Percutaneous Mechanical Circulatory Support Devices: Systems and Clinical Options

Cardiogenic shock (CS) still remains a leading cause of hospital death. The adoption of percutaneous ventricular assist devices (pVADs) as treatment of CS is an option which continues to rise. Several types of pVADs have been developed by time to provide full cardiac support with few related complications and easy implantation settings. pVADs are used to support the failing heart as a bridge to recovery, decision, durable device or heart transplantation. None of these devices adopted in the clinical practice is ideal for all patients. Disadvantages may be related to the risk of limb/arm ischaemia or cerebral stroke or haemolysis. The most important choice is to identify the best device for each patient depending on haemodynamics, clinical scenario and patient anatomical/pathological issues. This chapter discusses the current pVAD options to treat CS patients

Maze surgery normalizes left ventricular function in patients with persistent lone atrial fibrillation†

n/

Characterization of the Tn916 Conjugative Transposon in a Food-Borne Strain of Lactobacillus paracasei▿

Food-borne antibiotic-resistant lactic acid bacteria have received growing attention in the past few years. We have recently identified tetracycline-resistant Lactobacillus paracasei in samples of milk and natural whey starter cultures employed in the manufacturing process of a typical Italian fermented dairy product, Mozzarella di Bufala Campana. In the present study, we have characterized at the molecular level the genetic context of tetracycline resistance determinants in these natural strains, which we have identified as tet(M). This gene was present in 21 independent isolates, whose fingerprinting profiles were distributed into eight different repetitive extragenic palindromic groups by cluster analysis. We provide evidence that the gene is associated with the broad-host, conjugative transposon Tn916, which had never before been described to occur in L. paracasei. PCR analysis of four independent isolates by use of specifically designed primer pairs detected the presence of a circular intermediate form of the transposon, carrying a coupling sequence (GGCAAA) located between the two termini of Tn916. This novel coupling sequence conferred low conjugation frequency in mating experiments with the recipient strain JH2-2 of Enterococcus faecalis

Targeted genetic analysis unveils novel associations between ACE I/D and APO T158C polymorphisms with D-dimer levels in severe COVID-19 patients with pulmonary embolism

Only a percentage of COVID-19 patients develop thrombotic complications. We hypothesized that genetic profiles may explain part of the inter-individual differences. Our goal was to evaluate the genotypic distribution of targeted DNA polymorphisms in COVID-19 patients complicated (PE+) or not (PE-) by pulmonary embolism. We designed a retrospective observational study enrolling N = 94 consecutive patients suffering severe COVID-19 with pulmonary embolism (PE+, N = 47) or not (PE-, N = 47) during hospitalization. A panel of N = 13 prothrombotic DNA polymorphisms (FV R506Q and H1299R, FII G20210A, MTHFR C677T and A1298C, CBS 844ins68, PAI-1 4G/5G, GPIIIa HPA-1 a/b, ACE I/D, AGT T9543C, ATR-1 A1166C, FGB - 455G > A, FXIII103G > T) and N = 2 lipid metabolism-related DNA polymorphisms (APOE T 112C and T158C) were investigated using Reverse Dot Blot technique. Then, we investigated possible associations between genotypic subclasses and demographic, clinical, and laboratory parameters including age, obesity, smoking, pro-inflammatory cytokines, drug therapy, and biomarkers of thrombotic risk such as D-dimer (DD). We found that 58.7% of PE+ had homozygous mutant D/D genotype at ACE I/D locus vs. PE- (40.4%) and 87% of PE+ had homozygous mutant C/C genotype at APOE T158C locus vs. PE- (68.1%). In PE+ group, DD levels were significantly higher in D/D and I/D genotypes at ACE I/D locus (P = 0.00066 and P = 0.00023, respectively) and in C/C and T/C genotypes at APOE T158C locus (P = 1.6e-06 and P = 0.0012, respectively) than PE- group. For the first time, we showed significant associations between higher DD levels and ACE I/D and APOE T158C polymorphisms in PE+ vs. PE- patients suggesting potential useful biomarkers of poor clinical outcome

DELAYED ONSET POSTOPERATIVE PARAPLEGIA IN ACUTE TYPE A AORTIC DISSECTION

In operated type A aortic dissections (TAAD), irreversible spinal cord injury (SCI) may occur due to several factors: prolonged circulatory arrest, extension of replacement, hypoperfusion of segmental arteries due to aortic false lumen thrombosis. Careful neuroprotective strategies and shorter operative times are crucial to reduce SCI incidence. Despite optimal perioperative management, rarely delayed onset SCI occurs due to subacute aortic remodeling. We report the case of a 77 year old lady who underwent ascending aorta and hemiarch replacement for TAAD and developed delayed paraplegia on postoperative day 12

Long-Term Clinical and Echocardiographic Outcomes Following the Ross Procedure:A Post Hoc Analysis of a Randomized Clinical Trial

IMPORTANCE:The Ross procedure as treatment for adults with aortic valve disease (AVD) has been the subject of renewed interest. OBJECTIVE:To evaluate the long-term clinical and echocardiographic outcomes following the Ross procedure for the treatment of adults with AVD. DESIGN, SETTING, AND PARTICIPANTS:This post hoc analysis of a randomized clinical trial included adult patients (age &lt;69 years) who underwent a Ross procedure for the treatment of AVD, including those with active endocarditis, rheumatic AVD, decreased ejection fraction, and previous cardiac surgery. The trial, conducted from September 1, 1994, to May 31, 2001, compared homograft root replacement with the Ross procedure at a single center. Data after 2010 were collected retrospectively in November and December 2022. EXPOSURE:Ross procedure. MAIN OUTCOMES AND MEASURES:The primary end point was long-term survival among patients who underwent the Ross procedure compared with that in the age-, country of origin– and sex-matched general population. Secondary end points were freedom from any reintervention, autograft reintervention, or homograft reintervention and time-related valve function, autograft diameter, and functional status. RESULTS:This study included 108 adults (92 [85%] male) with a median age of 38 years (range, 19-66 years). Median duration of clinical follow-up was 24.1 years (IQR, 22.6-26.1 years; 2488 patient-years), with 98% follow-up completeness. Of these patients, 9 (8%) had active endocarditis and 45 (42%) underwent reoperations. The main hemodynamic lesion was stenosis in 30 (28%) and regurgitation in 49 (45%). There was 1 perioperative death (0.9%). Twenty-five year survival was 83.0% (95% CI, 75.5%-91.2%), representing a relative survival of 99.1% (95% CI, 91.8%-100%) compared with the general population (83.7%). At 25 years, freedom from any reintervention was 71.1% (95% CI, 61.6%-82.0%); from autograft reintervention, 80.3% (95% CI, 71.9%-89.6%); and from homograft reintervention, 86.3% (95% CI, 79.0%-94.3%). Thirty-day mortality after the first Ross-related reintervention was 0% and after all Ross-related reinterventions was 3.8% (n = 1); 10-year survival after reoperation was 96.2% (95% CI, 89.0%-100%).CONCLUSIONS AND RELEVANCE:This study found that the Ross procedure provided excellent survival into the third decade postoperatively that was comparable to that in the general population. Long-term freedom from reintervention demonstrated that the Ross procedure may be a durable substitute into late adulthood, showing a delayed but progressive functional decline.</p

Long-Term Clinical and Echocardiographic Outcomes Following the Ross Procedure

IMPORTANCE:The Ross procedure as treatment for adults with aortic valve disease (AVD) has been the subject of renewed interest. OBJECTIVE:To evaluate the long-term clinical and echocardiographic outcomes following the Ross procedure for the treatment of adults with AVD. DESIGN, SETTING, AND PARTICIPANTS:This post hoc analysis of a randomized clinical trial included adult patients (age &lt;69 years) who underwent a Ross procedure for the treatment of AVD, including those with active endocarditis, rheumatic AVD, decreased ejection fraction, and previous cardiac surgery. The trial, conducted from September 1, 1994, to May 31, 2001, compared homograft root replacement with the Ross procedure at a single center. Data after 2010 were collected retrospectively in November and December 2022. EXPOSURE:Ross procedure. MAIN OUTCOMES AND MEASURES:The primary end point was long-term survival among patients who underwent the Ross procedure compared with that in the age-, country of origin– and sex-matched general population. Secondary end points were freedom from any reintervention, autograft reintervention, or homograft reintervention and time-related valve function, autograft diameter, and functional status. RESULTS:This study included 108 adults (92 [85%] male) with a median age of 38 years (range, 19-66 years). Median duration of clinical follow-up was 24.1 years (IQR, 22.6-26.1 years; 2488 patient-years), with 98% follow-up completeness. Of these patients, 9 (8%) had active endocarditis and 45 (42%) underwent reoperations. The main hemodynamic lesion was stenosis in 30 (28%) and regurgitation in 49 (45%). There was 1 perioperative death (0.9%). Twenty-five year survival was 83.0% (95% CI, 75.5%-91.2%), representing a relative survival of 99.1% (95% CI, 91.8%-100%) compared with the general population (83.7%). At 25 years, freedom from any reintervention was 71.1% (95% CI, 61.6%-82.0%); from autograft reintervention, 80.3% (95% CI, 71.9%-89.6%); and from homograft reintervention, 86.3% (95% CI, 79.0%-94.3%). Thirty-day mortality after the first Ross-related reintervention was 0% and after all Ross-related reinterventions was 3.8% (n = 1); 10-year survival after reoperation was 96.2% (95% CI, 89.0%-100%).CONCLUSIONS AND RELEVANCE:This study found that the Ross procedure provided excellent survival into the third decade postoperatively that was comparable to that in the general population. Long-term freedom from reintervention demonstrated that the Ross procedure may be a durable substitute into late adulthood, showing a delayed but progressive functional decline.</p