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The Annals of thoracic surgery 04/2013; 95(4):1512-3. · 3.74 Impact Factor
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The Journal of thoracic and cardiovascular surgery 03/2013; 145(3):889-90. · 3.41 Impact Factor
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ABSTRACT: BACKGROUND: The aim of this retrospective study was to explore whether different tethering patterns in chronic ischemic mitral regurgitation have different distributions of left ventricular (LV) systolic longitudinal, circumferential, and radial strain before and after mitral valve repair. METHODS: Sixty-one patients with chronic ischemic mitral regurgitation who underwent mitral repair were divided on the basis of the preoperative anterior/posterior tethering angle ratio (cutoff value, 0.76). There were 29 patients with symmetric (group 1) and 32 with asymmetric (group 2) preoperative tethering patterns. Assessment of longitudinal peak systolic strain was performed offline by applying speckle-tracking imaging to the apical two-chamber, three-chamber, and four-chamber views of the left ventricle. Peak systolic radial and circumferential strain was obtained from short-axis views at the basal, middle, and apical levels. Twenty healthy subjects served as controls. RESULTS: In group 1, baseline LV strain was impaired in all LV segments, with the worst values in the anterolateral, anterior, and inferolateral segments at the midventricular and basal levels. In contrast, asymmetric patients showed higher values in the inferior and inferoseptal walls and values closer to normal in the other segments. After surgery, all strain measurements showed significant improvements in all LV segments in group 2, whereas in Group 1, strain worsened in the inferoseptal, inferior, and anteroseptal walls and did not change in the other segments CONCLUSIONS: Patients with baseline symmetric tethering patterns showed more extensive abnormal strain, which was observed in all LV segments and was not reverted by surgery. These findings require confirmation in additional larger studies.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 02/2013; · 2.98 Impact Factor
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ABSTRACT: Vernakalant is a new antiarrhythmic agent recently approved in Europe for the rapid cardioversion of recent onset atrial fibrillation. It works by blocking early-activating K+ atrial channels and frequency-dependent atrial Na+ channels, prolonging atrial refractory periods and rate-dependent slowing atrial conduction, without promoting ventricular arrhythmia. Pre-clinical and clinical trials showed good toleration of this drug. The main purpose of our review is to describe all the trials that led to the incorporation of Vernakalant into the current European atrial fibrillation guidelines. © 2013 Blackwell Publishing Ltd.
Cardiovascular Therapeutics 02/2013; · 2.35 Impact Factor
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ABSTRACT: PURPOSE OF REVIEW: The sutureless aortic bioprosthesis has been recently introduced in clinical practice for aortic valve replacement (SU-AVR) and appears to provide enhanced implantability and favourable haemodynamics, particularly advisable in minimally invasive surgery, in difficult anatomical situations or elderly patients. Implants of sutureless bioprosthesis are increasingly performed, and the first meaningful findings have been released and herewith analysed. RECENT FINDINGS: A two-centre experience in 208 patients has shown safety, ease of implantation, excellent haemodynamic performance and limited aortic cross-clamp (ACC) and cardiopulmonary (cardiopulmonary bypass, CPB) times, also in the case of associated coronary artery bypass grafting. Another multicentre experience with a third sutureless, albeit stented, valve implanted in 146 patients has been also presented with early favourable results. The sutureless aortic valve has been reported to be competitive also in relation to the transcatheter aortic valve implantation (TAVI) procedure in high-risk patients, as demonstrated by a propensity score based comparative analysis in a multicentre study, with reduced paravalvular leak rate but with increased atrial fibrillation occurrence in SU-AVR cases. Other single-centre series have been published with satisfactory results in terms of excellent haemodynamic performances or of enhanced implantability in high-risk patients or during minimally invasive procedures. SUMMARY: Sutureless aortic valve replacement has been shown to be well tolerated, to provide excellent haemodynamic performance and to be particularly suitable in minimally invasive procedures or in patients with extensive calcified aortic root or with the need of short ACC and CPB times for marked comorbidities. Further evaluations are, however, still necessary to conclusively show the actual advantages of SU-AVR, also as an alternative to TAVI procedures in operable high-risk patients.
Current opinion in cardiology 01/2013; · 2.66 Impact Factor
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Fabiana Lucà,
Leen van Garsse,
Carmelo Massimiliano Rao,
Orlando Parise,
Mark La Meir,
Calogero Puntrello,
Gaspare Rubino,
Rocco Carella,
Roberto Lorusso,
Gian Franco Gensini,
Jos G Maessen, Sandro Gelsomino
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ABSTRACT: In the recent years minimally invasive mitral valve surgery (MIMVS) has become a well-established and increasingly used option for managing patients with a mitral valve pathology. Nonetheless, whether the purported benefits of MIMVS translate into clinically important outcomes remains controversial. Therefore, in this paper we provide an overview of MIMVS and discuss results, morbidity, mortality, and quality of life following mitral minimally invasive procedures. MIMVS has been proven to be a feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. Reported benefits of MIMVS include also decreased postoperative pain, improved postoperative respiratory function, reduced surgical trauma, and greater patient satisfaction. Finally, compared to standard surgery, MIMVS demonstrated comparable efficacy across a range of long-term efficacy measures such as freedom from reoperation and long-term survival.
Minimally invasive surgery. 01/2013; 2013:179569.
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ABSTRACT: We explored the influence of global longitudinal strain (GLS) measured with two-dimensional speckle-tracking echocardiography on left ventricular mass regression (LVMR) in patients with pure aortic stenosis (AS) and normal left ventricular function undergoing aortic valve replacement (AVR). The study population included 83 patients with severe AS (aortic valve area <1 cm(2)) treated with AVR. Bioprostheses were implanted in 58 patients (69.8 %), and the 25 remaining patients (30.2 %) received mechanical prostheses. Peak systolic longitudinal strain was measured in four-chamber (PLS(4ch)), two-chamber (PLS(2ch)), and three-chamber (PLS(3ch)) views, and global longitudinal strain was obtained by averaging the peak systolic values of the 18 segments. Median follow-up was 66.6 months (interquartile range 49.7-86.3 months). At follow-up, values of PLS(4ch), PLS(2ch), PLS(3ch), and GLS were significantly lower (less negative) in patients who did not show left ventricular (LV) mass regression (all P < 0.001). Baseline global strain was the strongest predictor of lack of LVMR (odds ratio 3.5 (95 % confidence interval 3.0-4.9), P < 0.001), and GLS value ≥-9.9 % predicted lack of LVMR with 95 % sensitivity and 87 % specificity (P < 0.001). Other multivariable predictors were the preoperative LV mass value (cutoff value ≥147 g/m(2), P < 0.001), baseline effective orifice area index (cutoff ≤0.35 cm(2)/m(2), P = 0.01), and baseline mean gradient (cutoff ≥58 mmHg, P = 0.01). Finally, we failed to find interactions between GLS and other significant parameters (all P < 0.05). Global longitudinal strain accurately predicts LV mass regression in patients with pure AS undergoing AVR. Our findings must be confirmed by further larger studies.
