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Publications (211)
Objective
We sought to assess whether post-implant transcatheter aortic valve prosthesis multi detector computed characteristics differ between patients with native tricuspid and bicuspid aortic valve stenosis, as well as the effect on valve performance and clinical implications.
Methods
We analysed 100 consecutive post-implant multi detector comp...
Objective
There is conflicting evidence supporting the widespread use of transcatheter aortic prostheses for bicuspid valves. In these patients, prosthesis deformation, also known as non- uniform expansion, may frequently occur. Little information is available regarding post- implant prosthesis behaviour in the context of native tricuspid versus bi...
Aims
Subclinical thrombosis may represent an early stage of prosthesis structural disease. Most of the available evidence on the incidence, location, predictors, and consequences of thrombosis comes from studies that have employed balloon-expandable valves. We aimed to describe the different localisations of valvular and perivalvular thrombosis and...
Introduction
The trial hypothesized that minimally invasive extra-corporeal circulation (MiECC) reduces the risk of serious adverse events (SAEs) after cardiac surgery operations requiring extra-corporeal circulation without circulatory arrest.
Methods
This is a multicentre, international randomized controlled trial across fourteen cardiac surgery...
Introduction
Subclinical leaflets thrombosis is a condition diagnosed with multi–detector computer tomography (MDCT) characterized by a meniscal–shaped hypoattenuated lesion of one or more leaflets. Transcatheter aortic self–expandable valves are commonly manufactured with pliable pericardium over a nitinol frame that forms the leaflets and the ext...
Introduction
Transcatheter heart valve (THV) deformation may affect leaflet kinematics and coaptation, with potential formation of hypoattenuated leaflet thickening (HALT). The flexible nitinol frame of the self–expandable THV, conforms to the native annulus shape while maintaining the prosthesis in a higher position. This arrangement is called ste...
Objective:
Transcatheter aortic valve implant (TAVI) is the gold standard for the high-surgical-risk group of patients with aortic valve disease and it is an alternative to surgery in patients at intermediate risk. Lethal complications can occur, and many of these are manageable only with emergent conversion to open heart surgery. We retrospective...
Background
Transcatheter aortic valve replacement (TAVR) determines the creation of outer area between the cage and the aortic wall named the ‘anatomic sinus’ (Figure 1 A-B). This newly formed space of the sinuses of Valsalva (SOV) might disrupt the physiological currents of Valsalva and contribute to the formation of subclinical leaflets thrombosi...
Background
Measuring the chordae tendineae for mitral valve reconstruction is feasible with various techniques. However, the effect of different strategies on the durability of plastics at follow-up is unknown. The study aims to compare a conventional surgical technique for measuring artificial chordae length with our new approach, defined “track t...
Survival analysis and time-to-event analysis represent the same statistical technique. The nature of the event is different though. For the former, the outcome is mortality. For the latter, the outcome can be any binary event (i.e. cancer relapse, re-hospitalisation, etc.). Time-to-event/survival analysis is somewhat similar to logistic regression,...
Data can follow many distributions. However, the most common is the standard normal distribution. This chapter will explain what the characteristics of a standard normal distribution are and how to graphically and numerically ascertain if a variable is normally distributed. Histograms, quantile-quantile, boxplot and density plot are all important g...
In this chapter we discuss the fundamental topics in biostatistics, precision and accuracy. Precision tells us how close and similar our sample is to the general population. Such a difference is quantified by the standard error of the mean. Accuracy is represented by a range of values (confidence level) and tells us how confident we are that the tr...
Hypothesis can be defined as a claim or statement about a population parameter.This chapter covers the basics of hypothesis testing, founded on normal distribution, t-distribution and chi distribution. It explains what null and alternative hypotheses are and the meaning of a p-value, type I and II error. It provides the relevant “R” coding to carry...
This chapter covers logistic regression and its fundamental characteristics. It differs from linear regression since the modelled outcome of interest is binary. Logistic regression is frequently encountered in scientific medical papers, but is also pivotal for machine learning. We use logistic regression when we are interested in classification, to...
