parameters preoperatively, at the end of CPB, and 2 and 24h after operation. We also checked haemoglobinuria at these same time points. We assessed blood loss at 6, 12, and 24 h after the operation and calculated total postoperative bleeding. There was a tendency towards a greater increase in LDH, sGOT and sGPT in Group A more than in Group B, but these data did not reach statistical significance. Platelet count was always lower in Group A and aptoglobin increased in Group A more than in Group B. More patients in Group A had haemoglobinuria. These findings indicate that haemolysis is increased more in patients treated with vacuum assisted drainage, when compared to the rise in haemolysis in those treated with centrifugal pump venous drainage. Total bleeding is also greater in Group A. [ABSTRACT FROM AUTHOR]
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- 2001
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23. Mortality and morbidity from intra-aortic balloon pumps. Risk analysis
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Meco, M., Gramegna, G., Yassini, A., Bellisario, A., Mazzaro, E., Babbini, M., Pediglieri, A., Panisi, P., Tarelli, G., Alessandro Frigiola, Menicanti, L., and Cirri, S.
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Aged, 80 and over ,Male ,Intra-Aortic Balloon Pumping ,Heart Diseases ,Incidence ,Middle Aged ,Risk Assessment ,Postoperative Complications ,Predictive Value of Tests ,Risk Factors ,Humans ,Female ,Vascular Diseases ,Cardiac Surgical Procedures ,Aged ,Retrospective Studies - Abstract
The purpose of this study, was to assess the incidence of and predictors for mortality and morbidity in patients who required postoperative intra-aortic balloon pump (IABP) support.We have retrospectively estimated 116 patients and data were statistically analyzed, and significant variables were evaluated with multivariate analysis.Mortality rate was 57.8% (67 patients). Nineteen patients (16.3%) had major vascular complications: 12 patients (10.3%) limb ischemia, 1 patient (0.9%) aortic dissection, 6 patients (5.2%) mesenteric infarction. Thirty patients (25.8%) had minor vascular complication: 23 patients (19.8%) bleeding from insertion site, 7 (6%) patients infection of insertion site. Limb ischemia was resolved by IABP removal (10 patients), thrombectomy (2 patients). No patient required limb amputation. Sixty patients (51.7%) had renal insufficiency, of which 40 patients needed dialysis. Fifteen patients (10.3%) had neurological complications, 13 patients (11.2%) thrombocytopenia and 5 patients (4.3%) sepsis.The incidence of IABP insertion in our institution was 1.5%. Mortality rate is similar to mortality of other studies in which the IABP has been inserted in the postoperative period. We have found that timing of IABP insertion, thrombocytopenia, presence of peripheral vascular disease and the redo intervention are independent predictors of mortality. We also found that female sex, diabetes, history of cigarette smoking and preoperative use of antiplatelet drugs are independent predictors of limb ischemia. The following factors are instead independent predictors of renal insufficiency: postoperative ejection fraction lower than 40% and non use of dobutamine in the postoperative period.
24. Ectopic hyperparathyroidism. Detection of mediastinal localization,Hiperparatiroidismo ectópico. Detección de la localización mediastinal
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Boccalatte, L. A., Gómez, N. L., López, S. O., Yanzon, A., Abuawad, C. Y., Smith, D. E., Mazzaro, E. L., and Marcelo Figari
25. Stented bioprosthetic valve hemodynamics: is the supra-annular implant better than the intra-annular?
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Luigi Badano, Pavoni, D., Musumeci, S., Frassani, R., Gianfagna, P., Baldassi, M., Tursi, V., Mazzaro, E., Zakja, E., Fioretti, P. M., and Livi, U.
26. Reoperation in patients with a bioprosthesis in the mitral position: indications and early results
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Mazzucco, A., Aldo Domenico MILANO, Mazzaro, E., and Bortolotti, U.
27. Heart Failure and Severe Pulmonary Hypertension Caused by Distal Detachment of the Valve Conduit 16 Years After the Cabrol Composite Graft Procedure
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Tosoratti, E., Dall'Armellina, E., Badano, L.P., Frassani, R., Mazzaro, E., Zakja, E., Livi, U., and Fioretti, P.M.
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We report the case of a patient who underwent Cabrol composite graft procedure for ascending aorta aneurysm and aortic regurgitation. Sixteen years later he developed progressive dyspnea and a left-to-right shunt caused by distal detachment of the valve conduit with persistence of the perigraft space-right atrial fistula visualized with echocardiography. Our case shows that late manifestations of surgical complications of the Cabrol procedure may occur and transesophageal echocardiography may allow a comprehensive assessment in these patients. However, because surgical management of ascending aorta aneurysms has changed in the last decades a detailed knowledge of the surgical technique used is mandatory for adequate interpretation of transesophageal echocardiographic results.
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- 2006
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28. Risk scores and surgery for infective endocarditis: in search of a good predictive score
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Filippo Givone, Bernardo Benussi, Roberto Luzzati, Sidney Chocron, Ugolino Livi, Sandro Sponga, Maddalena Peghin, Enzo Mazzaro, Giuseppe Gatti, Veronica Ferrara, Matteo Bassetti, Aniello Pappalardo, Andrea Perrotti, Gatti, G., Sponga, S., Peghin, M., Givone, F., Ferrara, V., Benussi, B., Mazzaro, E., Perrotti, A., Bassetti, M., Luzzati, R., Chocron, S., Pappalardo, A., and Livi, U.
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Male ,medicine.medical_specialty ,Time Factors ,Valve surgery ,infective endocarditi ,Heart valve surgery ,030204 cardiovascular system & hematology ,Risk Assessment ,Decision Support Techniques ,infective endocarditis ,mortality/survival ,quality of care improvement ,risk factors ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Cardiology and Cardiovascular Medicine ,Predictive Value of Tests ,medicine ,Humans ,Hospital Mortality ,Registries ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Aged ,Retrospective Studies ,Endocarditis ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Cardiothoracic surgery ,Female ,Risk Factors ,Infective endocarditis ,Risk of death ,Mortality survival ,business - Abstract
Objectives: To evaluate scoring systems that have been created to predict the risk of death post-surgery in infective endocarditis (IE). Design: Eight scores - (1) The Society of Thoracic Surgery (STS) risk score for IE, (2) De Feo score, (3) PALSUSE score (prosthetic valve, age ≥70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex [female], EuroSCORE ≥10), (4) ANCLA score (anemia, New York Heart Association class IV, critical state, large intracardiac destruction, surgery of thoracic aorta), (5) Risk-Endocarditis Score (RISK-E), (6) score for heart valve or prosthesis IE (EndoSCORE), and (7,8) Association pour l'Étude et la Prévention de l'Endocadite Infectieuse (AEPEI) score I and II - were evaluated in 324 (mean age, 61.8 ± 14.6 years) consecutive patients having IE and undergoing cardiac operation (1999-2018, Regione Autonoma Friuli-Venezia Giulia, Italy). Results: There were 45 (13.9%) in-hospital deaths. Despite many differences on the number and the type of variables, all the investigated scores showed good goodness-of-fit (Hosmer-Lemeshow test, p ≥.28). For five scores, accuracy of prediction (receiver-operating characteristic curve analysis) was good (ANCLA score) or fair (STS risk score for IE, PALSUSE score, AEPEI score I and II). When compared one-to-one (Hanley-McNeil method), accuracy of prediction of ANCLA score was higher than all of other risk scores except for AEPEI score I (p = .077). Conclusions: Five of eight scores that were evaluated in this study showed satisfactory performance in predicting in-hospital mortality following surgery for IE. The ANCLA score should be preferred.