Heart and Vessels 11/2012; · 2.05 Impact Factor
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Roberto Lorusso, Sandro Gelsomino,
Enrico Vizzardi,
Antonio D'Aloia,
Giuseppe De Cicco,
Fabiana Lucà,
Orlando Parise,
Gian Franco Gensini,
Pierluigi Stefàno,
Ugolino Livi, [......],
Francesco Nicolini,
Tiziano Gherli,
Valentino Borghetti,
Alessandro Pardini,
Philippe-Primo Caimmi,
Ezio Micalizzi,
Carlo Fino,
Paolo Ferrazzi,
Michele Di Mauro,
Antonio Maria Calafiore
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ABSTRACT: OBJECTIVE: It is uncertain whether mitral valve replacement is really inferior to mitral valve repair for the treatment of chronic ischemic mitral regurgitation. This multicenter study aimed at providing a contribution to this issue. METHODS: Of 1006 patients with chronic ischemic mitral regurgitation and impaired left ventricular function (ejection fraction < 40%) operated on at 13 Italian institutions between 1996 and 2011, 298 (29.6%) underwent mitral valve replacement whereas 708 (70.4%) received mitral valve repair. Propensity scores were calculated by a nonparsimonious multivariable logistic regression, and 244 pairs of patients were matched successfully using calipers of width 0.2 standard deviation of the logit of the propensity scores. The postmatching median standardized difference was 0.024 (range, 0-0.037) and in none of the covariates did it exceed 10%. RESULTS: Early deaths were 3.3% (n = 8) in mitral valve repair versus 5.3% (n = 13) in mitral valve replacement (P = .32). Eight-year survival was 81.6% ± 2.8% and 79.6% ± 4.8% (P = .42), respectively. Actual freedom from all-cause reoperation and valve-related reoperation were 64.3% ± 4.3% versus 80% ± 4.1%, and 71.3% ± 3.5% versus 85.5% ± 3.9 in mitral valve repair and mitral valve replacement, respectively (P < .001). Actual freedom from all valve-related complications was 68.3% ± 3.1% versus 69.9% ± 3.3% in mitral valve repair and mitral valve replacement, respectively (P = .78). Left ventricular function did not improved significantly, and it was comparable in the 2 groups postoperatively (36.9% vs 38.5%, P = .66). At competing regression analysis, mitral valve repair was a strong predictor of reoperation (hazard ratio, 2.84; P < .001). CONCLUSIONS: Mitral valve replacement is a suitable option for patients with chronic ischemic mitral regurgitation and impaired left ventricular function. It provides better results in terms of freedom from reoperation with comparable valve-related complication rates.
The Journal of thoracic and cardiovascular surgery 11/2012; · 3.41 Impact Factor
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ABSTRACT: Minimally invasive atrial fibrillation surgery (MIAFS) has become a well established and increasingly used option for managing patients with stand-alone arrhythmia. Pulmonary veins (PVs) isolation continues to be the cornerstone of ablation strategies. Indeed, in most cases, atrial fibrillation (AF) is triggered in or near the PVs. Nevertheless, ectopic beats initiating AF may occasionally arise from non-PV foci. The knowledge of the anatomy and underlying morphology of PVs and non-PV foci is essential for cardiac surgeons treating AF patients with epicardial minimally invasive procedures. The anatomical structures relevant to the pathogenesis and the epicardial treatment of AF include the PVs, the pericardial space, the pericardial sinuses, the phrenic nerve, the left atrium, the retro-atrial and caval ganglionated plexuses, the ligament of Marshall, the caval veins and the left atrial appendage. In this review, we briefly describe the basic anatomy of these structures and discuss their specific correlations for cardiac surgeons interested in performing MIAFS.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 10/2012; · 2.40 Impact Factor
