Recycling thoracic arteries for redo coronary artery bypass grafting: Long-term follow-up

Redo coronary artery bypass graft (redo CABG) procedures are a surgical challenge, especially when one or both internal thoracic arteries (ITAs) have been previously harvested. The lack of available ITA grafts at reoperation might jeopardize the long-term outcomes, because pedicle ITAs have shown longer patency than have other grafts.1,2 Early and midterm results after recycling of ITA grafts in coronary reoperations were demonstrated to be satisfactory.3–5 We report clinical and angiographic long-term follow-up of this procedure

Treatment of Tricuspid Regurgitation at Subvalvular Level: Hemodynamic and Morphological Assessment in Ex-Vivo Beating Heart Model

ABSTRACTBackground: Functional tricuspid regurgitation (FTR) treatment is challenging and most therapies targeting tricuspid valve (TV) annulus have shown limited durability with high rate of resid..

Transcatheter Edge-to-Edge Treatment of Functional Tricuspid Regurgitation in an Ex Vivo Pulsatile Heart Model

Although associated with left heart pathologies, functional tricuspid regurgitation (FTR) is often left untreated during left heart surgery. Hence, owing to its degenerative character, reoperation is often needed, encompassing an impressive (25% to 35%) mortality rate. Thus transcatheter approaches to FTR are raising great interest

Cyclophilin A/EMMPRIN Axis Is Involved in Pro-Fibrotic Processes Associated with Thoracic Aortic Aneurysm of Marfan Syndrome Patients

Background: Marfan syndrome (MFS) is a genetic disease, characterized by thoracic aortic aneurysm (TAA), which treatment is to date purely surgical. Understanding of novel molecular targets is mandatory to unveil e ective pharmacological approaches. Cyclophilin A (CyPA) and its receptor EMMPRIN are associated with several cardiovascular diseases, including abdominal aortic aneurysm. Here, we envisioned the contribution of CyPA/EMMPRIN axis in MFS-related TAA. Methods: We obtained thoracic aortic samples from healthy controls (HC) and MFS patients' aortas and then isolated vascular smooth muscle cells (VSMC) from the aortic wall. Results: our findings revealed that MFS aortic tissue samples isolated from the dilated zone of aorta showed higher expression levels of EMMPRIN vs. MFS non-dilated aorta and HC. Interestingly, angiotensin II significantly stimulated CyPA secretion in MFS-derived VSMC (MFS-VSMC). CyPA treatment on MFS-VSMC led to increased levels of EMMPRIN and other MFS-associated pro-fibrotic mediators, such as TGF- 1 and collagen I. These molecules were downregulated by in vitro treatment with CyPA inhibitor MM284. Our results suggest that CyPA/EMMPRIN axis is involved in MFS-related TAA development, since EMMPRIN is upregulated in the dilated zone of MFS patients' TAA and the inhibition of its ligand, CyPA, downregulated EMMPRIN and MFS-related markers in MFS-VSMC. Conclusions: these insights suggest both a novel detrimental role for CyPA/EMMPRIN axis and its inhibition as a potential therapeutic strategy for MFS-related TAA treatment

Prognostic role of endocarditis in isolated tricuspid valve surgery. A propensity-weighted study

Objectives The role of the underlying etiology in isolated tricuspid valve surgery has not been investigated extensively in current literature. Aim of this study was to analyse outcomes of patients undergoing surgery due to endocarditis compared to other pathologies. Methods The SURTRI study is a multicenter study enrolling adult patients who underwent isolated tricuspid valve surgery (n = 406, 55 ± 16 y.o.; 56% female) at 13 international sites. Propensity weighted analysis was performed to compare groups (IE group n = 107 vs Not-IE group n = 299). Results No difference was found regarding the 30-day mortality (Group IE: 2.8% vs Group Not-IE = 6.8%; OR = 0.45) and major adverse events. Weighted cumulative incidence of cardiac death was significantly higher for patients with endocarditis (p = 0.01). The composite endpoint of cardiac death and reoperation at 6 years was reduced in the Group IE (63.2 ± 6.8% vs 78.9 ± 3.1%; p = 0.022). Repair strategy resulted in an increased late survival even in IE cases. Conclusions Data from SURTRI study report acceptable 30-day results but significantly reduced late survival in the setting of endocarditis of the tricuspid valve. Multi-disciplinary approach, repair strategy and earlier treatment may improve outcomes. © 2022 The Author

Mingling of human and veterinary strains of Staphylococcus aureus : an emerging issue in health-care systems

Aim: Methicillin-resistant Staphylococcus aureus remains a leading cause of hospital and community infections. We report a retrospective molecular characterization of S. aureus strains from different settings: hospital workers and patients, and veterinarian surgeons and pets. Materials and Methods: Eighty-nine S. aureus isolates obtained from nasal swabs of 10 patients, 17 health-care workers (HCWs), 9 pets, and 53 veterinarians were genotypically characterized by means of repetitive extragenic palindromic polymerase chain reaction (Rep PCR) and whole-genome sequencing. Results: Thirteen different sequence types (STs) were detected: ST398, ST22, ST8, ST30, ST15, ST5, ST121, ST45, ST10, ST6, ST34, ST97, and ST1. Two new STs differing from ST22 and ST5 for a single multilocus sequence typing gene were also identified. Rep PCR documented a genetic relationship among isolates obtained from 5 veterinarians and 10 HCWs. Conclusion: The large diversity of S. aureus strains detected may reflect a larger epidemiology within the hospital and community, in which companion animals likely act as a reservoir. We identified the circulation of ST5, ST8, ST15, ST22, ST30, ST45, and ST121 both in the hospital and veterinarian environment. Starting from the idea of a unique setting where our population lives, we consider the relationship between community- and hospital-acquired S. aureus

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide