Suad Qarra - Academia.edu (original) (raw)

Papers by Suad Qarra

Research paper thumbnail of EP22 Minimally Invasive Aortic Valve Surgery

Journal of Cardiovascular Medicine, 2018

Backgrounds: Ministernotomy represents the standard approach to isolated aortic valve replacement... more Backgrounds: Ministernotomy represents the standard approach to isolated aortic valve replacement (AVR) in our Centre. Sutureless Minithoracotomy AVR has been introduced from 2014. We aim to analize the evolution of techniques in minimally invasive (MI)-AVR. Methods: From November 2014 to January 2018, 216 patients underwent MI-AVR at our Institution: 180 ministernotomy AVR and 36 minithoracotomy Sutureless AVR. Preoperative characteristics showed a higher risk profile in the minithoracotomy group regarding age, hypertension and EUROscore (Table 1). Results: Results are summarized in Table 1. We recorded no mortality in the minithoracotomy, 2/180 (1.1%) in ministernotomy group; two (1.1%) postoperative neurological events in ministernotomy and one (2.8%) in minithoracotomy group (p = 0.67); no paravalvular leak that required redo surgery in both groups. A PM implant was necessary in 8 patients, 4 in ministernotomy (2.2%) and 4 (11.1%) in minithoracotomy group (p = 0.04). Clamping time (CT) and Cardiopulmunary By Pass time (CPB) were lower in minithoracotomy Sutureless AVR group (p CT = 0.01, p CBP = 0.03). Conclusions: MI-AVR can be performed safely, with low postoperative morbidity; sutureless Minithoracotomy AVR widens the minimally invasive portfolio especially in higher risk patients, it is associated with shorter CT and CPB times however it carries a higher risk of PM implant.

Research paper thumbnail of RF52 Mitral Valve Surgery in Obeses

Journal of Cardiovascular Medicine, 2018

Objective: obesity is become an important health problem in the Western world. The feasibility an... more Objective: obesity is become an important health problem in the Western world. The feasibility and efficacy of mitral surgery in very obese patients are controversial especially because of high risk of respiratory, infectious and wond complications. Methods: Between 1/2006 and 2/2018, 106 patients with BMI≥30 underwent minimally invasive MV surgery (9.0% of 1175): male were 50%, mean age was 63.4 ± 11.3, mean Euroscore was 6.3 ± 3.5 and Logistic was 11.1 ± 17.0. Comorbidities included: diabetes (26.4%), COPD (19.8%), chronic renal failure (17.0%), peripheral vasculopathy (5.7%), previous AMI (7.5%) and AF (47.2%). The mean EF was 54.9 ± 11.4 and 15.1% had pulmonary hypertension. In 22.6% had undergone previous cardiac surgery, in 4.7% were urgiences. Results: In 39.6% were mitral repair, associated procedures were TV procedures (10.4%) and AF-crioablation (17.0%). Mean cardiopulmonary and cross clamp time were respectively 142.2 ± 53.3 and 96.3 ± 33.5 minutes. The most utilized aortic clamp technique was endoreturn (61.3%). Conversions to sternotomy were 3.8%. Operative mortality was 0%. Reoperation for bleeding occured in 8.5%. Postoperatively, in 5.7% was necessary CVVH, in 3.8% PM implantation and in 2.8% tracheostomy. Only one patient suffered from major neurologic complications. Groin wound infection/linfocele occurred in 5.7% and in 2.8% was necessary a wound revision. Mean, median intubation time, ICU and hospital stay were respectively 45.4 ± 151.1 h (11 h), 3.8 ± 7.4days (1 day) and 12.0 ± 12.5days (8.0 days). The 30-day mortality rate was 5.7%. Conclusions: Minimally invasive approach appears to be safe, feasible and reproducible with low peri-operative morbidity expecially in obeses.

