Impact and analysis of a quantitative donor risk scores to predict short and long-term mortality in orthotopic heart transplantation

Introduzione Il trapianto cardiaco rimane la terapia di scelta nei pazienti in scompenso cardiaco avanzato. Purtroppo il numero dei donatori rimane molto limitato e non sufficiente a soddisfare il fabbisogno dei pazienti in lista d’attesa. In Italia, la valutazione del singolo donatore è basata su multipli fattori ma non esiste uno standard assoluto che possa predirne l’impatto sugli outcomes dopo l’intervento. Materiali L’obiettivo dello studio è stato quello di analizzare i pazienti che hanno ricevuto un trapianto di cuore presso il nostro istituto con particolare riferimento ai donatori, in modo da: (1) valutare l’impatto della donazione sugli outcomes intraospedalieri e sulla sopravvivenza a lungo termine, (2) identificare fattori di rischio del donatore predittivi di mortalità intraospedaliera e disfunzione precoce del graft (3), validare gli attuali score di rischio internazionali sul donatore non ancora utilizzati nella pratica clinica. Risultati Dal 2000 sono stato eseguiti 461 trapianti di cuore presso il Policlinico di Sant’Orsola. Una disfunzione precoce d’organo si è verificata in 74 pazienti (16.1%): di questi in 51 casi (11.1%) è stato necessario impiantare un supporto meccanico di assistenza cardiocircolatorio. Tra le variabili donatore dipendente solo il picco di troponina e un supporto inotropo con noradrenalina hanno rappresentato fattori di prognostici negativi per mortalità intraospedaliera. Tra gli score di rischio più comunemente utilizzati in ambito internazionale solo il RADIAL score sembrerebbe predire gli outcomes a breve e lungo termine post-trapianto. Conclusioni Il donatore ha un forte impatto sulla prognosi dopo il trapianto. Seppur i nostri donatori presentavano un normale profilo di rischio gli attuali score internazionali ad eccezione del RADIAL non sembrerebbero essere predittivi sulla prognosi di questi pazienti. Prossimo obiettivo sarà quello di creare un algoritmo decisionale per la gestione delle donazione basato sulle caratteristiche del donatore in modo da ottimizzare al massimo l’allocazione degli organi cardiaci.Introduction Heart transplantation is the therapeutic option still offering the best long-term survival and quality of life to patients with advanced heart failure. Organ availability is the main limitation to the access to care for most patients. Methods Objective of the study was to evaluate our overall experience on heart transplantation with particular regard to donor influence on early and late results. Moreover, new predictive donor risk scores (Donor, Radial and Weiss scoring systems) were applied to our population to understand their possible implications and impact on post-operative outcomes and survival. Results Between January 2000 and December 2017, 461 patients received a heart transplantation. An early graft failure was detected in 16.1% (74/461). Mechanical circulatory support was used in 11.1% (51/461). Of the donor related factors only the peak of troponine (p<0.001) and use of noradrenaline (p=0.02) negatively influenced on early outcomes. Of the actual available scoring systems, the Donor score didn’t influence the outcomes, the RADIAL significantly influenced both early mortality and late survival and the Weiss only on late survival. Conclusions According to our experience heart transplantation offers a definitive and stable treatment over time. The most validated donor scoring systems didn’t homogeneously demonstrate a strong correlation with post-operative outcomes and only the radial score seems an accurate predictor. Next step will be to set up a donor management protocol to maximize heart function protection and improve cardiovascular diagnostics algorithms

Open thoracoabdominal aortic aneurysm repair in the modern era: results from a 20-year single-centre experience

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Extracorporeal Membrane Oxygenation Support as Treatment for Early Graft Failure After Heart Transplantation