This chapter explains what propensity score matching (PSM) is and why it is useful in the setting of observational studies. I should start by saying that PSM is a matching statistical technique applied in observational studies, where a treatment case is matched with a control case (or in some cases control cases) based on each case’s propensity sco...
Regression techniques belong to inferential statistics. Linear regression can be used when the outcome of interest is numeric. Many outcomes of interest in medicine are numeric, such as length of hospital stay, amount of bleeding, etc. The outcome of interest is also named the dependent or response variable. Intuitively, the independent variables o...
Correlation is a statistical technique that can be applied between two, numeric only, variables. It tells us whether or not there is a relationship between two variables. If they move towards the same direction, the correlation is positive; if they move in opposite directions, the correlation is negative. Correlation is part of descriptive statisti...
“R” is a free software environment which helps to analyse, compute and present statistical information and graphics. It works with packages, some of which are already installed in “R”, others need to be downloaded and loaded into “R”. R-studio is a simpler interface of “R” and is easier and more intuitive to use. However, to use R-studio, you must...
Using the term exploratory data analysis (EDA), we refer to a general process of importing, cleaning and transforming (if required), analysing and finally visualising data to achieve a better understanding of it.This chapter sets out how to import a dataset, using the example dataset MMstat.csv, and how to start analysis of it, in the sense of star...
Before initiating statistical analysis, we should scrutinise the nature of the variables in our dataset. “R” broadly recognises two types of variables: numeric and non-numeric.However, they can also be described more specifically. Numeric variables with no decimals (e.g. number/s of bypasses performed) are defined as “integers”. Non-numeric variabl...
Subclinical leaflets valve thrombosis (SLT) is a recently identified phenomenon with multidetector computer tomography after tissue aortic valve replacement. Whether SLT is more frequent after transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) is currently not known. Thus, the aim of this pairwise meta-analysi...
Introduction: Postoperative Atrial Fibrillation (POAF) is a common complication of cardiac surgery, associated with increased mortality, stroke risk, cardiac failure and prolonged hospital stay. Our study aimed to assess the patterns of release of systemic cytokines in patients with and without POAF.
Methods: A post-hoc analysis of the Remote Isch...
Background:
Pre-operative embolization prior to surgical resection of carotid body tumors was meant to decrease intraoperative blood loss and operative time. Yet, potential confounders such as different Shamblin classes have never been analyzed. Aim of our meta-analysis was to investigate effectiveness of a pre-operative embolization according to...
Background:
Studies reporting on the outcome of 90-year-old patients undergoing cardiac surgery are scant in literature; and currently, those regarding the implementation of trans-catheter techniques number even fewer.
Methods:
We compared patients aged >89 years operated on between 1998 and 2008 at 8 Italian cardiac surgery centers, with patien...
Objectives: Myocardial infarction is one of the leading causes of death worldwide. Beyond the acute mechanical complications, it is clear the pathophysiological evolution that affects the left ventricle which in some cases generates a “new valvulopathy” of the mitral valve. We will focus on secondary, post ischemic mitral insufficiency with particu...
Background
Report the incidence and results of peri-operative extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) of patients undergoing mitral valve surgery (MVS) through right mini-thoracotomy (RT) and conventional full sternotomy (FS) for a period of 6 years from eleven tertiary Cardiac Surgery Institutes of GVM Care...
Background
The effect of metabolic syndrome (MetS), defined as insulin resistance along with two or more of: obesity, atherogenic dyslipidaemia and elevated blood pressure, on postoperative complications after isolated heart valve intervention remains controversial. We hypothesized that MetS may negatively influence the postoperative course in thes...
Background
Length measurement of artificial chordae remains a critical step during mitral valve repair (MVr). The aim of this study is to assess the effectiveness of a new length measuring technique.
Methods
All consecutive patients with anterior leaflet prolapse/flail who underwent MVr using the described method between January 2020 and January 2...
Background:
Insufflation of carbon dioxide (CO2) into the operative field to prevent cerebral or myocardial damage by air embolism is a well known strategy in open-heart surgery. However, here is no general consensus on the best delivery approach.
Methods:
From January 2018 to November 2021, we retrospectively collected data of one hundred conse...
Background
Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO duri...
Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO dur...