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ABSTRACT: AIMS: We retrospectively evaluated left atrial (LA) strain and strain rate (SR) before and after undersized mitral ring annuloplasty (UMRA) for chronic ischaemic mitral regurgitation (CIMR) with two-dimensional speckle-tracking echocardiography. METHODS AND RESULTS: Left atrial volumes, LA reservoir, LA conduit, LA contractile phases, and LA ejection fraction (LAEF) were measured in 95 CIMR patients who underwent coronary bypass grafting and UMRA. Left atrial peak global strain (ε), LA reservoir (SR(p)), LA conduit (SR(E)), and LA contractile phase (SR(A)) strain rates were obtained at the baseline and at the follow-up (median 41.5 months, interquartile range 23-61). Based on the recurrence of mitral regurgitation (MR) at the follow-up, the patients were divided into two groups: patients with (group MR+, n = 30) or without (group MR-, n = 65) recurrent MR. Twenty age-and gender-matched healthy adults were controls. In the MR- group, baseline ε (P < 0.001), SR(P) (P < 0.001), SR(E) (P < 0.001), and SR(A) (P < 0.001) were enhanced, while in MR+ group, ε (P < 0.001), SR(P) (P = 0.03), SR(E) (P = 0.03), and SR(A) (P = 0.003) were worse than controls. At the follow-up, none of these indices changed in the MR+ group while all returned to normal values in patients belonging to the MR- group. Left atrial deformation correlated with corresponding volumetric parameters. Furthermore, we found a direct correlation between SR(E) and early peak diastolic velocity (E) (ρ = 0.52, P = 0.02) and E-wave deceleration time (ρ = 0.50, P = 0.02). Finally, there was a strong correlation between ε, SR(P), and SR(A) (ρ = 0.72, P < 0.001 and ρ = 0.79, P < 0.001, respectively) and SR(E) (ρ = 0.69, P < 0.001 and ρ = 0.71, P < 0.001, respectively). Finally, ε, SR(P), and SR(E) (all, P < 0.001) were co-factors associated to recurrent MR. CONCLUSION: Left atrial peak global strain, peak systolic SR, and peak early diastolic SR were cofactors associated to recurrent MR. The assessment of LA strain and SR, in addition to other echocardiographic parameters, can be helpful in detecting patients undergoing UMRA who are unlikely to benefit from annuloplasty.
European heart journal cardiovascular Imaging. 10/2012;
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Leen van Garsse, Sandro Gelsomino,
Fabiana Lucà,
Orlando Parise,
Roberto Lorusso,
Emile Cheriex,
Sabina Caciolli,
Enrico Vizzardi,
Carmelo Massimiliano Rao,
Rocco Carella,
Gian Franco Gensini,
Jos Maessen
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ABSTRACT: BACKGROUND: In our study, we investigated the impact of papillary muscle systolic dyssynchrony (DYS-PAP) obtained by 2D speckle-tracking echocardiography (2D-STE) in the prediction of recurrent ischemic mitral regurgitation (MR) after restrictive annuloplasty. METHODS: The study population consisted of 524 consecutive patients who survived coronary artery bypass grafting (CABG) and restrictive annuloplasty, performed between 2001 and 2010 at 3 different Institutions and who met inclusion criteria. The assessment of DYS-PAP was performed preoperatively and at follow-up (median 45.3months [IQR 26-67]) by 2D-STE in the apical four-chamber view for the anterolateral papillary muscle (ALPM) and apical long-axis view for the posteromedial papillary muscle (PMPM). RESULTS: Recurrence of MR (≥2+ in patients with no/trivial MR at discharge) was found in 112 patients (21.3%) at follow-up. Compared to patients without recurrence of MR, these patients had higher DYS-PAP values at baseline (60.6±4.4ms vs. 47.2±2.9ms, p<0.001) which significantly worsened at follow-up (74.4±5.2ms, p=0.002 vs. baseline). In contrast, in patients with no MR recurrence, DYS-PAP was significantly reduced (25.3±4.4ms, p=0.002 vs. baseline). At logistic regression analysis DYS-PAP (odds ratio [OR]: 4.8, 95% Confidence Interval [CI]: 3.4-8.2, p<0.001), was the strongest predictor of recurrent MR with a cutoff ≥58ms (95%CI 51-66ms). The model showed an area under the Receiver Operating Characteristic (ROC) curve of 0.97 (CI 0.94-0.99 [optimism-corrected 0.94; CI 0.89-0.95]) with 98% sensitivity (CI 96-100% [optimism-corrected 95%; CI 91-96%]) and 90% specificity (CI 85-94% [optimism-corrected 87%; CI 82-90%]). CONCLUSIONS: DYS-PAP represents a reliable tool to identify patients with ischemic MR who can benefit from restrictive annuloplasty.
International journal of cardiology 10/2012; · 7.08 Impact Factor
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ABSTRACT: The very long-term results of the double-orifice mitral valve repair are unknown. The aim of this study was to assess the late clinical and echocardiographic outcomes of this technique in patients with degenerative mitral regurgitation.
