Merlanti Dott. Bruno
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Impact of balloon post-dilation on valve durability and long-term clinical outcomes after self-expanding transcatheter aortic valve implantation.
Catheter Cardiovasc Interv2024 Jan;103(1):209-218. doi: 10.1002/ccd.30907.
Sanz Sánchez Jorge, Regazzoli Damiano, Barbanti Marco, Fiorina Claudia, Adamo Marianna, Angelillis Marco, De Carlo Marco, Bellini Barbara, Montorfano Matteo, Mangieri Antonio, Bruschi Giuseppe, Merlanti Bruno, Agnifili Mauro Luca, Testa Luca, Ferrara Erica, Musto Carmine, Colombo Antonio, Tamburino Corrado, Reimers Bernhard
Abstract
BACKGROUND:
Balloon post-dilation (BPD) is a widely adopted strategy to optimize acute results of TAVI, with a positive impact on both paravalvular leak and mean gradients. On the other hand, the inflation of the balloon inside prosthetic leaflets may damage them increasing the risk of structural valve deterioration (SVD). Furthermore, the impact of BPD on long-term clinical outcomes and valve hemodynamics is yet unknown.
AIMS:
To evaluate the impact of BPD on valve durability and long-term clinical outcomes in patients undergoing self-expanding transcatheter valve implantation (TAVI).
METHODS:
Echocardiographic and clinical data from the ClinicalService (a nation-based data repository and medical care project) were analyzed. Patients were divided into two groups, those who underwent BPD after TAVI and those who did not. Coprimary endpoints were all-cause death and SVD. Cumulative incidence functions for SVD were estimated.
RESULTS:
Among 1835 patients included in the study, 417 (22.7%) underwent BPD and 1418 (77.3%) did not undergo BPD. No statistically significant differences at 6-year follow-up were found between groups in terms of all-cause mortality (HR: 1.05, 95% CI: 0.9-1.22; p?=?0.557) and SVD (2.1% vs. 1.4%, p?=?0.381). In addition, BPD did not predispose to higher risk of cardiovascular death, myocardial infarction, valve thrombosis, and endocarditis at 6-year follow-up.
CONCLUSIONS:
BPD following TAVI with a self-expanding prosthesis does not seem to be associated with an increased risk of adverse clinical outcomes or SVD at 6-year follow-up.
© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
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Prognostic value of right ventricle to pulmonary artery coupling in transcatheter aortic valve implantation recipients.
J Cardiovasc Med (Hagerstown)2022 Sep;23(9):615-622. doi: 10.2459/JCM.0000000000001336.
Adamo Marianna, Maccagni Gloria, Fiorina Claudia, Giannini Cristina, Angelillis Marco, Costa Giulia, Trani Carlo, Burzotta Francesco, Bruschi Giuseppe, Merlanti Bruno, Poli Arnaldo, Ferrara Erica, Fineschi Massimo, Iadanza Alessandro, Chizzola Giuliano, Metra Marco
Abstract
AIMS:
To investigate the impact of the right ventricle to pulmonary artery (RV-PA) coupling on the outcome of patients undergoing transcatheter aortic valve intervention (TAVI), and to describe changes in right ventricular function, pulmonary hypertension, and their ratio after TAVI.
METHODS:
Three hundred and seventy-seven patients from the Italian ClinicalService Project, who underwent TAVI between February 2011 and August 2020, were included. Tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio was retrospectively calculated as a surrogate of RV-PA coupling. The population was stratified according to TAPSE/PASP using a cut-off of 0.36?mm/mmHg derived from a receiving operating characteristic (ROC) curve. The primary end point was 6-month all-cause death.
RESULTS:
Compared with patients with a TAPSE/PASP ratio ?0.36?mm/mmHg (81%), those with TAPSE/PASP ratio
CONCLUSIONS:
A TAPSE/PASP ratio
Copyright © 2022 Italian Federation of Cardiology - I.F.C. All rights reserved.
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Predictors of early discharge after transcatheter aortic valve implantation: insight from the CoreValve ClinicalService.