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- 2019
29. Does extracorporeal cardiopulmonary resuscitation improve survival with favorable neurological outcome in out-of-hospital cardiac arrest? A systematic review and meta-analysis.
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Pagura L, Fabris E, Rakar S, Gabrielli M, Mazzaro E, Sinagra G, and Stolfo D
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- Humans, Treatment Outcome, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation statistics & numerical data, Extracorporeal Membrane Oxygenation methods, Extracorporeal Membrane Oxygenation statistics & numerical data, Out-of-Hospital Cardiac Arrest complications, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Purpose: Extracorporeal cardiopulmonary resuscitation (E-CPR) may improve survival with favorable neurological outcome in patients with refractory out-of-hospital cardiac arrest (OHCA). Unfortunately, recent results from randomized controlled trials were inconclusive. We performed a meta-analysis to investigate the impact of E-CPR on neurological outcome compared to conventional cardiopulmonary resuscitation (C-CPR)., Methods: A systematic research for articles assessing outcomes of adult patients with OHCA either treated with E-CPR or C-CPR up to April 27, 2023 was performed. Primary outcome was survival with favorable neurological outcome at discharge or 30 days. Overall survival was also assessed., Results: Eighteen studies were included. E-CPR was associated with better survival with favorable neurological status at discharge or 30 days (14% vs 7%, OR 2.35, 95% CI 1.61-3.43, I
2 = 80%, p < 0.001, NNT = 17) than C-CPR. Results were consistent if the analysis was restricted to RCTs. Overall survival to discharge or 30 days was also positively affected by treatment with E-CPR (OR = 1.71, 95% CI = 1.18-2.46, I2 = 81%, p = 0.004, NNT = 11)., Conclusions: In this meta-analysis, E-CPR had a positive effect on survival with favorable neurological outcome and, to a smaller extent, on overall mortality in patients with refractory OHCA., Competing Interests: Declaration of competing interest No competing interests to declared., (Copyright © 2024 Elsevier Inc. All rights reserved.)- Published
- 2024
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30. Malperfusion syndrome in patients undergoing repair for acute type A aortic dissection: Presentation, mortality, and utility of the Penn classification.
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Dell'Aquila AM, Wisniewski K, Georgevici AI, Szabó G, Onorati F, Rossetti C, Conradi L, Demal T, Rukosujew A, Peterss S, Caroline R, Buech J, Fiore A, Folliguet T, Perrotti A, Hervé A, Nappi F, Pinto AG, Lega JR, Pol M, Kacer P, Mazzaro E, Gatti G, Vendramin I, Piani D, Ferrante L, Rinaldi M, Quintana E, Pruna-Guillen R, Gerelli S, Di Perna D, Acharya M, Sherzad H, Mariscalco G, Field M, Harky A, Kuduvalli M, Pettinari M, Rosato S, Juvonen T, Mikko J, Mäkikallio T, Mustonen C, and Biancari F
- Abstract
Background: The current study aims to report the presentation of the malperfusion syndrome in patients with acute type A aortic dissection admitted to surgery and its impact on mortality., Methods: Data were retrieved from the multicenter European Registry of Type A Aortic Dissection. The Penn classification was used to categorize malperfusion syndromes. A machine-learning algorithm was applied to assess the multivariate interaction's importance regarding in-hospital mortality., Results: A total of 3902 consecutive patients underwent repair for acute type A aortic dissection. Local malperfusion syndrome occurred in 1584 (40.59%) patients. Multiorgan involvement occurred in 582 patients (36.74%) whereas 1002 patients (63.26%) had single-organ malperfusion. The prevalence was the greatest for cerebral (21.27%) followed by peripheral (13.94%), myocardial (9.7%), renal (9.33%), mesenteric (4.15%), and spinal malperfusion (2.10%). Multiorgan involvement predominantly occurred in organs perfused by the downstream aorta. Malperfusion significantly increased the risk of mortality (P < .001; odds ratio, 1.94 ± 0.29). The Boruta machine-learning algorithm identified the Penn classification as significantly associated with in-hospital mortality (P < .0001, variable importance = 7.91); however, 8 other variables yielded greater prediction importance. According to the Penn classification, mortality rates were 12.38% for Penn A, 20.71% for Penn B, 28.90% for Penn C, and 31.84% for Penn BC, respectively., Conclusions: Nearly one half of the examined cohort presented with signs of malperfusion syndrome predominantly attributable to local involvement. More than one third of patients with local malperfusion syndrome had a multivessel involvement. Furthermore, different levels of Penn classification can be used only as a first tool for preliminary stratification of early mortality risk., Competing Interests: Conflict of Interest Statement E.Q. receives payment or honoraria from Cardiva SL, AtriCure, Medtronic, and Edwards. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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31. Prediction of 30-day mortality after surgery for infective endocarditis using risk scores: Insights from a European multicenter comparative validation study.
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Gatti G, Fiore A, Ismail M, Dralov A, Saade W, Costantino V, Barbati G, Lim P, Lepeule R, Franzese I, Minati A, Sponga S, Fabris E, Luzzati R, Sinagra G, Biondi-Zoccai G, Frati G, Perrotti A, Vendramin I, and Mazzaro E
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- Humans, Male, Female, Risk Assessment methods, Retrospective Studies, Middle Aged, Aged, Europe epidemiology, Cardiac Surgical Procedures mortality, Risk Factors, ROC Curve, Prognosis, Time Factors, Endocarditis mortality, Endocarditis surgery
- Abstract
Background: It remains unclear today whether risk scores created specifically to predict early mortality after cardiac operations for infective endocarditis (IE) outperform or not the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II)., Methods: Perioperative data and outcomes from a European multicenter series of patients undergoing surgery for definite IE were retrospectively reviewed. Only the cases with known pathogen and without missing values for all considered variables were retained for analyses. A comparative validation of EuroSCORE II and 5 specific risk scores for early mortality after surgery for IE-(1) STS-IE (Society of Thoracic Surgeons for IE); (2) PALSUSE (Prosthetic valve, Age ≥70, Large intracardiac destruction, Staphylococcus spp, Urgent surgery, Sex (female), EuroSCORE ≥10); (3) ANCLA (Anemia, New York Heart Association class IV, Critical state, Large intracardiac destruction, surgery on thoracic Aorta); (4) AEPEI II (Association pour l'Étude et la Prévention de l'Endocardite Infectieuse II); (5) APORTEI (Análisis de los factores PROnósticos en el Tratamiento quirúrgico de la Endocarditis Infecciosa)-was carried out using calibration plot and receiver-operating characteristic curve analysis. Areas under the curve (AUCs) were compared 1:1 according to the Hanley-McNeil's method. The agreement between APORTEI score and EuroSCORE II of the 30-day mortality prediction after surgery was also appraised., Results: A total of 1,012 patients from 5 European university-affiliated centers underwent 1,036 cardiac operations, with a 30-day mortality after surgery of 9.7%. All IE-specific risk scores considered achieved better results than EuroSCORE II in terms of calibration; AEPEI II and APORTEI score showed the best performances. Despite poor calibration, EuroSCORE II overcame in discrimination every specific risk score (AUC, 0.751 vs 0.693 or less, P = .01 or less). For a higher/lesser than 20% expected mortality, the agreement of prediction between APORTEI score and EuroSCORE II was 86%., Conclusion: EuroSCORE II discrimination for 30-day mortality after surgery for IE was higher than 5 established IE-specific risk scores. AEPEI II and APORTEI score showed the best results in terms of calibration., Competing Interests: Conflict of interest Dr. Giuseppe Gatti, Prof. Gianfranco Sinagra and Prof. Roberto Luzzati are three out of the ANCLA score creators. Dr. Giuseppe Gatti and Prof. Andrea Perrotti are two out of the AEPEI score I and II creators., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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32. Role of gender in short- and long-term outcomes after surgery for type A aortic dissection: analysis of a multicentre European registry.