Research paper thumbnail of OC42 Minimally Invasive Mitral Valve Surgery in High-Risk Patients

Journal of Cardiovascular Medicine, 2018

Objective: This study analyzed the results of 12-year experience with mini-invasive MV operations... more Objective: This study analyzed the results of 12-year experience with mini-invasive MV operations in high-risk patients. Methods: From 1/2006 to 2/2018, 153 patients with EuroSCORE ≥ 10 underwent minimally invasive MV surgery (13.0% of 1175): mean EuroSCORE was 12.0 ± 3.1 and Logistic was 30.7 ± 15.8, mean age was 73.6 ± 8.6, male were 32.7%. Comorbidities included: diabetes (23.5%), COPD (24.2%), chronic renal failure (28.1%), peripheral vasculopathy (16.3%), previous AMI (10.5%), neurological deficit (13.7%), active endocarditis (9.2%) and AF (63.4%). The mean EF was 50.7 ± 13.8 and 34.0% had pulmonary hypertension. In 71.2% had undergone previous cardiac surgery, in 11.1% were urgiences. Results: In 24.8% were mitral repair, associated procedures were TV procedures (20.3%) and AF-crioablation (5.3%). Mean cardiopulmonary and cross clamp time were respectively 133.8 ± 54.1 and 83.8 ± 28.5 minutes. The most utilized aortic clamp technique was endoreturn (58.8%). Conversions to sternotomy were 4.6%. Reoperation for bleeding occured in 11.8%. Postoperatively, in 2.6% were reported major neurologic complications, in 14% was necessary CVVH, in 5.2% PM implantation and in 6.5% tracheostomy. Mean, median intubation time, ICU and hospital stay were respectively 135.3 ± 833.9 (12)h, 9.7 ± 36.0 (2)days and 20.1 ± 39.1 (10)days. The 30-day mortality rate was 9.2%. Conclusions: mini-invasive approach allows acceptable morbidity and mortality in high-risk patients.

Research paper thumbnail of OC65 Right Mini-Thoracotomy Approach for Atrial Septal Defect Closure and Partial Anomalous Pulmonary Venous Return Correction

Journal of Cardiovascular Medicine, 2018

13% required postoperative ECMO compared to 7.5% in the early repair although not statistically d... more 13% required postoperative ECMO compared to 7.5% in the early repair although not statistically different (p = 0.295). Post-operative left ventricular dysfunction at discharge occurred in 6 patients with no differences among groups (p = 0.536). Conclusions Arterial switch operation after 21 days of age can be achieved with good hospital survival although need of postoperative ECMO support is higher due to transitory LV dysfunction without impacting in patients survival.

Research paper thumbnail of Cerebral Autoregulation in Patients Treated with V-Vecmo for Severe Ards

Intensive Care Medicine Experimental, 2015

Research paper thumbnail of 016 * Minimally Invasive Mitral Valve Restrictive Annuloplasty: Standard of Care for Functional Mitral Regurgitation?

Interactive CardioVascular and Thoracic Surgery, 2013

Objectives: Surgical treatment of functional mitral regurgitation usually involves implantation o... more Objectives: Surgical treatment of functional mitral regurgitation usually involves implantation of an undersized complete rigid annuloplasty ring. This has been confirmed to be necessary to ensure better long-term results. This study was performed to analyse early and long-term results of minimally invasive mitral valve (MV) restrictive annuloplasty. Methods: From 2006 to October 2012, 461 consecutive MV operations have been performed using port access video-assisted right mini-thoracotomy. Among these 58 (12.6%) were performed on patients who had severe functional MV regurgitation. There were 18 (31.0%) female and 40 (69.0%) male with a mean age of 68.9 ± 3.5 years; 23 (39.6%) patients were ≥75-yearsold. Mean preoperative predictive mortality, according to EuroSCORE, was 16.3 ± 33.9%; 12 patients (48.3%) had a logistic EuroSCORE ≥12. In 18 cases (31.0%) predictive mortality was ≥20%. Twenty seven (46.5%) patients had undergone previous cardiac operations. Results: MV repair has been performed in 46 (79.3%) patients. The remaining 12 (20.7%) patients underwent MV replacement. Intraoperative mortality was 0%. Overall hospital mortality was 3.4%. The mean follow-up time was 30.4 ± 23.5 months (range 1-80 months) and 100% complete. Mean NYHA class at follow-up was 1.2 ± 1.0. Freedom from reoperation was 100% at 1 and 5 years. Kaplan-Meier analysis revealed an overall estimated 1-and 5-year survival respectively of 92.3% and 89%. Conclusions: Minimally invasive restrictive MV annuloplasty should be considered the standard of care for functional MR. It represents a safe, reproducible and durable option.