J Cardiovasc Med (Hagerstown)2022 Jul;23(7):454-462. doi: 10.2459/JCM.0000000000001318.
Angelillis Marco, Costa Giulia, Giannini Cristina, Fiorina Claudia, Branca Luca, Tamburino Corrado, Barbanti Marco, Gorla Riccardo, Casenghi Matteo, Bruschi Giuseppe, Merlanti Bruno, Montorfano Matteo, Ferri Luca A, Poli Arnaldo, Regazzoli Damiano, De Felice Francesco, Maffeo Diego, Trani Carlo, Iadanza Alessandro, Petronio Anna S
Abstract
AIMS:
The aim of this study was to minimize the procedure, and reduce the length of hospital stay (LoS) is the future objective for transcatheter aortic valve replacement (TAVI).Aims of the study are to identify procedural and electrocardiographical predictors of fast-track discharge in patients who underwent TAVI.
METHODS:
Patients treated with TAVI included in the One Hospital ClinicalService project were categorized according to the LoS. 'Fast-Track' population, with a postprocedural LoS less than or equal to 3?days, was compared with the 'Slow-Track' population with a postprocedural LoS greater than 3?days.
RESULTS:
One thousand five hundred and one patients were collected. Despite single baseline characteristics being almost similar between the two groups, Slow-Track group showed a higher surgical risk (P?0.001). Patients in the Slow-Track group were more frequently treated with general anaesthesia (P?=?0.002) and less frequently predilated (P?0.001) and received a lower amount of contrast media. No difference between Slow-Track and Fast-Track patients was observed at 30 days in death and in cardiovascular rehospitalization.In the multivariable analysis, STS score of at least 4% [odds ratio (OR): 1.64; P?=?0.01], general anaesthesia (OR: 2.80; P?=?0.03), predilation (OR: 0.45; P?001), NYHA 3-4 at baseline (OR: 1.65; P?=?0.01), AVB I/LBBB/RBBB onset (OR: 2.41; P?0.001) and in-hospital new PM (OR: 2.63; P?0.001) were independently associated with a higher probability of Slow-Track.
CONCLUSION:
Fast-Track patients were safely discharged home showing no difference in clinical outcomes after discharge up to 30?days compared with the Slow-Track group. The STS score, general anaesthesia, NYHA 3--4 at baseline, in-hospital onset of conduction disturbances and new PM implantation after TAVI turned out to be predictors of Slow-Track.
Copyright © 2022 Italian Federation of Cardiology - I.F.C. All rights reserved.
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Long-term effects of primary graft dysfunction after heart transplantation.
J Card Surg2022 May;37(5):1290-1298. doi: 10.1111/jocs.16364.
Settepani Fabrizio, Pedrazzini Giovanna L, Olivieri Guido M, Merlanti Bruno, Cannata Aldo, Lanfranconi Marco, Frigerio Maria, Russo Claudio F
Abstract
BACKGROUND:
We studied the incidence of primary graft dysfunction (PGD), its impact on in-hospital and follow-up outcomes and searched for independent risk factors.
METHODS:
During an 18-year period, 508 individuals underwent heart transplantation at our institution. Patients were diagnosed with none, mild, moderate or severe PGD according to ISHLT criteria.
RESULTS:
Thirty-eight patients (7.5%) met the ISHLT criteria for mild PGD, 92 (18.1%) for moderate PGD and 23 (4.5%) for severe PGD. Patients were classified into none/mild PGD (77.4%) and moderate/severe PGD (22.6%) groups. In-hospital mortality was 12.4% (7.8% for none/mild PGD and 28.7% for moderate/severe PGD; p?.001). Survival at 1, 5, and 15 years was 85.5?±?1.9% versus 67.2?±?4.5%, 80?±?2.2% versus 63.5?±?4.7%, and 60.4?±?3.6% versus 45.9?±?8.4%, respectively (p?.001). Excluding the events occurring during the first month of follow-up, survival was comparable between the two groups (93.1?±?1.4% vs. 94.7?±?2.6 at 1 year and 65.6?±?3.8% vs. 70.4?±?10.4% at 15 years, respectively; p?=?.88). Upon multivariate logistic regression analysis preoperative mechanical circulatory support (odds ratio [OR]?=?5.86) and preoperative intra-aortic balloon pump (IABP) (OR?=?9.58) were independently associated with moderate/severe PGD.
