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Papers by Emmanuel Villa

Research paper thumbnail of Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality

The American Journal of Cardiology, 2021

on behalf of the GIROC Investigators Permanent pacemaker implantation (PPI) represents a rare com... more on behalf of the GIROC Investigators Permanent pacemaker implantation (PPI) represents a rare complication after cardiac surgery, with no uniform agreement on timing and no information on follow-up. A multicenter retrospective study was designed to assess pacemaker dependency (PMD) and longterm mortality after cardiac surgery procedures. Between 2004 and 2016, PPI-patients from 18 centers were followed. Time-to-event data were evaluated with semiparametric regression Cox models and semiparametric Fine and Gray model for competing risk framework. Of 859 (0.90%) PPI-patients, 30% were pacemaker independent (PMI) at 6 months. PMD showed higher mortality compared with PMI (10-year survival 80.1% § 2.6% and 92.2% +2.4%, respectively, log-rank p-value < 0.001) with an unadjusted hazard ratio for death of 0.36 (95% CI 0.20 to 0.65, p< 0.001 favoring PMI) and an adjusted hazard ratio of 0.19 (95% CI 0.08 to 0.45, p< 0.001 with PMD as reference). Crude cumulative incidence function of restored PMI rhythm at follow-up at 6 months, 1 year and 12 years were 30.5% (95% CI 27.3% to 33.7%), 33.7% (95% CI 30.4% to 36.9%) and 37.2% (95% CI 33.8% to 40.6%) respectively. PMI was favored by preoperative sinus rhythm with normal conduction (SR) (HR 2.37, 95% CI 1.65 to 3.40, p< 0.001), whereas coronary artery bypass grafting and aortic valve replacement were independently associated with PMD (HR 0.63, 95% CI 0.45 to 0.88, p = 0.006 and HR 0.807, 95% CI 0.65 to 0.99, p = 0.047 respectively). Time-to-implantation was not associated with increased rate of PMI.

Research paper thumbnail of Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality

The American Journal of Cardiology, 2021

on behalf of the GIROC Investigators Permanent pacemaker implantation (PPI) represents a rare com... more on behalf of the GIROC Investigators Permanent pacemaker implantation (PPI) represents a rare complication after cardiac surgery, with no uniform agreement on timing and no information on follow-up. A multicenter retrospective study was designed to assess pacemaker dependency (PMD) and longterm mortality after cardiac surgery procedures. Between 2004 and 2016, PPI-patients from 18 centers were followed. Time-to-event data were evaluated with semiparametric regression Cox models and semiparametric Fine and Gray model for competing risk framework. Of 859 (0.90%) PPI-patients, 30% were pacemaker independent (PMI) at 6 months. PMD showed higher mortality compared with PMI (10-year survival 80.1% § 2.6% and 92.2% +2.4%, respectively, log-rank p-value < 0.001) with an unadjusted hazard ratio for death of 0.36 (95% CI 0.20 to 0.65, p< 0.001 favoring PMI) and an adjusted hazard ratio of 0.19 (95% CI 0.08 to 0.45, p< 0.001 with PMD as reference). Crude cumulative incidence function of restored PMI rhythm at follow-up at 6 months, 1 year and 12 years were 30.5% (95% CI 27.3% to 33.7%), 33.7% (95% CI 30.4% to 36.9%) and 37.2% (95% CI 33.8% to 40.6%) respectively. PMI was favored by preoperative sinus rhythm with normal conduction (SR) (HR 2.37, 95% CI 1.65 to 3.40, p< 0.001), whereas coronary artery bypass grafting and aortic valve replacement were independently associated with PMD (HR 0.63, 95% CI 0.45 to 0.88, p = 0.006 and HR 0.807, 95% CI 0.65 to 0.99, p = 0.047 respectively). Time-to-implantation was not associated with increased rate of PMI.

Research paper thumbnail of Surgical treatment for post-infarction papillary muscle rupture: a multicentre study

European Journal of Cardio-Thoracic Surgery, 2021

OBJECTIVES Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute... more OBJECTIVES Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient characteristics and early outcomes of the surgical management of post-infarction PMR from an international multicentre registry. METHODS Patients underwent surgery for post-infarction PMR between 2001 through 2019 were retrieved from database of the CAUTION study. The primary end point was in-hospital mortality. RESULTS A total of 214 patients were included with a mean age of 66.9 (standard deviation: 10.5) years. The posteromedial papillary muscle was the most frequent rupture location (71.9%); the rupture was complete in 67.3% of patients. Mitral valve replacement was performed in 82.7% of cases. One hundred twenty-two patients (57%) had concomitant coronary artery bypass grafting. In-hospital mortality was 24.8%. Temporal trends revealed no apparent improvement in in-hospital mortality during the study period. Mu...

Research paper thumbnail of Surgical treatment of isolated tricuspid valve infective endocarditis: 25-year results from a multicenter registry

International Journal of Cardiology, 2019

On behalf of The Italian Group of Research for Outcome in Cardiac Surgery (GIROC) Highlights  Pa... more On behalf of The Italian Group of Research for Outcome in Cardiac Surgery (GIROC) Highlights  Patients with TVIE are younger with higher prevalence of IVDU.  In TVIE, Staphylococcus aureus is the most common pathogen.  Age, fungal TVIE, IVDU, redo operation and leads are risk factors  TVIE undergoing surgical treatment show acceptable early and late outcomes.

Research paper thumbnail of Pacemaker after Sutureless and Rapid-Deployment Prostheses: A Progress Report from the SURD-IR

The Thoracic and Cardiovascular Surgeon

Objectives The aim of this study was to investigate the need for postoperative permanent pacemake... more Objectives The aim of this study was to investigate the need for postoperative permanent pacemaker implantation (PPI) following sutureless and rapid-deployment aortic valve replacement (SuRD-AVR) in the context of a progress report from a large multicenter international registry (SURD-IR). Methods We retrospectively analyzed 4,166 patients who underwent SuRD-AVR between 2008 and 2019. The primary outcome was the need for PPI before discharge. The study population was analyzed separately according to the implanted prostheses (Su cohort and RD cohort). Each cohort was divided into two groups based on the operation date: an early group (“EG” = 2008–2016) and a late group (“LG” = 2017–2019). Results The rate of PPI decreased significantly in the Su cohort over time (EG = 10.8% vs LG = 6.3%, p < 0.001). In the Su cohort, a decrease in age, risk profile, and incidence of bicuspid aortic valve, increased use of anterior right thoracotomy, reduction of cardiopulmonary bypass time and of ...

Research paper thumbnail of Commissural Alignment with New-generation Self-Expanding Transcatheter Heart Valves During Aortic Replacement

Cardiovascular Revascularization Medicine

Preserving coronary artery access is a crucial goal during transcatheter aortic valve replacement... more Preserving coronary artery access is a crucial goal during transcatheter aortic valve replacement (TAVR) procedures, especially in case of self-expandable transcatheter heart valve (SE-THV) implantation. In this light, a proper commissural alignment is needed to avoid the risk of coronary obstruction and to permit easy vessels re-cannulation for diagnostic and interventional purposes. New-generation SE-THVs have been furnished of different markers, able to guide operators to perform a correct commissural alignment. In this case series, we describe key procedural aspects of commissural alignment for the different available SE-THVs, providing a step-by-step tutorial for each device. Lastly, we illustrate a commissural alignment in a contrast-zero TAVR.

Research paper thumbnail of Cardiovascular Ultrasound BioMed Central Review

Factors affecting left ventricular remodeling after valve replacement for aortic stenosis. An ove... more Factors affecting left ventricular remodeling after valve replacement for aortic stenosis. An overview

Research paper thumbnail of Coronary artery bypass graft with minimal extracorporeal circulation

The heart surgery forum, 2003

BACKGROUND To evaluate the advantages and benefits of a minimized extracorporeal circulation syst... more BACKGROUND To evaluate the advantages and benefits of a minimized extracorporeal circulation system in the performance of coronary artery bypass grafts. METHODS From September 2000 to February 2003, 279 consecutive patients underwent isolated coronary artery bypass grafting with minimal extracorporeal circulation. A group of 243 patients at good risk as defined by a Euro- SCORE of 3 underwent complete bypass and blood cardioplegia, and a high-risk group of 45 patients (EuroSCORE, 6) underwent operations with partial assistance and a beating heart. In a prospective substudy analysis of thrombocyte and platelet counts, transfusion requirements, PaO2/FIO2, leukocyte count, C-reactive protein level, postoperative bleeding, intensive care unit stay, and ventilation, 40 patients from the good-risk group were matched and compared with 40 patients who underwent operations with a conventional extracorporeal system. RESULTS Revascularization was complete with a mean of 2.8 distal anastomoses ...

Research paper thumbnail of Implantation of one, two or multiple MitraClips for transcatheter mitral valve repair: insights from a 1824-patient multicenter study

Panminerva Medica

BACKGROUND Transcatheter mitral valve repair (TMVR) with the MitraClip device is an established t... more BACKGROUND Transcatheter mitral valve repair (TMVR) with the MitraClip device is an established treatment for mitral regurgitation (MR). More than one MitraClip may be implanted if a single one does not reduce MR adequately. We aimed at appraising the outlook of patients undergoing implantation of one, two or multiple MitraClips for TMVR. METHODS Exploiting the ongoing prospective GIse registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) Study dataset, we compared patients, procedural details and outcomes distinguishing those receiving one, two or multiple MitraClips. The primary endpoint was the composite of 1-year cardiac death or rehospitalization for heart failure. Additional endpoints included all cause death, surgical mitral repair, and functional class. Multivariable adjusted Cox proportional hazard analysis was used for confirmatory purposes. RESULTS As many as 1824 patients were included: 718 (39.4%) treated with a single MitraClip, and 940 (51.5%) receiving two MitraClips, and 166 (9.1%) receiving three or more. Significant differences were found for baseline features, including age, female gender, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, prior myocardial infarction, atrial fibrillation, permanent pacemaker, cardiac resynchronization therapy, implantable cardioverter defibrillator, and prior mitral valve repair (all p<0.05). Several imaging features were also different, including left ventricular dimensions, MR severity and proportionality, mitral valve area, flail leaflet, and pulmonary vein flow (all p<0.05). Among procedural features, significant differences were found for anesthesia type, MitraClip type, fluoroscopy, device, and operating room times, postprocedural mitral gradient, residual MR, smoke-like effect, device success partial detachment and surgical conversion (all p<0.05). In-hospital death occurred more frequently in patients receiving multiple MitraClips, and the same applied severe residual MR (all p<0.05). Mid-term follow-up (15±13 months) showed significant difference in the risk of death, cardiac death, rehospitalization for heart failure, and their composites, mainly, but not solely, associated with multiple MitraClips (all p<0.05). Adjusted analysis confirmed the significantly increased risk of composite adverse events when comparing the multiple vs single MitraClip groups (p=0.014 for death and rehospitalization, p=0.013 for cardiac death or rehospitalization). CONCLUSIONS Implantation of one or two MitraClips is associated with favorable clinical outcomes. Conversely, bail-out implantation of three or more MitraClips may portend a worse long-term prognosis.

Research paper thumbnail of Sutureless versus rapid deployment aortic valve replacement: results from a multicentric registry

The Annals of Thoracic Surgery

BACKGROUND To compare clinical and hemodynamic in-hospital outcomes of patients undergoing suture... more BACKGROUND To compare clinical and hemodynamic in-hospital outcomes of patients undergoing sutureless versus rapid deployment aortic valve replacement (SURD-AVR) in the large population of the Sutureless and Rapid Deployment International Registry (SURD-IR). METHODS We examined 4695 patients who underwent isolated or combined SURD-AVR. The "sutureless" Perceval valve was used in 3133 patients and the "rapid deployment" Intuity in 1562. Potential confounding factors were addressed by the use of propensity score matching. After matching, 2 well-balanced cohorts of 823 pairs (isolated SURD-AVR) and 467 pairs (combined SURD-AVR) were created. RESULTS Patients who received Perceval and Intuity valves showed similar in-hospital mortality and rate of major postoperative complications. Perceval was associated shorter cross clamp and cardiopulmonary bypass time. In the isolated SURD-AVR group, patients receiving Perceval were more likely to undergo anterior right thoracotomy incision. Postoperative transvalvular gradients were significantly lower for the Intuity valve compared to those of the Perceval valve, either in isolated and combined SURD-AVR. The Intuity valve was associated with a lower rate of postoperative mild aortic regurgitation. CONCLUSIONS Our results confirm the safety and efficacy of SURD-AVR regardless of the valve type. The Perceval valve was associated with reduced operative times and increased anterior right thoracotomy incision. The Intuity valve showed superior hemodynamic outcomes and a lower incidence of postoperative mild aortic regurgitation.

Research paper thumbnail of Italian Society of Interventional Cardiology ( GIse ) registry Of Transcatheter treatment of mitral valve r egurgitaTiOn ( GIOTTO ): impact of valve disease aetiology and residual mitral regurgitation after MitraClip implantation

European Journal of Heart Failure

The Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mi... more The Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) was conceived in order to assess the safety and efficacy of MitraClip therapy in Italy. The aim of this study was to assess procedural and mid‐term outcomes, and clinical and echocardiographic predictors of mid‐term mortality after MitraClip therapy, stratifying the results according to the diagnosis of functional and degenerative mitral regurgitation (FMR vs. DMR).

Research paper thumbnail of Characteristics and outcomes of MitraClip in octogenarians: Evidence from 1853 patients in the GIOTTO registry

International Journal of Cardiology

BACKGROUND We aimed at appraising features and outcomes of patients undergoing MitraClip treatmen... more BACKGROUND We aimed at appraising features and outcomes of patients undergoing MitraClip treatment according to their age. METHODS We queried the prospective GIOTTO multicenter registry including 19 Italian centers performing MitraClip implantation distinguishing patients <80 vs ≥80 years of age. RESULTS In total, 1853 patients were included, 751 (40.5%) octogenarians and 1102 (59.5%) non-octogenarians. Several baseline and procedural features were significantly different, including gender, regurgitation etiology, and functional class (all p < 0.05). In-hospital outcomes were similarly satisfactory, with death occurring in 18 (2.4%) and 32 (2.9%, p = 0.561), respectively, and improvement in mitral regurgitation in 732 (97.4%) and 1078 (97.8%, p = 0.746), respectively. After a mean follow-up of 15 months, death occurred in 152 (20.2%) and 264 (24.0%), and cardiac death in 85 (11.3%) and 138 (12.5%), respectively (both p > 0.05). Rehospitalization for heart failure and the composite of cardiac death or rehospitalization for heart failure were significantly less common in octogenarians: 63 (8.4%) vs 156 (14.2%, p < 0.001), and 125 (16.6%) vs 242 (22.0%, p = 0.005), respectively. Multivariable analysis showed that these differences were largely due to confounding features, as after adjustment for baseline, clinical and imaging characteristics no significant difference was found for the above clinical endpoints. CONCLUSIONS Transcatheter mitral valve repair with the MitraClip in carefully selected octogenarians appears feasible and safe, and is associated with favorable clinical outcomes at mid-term follow-up.

Research paper thumbnail of Urgency and emergency treatments in cardiovascular surgery during the COVID pandemic: results of extremized HUB and spoke organization in northern Italy

OBJECTIVES: Feasibility and results of cardiovascular hub-spoke networks to face COVID19 pandemic... more OBJECTIVES: Feasibility and results of cardiovascular hub-spoke networks to face COVID19 pandemic. The COVID-19 pandemic in Italy had the primary outbreak in the northern part of the country forcing the regional health care system to expand the availability of beds in the wards and intensive care units and to institute a Hub and Spoke hospital network to ensure assistance continuity for urgencies and emergencies. We report a descriptive analysis of the activity of the first 30 days of the Hub center. METHODS: Role of our Hub center was to guarantee 24/24h 7/7days cardiovascular surgical care for an area of 3.145.312 inhabitants’ area. Hub-spoke reorganization permitted a significant increase of ICU and ward beds availability for COVID patients needing hospitalization in all peripheral centers. Records of all consecutive patients admitted were collected and analyzed. RESULTS: a total of 100 patients were evaluated in the study period . Hub and spoke cooperation have been successful, all patients affected by cardiovascular urgencies or emergencies found a highly specialized hospital and was evaluated and treated. Global reduction of elective and non-deferrable interventions in spoke centers was achieved for both vascular and cardiac surgery while we detected a significant increase of urgent vascular interventions for acute limb ischemia. We did not observe an increase of in-hospital mortality in non-infected patients. CONCLUSION: Hub and spoke network for cardiovascular pathology is an effective way to face healthcare needs during the pandemic.

Research paper thumbnail of Current trends of sutureless and rapid deployment valves: an 11-year experience from the Sutureless and Rapid Deployment International Registry

European Journal of Cardio-Thoracic Surgery

OBJECTIVES Current evidence on sutureless and rapid deployment aortic valve replacement (SURD-AVR... more OBJECTIVES Current evidence on sutureless and rapid deployment aortic valve replacement (SURD-AVR) is limited and does not allow for the assessment of the clinical impact and the evolution of procedural and clinical outcomes of this new valve technology. The Sutureless and Rapid Deployment International Registry (SURD-IR) represents a unique opportunity to evaluate the current trends and outcomes of SURD-AVR interventions. METHODS Data from 3682 patients enrolled between 2007 and 2018 were analysed. Patients were divided according to the date of surgery into 6 equal groups and by the type of intervention: isolated SURD-AVR (n = 2472) and combined SURD-AVR (n = 1086). RESULTS Across the 11-year study period, significant changes occurred in patient characteristics including a decrease in age and in estimated surgical risk. Less invasive approaches for isolated SURD-AVR increased considerably from 49.4% to 85.5%. The overall in-hospital mortality rate was 1.6% and 3.9% in isolated and ...

Research paper thumbnail of Sutureless and rapid deployment implantation in bicuspid aortic valve: results from the sutureless and rapid-deployment aortic valve replacement international registry

Annals of Cardiothoracic Surgery

Background: Benefits of sutureless and rapid deployment (SURD) bioprostheses in bicuspid aortic v... more Background: Benefits of sutureless and rapid deployment (SURD) bioprostheses in bicuspid aortic valves (BAV) are controversial. The aim of this study is to report the outcomes of patients undergoing aortic valve replacement (AVR) for BAV from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR). Methods: Of the 4,636 patients who received primary isolated SURD-AVR between 2007 and 2018, 191 (4.1%) BAV patients underwent AVR with SURD valve. Results: Overall 30-day mortality was 1.6%. The Intuity valve was implanted in 53.9% of cases, whereas the Perceval was implanted in 46.1%. Rate of stroke for isolated AVR was 4.2%. No case of endocarditis, thromboembolism, myocardial infarction, valve dislocation or structural valve deterioration was reported in the early phase. Rate of pacemaker implantation and moderate-severe aortic regurgitation (AR) were 7.9% and 3.7%, respectively. Conclusions: BAV is not considered a contraindication for the implantation of SURD valves. However, detailed information of aortic root geometry as well as the knowledge of some technical considerations are mandatory for a good outcome.

Research paper thumbnail of Dysfunctional Bioprostheses and Mitral Annulus Calcification as a Docking Site for Transcatheter Mitral Valve Implantation

Structural Heart

Methods: Clinical and hemodynamic data were retrospectively reviewed in 11 consecutive patients (... more Methods: Clinical and hemodynamic data were retrospectively reviewed in 11 consecutive patients (mean age 84±2.5 years, 80% female, Society of Thoracic Surgeons score 15.5±3.5) who underwent TMVI at our center between January 2014 and January 2018. Nine patients (81.1%) with degenerated bioprostheses (mean endurance 10.5±2.9 years) were scheduled for transapical valve in valve TMVI and two, with heavy circumferential MAC, for open heart TMVI on native mitral annulus. Eight procedures (72.2%) were off-label and received approbation of our ethic committee. All patients underwent clinical and echocardiographic follow-up. Results: Implantation was uneventful in 10 patients. One procedure was safely aborted for ventricular frailty. The 30-day inhospital mortality was nil. Mean ICU stay was 1.2±0.4 days with a mean intubation time of 3.5±1 hours. In patients who received a valve in valve TMVI, median regurgitation grade and mean trans-prostheses gradients at discharge decreased respectively from 4.0 (IQR:3.2 to 4) to 0 (IQR:0 to1.0, p=0.033) and from 10 ±4.5 mmHg to 5.0 ±1.4 mmHg (p=0.017). Mean echocardiographic follow-up was 37±10 months and showed a mean transprosthetic gradient of 4.9±1.4 mmHg. No LVOT obstruction, intraor peri-prosthesis regurgitation was noted in all patients. Survival at 12 and 48 months was 90% and 77% respectively.

Research paper thumbnail of Mitroflow Aortic Bioprosthesis Failure in Type B Aortic Dissection: Preventive Left Main Stenting in Transapical Transcatheter Aortic Valve Implantation Strategy

Cardiology research, 2018

Mitroflow aortic prosthesis dysfunction in case of complex vascular disease is considered a chall... more Mitroflow aortic prosthesis dysfunction in case of complex vascular disease is considered a challenging scenario. Because of the high risk for surgical reoperation and the presence of chronic aortic dissection originated from a calcified Kommerel diverticulum, we considered to perform a transapical valve-in-valve transcatheter aortic valve implantation (TAVI) procedure. Myocardial ischemia is a dreadful complication reported in valve-in-valve TAVI procedures, mainly in patients with degenerated Mitroflow aortic bioprostheses. Because of the narrow shape of Valsalva sinuses and the short distance between Mitroflow annulus and left coronary ostium, to overcome the risk of possible Mitroflow leaflets displacement during TAVI expansion thus overlapping coronary ostia, we performed a preventive angioplasty. Then, we implanted a bare metal stent on the left main protruding in the aortic root. At 3 years follow-up the patient was in good clinical conditions.

Research paper thumbnail of Sutureless aortic valve replacement in high risk patients neutralizes expected worse hospital outcome: A clinical and economic analysis

Cardiology journal, Jan 20, 2018

Aortic valve replacement (AVR) by sutureless prostheses is changing surgeon options, although whi... more Aortic valve replacement (AVR) by sutureless prostheses is changing surgeon options, although which patients benefit most, as well as their possible economic impact is still to be defined. Perceval-S prosthesis (LivaNova) is reserved, at the documented Institution, for patients at perceived high surgical risk. This retrospective analysis of outcome and resource consumption compared Perceval with other tissue valves. To clarify the comparison, only patients respecting 'instructions-for-use' of Perceval were reviewed. > 65 years, +/- coronary artery bypass grafting, PFO closure or myectomy. bicuspid, combined valve or aortic surgery. Costs were calculated per patient on a daily basis including preoperative tests, operating costs (hourly basis), disposables, drugs, blood components and personnel. The sutureless group (SU-AVR) had a higher risk profile than the sutured group (ST-AVR). Cardiopulmonary bypass (CPB) and cross-clamp times were significantly shorter in SU-AVR (iso...

Research paper thumbnail of Dislocation of a sutureless prosthesis after type I bicuspid aortic valve replacement

The Journal of thoracic and cardiovascular surgery, Jan 10, 2018

From the Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy; and Cardiovascu... more From the Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy; and Cardiovascular Sciences Department, Catholic University of The Sacred Heart, Rome, Italy. Disclosures: G.T. is proctor for LivaNova. All other authors have nothing to disclose with regard to commercial support. Received for publication Nov 23, 2017; revisions received Jan 11, 2018; accepted for publication Feb 4, 2018; available ahead of print March 8, 2018. Address for reprints: Giovanni Alfonso Chiariello, MD, Cardiovascular Sciences Department, Catholic University of The Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy (E-mail: gio.chiariello88@tiscali.it). J Thorac Cardiovasc Surg 2018;156:e87-9 0022-5223/$36.00 Copyright 2018 by The American Association for Thoracic Surgery https://doi.org/10.1016/j.jtcvs.2018.02.002 Aortic regurgitation from prosthesis 5 inclination into the noncoronary sinus.

Research paper thumbnail of Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR): early results from 3343 patients

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 30, 2018

The Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR) was... more The Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR) was established by a consortium of 18 research centres-the International Valvular Surgery Study Group (IVSSG)-to overcome limitations of the literature and provide adequately powered evidence on sutureless and rapid-deployment aortic valves replacement (SURD-AVR). Data from 3343 patients undergoing SURD-AVR over a 10-year period (2007-2017) were collected in the registry. The mean age of the patients was 76.8 ± 6.7 years, with 36.4% being 80 years or older. The average logistic EuroSCORE was 11.3 ± 9.7%. Isolated SURD-AVR was performed in 70.7% (n = 2362) of patients using full sternotomy (35.3%) or less invasive approaches (64.8%). Overall hospital mortality was 2.1%, being 1.4% in patients who had isolated SURD-AVR and 3.5% in those who had concomitant procedures (P < 0.001). When considering baseline risk profile, mortality rate was 0.8% and 1.9% in low risk (logistic EuroSCORE <10...

Research paper thumbnail of Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality

The American Journal of Cardiology, 2021

on behalf of the GIROC Investigators Permanent pacemaker implantation (PPI) represents a rare com... more on behalf of the GIROC Investigators Permanent pacemaker implantation (PPI) represents a rare complication after cardiac surgery, with no uniform agreement on timing and no information on follow-up. A multicenter retrospective study was designed to assess pacemaker dependency (PMD) and longterm mortality after cardiac surgery procedures. Between 2004 and 2016, PPI-patients from 18 centers were followed. Time-to-event data were evaluated with semiparametric regression Cox models and semiparametric Fine and Gray model for competing risk framework. Of 859 (0.90%) PPI-patients, 30% were pacemaker independent (PMI) at 6 months. PMD showed higher mortality compared with PMI (10-year survival 80.1% § 2.6% and 92.2% +2.4%, respectively, log-rank p-value < 0.001) with an unadjusted hazard ratio for death of 0.36 (95% CI 0.20 to 0.65, p< 0.001 favoring PMI) and an adjusted hazard ratio of 0.19 (95% CI 0.08 to 0.45, p< 0.001 with PMD as reference). Crude cumulative incidence function of restored PMI rhythm at follow-up at 6 months, 1 year and 12 years were 30.5% (95% CI 27.3% to 33.7%), 33.7% (95% CI 30.4% to 36.9%) and 37.2% (95% CI 33.8% to 40.6%) respectively. PMI was favored by preoperative sinus rhythm with normal conduction (SR) (HR 2.37, 95% CI 1.65 to 3.40, p< 0.001), whereas coronary artery bypass grafting and aortic valve replacement were independently associated with PMD (HR 0.63, 95% CI 0.45 to 0.88, p = 0.006 and HR 0.807, 95% CI 0.65 to 0.99, p = 0.047 respectively). Time-to-implantation was not associated with increased rate of PMI.

Research paper thumbnail of Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality

The American Journal of Cardiology, 2021

on behalf of the GIROC Investigators Permanent pacemaker implantation (PPI) represents a rare com... more on behalf of the GIROC Investigators Permanent pacemaker implantation (PPI) represents a rare complication after cardiac surgery, with no uniform agreement on timing and no information on follow-up. A multicenter retrospective study was designed to assess pacemaker dependency (PMD) and longterm mortality after cardiac surgery procedures. Between 2004 and 2016, PPI-patients from 18 centers were followed. Time-to-event data were evaluated with semiparametric regression Cox models and semiparametric Fine and Gray model for competing risk framework. Of 859 (0.90%) PPI-patients, 30% were pacemaker independent (PMI) at 6 months. PMD showed higher mortality compared with PMI (10-year survival 80.1% § 2.6% and 92.2% +2.4%, respectively, log-rank p-value < 0.001) with an unadjusted hazard ratio for death of 0.36 (95% CI 0.20 to 0.65, p< 0.001 favoring PMI) and an adjusted hazard ratio of 0.19 (95% CI 0.08 to 0.45, p< 0.001 with PMD as reference). Crude cumulative incidence function of restored PMI rhythm at follow-up at 6 months, 1 year and 12 years were 30.5% (95% CI 27.3% to 33.7%), 33.7% (95% CI 30.4% to 36.9%) and 37.2% (95% CI 33.8% to 40.6%) respectively. PMI was favored by preoperative sinus rhythm with normal conduction (SR) (HR 2.37, 95% CI 1.65 to 3.40, p< 0.001), whereas coronary artery bypass grafting and aortic valve replacement were independently associated with PMD (HR 0.63, 95% CI 0.45 to 0.88, p = 0.006 and HR 0.807, 95% CI 0.65 to 0.99, p = 0.047 respectively). Time-to-implantation was not associated with increased rate of PMI.

Research paper thumbnail of Surgical treatment for post-infarction papillary muscle rupture: a multicentre study

European Journal of Cardio-Thoracic Surgery, 2021

OBJECTIVES Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute... more OBJECTIVES Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient characteristics and early outcomes of the surgical management of post-infarction PMR from an international multicentre registry. METHODS Patients underwent surgery for post-infarction PMR between 2001 through 2019 were retrieved from database of the CAUTION study. The primary end point was in-hospital mortality. RESULTS A total of 214 patients were included with a mean age of 66.9 (standard deviation: 10.5) years. The posteromedial papillary muscle was the most frequent rupture location (71.9%); the rupture was complete in 67.3% of patients. Mitral valve replacement was performed in 82.7% of cases. One hundred twenty-two patients (57%) had concomitant coronary artery bypass grafting. In-hospital mortality was 24.8%. Temporal trends revealed no apparent improvement in in-hospital mortality during the study period. Mu...

Research paper thumbnail of Surgical treatment of isolated tricuspid valve infective endocarditis: 25-year results from a multicenter registry

International Journal of Cardiology, 2019

On behalf of The Italian Group of Research for Outcome in Cardiac Surgery (GIROC) Highlights  Pa... more On behalf of The Italian Group of Research for Outcome in Cardiac Surgery (GIROC) Highlights  Patients with TVIE are younger with higher prevalence of IVDU.  In TVIE, Staphylococcus aureus is the most common pathogen.  Age, fungal TVIE, IVDU, redo operation and leads are risk factors  TVIE undergoing surgical treatment show acceptable early and late outcomes.

Research paper thumbnail of Pacemaker after Sutureless and Rapid-Deployment Prostheses: A Progress Report from the SURD-IR

The Thoracic and Cardiovascular Surgeon

Objectives The aim of this study was to investigate the need for postoperative permanent pacemake... more Objectives The aim of this study was to investigate the need for postoperative permanent pacemaker implantation (PPI) following sutureless and rapid-deployment aortic valve replacement (SuRD-AVR) in the context of a progress report from a large multicenter international registry (SURD-IR). Methods We retrospectively analyzed 4,166 patients who underwent SuRD-AVR between 2008 and 2019. The primary outcome was the need for PPI before discharge. The study population was analyzed separately according to the implanted prostheses (Su cohort and RD cohort). Each cohort was divided into two groups based on the operation date: an early group (“EG” = 2008–2016) and a late group (“LG” = 2017–2019). Results The rate of PPI decreased significantly in the Su cohort over time (EG = 10.8% vs LG = 6.3%, p < 0.001). In the Su cohort, a decrease in age, risk profile, and incidence of bicuspid aortic valve, increased use of anterior right thoracotomy, reduction of cardiopulmonary bypass time and of ...

Research paper thumbnail of Commissural Alignment with New-generation Self-Expanding Transcatheter Heart Valves During Aortic Replacement

Cardiovascular Revascularization Medicine

Preserving coronary artery access is a crucial goal during transcatheter aortic valve replacement... more Preserving coronary artery access is a crucial goal during transcatheter aortic valve replacement (TAVR) procedures, especially in case of self-expandable transcatheter heart valve (SE-THV) implantation. In this light, a proper commissural alignment is needed to avoid the risk of coronary obstruction and to permit easy vessels re-cannulation for diagnostic and interventional purposes. New-generation SE-THVs have been furnished of different markers, able to guide operators to perform a correct commissural alignment. In this case series, we describe key procedural aspects of commissural alignment for the different available SE-THVs, providing a step-by-step tutorial for each device. Lastly, we illustrate a commissural alignment in a contrast-zero TAVR.

Research paper thumbnail of Cardiovascular Ultrasound BioMed Central Review

Factors affecting left ventricular remodeling after valve replacement for aortic stenosis. An ove... more Factors affecting left ventricular remodeling after valve replacement for aortic stenosis. An overview

Research paper thumbnail of Coronary artery bypass graft with minimal extracorporeal circulation

The heart surgery forum, 2003

BACKGROUND To evaluate the advantages and benefits of a minimized extracorporeal circulation syst... more BACKGROUND To evaluate the advantages and benefits of a minimized extracorporeal circulation system in the performance of coronary artery bypass grafts. METHODS From September 2000 to February 2003, 279 consecutive patients underwent isolated coronary artery bypass grafting with minimal extracorporeal circulation. A group of 243 patients at good risk as defined by a Euro- SCORE of 3 underwent complete bypass and blood cardioplegia, and a high-risk group of 45 patients (EuroSCORE, 6) underwent operations with partial assistance and a beating heart. In a prospective substudy analysis of thrombocyte and platelet counts, transfusion requirements, PaO2/FIO2, leukocyte count, C-reactive protein level, postoperative bleeding, intensive care unit stay, and ventilation, 40 patients from the good-risk group were matched and compared with 40 patients who underwent operations with a conventional extracorporeal system. RESULTS Revascularization was complete with a mean of 2.8 distal anastomoses ...

Research paper thumbnail of Implantation of one, two or multiple MitraClips for transcatheter mitral valve repair: insights from a 1824-patient multicenter study

Panminerva Medica

BACKGROUND Transcatheter mitral valve repair (TMVR) with the MitraClip device is an established t... more BACKGROUND Transcatheter mitral valve repair (TMVR) with the MitraClip device is an established treatment for mitral regurgitation (MR). More than one MitraClip may be implanted if a single one does not reduce MR adequately. We aimed at appraising the outlook of patients undergoing implantation of one, two or multiple MitraClips for TMVR. METHODS Exploiting the ongoing prospective GIse registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) Study dataset, we compared patients, procedural details and outcomes distinguishing those receiving one, two or multiple MitraClips. The primary endpoint was the composite of 1-year cardiac death or rehospitalization for heart failure. Additional endpoints included all cause death, surgical mitral repair, and functional class. Multivariable adjusted Cox proportional hazard analysis was used for confirmatory purposes. RESULTS As many as 1824 patients were included: 718 (39.4%) treated with a single MitraClip, and 940 (51.5%) receiving two MitraClips, and 166 (9.1%) receiving three or more. Significant differences were found for baseline features, including age, female gender, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, prior myocardial infarction, atrial fibrillation, permanent pacemaker, cardiac resynchronization therapy, implantable cardioverter defibrillator, and prior mitral valve repair (all p<0.05). Several imaging features were also different, including left ventricular dimensions, MR severity and proportionality, mitral valve area, flail leaflet, and pulmonary vein flow (all p<0.05). Among procedural features, significant differences were found for anesthesia type, MitraClip type, fluoroscopy, device, and operating room times, postprocedural mitral gradient, residual MR, smoke-like effect, device success partial detachment and surgical conversion (all p<0.05). In-hospital death occurred more frequently in patients receiving multiple MitraClips, and the same applied severe residual MR (all p<0.05). Mid-term follow-up (15±13 months) showed significant difference in the risk of death, cardiac death, rehospitalization for heart failure, and their composites, mainly, but not solely, associated with multiple MitraClips (all p<0.05). Adjusted analysis confirmed the significantly increased risk of composite adverse events when comparing the multiple vs single MitraClip groups (p=0.014 for death and rehospitalization, p=0.013 for cardiac death or rehospitalization). CONCLUSIONS Implantation of one or two MitraClips is associated with favorable clinical outcomes. Conversely, bail-out implantation of three or more MitraClips may portend a worse long-term prognosis.

Research paper thumbnail of Sutureless versus rapid deployment aortic valve replacement: results from a multicentric registry

The Annals of Thoracic Surgery

BACKGROUND To compare clinical and hemodynamic in-hospital outcomes of patients undergoing suture... more BACKGROUND To compare clinical and hemodynamic in-hospital outcomes of patients undergoing sutureless versus rapid deployment aortic valve replacement (SURD-AVR) in the large population of the Sutureless and Rapid Deployment International Registry (SURD-IR). METHODS We examined 4695 patients who underwent isolated or combined SURD-AVR. The "sutureless" Perceval valve was used in 3133 patients and the "rapid deployment" Intuity in 1562. Potential confounding factors were addressed by the use of propensity score matching. After matching, 2 well-balanced cohorts of 823 pairs (isolated SURD-AVR) and 467 pairs (combined SURD-AVR) were created. RESULTS Patients who received Perceval and Intuity valves showed similar in-hospital mortality and rate of major postoperative complications. Perceval was associated shorter cross clamp and cardiopulmonary bypass time. In the isolated SURD-AVR group, patients receiving Perceval were more likely to undergo anterior right thoracotomy incision. Postoperative transvalvular gradients were significantly lower for the Intuity valve compared to those of the Perceval valve, either in isolated and combined SURD-AVR. The Intuity valve was associated with a lower rate of postoperative mild aortic regurgitation. CONCLUSIONS Our results confirm the safety and efficacy of SURD-AVR regardless of the valve type. The Perceval valve was associated with reduced operative times and increased anterior right thoracotomy incision. The Intuity valve showed superior hemodynamic outcomes and a lower incidence of postoperative mild aortic regurgitation.

