SOSTIENICI
Dott. Michele Mondino
Pubblicazioni Scientifiche 
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[ANMCO Position paper: Care pathway for advanced heart failure patients candidate for heart transplantation/ventricular assist device].
G Ital Cardiol (Rome)2022 May;23(5):340-378. doi: 10.1714/3796.37817.
Iacoviello Massimo, Cipriani Manlio, Valente Serafina, Marini Marco, Ammirati Enrico, Benvenuto Manuela, Cassaniti Leonarda Rosaria, De Maria Renata, Gori Mauro, Municinò Annamaria, Navazio Alessandro, Amodeo Vincenzo, Aspromonte Nadia, Barili Fabio, Casolo Giancarlo, Clemenza Francesco, Di Eusanio Marco, Di Lenarda Andrea, Di Tano Giuseppe, Domenicucci Stefano, Faggian Giuseppe, Francese Giuseppina Maura, Frongillo Doriana, Gilardi Rossella, Iacovoni Attilio, Imazio Massimo, Livi Ugolino, Maiello Ciro, Milano Aldo, Mondino Michele, Moreo Antonella Maurizia, Mortara Andrea, Murrone Adriano, Palmieri Vittorio, Pelenghi Stefano, Pini Daniela, Pistono Massimo, Porcu Maurizio, Potena Luciano, Rinaldi Mauro, Romanò Massimo, Roncon Loris, Rossini Roberta, Russo Claudio Francesco, Scotto di Uccio Fortunato, Urbinati Stefano, Zecchin Massimo, Caldarola Pasquale, Oliveti Alessandra, Frigerio Maria, Musumeci Francesco, Gulizia Michele Massimo, Oliva Fabrizio, Gabrielli Domenico, Colivicchi Furio
Abstract
Heart failure is a complex clinical syndrome with a severe prognosis, despite therapeutic progress. The management of the advanced stages of the syndrome is particularly complex in patients who are referred to palliative care as well as in those who are candidates for cardiac replacement therapy. For the latter group, a prompt recognition of the transition to the advanced stage as well as an early referral to the centers for cardiac replacement therapy are essential elements to ensure that patients follow the most appropriate diagnostic-therapeutic pathway. The aim of this document is to focus on the main diagnostic and therapeutic aspects related to the advanced stages of heart failure and, in particular, on the management of patients who are candidates for cardiac replacement therapy.
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Oxygen Partial Pressure in Cerebrospinal Fluid as a Potential Parameter to Identify Spinal Cord Ischaemia.
Eur J Vasc Endovasc Surg2022 Feb;63(2):352-353. doi: S1078-5884(21)00762-0.
Monzio-Compagnoni Nicola, Romani Federico, Mondino Michele G, Rampoldi Antonio G, Trimarchi Santi, Tolva Valerio S
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Successful recovery from severe inverted Takotsubo cardiomyopathy after liver transplantation: the efficacy of extracorporeal membrane oxygenation (ECMO).
Minerva Anestesiol2022 03;88(3):199-201. doi: 10.23736/S0375-9393.21.16140-1.
Lauterio Andrea, Bottiroli Maurizio, Cannata Aldo, DE Carlis Riccardo, Valsecchi Mila, Perricone Giovanni, Colombo Stefania, Buscemi Vincenzo, Zaniboni Matteo, Pedrazzini Giovanna, Mondino Michele, Russo Claudio, Fumagalli Roberto, DE Carlis Luciano
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Tracheostomy in Mechanically Ventilated Patients With SARS-CoV-2-ARDS: Focus on Tracheomalacia.
Respir Care2021 12;66(12):1797-1804. doi: 10.4187/respcare.09063.
Guarnieri Marcello, Andreoni Patrizia, Gay Hedwige, Giudici Riccardo, Bottiroli Maurizio, Mondino Michele, Casella Gianpaolo, Chiara Osvaldo, Morelli Oscar, Conforti Serena, Langer Thomas, Fumagalli Roberto
Abstract
BACKGROUND:
The SARS-CoV-2 pandemic increased the number of patients needing invasive mechanical ventilation, either through an endotracheal tube or through a tracheostomy. Tracheomalacia is a rare but potentially severe complication of mechanical ventilation, which can significantly complicate the weaning process. The aim of this study was to describe the strategies of airway management in mechanically ventilated patients with respiratory failure due to SARS-CoV-2, the incidence of severe tracheomalacia, and investigate the factors associated with its occurrence.
