Carrozzini Dott. Massimiliano
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Impact of COVID-19 on incidence and outcomes of post-infarction mechanical complications in Europe.
Interdiscip Cardiovasc Thorac Surg2023 Dec;37(6):. doi: ivad198.
Ronco Daniele, Matteucci Matteo, Ravaux Justine Mafalda, Kowalewski Mariusz, Massimi Giulio, Torchio Federica, Trumello Cinzia, Naito Shiho, Bonaros Nikolaos, De Bonis Michele, Fina Dario, Kowalówka Adam, Deja Marek, Jiritano Federica, Serraino Giuseppe Filiberto, Kalisnik Jurij Matija, De Vincentiis Carlo, Ranucci Marco, Fischlein Theodor, Russo Claudio Francesco, Carrozzini Massimiliano, Boeken Udo, Kalampokas Nikolaos, Golino Michele, De Ponti Roberto, Pozzi Matteo, Obadia Jean-François, Thielmann Matthias, Scrofani Roberto, Blasi Stefania, Troise Giovanni, Antona Carlo, De Martino Andrea, Falcetta Giosuè, Actis Dato Guglielmo, Severgnini Paolo, Musazzi Andrea, Lorusso Roberto
Abstract
OBJECTIVES:
Post-acute myocardial infarction mechanical complications (post-AMI MCs) represent rare but life-threatening conditions, including free-wall rupture, ventricular septal rupture and papillary muscle rupture. During the coronavirus disease-19 (COVID-19) pandemic, an overwhelming pressure on healthcare systems led to delayed and potentially suboptimal treatments for time-dependent conditions. As AMI-related hospitalizations decreased, limited information is available whether higher rates of post-AMI MCs and related deaths occurred in this setting. This study was aimed to assess how COVID-19 in Europe has impacted the incidence, treatment and outcome of MCs.
METHODS:
The CAUTION-COVID19 study is a multicentre retrospective study collecting 175 patients with post-AMI MCs in 18 centres from 6 European countries, aimed to compare the incidence of such events, related patients' characteristics, and outcomes, between the first year of pandemic and the 2 previous years.
RESULTS:
A non-significant increase in MCs was observed [odds ratio (OR)?=?1.15, 95% confidence interval (CI) 0.85-1.57; P?=?0.364], with stronger growth in ventricular septal rupture diagnoses (OR?=?1.43, 95% CI 0.95-2.18; P?=?0.090). No significant differences in treatment types and mortality were found between the 2 periods. In-hospital mortality was 50.9% and was higher for conservatively managed cases (90.9%) and lower for surgical patients (44.0%). Patients admitted during COVID-19 more frequently had late-presenting infarction (OR?=?2.47, 95% CI 1.24-4.92; P?=?0.010), more stable conditions (OR?=?2.61, 95% CI 1.27-5.35; P?=?0.009) and higher EuroSCORE II (OR?=?1.04, 95% CI 1.01-1.06; P?=?0.006).
CONCLUSIONS:
A non-significant increase in MCs incidence occurred during the first year of COVID-19, characterized by a significantly higher rate of late-presenting infarction, stable conditions and EuroSCORE-II if compared to pre-pandemic data, without affecting treatment and mortality.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
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Extracorporeal life support in mitral papillary muscle rupture: Outcome of multicenter study.
Artif Organs2023 Aug;47(8):1386-1394. doi: 10.1111/aor.14541.
Massimi Giulio, Matteucci Matteo, De Bonis Michele, Kowalewski Mariusz, Formica Francesco, Russo Claudio Francesco, Sponga Sandro, Vendramin Igor, Colli Andrea, Falcetta Giosuè, Trumello Cinzia, Carrozzini Massimiliano, Fischlein Theodor, Troise Giovanni, Actis Dato Guglielmo, D'Alessandro Stefano, Nia Peyman Sardari, Lodo Vittoria, Villa Emmanuel, Shah Shabir Hussain, Scrofani Roberto, Binaco Irene, Kalisnik Jurij Matija, Pettinari Matteo, Thielmann Matthias, Meyns Bart, Khouqeer Fareed A, Fino Carlo, Simon Caterina, Severgnini Paolo, Kowalowka Adam, Deja Marek A, Ronco Daniele, Lorusso Roberto
Abstract
BACKGROUND:
Post-acute myocardial infarction papillary muscle rupture (post-AMI PMR) may present variable clinical scenarios and degree of emergency due to result of cardiogenic shock. Veno-arterial extracorporeal life support (V-A ECLS) has been proposed to improve extremely poor pre- or postoperative conditions. Information in this respect is scarce.
METHODS:
From the CAUTION (meChanical complicAtion of acUte myocardial infarcTion: an InternatiOnal multiceNter cohort study) database (16 different Centers, data from 2001 to 2018), we extracted adult patients who were surgically treated for post-AMI PMR and underwent pre- or/and postoperative V-A ECLS support. The end-points of this study were in-hospital survival and ECLS complications.
RESULTS:
From a total of 214 post-AMI PMR patients submitted to surgery, V-A ECLS was instituted in 23 (11%) patients. The median age was 61.7?years (range 46-81?years). Preoperatively, ECLS was commenced in 10 patients (43.5%), whereas intra/postoperative in the remaining 13. The most common V-A ECLS indication was post-cardiotomy shock, followed by preoperative cardiogenic shock and cardiac arrest. The median duration of V-A ECLS was 4?days. V-A ECLS complications occurred in more than half of the patients. Overall, in-hospital mortality was 39.2% (9/23), compared to 22% (42/219) for the non-ECLS group.
CONCLUSIONS:
In post-AMI PMR patients, V-A ECLS was used in almost 10% of the patients either to promote bridge to surgery or as postoperative support. Further investigations are required to better evaluate a potential for increased use and its effects of V-A ECLS in such a context based on the still high perioperative mortality.
© 2023 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
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A Device Strategy-Matched Comparison Analysis among Different Intermacs Profiles: A Single Center Experience.
J Clin Med2022 Aug;11(16):. doi: 4901.
Caraffa Raphael, Bejko Jonida, Carrozzini Massimiliano, Bifulco Olimpia, Tarzia Vincenzo, Lorenzoni Giulia, Bottigliengo Daniele, Gregori Dario, Castellani Chiara, Bottio Tomaso, Angelini Annalisa, Gerosa Gino
Abstract
The present study evaluates outcomes of LVAD patients, taking into account the device strategy and the INTERMACS profile. We included 192 LVAD-patients implanted between January 2012 and May 2021. The primary and secondary end-points were survival and major adverse events between Profiles 1-3 vs. Profile 4, depending on implantation strategies (Bridge-to-transplant-BTT; Bridge-to-candidacy-BTC; Destination-Therapy-DT). The overall survival was 67% (61-75) at 12 months and 61% (54-70) at 24 months. Profile 4 patients showed significantly higher survival ( = 0.018). Incidences of acute right-ventricular-failure (RVF) ( = 0.046), right-ventricular-assist-device (RVAD) implantation ( = 0.015), and continuous-venovenous-hemofiltration (CVVH) ( = 0.006) were higher in Profile 1-3 patients, as well as a longer intensive care unit stays ( = 0.050) and in-hospital-mortality ( = 0.012). Twelve-month and 24-month survival rates were higher in the BTT rather than in BTC (log-rank = 0.410; log-rank = 0.120) and in DT groups (log-rank = 0.046). In the BTT group, Profile 1-3 patients had a higher need for RVAD support ( = 0.042). LVAD implantation in elective patients was associated with better survival and lower complications incidence. LVAD implantation in BTC patients has to be considered before their conditions deteriorate. DT should be addressed to elective patients in order to guarantee acceptable results.