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Onorati F, Francica A, Demal T, Nappi F, Peterss S, Buech J, Fiore A, Folliguet T, Perrotti A, Hervé A, Conradi L, Dell'Aquila AM, Rukosujew A, Pinto AG, Lega JR, Pol M, Rocek J, Kacer P, Wisniewski K, Mazzaro E, Vendramin I, Piani D, Ferrante L, Rinaldi M, Quintana E, Pruna-Guillen R, Gerelli S, Acharya M, Mariscalco G, Field M, Kuduvalli M, Pettinari M, Rosato S, D'Errigo P, Jormalainen M, Mustonen C, Mäkikallio T, Di Perna D, Juvonen T, Gatti G, Luciani GB, and Biancari F
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- Humans, Male, Female, Retrospective Studies, Europe epidemiology, Middle Aged, Aged, Sex Factors, Treatment Outcome, Reoperation statistics & numerical data, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic mortality, Postoperative Complications epidemiology, Propensity Score, Aortic Dissection surgery, Aortic Dissection mortality, Registries
- Abstract
Objectives: Gender difference in the outcome after type A aortic dissection (TAAD) surgery remains an issue of ongoing debate. In this study, we aimed to evaluate the impact of gender on the short- and long-term outcome after surgery for TAAD., Methods: A multicentre European registry retrospectively included all consecutive TAAD surgery patients between 2005 and 2021 from 18 hospitals across 8 European countries. Early and late mortality, and cumulative incidence of aortic reoperation were compared between genders., Results: A total of 3902 patients underwent TAAD surgery, with 1185 (30.4%) being females. After propensity score matching, 766 pairs of males and females were compared. No statistical differences were detected in the early postoperative outcome between genders. Ten-year survival was comparable between genders (47.8% vs 47.1%; log-rank test, P = 0.679), as well as cumulative incidences of distal or proximal aortic reoperations. Ten-year relative survival compared to country-, year-, age- and sex-matched general population was higher among males (0.65) compared to females (0.58). The time-period subanalysis revealed advancements in surgical techniques in both genders over the years. However, an increase in stroke was observed over time for both populations, particularly among females., Conclusions: The past 16 years have witnessed marked advancements in surgical techniques for TAAD in both males and females, achieving comparable early and late mortality rates. Despite these findings, late relative survival was still in favour of males., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2024
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33. Femoral arterial cannulation for surgical repair of stanford type A aortic dissection.
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Juvonen T, Vendramin I, Mariscalco G, Jormalainen M, Perrotti A, Hervé A, Mazzaro E, Gatti G, Pettinari M, Peterss S, Buech J, Nappi F, Pinto AG, Rodriguez Lega J, Pol M, Rocek J, Kacer P, Rukosujew A, Wisniewski K, Piani D, Demal T, Conradi L, Ferrante L, Rinaldi M, Quintana E, Pruna-Guillen R, Gerelli S, Di Perna D, Fiore A, Folliguet T, Acharya M, El-Dean Z, Field M, Kuduvalli M, Onorati F, Francica A, Mäkikallio T, Dell'Aquila AM, Mustonen C, Raivio P, Rosato S, and Biancari F
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic mortality, Catheterization methods, Catheterization, Peripheral methods, Propensity Score, Retrospective Studies, Treatment Outcome, Aortic Dissection surgery, Aortic Dissection mortality, Femoral Artery surgery, Hospital Mortality
- Abstract
Background: The benefits and harms associated with femoral artery cannulation over other sites of arterial cannulation for surgical repair of acute Stanford type A aortic dissection (TAAD) are not conclusively established., Methods: We evaluated the outcomes after surgery for TAAD using femoral artery cannulation, supra-aortic arterial cannulation (i.e., innominate/subclavian/axillary artery cannulation), and direct aortic cannulation., Results: 3751 (96.1%) patients were eligible for this analysis. In-hospital mortality using supra-aortic arterial cannulation was comparable to femoral artery cannulation (17.8% vs. 18.4%; adjusted OR 0.846, 95% CI 0.799-1.202). This finding was confirmed in 1028 propensity score-matched pairs of patients with supra-aortic arterial cannulation or femoral artery cannulation (17.5% vs. 17.0%, p = 0.770). In-hospital mortality after direct aortic cannulation was lower compared to femoral artery cannulation (14.0% vs. 18.4%, adjusted OR 0.703, 95% CI 0.529-0.934). Among 583 propensity score-matched pairs of patients, direct aortic cannulation was associated with lower rates of in-hospital mortality (13.4% vs. 19.6%, p = 0.004) compared to femoral artery cannulation. Switching of the primary site of arterial cannulation was associated with increased rate of in-hospital mortality (36.5% vs. 17.0%; adjusted OR 2.730, 95% CI 1.564-4.765). Ten-year mortality was similar in the study cohorts., Conclusions: In this study, the outcomes of surgery for TAAD using femoral arterial cannulation were comparable to those using supra-aortic arterial cannulation. However, femoral arterial cannulation was associated with higher in-hospital mortality than direct aortic cannulation., Trial Registration: ClinicalTrials.gov registration code: NCT04831073., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
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- 2024
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34. Hybrid extracorporeal cannulation for aortic root pseudoaneurysm re-operation: The role of a multidisciplinary team.
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Franzese I, Gripshi F, Anzini M, and Mazzaro E
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Introduction : Adequate cerebral protection for aortic reoperation is challenging and optimal technique is still controversial. Case Report : We report a hybrid cannulation approach to achieve safe cerebral protection during circulatory arrest to repair an aortic root pseudoaneurysm. Conclusion : A multidisciplinary approach combining conventional techniques and interventional expertise could be considered in complex aortic scenario., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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35. Nature of Neurological Complications and Outcome After Surgery for Type A Aortic Dissection.
