Erratum to : Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications

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ANALYSIS OF CLINICAL PREDICTIVE FACTORS OF THE TRIFECTA OUTCOME AFTER PARTIAL NEPHRECTOMY. AN AGILE STUDY

Scopo del lavoro The trifecta is an accepted index of the excellent surgical outcome after partial nephrectomy. Aim of this study was to assess which clinical variables may be an independent predictors of the trifecta outcome in patients candidates to partial nephrectomy. Materiali e metodi The data of 440 patients treated with open partial nephrectomy for T1 RCC were reviewed in our multicenter prospectively maintained database. Warm ischemia time (WIT)>25 min, complications, and postoperative acute kidney dysfunction (AKD), separately. The perioperative clinical variables associated with the Trifecta outcome, defined as warm ischemia time (WIT) Risultati The trifecta outcome was achieved in 315 (71.6%) patients; 7.5% of patients had WIT 65 25 min, 3.5% had PSM and 21.2% had perioperative complications. Reoperation rate for Clavien 653 complication was 6.7%. On univariate analysis the trifecta was significantly associated with patients gender (p Discussione In our analysis the clarity of the surgical field, associated to the containment of intraoperative bleeding and a favorable tumor nephrometry, resulted of critical importance for the achievement of the excellent surgical outcome. Conclusioni I P 128 NEPHRON SPARING SURGERY DOES NOT ALWAYS DECREASE OTHER-CAUSES MORTALITY RELATIVE TO RADICAL NEPHRECTOMY IN PATIENTS WITH NORMAL PREOPERATIVE RENAL FUNCTION U. Capitanio, C. Terrone, A. Antonelli, A. Minervini, A. Volpe, C. Fiori, F. Porpiglia, M. Furlan, R. Matloob, F. Regis, E. Di Trapani, P. De Angeli, S. Serni, R. Colombo, M. Carini, C. Simeone, F. Montorsi, R. Bertini (Milano) Scopo del lavoro Some reports suggested that nephron sparing surgery (NSS) may better protect against other-cause mortality (OCM) when compared with radical nephrectomy (RN) in patients with small renal masses. However, the majority of those studies could not adjust their results for potential selection bias secondary to clinical baseline characteristics of patients. In the current study, we aimed to test the effect of treatment type (NSS vs. RN) after accounting for clinical characteristics, comorbidities and individual cardiovascular risk. Materiali e metodi A multi-institutional collaboration among four European Tertiary Care Centers allowed collecting 2685 patients with a clinical T1a-T1b N0 M0 renal mass. Patients underwent RN (n=1059, 39.4%) or NSS (n=1626, 60.6%) and showed normal estimated glomerular filtration rates (eGFR) before surgery (defined as a pre-operative eGFR 6560 milliliters per minute per 1.73 m2). Descriptive, univariable and multivariable Cox regression analyses were used to predict the risk of OCM. To adjust for inherent baseline differences among patients, we included as covariates: age, clinical tumor size, gender, presence of hypertension at diagnosis, baseline Charlson comorbidity index (CCI), body mass index and smoker status. Risultati Mean follow up period was 76 months (median 61). Mean patient age resulted 60 years (median 62). Mean body mass index resulted 25 kg/m2. Overall, 37.2% and 9.4% of the patients had hypertension or diabetes, respectively. CCI resulted 0-1 in 73.2% of the patients. The 5- and 10-yr OCM rates after nephrectomy were 5.2% and 13.2% for NSS versus 7.4% and 15.1% for RN, respectively (p=0.3). At multivariable analyses, patients who underwent PN showed similar risk to die for OCM compared with their RN-treated counterparts (hazard ratio [HR]: 0.77; 95% confidence interval, 0.48-1.25; p=0.3). Increasing age (HR: 1.12

Renin-angiotensin-aldosterone system polymorphisms: a role or a hole in occurrence and long-term prognosis of acute myocardial infarction at young age