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Impact of Continuous Flow Left Ventricular Assist Device on Heart Transplant Candidates: A Multi-State Survival Analysis.
J Clin Med2022 Jun;11(12):. doi: 3425.
Carrozzini Massimiliano, Bottio Tomaso, Caraffa Raphael, Bejko Jonida, Bifulco Olimpia, Guariento Alvise, Lombardi Carlo Mario, Metra Marco, Azzolina Danila, Gregori Dario, Fedrigo Marny, Castellani Chiara, Tarzia Vincenzo, Toscano Giuseppe, Gambino Antonio, Jorgji Vjola, Ferrari Enrico, Angelini Annalisa, Gerosa Gino
Abstract
(1) Objectives: The aim of this study was to investigate the impact of the prolonged use of continuous-flow left ventricular assist devices (LVADs) on heart transplant (HTx) candidates. (2) Methods: Between January 2012 and December 2019, we included all consecutive patients diagnosed with end-stage heart failure considered for HTx at our institution, who were also eligible for LVAD therapy as a bridge to transplant (BTT). Patients were divided into two groups: those who received an LVAD as BTT (LVAD group) and those who were listed without durable support (No-LVAD group). (3) Results: A total of 250 patients were analyzed. Of these, 70 patients (28%) were directly implanted with an LVAD as BTT, 11 (4.4%) received delayed LVAD implantation, and 169 (67%) were never assisted with an implantable device. The mean follow-up time was 36 ± 29 months. In the multivariate analysis of survival before HTx, LVAD implantation showed a protective effect: LVAD vs. No-LVAD HR 0.01 (p
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Marginal versus Standard Donors in Heart Transplantation: Proper Selection Means Heart Transplant Benefit.
J Clin Med2022 May;11(9):. doi: 2665.
Bifulco Olimpia, Bottio Tomaso, Caraffa Raphael, Carrozzini Massimiliano, Guariento Alvise, Bejko Jonida, Fedrigo Marny, Castellani Chiara, Toscano Giuseppe, Lorenzoni Giulia, Tarzia Vincenzo, Gregori Dario, Cardillo Massimo, Puoti Francesca, Feltrin Giuseppe, Angelini Annalisa, Gerosa Gino
Abstract
BACKGROUND:
In this study, we assessed the mid-term outcomes of patients who received a heart donation from a marginal donor (MD), and compared them with those who received an organ from a standard donor (SD).
METHODS:
All patients who underwent HTx between January 2012 and December 2020 were enrolled at a single institution. The primary endpoints were early and long-term survival of MD recipients. Risk factors for primary graft failure (PGF) and mortality in MD recipients were also analyzed. The secondary endpoint was the comparison of survival of MD versus SD recipients.
RESULTS:
In total, 238 patients underwent HTx, 64 (26.9%) of whom received an organ from an MD. Hospital mortality in the MD recipient cohort was 23%, with an estimated 1 and 5-year survival of 70% (59.2-82.7) and 68.1% (57.1-81), respectively. A multivariate analysis in MD recipients showed that decreased renal function and increased inotropic support of recipients were associated with higher mortality ( = 0.04 and = 0.03). Cold ischemic time ( = 0.03) and increased donor inotropic support ( = 0.04) were independent risk factors for PGF. Overall survival was higher in SD than MD (85% vs. 68% at 5 years, log-rank = 0.008). However, risk-adjusted mortality ( = 0.2) and 5-year conditional survival (log-rank = 0.6) were comparable.
CONCLUSIONS:
Selected MDs are a valuable resource for expanding the cardiac donor pool, showing promising results. The use of MDs after prolonged ischemic times, increased inotropic support of the MD or the recipient and decreased renal function are associated with worse outcomes.
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Organ Care System Heart? in donors requiring high-risk excision of suspected neoplastic lesions.
Int J Artif Organs2022 Mar;45(3):337-339. doi: 10.1177/03913988221075040.
Olivieri Guido Maria, Carrozzini Massimiliano, Lanfranconi Marco, Russo Claudio Francesco
Abstract
Although Heart Transplant is still the gold standard treatment for end-stage heart failure patients, the limitation of this procedure is the discrepancy between the amount of waiting list patients and donors. Organ Care Systems, preventing the detrimental effects of cold ischemia, potentially increase donor pool. Herein we report three cases where high-risk excisions were required to clarify the nature of suspected lesions in donors. We decided to retrieve the organs and to place them in the devices before performing the excision. Our experience confirm the possibility to utilise this device as a time buffer in these peculiar scenarios.
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Oversampling and replacement strategies in propensity score matching: a critical review focused on small sample size in clinical settings.
BMC Med Res Methodol2021 Nov;21(1):256. doi: 256.
Bottigliengo Daniele, Baldi Ileana, Lanera Corrado, Lorenzoni Giulia, Bejko Jonida, Bottio Tomaso, Tarzia Vincenzo, Carrozzini Massimiliano, Gerosa Gino, Berchialla Paola, Gregori Dario
Abstract
BACKGROUND:
Propensity score matching is a statistical method that is often used to make inferences on the treatment effects in observational studies. In recent years, there has been widespread use of the technique in the cardiothoracic surgery literature to evaluate to potential benefits of new surgical therapies or procedures. However, the small sample size and the strong dependence of the treatment assignment on the baseline covariates that often characterize these studies make such an evaluation challenging from a statistical point of view. In such settings, the use of propensity score matching in combination with oversampling and replacement may provide a solution to these issues by increasing the initial sample size of the study and thus improving the statistical power that is needed to detect the effect of interest. In this study, we review the use of propensity score matching in combination with oversampling and replacement in small sample size settings.
METHODS:
We performed a series of Monte Carlo simulations to evaluate how the sample size, the proportion of treated, and the assignment mechanism affect the performances of the proposed approaches. We assessed the performances with overall balance, relative bias, root mean squared error and nominal coverage. Moreover, we illustrate the methods using a real case study from the cardiac surgery literature.