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Biancari F, Onorati F, Peterss S, Buech J, Mariscalco G, Lega JR, Pinto AG, Fiore A, Perrotti A, Hérve A, Rukosujew A, Demal T, Conradi L, Wisniewski K, Pol M, Kacer P, Gatti G, Mazzaro E, Vendramin I, Piani D, Rinaldi M, Ferrante L, Pruna-Guillen R, Di Perna D, Gerelli S, El-Dean Z, Nappi F, Field M, Kuduvalli M, Pettinari M, Francica A, Jormalainen M, Dell'Aquila AM, Mäkikallio T, Juvonen T, and Quintana E
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Prognosis, Hemorrhagic Stroke epidemiology, Brain Ischemia etiology, Brain Ischemia epidemiology, Risk Factors, Europe epidemiology, Retrospective Studies, Survival Rate trends, Aortic Dissection surgery, Aortic Dissection mortality, Postoperative Complications epidemiology, Registries, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic mortality, Hospital Mortality trends, Ischemic Stroke epidemiology
- Abstract
Surgery for type A aortic dissection (TAAD) is frequently complicated by neurologic complications. The prognostic impact of neurologic complications of different nature has been investigated in this study. The subjects of this analysis were 3,902 patients who underwent surgery for acute TAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD). During the index hospitalization, 722 patients (18.5%) experienced stroke/global brain ischemia. Ischemic stroke was detected in 539 patients (13.8%), hemorrhagic stroke in 76 patients (1.9%) and global brain ischemia in 177 patients (4.5%), with a few patients having had findings of more than 1 of these conditions. In-hospital mortality was increased significantly in patients with postoperative ischemic stroke (25.6%, adjusted odds ratio [OR] 2.422, 95% confidence interval [CI] 1.825 to 3.216), hemorrhagic stroke (48.7%, adjusted OR 4.641, 95% CI 2.524 to 8.533), and global brain ischemia (74.0%, adjusted OR 22.275, 95% CI 14.537 to 35.524) compared with patients without neurologic complications (13.5%). Similarly, patients who experienced ischemic stroke (46.3%, adjusted hazard ratio [HR] 1.719, 95% CI 1.434 to 2.059), hemorrhagic stroke (62.8%, adjusted HR 3.236, 95% CI 2.314 to 4.525), and global brain ischemia (83.9%, adjusted HR 12.777, 95% CI 10.325 to 15.810) had significantly higher 5-year mortality than patients without postoperative neurologic complications (27.5%). The negative prognostic effect of neurologic complications on survival vanished about 1 year after surgery. In conclusion, postoperative ischemic stroke, hemorrhagic stroke, and global cerebral ischemia increased early and midterm mortality after surgery for acute TAAD. The magnitude of risk of mortality increased with the severity of the neurologic complications, with postoperative hemorrhagic stroke and global brain ischemia being highly lethal complications., Competing Interests: Declaration of competing interest The authors have no competing interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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36. Classification of the Urgency of the Procedure and Outcome of Acute Type A Aortic Dissection.
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Biancari F, Dell'Aquila AM, Onorati F, Rossetti C, Demal T, Rukosujew A, Peterss S, Buech J, Fiore A, Folliguet T, Perrotti A, Hervé A, Nappi F, Conradi L, Pinto AG, Lega JR, Pol M, Kacer P, Wisniewski K, Mazzaro E, Gatti G, Vendramin I, Piani D, Ferrante L, Rinaldi M, Quintana E, Pruna-Guillen R, Gerelli S, Di Perna D, Acharya M, Mariscalco G, Field M, Kuduvalli M, Pettinari M, Rosato S, Mustonen C, Kiviniemi T, Roberts CS, Mäkikallio T, and Juvonen T
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- Humans, Retrospective Studies, Cohort Studies, Prognosis, Treatment Outcome, Aortic Dissection surgery, Azides, Deoxyglucose analogs & derivatives
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Surgery for type A aortic dissection (TAAD) is associated with a high risk of early mortality. The prognostic impact of a new classification of the urgency of the procedure was evaluated in this multicenter cohort study. Data on consecutive patients who underwent surgery for acute TAAD were retrospectively collected in the multicenter, retrospective European Registry of TAAD (ERTAAD). The rates of in-hospital mortality of 3,902 consecutive patients increased along with the ERTAAD procedure urgency grades: urgent procedure 10.0%, emergency procedure grade 1 13.3%, emergency procedure grade 2 22.1%, salvage procedure grade 1 45.6%, and salvage procedure grade 2 57.1% (p <0.0001). Preoperative arterial lactate correlated with the urgency grades. Inclusion of the ERTAAD procedure urgency classification significantly improved the area under the receiver operating characteristics curves of the regression model and the integrated discrimination indexes and the net reclassification indexes. The risk of postoperative stroke/global brain ischemia, mesenteric ischemia, lower limb ischemia, dialysis, and acute heart failure increased along with the urgency grades. In conclusion, the urgency of surgical repair of acute TAAD, which seems to have a significant impact on the risk of in-hospital mortality, may be useful to improve the stratification of the operative risk of these critically ill patients. This study showed that salvage surgery for TAAD is justified because half of the patients may survive to discharge., Competing Interests: Declaration of competing interest Dr. Biancari reports financial support was provided by Sigrid Jusélius Foundation and Finnish Heart Association. The remaining authors have no competing interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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37. The severity of early fluid overload assessed by bioelectrical vector impedance as an independent risk factor for longer patient care after cardiac surgery.
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Sanson G, Doriguzzi L, Garbari P, Ruggiero MJ, Valentinuzzo I, Mettulio T, Stolfa E, Fisicaro M, Vecchiet S, Mazzaro E, Zanetti M, and Fabiani A
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- Humans, Electric Impedance, Intensive Care Units, Length of Stay, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Cardiac Surgical Procedures adverse effects
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Background and Aims: Fluid overload is a common postoperative complication in patients undergoing cardiac surgery. Although this condition is notably associated with relevant adverse outcomes, assessment of hydration status in clinical practice is challenging. Bioelectrical impedance vector analysis (BIVA) has emerged as a potentially effective method to monitor hydration changes, but the available evidence in critically ill patients undergoing cardiac surgery is limited and sometimes conflicting. The aim of this study was to explore by mean of BIVA the evolution over time of hydration status and its impact on relevant outcomes., Methods: Prospective observational study enrolling 130 patients undergoing cardiac surgery. Height normalized impedance was calculated both before surgery (baseline) and in the first five postoperative days. Relevant clinical and laboratory data were collected daily close to BIVA measurements. Length of mechanical ventilation (MV), intensive care unit (ICU) and hospital stay exceeding the 75th percentile of the study population were considered as study endpoints., Results: Compared to baseline, a significant reduction in impedance was found at first postoperative day, demonstrating a relevant fluid overload. An adjusted impedance at first postoperative day shorter than the best respective threshold was associated to longer MV (7.4 times), ICU stay (4.7 times) and hospital stay (5.6 times). A significant change in impedance and phase angle was documented throughout the observation days (p < 0.001), without returning to the baseline value. The co-existence of low impedance and high plasma osmolarity increased significantly the risk of incurring the study outcomes., Conclusions: In patients with cardiac surgery-induced fluid overload, recovery to baseline conditions occurs slowly. A relevant early fluid overload should be considered predictive for longer time of MV, ICU and total hospital stay., Competing Interests: Conflicts of interest The authors declared no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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38. Comparison of 4 mortality scores for surgical repair of type A aortic dissection: a multicentre external validation.