Early graft failure (EGF) is a major risk factor for death after heart transplantation (Htx) accounting for >40% of deaths within 30 days postoperatively. According to the last International Society for Heart and Lung Transplantation (ISHLT) consensus statement, the graft dysfunction (GD) is to be classified into primary (PGD), in case of an unknown triggering factor or secondary (SGD) where there is a discernible cause such as acute rejection, pulmonary hypertension, or known surgical complications. The diagnosis of GD is to be made within 24 h after completion of Htx surgery and a severity scale for GD should include mild, moderate, or severe grades based on specified criteria. Mechanical circulatory support (MCS) for GD should be considered when medical management is not sufficient to support the newly transplanted graft. Currently, extra‐corporeal membrane oxygenation (ECMO) is widely accepted as treatment of severe EGF, given its easy and quick setup, the system versatility, the optimal end‐organ perfusion provided, and the possibility of both biventricular and lung assistance by usage of a low‐cost single pump

Aortic Root Replacement With Biological Valved Conduits

none9The execution of Bentall procedures using biological valved conduits is expanding owing to the increased incidence of aortic valve and root diseases in the aging population. To review the available data, a systematic search identified 29 studies with a total of 3,298 patients. Although evidence on short-term results suggested favorable outcomes after biological Bentall operations, data beyond 5 years are limited and highlight the urgent need for further investigations with longer follow-up.openCastrovinci, Sebastiano; Tian, David H; Murana, Giacomo; Cefarelli, Mariano; Berretta, Paolo; Alfonsi, Jacopo; Yan, Tristan D; Di Bartolomeo, Roberto; Di Eusanio, MarcoCastrovinci, Sebastiano; Tian, David H; Murana, Giacomo; Cefarelli, Mariano; Berretta, Paolo; Alfonsi, Jacopo; Yan, Tristan D; Di Bartolomeo, Roberto; Di Eusanio, Marc

Aortic valve repair in type A aortic dissection

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Ergonomics in the operating room and surgical training: a survey on the Italian scenario

IntroductionSurgical-related injuries are frequent, in fact the reported percentage of musculoskeletal disorders in surgeons is between 47% and 87%. These conditions are caused by long periods of standing, incorrect postures, repeated movements, little rest between operations, the lack of integrated operator rooms, the correct number and arrangement of monitors and the use of non-ergonomic instruments. This survey aims to assess the Italian overview both highlighting how prevalent surgical-related injury is in our surgeons and whether there is an operating room ergonomics education program in Italian surgical specialty schools.MethodsAn anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of 3 different sections concerning the general characteristics of the participants, their surgical background and any training performed, and any injuries or ailments related to the surgical activity. The survey was carried out in the period 1th of December 2022 and the 6th of February 2023.ResultsAt the close of our survey, 300 responses were collected. Among the participants, the two most represented specialties were Gynecology and Obstetrics (42.3%) and General Surgery (39.7%) and surgeons were mainly employed in the Northern regions of Italy (54.8%). Analyzing the participants’ background, 61.7% of the respondents had laparoscopic training during their training and only 53.1% had a pelvic trainer during their residency. In accordance with 98.7% of the respondents, during surgery we have the feeling of being in an uncomfortable position that causes discomfort or muscle pain, and regarding the frequency of these discomforts, the majority of our study population experiences these problems monthly (46.2%), while in 29.6% it is experienced weekly, 12.1% annually and finally 12.1% daily. The surgical approach that is most correlated with these disorders is laparoscopy (62.7%) while the one that causes the least discomfort is robotic surgery (1.4%). These discomforts cause 43.9% of our population to take a break or do short exercises to reduce pain during surgery, and the body areas most affected are the back (61.6%), neck (40.6%) and shoulders (37.8%).ConclusionDespite this, our survey allows us to highlight some now-known gaps present in the surgical training program of our schools and the lack of protection toward our surgeons during their long career

Open thoracoabdominal aortic aneurysm repair: Is there a "sex problem?"

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Commentary: Carotid is the best alternative for femoral transcatheter aortic valve replacement?

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Is wall stress like Wall Street when it comes to speculating on bicuspid versus tricuspid aortic valve aneurysm?

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Frozen elephant trunk technique: Ready to get back to the future?

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