CONCLUSIONS:
Our results confirm that PGD is associated with poor in-hospital outcome. The poor outcome does not extend beyond the first month of follow-up, with comparable survival between patients with none/mild PGD and moderate/severe PGD in the short and long-term. Mechanical circulatory support and preoperative IABP were found to be independent risk factors for moderate/severe PGD.
© 2022 Wiley Periodicals LLC.
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Gender Differences after Transcatheter Aortic Valve Replacement (TAVR): Insights from the Italian Clinical Service Project.
J Cardiovasc Dev Dis2021 Sep;8(9):. doi: 114.
Denegri Andrea, Romano Michele, Petronio Anna Sonia, Angelillis Marco, Giannini Cristina, Fiorina Claudia, Branca Luca, Barbanti Marco, Costa Giuliano, Brambilla Nedy, Mantovani Valentina, Montorfano Matteo, Ferri Luca, Bruschi Giuseppe, Merlanti Bruno, Reimers Bernhard, Pivato Carlo, Poli Arnaldo, Musto Carmine, Fineschi Massimo, Maffeo Diego, Trani Carlo, Airoldi Flavio, Lettieri Corrado
Abstract
BACKGROUND:
TAVR is a safe alternative to surgical aortic valve replacement (SAVR); however, sex-related differences are still debated. This research aimed to examine gender differences in a real-world transcatheter aortic valve replacement (TAVR) cohort.
METHODS:
All-comer aortic stenosis (AS) patients undergoing TAVR with a Medtronic valve across 19 Italian sites were prospectively included in the Italian Clinical Service Project (NCT01007474) between 2007 and 2019. The primary endpoint was 1-year mortality. We also investigated 3-year mortality, and ischemic and hemorrhagic endpoints, and we performed a propensity score matching to assemble patients with similar baseline characteristics.
RESULTS:
Out of 3821 patients, 2149 (56.2%) women were enrolled. Compared with men, women were older (83 ± 6 vs. 81 ± 6 years,
CONCLUSION:
Despite higher rates of peri-procedural complications, women presented better survival than men. This better adaptive response to TAVR may be driven by sex-specific factors.
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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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Interaction between severe chronic kidney disease and acute kidney injury in predicting mortality after transcatheter aortic valve implantation: Insights from the Italian Clinical Service Project.
Catheter Cardiovasc Interv2020 Dec;96(7):1500-1508. doi: 10.1002/ccd.28927.
Adamo Marianna, Provini Martino, Fiorina Claudia, Giannini Cristina, Angelillis Marco, Testa Luca, Barbanti Marco, Merlanti Bruno, Poli Arnaldo, Ferrara Erica, Latib Azeem, Reimers Bernhard, Maffeo Diego, Bruschi Giuseppe, Montorfano Matteo, Petronio Anna Sonia, Bedogni Francesco, Tamburino Corrado, Metra Marco, Curello Salvatore
Abstract
AIMS:
We aim at exploring whether severe chronic kidney disease (CKD) may modify the impact of acute kidney injury (AKI) post-transcatheter aortic valve implantation (TAVI) on early, mid, and long-term mortality.
METHODS AND RESULTS:
The analysis included 2,733 TAVI patients from the Italian Clinical Service Project. The population was stratified in four groups according to the presence of baseline severe CKD and postprocedural AKI. All-cause mortality was the primary end point. Postprocedural AKI is associated with an increased risk of early and mid-term mortality after TAVI regardless of baseline severe CKD. Preprocedural severe CKD is associated with an increased risk of long-term mortality after TAVI regardless of postprocedural AKI. No interaction between preprocedural severe CKD and postprocedural AKI was observed in predicting mortality at both 30-day (CKD: hazard ratio [HR] =?2.65, 95% confidence interval [CI] =?1.15-6.12; no-CKD: HR = 3.83, 95% CI = 2.23-6.58; P =?.129) and 1-year (CKD: HR = 2.29, 95% CI = 1.37-3.82; no-CKD: HR = 2.47, 95% CI = 1.75-3.49; P =?.386). Preprocedural severe CKD is an independent predictor of postprocedural AKI (HR = 2.17, 95% CI = 1.56-3.03; p .001) as well as general anesthesia and access alternative to femoral. Among no-AKI patients, those with severe CKD at admission underwent kidney function recovery after TAVI (serum creatinine at baseline 2.24?±?1.57?mg/dL and at 48-hr 1.80?±?1.17?mg/dL; p =?.003).