METHODS:
This retrospective, single-center study was performed in an Italian teaching hospital. All adult subjects admitted to the ICU between February 24, 2020, and June 30, 2020, treated with invasive mechanical ventilation for respiratory failure caused by SARS-CoV-2 were included. Clinical data were collected on the day of ICU admission, whereas information regarding airway management was collected daily.
RESULTS:
A total of 151 subjects were included in the study. On admission, ARDS severity was mild in 21%, moderate in 62%, and severe in 17% of the cases, with an overall mortality of 40%. A tracheostomy was performed in 73 (48%), open surgical technique in 54 (74%), and percutaneous Ciaglia technique in 19 (26%). Subjects who had a tracheostomy performed had, compared to the other subjects, a longer duration of mechanical ventilation and longer ICU and hospital stay. Tracheomalacia was diagnosed in 8 (5%). The factors associated with tracheomalacia were female sex, obesity, and tracheostomy.
CONCLUSIONS:
In our population, approximately 50% of subjects with ARDS due to SARS-CoV-2 were tracheostomized. Tracheostomized subjects had a longer ICU and hospital stay. In our population, 5% were diagnosed with tracheomalacia. This percentage is 10 times higher than what is reported in available literature, and the underlying mechanisms are not fully understood.
Copyright © 2021 by Daedalus Enterprises.
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Emergency cardiac imaging for coronavirus disease 2019 (COVID-19) in practice: a case of takotsubo stress cardiomyopathy.
Cardiovasc Ultrasound2021 Aug;19(1):31. doi: 10.1186/s12947-021-00251-4.
Belli Oriana, Ardissino Maddalena, Bottiroli Maurizio, Soriano Francesco, Blanda Calogero, Oreglia Jacopo, Mondino Michele, Moreo Antonella
Abstract
BACKGROUND:
Cardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of 'takotsubo' stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit. An intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing.
CONCLUSION:
This case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.
© 2021. The Author(s).
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The repurposed use of anesthesia machines to ventilate critically ill patients with coronavirus disease 2019 (COVID-19).
BMC Anesthesiol2021 05;21(1):155. doi: 10.1186/s12871-021-01376-9.
Bottiroli Maurizio, Calini Angelo, Pinciroli Riccardo, Mueller Ariel, Siragusa Antonio, Anelli Carlo, Urman Richard D, Nozari Ala, Berra Lorenzo, Mondino Michele, Fumagalli Roberto
Abstract
BACKGROUND:
The surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice.
METHODS:
We designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group.
RESULTS:
Complete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p?=?0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75-9.33, p?=?0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns.
CONCLUSIONS:
Our results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic.
CLINICAL TRIAL NUMBER:
Not applicable.
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Percutaneous RVAD with the Protek Duo for severe right ventricular primary graft dysfunction after heart transplant.
J Heart Lung Transplant2021 07;40(7):580-583. doi: S1053-2498(21)02242-7.
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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The repurposed use of anesthesia machines to ventilate critically ill patients with Coronavirus Disease 2019 (COVID-19).
Res Sq2021 Feb;():. doi: rs.3.rs-228821.
Bottiroli Maurizio, Calini Angelo, Pinciroli Riccardo, Mueller Ariel, Siragusa Antonio, Anelli Carlo, Urman Richard, Nozari Ala, Berra Lorenzo, Mondino Michele, Fumagalli Roberto
Abstract
BackgroundThe surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice.MethodsWe designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group.ResultsComplete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p?=?0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75-9.33, p?=?0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns.ConclusionsOur results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic.Clinical Trial NumberNot applicable.
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Outcome of patients on heart transplant list treated with a continuous-flow left ventricular assist device: Insights from the TRans-Atlantic registry on VAd and TrAnsplant (TRAViATA).
Int J Cardiol2021 02;324():122-130. doi: S0167-5273(20)33807-9.
Ammirati Enrico, Brambatti Michela, Braun Oscar Ö, Shah Palak, Cipriani Manlio, Bui Quan M, Veenis Jesse, Lee Euyhyun, Xu Ronghui, Hong Kimberly N, Van de Heyning Caroline M, Perna Enrico, Timmermans Philippe, Cikes Maja, Brugts Jasper J, Veronese Giacomo, Minto Jonathan, Smith Saige, Gjesdal Grunde, Gernhofer Yan K, Partida Cynthia, Potena Luciano, Masetti Marco, Boschi Silvia, Loforte Antonio, Jakus Nina, Milicic Davor, Nilsson Johan, De Bock Dina, Sterken Caroline, Van den Bossche Klaartje, Rega Filip, Tran Hao, Singh Ramesh, Montomoli Jonathan, Mondino Michele, Greenberg Barry, Russo Claudio F, Pretorius Victor, Liviu Klein, Frigerio Maria, Adler Eric D
Abstract
BACKGROUND:
Geographic variations in management and outcomes of individuals supported by continuous-flow left ventricular assist devices (CF-LVAD) between the United States (US) and Europe (EU) is largely unknown.