From 1993 to 2000, 174 patients with severe degenerative mitral regurgitation were treated with the double-orifice technique combined with ring annuloplasty. Mean age of patients was 52 ± 12.8 years, New York Heart Association class I or II was present in 71% of the patients, atrial fibrillation in 17.2%, and preoperative left ventricular ejection fraction was 59.5% ± 7.5%. Mitral regurgitation was due to anterior leaflet prolapse in 36 patients (20.6%), bileaflet prolapse in 128 (73.5%), and posterior leaflet prolapse in 10 patients (5.7%).
There were no hospital deaths. At hospital discharge, mitral regurgitation was absent or mild in 169 patients (97.1%) and moderate (2+/4+) in 5 patients (2.8%). Mitral stenosis requiring reoperation was detected in 1 patient (0.6%). Clinical and echocardiographic follow-up was 97.1% complete (mean length, 11.5 ± 2.53 years; median, 11.6 years; longest duration, 17.6 years). At 14 years, actuarial survival was 86.9% ± 3.37%, freedom from cardiac death was 95.8% ± 1.54%, and freedom from reoperation was 89.6 ± 2.51%. At the last echocardiographic examination, recurrence of mitral regurgitation ≥3+ was documented in 23 patients (23/169, 13.6%). Freedom from mitral regurgitation ≥3+ at 14 years was 83.8% ± 3.39%. The only predictor of recurrence of mitral regurgitation ≥3+ was residual mitral regurgitation greater than mild at hospital discharge (hazard ratio, 5.7; 95% confidence interval, 1.6-20.6; P = .007).
The double-orifice repair combined with ring annuloplasty provides very satisfactory long-term results in patients with degenerative mitral regurgitation in the setting of bileaflet and anterior leaflet prolapse.
The Journal of thoracic and cardiovascular surgery 08/2012; 144(5):1019-26. · 3.41 Impact Factor
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ABSTRACT: Objective: We investigated the impact of papillary muscle dyssynchrony (DYS-PAP) in predicting recurrent mitral regurgitation (MR) in patients with ischemic cardiomyopathy (ICM) undergoing undersized mitral ring annuloplasty (UMRA). Methods: One hundred forty-four ICM patients (left ventricular ejection fraction <35%) in sinus rhythm undergoing UMRA between January 2001 and December 2010 at three Institutions (University Hospital, Maastricht, The Netherlands; Careggi Hospital, Florence, Italy; Civic Hospital, Brescia, Italy) were recruited. The primary endpoint was the recurrence of MR at the latest echocardiographic study defined as insufficiency ≥2+ in patients with no/trivial MR at discharge. The assessment of DYS-PAP was performed by applying two-dimensional (2D) speckle-tracking imaging. Results: In patients with MR recurrence, DYS-PAP significantly worsened (84.1 ± 8.8 msec vs.65.4 ± 8.8 msec at baseline, P < 0.001) whereas in patients with no MR recurrence, DYS-PAP did not vary (22.3 ± 5.3 msec vs. 25.9 ± 7.2 msec at baseline, P = 0.8). Recurrent MR was positively correlated with preoperative DYS-PAP (P < 0.001), baseline anterior mitral leaflet tethering angle α (P < 0.001) and tethering symmetry index α/β before surgery (P < 0.001). There was no significant correlation between MR recurrence and other echocardiographic parameters. Logistic regression analysis revealed that baseline values of DYS-PAP (OR: 5.4 [95% CI: 3.1-7.7], P < 0.001), α (OR: 5.0 [2.6-6.7], P < 0.001), and α/β (OR: 3.9 [2.5-5.7], p < 0.001) were predictors of recurrent MR. A DYS-PAP value ≥ 58 msec predicted recurrence of MR with 100% sensitivity and 83% specificity (area under the curve [AUC]: 0.92 [0.7-1], P < 0.001). Conclusions: A DYS-PAP cutoff value of 58 msec is useful to identify patients in whom UMRA is likely to fail. That way decision making in ischemic functional MR might be facilitated.