RESULTS:
Matching without replacement produced estimates with lower bias and better nominal coverage than matching with replacement when 1:1 matching was considered. In contrast to that, matching with replacement showed better balance, relative bias, and root mean squared error than matching without replacement for increasing levels of oversampling. The best nominal coverage was obtained by using the estimator that accounts for uncertainty in the matching procedure on sets of units obtained after matching with replacement.
CONCLUSIONS:
The use of replacement provides the most reliable treatment effect estimates and that no more than 1 or 2 units from the control group should be matched to each treated observation. Moreover, the variance estimator that accounts for the uncertainty in the matching procedure should be used to estimate the treatment effect.
© 2021. The Author(s).
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Surgical treatment for post-infarction papillary muscle rupture: a multicentre study.
Eur J Cardiothorac Surg2022 Jan;61(2):469-476. doi: 10.1093/ejcts/ezab469.
Massimi Giulio, Ronco Daniele, De Bonis Michele, Kowalewski Mariusz, Formica Francesco, Russo Claudio Francesco, Sponga Sandro, Vendramin Igor, Falcetta Giosuè, Fischlein Theodor, Troise Giovanni, Trumello Cinzia, Actis Dato Guglielmo, Carrozzini Massimiliano, Shah Shabir Hussain, Coco Valeria Lo, Villa Emmanuel, Scrofani Roberto, Torchio Federica, Antona Carlo, Kalisnik Jurij Matija, D'Alessandro Stefano, Pettinari Matteo, Sardari Nia Peyman, Lodo Vittoria, Colli Andrea, Ruhparwar Arjang, Thielmann Matthias, Meyns Bart, Khouqeer Fareed A, Fino Carlo, Simon Caterina, Kowalowka Adam, Deja Marek A, Beghi Cesare, Matteucci Matteo, Lorusso Roberto
Abstract
OBJECTIVES:
Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient characteristics and early outcomes of the surgical management of post-infarction PMR from an international multicentre registry.
METHODS:
Patients underwent surgery for post-infarction PMR between 2001 through 2019 were retrieved from database of the CAUTION study. The primary end point was in-hospital mortality.
RESULTS:
A total of 214 patients were included with a mean age of 66.9 (standard deviation: 10.5) years. The posteromedial papillary muscle was the most frequent rupture location (71.9%); the rupture was complete in 67.3% of patients. Mitral valve replacement was performed in 82.7% of cases. One hundred twenty-two patients (57%) had concomitant coronary artery bypass grafting. In-hospital mortality was 24.8%. Temporal trends revealed no apparent improvement in in-hospital mortality during the study period. Multivariable analysis showed that preoperative chronic kidney disfunction [odds ratio (OR): 2.62, 95% confidence interval (CI): 1.07-6.45, P?=?0.036], cardiac arrest (OR: 3.99, 95% CI: 1.02-15.61, P?=?0.046) and cardiopulmonary bypass duration (OR: 1.01, 95% CI: 1.00-1.02, P?=?0.04) were independently associated with an increased risk of in-hospital death, whereas concomitant coronary artery bypass grafting was identified as an independent predictor of early survival (OR: 0.38, 95% CI: 0.16-0.92, P?=?0.031).
CONCLUSIONS:
Surgical treatment for post-infarction PMR carries a high in-hospital mortality rate, which did not improve during the study period. Because concomitant coronary artery bypass grafting confers a survival benefit, this additional procedure should be performed, whenever possible, in an attempt to improve the outcome.
CLINICAL TRIAL REGISTRATION:
clinicaltrials.gov: NCT03848429.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Surgical Treatment of Postinfarction Ventricular Septal Rupture.
JAMA Netw Open2021 Oct;4(10):e2128309. doi: e2128309.
Ronco Daniele, Matteucci Matteo, Kowalewski Mariusz, De Bonis Michele, Formica Francesco, Jiritano Federica, Fina Dario, Folliguet Thierry, Bonaros Nikolaos, Russo Claudio Francesco, Sponga Sandro, Vendramin Igor, De Vincentiis Carlo, Ranucci Marco, Suwalski Piotr, Falcetta Giosuè, Fischlein Theodor, Troise Giovanni, Villa Emmanuel, Dato Guglielmo Actis, Carrozzini Massimiliano, Serraino Giuseppe Filiberto, Shah Shabir Hussain, Scrofani Roberto, Fiore Antonio, Kalisnik Jurij Matija, D'Alessandro Stefano, Lodo Vittoria, Kowalówka Adam R, Deja Marek A, Almobayedh Salman, Massimi Giulio, Thielmann Matthias, Meyns Bart, Khouqeer Fareed A, Al-Attar Nawwar, Pozzi Matteo, Obadia Jean-François, Boeken Udo, Kalampokas Nikolaos, Fino Carlo, Simon Caterina, Naito Shiho, Beghi Cesare, Lorusso Roberto
Abstract
IMPORTANCE:
Ventricular septal rupture (VSR) is a rare but life-threatening mechanical complication of acute myocardial infarction associated with high mortality despite prompt treatment. Surgery represents the standard of care; however, only small single-center series or national registries are usually available in literature, whereas international multicenter investigations have been poorly carried out, therefore limiting the evidence on this topic.
OBJECTIVES:
To assess the clinical characteristics and early outcomes for patients who received surgery for postinfarction VSR and to identify factors independently associated with mortality.
DESIGN, SETTING, AND PARTICIPANTS:
The Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort (CAUTION) Study is a retrospective multicenter international cohort study that includes patients who were treated surgically for mechanical complications of acute myocardial infarction. The study was conducted from January 2001 to December 2019 at 26 different centers worldwide among 475 consecutive patients who underwent surgery for postinfarction VSR.
EXPOSURES:
Surgical treatment of postinfarction VSR, independent of the technique, alone or combined with other procedures (eg, coronary artery bypass grafting).
MAIN OUTCOMES AND MEASURES:
The primary outcome was early mortality; secondary outcomes were postoperative complications.
RESULTS:
Of the 475 patients included in the study, 290 (61.1%) were men, with a mean (SD) age of 68.5 (10.1) years. Cardiogenic shock was present in 213 patients (44.8%). Emergent or salvage surgery was performed in 212 cases (44.6%). The early mortality rate was 40.4% (192 patients), and it did not improve during the nearly 20 years considered for the study (median [IQR] yearly mortality, 41.7% [32.6%-50.0%]). Low cardiac output syndrome and multiorgan failure were the most common causes of death (low cardiac output syndrome, 70 [36.5%]; multiorgan failure, 53 [27.6%]). Recurrent VSR occurred in 59 participants (12.4%) but was not associated with mortality. Cardiogenic shock (survived: 95 [33.6%]; died, 118 [61.5%]; P?.001) and early surgery (time to surgery ?7 days, survived: 105 [57.4%]; died, 47 [35.1%]; P?.001) were associated with lower survival. At multivariate analysis, older age (odds ratio [OR], 1.05; 95% CI, 1.02-1.08; P?=?.001), preoperative cardiac arrest (OR, 2.71; 95% CI, 1.18-6.27; P?=?.02) and percutaneous revascularization (OR, 1.63; 95% CI, 1.003-2.65; P?=?.048), and postoperative need for intra-aortic balloon pump (OR, 2.98; 95% CI, 1.46-6.09; P?=?.003) and extracorporeal membrane oxygenation (OR, 3.19; 95% CI, 1.30-7.38; P?=?.01) were independently associated with mortality.