CONCLUSIONS:
Preprocedural severe CKD did not modify the impact of postprocedural AKI in predicting early and mid-term mortality after TAVI. Closely monitoring of serum creatinine and strategies to prevent AKI post-TAVI are needed also in patients without severe CKD at admission.
© 2020 Wiley Periodicals LLC.
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Sequencing of NOTCH1 gene in an Italian population with bicuspid aortic valve: Preliminary results from the GISSI OUTLIERS VAR study.
Gene2019 Oct;715():143970. doi: 10.1016/j.gene.2019.143970.
Pileggi Silvana, De Chiara Benedetta, Magnoli Michela, Franzosi Maria Grazia, Merlanti Bruno, Bianchini Francesca, Moreo Antonella, Romeo Gabriella, Russo Claudio Francesco, Rizzo Stefania, Basso Cristina, Martinelli Luigi, Maseri Attilio,
Abstract
BACKGROUND:
Bicuspid aortic valve (BAV) formation is genetically determined, with reduced penetrance and variable expressivity. NOTCH1 is a proven candidate gene and its mutations have been found in familial and sporadic cases of BAV.
METHODS:
66 BAV patients from the GISSI VAR study were genotyped for the NOTCH1 gene.
RESULTS:
We identified 63 variants, in heterozygous and homozygous states. Fifty-two are common polymorphisms present in almost all patients. Eleven variants are new and never yet reported: two are non-synonymous substitutions, Gly540Asp in exon 10 and Glu851Gln in exon 16; one is in the 3'UTR region and seven in introns, one corresponds to a T allele insertion in intron 27. We selected four statistically noteworthy and seven new variants identified in six BAV patients and correlated them with clinical and demographic variables and with imaging and histological parameters. Preliminary data show that four were BAV patients with isolated stenosis in patients over 60 aged. These variants may correlate with a later need for surgery for the presence of stenosis and not aortic valve regurgitation or ascending aortic aneurysm.
CONCLUSIONS:
Completing the genotyping of 62 BAV patients we found 11 new variants in the NOTCH1 gene never yet reported. These findings confirm that the identification of new, clinically remarkable biomarkers for BAV requires a deeper genetic understanding of the NOTCH1 gene variants, which could be targeted by future diagnostic and therapeutic strategies.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Evolut R implantation via the brachial artery.
Eur J Cardiothorac Surg2018 Dec;54(6):1137-1139. doi: 10.1093/ejcts/ezy201.
Bruschi Giuseppe, Merlanti Bruno, Colombo Paola, Russo Claudio F
Abstract
Transfemoral transcatheter aortic valve implantation is an established therapy to treat elderly patients affected by severe aortic stenosis, who are considered to be at high or extreme risk for surgical aortic valve replacement. The transfemoral approach is contraindicated in patients with severe peripheral artery disease, small vessel size or severe tortuosity. In these patients, other vascular access routes such as transapical, subclavian or direct-aortic access may be considered. We describe the first case of a Medtronic Evolut R (Medtronic, Minneapolis, MN, USA) implantation made through the brachial artery in a 75-year-old patient affected by severe aortic stenosis.
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Late Echocardiographic Study of Aortic Valve and Aortic Root after Surgery for Type A Acute Aortic Dissection.
J Cardiovasc Echogr2016 ;26(3):78-82. doi: 10.4103/2211-4122.187948.