Recent years have seen a rising interest in measuring quality of life (QoL) as an outcome of cardiac surgery for mitral valve repair/replacement rather than focusing solely on postoperative morbidity and mortality. Several instruments are used to measure QoL after cardiac surgery that can be used individually or in combination to assess QoL as an o...
Background. The effect of metabolic syndrome (MetS), defined as insulin resistance along with two or more of: obesity, atherogenic dyslipidaemia and elevated blood pressure, on post-operative complications after isolated heart valve intervention remains controversial. We hypothesized that MetS may negatively influence the post-operative course in t...
Heart failure and atrial fibrillation are often associated. Both conditions share pathophysiology and risk factor, an example, atrial fibrillation may be regarded as either the “cause” or the “consequence” of heart failure. If coexistent, they are associated to very poor outcome. With this in mind, finding effective therapy for patients presenting...
Introduction
Cardiac surgery involving cardiopulmonary bypass (CPB) activates an inflammatory response releasing cytokines that are associated with less favourable outcomes.
This study aims to compare i) CPB during cardiac surgery (control) versus ii) CPB with haemoadsorption therapy; and assess the effect of adding this therapy in reducing the inf...
Heart failure and atrial fibrillation are often associated. Both conditions share pathophysiology and risk factor; as an example, atrial fibrillation may be regarded as either the ‘cause’ or the ‘consequence’ of heart failure. If coexistent, they are associated to very poor outcome. With this in mind, finding effective therapy for patients presenti...
There is no solid evidence from the literature that compare Cox‐Maze with pulmonary vein isolation techniques for atrial fibrillation in the context of concomitant mitral valve surgery. Although the first is perhaps more effective and linked to higher freedom from atrial fibrillation, it is more invasive compared to the pulmonary isolation.
There are no solid evidence from literature that compare Cox-Maze with pulmonary vein isolation technique for atrial fibrillation in the context of concomitant mitral valve surgery. While the first is perhaps more effective and linked to higher freedom form atrial fibrillation, it is more invasive compared to the pulmonary isolation.
The landmark 2016 Minimal Invasive Extracorporeal Technologies International Society (MiECTiS) position paper promoted the creation of a common language between cardiac surgeons, anesthesiologists and perfusionists which led to the development of a stable framework that paved the way for the advancement of minimal invasive perfusion and related tec...
Background
Catheter-based or surgical procedures in patients with long-standing persistent atrial fibrillation (LSPAF) remain a challenge. As a result, different approaches including hybrid (surgical and endocardial) ablation have been developed. Bachmann’s bundle (BB) is a mainly epicardial structure capable of sustaining arrhythmic reentry that c...
Introduction
Changes in cardiac metabolites in adult patients undergoing open-heart surgery using ischemic cardioplegic arrest have largely been reported for non-ventricular tissue or diseased left ventricular tissue, with few studies attempting to assess such changes in both ventricular chambers. It is also unknown whether such changes are altered...
BACKGROUND
The effect of hospital-associated Sars-Cov-2 infections in cardiac surgery patients remains poorly investigated and current data are limited to small case series with conflicting results.
METHODS
A multicenter European collaboration was organized to analyse the outcomes of patients who tested positive with hospital-associated Sars-Cov-2...
Our earlier work has shown inter‑disease and intra‑disease differences in the cardiac proteome between right (RV) and left (LV) ventricles of patients with aortic valve stenosis (AVS) or coronary artery disease (CAD). Whether disease remodeling also affects acute changes occuring in the proteome during surgical intervention is unknown. This study i...
Objectives
The aim of this study was to evaluate outcomes of real-world patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) with the 34 mm Evolut R (Medtronic, Minneapolis, Minnesota).
Background
Larger aortic annulus has been associated with increased incidence of paravalvular leaks (PVLs) after TAVR. Howev...
Objectives:
The need for concomitant tricuspid surgery in patients who need mitral valve surgery casts doubt on its feasibility via a minimally invasive approach. Our goal was to evaluate the short-term outcomes of patients undergoing concomitant mitral and tricuspid valve surgery either with a standard full sternotomy (full-MTS) or a minimally in...