Echocardiography 08/2012; · 1.24 Impact Factor
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Gabriella Di Lascio,
Guy Harmelin,
Mattia Targetti,
Cristina Nanni,
Giacomo Bianchi,
MD,
Tommaso Gasbarri, Sandro Gelsomino,
Daniele Bani,
Sandra Zecchi Orlandini,
Massimo Bonacchi
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 08/2012; 39(4):488-499. · 0.65 Impact Factor
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ABSTRACT: We evaluated the papillary muscle systolic dyssynchrony (DYS-PAP) using two-dimensional speckle tracking echocardiography (2D-STE) in patients with chronic ischemic mitral regurgitation (CIMR) showing different preoperative leaflet pattern and investigated the impact of baseline tethering pattern in the prediction of significant post-repair desynchronized papillary muscle contraction.
We recruited 152 CIMR consecutive patients (64.4% male, mean age 65.9 ± 7.1 years) who survived coronary artery bypass grafting (CABG) and (undersized mitral ring annuloplasty, performed between 2001and 2010. The assessment of DYS-PAP was performed preoperatively and at follow-up (median 41.5 months [IQR 23-61]) by 2D-STE in the apical 4-chamber view for anterolateral papillary muscle and apical long-axis view for posteromedial papillary muscle). Based on the cutoff value (anterior-posterior tethering angle ratio α/β ≥ 0.76) patients were classified in 2 groups; symmetrical (group 1, n = 73, mean α/β = 0.81 ± 0.6) and asymmetrical preoperative tethering pattern (group 2, n = 79, mean α/β = 0.66 ± 0.4).
Recurrent MR occurred in 67.1% (n = 49) in group 1 versus 3.8% (n = 3) in group 2 (p < 0.001). Comparing both groups at baseline, patients in group 1 had higher DYS-PAP (57.7 ± 5.3 vs 29.8 ± 2.4 ms in group 2, p < 0.001) that significantly worsened at follow-up (78.1 ± 8.8 ms, p < 0.001 versus baseline), whereas in group 2 it improved (26.6 ± 6.0 ms, p < 0.001 versus baseline). Tethering symmetry significantly correlated with DYS-PAP (r = 0.90, p < 0.001) and it was a strong multivariable predictor of significant postoperative DYS-PAP (odds ratio 4.2; 95% confidence level 3.4 to 5.2, p < 0.001).
Tethering symmetry is an easy and immediate tool to identify CIMR patients with advanced DYS-PAP who are unlikely to benefit from mitral repair with undersized mitral ring annuloplasty.
The Annals of thoracic surgery 08/2012; 94(5):1418-28. · 3.74 Impact Factor
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ABSTRACT: The hybrid technique combines a mono or bilateral epicardial approach with a percutaneous endocardial ablation in a single-step procedure. We present our early results with this technique employing a monopolar radiofrequency source through a right thoracoscopy in patients with lone atrial fibrillation (LAF).
Between June 2009 and December 2010 nineteen consecutive patients (mean 60.8 ± 8.6 years, 84.2% male) underwent right unilateral minimally invasive hybrid procedure for LAF at our Institution. Ten patients (52.6.6%) had long-standing persistent AF while four (21.1%) had persistent and five (26.3%) paroxysmal AF. All patients were followed-up according the Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society (HRS/EHRA/ECA) and Society of Thoracic Surgeon (STS) guidelines.
There were neither early nor late deaths. It was possible to complete all the procedures as planned without any conversion to cardiopulmonary bypass. No patient died during the follow up. At one year, 7/19 (36.8%) patients were in sinus rhythm with no episode of AF and off antiarrhythmic drugs (AAD). Time-related prevalence of postoperative AF peaked at 44.4% (41.3-47.4) at two weeks, was 30.4% (27.3-34.9) at three months, fell to 14.2% (11.6-18.1) by 6 months and was 13.3% (11.0-17.4) at 12 months Among patients with long-standing persistent (LSP) AF, 20% (2/10) were in Sinus rythm and off AAD. One-year success rates were 50% (2/4) in persistent and 60% (3/5) in paroxysmal AF. At 12 months estimated prevalence of antyarrhythmic drugs and Warfarin use were 26% (22.4-33.1) and 48% (37.2-53.2), respectively.
