Late Myocardial Infarction and Repeat Revascularization after Coronary Artery Bypass Grafting in Patients with Prior Percutaneous Coronary Intervention

Objectives: The aim of the present study was to evaluate the risk of late mortality and major adverse cardiovascular and cerebral events after coronary artery bypass grafting (CABG) in patients with prior percutaneous coronary intervention (PCI). Methods: A total of 2948 patients undergoing isolated CABGs were included in a prospective multicenter registry. Outcomes were adjusted for multiple covariates in logistic regression, Cox proportional hazards analysis and competing risk analysis. Results: In all, 2619 patients fulfilled the inclusion criteria of this analysis. Of them, 2199 (79.1%) had no history of PCI and 420 (20.9%) had a prior PCI. An adjusted analysis showed that a single prior PCI and multiple prior PCIs did not increase the risk of 30-day and 5-year mortality. Patients with multiple prior PCIs had a significantly higher risk of 5-year myocardial infarction (SHR 2.566, 95%CI 1.379–4.312) and repeat revascularization (SHR 1.774, 95%CI 1.140–2.763). Similarly, 30-day and 5-year mortality were not significantly increased in patients with prior PCI treatment of single or multiple vessels. Patients with multiple vessels treated with PCI had a significantly higher risk of 5-year myocardial infarction (SHR 2.640, 95%CI 1.497–4.658), repeat revascularization (SHR 1.648, 95%CI 1.029–2.638) and stroke (SHR 2.215, 95%CI 1.056–4.646) at 5-year. The risk for repeat revascularization was also increased with a prior single vessel PCI, but not for other outcomes. Conclusions: Among patients undergoing CABGs, multiple prior PCIs seem to increase the risk of late myocardial infarction and the need for repeat revascularization, but not the risk of mortality

Prognostic role of endocarditis in isolated tricuspid valve surgery. A propensity-weighted study

Objectives The role of the underlying etiology in isolated tricuspid valve surgery has not been investigated extensively in current literature. Aim of this study was to analyse outcomes of patients undergoing surgery due to endocarditis compared to other pathologies. Methods The SURTRI study is a multicenter study enrolling adult patients who underwent isolated tricuspid valve surgery (n = 406, 55 ± 16 y.o.; 56% female) at 13 international sites. Propensity weighted analysis was performed to compare groups (IE group n = 107 vs Not-IE group n = 299). Results No difference was found regarding the 30-day mortality (Group IE: 2.8% vs Group Not-IE = 6.8%; OR = 0.45) and major adverse events. Weighted cumulative incidence of cardiac death was significantly higher for patients with endocarditis (p = 0.01). The composite endpoint of cardiac death and reoperation at 6 years was reduced in the Group IE (63.2 ± 6.8% vs 78.9 ± 3.1%; p = 0.022). Repair strategy resulted in an increased late survival even in IE cases. Conclusions Data from SURTRI study report acceptable 30-day results but significantly reduced late survival in the setting of endocarditis of the tricuspid valve. Multi-disciplinary approach, repair strategy and earlier treatment may improve outcomes. © 2022 The Author

Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery

BackgroundRecent studies suggested that prothrombin complex concentrate (PCC) might be more effective than fresh frozen plasma (FFP) to reduce red blood cell (RBC) transfusion requirement after cardiac surgery.MethodsThis is a comparative analysis of 416 patients who received FFP postoperatively and 119 patients who received PCC with or without FFP after isolated coronary artery bypass grafting (CABG).ResultsMixed-effects regression analyses adjusted for multiple covariates and participating centres showed that PCC significantly decreased RBC transfusion (67.2% vs. 87.5%, adjusted OR 0.319, 95%CI 0.136–0.752) and platelet transfusion requirements (11.8% vs. 45.2%, adjusted OR 0.238, 95%CI 0.097–0.566) compared with FFP. The PCC cohort received a mean of 2.7 ± 3.7 (median, 2.0, IQR 4) units of RBC and the FFP cohort received a mean of 4.9 ± 6.3 (median, 3.0, IQR 4) units of RBC (adjusted coefficient, −1.926, 95%CI −3.357–0.494). The use of PCC increased the risk of KDIGO (Kidney Disease: Improving Global Outcomes) acute kidney injury (41.4% vs. 28.2%, adjusted OR 2.300, 1.203–4.400), but not of KDIGO acute kidney injury stage 3 (6.0% vs. 8.0%, OR 0.850, 95%CI 0.258–2.796) when compared with the FFP cohort.ConclusionsThese results suggest that the use of PCC compared with FFP may reduce the need of blood transfusion after CABG.</p

