Transapical off-pump mitral valve repair with Neochord Implantation (TOP-MINI): step-by-step guide

open10openColli, Andrea; Zucchetta, Fabio; Torregrossa, Gianluca; Manzan, Erica; Bizzotto, Eleonora; Besola, Laura; Bellu, Roberto; Sarais, Cristiano; Pittarello, Demetrio; Gerosa, GinoColli, Andrea; Zucchetta, Fabio; Torregrossa, Gianluca; Manzan, Erica; Bizzotto, Eleonora; Besola, Laura; Bellu, Roberto; Sarais, Cristiano; Pittarello, Demetrio; Gerosa, Gin

Cardiac injury and mortality in patients with Coronavirus disease 2019 (COVID-19): insights from a mediation analysis

Patients at greatest risk of severe clinical conditions from coronavirus disease 2019 (COVID-19) and death are elderly and comorbid patients. Increased levels of cardiac troponins identify patients with poor outcome. The present study aimed to describe the clinical characteristics and outcomes of a cohort of Italian inpatients, admitted to a medical COVID-19 Unit, and to investigate the relative role of cardiac injury on in-hospital mortality

Early Diagnosis of Type-2 Cardio-renal Syndrome by Doppler Sonographic Evaluation of Renal Vasoconstriction

Renal failure of type-2 cardio-renal syndrome is due to renal hypoperfusion secondary to heart failure and is mediated by an imbalance between vasoconstrictors and vasodilators. The decrease in glomerular filtration rate does not correlate with left ventricular ejection fraction. Aim of this study was to evaluate, by Doppler sonography, renal hemodynamic alterations in heart failure. Thirty patients (age: 51\ub115yr) with dilated cardiomyopathy (DCM) and 20 normal subjects (C) were studied. Cardiomyopathy was essential in 36.6%, post-ischemic in 36.6%, alcoholic in 16.7%, post-myocarditis in 10% of patients. All patients were hemodynamically stable. In each patient, echocardiography and renal Doppler sonography (interlobar arterial pulsatility index, PI-K) were performed the same day, together with BUN, creatinine, NT-proBNP measurement. Patients with DCM had normal kidneys morphology and volume. LVEF was 26\ub16.8%. PI-K was increased compared to C (1.74\ub10.71 vs 0.95\ub10.19, p<0.001) and also renal function was impaired (creatinine 128.5\ub184 vs 70\ub130 umol/L, p<0.01, BUN 11.6\ub15.8 vs 7\ub11.5 mmol/L, p<0.01). Prevalence of renal failure was 36.6% (NYHA 1-2: 23%, NYHA 3-4: 52.9%) while prevalence of increased PI-K was 83.3% (NYHA 1-2: 69.2%, NYHA 3-4: 94.1%). PI-K was increased already in mild heart failure (NYHA 1-2) (PI-K: 1.37\ub10.3 p<0,01), but more so in patients with more severe heart dysfunction (NYHA 3 e 4) (PI-K: 2,1\ub10,8 p<0.01) without significant correlation with LVEF or right atrial pressure. There were no differences in creatinine or BUN among patients with different severity of heart dysfunction (creatinine 105\ub123 vs 140\ub1104 umol/L, urea 10.3\ub15.7 vs 12.3\ub16 mmol/L). NT-proBNP was increased in patients with DCM (6249.61\ub13.963 ng/L) and did not correlate with LVEF, PI-K, renal function, right atrial pressure. In conclusion, in patients with chronic heart failure renal vasoconstriction can be demonstrated by Doppler-sonography in the early stage, when renal function is still normal, and increases with the worsening of heart failure. Renal Doppler resistance indices may be used for early diagnosis of type-2 cardiorenal syndrome and for prevention of acute, diuretic-induced, renal failure. Author Disclosures: D. Sacerdoti: None. S. Gaiani: None. S. Tonello: None. E. Franceschini: None. P. Pesce: None. P. Bizzotto: None. G. Bombonato: None. C. Sarais: None. M. Bolognesi: None. Key Words: Heart failure \u2022 Renal circulation \u2022 Renal function \u2022 Doppler ultrasoun

Early Diagnosis of Type-2 Cardio-renal Syndrome by Doppler Sonographic Evaluation of Renal Vasoconstriction

Renal failure of type-2 cardio-renal syndrome is due to renal hypoperfusion secondary to heart failure and is mediated by an imbalance between vasoconstrictors and vasodilators. The decrease in glomerular filtration rate does not correlate with left ventricular ejection fraction. Aim of this study was to evaluate, by Doppler sonography, renal hemodynamic alterations in heart failure. Thirty patients (age: 51\ub115yr) with dilated cardiomyopathy (DCM) and 20 normal subjects (C) were studied. Cardiomyopathy was essential in 36.6%, post-ischemic in 36.6%, alcoholic in 16.7%, post-myocarditis in 10% of patients. All patients were hemodynamically stable. In each patient, echocardiography and renal Doppler sonography (interlobar arterial pulsatility index, PI-K) were performed the same day, together with BUN, creatinine, NT-proBNP measurement. Patients with DCM had normal kidneys morphology and volume. LVEF was 26\ub16.8%. PI-K was increased compared to C (1.74\ub10.71 vs 0.95\ub10.19, p<0.001) and also renal function was impaired (creatinine 128.5\ub184 vs 70\ub130 umol/L, p<0.01, BUN 11.6\ub15.8 vs 7\ub11.5 mmol/L, p<0.01). Prevalence of renal failure was 36.6% (NYHA 1-2: 23%, NYHA 3-4: 52.9%) while prevalence of increased PI-K was 83.3% (NYHA 1-2: 69.2%, NYHA 3-4: 94.1%). PI-K was increased already in mild heart failure (NYHA 1-2) (PI-K: 1.37\ub10.3 p<0,01), but more so in patients with more severe heart dysfunction (NYHA 3 e 4) (PI-K: 2,1\ub10,8 p<0.01) without significant correlation with LVEF or right atrial pressure. There were no differences in creatinine or BUN among patients with different severity of heart dysfunction (creatinine 105\ub123 vs 140\ub1104 umol/L, urea 10.3\ub15.7 vs 12.3\ub16 mmol/L). NT-proBNP was increased in patients with DCM (6249.61\ub13.963 ng/L) and did not correlate with LVEF, PI-K, renal function, right atrial pressure. In conclusion, in patients with chronic heart failure renal vasoconstriction can be demonstrated by Doppler-sonography in the early stage, when renal function is still normal, and increases with the worsening of heart failure. Renal Doppler resistance indices may be used for early diagnosis of type-2 cardiorenal syndrome and for prevention of acute, diuretic-induced, renal failure. Author Disclosures: D. Sacerdoti: None. S. Gaiani: None. S. Tonello: None. E. Franceschini: None. P. Pesce: None. P. Bizzotto: None. G. Bombonato: None. C. Sarais: None. M. Bolognesi: None. Key Words: Heart failure \u2022 Renal circulation \u2022 Renal function \u2022 Doppler ultrasoun