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Pollari F, Nardi P, Mikus E, Ferraro F, Gemelli M, Franzese I, Chirichilli I, Romagnoni C, Santarpino G, Nicolardi S, Scrofani R, Musumeci F, Mazzaro E, Gerosa G, Massetti M, Savini C, Ruvolo G, Di Mauro M, Di Marco L, Barili F, Parolari A, and Fischlein T
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- Humans, Female, Middle Aged, Aged, Male, Retrospective Studies, Hospital Mortality, Europe, Registries, Risk Factors, Treatment Outcome, Aortic Dissection surgery, Azides, Deoxyglucose analogs & derivatives
- Abstract
Objectives: In the last decades, 4 different scores for the prediction of mortality following surgery for type A acute aortic dissection (TAAD) were proposed. We aimed to validate these scores in a large external multicentre cohort., Methods: We retrospectively analysed patients who underwent surgery for TAAD between 2000 and 2020. Patients were enrolled from 10 centres from 2 European countries. Outcomes were the early (30-day and/or in-hospital) and 1-year mortality. Discrimination, calibration and observed/expected (O/E) ratio were evaluated., Results: A total of 1895 patients (31.7% females, mean age 63.72 ± 12.8 years) were included in the study. Thirty-day mortality and in-hospital mortality were 21.7% (n = 412) and 22.5% (n = 427) respectively. The German Registry of Acute Aortic Dissection Type A (GERAADA) score shows to have the best discrimination [area under the curve (AUC) 0.671 and 0.672] in predicting as well the early and the 1-year mortality, followed by the International Registry of Acute Aortic Dissection (IRAD) model 1 (AUC 0.658 and 0.672), the Centofanti (AUC 0.645 and 0.66) and the UK aortic score (AUC 0.549 and 0.563). According to Hosmer-Lemeshow and Brier tests, the IRAD model I and GERAADA, respectively, were well calibrated for the early mortality, while the GERAADA and Centofanti for the 1-year mortality. The O/E analysis showed a marked underestimation for patients labelled as low-risk for UK aortic score and IRAD model I for both outcomes., Conclusions: The GERAADA score showed the best performance in comparison with other scores. However, none of them achieved together a fair discrimination and a good calibration for predicting either the early or the 1-year mortality., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2024
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39. When surgical option is not provided: a successful multidisciplinary approach to a refractory case of sternal osteomyelitis following coronary surgery.
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Gatti G, Amato P, Dore F, Crisafulli C, Belgrano M, Maurel C, Costantino V, Luzzati R, and Mazzaro E
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- Humans, Sternum surgery, Surgical Wound Infection diagnosis, Surgical Wound Infection therapy, Coronary Artery Bypass adverse effects, Osteomyelitis diagnosis, Osteomyelitis drug therapy, Osteomyelitis surgery
- Abstract
Purpose: Sternal osteomyelitis is a major complication of cardiac operations performed through median sternotomy. The surgical treatment, which involves the debridement and removal of whole infected and necrotic tissue is the standard of care, although it is sometimes unachievable. This may occur, for instance, when the infectious-inflammatory process invades the anterior mediastinum and tenaciously incorporates one or more of vital anatomical structures., Methods and Results: An inoperable case of postoperative sternal osteomyelitis that involved the right ventricle and the right coronary artery, and that was successfully treated using a nonsurgical multidisciplinary approach, is reported here., Conclusion: For highly selected patients with sternal osteomyelitis for whom surgery is a too risky option, an approach including the contribution of various specialists might be a viable way out., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
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- 2024
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40. Baseline risk factors of in-hospital mortality after surgery for acute type A aortic dissection: an ERTAAD study.
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Biancari F, Demal T, Nappi F, Onorati F, Francica A, Peterss S, Buech J, Fiore A, Folliguet T, Perrotti A, Hervé A, Conradi L, Rukosujew A, Pinto AG, Lega JR, Pol M, Rocek J, Kacer P, Wisniewski K, Mazzaro E, Vendramin I, Piani D, Ferrante L, Rinaldi M, Quintana E, Pruna-Guillen R, Gerelli S, Di Perna D, Acharya M, Mariscalco G, Field M, Kuduvalli M, Pettinari M, Rosato S, D'Errigo P, Jormalainen M, Mustonen C, Mäkikallio T, Dell'Aquila AM, Juvonen T, and Gatti G
- Abstract
Background: Surgery for type A aortic dissection (TAAD) is associated with high risk of mortality. Current risk scoring methods have a limited predictive accuracy., Methods: Subjects were patients who underwent surgery for acute TAAD at 18 European centers of cardiac surgery from the European Registry of Type A Aortic Dissection (ERTAAD)., Results: Out of 3,902 patients included in the ERTAAD, 2,477 fulfilled the inclusion criteria. In the validation dataset (2,229 patients), the rate of in-hospital mortality was 18.4%. The rate of composite outcome (in-hospital death, stroke/global ischemia, dialysis, and/or acute heart failure) was 41.2%, and 10-year mortality rate was 47.0%. Logistic regression identified the following patient-related variables associated with an increased risk of in-hospital mortality [area under the curve (AUC), 0.755, 95% confidence interval (CI), 0.729-0.780; Brier score 0.128]: age; estimated glomerular filtration rate; arterial lactate; iatrogenic dissection; left ventricular ejection fraction ≤50%; invasive mechanical ventilation; cardiopulmonary resuscitation immediately before surgery; and cerebral, mesenteric, and peripheral malperfusion. The estimated risk score was associated with an increased risk of composite outcome (AUC, 0.689, 95% CI, 0.667-0.711) and of late mortality [hazard ratio (HR), 1.035, 95% CI, 1.031-1.038; Harrell's C 0.702; Somer's D 0.403]. In the validation dataset (248 patients), the in-hospital mortality rate was 16.1%, the composite outcome rate was 41.5%, and the 10-year mortality rate was 49.1%. The estimated risk score was predictive of in-hospital mortality (AUC, 0.703, 95% CI, 0.613-0.793; Brier score 0.121; slope 0.905) and of composite outcome (AUC, 0.682, 95% CI, 0.614-0.749). The estimated risk score was predictive of late mortality (HR, 1.035, 95% CI, 1.031-1.038; Harrell's C 0.702; Somer's D 0.403), also when hospital deaths were excluded from the analysis (HR, 1.024, 95% CI, 1.018-1.031; Harrell's C 0.630; Somer's D 0.261)., Conclusions: The present analysis identified several baseline clinical risk factors, along with preoperative estimated glomerular filtration rate and arterial lactate, which are predictive of in-hospital mortality and major postoperative adverse events after surgical repair of acute TAAD. These risk factors may be valuable components for risk adjustment in the evaluation of surgical and anesthesiological strategies aiming to improve the results of surgery for TAAD., Clinical Trial Registration: https://clinicaltrials.gov, identifier NCT04831073., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2024 Biancari, Demal, Nappi, Onorati, Francica, Peterss, Buech, Fiore, Folliguet, Perrotti, Hervé, Conradi, Rukosujew, Pinto, Lega, Pol, Rocek, Kacer, Wisniewski, Mazzaro, Vendramin, Piani, Ferrante, Rinaldi, Quintana, Pruna-Guillen, Gerelli, Di Perna, Acharya, Mariscalco, Field, Kuduvalli, Pettinari, Rosato, D'Errigo, Jormalainen, Mustonen, Mäkikallio, Dell'aquila, Juvonen and Gatti.)