Numerical simulation of the filling and curing stages in reaction injection moulding, using CFX

Mestrado em Engenharia MecânicaOs métodos habitualmente utilizados para a simulação de injecção em moldes envolvem um número considerável de simplificações, originando reduções significativas do esforço computacional mas, nalguns casos também limitações. Neste trabalho são efectuadas simulações de Reaction Injection Moulding (RIM) com o mínimo de simplificações, através da utilização do software de CFD multi-objectivos CFX, concebido para a simulação numérica de escoamentos e transferência de calor e massa. Verifica-se que o modelo homogéneo para escoamentos multifásicos do CFX, geralmente considerado o apropriado para a modelação de escoamentos de superfície livre em que as fases estão completamente estratificadas, é incapaz de modelar correctamente o processo de enchimento. Este problema é ultrapassado através da implementação do modelo não homogéneo juntamente com a condição de fronteira de escorregamento livre para o ar. A reacção de cura é implementada no código como uma equação de transporte para uma variável escalar adicional, com um termo fonte. São testados vários esquemas transitórios e advectivos, com vista ao reconhecimentos de quais os que produzem os resultados mais precisos. Finalmente, as equações de conservação de massa, quantidade de movimento, cura e energia são implementadas conjuntamente para simular os processos simultâneos de enchimento e cura presentes no processo RIM. Os resultados numéricos obtidos reproduzem com boa fidelidade outros resultados numéricos e experimentais disponíveis, sendo necessários no entanto tempos de computação consideravelmente longos para efectuar as simulações. ABSTRACT: Commonly used methods for injection moulding simulation involve considerable number of simplifications, leading to a significant reduction of the computational effort but, in some cases also to limitations. In this work, Reaction Injection Moulding (RIM) simulations are performed with minimum of simplifications, by using the general purpose CFD software package CFX, designed for numerical simulation of fluid flow and heat and mass transfer. The CFX’s homogeneous multiphase flow model, which is generally considered to be the appropriate choice for modelling free surface flows where the phases are completely stratified and the interface is well defined, is shown to be unable to model the filling process correctly. This problem is overcome through the implementation of the inhomogeneous model in combination with the free-slip boundary condition for the air phase. The cure reaction is implemented in the code as a transport equation for an additional scalar variable, with a source term. Various transient and advection schemes are tested to determine which ones produce the most accurate results. Finally, the mass conservation, momentum, cure and energy equations are implemented all together to simulate the simultaneous filling and curing processes present in the RIM process. The obtained numerical results show a good global accuracy when compared with other available numerical and experimental results, though considerably long computation times are required to perform the simulations

Plastica di allargamento dell'annulus nella sostituzione valvolare aortica: 18 anni di esperienza della cardiochirurgia pisana

Studio monocentrico sui risultati a lungo termine della plastica di allargamento aortico nei pazienti sottoposti a sostituzione valvolare aortica con ridotte dimensioni dell'annulus. I pazienti sono stati sottoposti a follow up clinico e strumentale (ecocardiografia e angiotc aorta toracica)

Transcatheter Aortic Valve Replacement With Next-Generation Self-Expanding Devices: A Multicenter, Retrospective, Propensity-Matched Comparison of Evolut PRO Versus Acurate neo Transcatheter Heart Valves