<p>Abstract</p> <p>Background</p> <p>The renin-angiotensin-aldosterone system (RAAS) is involved in the cardiovascular homeostasis as shown by previous studies reporting a positive association between specific RAAS genotypes and an increased risk of myocardial infarction. Anyhow the prognostic role in a long-term follow-up has not been yet investigated.</p> <p>Aim of the study was to evaluate the influence of the most studied RAAS genetic Single Nucleotide Polymorphisms (SNPs) on the occurrence and the long-term prognosis of acute myocardial infarction (AMI) at young age in an Italian population.</p> <p>Methods</p> <p>The study population consisted of 201 patients and 201 controls, matched for age and sex (mean age 40 ± 4 years; 90.5% males). The most frequent conventional risk factors were smoke (p < 0.001), family history for coronary artery diseases (p < 0.001), hypercholesterolemia (p = 0.001) and hypertension (p = 0.002). The tested genetic polymorphisms were angiotensin converting enzyme insertion/deletion (ACE I/D), angiotensin II type 1 receptor (AGTR1) A1166C and aldosterone synthase (CYP11B2) C-344T. Considering a long-term follow-up (9 ± 4 years) we compared genetic polymorphisms of patients with and without events (cardiac death, myocardial infarction, revascularization procedures).</p> <p>Results</p> <p>We found a borderline significant association of occurrence of AMI with the ACE D/I polymorphism (DD genotype, 42% in cases vs 31% in controls; p = 0.056). DD genotype remained statistically involved in the incidence of AMI also after adjustment for clinical confounders.</p> <p>On the other hand, during the 9-year follow-up (65 events, including 13 deaths) we found a role concerning the AGTR1: the AC heterozygous resulted more represented in the event group (p = 0.016) even if not independent from clinical confounders. Anyhow the Kaplan-Meier event free curves seem to confirm the unfavourable role of this polymorphism.</p> <p>Conclusion</p> <p>Polymorphisms in RAAS genes can be important in the onset of a first AMI in young patients (ACE, CYP11B2 polymorphisms), but not in the disease progression after a long follow-up period. Larger collaborative studies are needed to confirm these results.</p

Prognostic Impact of Nutritional Status After Transcatheter Edge-to-Edge Mitral Valve Repair: The MIVNUT Registry

Background Malnutrition is associated with poor prognosis in several cardiovascular diseases. However, its prognostic impact in patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) is not well known. This study sought to assess the prevalence, clinical associations, and prognostic consequences of malnutrition in patients undergoing TEER. Methods and Results A total of 892 patients undergoing TEER from the international MIVNUT (Mitral Valve Repair and Nutritional Status) registry were studied. Malnutrition status was assessed with the Controlling Nutritional Status score. The association of nutritional status with mortality was analyzed with multivariable Cox regression models, whereas the association with heart failure admission was assessed by Fine-Gray models, with death as a competing risk. According to the Controlling Nutritional Status score, 74.4% of patients with TEER had any degree of malnutrition at the time of TEER (75.1% in patients with body mass index <25?kg/m2, 72.1% in those with body mass index ?25?kg/m2). However, only 20% had moderate-severe malnutrition. TEER was successful in most of patients (94.2%). During a median follow-up of 1.6?years (interquartile range, 0.6-3.0), 267 (29.9%) patients died and 256 patients (28.7%) were admitted for heart failure after TEER. Compared with normal nutritional status moderate-severe malnutrition resulted a strong predictor of mortality (adjusted hazard ratio [HR], 2.1 [95% CI, 1.1-2.4]; P<0.001) and heart failure admission (adjusted subdistribution HR, 1.6 [95% CI, 1.1-2.4]; P=0.015). Conclusions Malnutrition is common among patients submitted to TEER, and moderate-severe malnutrition is strongly associated with increased mortality and heart failure readmission. Assessment of nutritional status in these patients may help to improve risk stratification

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%