Research paper thumbnail of The HeartLander: A novel epicardial crawling robot for myocardial injections

International Congress Series, 2005

Myocardial infarction is the leading cause of congestive heart failure and death in the industria... more Myocardial infarction is the leading cause of congestive heart failure and death in the industrialized world. Stem cell transplantation to failing myocardium appears to improve heart function following myocardial infarction, but further refinement of the delivery methodology is required. The HeartLander miniature mobile robot has the ability to adhere to the epicardium, travel to the operative site, and perform intramyocardial injections under direct control of the surgeon. This paradigm obviates sternotomy, cardiopulmonary bypass, mechanical stabilization and lung deflation, while granting improved access. To facilitate movement under the pericardium, a small prototype with a tapered front has been constructed that is 11 mm tall and fits through a 15-mm cannula. This prototype was tested in beating-heart porcine trials via median sternotomy, but with the pericardium intact (N = 2). The HeartLander was able to maintain prehension and travel without being displaced by the overhead motion of the pericardium. Myocardial injections of tissue dye were performed successfully at several locations. These experiments show the feasibility of navigating under the pericardium and performing needle injections into the myocardium using video feedback. Future research will move toward minimally invasive testing without sternotomy, including both locomotion and therapy.

Research paper thumbnail of Additional file 1: of Magnetic resonance imaging for cerebral lesions during minimal invasive mitral valve surgery: study protocol for a randomized controlled trial

SPIRIT Checklist. (DOC 123Â kb)

Research paper thumbnail of OUP accepted manuscript

European Heart Journal - Cardiovascular Imaging, 2021

Research paper thumbnail of Multiple cysts involving heart, brain and kidney

The Journal of cardiovascular surgery, 2009

Research paper thumbnail of Single Versus Double Lung Transplantation in Pulmonary Fibrosis: A Debated Topic

Transplantation Proceedings, 2008

Research paper thumbnail of Safety and usefulness of composite grafts for total arterial myocardial revascularization: A prospective randomized evaluation

The Journal of Thoracic and Cardiovascular Surgery, 2003

See related editorial on page 782. Objectives: To evaluate the results of total arterial revascul... more See related editorial on page 782. Objectives: To evaluate the results of total arterial revascularization with composite grafts compared with the results of conventional coronary surgery, we enrolled 200 consecutive patient undergoing myocardial revascularization. Methods: Patients were randomly assigned to 2 groups of 100 patients each: group 1 underwent total arterial revascularization, and group 2 received left internal thoracic artery on left anterior descending artery grafts plus additional saphenous vein grafts. The groups were comparable in terms of continuous and discrete variables and preoperative risk factors. Results: There were no differences between group 1 and group 2 in terms of the number of grafted vessels (mean, 2.8 vs 2.9, respectively), crossclamping time (mean, 38 Ϯ 7 vs 40 Ϯ 6 min, respectively), intensive care unit stay (mean, 25 Ϯ 8 vs 24 Ϯ 7 hours, respectively), and hospital mortality (1% in both groups) nor were there any differences in postoperative complications. At the mean follow-up of 12 Ϯ 4 months, patients receiving total arterial revascularization (group 1) showed a better outcome in terms of angina recurrence (group 1 vs group 2: 2 vs 13 patients, P ϭ .007), need of percutaneous transluminal coronary angioplasty reintervention (group 1 vs group 2: 0 vs 8 patients, P ϭ .0012), and actuarial freedom from cardiac events (group 1 vs group 2: 96% vs 67%, P ϭ .006). Angiography carried out in 72% in group 1 and in 68% in group 2 demonstrated a patency rate of 99% of saphenous vein grafts in group 1 and 89% of saphenous grafts in group 2. Conclusions: Total myocardial revascularization with composite arterial grafts provided superior clinical results and improved patient outcome, even in the short term to midterm. Arterial conduit-related benefits were clearly evident with respect to recurrence of angina and a higher graft patency rate.

