Minimally Invasive Ventricular Assist Device Surgery

Heart failure is a growing disease that affects millions of people around the world. Heart transplantation is currently the therapy of choice for these patients. However, the lack of donors has forced the physician to evolve another kind of therapy such as ventricular assist device (VAD) as a bridge to transplant to compensate the lack of organs. Ventricular assist devices are today a successful therapy for the treatment of heart failure; the evolution of these devices and their progressive miniaturization have allowed an evolution of their implantation technique. To date, therefore, in addition to the traditional implant through sternotomy, there are more mini-invasive implant techniques. The purpose of the treaty is to describe these techniques, the implantation sites, and the benefits they can bring to patients

Surgical Treatment of Hypertrophic Obstructive Cardiomyopathy

Hypertrophic cardiomyopathy is a genetic disorder of the myocardium, characterized by marked myocardial hypertrophy that may lead to the development of symptoms such as dyspnea, angina pectoris, or stress-induced syncopes, with an increased risk of sudden cardiac death, due to obstruction of the left ventricular outflow tract (hypertrophic obstructive cardiomyopathy). Septal reduction treatment is needed in these patients, in order to relieve of the symptoms. In addition, mitral valve apparatus should be assessed in these patients, in order to recognize a dynamic movement of the MV during systole anteriorly toward the LVOT. In this chapter, we will describe the current surgical management of HOCM

Transcatheter Cardiac Surgery

The introduction of transcatheter aortic valve implantation (TAVI) have changed the management of patients affected by severe aortic stenosis. Nowadays, TAVI procedure represents the treatment of choice in patients with severe AS inoperable or at high risk. MDCT is the technique of choice in preoperative planning: it provides information regarding aortic valve and vascular access. Particular attention should be paid on bicuspid valve morphology. The choice of valve is, basically, based on confidence and experience of the operator and center

Does the distance between residency and implanting center affect the outcome of patients supported by left ventricular assist devices? A multicenter Italian study on radial mechanically assisted circulatory support (MIRAMACS) analysis

Background Patients with LVAD require continuous monitoring and care, and since Implanting Centers (ICs) are more experienced in managing LVAD patients than other healthcare facilities, the distance between patient residency and IC could negatively affect the outcomes. Methods Data of patients discharged after receiving an LVAD implantation between 2010 and 2021 collected from the MIRAMACS database were retrospectively analyzed. The population was divided into two groups: A (n = 175) and B (n = 141), according to the distance between patient residency and IC 90 miles. The primary endpoint was freedom from Adverse Events (AEs), a composite outcome composed of death, cerebrovascular accident, hospital admission because of GI bleeding, infection, pump thrombosis, and right ventricular failure. Secondary endpoints were incidences of mortality and complications. All patients were followed-up regularly, according to participating center protocols. Results Baseline clinical characteristics and indications for LVAD did not differ between the two groups. The mean duration of support was 25.5 +/- 21 months for Group A and 25.7 +/- 20 months for Group B (p = 0.79). At 3 years, freedom from AEs was similar between Group A and Group B (p = 0.36), and there were no differences in rates of mortality and LVAD-related complications. Conclusions Distance from the IC does not represent a barrier to successful outcomes as long as regular and continuous follow-up is provided

Twenty Year Patient Survival and 17 Year Complications of Isolated Mitral Biocor Standard Porcine Valve

Objective: Performance of the prostheses must be verified in the time domain. We report the 20-year survival of 230 patients operated of mitral replacement with Biocor Standard prosthesis in Padova and Verona and the 17 year prosthetic failure and complications of the series of Padova. Methods: 230 patients, 150 females and 80 males, aged 71 ± 6.3 received 235 isolated mitral Prostheses in Verona (67) and Padova (168), between June 1989 and August 2004. Twenty-year survival including 1698 patient- years was complete. Prosthesis survival was evaluated in the patients of Padova with a 90% goodness of follow-up and included 905 patient-years. Results: Twenty-seven operations were done in the eighties, 168 in the nineties, 52 in this century. Three operations were emergent, 20 urgent. The indication was prosthetic malfunction in 50 cases (21.7%), regurgitation in 114 (49.6%), stenosis in 22 (9.7%), mixed lesion in 44 (19.1%), concomitant CABG (Coronary Artery Bypass Graft) was performed in 23%. Overall survival was 6% (2-13%), Thirty day mortality was 8.9% (5.6-13.3%). The early hazard phase extended to 2.5 years with a linearized rate 1.4%/patient-years vs. a late rate of 7.2%/patient-years. Seventeen years freedom from reoperation was 80.5% (55.3-92.3%), actual 92% (86.4-94.5%), from SVD (Structural Valve Degeneration) 85.2% (52.6-96.1%) actual 94% (88.2-96.7%), from perivalvular leak 92.6% (86.5-96%), from embolism 83.1% (73-89.7%), from haemorrhage 83.8% (71.5-91.1%), from endocarditis 90.9% (82.4-95.4%), from pacemaker 77% (60.2-87.5%). Conclusion: Mitral Biocor has optimal durability and average complications. Premature mortality (6% vs. 30% survival of US (United States) matched population) is unrelated to prosthesis performance and suggest failure of our surgical strategy of the past centur