CONCLUSIONS AND RELEVANCE:
In this study, surgical repair of postinfarction VSR was associated with a high risk of early mortality; this risk has remained unchanged during the last 2 decades. Delayed surgery seemed associated with better survival. Age, preoperative cardiac arrest and percutaneous revascularization, and postoperative need for intra-aortic balloon pump and extracorporeal membrane oxygenation were independently associated with early mortality. Further prospective studies addressing preoperative and perioperative patient management are warranted to hopefully improve the currently suboptimal outcome.
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Percutaneous RVAD with the Protek Duo for severe right ventricular primary graft dysfunction after heart transplant.
J Heart Lung Transplant2021 Jul;40(7):580-583. doi: 10.1016/j.healun.2021.03.016.
Carrozzini Massimiliano, Merlanti Bruno, Olivieri Guido Maria, Lanfranconi Marco, Bruschi Giuseppe, Mondino Michele, Russo Claudio Francesco
Abstract
Right ventricular primary graft dysfunction after heart transplant is a serious life-threatening condition. The severe form, refractory to maximal medical therapy, has traditionally required temporary mechanical support through veno-arterial extracorporeal membrane oxygenation or central right ventricular support. The Protek Duo is a dual lumen cannula recently introduced in the market, which allows for the institution of a percutaneous right ventricular support. We present the first promising case series of the use of this novel support in patients with right ventricular primary graft dysfunction after heart transplant.
Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
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COVID-19 in Heart Transplant Recipients: A Multicenter Analysis of the Northern Italian Outbreak.
JACC Heart Fail2021 Jan;9(1):52-61. doi: 10.1016/j.jchf.2020.10.009.
Bottio Tomaso, Bagozzi Lorenzo, Fiocco Alessandro, Nadali Matteo, Caraffa Raphael, Bifulco Olimpia, Ponzoni Matteo, Lombardi Carlo Maria, Metra Marco, Russo Claudio Francesco, Frigerio Maria, Masciocco Gabriella, Potena Luciano, Loforte Antonio, Pacini Davide, Faggian Giuseppe, Onorati Francesco, Sponga Sandro, Livi Ugolino, Iacovoni Attilio, Terzi Amedeo, Senni Michele, Rinaldi Mauro, Boffini Massimo, Marro Matteo, Jorgji Vjola, Carrozzini Massimiliano, Gerosa Gino
Abstract
OBJECTIVES:
The aim of this study was to assess the clinical course and outcomes of all heart transplant recipients affected by coronavirus disease-2019 (COVID-19) who were followed at the leading heart transplant centers of Northern Italy.
BACKGROUND:
The worldwide severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic has created unprecedented challenges for public health, demanding exceptional efforts for the successful management and treatment of affected patients. Heart transplant patients represent a unique cohort of chronically immunosuppressed subjects in which SARS-CoV-2 may stimulate an unpredictable clinical course of infection.
METHODS:
Since February 2020, we enrolled all 47 cases (79% male) in a first cohort of patients, with a mean age of 61.8 ± 14.5 years, who tested positive for SARS-CoV-2, out of 2,676 heart transplant recipients alive before the onset of the COVID-19 pandemic at 7 heart transplant centers in Northern Italy.
RESULTS:
To date, 38 patients required hospitalization while 9 remained self-home quarantined and 14 died. Compared to the general population, prevalence (18 vs. 7 cases per 1,000) and related case fatality rate (29.7% vs. 15.4%) in heart transplant recipients were doubled. Univariable analysis showed older age (p = 0.002), diabetes mellitus (p = 0.040), extracardiac arteriopathy (p = 0.040), previous PCI (p = 0.040), CAV score (p = 0.039), lower GFR (p = 0.004), and higher NYHA functional classes (p = 0.023) were all significantly associated with in-hospital mortality. During the follow-up two patients died and a third patient has prolonged viral-shedding alternating positive and negative swabs. Since July 1st, 2020, we had 6 new patients who tested positive for SARS-CoV-2, 5 patients asymptomatic were self-quarantined, while 1 is still hospitalized for pneumonia. A standard therapy was maintained for all, except for the hospitalized patient.
CONCLUSIONS:
The prevalence and mortality of SARS-CoV-2 should spur clinicians to immediately refer heart transplant recipients suspected as having SARS-CoV2 infection to centers specializing in the care of this vulnerable population.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Coronavirus disease 2019 (COVID-19) in the heart transplant population: a single-centre experience.
Eur J Cardiothorac Surg2020 Nov;58(5):899-906. doi: 10.1093/ejcts/ezaa323.
Caraffa Raphael, Bagozzi Lorenzo, Fiocco Alessandro, Bifulco Olimpia, Nadali Matteo, Ponzoni Matteo, Carrozzini Massimiliano, Toscano Giuseppe, Fraiese Angela Pompea, Metra Marco, Lombardi Carlo Maria, Serafini Francesco, Ribola Angela, Jorgji Vjola, Bottio Tomaso, Gerosa Gino
Abstract
OBJECTIVES:
Few anecdotal cases have been reported in the literature regarding heart transplant recipients and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report our experience with 6 patients hospitalized in Northern Italy during the outbreak.
METHODS:
Of the 396 living heart transplant recipients from 1985 to 2020 included in the study, 6 patients developed the novel 2019 coronavirus disease. Risk factors, last follow-up characteristics, onset presentation, in-hospital course of disease and blood examinations data were collected for these patients.
RESULTS:
All patients were symptomatic and had positive results from a nasopharyngeal swab test for SARS-CoV-2. Of the 6 patients, 5 were hospitalized and 1 remained self-quarantined at home. Two patients died and 3 were discharged home. Two patients were admittted to the intensive care unit . Immunosuppressive therapy was modified with a median reduction comprising doses that were 50% cyclosporine and 50% mycophenolate. All patients received a medium-dose of corticosteroids as a bolus medication in addition to their therapy. All hospitalized patients received hydroxychloroquine; 2 patients received ritonavir/lopinavir. Broad-spectrum antibiotics for prophylaxis were administered to all. One patient had an ischaemic stroke and died of sepsis.
CONCLUSIONS:
In the absence of any strong evidence regarding the treatment of heart transplant recipients infected with SARS-CoV-2, we faced a new challenge in managing viral infection in an immunosuppressed population. Because immunomodulation interaction with the infection seems to be crucial for developing severe forms of the disease, we managed to reduce immunosuppressive therapy by adding medium doses of corticosteroids. Despite the limited number of affected patients, this report suggests that special considerations should be given to treating coronavirus disease in the heart transplant recipient population.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Heart transplant in a dissecated patient: could be a potential contraindication?