Objectives
Blood transfusions after coronary artery bypass grafting (CABG) has been associated to adverse outcomes, especially in anemic patients. However, little is known about the influence of the modality of revascularization. Total arterial revascularization (TAR) was shown to reduce postoperative transfusion when compared to saphenous vein‐bas...
Objectives
: Little is known about the safety and clinical utility of retrograde autologous priming (RAP) in patients undergoing minimally invasive mitral valve surgery. We hypothesized that RAP would increase the oxygen delivery index (DO2i) while decreasing red blood cells transfusion requirements compared to valve surgery without RAP.
Design
:...
Background
The COVID-19 pandemic has spread globally infecting and killing millions. Those with cardiovascular disease (CVD) are at higher risk of increased disease severity and mortality. We performed a systematic review and meta-analysis to estimate the rate of in-hospital mortality following different treatments on COVID-19 in patients with CVD....
Background
Patients with coronary artery disease and concomitant heart failure (left ventricular ejection fraction < 35%) requiring myocardial revascularization are at risk of poor long-term prognosis and higher mortality. The benefits of minimally invasive extracorporeal circulation (MiECC), particularly in end-stage coronary artery disease patien...
The aim of this study is to describe a modified technique for aortic prosthesis implantation in the sinuses of Valsalva without the use of a patch for aortic annular reconstruction in patients with prosthetic valve endocarditis complicated by aortic abscess. From January 2008 to March 2021, 47 patients underwent aortic valve replacement due to pros...
Infective endocarditis represents a surgical challenge associated with perioperative mortality. The aim of this study is to evaluate the predictors of operative mortality and long-term outcomes in high-risk patients. We retrospectively analyzed 123 patients operated on for infective endocarditis from January 2011 to December 2020. Logistic regressi...
Metabolism management plays an essential role in extracorporeal technologies. There are different metabolic management devices integrated to extracorporeal devices; the most commonly used and accepted metabolic target in adult patients is indexed oxygen delivery (280 mL/min/m²) and cardiac index (2.4 L/min/m²), which can be managed independently or...
Background
This study was conducted to compare the outcomes of prosthetic ring versus autologous pericardial strip for the treatment of functional tricuspid regurgitation during left-sided valve surgery by minimally invasive approach.
Methods
From January 2008 and July 2016, autologous pericardial strip (group P-TAP) was used in 109 patients, and...
Background: We conducted a systematic review and meta-analysis to evaluate the short and long-term effects of coronary artery bypass grafting (CABG) on disease-specific and generic quality of life (QOL) and a quantitative comparison from before surgery to up to five years after surgery across contemporary randomized clinical trials.
Methods: We sea...
Background and Aim of the Study
The debate on the usefulness of the minimally invasive approach in mitral valve surgery is still open. The aim of this study is to describe a single-center case series of all comers undergoing minimally invasive mitral valve reconstruction.
Methods
From 2010 to 2019, all the data recorded in the medical records of 8...
Background
More than 1.6 million Americans have at least moderate to severe valvular tricuspid regurgitation, yet fewer than 8000 tricuspid valve operations are performed annually in the USA. The undertreatment for isolated tricuspid regurgitation might be related to the fact that in the past years no clear guidelines on ‘how’ and ‘when’ to treat t...
Background: We conducted a systematic review and meta-analysis to evaluate the short and long-term effects of coronary artery bypass grafting (CABG) on disease-specific and generic quality of life (QOL) and a quantitative comparison from before surgery to up to five years after surgery across contemporary randomized clinical trials.
Methods: We se...
More than 1.6 million Americans have at least moderate to severe tricuspid regurgitation, yet fewer than 8000 tricuspid valve operations are performed annually in the USA.The under-treatment for isolated tricuspid regurgitation might be related to the fact that in the past years no clear guidelines on how and when to treat tricuspid regurgitation w...
Background
We conducted a systematic review and meta-analysis to evaluate temporal trends in quality of life (QoL) after coronary artery bypass grafting (CABG) surgery in randomized clinical trials, and a quantitative comparison from before surgery to up to five years after surgery.
Methods
We searched MEDLINE, CINAHL EMBASE, Cochrane Library, Psy...