METHODS:
We created a retrospective, multinational registry of 524 patients who received a CF-LVAD (either HVAD or Heartmate II) between January 2008 and April 2017. Follow up spanned from date of CF-LVAD implant to post-HTx period with a median follow up of 44.8 months.
RESULTS:
The cohort included 299 (57.1%) EU and 225 (42.9%) US patients. Although the US cohort was significantly older with a higher prevalence of comorbidities, survival was similar between the cohorts (US 63.1%, EU 68.4% at 5 years, unadjusted log-rank test p = 0.43).Multivariate analyses suggested that older age, higher body mass index, elevated creatinine, use of temporary mechanical circulatory support prior CF-LVAD, and implantation of HVAD were associated with increased mortality. Among CF-LVAD patients undergoing HTx, the median time on CF-LVAD support was shorter in the US, meanwhile US donors were younger. Finally, the pattern of adverse events (stroke, gastrointestinal bleedings, late right ventricular failure, and driveline infection) during support differed significantly between US and EU.
CONCLUSIONS:
Although waitlisted patients in the US on CF-LVAD have higher risk comorbid conditions, the overall outcome is similar in US and EU. Geographic variations with regards to donor characteristics, duration of CF-LVAD support prior to transplant, and adverse events on support can explain the disparity in the utilization of mechanical bridge to transplant strategy between US and EU.
Copyright © 2020 Elsevier B.V. All rights reserved.
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Takotsubo syndrome as a complication in a critically ill COVID-19 patient.
ESC Heart Fail2020 Sep;():. doi: 10.1002/ehf2.12912.
Bottiroli Maurizio, De Caria Daniele, Belli Oriana, Calini Angelo, Andreoni Patrizia, Siragusa Antonio, Moreo Antonella, Ammirati Enrico, Mondino Michele, Fumagalli Roberto
Abstract
Coronavirus disease 2019 (COVID-19) patients with cardiac injury have an increased risk of mortality. It remains to be determined the mechanism of cardiac injury and the identification of specific conditions that affect the heart during COVID-19. We present the case of a 76-year-old woman with COVID-19 pneumonia that developed a takotsubo syndrome (TTS). Although the patient presented normal left ventricular ejection fraction and normal levels of troponin on admission, after 16 days in intensive care unit due to respiratory distress, she suddenly developed cardiogenic shock. Shock occurred few hours after a spontaneous breathing trial through her tracheostomy. Bed-side echocardiographic revealed apical ballooning promptly supporting the diagnosis of TTS. She was successfully treated with deep sedation and low dosage of epinephrine. The relevance of this case is that TTS can occur in the late phase of COVID-19. Awareness of late TTS and bed-side echocardiographic evaluation can lead to prompt identification and treatment.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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Safety and efficacy of anti-il6-receptor tocilizumab use in severe and critical patients affected by coronavirus disease 2019: A comparative analysis.
J Infect2020 10;81(4):e11-e17. doi: S0163-4453(20)30467-9.
Rossotti Roberto, Travi Giovanna, Ughi Nicola, Corradin Matteo, Baiguera Chiara, Fumagalli Roberto, Bottiroli Maurizio, Mondino Michele, Merli Marco, Bellone Andrea, Basile Andriano, Ruggeri Ruggero, Colombo Fabrizio, Moreno Mauro, Pastori Stefano, Perno Carlo Federico, Tarsia Paolo, Epis Oscar Massimiliano, Puoti Massimo,
Abstract
BACKGROUND:
As the novel SARS-CoV-2 pandemic occurred, no specific treatment was yet available. Inflammatory response secondary to viral infection might be the driver of severe diseases. We report the safety and efficacy (in terms of overall survival and hospital discharge) of the anti-IL6 tocilizumab (TCZ) in subjects with COVID-19.
METHODS:
This retrospective, single-center analysis included all the patients consecutively admitted to our Hospital with severe or critical COVID-19 who started TCZ treatment from March 13th to April 03rd, 2020. A 1:2 matching to patients not treated with TCZ was performed according to age, sex, severity of disease, P/F, Charlson Comorbidity Index and length of time between symptoms onset and hospital admittance. Descriptive statistics and non-parametric tests to compare the groups were applied. Kaplan Meier probability curves and Cox regression models for survival, hospital discharge and orotracheal intubation were used.
