Cappai Dott. Antioco
Pubblicazioni su PubMed
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Transapical aortic valve replacement is a safe option in patients with poor left ventricular ejection fraction: results from the Italian Transcatheter Balloon-Expandable Registry (ITER).
Eur J Cardiothorac Surg2017 Nov;52(5):874-880. doi: 10.1093/ejcts/ezx227.
D'Onofrio Augusto, Salizzoni Stefano, Filippini Claudia, Agrifoglio Marco, Alfieri Ottavio, Chieffo Alaide, Tarantini Giuseppe, Gabbieri Davide, Savini Carlo, Immè Sebastiano, Ribichini Flavio, Cugola Diego, Raviola Eliana, Loi Bruno, Pompei Esmeralda, Cappai Antioco, Cassese Mauro, Luzi Giampaolo, Aiello Marco, Santini Francesco, Rinaldi Mauro, Gerosa Gino
Abstract
OBJECTIVES:
The most commonly used accesses for transcatheter aortic valve implantation (TAVI) are the transfemoral (TF-TAVI) and the transapical (TA-TAVI) ones. There are concerns about TA-TAVI use in patients with reduced left ventricular ejection fraction (LVEF). The aim of this retrospective multicentre study was to compare the outcomes of TA-TAVI and TF-TAVI in patients with poor LVEF.
METHODS:
Patients with LVEF ?35% were included in the analysis. Data were obtained from the Italian Transcatheter Balloon-Expandable Registry (ITER), which enrolled patients undergoing TAVI with the Sapien bioprosthesis in 33 national centres. Patients were divided into 2 groups according to the access: TA or TF. A multivariable logistic regression analysis was performed in order to evaluate whether the type of approach (TA and TF) has an impact on outcomes.
RESULTS:
Between 2007 and 2012, 1882 patients were enrolled in the Registry. LVEF ?35% was found in 208 (11.1%) patients. TA-TAVI and TF-TAVI were performed in 69 (33.2%) and 139 (66.8%) patients, respectively. Overall 30-day mortality was 11.6% and 7.9% in TA and TF patients, respectively (P?=?0.45). Overall Kaplan-Meier survival was significantly higher in the TF-TAVI group (log rank: P?=?0.003). Age [odds ratio (OR) 1.066, P?=?0.016], creatinine (OR: 2.301, P?0.001), preoperative permanent pacemaker (OR: 4.662, P?=?0.035) and TA approach (OR: 2.577, P?=?0.006) were identified as independent predictors of overall mortality at follow-up. However, the TA approach resulted an independent variable of mortality only 3?years after TAVI.
CONCLUSIONS:
TAVI yields good results in patients with depressed LVEF. Age, preoperative creatinine and preoperative pacemaker are independently associated with mortality. The TA access is associated with mortality only after 3?years of follow-up, thus probably reflecting a worse general clinical status of these patients.
© 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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Does pre-existing aortic regurgitation protect from death in patients who develop paravalvular leak after TAVI?
Int J Cardiol2017 Apr;233():52-60. doi: 10.1016/j.ijcard.2017.02.005.
Colli Andrea, Besola Laura, Salizzoni Stefano, Gregori Dario, Tarantini Giuseppe, Agrifoglio Marco, Chieffo Alaide, Regesta Tommaso, Gabbieri Davide, Saia Francesco, Tamburino Corrado, Ribichini Flavio, Valsecchi Orazio, Loi Bruno, Iadanza Alessandro, Stolcova Miroslava, Minati Alessandro, Martinelli Gianluca, Bedogni Francesco, Petronio Anna, Dallago Michele, Cappai Antioco, D'Onofrio Augusto, Gerosa Gino, Rinaldi Mauro
Abstract
OBJECTIVE:
The aim of this study was to investigate interactions among pre-procedural aortic regurgitation (AR), post-procedural paravalvular leak (PVL) and long-term clinical outcomes.
METHODS AND RESULTS:
We analyzed data prospectively collected in the Italian Transcatheter balloon-Expandable Registry (ITER) on aortic stenosis (AS) patients. The degree of pre-procedural AR and post-procedural PVL was stratified as: absent/trivial, mild, and moderate/severe. VARC definitions were applied to outcomes. Of 1708 patients, preoperatively, AR was absent/trivial in 40% of the patients, mild in 42%, and moderate in 18%. Postoperatively, PVL was moderate-severe in 5%, mild in 32% of patients, and absent/trivial in 63%. Clinical follow-up, median 821days (IQR 585.75), was performed in 99.7% of patients. PVL, but not preoperative AR, was a major predictor of adverse outcome (HR 1.33, CI 95% 0.9-2.05, p=0.012 for mild PVL, HR 1.36, CI 95% 0.9-2.05, p75ml/m) showed better survival than those without dilatation (HR 8.63, p=0.001).
CONCLUSIONS:
In patients with severe AS treated with balloon-expandable TAVI, the presence of PVL, but not pre-procedural AR, was a major predictor of adverse outcome. Preoperative LV dilatation seemed to offer some clinical advantages.
Copyright © 2017 Elsevier B.V. All rights reserved.
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Impact of Cusp Repair on Reoperation Risk After the David Procedure.