Research paper thumbnail of Aortic Valve Replacement and Mitral Valve Repair with Allograft

Journal of Cardiac Surgery, 1993

Techniques of repair of defects in the anterior leaflet of the mitral valve and replacement of th... more Techniques of repair of defects in the anterior leaflet of the mitral valve and replacement of the aortic valve using allograft are presented. The case history and operative procedure of a reconstructive operation that did not require anticoagulant therapy after surgery are described for three adult patients. Mitral valve defects were repaired using the anterior leaflet of the mitral valve of the allograft. The aortic valve or entire root was replaced with the aortic allograft. The aortic/mitral allograft should be considered as an alternative to replacement of the aortic and mitral valves with prostheses in selected patients.

Research paper thumbnail of Steps Forward in Minimally Invasive Cardiac Surgery: 10-Year Experience

The Annals of Thoracic Surgery, 2019

Research paper thumbnail of Magnetic resonance imaging for cerebral lesions during minimal invasive mitral valve surgery: study protocol for a randomized controlled trial

Trials, 2017

Background: Recent data have highlighted a higher rate of neurological injuries in minimal invasi... more Background: Recent data have highlighted a higher rate of neurological injuries in minimal invasive mitral valve surgery (MIMVS) compared with the standard sternotomy approach; therefore, the role of specific clamping techniques and perfusion strategies on the occurrence of this complication is a matter of discussion in the medical literature. The purpose of this trial is to prospectively evaluate major, minor and silent neurological events in patients undergoing right mini-thoracotomy mitral valve surgery using retrograde perfusion and an endoaortic clamp or a transthoracic clamp. Methods/design: A prospective, blinded, randomized controlled study on the rate of neurological embolizations during MIMVS started at the University of Turin in June 2014. Major, minor and silent neurological events are being investigated through standard neurological evaluation and magnetic resonance imaging assessment. The magnetic resonance imaging protocol includes conventional sequences for the morphological and quantitative assessment and nonconventional sequences for the white matter microstructural evaluation. Imaging studies are performed before surgery as baseline assessment and on the third postoperative day and, in patients who develop postoperative ischemic lesions, after 6 months. Discussion: Despite recent concerns raised about the endoaortic setting with retrograde perfusion, we expect to show equivalence in terms of neurological events of this technique compared with the transthoracic clamp in a selected cohort of patients. With the first results expected in December 2016 the findings would be of help in confirming the efficacy and safety of MIMVS.

Research paper thumbnail of Right Minithoracotomy for Mitral Valve Surgery: Impact of Tailored Strategies on Early Outcome

The Annals of thoracic surgery, Jan 16, 2016

Interest in right minithoracotomy mitral valve surgery (MVS) is rapidly growing and, to date, dif... more Interest in right minithoracotomy mitral valve surgery (MVS) is rapidly growing and, to date, different perfusion strategies and aortic clamping techniques are available. However each approach carries specific advantages and drawbacks. This retrospective study analyses our experience in right minithoracotomy MVS with different arterial perfusion and aortic clamping strategies, highlighting the results of a patient tailored approach. Between March 2009 and March 2014, 460 patients with a full preoperative work-up that included also aortoiliac-femoral axis' screening underwent right minithoracotomy MVS. One hundred and eight were redo cases (23.5%), 63 had aortoiliac atheromatous disease or significant tortuosity (13.7%), and 38 had chronic obstructive pulmonary disease (8.3%). Based on anatomy and comorbidities, each patient was allocated to the most appropriate of 3 approaches: femoral arterial cannulation with endoaortic balloon (P+EB) (247, 53.7%) or with transthoracic clamp (...

Research paper thumbnail of Mitral annulus calcification: current management and future challenges

Asian Cardiovascular and Thoracic Annals

Research paper thumbnail of Mitral annulus calcification: current management and future challenges

Asian Cardiovascular and Thoracic Annals

Research paper thumbnail of Aortic cannulation system for minimally invasive mitral valve surgery

The Journal of Thoracic and Cardiovascular Surgery, 2015

Research paper thumbnail of The Use of CO2 Removal Devices in Patients Awaiting Lung Transplantation: An Initial Experience

Transplantation Proceedings, 2010

Background. Lung transplantation is the treatment of choice for patients with end-stage lung fail... more Background. Lung transplantation is the treatment of choice for patients with end-stage lung failure. Limitations are presented by the shortage of donors and the long waiting list periods. New techniques, such as extracorporeal membrane ventilator devices with or without pump support, have been developed as bridges to transplantation for patients with severe, unresponsive respiratory insufficiency. Methods. Between