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- 2024
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41. Impact of Previous Cardiac Operations in Patients Undergoing Surgery for Type A Acute Aortic Dissection. Long-Term Follow Up.
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D'Onofrio A, Salizzoni S, Onorati F, Di Marco L, Gatti G, Luciani GB, Rinaldi M, Pacini D, Mazzaro E, Lorenzoni G, Gregori D, Livi U, Vendramin I, and Gerosa G
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- Humans, Follow-Up Studies, Treatment Outcome, Kaplan-Meier Estimate, Risk Factors, Multicenter Studies as Topic, Aortic Dissection surgery, Cardiac Surgical Procedures adverse effects
- Abstract
Aim of this multicenter study was to evaluate the impact of reoperative cardiac surgery for type A acute aortic dissection (TAAAD) on early and long-term outcomes. Patients with history of previous cardiac surgery were included in group R while those undergoing first operation where included in group F. Kaplan-Meier analysis was used to evaluate long-term survival in the 2 groups. A total of 1472 patients were included in the analysis. Of these, 85 (5.8%) and 1387 (94.2%) were included in group R and F, respectively. Thirty-day mortality was 24% (20 patients) and 18% (249 patients) in groups R and F, respectively(P = 0.8). Kaplan-Meier survival at 10 and at 20-year was 51.5% and 30.2% in group R and 48% and 32% in group F (P = 0.368). Patients with a history of previous cardiac operations who develop TAAAD can undergo surgery with similar early and long-term outcomes compared to those at their first operation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Published
- 2023
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42. Direct Aortic Versus Supra-Aortic Arterial Cannulation During Surgery for Acute Type A Aortic Dissection.
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Juvonen T, Jormalainen M, Mustonen C, Demal T, Fiore A, Perrotti A, Hervé A, Mazzaro E, Gatti G, Pettinari M, Peterss S, Buech J, Nappi F, Conradi L, Pinto AG, Rodriguez Lega J, Pol M, Kacer P, Dell'Aquila AM, Rukosujew A, Wisniewski K, Vendramin I, Piani D, Ferrante L, Rinaldi M, Quintana E, Pruna-Guillen R, Gerelli S, Di Perna D, Folliguet T, Acharya M, Field M, Kuduvalli M, Onorati F, Rossetti C, Mäkikallio T, Raivio P, Mariscalco G, and Biancari F
- Subjects
- Humans, Cohort Studies, Treatment Outcome, Aorta, Retrospective Studies, Catheterization, Aortic Dissection surgery
- Abstract
Aims: In this study we evaluated the impact of direct aortic cannulation versus innominate/subclavian/axillary artery cannulation on the outcome after surgery for type A aortic dissection., Methods: The outcomes of patients included in a multicenter European registry (ERTAAD) who underwent surgery for acute type A aortic dissection with direct aortic cannulation versus those with innominate/subclavian/axillary artery cannulation, i.e. supra-aortic arterial cannulation, were compared using propensity score matched analysis., Results: Out of 3902 consecutive patients included in the registry, 2478 (63.5%) patients were eligible for this analysis. Direct aortic cannulation was performed in 627 (25.3%) patients, while supra-aortic arterial cannulation in 1851 (74.7%) patients. Propensity score matching yielded 614 pairs of patients. Among them, patients who underwent surgery for TAAD with direct aortic cannulation had significantly decreased in-hospital mortality (12.7% vs. 18.1%, p = 0.009) compared to those who had supra-aortic arterial cannulation. Furthermore, direct aortic cannulation was associated with decreased postoperative rates of paraparesis/paraplegia (2.0 vs. 6.0%, p < 0.0001), mesenteric ischemia (1.8 vs. 5.1%, p = 0.002), sepsis (7.0 vs. 14.2%, p < 0.0001), heart failure (11.2 vs. 15.2%, p = 0.043), and major lower limb amputation (0 vs. 1.0%, p = 0.031). Direct aortic cannulation showed a trend toward decreased risk of postoperative dialysis (10.1 vs. 13.7%, p = 0.051)., Conclusions: This multicenter cohort study showed that direct aortic cannulation compared to supra-aortic arterial cannulation is associated with a significant reduction of the risk of in-hospital mortality after surgery for acute type A aortic dissection., Trial Registration: ClinicalTrials.gov Identifier: NCT04831073., (© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)
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- 2023
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43. Preoperative arterial lactate and outcome after surgery for type A aortic dissection: The ERTAAD multicenter study.
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Biancari F, Nappi F, Gatti G, Perrotti A, Hervé A, Rosato S, D'Errigo P, Pettinari M, Peterss S, Buech J, Juvonen T, Jormalainen M, Mustonen C, Demal T, Conradi L, Pol M, Kacer P, Dell'Aquila AM, Wisniewski K, Vendramin I, Piani D, Ferrante L, Mäkikallio T, Quintana E, Pruna-Guillen R, Fiore A, Folliguet T, Mariscalco G, Acharya M, Field M, Kuduvalli M, Onorati F, Rossetti C, Gerelli S, Di Perna D, Mazzaro E, Pinto AG, Lega JR, and Rinaldi M
- Abstract
Background: Acute type A aortic dissection (TAAD) is associated with significant mortality and morbidity. In this study we evaluated the prognostic significance of preoperative arterial lactate concentration on the outcome after surgery for TAAD., Methods: The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) at 18 European centers of cardiac surgery., Results: Data on arterial lactate concentration immediately before surgery were available in 2798 (71.7 %) patients. Preoperative concentration of arterial lactate was an independent predictor of in-hospital mortality (mean, 3.5 ± 3.2 vs 2.1 ± 1.8 mmol/L, adjusted OR 1.181, 95%CI 1.129-1.235). The best cutoff value preoperative arterial lactate concentration was 1.8 mmol/L (in-hospital mortality, 12.0 %, vs. 26.6 %, p < 0.0001). The rates of in-hospital mortality increased along increasing quintiles of arterial lactate and it was 12.1 % in the lowest quintile and 33.6 % in the highest quintile (p < 0.0001). The difference between multivariable models with and without preoperative arterial lactate was statistically significant (p = 0.0002). The NRI was 0.296 (95%CI 0.200-0.391) (p < 0.0001) with -17 % of events correctly reclassified (p = 0.0002) and 46 % of non-events correctly reclassified (p < 0.0001). The IDI was 0.025 (95%CI 0.016-0.034) (p < 0.0001). Six studies from a systematic review plus the present one provided data for a pooled analysis which showed that the mean difference of preoperative arterial lactate between 30-day/in-hospital deaths and survivors was 1.85 mmol/L (95%CI 1.22-2.47, p < 0.0001, I
2 64 %)., Conclusions: Hyperlactatemia significantly increased the risk of mortality after surgery for acute TAAD and should be considered in the clinical assessment of these critically ill patients., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Fausto Biancari reports financial support was provided by 10.13039/501100005633Finnish Foundation for Cardiovascular Research. Fausto Biancari reports financial support was provided by Sigrid Jusélius Foundation., (© 2023 The Authors.)- Published
- 2023
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44. Current Outcome after Surgery for Type A Aortic Dissection.