J Cardiovasc Med (Hagerstown)2021 Mar;22(3):225-227. doi: 10.2459/JCM.0000000000001039.
Cibin Giorgia, Carrozzini Massimiliano, Bejko Jonida, Tarzia Vincenzo, Gerosa Gino, Bottio Tomaso
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Heart transplantation management in northern Italy during COVID-19 pandemic: single-centre experience.
ESC Heart Fail2020 Oct;7(5):2003-2006. doi: 10.1002/ehf2.12874.
Fiocco Alessandro, Ponzoni Matteo, Caraffa Raphael, Carrozzini Massimiliano, Bagozzi Lorenzo, Nadali Matteo, Bifulco Olimpia, Toscano Giuseppe, Fraiese Angela Pompea, Bottio Tomaso, Gerosa Gino
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Aortic dissection during heart transplant: when a nightmare comes true.
J Cardiovasc Med (Hagerstown)2020 Nov;21(11):915-916. doi: 10.2459/JCM.0000000000000994.
Cibin Giorgia, Carrozzini Massimiliano, Bejko Jonida, Colli Andrea, Gerosa Gino, Bottio Tomaso
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Outcomes of patients with continuous flow left ventricular assist device undergoing emergency endovascular treatment for atraumatic bleeding.
CVIR Endovasc2019 Dec;2(1):40. doi: 40.
Bernardinello Valentina, Barbiero Giulio, Battistel Michele, Dengo Caterina, Stramare Roberto, Folino Giulio, Bejko Jonida, Carrozzini Massimiliano, Tarzia Vincenzo, Gerosa Gino, Bottio Tomaso
Abstract
INTRODUCTION:
Severe spontaneous bleeding is a significant complication in patients with continuous flow left ventricular assist devices; there is little evidence on endovascular treatment to support its use.
MATERIALS AND METHODS:
We observed seven patients (five men, two women, age 43-67?years) with continuous flow left ventricular assist devices on antiaggregant/coagulant therapy, admitted to our hospital for uncorrectable symptomatic anemia; CT-angiography and diagnostic angiography confirmed the presence of atraumatic arterious bleeding from the gastrointestinal tract (six patients), from the intercostal artery and from the bronchial tree (one patient).
RESULTS:
All patients where successfully treated via an endovascular approach with superselective embolization of the involved arterial branches with coils and particles.
CONCLUSION:
Spontaneous atraumatic bleeding is a frequent complication in patients with continuous flow left ventricular assist devices; endovascular treatment represents a promising alternative to the surgical approach as it is less invasive, easily repeatable and associated to a reduced procedural risk.
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Transfemoral aortic valve replacement as a solution in aortic valve stenosis and coronary artery fistulas.
J Thorac Cardiovasc Surg2020 Jan;159(1):e27-e29. doi: 10.1016/j.jtcvs.2019.04.025.
Folino Giulio, Bernardinello Valentina, Carrozzini Massimiliano, Bejko Jonida, Gerosa Gino, Bottio Tomaso
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How to implant the Jarvik 2000 post-auricular driveline: evolution to a novel technique.
J Artif Organs2019 Sep;22(3):188-193. doi: 10.1007/s10047-019-01104-8.
Carrozzini Massimiliano, Bejko Jonida, Gregori Dario, Gerosa Gino, Bottio Tomaso
Abstract
The post-auricular (PA) driveline positioning for percutaneous power delivery is a specific feature of the Jarvik 2000 FlowMaker LVAD. We applied several technical refinements to optimise the PA implant. Here, we present and discuss these modifications. We retrospectively reviewed all patients implanted with Jarvik 2000 at our Institution. Different PA implant techniques were described. A machine learning analysis was performed to evaluate the determinants of driveline infection. From December 2008 to December 2017, 62 patients were implanted with Jarvik 2000, at our Institution. The PA connection was managed through the "question mark-shaped" incision in 24 patients (39%) and with the "C-shaped" in 18 (29%), whereas 10 (16%) cases received the "vertical incision" and 10 (16%) the "orthogonal incision". The implant technique resulted highly predictive of driveline infection. The rate of driveline infections was numerically lower among cases managed with the last two techniques. After evolving through different implant techniques, we propose and suggest the "orthogonal incision" to maximise the advantages of the Jarvik 2000 post-auricular driveline.
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Bilateral mini-thoracotomy approach for minimally invasive implantation of HeartMate 3.
Artif Organs2019 Jun;43(6):593-595. doi: 10.1111/aor.13387.
Carrozzini Massimiliano, Bejko Jonida, Gerosa Gino, Bottio Tomaso
Abstract
Left ventricular assist devices (LVADs) are an established option for the treatment of end-stage heart failure. Last-generation devices are characterized by a miniaturized pump size, allowing for intra-pericardial placement. This feature enabled the introduction of less-invasive implantation techniques, which have been linked to many favorable effects. The HeartMate 3 LVAD is a continuous-flow centrifugal pump, recently introduced for clinical use. Here, we describe the minimally invasive implantation of the HeartMate 3 through a bilateral mini-thoracotomy.
© 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
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Results of new-generation intrapericardial continuous flow left ventricular assist devices as a bridge-to-transplant.
J Cardiovasc Med (Hagerstown)2018 Dec;19(12):739-747. doi: 10.2459/JCM.0000000000000721.
Carrozzini Massimiliano, Bejko Jonida, Gambino Antonio, Tarzia Vincenzo, Lanera Corrado, Gregori Dario, Gerosa Gino, Bottio Tomaso
Abstract
AIMS:
We analysed the outcomes with the use of a new-generation continuous-flow left ventricular assist device (CF-LVAD) as a bridge-to-transplant (BTT).
MATERIALS AND METHODS:
We included all patients implanted with an intrapericardial CF-LVAD as BTT, between January 2012 and December 2016. Primary outcomes were overall survival, survival on waiting list and postheart transplant (HTx) survival. The outcomes after HTx were compared with those of a contemporary cohort of patients transplanted without previous CF-LVAD (No-LVAD group, n?=?73).
RESULTS:
We included 53 patients with a median age of 52 years (interquartile range: 43-59 years). Seventy-two percent were in INTERMACS profile 1-2 before implant; all entered the HTx waiting list after receiving the CF-LVAD. HTx was performed in 42 (79%) cases (LVAD group). Overall estimated survival (considering both pre-HTx and post-HTx) was 89% [95% confidence interval (CI) 81-98%] at 1 year and 80% (CI 70-92%) at 2 years. The estimated survival on waiting list was 91% (CI 80-100%) at 6 months, whereas the 1-year estimated post-HTx survival was 88% (CI 79-98%). The Kaplan-Meier curves of survival after HTx of LVAD versus No-LVAD group were comparable (log-rank P?=?0.54), as well as the rates of post-HTx adverse events. A multivariable model of survival after HTx, accounting for the most relevant patient characteristics, identified LVAD use as a significant protective factor [LVAD versus No-LVAD hazard ratio 0.22 (CI 0.06-0.91)].