Research paper thumbnail of EP22 Minimally Invasive Aortic Valve Surgery

Journal of Cardiovascular Medicine, 2018

Backgrounds: Ministernotomy represents the standard approach to isolated aortic valve replacement... more Backgrounds: Ministernotomy represents the standard approach to isolated aortic valve replacement (AVR) in our Centre. Sutureless Minithoracotomy AVR has been introduced from 2014. We aim to analize the evolution of techniques in minimally invasive (MI)-AVR. Methods: From November 2014 to January 2018, 216 patients underwent MI-AVR at our Institution: 180 ministernotomy AVR and 36 minithoracotomy Sutureless AVR. Preoperative characteristics showed a higher risk profile in the minithoracotomy group regarding age, hypertension and EUROscore (Table 1). Results: Results are summarized in Table 1. We recorded no mortality in the minithoracotomy, 2/180 (1.1%) in ministernotomy group; two (1.1%) postoperative neurological events in ministernotomy and one (2.8%) in minithoracotomy group (p = 0.67); no paravalvular leak that required redo surgery in both groups. A PM implant was necessary in 8 patients, 4 in ministernotomy (2.2%) and 4 (11.1%) in minithoracotomy group (p = 0.04). Clamping time (CT) and Cardiopulmunary By Pass time (CPB) were lower in minithoracotomy Sutureless AVR group (p CT = 0.01, p CBP = 0.03). Conclusions: MI-AVR can be performed safely, with low postoperative morbidity; sutureless Minithoracotomy AVR widens the minimally invasive portfolio especially in higher risk patients, it is associated with shorter CT and CPB times however it carries a higher risk of PM implant.

Research paper thumbnail of RF52 Mitral Valve Surgery in Obeses

Journal of Cardiovascular Medicine, 2018

Objective: obesity is become an important health problem in the Western world. The feasibility an... more Objective: obesity is become an important health problem in the Western world. The feasibility and efficacy of mitral surgery in very obese patients are controversial especially because of high risk of respiratory, infectious and wond complications. Methods: Between 1/2006 and 2/2018, 106 patients with BMI≥30 underwent minimally invasive MV surgery (9.0% of 1175): male were 50%, mean age was 63.4 ± 11.3, mean Euroscore was 6.3 ± 3.5 and Logistic was 11.1 ± 17.0. Comorbidities included: diabetes (26.4%), COPD (19.8%), chronic renal failure (17.0%), peripheral vasculopathy (5.7%), previous AMI (7.5%) and AF (47.2%). The mean EF was 54.9 ± 11.4 and 15.1% had pulmonary hypertension. In 22.6% had undergone previous cardiac surgery, in 4.7% were urgiences. Results: In 39.6% were mitral repair, associated procedures were TV procedures (10.4%) and AF-crioablation (17.0%). Mean cardiopulmonary and cross clamp time were respectively 142.2 ± 53.3 and 96.3 ± 33.5 minutes. The most utilized aortic clamp technique was endoreturn (61.3%). Conversions to sternotomy were 3.8%. Operative mortality was 0%. Reoperation for bleeding occured in 8.5%. Postoperatively, in 5.7% was necessary CVVH, in 3.8% PM implantation and in 2.8% tracheostomy. Only one patient suffered from major neurologic complications. Groin wound infection/linfocele occurred in 5.7% and in 2.8% was necessary a wound revision. Mean, median intubation time, ICU and hospital stay were respectively 45.4 ± 151.1 h (11 h), 3.8 ± 7.4days (1 day) and 12.0 ± 12.5days (8.0 days). The 30-day mortality rate was 5.7%. Conclusions: Minimally invasive approach appears to be safe, feasible and reproducible with low peri-operative morbidity expecially in obeses.