RESULTS:
Seventy-four patients treated with TCZ were matched with 148 matched controls. They were mainly males (81.5%), Caucasian (82.0%) and with a median age of 59 years. The majority (69.8%) showed critical stage COVID-19 disease. TCZ use was associated with a better overall survival (HR 0.499 [95% CI 0.262-0.952], p?=?0.035) compared to controls but with a longer hospital stay (HR 1.658 [95% CI 1.088-2.524], p?=?0.019) mainly due to biochemical, respiratory and infectious adverse events.
DISCUSSION:
TCZ use resulted potentially effective on COVID-19 in terms of overall survival. Caution is warranted given the potential occurrence of adverse events.
FINANCIAL SUPPORT:
Some of the tocilizumab doses used in the subjects included in this analysis were provided by the "Multicenter study on the efficacy and tolerability of tocilizumab in the treatment of patients with COVID-19 pneumonia" (EudraCT Number: 2020-001110-38) supported by the Italian National Agency for Drugs (AIFA). No specific funding support was planned for study design, data collection and analysis and manuscript writing of this paper.
Copyright © 2020. Published by Elsevier Ltd.
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[Platypnea-orthodeoxia syndrome associated with patent foramen ovale and aortic root aneurysm].
G Ital Cardiol (Rome)2020 Jul;21(7):562-563. doi: 10.1714/3386.33646.
Bottiroli Maurizio, Vignati Gabriele, Cannata Aldo, Colombo Jacopo, Pinciroli Riccardo, Mondino Michele
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Fulminant myocarditis triggered by OC43 subtype coronavirus: a disease deserving evidence-based care bundles.
J Cardiovasc Med (Hagerstown)2020 07;21(7):529-531. doi: 10.2459/JCM.0000000000000989.
Veronese Giacomo, Cipriani Manlio, Bottiroli Maurizio, Garascia Andrea, Mondino Michele, Pedrotti Patrizia, Pini Daniela, Cozzi Ottavia, Messina Antonio, Droandi Ginevra, Petrella Duccio, Frigerio Maria, Ammirati Enrico
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Safety of centrifugal left ventricular assist device in patients previously treated with MitraClip system.
Int J Cardiol2019 05;283():131-133. doi: S0167-5273(18)36049-2.
Ammirati Enrico, Van De Heyning Caroline M, Musca Francesco, Brambatti Michela, Perna Enrico, Cipriani Manlio, Cannata Aldo, Mondino Michele, Moreo Antonella, De Bock Dina, Pretorius Victor, Claeys Marc J, Adler Eric D, Russo Claudio F, Frigerio Maria
Abstract
INTRODUCTION:
No data regarding the safety of continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with previous MitraClip have been reported. Thus, it remains unknown whether an initial treatment strategy with MitraClip therapy might complicate future heart failure management in patients who are also considered for CF-LVAD.
METHODS:
We retrospectively identified 6 patients (median age of 62?years; 2 women) who had been treated with MitraClip, that were eventually implanted with a CF-LVAD (all Heartware HVAD) in 3 hospitals between 2013 and 2018.
RESULTS:
Patients were treated in 4 cases with 2 clips, and in 2 cases with 1 clip. Median time from MitraClip implantation to CF-LVAD implant was 282?days (interquartile range 67 to 493), and median time on CF-LVAD support was 401?days (interquartile range 105 to 492?days). Two patients underwent a heart transplant, 3 patients died on support, and 1 is alive on support. In all cases, there was a reduction of functional mitral regurgitation without MitraClip-related complications.
CONCLUSIONS:
Based on this small case series, implantation of a CF-LVAD appears safe in patients with a previously positioned MitraClip system, at least, with 1 or 2 clips in place, with no need for additional mitral valve surgery.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis.
Circulation2017 Aug;136(6):529-545. doi: 10.1161/CIRCULATIONAHA.117.026386.
Ammirati Enrico, Cipriani Manlio, Lilliu Marzia, Sormani Paola, Varrenti Marisa, Raineri Claudia, Petrella Duccio, Garascia Andrea, Pedrotti Patrizia, Roghi Alberto, Bonacina Edgardo, Moreo Antonella, Bottiroli Maurizio, Gagliardone Maria P, Mondino Michele, Ghio Stefano, Totaro Rossana, Turazza Fabio M, Russo Claudio F, Oliva Fabrizio, Camici Paolo G, Frigerio Maria
Abstract
BACKGROUND:
Previous reports have suggested that despite their dramatic presentation, patients with fulminant myocarditis (FM) might have better outcome than those with acute nonfulminant myocarditis (NFM). In this retrospective study, we report outcome and changes in left ventricular ejection fraction (LVEF) in a large cohort of patients with FM compared with patients with NFM.