CONCLUSION:
The use of new-generation intrapericardial CF-LVADs as a BTT resulted, in our series, in satisfactory pre-HTx and post-HTx outcomes.
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Minimally Invasive Implantation of Continuous Flow Left Ventricular Assist Devices: The Evolution of Surgical Techniques in a Single-Center Experience.
Artif Organs2019 Mar;43(3):E41-E52. doi: 10.1111/aor.13339.
Carrozzini Massimiliano, Bejko Jonida, Guariento Alvise, Rubino Maurizio, Bianco Roberto, Tarzia Vincenzo, Gregori Dario, Bottio Tomaso, Gerosa Gino
Abstract
In this work we aimed to evaluate the evolution of our surgical experience with the implantation of a continuous flow left ventricular assist device (LVAD), from the original full sternotomy approach to less invasive surgical strategies including mini-sternotomy and/or mini-thoracotomies. We reviewed all consecutive patients implanted with a continuous flow LVAD at our Institute. To exclude the possible bias related to the device used, out of 91 collected LVADs implants, we selected only those patients (n = 42) who received, between 2012 and 2015, the HeartWare HVAD. The analysis focused on the surgical approach used for the LVAD implant. Most of the patients (95%) were affected by dilated or ischemic cardiomyopathy, with an INTERMACS class I-II in the majority of cases (77%). The LVAD implant was performed through a full sternotomy in 10 patients (24%); the remaining 32 cases (76%) were managed with minimally invasive procedures. These were left mini-thoracotomy with upper mini-sternotomy (20 patients, 62%), right and left mini-thoracotomy (7 patients, 22%), and a recently developed left mini-thoracotomy with outflow graft anastomosis to the left axillary artery (5 patients, 16%). The most common adverse event on device was right heart failure (26%). Eighteen patients (43%) were transplanted. Overall estimated 24 months survival (on device or after transplant) was 68 ± 7%. The causal analysis, adjusted by propensity score weighting baseline data and sample size, showed that left mini-thoracotomy with outflow anastomosis to the left axillary artery resulted in a significantly reduced rate of post implant right heart failure (P
© 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
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Repair Techniques for Mitral Valve Insufficiency in Children.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu2018 Mar;21():41-45. doi: 10.1053/j.pcsu.2017.11.004.
Vida Vladimiro L, Zanotto Lorenza, Carrozzini Massimiliano, Padalino Massimo A, Stellin Giovanni
Abstract
Congenital mitral valve (MV) dysplasia is a relatively rare and highly complex cardiac disease. We sought to provide a comprehensive analysis of the current surgical techniques for treating mitral valve insufficiency and the results of mitral valve repair at our institution. Between 1972 and 2017, 104 consecutive patients underwent surgical repair of congenital MV dysplasia-insufficiency at our institution. Among these, 59 patients presented with MV insufficiency (or prevalent MV insufficiency) and were part of the study. There was 1 early (1.7%) and 1 late death (1.7%). Survival at 5, 10 and 20 years was 98%, 98% and 94%, respectively. Eight patients (14%) required MV replacement for residual significant MV insufficiency. Freedom from re-intervention for MV dysfunction at 5, 10 and 20 years were 89%, 84% and 79%, respectively. Surgical techniques for treating mitral valve insufficiency must be tailored for each patient with the main goal of achieving a proper valve function, rather than a "normal" anatomy. The mechanism underlying valve dysfunction in congenital mitral valve insufficiency is multifactorial and requires the application of a variety of surgical techniques in each case.
Copyright © 2017 Elsevier Inc. All rights reserved.
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Irreversible cardiac failure with intraventricular thrombosis: A novel technique of paracorporeal biventricular assist device implantation with ventricles excision.
J Thorac Cardiovasc Surg2018 Apr;155(4):1632-1634. doi: 10.1016/j.jtcvs.2017.11.085.
Carrozzini Massimiliano, Toto Francesca, Gerosa Gino, Bottio Tomaso
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Acute DeBakey Type I aortic dissection without intimal tear in the arch: is total arch replacement the right choice?
Interact Cardiovasc Thorac Surg2018 Jan;26(1):84-90. doi: 10.1093/icvts/ivx229.
Colli Andrea, Carrozzini Massimiliano, Francescato Annalisa, Galuppo Marco, Comisso Marina, Toto Francesca, Gregori Dario, Gerosa Gino
Abstract
OBJECTIVES:
Surgical management of acute DeBakey Type I aortic dissection without intimal tear in the aortic arch is controversial. This study compared short- and long-term outcomes of total arch replacement (TAR) versus limited ascending aorta/hemiarch replacement (no-TAR) in a consecutive series of patients.
METHODS:
Between January 1998 and December 2015, 220 consecutive patients were operated for DeBakey Type I acute aortic dissection; 135 cases did not exhibit an intimal entry tear in the aortic arch and were subsequently selected to comprise the primary study cohort. A secondary subgroup analysis was made within these 135 cases, which comprised patients who received antegrade cerebral perfusion as the neuroprotective strategy of choice (n?=?45).
RESULTS:
Mean follow-up period was 5?±?4?years. Among the patients selected, 21 (16%) underwent TAR. Thirty-day mortality was higher in the TAR group (38% vs 21%, P?=?0.04). Postoperative complication rates were similar between the groups (61% vs 73%, P?=?0.31). Long-term mortality and late aortic reintervention rates were also similar (7% vs 30%, P?=?0.36 and 27% vs 14%, P?=?0.32, respectively). From the subgroup of patients with antegrade cerebral perfusion, 14 (31%) underwent TAR and 31 (69%) had no-TAR. Mean follow-up-time was 3?±?2?years. Thirty-day mortality was higher in the TAR group (50% vs 16%, P?0.01), postoperative complications, long-term mortality and late aortic reintervention rates were similar (64% vs 69%, P?=?0.73; 0% vs 19%, P?=?0.22; 29% vs 8%, P?=?0.17, respectively).
CONCLUSIONS:
TAR was associated with higher 30-day mortality compared with the less extensive hemiarch replacement. In the long term, TAR showed a trend of improved survival and higher reintervention rate.
© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Vacuum-Assisted Closure Therapy for the Treatment of Poststernotomy Wound Dehiscence in Neonates and Infants.
Thorac Cardiovasc Surg2019 Jan;67(1):55-57. doi: 10.1055/s-0037-1603933.
