Marco Aiello

Publications (11)37.84 Total impact

• Article: Minimally invasive video-assisted cardiac surgery: operative techniques, application fields and clinical outcomes.

  Nicola Vistarini, Marco Aiello, Mario Viganò
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  ABSTRACT: Minimally invasive video-assisted surgery through a right minithoracotomy has become the standard surgical approach for several cardiac diseases at many major centers worldwide. In this article we review the existing literature on the subject and describe different operative techniques, application fields and clinical outcomes.
  Future Cardiology 11/2011; 7(6):775-87.
• Article: Clinical and hemodynamic outcomes of "all-comers" undergoing transapical aortic valve implantation: results from the Italian Registry of Trans-Apical Aortic Valve Implantation (I-TA).

  Augusto D'Onofrio, Paolo Rubino, Melissa Fusari, Loris Salvador, Francesco Musumeci, Mauro Rinaldi, Ettore O Vitali, Mattia Glauber, Roberto Di Bartolomeo, Ottavio R Alfieri, [......], Marco Aiello, Riccardo Casabona, Ugolino Livi, Claudio Grossi, Mauro Cassese, Aniello Pappalardo, Tiziano Gherli, Guglielmo Stefanelli, Giuseppe G Faggian, Gino Gerosa
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  ABSTRACT: The aim of this study was to assess clinical and hemodynamic outcomes of transapical aortic valve implantation (TA-TAVI) in patients enrolled in the Italian Registry of Trans-Apical Aortic Valve Implantation (I-TA). From April 2008 until November 2010, 504 patients from 20 Italian centers were enrolled in the I-TA registry. Mean logistic EuroSCORE and Society of Thoracic Surgeons score were 24% ± 16% and 11% ± 4%, respectively. Mean follow-up was 9.2 ± 6.5 months (range, 1-26 months). Outcomes were analyzed according to intraoperative complications, procedural volume (high-volume centers, >20 cases; low-volume centers, < 20 cases) and learning curve (first 50% cases vs second 50% cases of each center). All-cause overall mortality was 8.3% (42 patients). Device success was 99% (500/504 patients). Intraoperative severe complications occurred in 24 (4.8%) patients. Overall 2-year survival was 71.5% ± 6.2%. At discharge, peak and mean gradients were 16.4 ± 11.2 and 8.7 ± 4.1 mm Hg, respectively, and effective orifice area was 1.67 cm(2). These values remained stable at 3, 6, and 12 months after surgery. Independent risk factors for mortality after TA-TAVI were as follows: New York Heart Association class III and IV (odds ratio [OR], 4.43; 95% confidence intervals [CI], 1.28-15.40; P = .02); logistic EuroSCORE greater than 20 (OR, 1.83; 95% CI, 1.02-3.29; P = .04); creatinine concentration greater than 200 μmol/L (OR, 2.56; 95% CI, 1.07-6.15; P = .03), and intraoperative complications (OR, 5.80; 95% CI, 2.68-12.55; P < .001). There were no significant differences in outcomes between high- and low-volume centers and between the first and the second 50% of cases. TA-TAVI represents a safe and effective alternative treatment for patients who are inoperable or at high risk for surgery. The occurrence of an intraoperative complication significantly affects survival. Procedural volume and learning curve have no impact on patient survival.
  The Journal of thoracic and cardiovascular surgery 08/2011; 142(4):768-75. · 3.41 Impact Factor
• Article: Excellent long-term result 10 years after minimally invasive quadruple coronary artery bypass.

  Nicola Vistarini, Fabrizio Gazzoli, Marco Aiello, Gaetano Minzioni, Mario Viganò
  Journal of Cardiovascular Medicine 04/2011; 12(4):280-1. · 1.51 Impact Factor
• Article: Minimally invasive aortic valve replacement in a transplanted heart.

  Nicola Vistarini, Andrea Maria D'Armini, Carlo Pellegrini, Marco Aiello, Michele Toscano, Gaetano Minzioni, Mario Viganò
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  ABSTRACT: Heart transplantation is subject to a number of chronic complications that may limit graft survival and be detrimental to the patient's quality of life. Aortic valve stenosis is a rare complication found after cardiac transplantation, which we believe has never been described on a tricuspid normal aortic valve. In the present study, we report a case of successful aortic valve replacement performed 16 years after cardiac transplantation on an extensively calcified tricuspid valve. Surgery was performed by using a minimally invasive approach with a reverse T upper mini-sternotomy, and the aortic valve was replaced by a biological prosthesis. The postoperative course was uneventful and the patient was discharged 7 days after the operation.
  The Annals of thoracic surgery 11/2010; 90(5):1688-90. · 3.74 Impact Factor
• Article: Port-access surgery as elective approach for mitral valve operation in re-do procedures.

