Complicated Bi-Pella Support: Acute Mitral Regurgitation and Bailout MitraClip Repair

During the last decades, the use of mechanical circulatory support devices (MCS) has increased exponentially. In this scenario, a fully percutaneous approach to biventricular cardiogenic shock has ..

Surgical Techniques for Tricuspid Valve Disease

Tricuspid valve disease affects millions of patients worldwide. It has always been considered less relevant than the left-side valves of the heart, but this “forgotten valve” still represents a great challenge for the cardiac surgeons, especially in the most difficult symptomatic scenarios. In this review we analyze the wide spectrum of surgical techniques for the treatment of a diseased tricuspid valve

Successful Treatment of Embolic Aortic Valve Endocarditis in a Patient Affected by COVID-19 Pneumonia

The COVID-19 pandemic has required reorganization of the cardiac surgery system in the Italian region of Lombardy during early 2020. As a consequence, the hub-and-spoke (H&S) model was introduced to manage emergent/urgent cardiac surgery cases. In this challenging scenario, in which thousands of people were affected by the novel coronavirus, we present the case of a successful treatment of a middle-aged patient affected by both COVID-19 pneumonia and subacute aortic endocarditis. Learning objective: How to treat endocarditis during the COVID-19 pandemic

Surgical correction of anomalous origin of the right coronary artery from the left sinus of Valsalva: How, where, and when

Anomalous origin of the right coronary artery from the left sinus of Valsalva has a very low prevalence in the general population. Although the vast majority of patients are asymptomatic, the clinical consequence of this heart disorder can be sudden death. In many of these sudden death cases the right coronary artery is running between the anterior aspect of the aorta and behind the common trunk of the pulmonary artery, where systolic compression may have an impact on myocardial perfusion. Asymptomatic patients with this malignant course present the surgeon with a difficult decision, and they should be carefully evaluated in order to facilitate a tailored surgical approach. In this video tutorial we present a patient with this anomalous course of the right coronary artery, which was documented by coronary computed tomography angiography using a 3D reconstruction. The patient received an off-pump coronary artery bypass graft using an original surgical technique that prevents any type of flow competition. The case had an excellent final outcome, with good results at follow-up. Finally, a systematic review of the literature with a discussion of the different treatment modalities is provided

The Alfieri’s edge-to-edge technique for mitral valve repair: from a historical milestone of cardiac surgery to the origin of the transcatheter era

After 30 years since its introduction, the edge-to-edge technique has become one of the most popular and adopted worldwide for surgical repair of mitral regurgitation. The success of this procedure could possibly be explained by its unique simplicity and high level of reproducibility. Indeed, it possesses the ability of being very versatile and it has been used in a wide spectrum of mitral valve pathologies and lesions: from degenerative to functional disease, from posterior to anterior leaflet lesions, including commissural defects. The rapidity of this easy surgical gesture has also enhanced its application in minimally invasive approaches. Finally, it has become a true milestone for the era of transcatheter correction of mitral regurgitation. Here, we describe the history and evolution of this breakthrough in the world of cardiac surgery

Three Logistic Predictive Models for the Prediction of Mortality and Major Pulmonary Complications after Cardiac Surgery

Background and Objectives: Pulmonary complications are a leading cause of morbidity after cardiac surgery. The aim of this study was to develop models to predict postoperative lung dysfunction and mortality. Materials and Methods: This was a single-center, observational, retrospective study. We retrospectively analyzed the data of 11,285 adult patients who underwent all types of cardiac surgery from 2003 to 2015. We developed logistic predictive models for in-hospital mortality, postoperative pulmonary complications occurring in the intensive care unit, and postoperative non-invasive mechanical ventilation when clinically indicated. Results: In the “preoperative model” predictors for mortality were advanced age (p p p = 0.036); predictors for non-invasive mechanical ventilation were advanced age (p p = 0.023), higher body mass index (p p = 0.043); predictors for postoperative pulmonary complications were preoperative chronic obstructive pulmonary disease (p = 0.007), preoperative kidney injury (p p = 0.033). In the “surgery model” predictors for mortality were intraoperative inotropes (p = 0.003) and intraoperative intra-aortic balloon pump (p p p p = 0.029) and PaO2/FiO2 ratio at discharge (p = 0.028); predictors for non-invasive mechanical ventilation were kidney injury (p p p 2/FiO2 ratio at the discharge (p Conclusions: In this retrospective study, we identified the preoperative, intraoperative and postoperative characteristics associated with mortality and complications following cardiac surgery

Long-term results of thoracoscopic ablation of paroxysmal atrial fibrillation: is the glass half full or half empty?

Previous series showed the outcomes of thoracoscopic ablation of stand-alone symptomatic paroxysmal atrial fibrillation (AF) for up to 7 years of follow-up. The goal of this study was to assess the long-term durability of surgical pulmonary vein isolation (PVI) beyond 7 years

Patients younger than 70 undergoing transcatheter aortic valve implantation: Procedural outcomes and mid-term survival

Introduction: Based on recent data, the indication for transcatheter aortic valve implantation (TAVI) is expanding to individuals at lower surgical risk, who are generally younger than subjects historically treated for severe aortic stenosis. Indeed, younger patients have traditionally been under-represented in current TAVI literature. The aim of the present study is to report about clinical features, procedural outcomes and mid-term outcomes of patients younger than 70 who underwent TAVI in a single high-volume center. Materials and methods: Consecutive patients younger than 70 years of age who underwent TAVI for severe, symptomatic aortic stenosis between 2007 and 2019 at a single, tertiary referral center have been included in this retrospective study. Procedural and mid-term outcomes were analyzed, comparing 1st generation with 2nd generation devices. Results: Between 2007 and 2019, 1740 TAVI procedures were performed in our center. Among these, one hundred twenty-nine (7.4%) patients were younger than 70 years at the time of the intervention and were included in the present analysis. Fifty-eight patients (45%) were implanted with a 1st generation prosthesis while seventy-one patients (55%) were implanted with a 2nd generation device. Reasons which lead to a transcatheter approach in this population were: previous CABG (27.9%); porcelain aorta (24%); severe left ventricular systolic dysfunction (21.7%); prior chest radiation (19.4%); severe lung disease (8.5%); hemodynamic instability (7.0%); advanced liver disease (4.6%) and active cancer (3.9%). Overall device success rate was 89%, with no differences among 1st and 2nd generation devices. Threeyears all-cause mortality was 34%, with no difference among the two groups. Low incidence of aortic-valve re-intervention was observed at mid-term follow-up (late valve re-intervention = 2.3%). Conclusions: TAVI in young patient with appropriate indication for intervention is a safe procedure, associated with low rate of in hospital mortality and low rate of severe complications both with 1st and with 2nd generation devices. When considering long term durability, more data are needed; in our case series long-term follow up shows a good survival and also an extremely low rate of valve re-intervention