METHODS:
The study population consists of 187 consecutive patients admitted between May 2001 and November 2016 with a diagnosis of acute myocarditis (onset of symptoms
RESULTS:
In the whole population (n=187), the rate of in-hospital death or heart transplantation was 25.5% versus 0% in FM versus NFM, respectively (
CONCLUSIONS:
Patients with FM have an increased mortality and need for heart transplantation compared with those with NFM. From a functional viewpoint, patients with FM have a more severely impaired LVEF at admission that, despite steep improvement during hospitalization, remains lower than that in patients with NFM at long-term follow-up. These findings also hold true when only the viral forms are considered and are different from previous studies showing better prognosis in FM.
© 2017 American Heart Association, Inc.
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Right anterior mini-thoracotomy direct aortic self-expanding trans-catheter aortic valve implantation: A single center experience.
Int J Cardiol2015 Feb;181():437-42. doi: 10.1016/j.ijcard.2014.11.108.
Bruschi Giuseppe, De Marco Federico, Botta Luca, Barosi Alberto, Colombo Paola, Mauri Silvia, Cannata Aldo, Morici Nuccia, Colombo Tiziano, Fratto Pasquale, Nonini Sandra, Soriano Francesco, Mondino Michele, Giannattasio Cristina, Klugmann Silvio
Abstract
OBJECTIVE:
Transcatheter aortic valve implantation (TAVI) has been designed to treat elderly patients with severe aortic stenosis at high risk for surgery. These patients are also often affected by severe iliac-femoral arteriopathy, rendering the trans-femoral approach unusable. We report our experience with the direct-aortic approach to treat these patients.
METHODS:
From May 2008 to November 2013 two hundred and thirty-two patients (131 female, 56%) with severe symptomatic aortic stenosis and no reasonable surgical option due to excessive risk were evaluated for TAVI at our department. Of these patients, 202 were deemed eligible for TAVI. Of this group, 50 underwent CoreValve implantation by the direct aortic approach through a right anterior mini-thoracotmy (28 female, 56%), mean age 81.2±6.9. A combined team of cardiologists, cardiac surgeons with expertise in hybrid procedures, and anesthetists performed all the procedures.
RESULTS:
Twenty-eight (56%) patients were female and 11 (22%) were redo at TAVI. We used a 23-mm CoreValve Evolute in 3 patients (6%), and the most used valve size was the 29mm in 46% of patients. Mean hemodynamic trans-aortic gradient was less than 5mmHg. The paravalvular regurgitation was ? grade 1 in 46 patients as assessed by peri-procedural transesophageal echocardiography (TEE). Seven patients (7/43, 16%) required a permanent pacemaker implantation; 30-day mortality was 6% (3 patients). Seven patients (14.8%) died during follow-up. Actuarial survival at 2years is 84.7±5.3%.
CONCLUSIONS:
Transcatheter aortic valve implantation with the direct aortic approach is safe and feasible, offering a new attractive option to treat selected high-risk patients with severe aortic stenosis and peripheral vasculopathy, including those requiring a re-do procedure.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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How to remove the CoreValve aortic bioprosthesis in a case of surgical aortic valve replacement.
Ann Thorac Surg2012 Jan;93(1):329-30. doi: 10.1016/j.athoracsur.2011.07.059.
Bruschi Giuseppe, Oreglia Jacopo, De Marco Federico, Colombo Paola, Mondino Michele, Paino Roberto, Klugmann Silvio, Martinelli Luigi
Abstract
Transcatheter aortic valve implantation has been introduced as a treatment modality applied to high-risk surgery patients with severe symptomatic aortic stenosis, and it has been demonstrated to be an efficient and safe treatment option. Litzler and colleagues reported a case of a bailout of a transcatheter aortic valve implantation because of severe paravalvular leaks, using a 23-mm Edwards-SAPIEN Valve (Edwards Lifesciences, Irvine, CA), with conversion to conventional surgical aortic valve replacement. The authors reported an easy valve removal despite the impaction of the stent in the cusps of the native valve. Thyregod and colleagues reported a surgical valve replacement in a patient with a dysfunctional CoreValve self-expanding aortic valve bioprosthesis 4 months after implantation.
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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