Padalino Massimo A, Carrozzini Massimiliano, Vida Vladimiro, Stellin Giovanni
Abstract
We sought to analyze effectiveness and results of a vacuum-assisted closure system for the treatment of sternal wound dehiscence in newborns and children after cardiac surgery in our institution. Six patients with poststernotomy wound problems (large defects of epithelialization or mediastinitis) were treated with a vacuum-assisted closure (VAC) therapy. Median age was 5 months (range: 1-144); VAC therapy was started with negative pressure -75 mm Hg, continuously. All children achieved healing of the sternal wound and a subsequent closure after a median length of treatment of 8.3 days (range: 4-14). In conclusion, VAC therapy with high negative pressure is safe, effective, and is a well-tolerated therapy in pediatric patients with either early- or late poststernotomy wound dehiscence.
Georg Thieme Verlag KG Stuttgart · New York.
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Surgical Treatment of Congenital Mitral Valve Dysplasia.
J Card Surg2016 May;31(5):352-6. doi: 10.1111/jocs.12743.
Vida Vladimiro L, Carrozzini Massimiliano, Padalino Massimo, Milanesi Ornella, Stellin Giovanni
Abstract
BACKGROUND AND AIM OF THE STUDY:
Congenital mitral valve (MV) dysplasia is a relatively rare and highly complex cardiac disease. We present our results and illustrate the techniques used to repair these valves.
METHODS:
Between 1972 and 2014, 100 consecutive patients underwent surgical repair of congenital MV dysplasia at our institution. Predominant MV regurgitation was present in 53 patients (53%) whereas mitral stenosis was prevalent in 47 (47%).
RESULTS:
There were five early (5%) and eight late deaths (9%). Actuarial survival was 95%, 94%, and 93% at 5, 10, and 20 years, respectively. Sixteen patients (18%) required reintervention due to subsequent MV dysfunction. Actuarial freedom from reintervention for MV dysfunction was 95%, 92%, and 89% at 5, 10, and 20 years, respectively.
CONCLUSIONS:
The mechanism underlying the valve dysfunction in congenital mitral valve dysplasia is multifactorial and requires the application of a variety of surgical techniques for repair. doi: 10.1111/jocs.12743 (J Card Surg 2016;31:352-356).
© 2016 Wiley Periodicals, Inc.
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Coronary Artery Bypass Grafting in Elderly Patients: Insights from a Comparative Analysis of Total Arterial and Conventional Revascularization.
J Cardiovasc Transl Res2016 Jun;9(3):223-229. doi: 10.1007/s12265-016-9688-y.
Bortolussi Giacomo, Bejko Jonida, Gallo Michele, Comisso Marina, Carrozzini Massimiliano, Guglielmi Cosimo, Testolin Luca, Toscano Giuseppe, Rubino Maurizio, Bianco Roberto, Tarzia Vincenzo, Gerosa Gino, Bottio Tomaso
Abstract
The benefits of total arterial (TAR) versus conventional (CR) revascularization are controversial in the higher-risk cohort of elderly patients. Taking for granted its benefit on long-term survival, we evaluated the effect of TAR on safety (death, myocardial infarction, and stroke) of patients undergoing CABG. Between 2000 and 2009, 487 patients >75 years underwent isolated CABG at our institution (150 TAR and 337 CR). Patients with arterial free-grafts were excluded. After propensity matching, the outcomes of 131 TAR and 127 CR patients were compared. TAR patients had lower incidence of post-operative myocardial infarction (p?=?0.025) and stroke (p?=?0.005). They also experienced shorter intensive care unit (p?=?0.046) and ward stay (p?=?0.028), lower output of TnI (p?=?0.035), and less wound complications (leg included) (p?=?0.0001), while mortality was comparable (p?=?0.57). In our cohort of elderly patients with multivessel disease, TAR was associated with lower rates of myocardial infarction, stroke, and shorter hospital stay.
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Analysis of early and long-term outcomes of acute type A aortic dissection according to the new international aortic arch surgery study group recommendations.
Heart Vessels2016 Oct;31(10):1616-24. doi: 10.1007/s00380-015-0770-1.
Colli Andrea, Carrozzini Massimiliano, Galuppo Marco, Comisso Marina, Toto Francesca, Gregori Dario, Gerosa Gino
Abstract
To evaluate predictors of early and long-term outcomes of surgical repair of acute Type A aortic dissection. Retrospective single-centre study evaluating patients surgically treated between 1998 and 2013. Clinical follow-up was performed. Complications were classified according to the International Aortic Arch Surgery Study Group recommendations. Statistical analysis included univariate and multivariate analysis of preoperative and operative data. One hundred eighty-five patients were evaluated. The follow-up was complete for 180 patients (97 %). Mean age was 63 years, 82 % had a DeBakey type I aortic dissection, 18 % a type II. Eleven patients (6 %) died intraoperatively, 119 of the remaining (68 %) had postoperative complications. Thirty-day mortality was 21 % (38 patients). Average ICU and hospital stay were 6 and 14 days, respectively. During a mean follow-up time of 6 ± 4 years we observed 44 deaths (31 %). Twenty patients (14 %) needed late thoracic aorta reoperation. Results from the multivariate analysis are as follows. Thirty-day mortality was associated with abdominal pain at presentation (p
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Comparison of Efficacy and Cost of Iodine Impregnated Drape vs. Standard Drape in Cardiac Surgery: Study in 5100 Patients.
J Cardiovasc Transl Res2015 Oct;8(7):431-7. doi: 10.1007/s12265-015-9653-1.
Bejko Jonida, Tarzia Vincenzo, Carrozzini Massimiliano, Gallo Michele, Bortolussi Giacomo, Comisso Marina, Testolin Luca, Guglielmi Cosimo, De Franceschi Marco, Bianco Roberto, Gerosa Gino, Bottio Tomaso
Abstract
We sought to examine the efficacy in preventing surgical site infection (SSI) in cardiac surgery, using two different incise drapes (not iodine-impregnated and iodine-impregnated). A cost analysis was also considered. Between January 2008 and March 2015, 5100 consecutive cardiac surgery patients, who underwent surgery in our Institute, were prospectively collected. A total of 3320 patients received a standard not iodine-impregnated steri-drape (group A), and 1780 patients received Ioban(®) 2 drape (group B). We investigated, by a propensity matched analysis, whether the use of standard incise drape or iodine-impregnated drape would impact upon SSI rate. Totally, 808 patients for each group were matched for the available risk factors. Overall incidence of SSI was significantly higher in group A (6.5 versus 1.9 %) (p?=?0.001). Superficial SSI incidence was significantly higher in group A (5.1 vs 1.6 %) (p?=?0.002). Deep SSI resulted higher in group A (1.4 %) than in group B (0.4 %), although not significantly (p?=?0.11). Consequently, the need for vacuum-assisted closure (VAC) therapy use resulted 4.3 % in group A versus 1.2 % in group B (p?=?0.001). Overall costs for groups A and B were 12.494.912 ? and 11.721.417 ?, respectively. The Ioban(®) 2 offered totally 773.495 ? cost savings compared to standard steri-drape. Ioban 2 drape assured a significantly lower incidence of SSI. Additionally, Ioban(®) 2 drape proved to be cost-effective in cardiac surgery.