One year results combining the percutaneous endocardial with the right thoracoscopic epicardial technique were, in our experience, not satisfactory, particularly in patients with LSP and persistent AF. Our findings need to be confirmed by larger studies.
Journal of Cardiothoracic Surgery 07/2012; 7:71. · 1.19 Impact Factor
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ABSTRACT: AIMS: Despite its proven efficacy, the Cox-Maze III procedure did not gain widespread acceptance for the treatment of stand-alone atrial fibrillation (SA-AF) because of its complexity and technical difficulty. Surgical ablation for SA-AF can now be successfully performed utilizing minimally invasive surgery (MIS). This study provides an overview of state-of-the-art MIS for the treatment of SA-AF.METHODS AND RESULTS: Studies selected for this review were identified on PUBMED and exclusion and inclusion criteria were applied to select the publication to be screened. Twenty-eight studies were included; 27 (96.4%) were observational in nature whereas 1 was prospective non-randomized. The total number of patients was 1051 (range 14-114). Mean age ranged from 45.3 to 67.1 years. Suboptimal results were obtained when employing microwave and high focused ultrasound energies. In contrast, MIS ablation of SA-AF achieved satisfactory 1-year results when the bipolar radiofrequency was employed as energy source, with antiarrhythmic drug-free success rate comparable to percutaneous catheter ablation (PCA). The success rate in paroxysmal was even higher than in PCA. In contrast, ganglionated plexi ablation and left atrial appendage removal seem not to influence the recurrence of AF and the occurrence of postoperative thromboembolic events.CONCLUSION: Minimally invasive surgery ablation of SA-AF achieved satisfactory 1-year results when the bipolar radiofrequency was employed. Nevertheless, the relatively high complication rate reported suggest that such techniques require further refinement. Finally, the preliminary results of the hybrid approach are promising but they need to be confirmed.
Europace 07/2012; · 1.98 Impact Factor
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ABSTRACT: OBJECTIVE: The present study was aimed at demonstrating the beneficial effect of minimally invasive radiofrequency surgical ablation on left atrial remodeling using 2-dimensional speckle-tracking echocardiography. METHODS: The study population consisted of 33 patients (mean age, 64.6 ± 6.9 years; 84.8% men) with paroxysmal lone atrial fibrillation undergoing minimally invasive radiofrequency surgical ablation at our institution (University Hospital Maastricht, Maastricht, The Netherlands) from 2007 to 2011. The control group included 20 age- and gender-matched healthy adults. The left atrial peak systolic strain, peak strain rate, peak early diastolic strain rate, and peak negative strain rate were measured. Left atrial reverse remodeling was defined as a reduction in the left atrial volume index of 15% or greater. RESULTS: The peak systolic strain was lower in patients with atrial fibrillation than in the controls (P < .001). It had increased significantly at 3 months (P < .001) and 12 months (P = .01) after surgery. Similarly, the peak strain rate (P < .001) was lower in patients with atrial fibrillation but had increased 3 months (P = .004) and 12 months (P = .001) after surgery. Finally, the peak early diastolic strain rate (P < .001) and peak negative strain rate (P < .001) were less negative at baseline compared with the rates in the controls. Both indexes had improved significantly at the follow-up examinations (3 months, P = .008 and P = .02; 12 months, both P = .01). Left atrial reverse remodeling occurred in 60.6% of patients at 3 months and 72.7% at 12 months postoperatively. CONCLUSIONS: Minimally invasive radiofrequency ablation resulted in significant left atrial reverse remodeling and significant improvement in left atrial compliance and function after restoration of sinus rhythm, as demonstrated by 2-dimensional speckle-tracking echocardiography analysis. Our findings need to be confirmed by additional and larger prospective studies.