Research paper thumbnail of OC42 Minimally Invasive Mitral Valve Surgery in High-Risk Patients

Journal of Cardiovascular Medicine, 2018

Objective: This study analyzed the results of 12-year experience with mini-invasive MV operations... more Objective: This study analyzed the results of 12-year experience with mini-invasive MV operations in high-risk patients. Methods: From 1/2006 to 2/2018, 153 patients with EuroSCORE ≥ 10 underwent minimally invasive MV surgery (13.0% of 1175): mean EuroSCORE was 12.0 ± 3.1 and Logistic was 30.7 ± 15.8, mean age was 73.6 ± 8.6, male were 32.7%. Comorbidities included: diabetes (23.5%), COPD (24.2%), chronic renal failure (28.1%), peripheral vasculopathy (16.3%), previous AMI (10.5%), neurological deficit (13.7%), active endocarditis (9.2%) and AF (63.4%). The mean EF was 50.7 ± 13.8 and 34.0% had pulmonary hypertension. In 71.2% had undergone previous cardiac surgery, in 11.1% were urgiences. Results: In 24.8% were mitral repair, associated procedures were TV procedures (20.3%) and AF-crioablation (5.3%). Mean cardiopulmonary and cross clamp time were respectively 133.8 ± 54.1 and 83.8 ± 28.5 minutes. The most utilized aortic clamp technique was endoreturn (58.8%). Conversions to sternotomy were 4.6%. Reoperation for bleeding occured in 11.8%. Postoperatively, in 2.6% were reported major neurologic complications, in 14% was necessary CVVH, in 5.2% PM implantation and in 6.5% tracheostomy. Mean, median intubation time, ICU and hospital stay were respectively 135.3 ± 833.9 (12)h, 9.7 ± 36.0 (2)days and 20.1 ± 39.1 (10)days. The 30-day mortality rate was 9.2%. Conclusions: mini-invasive approach allows acceptable morbidity and mortality in high-risk patients.

Research paper thumbnail of OC65 Right Mini-Thoracotomy Approach for Atrial Septal Defect Closure and Partial Anomalous Pulmonary Venous Return Correction

Journal of Cardiovascular Medicine, 2018

13% required postoperative ECMO compared to 7.5% in the early repair although not statistically d... more 13% required postoperative ECMO compared to 7.5% in the early repair although not statistically different (p = 0.295). Post-operative left ventricular dysfunction at discharge occurred in 6 patients with no differences among groups (p = 0.536). Conclusions Arterial switch operation after 21 days of age can be achieved with good hospital survival although need of postoperative ECMO support is higher due to transitory LV dysfunction without impacting in patients survival.

Research paper thumbnail of Cerebral Autoregulation in Patients Treated with V-Vecmo for Severe Ards

Intensive Care Medicine Experimental, 2015

Research paper thumbnail of 016 * Minimally Invasive Mitral Valve Restrictive Annuloplasty: Standard of Care for Functional Mitral Regurgitation?

Interactive CardioVascular and Thoracic Surgery, 2013

Objectives: Surgical treatment of functional mitral regurgitation usually involves implantation o... more Objectives: Surgical treatment of functional mitral regurgitation usually involves implantation of an undersized complete rigid annuloplasty ring. This has been confirmed to be necessary to ensure better long-term results. This study was performed to analyse early and long-term results of minimally invasive mitral valve (MV) restrictive annuloplasty. Methods: From 2006 to October 2012, 461 consecutive MV operations have been performed using port access video-assisted right mini-thoracotomy. Among these 58 (12.6%) were performed on patients who had severe functional MV regurgitation. There were 18 (31.0%) female and 40 (69.0%) male with a mean age of 68.9 ± 3.5 years; 23 (39.6%) patients were ≥75-yearsold. Mean preoperative predictive mortality, according to EuroSCORE, was 16.3 ± 33.9%; 12 patients (48.3%) had a logistic EuroSCORE ≥12. In 18 cases (31.0%) predictive mortality was ≥20%. Twenty seven (46.5%) patients had undergone previous cardiac operations. Results: MV repair has been performed in 46 (79.3%) patients. The remaining 12 (20.7%) patients underwent MV replacement. Intraoperative mortality was 0%. Overall hospital mortality was 3.4%. The mean follow-up time was 30.4 ± 23.5 months (range 1-80 months) and 100% complete. Mean NYHA class at follow-up was 1.2 ± 1.0. Freedom from reoperation was 100% at 1 and 5 years. Kaplan-Meier analysis revealed an overall estimated 1-and 5-year survival respectively of 92.3% and 89%. Conclusions: Minimally invasive restrictive MV annuloplasty should be considered the standard of care for functional MR. It represents a safe, reproducible and durable option.