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Biancari F, Juvonen T, Fiore A, Perrotti A, Hervé A, Touma J, Pettinari M, Peterss S, Buech J, Dell'Aquila AM, Wisniewski K, Rukosujew A, Demal T, Conradi L, Pol M, Kacer P, Onorati F, Rossetti C, Vendramin I, Piani D, Rinaldi M, Ferrante L, Quintana E, Pruna-Guillen R, Rodriguez Lega J, Pinto AG, Acharya M, El-Dean Z, Field M, Harky A, Nappi F, Gerelli S, Di Perna D, Gatti G, Mazzaro E, Rosato S, Raivio P, Jormalainen M, and Mariscalco G
- Subjects
- Humans, Retrospective Studies, Treatment Outcome, Reoperation, Aortic Aneurysm surgery, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects
- Abstract
Objective: The aim of this study was to evaluate the outcomes of different surgical strategies for acute Stanford type A aortic dissection (TAAD)., Summary Background Data: The optimal extent of aortic resection during surgery for acute TAAD is controversial., Methods: This is a multicenter, retrospective cohort study of patients who underwent surgery for acute TAAD at 18 European hospitals., Results: Out of 3902 consecutive patients, 689 (17.7%) died during the index hospitalization. Among 2855 patients who survived 3 months after surgery, 10-year observed survival was 65.3%, while country-adjusted, age-adjusted, and sex-adjusted expected survival was 81.3%, yielding a relative survival of 80.4%. Among 558 propensity score-matched pairs, total aortic arch replacement increased the risk of in-hospital (21.0% vs. 14.9%, P =0.008) and 10-year mortality (47.1% vs. 40.1%, P =0.001), without decreasing the incidence of distal aortic reoperation (10-year: 8.9% vs. 7.4%, P =0.690) compared with ascending aortic replacement. Among 933 propensity score-matched pairs, in-hospital mortality (18.5% vs. 18.0%, P =0.765), late mortality (at 10-year: 44.6% vs. 41.9%, P =0.824), and cumulative incidence of proximal aortic reoperation (at 10-year: 4.4% vs. 5.9%, P =0.190) after aortic root replacement was comparable to supracoronary aortic replacement., Conclusions: Replacement of the aortic root and aortic arch did not decrease the risk of aortic reoperation in patients with TAAD and should be performed only in the presence of local aortic injury or aneurysm. The relative survival of TAAD patients is poor and suggests that the causes underlying aortic dissection may also impact late mortality despite surgical repair of the dissected aorta., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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45. Revascularization of Occluded Right Coronary Artery and Outcome After Coronary Artery Bypass Grafting.
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Biancari F, Dalén M, Tauriainen T, Gatti G, Salsano A, Santini F, Feo M, Zhang Q, Mazzaro E, Franzese I, Bancone C, Zanobini M, Mäkikallio T, Saccocci M, Francica A, Onorati F, El-Dean Z, and Mariscalco G
- Subjects
- Humans, Prospective Studies, Treatment Outcome, Coronary Artery Bypass, Coronary Artery Disease surgery, Percutaneous Coronary Intervention
- Abstract
Objectives: The aim of the present study was to evaluate the results of isolated coronary artery bypass grafting (CABG) with or without revascularization of the occluded right coronary artery (RCA)., Methods: Patients undergoing isolated CABG were included in a prospective European multicenter registry. Outcomes were adjusted for imbalance in preoperative variables with propensity score matching analysis. Late outcomes were evaluated with Kaplan-Meier's method and competing risk analysis., Results: Out of 2,948 included in this registry, 724 patients had a total occlusion of the RCA and were the subjects of this analysis. Occluded RCA was not revascularized in 251 (34.7%) patients with significant variability between centers. Among 245 propensity score-matched pairs, patients with and without revascularization of occluded RCA had similar early outcomes. The nonrevascularized RCA group had increased rates of 5-year all-cause mortality (17.7 vs. 11.7%, p = 0.039) compared with patients who had their RCA revascularized. The rates of myocardial infarction and repeat revascularization were only numerically increased but contributed to a significantly higher rate of MACCE (24.7 vs. 15.7%, p = 0.020) at 5 year among patients with nonrevascularized RCA., Conclusion: In this multicenter study, one-third of totally occluded RCAs was not revascularized during isolated CABG for multivessel coronary artery disease. Failure to revascularize an occluded RCA in these patients increased the risk of all-cause mortality and MACCEs at 5 years., Competing Interests: None declared., (Thieme. All rights reserved.)
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- 2023
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46. Interinstitutional analysis of the outcome after surgery for type A aortic dissection.
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Biancari F, Dell'Aquila AM, Gatti G, Perrotti A, Hervé A, Touma J, Pettinari M, Peterss S, Buech J, Wisniewski K, Juvonen T, Jormalainen M, Mustonen C, Rukosujew A, Demal T, Conradi L, Pol M, Kacer P, Onorati F, Rossetti C, Vendramin I, Piani D, Rinaldi M, Ferrante L, Quintana E, Pruna-Guillen R, Lega JR, Pinto AG, Acharya M, El-Dean Z, Field M, Harky A, Kuduvalli M, Nappi F, Gerelli S, Di Perna D, Mazzaro E, Rosato S, Fiore A, and Mariscalco G
- Subjects
- Humans, Retrospective Studies, Treatment Outcome, Hospitals, Hospital Mortality, Aortic Dissection surgery
- Abstract
Purpose: To evaluate the impact of individual institutions on the outcome after surgery for Stanford type A aortic dissection (TAAD)., Methods: This is an observational, multicenter, retrospective cohort study including 3902 patients who underwent surgery for TAAD at 18 university and non-university hospitals., Results: Logistic regression showed that four hospitals had increased risk of in-hospital mortality, while two hospitals were associated with decreased risk of in-hospital mortality. Risk-adjusted in-hospital mortality rates were lower in four hospitals and higher in other four hospitals compared to the overall in-hospital mortality rate (17.7%). Participating hospitals were classified as overperforming or underperforming if their risk-adjusted in-hospital mortality rate was lower or higher than the in-hospital mortality rate of the overall series, respectively. Propensity score matching yielded 1729 pairs of patients operated at over- or underperforming hospitals. Overperforming hospitals had a significantly lower in-hospital mortality (12.8% vs. 22.2%, p < 0.0001) along with decreased rate of stroke and/or global brain ischemia (16.5% vs. 19.9%, p = 0.009) compared to underperforming hospitals. Aggregate data meta-regression of the results of participating hospitals showed that hospital volume was inversely associated with in-hospital mortality (p = 0.043). Hospitals with an annual volume of less than 15 cases had an increased risk of in-hospital mortality (adjusted OR, 1.345, 95% CI 1.126-1.607)., Conclusion: The present findings indicate that there are significant differences between hospitals in terms of early outcome after surgery for TAAD. Low hospital volume may be a determinant of poor outcome of TAAD., Trial Registration: ClinicalTrials.gov Identifier: NCT04831073., (© 2023. The Author(s).)