Ann Thorac Surg2016 Nov;102(5):1503-1511. doi: 10.1016/j.athoracsur.2016.04.061.
Settepani Fabrizio, Cappai Antioco, Basciu Alessio, Barbone Alessandro, Moz Monica, Citterio Enrico, Ornaghi Diego, Tarelli Giuseppe
Abstract
BACKGROUND:
We assessed whether additional cusp repair during valve-sparing aortic root replacement affects the echocardiographic mid-term results; a subgroup analysis among patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) was performed.
METHODS:
Between June 2002 and May 2015, 157 consecutive patients underwent valve-sparing aortic root replacement with the David technique. Thirty patients (19%) had BAV. In 19 patients (12%), cusp motion or anatomic abnormalities contributed in determining aortic regurgitation requiring an additional cusp repair. Mean follow-up was 7 ± 3.4 years.
RESULTS:
The cumulative 1-, 5-, and 12-year survival rates were 98%, 94%, and 90%, respectively. Fourteen patients (9%) required aortic valve replacement during follow-up. In 2 patients the underlying cause was bacterial endocarditis. Freedom from aortic valve reoperation was 96% at 1 year, 92% at 5 years, and 89% at 12 years. Reoperation rate was significantly higher (p
CONCLUSIONS:
Adjunctive cusp repair seems to affect the mid-term reoperation risk in patients with BAV and not in patients with tricuspid aortic valve. We recommend caution in using this technique in case of asymmetric BAV requiring cusp repair.
Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Early and mid-term outcomes of 1904 patients undergoing transcatheter balloon-expandable valve implantation in Italy: results from the Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER).
Eur J Cardiothorac Surg2016 Dec;50(6):1139-1148. doi: 10.1093/ejcts/ezw218.
Salizzoni Stefano, D'Onofrio Augusto, Agrifoglio Marco, Colombo Antonio, Chieffo Alaide, Cioni Micaela, Besola Laura, Regesta Tommaso, Rapetto Filippo, Tarantini Giuseppe, Napodano Massimo, Gabbieri Davide, Saia Francesco, Tamburino Corrado, Ribichini Flavio, Cugola Diego, Aiello Marco, Sanna Francesco, Iadanza Alessandro, Pompei Esmeralda, Stefàno Pierluigi, Cappai Antioco, Minati Alessandro, Cassese Mauro, Martinelli Gian Luca, Agostinelli Andrea, Fiorilli Rosario, Casilli Francesco, Reale Maurizio, Bedogni Francesco, Petronio Anna Sonia, Mozzillo Rosa Alba, Bonmassari Roberto, Briguori Carlo, Liso Armando, Sardella Gennaro, Bruschi Giuseppe, Fiorina Claudia, Filippini Claudia, Moretti Claudio, D'Amico Maurizio, La Torre Michele, Conrotto Federico, Di Bartolomeo Roberto, Gerosa Gino, Rinaldi Mauro,
Abstract
OBJECTIVES:
The aim of this multicentre study is to report the clinical experiences of all patients undergoing transcatheter aortic valve implantation (TAVI) with a balloon-expandable device in Italy.
METHODS:
The Italian Transcatheter balloon-Expandable valve Registry (ITER) is a real-world registry that includes patients who have undergone TAVI with the Sapien (Edwards Lifesciences, Irvine, CA, USA) bioprosthesis in Italy since it became available in clinical practice. From 2007 to 2012, 1904 patients were enrolled to undergo TAVI in 33 Italian centres. Outcomes were classified according to the updated Valve Academic Research Consortium (VARC-2) definitions. A multivariable analysis was performed to identify independent predictors of all-cause mortality.
RESULTS:
Mean age was 81.7 (SD:6.2) years, and 1147 (60.2%) patients were female. Mean Logistic EuroSCORE was 21.1% (SD:13.7). Transfemoral, transapical, transaortic and transaxillary TAVI was performed in 1252 (65.8%), 630 (33.1%), 18 (0.9%) and 4 (0.2%) patients, respectively. Operative mortality was 7.2% (137 patients). The VARC-2 outcomes were as follows: device success, 88.1%; disabling stroke, 1.0%; life-threatening and major bleeding 9.8 and 10.5%, respectively; major vascular complication, 9.7%; acute kidney injury, 8.2%; acute myocardial infarction ?72 h, 1.5%. Perioperative pacemaker implantation was necessary in 116 (6.1%) patients. At discharge, the mean transprosthetic gradient was 10.7 (SD:4.5) mmHg. Incidence of postoperative mild, moderate or severe paravalvular leak was, respectively, 32.1, 5.0 and 0.4%. A total of 444/1767 (25.1%) deaths after hospital discharge were reported: of these, 168 (37.8%) were classified as cardiac death. Preoperative independent predictors of all-cause mortality were male gender (HR: 1.395; 95% CI:1.052-1.849); overweight, BMI 25-30 kg/m (HR: 0.775; 95% CI: 0.616-0.974); serum creatinine level (every 1 mg/dl increase; HR: 1.314; 95% CI:1.167-1.480); haemoglobin level (every 1 g/dl increase; HR: 0.905; 95% CI:0.833-0.984); critical preoperative state (HR: 2.282; 95% CI: 1.384-3.761); neurological dysfunction (HR: 1.552; 95% CI:1.060-2.272); atrial fibrillation (HR: 1.556; 95% CI:1.213-1.995); pacemaker rhythm (HR: 1.948; 95% CI:1.310-2.896); NYHA Class III or IV (HR: 1.800; 95% CI:1.205-2.689 or HR: 2.331; 95% CI:1.392-3.903, respectively).