Molteni Martina, De Chiara Benedetta, Casadei Francesca, Botta Luca, Merlanti Bruno, Russo Claudio Francesco, Giannattasio Cristina, Moreo Antonella
Abstract
OBJECTIVE:
In case of concomitant aortic regurgitation (AR) valve, sparing operation is considered the first choice in selected patients. The aim of this retrospective clinical and echocardiographic study was to evaluate the long-term survival results of conservative approach and the determinants of recurrent AR.
METHODS:
From 2000 to 2011, fifty patients (median: 63 years and interquartile range: 53-72) underwent an aortic valve-sparing procedure for acute aortic dissection, and discharged alive. The long-term clinical and echocardiographic outcome was analyzed.
RESULTS:
Late all-causes mortality was 18% (nine patients) at a median follow-up of 55.8 months. Ten patients (20%) underwent re-operations, five of them for aortic valve/root recurrent disease; freedom from proximal re-operation was 90%. Two-third of the patients had a preoperative AR grade
CONCLUSIONS:
Preoperative AR and late aortic root diameter were not the predictors of late AR. Late AR is higher in patients who underwent aortic commissures and cusps resuspension compared to the only replacement of the ascending aorta.
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Portico Sheathless Transcatheter Aortic Valve Implantation via Distal Axillary Artery.
Ann Thorac Surg2017 Feb;103(2):e175-e177. doi: 10.1016/j.athoracsur.2016.07.065.
Bruschi Giuseppe, Colombo Paola, Botta Luca, Nava Stefano, Merlanti Bruno, Belli Oriana, Musca Francesco, Soriano Francesco, Russo Claudio F, Oliva Fabrizio
Abstract
Transcatheter aortic valve implantation has been designed to treat older patients affected by severe aortic stenosis who are considered high-risk surgical candidates because of multiple comorbidities. The least invasive approach for transcatheter aortic valves implantation should be considered the transfemoral retrograde route, because it is minimally invasive and is feasible with local anesthesia and mild sedation. Despite significant technical improvements in recent years, the transfemoral approach is contraindicated in cases of severe peripheral artery disease. We describe the first case of a Portico transcatheter aortic valve implantation system (St. Jude Medical, Minneapolis, MN) made through the distal axillary artery in a 90-year-old patient affected by severe aortic stenosis.
Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Arterial Stiffness in Aortic Stenosis: Relationship with Severity and Echocardiographic Procedures Response.
High Blood Press Cardiovasc Prev2017 Mar;24(1):19-27. doi: 10.1007/s40292-016-0176-x.
Bruschi Giuseppe, Maloberti Alessandro, Sormani Paola, Colombo Giulia, Nava Stefano, Vallerio Paola, Casadei Francesca, Bruno Jolie, Moreo Antonella, Merlanti Bruno, Russo Claudio, Oliva Fabrizio, Klugmann Silvio, Giannattasio Cristina
Abstract
INTRODUCTION:
Aortic stenosis (AS) is more than only a degenerative disease, it could be also an atherosclerotic-like process involving the valve instead of the vessels. Little is known about the relation of arterial stiffness and AS.
AIM:
We sought to determine wether pulse wave velocity (PWV), is related to AS severity and to the procedures response, both as surgical aortic-valve-replacement (AVR) and trascatheter-aortic-valve-implantation (TAVI).
METHODS:
30 patients with severe AS were treated (15 AVR, 15 TAVI). Before the procedures (t0) and after 1 week (t1) echocardiography and PWV were evaluated.
RESULTS:
On the whole population, subjects with higher PWV showed higher transvalvular pressure gradient at baseline (mean: 56.5 ± 15.1 vs 45.4 ± 9.5; peak: 93.3 ± 26.4 vs 73.3 ± 14.9, p = 0.02) and, a significantly greater response to the procedures (mean: -42.9 ± 17.2 vs -27.9 ± 10.1, peak: -68.7 ± 29.2 vs -42.8 ± 16.4, p = 0.02). When the two different procedures groups were separated, data were confirmed only in the TAVI subgroup.
