Initial Surgical Strategy for the Treatment of Type A Acute Aortic Dissection: Does Proximal or Distal Extension of the Aortic Resection Influence the Outcomes?

(1) Background: We sought to analyze and compare the outcomes in terms of early and late mortality and freedom from a redo operation in patients undergoing surgical treatment for a type A acute aortic dissection in relation to the initial surgical treatment strategy, i.e., proximal or distal extension of the aortic segment resection, compared with isolated resection of the supracoronary ascending aorta. (2) Methods: This is a retrospective study in which we included 269 patients who underwent operations for a type A acute aortic dissection in the Department of Cardiac Surgery of Tor Vergata University from May 2006 to May 2016. The patients were grouped according to the extent of the performed surgical treatment: isolated replacement of the supracoronary ascending aorta (NE, no extension), replacement of the aortic root (PE, proximal extension), replacement of the aortic arch (DE, distal extension), and both (BE, bilateral extension). The analyzed variables were in-hospital mortality, postoperative complications (incidence of neurological damage, renal failure and need for prolonged intubation), late mortality and need for a redo operation. (3) Results: Unilateral cerebral perfusion was performed in 49.3% of the patients, and bilateral perfusion-in 50.6%. The overall in-hospital mortality was 31.97%. In the multivariate analysis, advanced age, cardiopulmonary bypass time and preoperative orotracheal intubation were independent predictors of in-hospital mortality. In the population of patients who survived the surgery, the probability of survival at 92 months was 70 +/- 5%, the probability of freedom from a redo operation was 71.5 +/- 5%, the probability of freedom from the combined end-point death and a redo operation was 50 +/- 5%. The re-intervention rate in the general population was 16.9%. The overall probability of freedom from re-intervention was higher in patients undergoing aortic root replacement, although not reaching a level of statistical significance. Patients who underwent aortic arch treatment showed reduced survival. (4) Conclusions: In the treatment of type A acute aortic dissection, all the surgical strategies adopted were associated with satisfactory long-term survival. In the group of patients in which the aortic root had not been replaced, we observed reduced event-free survival

Circulating Levels of Ferritin, RDW, PTLs as Predictive Biomarkers of Postoperative Atrial Fibrillation Risk after Cardiac Surgery in Extracorporeal Circulation

Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery in conventional extracorporeal circulation (CECC), with an incidence of 15-50%. The POAF pathophysiology is not known, and no blood biomarkers exist. However, an association between increased ferritin levels and increased AF risk, has been demonstrated. Based on such evidence, here, we evaluated the effectiveness of ferritin and other haematological parameters as POAF risk biomarkers in patients subjected to cardiac surgery. We enrolled 105 patients (mean age = 70.1 +/- 7.1 years; 70 men and 35 females) with diverse heart pathologies and who were subjected to cardiothoracic surgery. Their blood samples were collected and used to determine hematological parameters. Electrocardiographic and echocardiographic parameters were also evaluated. The data obtained demonstrated significantly higher levels of serum ferritin, red cell distribution width (RDW), and platelets (PLTs) in POAF patients. However, the serum ferritin resulted to be the independent factor associated with the onset POAF risk. Thus, we detected the ferritin cut-off value, which, when >= 148.5 ng/mL, identifies the subjects at the highest POAF risk, and with abnormal ECG atrial parameters, such as PW indices, and altered structural heart disease variables. Serum ferritin, RDW, and PTLs represent predictive biomarkers of POAF after cardiothoracic surgery in CECC; particularly, serum ferritin combined with anormal PW indices and structural heart disease variables can represent an optimal tool for predicting not only POAF, but also the eventual stroke onset

Kinetics of CO2methanation on a Ru-based catalyst at process conditions relevant for Power-to-Gas applications

In this paper we show that a 0.5 wt.% Ru/γ-Al2O3catalyst is appropriate to carry out the Sabatier reaction (CO2methanation) under process conditions relevant for the Power-to-Gas application and we provide a kinetic model able to describe the CO2conversion over a wide range of process conditions, previously unexplored. To achieve these goals, the effects of feed gas composition (H2/CO2ratio and presence of diluents), space velocity, temperature and pressure on catalyst activity and selectivity are investigated. The catalyst is found stable when operating over a wide range of CO2conversion values, with CH4selectivity always over 99% and no deactivation, even when working with carbon-rich gas streams. The effect of water on the catalyst performance is also investigated and an inhibiting kinetic effect is pointed out. Eventually, the capacity of kinetic models taken from the literature to account for CO2conversion under the explored experimental conditions is assessed. It is found that the kinetic model proposed by Lunde and Kester in 1973 (J. Catal. 30 (1973) 423) is able to describe satisfactorily the catalyst behavior in a wide range of CO2conversion spanning from differential conditions to thermodynamic equilibrium, provided that a new set of kinetic parameters is used. It is shown however that a better fitting can be achieved by using a modified kinetic model, accounting for the inhibiting effect of H2O on CO2conversion rate