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- 2023
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47. Adequacy of protein and calorie delivery according to the expected calculated targets: a day-by-day assessment in critically ill patients undergoing enteral feeding.
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Fabiani A, Dreas L, Mazzaro E, Trampus E, Zanetti M, Calabretti A, Gatti G, and Sanson G
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- Humans, Retrospective Studies, Energy Intake, Parenteral Nutrition, Intensive Care Units, Enteral Nutrition, Critical Illness therapy
- Abstract
Background: In critically ill patients requiring mechanical ventilation for longer than 48-72 h enteral nutrition (EN) should be started early. Because EN alone may be unable to reach the target nutritional requirement, supplemental parenteral nutrition (PN) should be administered. This study aimed at describing the daily rate of administered calories and proteins according to the expected calculated targets. The impact of calorie adequacy, deficit or excess on relevant clinical outcomes was explored., Methods: A retrospective cohort study was conducted in 217 patients undergoing cardiac surgery, admitted postoperatively in intensive care unit and undergoing EN. The effective intake provided via EN, PN, oral nutritional supplements (ONS) and nonnutritional calories (NNC) was documented for a maximum of 20 days. The administered/required calorie and protein ratios (Kcal
A/R , ProtA/R ) were calculated daily. Patients receiving 80%-100%, <80% or >100% of KcalA/R and ProtA/R were identified. The association between mean KcalA/R between days 4-7 and 30 days' mortality was explored., Results: A mean KcalA/R ratio of 92.0 ± 40.6% was ensured between days 4 and 20. During days 4-7 the 80%-100% calorie target was achieved in 26.9% of patients, whereas 44.9% were below and 28.2% over this range. EN contributed 47.1% and PN 41.2% to the total energy intake. An increase in 30-day mortality risk was documented for patients exceeding 100% of KcalA/R ratio (adjusted-hazard ratio [HR] 5.2; 95% confidence interval [CI] 1.1 -23.9; p = 0.035)., Conclusions: Despite a preliminary estimate of nutritional requirement, a steady daily optimal 80%-100% KcalA/R was not ensured for all patients. EN contributed only partially to both energy and protein intakes so that PN was largely used to achieve the desired nutritional targets., (© 2022 The British Dietetic Association Ltd.)- Published
- 2023
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48. Cardiac Vascular Hamartoma: Adult Diagnosis and Cardiac Reconstruction.
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Franzese I, Gripshi F, Fiocco A, Rauber E, Ruggiero D, Bussani R, and Mazzaro E
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- Female, Humans, Adult, Middle Aged, Heart, Tomography, X-Ray Computed, Thorax, Hamartoma diagnosis, Plastic Surgery Procedures
- Abstract
Cardiac hamartoma is a rare benign tumor of the heart, and the vascular type is an extremely rare histologic diagnosis. A small number of cases have previously been described in childhood. We report the case of a 63-year-old woman with an incidentally detected cardiac mass that was finally diagnosed as vascular hamartoma. Approval for publication was obtained from the patient., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2023
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49. Outcome after Surgery for Iatrogenic Acute Type A Aortic Dissection.
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Biancari F, Pettinari M, Mariscalco G, Mustonen C, Nappi F, Buech J, Hagl C, Fiore A, Touma J, Dell'Aquila AM, Wisniewski K, Rukosujew A, Perrotti A, Hervé A, Demal T, Conradi L, Pol M, Kacer P, Onorati F, Rossetti C, Vendramin I, Piani D, Rinaldi M, Ferrante L, Quintana E, Pruna-Guillen R, Rodriguez Lega J, Pinto AG, Mäkikallio T, Acharya M, El-Dean Z, Field M, Harky A, Gerelli S, Di Perna D, Jormalainen M, Gatti G, Mazzaro E, Juvonen T, and Peterss S
- Abstract
(1) Background: Acute Stanford type A aortic dissection (TAAD) may complicate the outcome of cardiovascular procedures. Data on the outcome after surgery for iatrogenic acute TAAD is scarce. (2) Methods: The European Registry of Type A Aortic Dissection (ERTAAD) is a multicenter, retrospective study including patients who underwent surgery for acute TAAD at 18 hospitals from eight European countries. The primary outcomes were in-hospital mortality and 5-year mortality. Twenty-seven secondary outcomes were evaluated. (3) Results: Out of 3902 consecutive patients who underwent surgery for acute TAAD, 103 (2.6%) had iatrogenic TAAD. Cardiac surgery (37.8%) and percutaneous coronary intervention (36.9%) were the most frequent causes leading to iatrogenic TAAD, followed by diagnostic coronary angiography (13.6%), transcatheter aortic valve replacement (10.7%) and peripheral endovascular procedure (1.0%). In hospital mortality was 20.5% after cardiac surgery, 31.6% after percutaneous coronary intervention, 42.9% after diagnostic coronary angiography, 45.5% after transcatheter aortic valve replacement and nihil after peripheral endovascular procedure (p = 0.092), with similar 5-year mortality between different subgroups of iatrogenic TAAD (p = 0.710). Among 102 propensity score matched pairs, in-hospital mortality was significantly higher among patients with iatrogenic TAAD (30.4% vs. 15.7%, p = 0.013) compared to those with spontaneous TAAD. This finding was likely related to higher risk of postoperative heart failure (35.3% vs. 10.8%, p < 0.0001) among iatrogenic TAAD patients. Five-year mortality was comparable between patients with iatrogenic and spontaneous TAAD (46.2% vs. 39.4%, p = 0.163). (4) Conclusions: Iatrogenic origin of acute TAAD is quite uncommon but carries a significantly increased risk of in-hospital mortality compared to spontaneous TAAD.
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- 2022
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50. Cardiology of the future: xenotransplantation with porcine heart.
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Sinagra G, Pagura L, Radesich C, Gagno G, Cannata' A, Barbisan D, Cittar M, Paldino A, Perotto M, Mase' M, Dal Ferro M, Mazzaro E, and Merlo M
- Abstract
The reduced availability of human donor hearts compared with the needs of patients with advanced heart failure refractory to medical therapy has promoted the search for therapeutic alternatives to cardiac allografts. Porcine heart xenotransplantation represents one of the most promising frontiers in this field today. From the first researches in the 1960s to today, the numerous advances achieved in the field of surgical techniques, genetic engineering and immunosuppression have made it possible at the beginning of 2022 to carry out the first swine-to-human heart transplant, attaining a survival of 2 months after surgery. The main intellectual and experimental stages that have marked the history of xenotransplantation, the latest acquisitions in terms of genetic editing, as well as the improvement of immunosuppressive therapy are discussed analytically in this article in order to illustrate the underlying complexity of this therapeutic model., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2022
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