Background
The COVID-19 pandemic has spread globally, infecting and killing millions. Those subjects with cardiovascular disease (CVD) are at higher risk of severe COVID-19 morbidity and mortality following SARS-CoV-2 infection.
Purpose
To investigate the response to different treatments against COVID-19 in patients with a pre-existing CVD.
Metho...
Surgical left ventricle restoration (SVR) was firstly by Cooley in 1958 with the “linear suture technique”, and three decades later, Dor used a circular patch to reconstruct the left ventricle excluding the scarred parts of the septum and ventricular wall. It gained popularity and eventually almost abandoned after the contrasting literature evidenc...
Background
Much debate is still going on about the best ablation strategy—via endocardial or epicardial approach—in patients with atrial fibrillation (AF), and evidence gaps exist in current guidelines in this area. More specifically, there are no clear long-term outcome data after failed surgical AF ablation.
Methods
Since June 2008, 549 surgical...
Surgical left ventricle restoration (SVR) was first by Cooley in 1958 with the “linear suture technique,” and three decades later, Dor used a circular patch to reconstruct the left ventricle excluding the scarred parts of the septum and ventricular wall. It gained popularity and eventually almost abandoned after the contrasting literature evidence....
Background
Recent data suggested that transcatheter aortic valve replacement (TAVR) may be indicated also for low-risk patients. However, robust evidence is still lacking, particularly regarding valve performance at follow-up that confers a limitation to its use in young patients. Moreover, a literature gap exists in terms of ‘real-world’ data anal...
Background
An increased degree of aortic angulation (AA) represents a challenging feature for bioprosthesis positioning. Whether AA has an impact on procedural outcomes of contemporary self-expanding valves remains unsettled. The aim of this study was to evaluate the impact of AA on procedural outcomes of transcatheter aortic valve replacement with...
OBJECTIVES
Female sex is an established risk factor for postoperative complications after heart surgery, but the influence of sex on outcomes after minimally invasive cardiac surgery (MICS) for valvular replacement/repair remains controversial. We examined whether the role of sex as a risk factor varies by surgical approach [MICS vs conventional st...
Background and aims
Despite the relation between autoimmune diseases and increased atherosclerotic risk is established, the influence of autoimmune disorders on in stent restenosis (ISR) after percutaneous coronary intervention (PCI) is only partly known. ISR is an aberrant reparative process mainly characterized by an increased number of vascular...
Background – Much debate is still going on about the best ablation strategy – via endocardial or epicardial approach – in patients with atrial fibrillation (AF), and evidence gaps exist in current guidelines in this area. More specifically, there are no clear long-term outcome data after failed surgical AF ablation.
Methods – Since June 2008, 549 s...
This article introduces management algorithms to support operators in choosing the best strategy for metabolic management during cardiopulmonary bypass using artificial intelligence systems. We developed algorithms for the identification of the optimal way for assessing metabolic parameters. Different management algorithms for extracorporeal proced...
Background
The debate on the best treatment strategy for atrial fibrillation (AF) has expanded following the introduction of the so-called “hybrid procedure” that combines minimally invasive epicardial ablation with endocardial catheter ablation. However, the advantage of the hybrid approach over conventional epicardial ablation remains to be estab...
Background:
Dual antiplatelet therapy (DAPT) with acetylsalicylic acid and oral P2Y12 inhibitor (P2Y12-I) represents the standard of care for patients with acute coronary syndromes (ACS) or with chronic coronary syndromes (CCS) treated with percutaneous coronary intervention (PCI). Cangrelor, the first intravenous P2Y12-I, is deemed to overcome th...
Background
Horizontal aorta (HA) is an anatomical feature that can pose significant technical challenges for the successful positioning of the bioprosthetic valve during transcatheter aortic valve replacement (TAVR). Physiological range of aortic angle (AA) is unknown; hence there is no cutoff AA for classifying HA. Moreover, patient characteristic...
Background - The debate on the best treatment strategy for AF has expanded following the introduction of the so-called “hybrid procedure” that combines minimally invasive epicardial ablation with endocardial catheter ablation. However, the advantage of the hybrid approach over conventional epicardial ablation remains to be established.
Methods -Fro...