OBJECTIVES The aim of this study was to compare transcatheter aortic valve replacement (TAVR) with the Acurate neo (NEO) and Evolut PRO (PRO) devices. BACKGROUND The NEO and PRO bioprostheses are 2 next-generation self-expanding devices developed for TAVR. METHODS The NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) registry retrospectively included patients who underwent transfemoral TAVR with either NEO or PRO valves at 24 centers between January 2012 and March 2018. One-to-one propensity score matching resulted in 251 pairs. Pre-discharge and 30-day Valve Academic Research Consortium (VARC)-2 defined outcomes were evaluated. Binary logistic regression was performed to adjust the treatment effect for propensity score quintiles. RESULTS A total of 1,551 patients (n = 1,263 NEO; n = 288 PRO) were included. The mean age was 82 years, and the mean Society of Thoracic Surgeons score was 5.1%. After propensity score matching (n = 502), VARC-2 device success (90.6% vs. 91.6%; p = 0.751) and pre-discharge moderate to severe (II+) paravalvular aortic regurgitation (7.3% vs. 5.7%; p = 0.584) were comparable between the NEO and PRO groups. Furthermore, there were no significant differences in any 30-day clinical outcome between matched NEO and PRO pairs, including all-cause mortality (3.2% vs. 1.2%; p = 0.221), stroke (2.4% vs. 2.8%; p = 1.000), new permanent pacemaker implantation (11.0% vs. 12.8%; p = 0.565), and VARC-2 early safety endpoint (10.6% vs. 10.4%; p = 1.000). Logistic regression on the unmatched cohort confirmed a similar risk of VARC-2 device success, paravalvular aortic regurgitation II+, and 30-day clinical outcomes after NEO and PRO implantation. CONCLUSIONS In this multicenter registry, transfemoral TAVR with the NEO and PRO bioprostheses was associated with high device success, acceptable rates of paravalvular aortic regurgitation II+, and good 30-day clinical outcomes. After adjusting for potential confounders, short-term outcomes were similar between the devices

Mitral valve interventions in structural heart disease

PURPOSE OF REVIEW: Analyze the current state of the art and the future perspectives of mitral interventions in clinical setting. RECENT FINDINGS: A systematic and critical review of the new mitral percutaneous therapies and imaging technologies is the basis to adopt the right treatment for each patient according to specific valve dysfunction and clinical presentation, waiting for definitive guidelines. While surgical mitral repair will remain the gold standard for low-risk healthy patients with degenerative mitral regurgitation (DMR), transcatheter mitral valve repair is becoming first line therapy in high risk patients with functional mitral regurgitation (FMR). The introduction of transcatheter mitral valve replacement will expand indications for advanced DMR and FMR in inoperable patients. The introduction of transcatheter mitral interventions is changing the mitral therapy scenario. Mitral interventionalists might evolve into hybrid professional figures able to offer a tailored approach for each patient, including surgical and percutaneous approaches, depending on the anatomo-functional status of the valve, to clinical conditions, and to the timing of the intervention

Reintroducing heart sounds for early detection of acute myocardial ischemia in a porcine model - correlation of acoustic cardiography with gold standard of pressure-volume analysis

Background Acoustic cardiography is a hybrid technique that couples heart sounds recording with ECG providing insights into electrical-mechanical activity of the heart in an unsupervised, non-invasive and inexpensive manner. During myocardial ischemia hemodynamic abnormalities appear in the first minutes and we hypothesize a putative diagnostic role of acoustic cardiography for prompt detection of cardiac dysfunction for future patient management improvement. Methods and Results Ten female Swiss large white pigs underwent permanent distal coronary occlusion as a model of acute myocardial ischemia. Acoustic cardiography analyses were performed prior, during and after coronary occlusion. Pressure-volume analysis was conducted in parallel as an invasive method of hemodynamic assessment for comparison. Similar systolic and diastolic intervals obtained with the two techniques were significantly correlated [Q to min dP/dt vs. Q to second heart sound (r$^{2}$ = 0.9583, p < 0.0001), PV diastolic filling time vs. AC perfusion time (r$^{2}$ = 0.9686, p < 0.0001)]. Indexes of systolic and diastolic impairment correlated with quantifiable features of heart sounds [Tau vs. fourth heart sound Display Value (r$^{2}$ = 0.2721, p < 0.0001) cardiac output vs. third heart sound Display Value (r$^{2}$ = 0.0791 p = 0.0023)]. Additionally, acoustic cardiography diastolic time (AUC 0.675, p = 0.008), perfusion time (AUC 0.649, p = 0.024) and third heart sound Display Value (AUC 0.654, p = 0.019) emerged as possible indicators of coronary occlusion. Finally, these three parameters, when joined with heart rate into a composite joint-index, represent the best model in our experience for ischemia detection (AUC 0.770, p < 0.001). Conclusion In the rapidly evolving setting of acute myocardial ischemia, acoustic cardiography provided meaningful insights of mechanical dysfunction in a prompt and non-invasive manner. These findings should propel interest in resurrecting this technique for future translational studies as well as reconsidering its reintroduction in the clinical setting