CONCLUSIONS:
TAVI with a balloon-expandable device in the 'real world' shows good mid-term outcomes in terms of survival, technical success, valve-related adverse events and haemodynamic performance.
© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Predictive ability of the CHADS2 and CHA2DS2-VASc scores for stroke after transcatheter aortic balloon-expandable valve implantation: an Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis.
Eur J Cardiothorac Surg2016 Nov;50(5):867-873.
Conrotto Federico, D'Ascenzo Fabrizio, D'Onofrio Augusto, Agrifoglio Marco, Chieffo Alaide, Cioni Micaela, Regesta Tommaso, Tarantini Giuseppe, Gabbieri Davide, Saia Francesco, Tamburino Corrado, Ribichini Flavio, Cugola Diego, Aiello Marco, Sanna Francesco, Iadanza Alessandro, Pompei Esmeralda, Stolcova Miroslava, Cappai Antioco, Minati Alessandro, Cassese Mauro, Martinelli Gian Luca, Agostinelli Andrea, Gerosa Gino, Gaita Fiorenzo, Rinaldi Mauro, Salizzoni Stefano
Abstract
OBJECTIVES:
Stroke incidence after transcatheter aortic valve implantation (TAVI) still represents a concern. This multicentre study aimed at investigating the hypothesis that CHADS2 and CHA2DS2-VASc scores may be used to predict perioperative stroke after TAVI.
METHODS:
The Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) is a multicentre, prospective registry of patients undergoing balloon-expandable TAVI using Edwards Sapien and Sapien XT prosthesis between 2007 and 2012. The primary end-point of this study was the 30-day stroke rate. Secondary safety end-points were all the major adverse events based on Valve Academic Research Consortium (VARC-2) criteria.
RESULTS:
One thousand nine hundred and four patients were enrolled in the registry. Mean age was 81.6 ± 6.2 years and 1147 (60.2%) patients were female; mean CHADS and CHADS-VASc scores were 2.2 ± 0.8 and 4.4 ± 1.1, respectively. Fifty-four (2.8%) patients had a stroke within 30 days. At multivariable logistic regression analysis, CHADS-VASc (OR: 1.35, 95% CI: 1.03-1.78; P = 0.031) and previous cardiac surgery (OR: 1.96, 95% CI: 1.06-3.6; P = 0.033) but not CHADS (OR: 1.05, 95% CI: 0.76-1.44; P = 0.77) were found to be independent predictors of in-hospital stroke. A CHADS-VASc score ?5 was strongly related to the occurrence of in-hospital stroke (OR: 2.51, 95% CI: 1.38-4.57; P= 0.001). However, CHADS-VASc score showed only poor accuracy for in-hospital stroke with a trend for better accuracy when compared with CHADS score (area under the curve: 0.61, 95% CI: 0.59-0.63 vs 0.51; 95% CI: 0.49-0.54, respectively, P = 0.092).
CONCLUSIONS:
In TAVI patients, CHADS-VASc provided a strong correlation for in-hospital stroke but with low accuracy. Dedicated scores to properly tailor procedures and preventive strategies are needed.
© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Outcome of open total arch replacement in the modern era.
J Vasc Surg2016 Feb;63(2):537-45. doi: 10.1016/j.jvs.2015.10.061.
Settepani Fabrizio, Cappai Antioco, Basciu Alessio, Barbone Alessandro, Tarelli Giuseppe
Abstract
OBJECTIVE:
To shed light on contemporary results of open total aortic arch surgery, we undertook a systematic review to identify all reports on this procedure published in the last 10 years.
METHODS:
Extensive electronic literature search was undertaken to identify all published articles from 2004 to 2014 that provided results on total aortic arch replacement. According to inclusion and exclusion criteria, 21 relevant studies were selected and meta-analyzed to assess outcomes.
RESULTS:
The pooled estimate for operative mortality was 5.3%. Permanent and transient neurologic deficit occurred postoperatively at a pooled rate of 3.4% and 5.2%, respectively. Pooled rate of irreversible spinal cord injury was 0.6%, whereas renal failure occurred at a pooled rate of 4.1%. Prolonged intubation occurred at pooled rate of 15.4%. Among elective patients, pooled rate of mortality and permanent neurologic deficit was 2.9% and 2.2%, respectively, with a significant difference compared with urgent/emergency surgery cases.
CONCLUSIONS:
The main findings from this meta-analysis indicate that total aortic arch replacement can be performed with satisfactory mortality and morbidity. The pooled rates of mortality and permanent neurologic deficit among elective cases were surprisingly low, and these data have an even greater prominence when they are compared with outcomes of hybrid arch series. Under urgent/emergency surgery, early mortality and neurologic complications showed an about threefold higher rate. Moderate hypothermic circulatory arrest and early rewarming seem to provide proper renal protection, with an intermediate risk of prolonged intubation.
Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
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Iatrogenic left ventricular false aneurysm.
J Cardiovasc Med (Hagerstown)2016 Dec;17 Suppl 2():e158. doi: 10.2459/JCM.0000000000000310.
Cappai Antioco, Settepani Fabrizio, Barbone Alessandro, Ornaghi Diego, Malvindi Pietro Giorgio
Abstract
: We present a false aneurysm of ventricular left apex after mitral valve in valve prosthesis transapical implantation.
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Hybrid Versus Conventional Treatment of Acute Type A Aortic Dissection.
J Card Surg2015 Sep;30(9):707-13. doi: 10.1111/jocs.12598.
Settepani Fabrizio, Cappai Antioco, Basciu Alessio, Barbone Alessandro, Citterio Enrico, Ornaghi Diego, Tarelli Giuseppe
Abstract
BACKGROUND:
To determine whether the hybrid approach to acute type A aortic dissection results in improved outcomes in terms of mortality, neurologic complications, need for distal aortic reintervention, and false lumen thrombosis compared with the conventional approach.
METHODS:
Data from comparative studies of hybrid versus conventional treatment of acute type A aortic dissection were combined through meta-analysis. Pooled odd ratios were calculated using random effects models.
RESULTS:
Seven comparative studies including 967 patients were identified; of these, 503 underwent conventional proximal aortic repair and 429 extensive distal aortic repair including a stented elephant trunk technique. Between the two groups there was no significant difference in operative mortality (p?=?0.96), permanent neurologic deficit (p?=?0.95), and late mortality (p?=?0.59). Distal aortic repair showed a higher rate of false lumen thrombosis of the thoracic aorta (odd ratio 11.16; p?0.001) and a reduced risk of distal reintervention (odd ratio 0.37; p?=?0.01). In sub-group analysis, frozen elephant trunk procedure showed a lower rate of distal aortic reintervention and a higher rate of false lumen thrombosis than antegrade/retrograde stent deployment techniques (p?=?0.008 and
CONCLUSIONS:
Distal aortic repair may reduce the risk of distal reintervention and increase the rate of false lumen thrombosis without significant increase in operative mortality and permanent neurologic deficit; however, no benefit with respect to late mortality was found. The frozen elephant trunk may reduce the risk of distal aortic reintervention and may increase the false lumen thrombosis of the thoracic aorta in comparison with antegrade/retrograde stent deployment procedures.
© 2015 Wiley Periodicals, Inc.
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A Hybrid Double Access for Transcatheter Mitral Valve-In-Valve Implantation.
Ann Thorac Surg2015 Jun;99(6):e149-50. doi: 10.1016/j.athoracsur.2015.02.101.
Pagnotta Paolo, Mennuni Marco G, Ferrante Giuseppe, Ornaghi Diego, Bragato Renato, Cappai Antioco, Presbitero Patrizia
Abstract
We present a case of hybrid mitral valve-in valve implantation. The planned transapical approach failed due to the inability to cross the degenerated stenotic mitral bioprosthesis. An alternative strategy was performed: first, an anterograde crossing of mitral stenosis, and then, a guidewire externalization through the apex by using a snare. To our knowledge, this is the first described case of double approach mitral valve-in valve implantation.
Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Balanced Double Aortic Arch in an Older Patient.
Ann Thorac Surg2015 Jun;99(6):2221. doi: 10.1016/j.athoracsur.2014.12.100.
Settepani Fabrizio, Cappai Antioco, Basciu Alessio, Barbone Alessandro, Tarelli Giuseppe
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Vertebral erosion due to spontaneous thoracic aortic false aneurysm.
Tex Heart Inst J2015 Apr;42(2):188-9. doi: 10.14503/THIJ-13-3949.
Cappai Antioco, Settepani Fabrizio, Tarelli Giuseppe, Malvindi Pietro Giorgio
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Transapical transcatheter valve-in-valve replacement for deteriorated mitral valve bioprosthesis without radio-opaque indicators: the "invisible" mitral valve bioprosthesis.
Heart Lung Circ2015 Feb;24(2):e19-22. doi: 10.1016/j.hlc.2014.09.016.
Rossi Marco Luciano, Barbaro Cristina, Pagnotta Paolo, Cappai Antioco, Ornaghi Diego, Belli Guido, Presbitero Patrizia
Abstract
In view of the high number of bioprosthetic valves implanted during the past 30 years, an increasing number of patients are coming to medical attention because of degenerated bioprostheses. Transcatheter aortic valve-in-valve implantation has been described as a less invasive alternative to re-operation to treat severe structural valve deterioration. As far as degenerated mitral valve bioprostheses are concerned, transcatheter transapical mitral valve-in-valve replacement (TMVR) has been less commonly performed, but may also become a viable alternative to re-do replacement surgery. We describe treatment of a degenerated bioprosthetic mitral valve, characterised by complete absence of any radio-opaque landmarks making the TMVR procedure very challenging.
Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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Cusp repair during aortic valve-sparing operation: technical aspects and impact on results.
J Cardiovasc Med (Hagerstown)2015 Apr;16(4):310-7. doi: 10.2459/JCM.0000000000000031.