The Journal of thoracic and cardiovascular surgery 06/2012; · 3.41 Impact Factor
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ABSTRACT: BACKGROUND: We compared short-term results of a hybrid versus a standard surgical bilateral thoracoscopic approach employing radiofrequency (RF) sources in the surgical treatment of lone atrial fibrillation (LAF). METHODS: Between January 2008 and July 2010 sixty-three consecutive patients with LAF underwent minimally invasive surgery. Thirty-five (55.5%) underwent surgery with the hybrid approach whereas 28 (45.5%) underwent bilateral thoracoscopic standard procedure (no-hybrid group). All patients underwent continuous 7-day Holter Monitoring (HM) at 3months, 6months and 1year. RESULTS: At 1year, 91.4% and 82.1% (time-related prevalence 5.2% vs.6.0% [p=0.56]) of the patients were free of AF and AAD. The hybrid group yielded better results in long standing persistent AF (8.2% [time related prevalence 81.8% vs. 44.4%, p=0.001] vs.14.9%, p=0.04). One-year success rates were 87.5% vs. 100% (p=0.04) in persistent [time related prevalence 3.8% vs. 0%, p<0.001] and 87.5% vs. 100% (p=0.04) in paroxysmal AF [time related prevalence 3.2% vs. 0%, p<0.001] in the two groups. One-year prevalence of Warfarin use was significantly higher in the hybrid group (29.0% [26.2-33.1] and 13.4% [9.9-16.3]) with no difference by AF type. LA reverse remodeling occurred in 81.7% (n=30) of hybrid patients and 67.8% (n=19) of no-hybrid patients at latest control (p=0.02). Left atrial emptying fraction increased in both groups (50±14%, p<0.001and 52±12%, p=0.004 in hybrid and no-hybrid, respectively) without differences between groups (p=0.6). CONCLUSIONS: The hybrid procedure yielded excellent results in long-standing persistent AF. Our findings need to be confirmed by further larger studies.
International journal of cardiology 05/2012; · 7.08 Impact Factor
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Sandro Gelsomino,
Jos G Maessen,
Frederik van der Veen,
Ugolino Livi,
Attilio Renzulli,
Fabiana Lucà,
Rocco Carella,
Elena Crudeli,
Antonio Rubino,
Carlo Rostagno,
Claudio Russo,
Valentino Borghetti,
Cesare Beghi,
Michele De Bonis,
Gian Franco Gensini,
Roberto Lorusso
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ABSTRACT: Limited information exists about the real impact of the etiology of shock on early and late outcome after emergency surgery in acute native mitral valve endocarditis (ANMVE). This multicenter study analyzed the impact of the etiology of shock on early and late outcome in patients with ANMVE.
Data were collected in eight institutions. Three hundred-seventy-nine ANMVE patients undergoing surgery on an emergency basis between May 1991 and December 2009 were eligible for the study. According to current criteria used for the differential diagnosis of shock, patients were retrospectively assigned to one of three groups: group 1, no shock (n=154), group 2, cardiogenic shock (CS [n=118]), and group 3, septic shock (SS [n=107]). Median follow-up was 69.8 months.
Early mortality was significantly higher in patients with SS (p<0.001). At multivariable logistic regression analysis, compared with patients with CS, patients with SS had more than 3.8 times higher risk of death. That rose to more than 4 times versus patients without shock. In addition, patients with SS had 4.2 times and 4.3 times higher risk of complications compared with patients with CS and without shock, respectively. Sepsis was also an independent predictor of prolonged artificial ventilation (p=0.04) and stroke (p=0.003) whereas CS was associated with a higher postoperative occurrence of low output syndrome and myocardial infarction (p<0.001). No difference was detected between groups in 18-year survival, freedom from endocarditis, and freedom from reoperation.
Our study suggests that emergency surgery for ANMVE in patients with CS achieved satisfactory early and late results. In contrast, the presence of SS was linked to dismal early prognosis. Our findings need to be confirmed by further larger studies.
The Annals of thoracic surgery 02/2012; 93(5):1469-76. · 3.74 Impact Factor