Research paper thumbnail of Italian Society of Interventional Cardiology ( GIse ) registry Of Transcatheter treatment of mitral valve r egurgitaTiOn ( GIOTTO ): impact of valve disease aetiology and residual mitral regurgitation after MitraClip implantation

European Journal of Heart Failure

The Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mi... more The Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) was conceived in order to assess the safety and efficacy of MitraClip therapy in Italy. The aim of this study was to assess procedural and mid‐term outcomes, and clinical and echocardiographic predictors of mid‐term mortality after MitraClip therapy, stratifying the results according to the diagnosis of functional and degenerative mitral regurgitation (FMR vs. DMR).

Research paper thumbnail of Characteristics and outcomes of MitraClip in octogenarians: Evidence from 1853 patients in the GIOTTO registry

International Journal of Cardiology

BACKGROUND We aimed at appraising features and outcomes of patients undergoing MitraClip treatmen... more BACKGROUND We aimed at appraising features and outcomes of patients undergoing MitraClip treatment according to their age. METHODS We queried the prospective GIOTTO multicenter registry including 19 Italian centers performing MitraClip implantation distinguishing patients <80 vs ≥80 years of age. RESULTS In total, 1853 patients were included, 751 (40.5%) octogenarians and 1102 (59.5%) non-octogenarians. Several baseline and procedural features were significantly different, including gender, regurgitation etiology, and functional class (all p < 0.05). In-hospital outcomes were similarly satisfactory, with death occurring in 18 (2.4%) and 32 (2.9%, p = 0.561), respectively, and improvement in mitral regurgitation in 732 (97.4%) and 1078 (97.8%, p = 0.746), respectively. After a mean follow-up of 15 months, death occurred in 152 (20.2%) and 264 (24.0%), and cardiac death in 85 (11.3%) and 138 (12.5%), respectively (both p > 0.05). Rehospitalization for heart failure and the composite of cardiac death or rehospitalization for heart failure were significantly less common in octogenarians: 63 (8.4%) vs 156 (14.2%, p < 0.001), and 125 (16.6%) vs 242 (22.0%, p = 0.005), respectively. Multivariable analysis showed that these differences were largely due to confounding features, as after adjustment for baseline, clinical and imaging characteristics no significant difference was found for the above clinical endpoints. CONCLUSIONS Transcatheter mitral valve repair with the MitraClip in carefully selected octogenarians appears feasible and safe, and is associated with favorable clinical outcomes at mid-term follow-up.

Research paper thumbnail of Urgency and emergency treatments in cardiovascular surgery during the COVID pandemic: results of extremized HUB and spoke organization in northern Italy

OBJECTIVES: Feasibility and results of cardiovascular hub-spoke networks to face COVID19 pandemic... more OBJECTIVES: Feasibility and results of cardiovascular hub-spoke networks to face COVID19 pandemic. The COVID-19 pandemic in Italy had the primary outbreak in the northern part of the country forcing the regional health care system to expand the availability of beds in the wards and intensive care units and to institute a Hub and Spoke hospital network to ensure assistance continuity for urgencies and emergencies. We report a descriptive analysis of the activity of the first 30 days of the Hub center. METHODS: Role of our Hub center was to guarantee 24/24h 7/7days cardiovascular surgical care for an area of 3.145.312 inhabitants’ area. Hub-spoke reorganization permitted a significant increase of ICU and ward beds availability for COVID patients needing hospitalization in all peripheral centers. Records of all consecutive patients admitted were collected and analyzed. RESULTS: a total of 100 patients were evaluated in the study period . Hub and spoke cooperation have been successful, all patients affected by cardiovascular urgencies or emergencies found a highly specialized hospital and was evaluated and treated. Global reduction of elective and non-deferrable interventions in spoke centers was achieved for both vascular and cardiac surgery while we detected a significant increase of urgent vascular interventions for acute limb ischemia. We did not observe an increase of in-hospital mortality in non-infected patients. CONCLUSION: Hub and spoke network for cardiovascular pathology is an effective way to face healthcare needs during the pandemic.

Research paper thumbnail of Current trends of sutureless and rapid deployment valves: an 11-year experience from the Sutureless and Rapid Deployment International Registry

European Journal of Cardio-Thoracic Surgery

OBJECTIVES Current evidence on sutureless and rapid deployment aortic valve replacement (SURD-AVR... more OBJECTIVES Current evidence on sutureless and rapid deployment aortic valve replacement (SURD-AVR) is limited and does not allow for the assessment of the clinical impact and the evolution of procedural and clinical outcomes of this new valve technology. The Sutureless and Rapid Deployment International Registry (SURD-IR) represents a unique opportunity to evaluate the current trends and outcomes of SURD-AVR interventions. METHODS Data from 3682 patients enrolled between 2007 and 2018 were analysed. Patients were divided according to the date of surgery into 6 equal groups and by the type of intervention: isolated SURD-AVR (n = 2472) and combined SURD-AVR (n = 1086). RESULTS Across the 11-year study period, significant changes occurred in patient characteristics including a decrease in age and in estimated surgical risk. Less invasive approaches for isolated SURD-AVR increased considerably from 49.4% to 85.5%. The overall in-hospital mortality rate was 1.6% and 3.9% in isolated and ...

Research paper thumbnail of Sutureless and rapid deployment implantation in bicuspid aortic valve: results from the sutureless and rapid-deployment aortic valve replacement international registry

Annals of Cardiothoracic Surgery

Background: Benefits of sutureless and rapid deployment (SURD) bioprostheses in bicuspid aortic v... more Background: Benefits of sutureless and rapid deployment (SURD) bioprostheses in bicuspid aortic valves (BAV) are controversial. The aim of this study is to report the outcomes of patients undergoing aortic valve replacement (AVR) for BAV from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR). Methods: Of the 4,636 patients who received primary isolated SURD-AVR between 2007 and 2018, 191 (4.1%) BAV patients underwent AVR with SURD valve. Results: Overall 30-day mortality was 1.6%. The Intuity valve was implanted in 53.9% of cases, whereas the Perceval was implanted in 46.1%. Rate of stroke for isolated AVR was 4.2%. No case of endocarditis, thromboembolism, myocardial infarction, valve dislocation or structural valve deterioration was reported in the early phase. Rate of pacemaker implantation and moderate-severe aortic regurgitation (AR) were 7.9% and 3.7%, respectively. Conclusions: BAV is not considered a contraindication for the implantation of SURD valves. However, detailed information of aortic root geometry as well as the knowledge of some technical considerations are mandatory for a good outcome.