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Extracorporeal life support in cardiogenic shock: Impact of acute versus chronic etiology on outcome.
J Thorac Cardiovasc Surg2015 Aug;150(2):333-40. doi: 10.1016/j.jtcvs.2015.02.043.
Tarzia Vincenzo, Bortolussi Giacomo, Bianco Roberto, Buratto Edward, Bejko Jonida, Carrozzini Massimiliano, De Franceschi Marco, Gregori Dario, Fichera Dario, Zanella Fabio, Bottio Tomaso, Gerosa Gino
Abstract
BACKGROUND:
The role of extracorporeal life support (ECLS) in primary cardiogenic shock (PCS) is well established. In this study, we evaluated the impact of etiology on outcomes.
METHODS:
Between January 2009 and March 2013, we implanted a total of 249 patients with ECLS; we focused on 64 patients for whom peripheral ECLS was the treatment for PCS. Of these, 37 cases (58%) were "acute" (mostly acute myocardial infarction: 39%); 27 (42%) had an exacerbation of "chronic" heart failure (dilated cardiomyopathy: 30%; post-ischemic cardiomyopathy: 9%; and congenital: 3%).
RESULTS:
In the group with chronic etiology, 23 patients were bridged to a left ventricular assist device (52%) or heart transplantation (33%). In the group with acute etiology, ECLS was used as a bridge-to-transplantation in 3 patients (8%), a bridge-to-bridge in 9 (24%), and a bridge-to-recovery in 18 (49%). One patient in each group was bridged to conventional surgery. Recovery of cardiac function was achieved in only the group with acute primary cardiogenic shock (18 vs 0 patients, P = .0001). A mean flow during support of ?60% of the theoretic flow (body surface area × 2.4) was a predictor of successful weaning (P = .02). Median duration of ECLS support was 7 days (range: 2-11.5 days). Nine patients (14%) died during support; 30-day overall survival was 80% (51 of 64 patients); and 59% of patients were discharged, in whom survival at 48 months was 90%. Thirty-day survival was correlated with duration of ECLS support.
CONCLUSIONS:
In "chronic" heart failure, ECLS represents a bridge to a ventricular assist device or heart transplantation, whereas in "acute" settings, it offers a considerable chance of recovery, and is often the only required therapy.
Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
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Italian multicentre study on type A acute aortic dissection: a 33-year follow-up?.
Eur J Cardiothorac Surg2016 Jan;49(1):125-31. doi: 10.1093/ejcts/ezv048.
Russo Claudio F, Mariscalco Giovanni, Colli Andrea, Santè Pasquale, Nicolini Francesco, Miceli Antonio, De Chiara Benedetta, Beghi Cesare, Gerosa Gino, Glauber Mattia, Gherli Tiziano, Nappi Gianantonio, Murzi Michele, Molardi Alberto, Merlanti Bruno, Vizzardi Enrico, Bonadei Ivano, Coletti Giuseppe, Carrozzini Massimiliano, Gelsomino Sandro, Caiazzo Antonio, Lorusso Roberto
Abstract
OBJECTIVES:
Despite substantial progress in surgical techniques and perioperative management, the treatment and long-term follow-up of type A acute aortic dissection (AAD) still remain a major challenge. The objective of this retrospective, multicentre study was to assess in a large series of patients the early and long-term results after surgery for type A AAD.
METHODS:
We analysed the preoperative, intraoperative and postoperative conditions of 1.148 consecutive patients surgically treated in seven large referral centres from 1981 to 2013. We applied to each patient three different multi-parameter risk profiles (preadmission risk, admission risk and post-surgery risk) in order to compare risk factors and outcome. Long-term Kaplan-Meier survival was evaluated.
RESULTS:
The median age was 64 years and the male population was predominant (66%). Identified diagnosis of collagen disease was present in 9%, and Marfan syndrome in 5%. Bicuspid aortic valve was present in 69 patients (6%). Previous cardiac surgery was identified in 10% of the patients. During surgery, the native aortic valve was preserved in 72% of the cases, including leaflet resuspension in 23% and David operation in 1.2%. Considering aortic valve replacement (AVR: 28%), bioprosthesis implantation was performed in 14.7% of the subjects. Neurological impairment at discharge was shown in 23% of the cases among which 21% of patients had new neurological impairment versus preoperative conditions. The overall 30-day mortality rate was 25.7%. All risk profiles remained independently associated with in-hospital mortality. During the available follow-up of hospital survivors (median: 70 months, interquartile range: 34-113, maximum: 396), cardiac-related death occurred in 7.9% of the subjects. The cumulative survival rate for cardiac death was 95.3% at 5 years, 92.8% at 10 years and 52.8% at 20 years. Severe aortic regurgitation (AR) (grade 3-4) at the time of surgery showed to be a significant risk factor for reintervention during the follow-up (P
CONCLUSIONS:
Although surgery for type A has remained challenging over more than three decades, there is a positive trend in terms of hospital mortality and long-term follow-up. About 90% of patients were free from reoperation in the long term, although late AR remains a critical issue, suggesting that a thorough debate on surgical options, assessment and results of a conservative approach should be considered.
© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Impact of vacuum-assisted closure therapy on outcomes of sternal wound dehiscence?.
Interact Cardiovasc Thorac Surg2014 Jul;19(1):70-5. doi: 10.1093/icvts/ivu101.
Tarzia Vincenzo, Carrozzini Massimiliano, Bortolussi Giacomo, Buratto Edward, Bejko Jonida, Comisso Marina, Mescola Valentina, Penzo Valentina, Guarino Mauro, De Franceschi Marco, Pagnin Chiara, Castoro Massimo, Guglielmi Cosimo, Testolin Luca, Bottio Tomaso, Gerosa Gino
Abstract
OBJECTIVES:
Sternal wound dehiscence (SWD) after cardiac surgery is a rare but serious condition associated with considerable costs and morbidity. We sought to evaluate the results of the introduction of vacuum-assisted closure (VAC) therapy in the management of sternal wound dehiscence, compared with those of previous conventional treatments.
METHODS:
We retrospectively collected 7148 patients who underwent cardiac surgery at our institution between January 2002 and June 2012. A total of 152 (2.1%) patients had a sternal wound dehiscence: 107 were treated with conventional treatments (Group A) and 45 were managed with VAC therapy (Group B). Patients were stratified according to preoperative risk factors and type of sternal wound dehiscence (superficial or deep; infected or not) and compared by means of a propensity-matched analysis. A cost analysis was also performed.
RESULTS:
Forty-five patients of each group matched for all preoperative risk factors and type of sternal wound dehiscence. SWD-related mortality rate was significantly lower in Group B (11 vs 0%; P = 0.05). Incidence of mediastinitis (P
CONCLUSIONS:
In our experience, the use of VAC therapy for the management of SWD was considerably effective in decreasing mortality (SWD related), incidence of complications and need for surgical procedures; thus, leading to a significant reduction of costs.
© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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