Settepani Fabrizio, Cappai Antioco, Raffa Giuseppe M, Basciu Alessio, Barbone Alessandro, Berwick Daniele, Citterio Enrico, Ornaghi Diego, Tarelli Giuseppe, Malvindi Pietro G
Abstract
AIMS:
Aortic valve-sparing operations are nowadays considered safe and reliable procedures in terms of mid-term and long-term results. Although surgical techniques regarding the modality of grafts' implantation have been properly addressed, the modality of cusp repair, when needed, is still open to debate. We sought to review the literature to try to shed light on when the cusp repair is required and how it should be performed.
METHODS:
We searched the PubMed database using the keywords aortic valve-sparing operation, aortic valve-sparing reimplantation, valve-sparing aortic root replacement, aortic valve repair, and aortic cusp repair. Only studies that included and described in detail the technique of cusp repairs in adjunct to aortic valve-sparing operation were considered.
RESULTS:
Bicuspid aortic valve more often requires correction when compared with tricuspid valve. The range of the techniques varies from the 'simple' free margin plication to the more complex triangular resection with patch repair. Results in the literature seem to be encouraging, showing that, in most of the cases, cusp repair does not affect valve competence in the mid-term and long-term.
CONCLUSION:
Correction of the cusp is a delicate balance between undercorrection that could lead to residual prolapse and overcorrection that could lead to cusp restriction. Although complex repair of the aortic valve in addition to root replacement provided satisfactory results, it should be reserved for experienced centers with a large volume of patients.
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Unusable radial artery for severe atherosclerosis in a young patient.
J Card Surg2015 Mar;30(3):263-4. doi: 10.1111/jocs.12356.
Settepani Fabrizio, Cappai Antioco, Citterio Enrico, Melis Licia C M, Tarelli Giuseppe
Abstract
We report a young diabetic patient who was found to have an unusable radial artery (RA) for coronary bypass grafting because of severe and diffuse atherosclerosis. Techniques to diagnose RA conduits, which are not usable for coronary surgery, are reviewed.
© 2014 Wiley Periodicals, Inc.
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[CircuLite Synergy ventricular assist device: a new approach to end-stage congestive heart failure].
G Ital Cardiol (Rome)2014 Feb;15(2):116-22. doi: 10.1714/1424.15781.
Barbone Alessandro, Pini Daniela, Ornaghi Diego, Visigalli Maria Maddalena, Ardino Laura, Bragato Renato, Curzi Mirko, Cioccarelli Sara Anna, Di Diodoro Lara, Basciu Alessio, Cappai Antioco, Settepani Fabrizio, Citterio Enrico, Cappelleri Alessio, Calcagnino Margherita, Mangiavacchi Maurizio, Tarelli Giuseppe, Lettino Maddalena, Vitali Ettore
Abstract
BACKGROUND:
The Synergy system, a miniature partial circulatory support device, is implanted by an off-pump, minimally invasive surgical approach. The system has been optimized to improve performance in an EU clinical trial for chronic ambulatory heart failure. This therefore offers the possibility of treating elderly chronic heart failure patients who might not usually be considered for long-term circulatory support.
METHODS:
From June 2007 to December 2012, 63 patients were implanted with the Synergy system (12 patients ?70 years) using four different releases of the device. Briefly, the system draws blood through the inflow cannula from the left atrium into the micro-pump (placed in a right subclavicular pocket) and pumps it through an outflow graft to the right subclavian artery. In this paper, we present an intermediate analysis of the clinical trial as performed on April 30, 2013, leading to the placing of the CE mark.
RESULTS:
Mean duration of support is ongoing at 230 days (range 23-1387). Follow-up showed improved hemodynamic response, with additional improvements in 6-min walk distance (299 ± 144 to 420 ± 119 m) and Minnesota Living with Heart Failure Questionnaire (69.5 ± 20.4 to 49.2 ± 24.3). Older patients had longer mean durations of support (337 vs 188 days). On average, elderly and younger patients showed similar improvements in hemodynamics and 6-min walk distance (107 ± 120 vs 130 ± 121 m). Major adverse cardiac events included bleeding (n=4) with one bleeding related to renal failure resulting in death.
CONCLUSIONS:
Clinical use of the Synergy device was associated with a significant functional improvement. Very low adverse event rates were reported with the latest device release. Older patients had smaller body sizes and worse renal function than younger patients. Both groups experienced similar hemodynamic benefits and functional improvements. The risk of bleeding and renal dysfunction appears to be increased in the elderly, though still within acceptable ranges compared to other full support devices. Minimally invasive long-term circulatory support devices, like Synergy, offer a new treatment option that might be available even for the elderly chronic heart failure population.
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Analysis of postsurgical aortic false aneurysm in 27 patients.
Tex Heart Inst J2013 ;40(3):274-80.