CONCLUSIONS:
In patients undergoing procedures for AS, PWV is correlated with transvalvular gradient and, in TAVI subjects, is able to predict the echocardiographic response. Baseline evaluation of PWV in patients candidates to TAVI can help the selection of subjects, even if larger and longer studies are needed before definitive conclusion can be drawn.
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Evolut R Implantation to Treat Severe Pure Aortic Regurgitation in a Patient With Mitral Bioprosthesis.
Ann Thorac Surg2016 Dec;102(6):e521-e524. doi: 10.1016/j.athoracsur.2016.05.054.
Bruschi Giuseppe, Colombo Paola, Nava Stefano, Musca Francesco, Merlanti Bruno, Belli Oriana, Soriano Francesco, Botta Luca, De Caria Danile, Giannattasio Cristina, Russo Claudio F
Abstract
Transcatheter aortic valves have been designed to treat high-risk surgical candidates affected by severe aortic stenosis, but little is known about the use of transcatheter valves in patients with severe pure aortic regurgitation. We describe the implantation of Medtronic CoreValve Evolut R (Medtronic, Minneapolis, MN) to treat an 82-year-old patient affected by severe pure aortic regurgitation who underwent prior mitral valve replacement with a biological valve protruding into the left ventricular outflow tract.
Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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A new access for transcatheter aortic valve implantation: Distal axillary artery.
Int J Cardiol2016 Nov;223():810-812. doi: 10.1016/j.ijcard.2016.08.290.
Bruschi Giuseppe, Colombo Paola, Merlanti Bruno, Nava Stefano, Belli Oriana, Musca Francesco, Soriano Francesco, Botta Luca, Calini Angelo, De Caria Daniele F, Oliva Fabrizio, Russo Claudio F
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Rationale and design of GISSI OUTLIERS VAR Study in bicuspid aortic valve patients: prospective longitudinal, multicenter study to investigate correlation between surgical, echo distinctive features, histologic and genetic findings in phenotypically homogeneous outlier cases.
Int J Cardiol2015 Nov;199():180-5. doi: 10.1016/j.ijcard.2015.06.182.
Merlanti Bruno, De Chiara Benedetta, Maggioni Aldo Pietro, Moreo Antonella, Pileggi Silvana, Romeo Gabriella, Russo Claudio Francesco, Rizzo Stefania, Martinelli Luigi, Maseri Attilio,
Abstract
BACKGROUND/OBJECTIVES:
Bicuspid aortic valve (BAV) is the most common congenital heart disorder, affecting up to 2% of the population. Involvement of aortic root and ascending aorta (aneurysm or, eventually, dissection) is frequent in patients with pathologic or normal functioning BAV. Unfortunately, there are no well-known correlations between valvular and vascular diseases. In VAR protocol, with a new strategy of research, we analysemultiple aspects of BAV disease through correlation between surgical, echo, histologic and genetic findings in phenotypically homogeneous outlier cases.
METHODS:
VAR protocol is a prospective, longitudinal, multicenter study. It observes 4 homogeneous small groups of BAV surgical patients (15 patients each): isolated aortic regurgitation, isolated ascending aortic aneurysm, aortic regurgitation associated with aortic aneurysm, isolated aortic stenosis in older patients (>60years). Echo analysis is extended to first-degree relatives and, in case of BAV, genetic test is performed. Patients and relatives are enrolled in 10 cardiac surgery/cardiologic centers throughout Italy.
CONCLUSIONS:
The aim of the study is to identify predictors of favorable or unfavorable evolution of BAV in terms of valvular dysfunction and/or aortic aneurysm. Correlations between different features could help in identification of various BAV risk groups, rationalizing follow-up and treatment.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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Biological and clinical outcomes in the elderly with left ventricular dysfunction: Are there differences between on-pump and off-pump coronary artery bypass grafting?
Ann Ital Chir2015 ;86(2):106-13. doi: S0003469X15021247.
Concistrè Giovanni, Dell'Aquila Angelo Maria, Piccardo Alessandro, Pansini Stefano, Gargiulo Raffaele, Gallo Alina, Merlanti Bruno, Passerone Giancarlo, Regesta Tommaso
Abstract
AIM:
To compair biological and clinical outcomes after off-pump coronary artery bypass grafting (OPCABG) and conventional on-pump coronary artery bypass grafting (CCABG) in the elderly with left ventricular (LV) dysfunction.