  Davide Ricci, Carlo Pellegrini, Marco Aiello, Alessia Alloni, Barbara Cattadori, Andrea M D'Armini, Mauro Rinaldi, Mario Viganò
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  ABSTRACT: Re-do mitral valve procedures performed through median sternotomy carry substantial mortality and morbidity. To avoid complications of sternal re-entry and to provide adequate mitral valve exposure, antero-lateral thoracotomy has been suggested by some authors. From October 1997 to January 2007, 677 mitral valve operations have been performed in our centre using port-access video-assisted right mini-thoracotomy. Among these, 241 (35.6%) were performed on patients who had undergone one or more previous cardiac surgery procedures. Mean cardio-pulmonary bypass time and endo-clamp time were 117+/-46 min and 71+/-31 min, respectively. Arterial cannulation was performed either on the ascending aorta, with the endo-direct cannula (112 patients, 46.5%), or peripherally with a femoral artery approach (129 patients, 53.5%). Conversion to median sternotomy was necessary in only two patients (0.8%) due to aortic dissection (one case) and left ventricle free wall rupture (one case). Median intensive care unit stay was 24h, median mechanical ventilation time was 12h; median hospital stay was 8 days. Bleeding requiring surgical revision occurred in 12 patients (4.9%). Hospital mortality was 4.9% (12/241 patients). Port-access video-assisted right mini-thoracotomy allows good results in a difficult subset of patients; it allows minimal adhesion dissection, short ICU and hospital stay. In our practice, this technique has become the treatment of choice for mitral valve re-do surgery.
  European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 11/2009; 37(4):920-5. · 2.40 Impact Factor
• Article: Minimally invasive video-assisted approach for left atrial myxoma resection.

  Nicola Vistarini, Alessia Alloni, Marco Aiello, Mario Viganò
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  ABSTRACT: Minimally invasive surgery has become the standard approach for several cardiac diseases. We report in the present study our ten-year experience with endoscopic cardiac surgery for left atrial myxoma resection. Between January 1998 and January 2008, 14 patients (median age: 61 years) underwent surgery for left atrial myxoma resection at our institution. The Heartport access system and the video-assistance were systematically employed to provide excellent vision and facilitate surgery. The aortic clamping was obtained with an 'EndoClamp' in 11 cases (using a central or peripheral endoaortic balloon, depending on the site of the arterial cannulation) or transthoracically with the Portaclamp system in two cases and the Chitwood clamp in one case. The average time needed for cross-clamping was 49+/-29 min, with a mean cardiopulmonary bypass (CPB) time of 88+/-57 min. There were no early or late hospital deaths. Mean intensive care unit and hospital stay were three and eight days, respectively. The mean follow-up time was 64 months and there was no evidence of residual or recurrent tumor. There were two late deaths due to acute ischemic stroke. Minimally invasive video-assisted surgery for left atrial myxoma resection is a safe, reproducible and cosmetic operation and can be considered an effective oncologic approach as an alternative to standard sternotomy.
  Interactive cardiovascular and thoracic surgery 10/2009; 10(1):9-11.
• Article: Should we perform heart retransplantation in early graft failure?

  Nicola Vistarini, Carlo Pellegrini, Marco Aiello, Alessia Alloni, Cristian Monterosso, Barbara Cattadori, Carmine Tinelli, Andrea M D'Armini, Mario Vigano
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  ABSTRACT: Cardiac retransplantation represents the gold standard treatment for a failing cardiac graft but the decision to offer the patient a second chance is often made difficult by both lack of donors and the ethical issues involved. The aim of this study was to evaluate whether retransplantation is a reasonable option in case of early graft failure. Between November 1985 and June 2008, 922 patients underwent cardiac transplantation at our Institution. Of these, 37 patients (4%) underwent cardiac retransplantation for cardiac failure resulting from early graft failure (n = 11) or late graft failure (acute rejection: n = 2, transplant-related coronary artery disease: n = 24). Survival at 1, 5 and 10 years of patients with retransplantation was 59%, 50% and 40% respectively. An interval between the first and the second transplantation of less than (n = 11, all in early graft failure) or more than (n = 26) 1 month was associated with a 1-year survival of 27% and 73%, and a 5-year survival of 27% and 65% respectively (P = 0.01). The long-term outcome of cardiac retransplantation is comparable with that of primary transplantation only in patients with transplant-related coronary artery disease. Early graft failure is a significant risk factor for survival after cardiac retransplantation and should be considered as an exclusion criteria.
  Transplant International 09/2009; 23(1):47-53. · 2.92 Impact Factor
• Article: Port-access minimally invasive surgery for atrial septal defects: a 10-year single-center experience in 166 patients.