Research paper thumbnail of Dysfunctional Bioprostheses and Mitral Annulus Calcification as a Docking Site for Transcatheter Mitral Valve Implantation

Structural Heart

Methods: Clinical and hemodynamic data were retrospectively reviewed in 11 consecutive patients (... more Methods: Clinical and hemodynamic data were retrospectively reviewed in 11 consecutive patients (mean age 84±2.5 years, 80% female, Society of Thoracic Surgeons score 15.5±3.5) who underwent TMVI at our center between January 2014 and January 2018. Nine patients (81.1%) with degenerated bioprostheses (mean endurance 10.5±2.9 years) were scheduled for transapical valve in valve TMVI and two, with heavy circumferential MAC, for open heart TMVI on native mitral annulus. Eight procedures (72.2%) were off-label and received approbation of our ethic committee. All patients underwent clinical and echocardiographic follow-up. Results: Implantation was uneventful in 10 patients. One procedure was safely aborted for ventricular frailty. The 30-day inhospital mortality was nil. Mean ICU stay was 1.2±0.4 days with a mean intubation time of 3.5±1 hours. In patients who received a valve in valve TMVI, median regurgitation grade and mean trans-prostheses gradients at discharge decreased respectively from 4.0 (IQR:3.2 to 4) to 0 (IQR:0 to1.0, p=0.033) and from 10 ±4.5 mmHg to 5.0 ±1.4 mmHg (p=0.017). Mean echocardiographic follow-up was 37±10 months and showed a mean transprosthetic gradient of 4.9±1.4 mmHg. No LVOT obstruction, intraor peri-prosthesis regurgitation was noted in all patients. Survival at 12 and 48 months was 90% and 77% respectively.

Research paper thumbnail of Mitroflow Aortic Bioprosthesis Failure in Type B Aortic Dissection: Preventive Left Main Stenting in Transapical Transcatheter Aortic Valve Implantation Strategy

Cardiology research, 2018

Mitroflow aortic prosthesis dysfunction in case of complex vascular disease is considered a chall... more Mitroflow aortic prosthesis dysfunction in case of complex vascular disease is considered a challenging scenario. Because of the high risk for surgical reoperation and the presence of chronic aortic dissection originated from a calcified Kommerel diverticulum, we considered to perform a transapical valve-in-valve transcatheter aortic valve implantation (TAVI) procedure. Myocardial ischemia is a dreadful complication reported in valve-in-valve TAVI procedures, mainly in patients with degenerated Mitroflow aortic bioprostheses. Because of the narrow shape of Valsalva sinuses and the short distance between Mitroflow annulus and left coronary ostium, to overcome the risk of possible Mitroflow leaflets displacement during TAVI expansion thus overlapping coronary ostia, we performed a preventive angioplasty. Then, we implanted a bare metal stent on the left main protruding in the aortic root. At 3 years follow-up the patient was in good clinical conditions.

Research paper thumbnail of Sutureless aortic valve replacement in high risk patients neutralizes expected worse hospital outcome: A clinical and economic analysis

Cardiology journal, Jan 20, 2018

Aortic valve replacement (AVR) by sutureless prostheses is changing surgeon options, although whi... more Aortic valve replacement (AVR) by sutureless prostheses is changing surgeon options, although which patients benefit most, as well as their possible economic impact is still to be defined. Perceval-S prosthesis (LivaNova) is reserved, at the documented Institution, for patients at perceived high surgical risk. This retrospective analysis of outcome and resource consumption compared Perceval with other tissue valves. To clarify the comparison, only patients respecting 'instructions-for-use' of Perceval were reviewed. > 65 years, +/- coronary artery bypass grafting, PFO closure or myectomy. bicuspid, combined valve or aortic surgery. Costs were calculated per patient on a daily basis including preoperative tests, operating costs (hourly basis), disposables, drugs, blood components and personnel. The sutureless group (SU-AVR) had a higher risk profile than the sutured group (ST-AVR). Cardiopulmonary bypass (CPB) and cross-clamp times were significantly shorter in SU-AVR (iso...

Research paper thumbnail of Dislocation of a sutureless prosthesis after type I bicuspid aortic valve replacement

The Journal of thoracic and cardiovascular surgery, Jan 10, 2018

From the Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy; and Cardiovascu... more From the Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy; and Cardiovascular Sciences Department, Catholic University of The Sacred Heart, Rome, Italy. Disclosures: G.T. is proctor for LivaNova. All other authors have nothing to disclose with regard to commercial support. Received for publication Nov 23, 2017; revisions received Jan 11, 2018; accepted for publication Feb 4, 2018; available ahead of print March 8, 2018. Address for reprints: Giovanni Alfonso Chiariello, MD, Cardiovascular Sciences Department, Catholic University of The Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy (E-mail: gio.chiariello88@tiscali.it). J Thorac Cardiovasc Surg 2018;156:e87-9 0022-5223/$36.00 Copyright 2018 by The American Association for Thoracic Surgery https://doi.org/10.1016/j.jtcvs.2018.02.002 Aortic regurgitation from prosthesis 5 inclination into the noncoronary sinus.

Research paper thumbnail of Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR): early results from 3343 patients

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 30, 2018

The Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR) was... more The Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR) was established by a consortium of 18 research centres-the International Valvular Surgery Study Group (IVSSG)-to overcome limitations of the literature and provide adequately powered evidence on sutureless and rapid-deployment aortic valves replacement (SURD-AVR). Data from 3343 patients undergoing SURD-AVR over a 10-year period (2007-2017) were collected in the registry. The mean age of the patients was 76.8 ± 6.7 years, with 36.4% being 80 years or older. The average logistic EuroSCORE was 11.3 ± 9.7%. Isolated SURD-AVR was performed in 70.7% (n = 2362) of patients using full sternotomy (35.3%) or less invasive approaches (64.8%). Overall hospital mortality was 2.1%, being 1.4% in patients who had isolated SURD-AVR and 3.5% in those who had concomitant procedures (P < 0.001). When considering baseline risk profile, mortality rate was 0.8% and 1.9% in low risk (logistic EuroSCORE <10...