Malvindi Pietro Giorgio, Cappai Antioco, Raffa Giuseppe Maria, Barbone Alessandro, Basciu Alessio, Citterio Enrico, Ornaghi Diego, Tarelli Giuseppe, Settepani Fabrizio
Abstract
Aortic false aneurysm is a rare complication after cardiac surgery. In recent years, improved results have been reported in regard to the surgical management of these high-risk lesions. We retrospectively examined 28 consecutive cases (in 27 patients) of postsurgical aortic false aneurysm diagnosed at our institution from May 1999 through December 2011. Twenty-four patients underwent reoperation. Cardiopulmonary bypass was instituted before sternotomy in 15 patients (63%). Isolated repair of the aortic false aneurysm was performed in 15 patients. Four patients (including one who had already undergone repeat false-aneurysm repair) declined surgery in favor of clinical monitoring. Eleven patients were asymptomatic at the time of diagnosis. In the other 16, the main cause was infection in 7, and previous operation for acute aortic dissection in 9. The in-hospital mortality rate was 16.6% (4 patients, 3 of whom had infective false aneurysms). Relevant postoperative sequelae were noted in 7 patients (29%). The cumulative 1-year and 5-year survival rates were 83% and 62%, respectively. The 4 patients who did not undergo reoperation were alive at a median interval of 23 months (range, 9-37 mo). Two underwent imaging evaluations; in one, computed tomography revealed an 8-mm increase of the false aneurysm's maximal diameter at 34 months. Aortic false aneurysm can develop silently. Surgical procedures should be proposed even to asymptomatic patients because of the unpredictable evolution of the condition. Radical aortic-graft replacement should be chosen rather than simple repair, because recurrent false aneurysm is possible.
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Minimally invasive direct coronary artery bypass in the era of percutaneous coronary intervention.
J Cardiovasc Med (Hagerstown)2015 Feb;16(2):118-24. doi: 10.2459/JCM.0b013e3283630c60.
Raffa Giuseppe M, Malvindi Pietro G, Ornaghi Diego, Citterio Enrico, Cappai Antioco, Basciu Alessio, Barbone Alessandro, Fossati Francesca, Tarelli Giuseppe, Settepani Fabrizio
Abstract
AIM:
Minimally invasive coronary artery bypass (MIDCAB) allows revascularization of the left anterior descending coronary (LAD) artery through a less traumatic surgical approach. However, the procedure is technically challenging and concern still exists, mainly based on graft patency. The purpose of this study is to critically evaluate short and long-term benefits of this surgical treatment.
METHODS:
Between June 1997 and July 2012, 306 patients underwent MIDCAB on LAD. The mean age was 62?±?10 years (range, 32-87 years) and 264 patients (86.3%) were men. Mean ejection fraction was 54%. Eighty-nine procedures (29.1%) were performed using a hybrid approach by means of MIDCAB and postoperative (60 patients, 67.4%) or preoperative (29 patients, 32.6%) percutaneous interventions on non-LAD vessels. A EuroScore more than 6 was found in 43 (14%) patients. The average follow-up time was 9.5?±?3.2 years and was 89% complete.
RESULTS:
Six patients (1.9%) required intraoperative conversion to sternotomy, whereas cardiopulmonary bypass institution after the sternotomy was necessary in one. Postoperative acute myocardial infarction occurring nine patients (2.9%), low output syndrome in four (1.3%). Postoperative mortality was 1.6% (n?=?5), and perioperative stroke rate 0.6% (n?=?2). Five and 10-year survival were 94.1 and 86.9%, respectively. Freedom from death due to cardiac events and major cardiac and cerebral events at 10 years was, respectively, 97.1 and 92.1%.
CONCLUSIONS:
The results confirm the favorable short and long-term results of the MIDCAB procedure. MIDCAB, in experienced centers, can represent an alternative treatment option for LAD disease.
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Mitral and aortic valve prosthetic endocarditis after percutaneous closure of mitral paravalvular leak.
Ann Thorac Surg2013 Feb;95(2):e45-6. doi: 10.1016/j.athoracsur.2012.08.020.
Malvindi Pietro Giorgio, Raffa Giuseppe Maria, Cappai Antioco, Barbone Alessandro, Basciu Alessio, Settepani Fabrizio, Citterio Enrico, Ornaghi Diego, Tarelli Giuseppe, Vitali Ettore
Abstract
A 67-year-old man presented to our hospital with massive mitral and aortic valve prosthetic endocarditis 2 months after transcatheter percutaneous closure of a mitral paravalvular leak with an Amplatzer duct occluder device (AGA Medical Corp, Plymouth MN). He underwent successful reoperation for valve prosthesis replacement and reconstruction of the anterior fibrous trigone. Although transcatheter treatment of periprosthetic valve defects has been shown to be feasible, follow-up data are still limited. This procedure should be reserved only for patients who are not eligible for open surgical procedures and those with small periprosthetic defects.
Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Hamartoma of mature cardiac myocytes in adults and young: case report and literature review.
Int J Cardiol2013 Feb;163(2):e28-30. doi: 10.1016/j.ijcard.2012.08.052.
Raffa Giuseppe Maria, Malvindi Pietro Giorgio, Settepani Fabrizio, Melotti Flavia, Monti Lorenzo, Spaggiari Paola, Basciu Alessio, Cappai Antioco, Citterio Enrico, Tarelli Giuseppe
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Left ventricular cleft.
Eur Heart J Cardiovasc Imaging2013 Jan;14(1):14. doi: 10.1093/ehjci/jes157.
Cappai Antioco, Malvindi Pietro Giorgio, Raffa Giuseppe Maria, Basciu Alessio, Monti Lorenzo
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Bicuspidy does not affect reoperation risk following aortic valve reimplantation.