  Nicola Vistarini, Marco Aiello, Gabriella Mattiucci, Alessia Alloni, Barbara Cattadori, Carmine Tinelli, Carlo Pellegrini, Andrea Maria D'Armini, Mario Viganò
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  ABSTRACT: We assessed the surgical results and the benefits to the patient of a minimally invasive surgical approach for atrial septal defects. Between May 1998 and May 2008, 166 patients (median age, 44 years) had surgery for atrial septal defects in our institution. Of these patients, 118 (71%) had a patent foramen ovale (associated with atrial septal aneurysm in 48 cases), 33 (20%) had a wide ostium secundum defect, 6 (3.6%) had an ostium primum defect, 6 (3.6%) had a sinus venosus defect with abnormal pulmonary vein connection, and 1 (0.6%) had a coronary sinus defect. In 2 cases (1.2%) patients were referred to our department for surgical correction after failure of interventional occluder placement. All patients were operated on via a right minithoracotomy (mean incision, 5.5 + or - 1 cm) in the fourth intercostal space and under cardiopulmonary bypass. The HeartPort access system was used in 106 patients (64%), with an endoaortic clamp (central kit in 50 cases and peripheral kit in 56). In the remaining patients (36%), we preferred the Portaclamp system (37 cases) or the Chitwood clamp (23 cases). Average crossclamp time was 38.4 + or - 22.2 minutes with a mean cardiopulmonary bypass time of 64.9 + or - 34.5 minutes. There was no conversion in classic sternotomy. There were no early or late hospital deaths. Surgical revision was performed in 6 patients for bleeding from the thoracic wall. The mean hospital stay was 5.8 days. At 51 months mean follow-up, 4 patients died of non-cardiac-related causes. Port-access minimally invasive surgery for atrial septal defects is a safe, less-invasive, reproducible, and cosmetic operation, providing an excellent outcome and an effective correction, and could be now considered the standard approach for this type of patient.
  The Journal of thoracic and cardiovascular surgery 09/2009; 139(1):139-45. · 3.41 Impact Factor
• Article: Cribriform atrial septal aneurysm.

  Nicola Vistarini, Marco Aiello, Mario Viganò
  Journal of the American College of Cardiology 07/2009; 53(25):2404. · 14.16 Impact Factor
• Article: Directional coronary atherectomy plus stent implantation vs. left internal mammary artery bypass grafting for isolated proximal stenosis of the left anterior descending coronary artery.

  Nedy Brambilla, Alessandra Repetto, Ezio Bramucci, Umberto Canosi, Maurizio Ferrario, Luigi Angoli, Marco Aiello, Mauro Rinaldi, Catherine Klersy, Mario Viganò, Luigi Tavazzi
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  ABSTRACT: The aim of this study was to compare the short- (< 30 days) and long-term (> or = 30 days) clinical outcomes of left internal mammary artery bypass grafting (LIMA-LAD) and directional coronary atherectomy plus stent implantation (DCA + stent) in the treatment of isolated proximal left anterior descending coronary (LAD) lesions. One hundred and twenty-six patients underwent LIMA-LAD and 132 consecutive patients underwent DCA + stenting. The primary endpoint was the incidence of short- and long-term major adverse cardiac events (MACE); the secondary endpoints included any periprocedural events and long-term target vessel revascularization (TVR). We found no significant between-treatment difference in the occurrence of short-term MACE, and the long-term MACE rate per 100 person-years was 3.0 in the LIMA-LAD group and 4.6 in the DCA + stent group. After 5-year follow-up, 79% of the patients in the DCA + stent group and 89% of those in the LIMA-LAD group were still MACE-free. The risk of any periprocedural events was six times lower in the DCA + stent group, and the risk of TVR was six times higher. We conclude that both procedures lead to good short- and long-term follow-up results in isolated proximal LAD disease. As fewer periprocedural events and more TVRs occur after DCA + stenting than after LIMA-LAD, they can be considered valuable alternatives to each other.
  Catheterization and Cardiovascular Interventions 02/2005; 64(1):45-52. · 2.29 Impact Factor
• Article: Clodronate treatment of established bone loss in cardiac recipients: a randomized study.

  Giovanbattista Ippoliti, Carlo Pellegrini, Carlo Campana, Mauro Rinaldi, Andrea D'Armini, Claudio Goggi, Marco Aiello, Mario Viganò
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  ABSTRACT: Bone loss has been reported as a complication after heart transplantation (HTx), and the increase in bone fractures is an effective problem. Treatment of osteoporosis has obtained mixed results. In this study we evaluate the effect of treatment with an oral bisphosphonate. Sixty-four patients with low mineral density 6 months after HTx were randomized as follows: Group A received oral clodronate (1600 mg/day in two divided doses), and Group B received placebo. Every patient was also treated with 2000 mg/day of oral calcium carbonate. Bone mineral density (BMD) was measured by dual energy x-ray absorptiometry at the lumbar spine, 1/3 and 1/10 of the distal nondominant forearm before and after 12 months of treatment. Laboratory tests were performed at 3, 6, and 12 months of treatment. All patients demonstrated manifest bone loss 6 months after HTx compared with normal non-HTx controls (P=0.0001). After 1 year of clodronate therapy, BMD at the lumbar spine increased from 0.77+/-1.4 g/cm(2) to 0.86 g/cm(2) (P=0.02). Laboratory tests did not show any significant variation, except for the bone isoenzyme of alkaline phosphatase, which showed a significant decrease after 1 year of treatment. The incidence of new fractures was 9.3% in the placebo group and 0% in the clodronate group. Therapy was well tolerated without impact on graft function. One year of clodronate therapy induced a significant increase in BMD at the lumbar spine in our HTx patients. Treatment was well tolerated without onset of new bone fractures.
  Transplantation 03/2003; 75(3):330-4. · 4.00 Impact Factor