MATERIAL OF STUDY:
We retrospectively reviewed 90 consecutive patients aged more than 75 years with preoperative left ventricular ejection fraction (LVEF)
RESULTS:
The overall in-hospital mortality was 2% (2/90) and was similar in both groups (p=0.8336). Mean troponin T levels at 6,24,48 hours after operation were significantly lower in the OPCABG group (p=0.0001; p=0.0021; p=0.0070, respectively). Overall survival was 77.6% at 10 years and no significant difference in MACCE was observed (p=0.3016).
DISCUSSION:
Our results show a lower incidence of myocardial injury in OPCABG group, but there aren't differences in term of MACCE in both groups. Recent studies have indicated the advantages of OPCABG in the elderly patients, reporting a reduction of postoperative morbidity and organ dysfunction. However these studies not analyzed the impact of LV dysfunction on early and late postoperative outcomes in high-risk patients.
CONCLUSIONS:
In the elderly with LV dysfunction, the OPCABG technique showed lower incidence of postoperative myocardial injury. However, at the follow-up, this does not reflect any significant differences in incidence of MACCE.
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Direct aortic Direct Flow implantation via right anterior thoracotomy in a patient with patent bilateral mammary artery coronary grafts.
Int J Cardiol2015 Apr;185():22-4. doi: 10.1016/j.ijcard.2015.03.083.
Bruschi Giuseppe, Merlanti Bruno, Barosi Alberto, Colombo Paola, Fratto Pasquale, Nava Stefano, Soriano Francesco, Montrasio Elisa, Klugmann Silvio, de Marco Federico
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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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Redo mitral valve replacement through a right mini-thoracotomy with an unclamped aorta.
Multimed Man Cardiothorac Surg2014 Aug;2014():. doi: mmu013.
Botta Luca, Fratto Pasquale, Cannata Aldo, Bruschi Giuseppe, Merlanti Bruno, Brignani Christian, Bosi Mauro, Martinelli Luigi
Abstract
Redo cardiac surgery represents a clinical challenge due to a higher rate of perioperative morbidity and mortality. Mitral valve (MV) re operations can particularly be demanding in patients with patent coronary grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, leaks or thrombosis). In this article we describe our technique to manage complex mitral reoperations using a minimally invasive approach, moderate hypothermia and avoiding aortic cross-clamping. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of less invasive access and continuous myocardial perfusion. The advantage of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, reducing the risk of cardiac structures or patent graft injury. Moderate hypothermia and continuous blood perfusion can guarantee adequate myocardial protection particularly in the case of patent grafts, decreasing the dangers of an incomplete or imperfect aortic clamping at mild hypothermia and potential lesions due to demanding clamp placing. Complex MV reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space with an unclamped aorta.
© 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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Does the cardioplegic solution have an effect on early outcomes following heart transplantation?
Eur J Cardiothorac Surg2012 Apr;41(4):e48-52; discussion e52-3. doi: 10.1093/ejcts/ezr321.
Cannata Aldo, Botta Luca, Colombo Tiziano, Russo Claudio F, Taglieri Corrado, Bruschi Giuseppe, Merlanti Bruno, Frigerio Maria, Martinelli Luigi
Abstract
OBJECTIVE:
The choice of cardioplegic solution for myocardial preservation in heart transplantation (HT) remains debated. We analysed our experience with three different cardioplegic solutions in adult HT performed during past 5 years, in terms of non-immunological intraoperative biventricular graft failure (BVF) and in-hospital mortality.
METHODS:
A total of 133 patients underwent HT at our hospital from January 2006 to December 2010. Patients were divided into three groups, according to the solution adopted in the donor: HTK-Custodiol (n = 61), Celsior (n = 38) and St Thomas (n = 34). For each patient, solution was chosen according to surgeon's preference.