Bentall procedures with a novel valved conduit incorporating "sinuses of Valsalva"

The Bentall operation is preferred when a diseased aortic valve is associated with a dilated or dissected ascending aorta. Composite valved grafts have been devised to facilitate and expedite this procedure. The initial clinical results of the Bentall procedure using a vascular conduit modified to incorporate "pseudosinuses of Valsalva," with the aim of simplifying coronary button anastomoses and decreasing tension upon them, is described herein. Over a period of 40 months since its introduction, the novel conduit has been used, for a Bentall procedure in 37 consecutive patients. Of this group, 31 were men and 6 were women, with a mean age of 63.8+/-9.9 years. Five were Marfan patients, 8 were patients after acute or chronic dissection, and 8 were patients who required redo procedures. In 22 patients, the modified conduit was used in association with a biological valve (4 stentless valve) and in 15, with a mechanical valve. The mean durations of CPB and X-clamp time were 117+/-32 and 88+/-22 minutes, respectively. No operative or late deaths occurred after a mean follow-up period of 20+/-12 months. This study indicates that the new vascular prosthesis appears to facilitate implantation by maintaining a more natural shape of the reconstructed aortic root

CORRECTION OF PECTUS EXCAVATUM WITH A SELF-RETAINING SEA-GULL WING PROSTHESIS - LONG-TERM FOLLOW-UP

Between June 1958 and December 1991, 315 patients (217 male and 98 female, mean age = 17.8 +/- 5.5 years) affected by pectus excavatum (PE) were surgically treated, Most of the patients required operation for aesthetic reasons only (299 patients; 95 percent). The grade of PE (Chin classification) was I in 72 patients, II in 152, and III in the remaining 91. The surgical technique consisted of a double transversal sternotomy at the level of the lowest and highest part of the depression associated with a longitudinal sternotomy. A wedge resection of the ribs was then performed and the sternum was fixed using a stainless steel strut molded into a seagull wing prosthesis, The strut was removed 12 months postoperatively. There were no operative mortalities, Four patients had sternal wound infection that was successfully treated, The mean follow-up was 15.8 years per patient and was 60 percent complete. From the aesthetic point of view, the postoperative results were excellent in 246 patients (78 percent), good in 57 (18 percent), and poor in 12 (4 percent), All subjective symptoms, when present, disappeared after surgery. The seagull wing prosthesis appears to be safe,easy to implant and to remove, and comfortable for the patient. This technique has shown good long-term results independently of type of deformity and patient age

Mid-Term Outcome of Mitral Valve Repair and Coronary Artery Bypass Grafting for Ischemic or Degenerative Mitral Regurgitation

Aim of the study. To verify the impact of the etiology of mitral valve regurgitation on a 5-year outcome after repair and concomitant coronary artery bypass grafting (CABG). Methods. One hundred and eleven consecutive patients (mean age of 69+/-8 years) who underwent mitral valve repair, 65 for ischemic and 46 for degenerative mitral regurgitation, and concomitant CABG, were retrospectively analyzed. The mean follow-up was 40+/-28 (9-104) months. Five-year survival (including operative mortality), and survival free from events (postoperative low output syndrome, progression of mitral regurgitation, onset or worsening of congestive heart failure, recurrence of myocardial infarction, and the need for mitral valve replacement) were analyzed. Results. Compared with degenerative, ischemic mitral regurgitation was associated with a higher incidence of previous myocardial infarction (P<0.0001), left ventricular ejection fraction (LVEF) <0.45 (P<0.0001), and more diseased coronary vessels per patient (P<0.0001). Five-year all-cause mortality was 18% (20/111). Independent predictors of mortality were older age at operation (P=0.0008), LVEF<0.45 (P=0.04), and the ischemic etiology of mitral regurgitation (P=0.03). At five years, survival was 69%+/-7.6% for ischemic versus 87%+/-6.5% for degenerative etiology (P=0.03); event-free survival was 58%+/-8.4% versus 75%+/-8% (P=0.02), and freedom from late cardiac death was 85%+/-6.6% versus 100% (P=0.02). Freedom from mitral valve reoperation was 97+/-2.4%. Conclusions. Ischemic mitral regurgitation and ldquo;per se and rdquo; predicted limited survival and event-free survival. Left ventricular dysfunction is frequently associated with the ischemic etiology. An early surgical indication to prevent left ventricular dysfunction could be important to improve the mid-term outcome. [Arch Clin Exp Surg 2012; 1(3.000): 129-137