State of the art for approaching the mitral valve: sternotomy, minimally invasive or total endoscopic robotic?

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Extending the suitability of endovascular therapies during type A acute aortic dissection repair

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TCT-737 MONITORING THE LEARNING CURVE AND QUALITY OF CARE IN TAVI PROCEDURES BY CUSUM ANALYSIS

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An Original Single-Body Synthetic Heart Valve: Feasibility Study And Prototype Realization

The research for durable, non-thrombogenic heart valve prostheses able to overcome the limits of biological and mechanical ones, promoted the development of synthetic valves. Their success has been hampered by lack of durability, due to calcification and thromboembolic complications. The aim of this work was to develop a prototype of a new elastomeric biocompatible valve, durable and free from calcification

Minimally invasive aortic valve replacement with a sutureless valve through a right anterior mini-thoracotomy versus transcatheter aortic valve implantation in high-risk patients

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Minimally Invasive Aortic Valve Replacement with Sutureless Valves:Results From an International Prospective Registry

Objective: To report the early and mid-term results of patients who underwent minimally invasive aortic valve replacement (MI-AVR) with a sutureless prosthesis from an international prospective registry. Methods: Between March 2011 and September 2018, among 957 patients included in the prospective observational SURE-AVR (Sorin Universal REgistry on Aortic Valve Replacement) registry, 480 patients underwent MI-AVR with self-expandable Perceval aortic bioprosthesis (LivaNova PLC, London, UK) in 29 international institutions through either minithoracotomy (n = 266) or ministernotomy (n = 214). Postoperative, follow-up, and echocardiographic outcomes were analyzed for all patients. Results: Patient age was 76.1 ± 7.1 years; 64.4% were female. Median EuroSCORE I was 7.9% (interquartile range [IQR], 4.8 to 10.9). Median cardiopulmonary bypass and cross-clamp times were 81 minutes (IQR 64 to 100) and 51 minutes (IQR 40 to 63). First successful implantation was achieved in 97.9% of cases. Two in-hospital deaths occurred, 1 for noncardiovascular causes and 1 following a disabling stroke. In the early (≤30 days) period, stroke rate was 1.4%. Three early explants were reported: 2 due to nonstructural valve dysfunction (NSVD) and 1 for malpositioning. One mild and 1 moderate paravalvular leak were reported. In 16 patients (3.3%) pacemaker implantation was needed. Mean follow-up was 2.4 years (maximum = 7 years). During follow-up 5 explants were reported, 3 due to endocarditis and 2 due to NSVD. Follow-up stroke rate was 2.5%. Three structural valve deteriorations not requiring reintervention were reported. Five-year survival was 91.45%. Conclusions: In this large prospective international registry, MI-AVR with Perceval valve confirmed to be safe, reproducible, and effective in an intermediate-risk population, providing excellent clinical recovery both in early and mid-term follow-up

Data Integration in Cardiac Surgery and Resource Management

At "G. Pasquinucci" Hospital in Massa, a section of CNR Institute of Clinical Physiology, an information system for cardiac surgery has been in use during the last years. This system was integrated with the Hospital Information System, already set up at the head of our institute in Pisa. Anesthesia data are recorded in the Operating Room (OR) as well as materials used during cardiac surgery operations. From the OR, data are transferred into the central clinical database, creating surgery reports in the medical record and filling in standardized clinical registers. Since 2000 a total of 2185 adult and 956 pediatric cardiac surgery operations were recorded

Expression level of CCR5 chemokine receptor on blood CD4+ and CD8+ T-cells plays an important role in the Ascending Aortic Aneurysm pathophysiology.

Background and aim: The CC chemokine receptor 5 (CCR5) is involved in the migration of circulating NK and Th1 cells towards inflammatory sites. CCR5 expression has also been demonstrated on endothelial cells, aortic smooth muscle cells and implicated in the development of abdominal aortic aneurysm. Thoracic aortic aneurysm (TAA) is a lethal disease burdened by complications such as aortic dissection/rupture. The risk of these acute events has been related to the severity of aortic enlargement. The aim of our study is to investigate a possible role of CCR5 expression on peripheral blood CD4+ and CD8+ T-lymphocytes in the pathogenesis of TAA. Methods: We have studied 14 patients (8 female, 6 male) with mean age of 67.35?7.70, undergoing isolated aortic valve replacement (AVR) and/or TAA surgery. Preoperatively, venous blood samples were obtained. A three colors flow cytometric analysis was performed by appropriate combinations of monoclonal antibodies directed against the following surface molecules: CD3, CD4, CD8, CCR5. Data are expressed in terms of percentage of positivity. Maximal aortic diameter (MAD) was determined by transesophageal echocardiography. For each patient we calculated the aortic size index (ASI), defined as MAD/BSA (mm/m2). Results: Aortic index was 21.52?3.14 mm/m2. Nine patients underwent isolated AVR (group 1) and five patients underwent TAA surgery (group 2). The percentage of CCR5+ on CD4+ was significantly higher in group 2 (17.03?3.08 vs 13.03?2.72, p=0.0269). A trend towards a higher percentage of CCR5+ on CD8+ was observed in group 2 (22.74?8,39 vs 16.26?3.75, p=0.0653). A significant correlation between aortic index and the percentage of CD4+ and CD8+ T-cells expressing CCR5 was observed (p=0.048, R2=0.287 and p=0.0067, R2=0.471 respectively). Conclusions: The correlation between the percentage of CD4+ and CD8+ T-cells expressing CCR5 and aortic index suggests the role of a T-cell immune-mediated cytotoxic mechanism in the progression of TAA disease

Predictive value of less than moderate residual mitral regurgitation as assessed by transesophageal echocardiography for the short-term outcomes of patients with mitral regurgitation treated with mitral valve repair

<p>Abstract</p> <p>Background</p> <p>Traditionally, in patients with mitral regurgitation (MR) a successful mitral valve repair is considered when residual MR by post-pump transesophageal echocardiography (TEE) is less than moderate or absent. Little is known about the prognostic value of less than moderate (mild or mild-to-moderate) residual MR for the early outcome of patients treated with mitral valve repair.</p> <p>Methods</p> <p>Eligible for this study were patients undergoing isolated mitral valve repair. Patients with moderate or severe residual MR after valve repair were excluded. The primary endpoint of the study was the composite of death or need of reintervention.</p> <p>Results</p> <p>A total of 98 patients (54 with no residual MR-Group 1, and 44 with less than moderate residual MR-Group 2) were analyzed. Of these, 72% presented with New York Heart Association (NYHA) 3/4, and 38% were women. The primary endpoint of the study occurred in 3 (5.5%) patients in Group 1 and 6 (13.6%) patients in Group 2 MR (<it>P </it>= 0.31). There was a trend toward a higher incidence of use of inotropic drugs post-interventional (<it>P </it>= 0.12), and a longer hospital stay among patients with less than moderate residual MR (<it>P </it>= 0.18).</p> <p>Conclusion</p> <p>In our study population, patients with less than moderate residual MR had a trend toward a higher risk of early adverse outcomes as compared with patients with no residual MR by post-pump TEE. Studies with a larger patient population and longer follow-up data may be useful to better define the clinical significance of residual mild MR after mitral vale repair.</p