RESULTS:
Recipient and donor mean age was 48.2 ± 12.7 and 43.8 ± 13.6 years, respectively. Twenty-four patients (18.0%) were in Status 1 at the transplant. The mean ischaemic time was 187.9 ± 52.6 min. Intraoperative BVF was observed in 18 cases (13.5%). Patients with BVF, and their respective donors, were older than the other patients (patients: 53.3 vs 47.4 years, P = 0.06; donors: 49.4 vs 42.9 years, P 0.06), and experienced significantly higher in-hospital mortality (47.3 vs 7.8%, P = 0.0001). The combination of patients aged 60 years or older with donors aged 60 years or older carried a mortality of 66.6% (6 out of 9). The three groups of patients did not differ significantly in terms of preoperative and intraoperative features and outcomes, including biventricular graft failure and death. At multivariate analysis, predictors of in-hospital death were a combination of both a recipient and a donor aged ? 60 years (OR 27.9), intraoperative BVF (OR 14.8) and previous cardiac surgery (OR 13.0). Cardioplegic solution did not predict mortality.
CONCLUSIONS:
We did not observe a significant effect of the kind of cardioplegic solution on the early HT outcomes. The combination between both a recipient and a donor aged ? 60 years, reoperation and BVF are strong predictors of in-hospital death.
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An inverted location of the bicuspid valve disease: a variant of a variant.
Circulation2011 Nov;124(20):e513-5. doi: 10.1161/CIRCULATIONAHA.111.055285.
Magnoni Marco, Turri Carlo, Roghi Alberto, Merlanti Bruno, Maseri Attilio
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Cavernous hemangioma replacing the septal leaflet of the tricuspid valve.
J Card Surg2010 Sep;25(5):524-7. doi: 10.1111/j.1540-8191.2010.01064.x.
Cannata Aldo, Russo Claudio F, Merlanti Bruno, Pedrotti Patrizia, Moreo Antonella, Botta Luca, Martinelli Luigi
Abstract
Heart valve hemangioma is a rare finding. Here, we report a case of a hemangioma completely replacing the septal leaflet of the tricuspid valve. Preoperative imaging studies and operative anatomy are described.
© 2010 Wiley Periodicals, Inc.
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Off-pump coronary revascularization in chronic dialysis-dependent patients: early outcomes at a single institution.
J Cardiovasc Med (Hagerstown)2010 Jul;11(7):481-7.
Bruschi Giuseppe, Colombo Tiziano, Botta Luca, Colombo Paola, Pelenghi Stefano, Trunfio Salvatore, Cannata Aldo, Merlanti Bruno, Paino Roberto, Klugmann Silvio, Martinelli Luigi
Abstract
INTRODUCTION:
Atherosclerotic vascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease. Several authors reported that chronic dialytic patients have a high operative risk when submitted to coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB) whereas little information exists about off-pump myocardial revascularization in these patients.
MATERIAL AND METHODS:
Between January 2000 and December 2008, 17 consecutive patients (12 men, mean age of 62.3 +/- 12.3 years) with end-stage renal failure maintained on chronic hemodialysis underwent isolated off-pump CABG at our center. To evaluate this approach we compared the outcomes of off-pump revascularization with those obtained in the same period in 23 patients (20 men, mean age of 64.0 +/- 9.7 years), with the same preoperative features, who underwent conventional CABG on the arrested heart using CPB.
RESULTS:
Off-pump revascularization in end-stage renal disease patients showed a satisfactory incidence of mortality and morbidity rates. When compared with conventional CPB CABG group, off-pump patients had a lower incidence of bleeding, transfusions, ventilation support time, length of inotropic support and perioperative myocardial infarction. Also ICU and hospital stay and incidence of new-onset atrial fibrillation were lower in off-pump CABG patients.
CONCLUSION:
In our experience, avoidance of CPB in end-stage renal disease patients was associated with an acceptable incidence of postoperative complications and of major adverse events. Off-pump CABG is a safe and effective method of myocardial revascularization in chronically dialyzed patients that should strongly be taken in consideration when planning the surgical strategy in this selected cohort of patients, although multicentric prospective randomized controlled trials are strongly recommended.
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