Research paper thumbnail of The HeartLander: A novel epicardial crawling robot for myocardial injections

International Congress Series, 2005

Myocardial infarction is the leading cause of congestive heart failure and death in the industria... more Myocardial infarction is the leading cause of congestive heart failure and death in the industrialized world. Stem cell transplantation to failing myocardium appears to improve heart function following myocardial infarction, but further refinement of the delivery methodology is required. The HeartLander miniature mobile robot has the ability to adhere to the epicardium, travel to the operative site, and perform intramyocardial injections under direct control of the surgeon. This paradigm obviates sternotomy, cardiopulmonary bypass, mechanical stabilization and lung deflation, while granting improved access. To facilitate movement under the pericardium, a small prototype with a tapered front has been constructed that is 11 mm tall and fits through a 15-mm cannula. This prototype was tested in beating-heart porcine trials via median sternotomy, but with the pericardium intact (N = 2). The HeartLander was able to maintain prehension and travel without being displaced by the overhead motion of the pericardium. Myocardial injections of tissue dye were performed successfully at several locations. These experiments show the feasibility of navigating under the pericardium and performing needle injections into the myocardium using video feedback. Future research will move toward minimally invasive testing without sternotomy, including both locomotion and therapy.

Research paper thumbnail of Additional file 1: of Magnetic resonance imaging for cerebral lesions during minimal invasive mitral valve surgery: study protocol for a randomized controlled trial

SPIRIT Checklist. (DOC 123Â kb)

Research paper thumbnail of OUP accepted manuscript

European Heart Journal - Cardiovascular Imaging, 2021

Research paper thumbnail of Multiple cysts involving heart, brain and kidney

The Journal of cardiovascular surgery, 2009

Research paper thumbnail of Single Versus Double Lung Transplantation in Pulmonary Fibrosis: A Debated Topic

Transplantation Proceedings, 2008

Research paper thumbnail of Safety and usefulness of composite grafts for total arterial myocardial revascularization: A prospective randomized evaluation

The Journal of Thoracic and Cardiovascular Surgery, 2003

See related editorial on page 782. Objectives: To evaluate the results of total arterial revascul... more See related editorial on page 782. Objectives: To evaluate the results of total arterial revascularization with composite grafts compared with the results of conventional coronary surgery, we enrolled 200 consecutive patient undergoing myocardial revascularization. Methods: Patients were randomly assigned to 2 groups of 100 patients each: group 1 underwent total arterial revascularization, and group 2 received left internal thoracic artery on left anterior descending artery grafts plus additional saphenous vein grafts. The groups were comparable in terms of continuous and discrete variables and preoperative risk factors. Results: There were no differences between group 1 and group 2 in terms of the number of grafted vessels (mean, 2.8 vs 2.9, respectively), crossclamping time (mean, 38 Ϯ 7 vs 40 Ϯ 6 min, respectively), intensive care unit stay (mean, 25 Ϯ 8 vs 24 Ϯ 7 hours, respectively), and hospital mortality (1% in both groups) nor were there any differences in postoperative complications. At the mean follow-up of 12 Ϯ 4 months, patients receiving total arterial revascularization (group 1) showed a better outcome in terms of angina recurrence (group 1 vs group 2: 2 vs 13 patients, P ϭ .007), need of percutaneous transluminal coronary angioplasty reintervention (group 1 vs group 2: 0 vs 8 patients, P ϭ .0012), and actuarial freedom from cardiac events (group 1 vs group 2: 96% vs 67%, P ϭ .006). Angiography carried out in 72% in group 1 and in 68% in group 2 demonstrated a patency rate of 99% of saphenous vein grafts in group 1 and 89% of saphenous grafts in group 2. Conclusions: Total myocardial revascularization with composite arterial grafts provided superior clinical results and improved patient outcome, even in the short term to midterm. Arterial conduit-related benefits were clearly evident with respect to recurrence of angina and a higher graft patency rate.

Research paper thumbnail of Aortic Valve Replacement and Mitral Valve Repair with Allograft

Journal of Cardiac Surgery, 1993

Techniques of repair of defects in the anterior leaflet of the mitral valve and replacement of th... more Techniques of repair of defects in the anterior leaflet of the mitral valve and replacement of the aortic valve using allograft are presented. The case history and operative procedure of a reconstructive operation that did not require anticoagulant therapy after surgery are described for three adult patients. Mitral valve defects were repaired using the anterior leaflet of the mitral valve of the allograft. The aortic valve or entire root was replaced with the aortic allograft. The aortic/mitral allograft should be considered as an alternative to replacement of the aortic and mitral valves with prostheses in selected patients.

Research paper thumbnail of Steps Forward in Minimally Invasive Cardiac Surgery: 10-Year Experience

The Annals of Thoracic Surgery, 2019

Research paper thumbnail of Magnetic resonance imaging for cerebral lesions during minimal invasive mitral valve surgery: study protocol for a randomized controlled trial

Trials, 2017

Background: Recent data have highlighted a higher rate of neurological injuries in minimal invasi... more Background: Recent data have highlighted a higher rate of neurological injuries in minimal invasive mitral valve surgery (MIMVS) compared with the standard sternotomy approach; therefore, the role of specific clamping techniques and perfusion strategies on the occurrence of this complication is a matter of discussion in the medical literature. The purpose of this trial is to prospectively evaluate major, minor and silent neurological events in patients undergoing right mini-thoracotomy mitral valve surgery using retrograde perfusion and an endoaortic clamp or a transthoracic clamp. Methods/design: A prospective, blinded, randomized controlled study on the rate of neurological embolizations during MIMVS started at the University of Turin in June 2014. Major, minor and silent neurological events are being investigated through standard neurological evaluation and magnetic resonance imaging assessment. The magnetic resonance imaging protocol includes conventional sequences for the morphological and quantitative assessment and nonconventional sequences for the white matter microstructural evaluation. Imaging studies are performed before surgery as baseline assessment and on the third postoperative day and, in patients who develop postoperative ischemic lesions, after 6 months. Discussion: Despite recent concerns raised about the endoaortic setting with retrograde perfusion, we expect to show equivalence in terms of neurological events of this technique compared with the transthoracic clamp in a selected cohort of patients. With the first results expected in December 2016 the findings would be of help in confirming the efficacy and safety of MIMVS.

Research paper thumbnail of Right Minithoracotomy for Mitral Valve Surgery: Impact of Tailored Strategies on Early Outcome

The Annals of thoracic surgery, Jan 16, 2016

Interest in right minithoracotomy mitral valve surgery (MVS) is rapidly growing and, to date, dif... more Interest in right minithoracotomy mitral valve surgery (MVS) is rapidly growing and, to date, different perfusion strategies and aortic clamping techniques are available. However each approach carries specific advantages and drawbacks. This retrospective study analyses our experience in right minithoracotomy MVS with different arterial perfusion and aortic clamping strategies, highlighting the results of a patient tailored approach. Between March 2009 and March 2014, 460 patients with a full preoperative work-up that included also aortoiliac-femoral axis' screening underwent right minithoracotomy MVS. One hundred and eight were redo cases (23.5%), 63 had aortoiliac atheromatous disease or significant tortuosity (13.7%), and 38 had chronic obstructive pulmonary disease (8.3%). Based on anatomy and comorbidities, each patient was allocated to the most appropriate of 3 approaches: femoral arterial cannulation with endoaortic balloon (P+EB) (247, 53.7%) or with transthoracic clamp (...

Research paper thumbnail of Mitral annulus calcification: current management and future challenges

Asian Cardiovascular and Thoracic Annals

Research paper thumbnail of Mitral annulus calcification: current management and future challenges

Asian Cardiovascular and Thoracic Annals

Research paper thumbnail of Aortic cannulation system for minimally invasive mitral valve surgery

The Journal of Thoracic and Cardiovascular Surgery, 2015

Research paper thumbnail of The Use of CO2 Removal Devices in Patients Awaiting Lung Transplantation: An Initial Experience

Transplantation Proceedings, 2010

Background. Lung transplantation is the treatment of choice for patients with end-stage lung fail... more Background. Lung transplantation is the treatment of choice for patients with end-stage lung failure. Limitations are presented by the shortage of donors and the long waiting list periods. New techniques, such as extracorporeal membrane ventilator devices with or without pump support, have been developed as bridges to transplantation for patients with severe, unresponsive respiratory insufficiency. Methods. Between