Interact Cardiovasc Thorac Surg2012 Jun;14(6):717-20. doi: 10.1093/icvts/ivs059.
Malvindi Pietro Giorgio, Raffa Giuseppe Maria, Basciu Alessio, Citterio Enrico, Cappai Antioco, Ornaghi Diego, Tarelli Giuseppe, Settepani Fabrizio
Abstract
Aortic valve reimplantation has been shown to be a safe procedure. However, evidences of durability in bicuspid aortic valves (BAVs) are limited in the literature. Between 2002 and 2011, 132 patients (mean age 61 ± 12 years) underwent aortic valve reimplantation. In 24 patients (18%), aortic valve was bicuspid. Mean follow-up was 50 ± 26 months (range 1-102 months) and was 99% complete. In-hospital mortality was 0.8% (1 patient). Survival at 1 and 5 years was 99 and 94%, respectively. Overall freedom from aortic valve reoperation at 1 and 5 years was 96 and 90%, respectively, without significant difference between patients with bicuspid and tricuspid aortic valve. Freedom from aortic valve regurgitation >2+/4+, excluding patients reoperated, was at 1 and 5 years of 100 and 99%, respectively. Patients with valve cusp repair showed a higher rate of aortic valve reoperation; however, only postoperative aortic regurgitation >2+/4+ was significant risk factor for redo procedure at multivariate analysis. Aortic valve reimplantation in BAV without cusp repair provides excellent mid-term results. Further observations and longer follow-up are necessary to determine if BAV sparing, even in the presence of cusps alterations, could allow satisfying durability.
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Aortic valve replacement for paraprosthetic leak after transcatheter implantation.
J Card Surg2012 Jan;27(1):47-51. doi: 10.1111/j.1540-8191.2011.01351.x.
Raffa Giuseppe M, Malvindi Pietro Giorgio, Settepani Fabrizio, Ornaghi Diego, Basciu Alessio, Cappai Antioco, Tarelli Giuseppe
Abstract
Conversion to surgical aortic valve replacement (AVR) has been described as a complication following transcatheter aortic valve implantation. This complication occurs in up to 8% of cases and, to the best of our knowledge, preoperative data and surgical outcomes of such patients have not been properly evaluated. Mild paraprosthetic regurgitation is commonly observed after transcatheter aortic valve implantation and usually leads to a benign clinical course. Unequal distribution of valve calcifications is described as a potential mechanism. We report a case of a perioperative paraprosthetic regurgitation that underwent successful urgent surgical AVR and review the incidence and results of paraprosthetic leaks following transcatheter implantation.
© 2011 Wiley Periodicals, Inc.
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Giant left atrium syndrome.
J Cardiovasc Med (Hagerstown)2011 Oct;12(10):745-6. doi: 10.2459/JCM.0b013e32834a65b1.
Raffa Giuseppe M, Cappai Antioco, Tarelli Giuseppe
Abstract
Giant left atrium syndrome can occasionally occur in patients with rheumatic mitral valve regurgitation and can be responsible for oesophagus and/or airways compression. Abnormally enlarged left atriomegaly creates unusual right chest opacification on radiographs.
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Recurrent pericardial effusion after cardiac surgery: the use of colchicine after recalcitrant conventional therapy.
J Cardiothorac Surg2011 Aug;6():96. doi: 10.1186/1749-8090-6-96.
Dainese Luca, Cappai Antioco, Biglioli Paolo
Abstract
Pericardial effusion represents a common postoperative complication in cardiac surgery. Nonetheless, it can be resistant to conventional therapy leading to prolonged in-hospital stay and worsening of clinical conditions. Recent literature shows that colchicine therapy should be useful in the treatment of recurrent post surgical pericardial effusion. Hereby we report the case of a patient with postsurgical recurrent effusion treated with colchicine, and a review of literature concerning the use of this old drug.
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Penetrating atherosclerotic ulcer of the ascending aorta: the role of computed tomography scan.
J Cardiovasc Med (Hagerstown)2011 Sep;12(9):671-2. doi: 10.2459/JCM.0b013e32834806cd.
Agrifoglio Marco, Cappai Antioco, Filippi Niccolò, Alamanni Francesco
Abstract
Asymptomatic penetrating atherosclerotic ulcer is a rare pathology of the ascending aorta, more frequent in the descending thoracic aorta, even in multiple localizations. We present a case report of a patient with penetrating atherosclerotic ulcer and the preoperative role of the computed tomography scan.
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Endovascular treatment of abdominal aortic aneurysm after previous left pneumonectomy: a sound choice.
Ann Vasc Surg2011 May;25(4):556.e7-10. doi: 10.1016/j.avsg.2010.11.009.
Agrifoglio Marco, Zoli Stefano, Cappai Antioco, Trabattoni Piero, Spirito Rita, Biglioli Paolo
Abstract
Surgical treatment of abdominal aortic aneurysm after previous pneumonectomy is a challenge because of the impaired respiratory function and increased surgical risks. Endovascular aneurysm repair in anatomically suited high-surgical-risk patients offers excellent short-term results and provides good protection from aneurysm-related death. In this article, we report a successful endovascular aneurysm repair of an infrarenal aortic aneurysm in a patient with past left pneumonectomy.
Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
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Incidence of stent fractures and patency after femoropopliteal stenting with the nitinol self-expandable SMART stent: a single-center study.
J Cardiovasc Med (Hagerstown)2010 Sep;11(9):678-82. doi: 10.2459/JCM.0b013e3283383370.
Trabattoni Daniela, Agrifoglio Marco, Cappai Antioco, Bartorelli Antonio L
Abstract
OBJECTIVE:
The aim of the study was to investigate long-term incidence of stent fractures and patency after femoropopliteal stenting.
METHODS:
Sixty consecutive patients (mean age 70 + or - 7 years) were treated with implantation of single (31 patients) or multiple (29 patients) self-expandable nitinol SMART stents (Cordis, Miami, Florida, USA; mean stent length 108.8 + or - 73 mm) between year 2000 and 2005. At a mean follow-up of 66 + or - 20 months, 37 patients (85% men, mean age 71 + or - 7 years) were alive and underwent plain radiograph and color-coded duplex sonography. A peak systolic velocity was measured proximally, intrastent and distally.
RESULTS:
Stent fractures were detected by radiograph in three of the 39 (7.7%) legs (mean stented segment 207 + or - 64 mm). In one case, a moderate strut fracture was associated with in-stent occlusive restenosis confirmed by angiography. Color-coded duplex sonography revealed a mean in-lesion peak systolic velocity of 73 + or - 35 cm/s, six (15%) in-stent restenoses and four (11%) total occlusions. Primary patency rate 5 years after nitinol SMART stent implantation was 74.6%. Patients symptomatic for claudication or presenting with diagnosis of in-stent restenosis underwent angiography.
CONCLUSION:
Long-term femoral SMART stenting showed minimal incidence of fractures compared with previously published data with different stent types. In-stent restenosis and occlusive restenosis seem to be correlated with stented segment length.
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An occasional diagnosis of myasthenia gravis--a focus on thymus during cardiac surgery: a case report.
J Cardiothorac Surg2009 Oct;4():55. doi: 10.1186/1749-8090-4-55.
Agrifoglio Marco, Barili Fabio, Dainese Luca, Cappai Antioco, Cheema Faisal H, Biglioli Paolo
Abstract
BACKGROUND:
Myasthenia gravis, an uncommon autoimmune syndrome, is commonly associated with thymus abnormalities. Thymomatous myasthenia gravis is considered to have worst prognosis and thymectomy can reverse symptoms if precociously performed.
CASE REPORT:
We describe a case of a patient who underwent mitral valve repair and was found to have an occasional thymomatous mass during the surgery. A total thymectomy was performed concomitantly to the mitral valve repair.
CONCLUSION:
The diagnosis of thymomatous myasthenia gravis was confirmed postoperatively. Following the surgery this patient was strictly monitored and at 1-year follow-up a complete stable remission had been successfully achieved.
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Right aortic arch related to Kommerell diverticulum and internal carotid artery agenesis.
Circ Cardiovasc Imaging2009 Mar;2(2):e6-7. doi: 10.1161/CIRCIMAGING.108.797159.
Dainese Luca, Spirito Rita, Barili Fabio, Fusari Melissa, Trabattoni Piero, Sommaruga Simona, Andreini Daniele, Cappai Antioco, Biglioli Paolo
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Preoperative assessment of thymoma: evaluation of mediastinal arterial anatomy by cardiac multidetector computed tomography.
J Thorac Imaging2009 Feb;24(1):31-3. doi: 10.1097/RTI.0b013e3181820850.
Andreini Daniele, Pontone Gianluca, Dainese Luca, Formenti Alberto, Mushtaq Saima, Cappai Antioco, Pepi Mauro, Ballerini Giovanni, Biglioli Paolo
Abstract
We describe the clinical case of a thymoma, surgically removed after diagnosis, staging, and preoperative assessment performed by means of cardiac electrocardiogram-gated multidetector computed tomography. This technique allowed a very accurate assessment of the mass, proving superior to conventional computed tomography thanks to the possibility of identifying the relationships of the mass with the mediastinal structures, including the large vessels and coronary arteries. It also established the origin of the arterial vascularization from a tributary branch of the left internal mammary artery, visualizing the pathway and the relationship of the vessel with the mass and the point where it is penetrated. Finally, we analyzed the anatomy and patency of the coronary arteries, essential data in this patient with a high risk of coronary artery disease.
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Intraoperative antiaggregant strategy for off-pump coronary artery bypass grafting in a patient with heparin-induced thrombocytopenia.
Heart Surg Forum2008 ;11(1):E54-5. doi: 10.1532/HSF98.20071156.
Zanobini Marco, Barili Fabio, Alamanni Francesco, Dainese Luca, Stringi Vincenzo, Cappai Antioco, Dell'orto Margherita, Porqueddu Massimo, Roberto Maurizio, Kassem Samer, Pompilio Giulio, Biglioli Paolo
Abstract
Immune heparin-induced thrombocytopenia is a rare complication of heparin administration. We describe a patient with a previous diagnosis of heparin-induced thrombocytopenia and related contraindications to anticoagulation who underwent urgent off-pump myocardial revascularization with the administration of only antiaggregant therapy.
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