Bilateral mini-thoracotomy for combined minimally invasive direct coronary artery bypass and mitral valve repair

Consistent evidence recognizes minimally invasive valve surgery as the top-tier surgical approach for heart valve pathology. Conversely, the overall adoption of minimally invasive coronary surgery remains low. Notwithstanding, excellent clinical outcomes have been recently reported, further consolidating a technique that addresses major concerns associated with the traditional approach for the most frequently performed cardiac operation, including sternal dehiscence (i.e., sternal sparing), stroke (i.e., no-touch aorta), but that also guarantees a reduced resort to blood transfusions, diminished pain, and faster recovery. More to the point, the suitability of minimally invasive strategies for combined coronary and valve procedures remains debatable. Almost no reports of such combined procedures are available in literature and the very few published experiences appear scarce and heterogeneous about the surgical access (i.e., single versus bilateral mini-thoracotomy). However, bilateral mini-thoracotomy has been proposed as a feasible and safe strategy for different cardiac operations like surgical ablation and left ventricular assist device implantation, but also for isolated multivessel minimally invasive coronary surgery. Here we describe feasibility of combined minimally invasive mitral valve and coronary surgery performed through bilateral mini-thoracotomy and we report outcomes of our initial series of 3 cases

Proximal repair in acute type A aortic dissection: The dark side of the root

Abstract There is no agreement regarding the best treatment for proximal repair in acute type A aortic dissection. Isolated replacement of the ascending aorta has been shown effective but can leave patients at a higher risk of further aortic procedures. The interpretation of the results coming from the literature is difficult because of the great variability of the clinical scenarios and the anatomic extension of the dissection. The analysis of the risk factors suggests that the presence of the underlying root pathology and a more extensive involvement of the aortic root should address the surgeon towards a more radical proximal resection

Cor triatriatum dexter: a rare incidentaloma

Cor triatriatum dexter (CTD) is an extremely rare finding resulting from the persistence of the right valve of sinus venosus. It is a congenital cardiac anomaly defined by an abnormal septation of the atrium leading to inflow obstruction to the respective ventricle. Multimodal diagnostic modalities are necessary to characterize it for an optimal patient management. We report the case of a 68-year-old woman who presented to our clinic for further feedback of ventricular ectopic beats

Do Italian consumers value health claims on extra-virgin olive oil?

The present study aims to extend the existing literature on EVOO consumers by assessing the importance of health claims in selecting EVOO products by jointly accounting for consumer preferences for the many search, experience, and credence attributes potentially available on EVOO, as well as by accounting for attitudinal and psychographic individual characteristics which affect consumer decision to prefer products with health claims over conventional ones (i.e. subjective nutritional knowledge, nutritional knowledge, nutritional importance, attitudes towards using food as a medicine, general health interest). The latter characteristics play a pivotal role in individual decisions to consider health claims when purchasing food, as indicated in the general literature on consumers and health claims. Such individual related characteristics capture the individual attitude and interest in preventing health losses through food choices and diet (see for instance, Roininen et al. (1999), Van Trijp & Van der Lans (2007) Dean et al. (2012)). To achieve our research goal, we employed a best-worst (BW) approach on a representative sample of Italian household members who are responsible for food shopping. Consumers tested competitively the multiple product attributes of EVOO. The share of consumers interested in health claims was detected by a latent class clustering model and characterized based on their socio-demographic, attitudinal, and psychographic features. Thus, this is the first study attempting to identify the features of consumers interested in health claims while purchasing EVOO using a large sample of household responsible of food purchases

Minimally invasive aortic valve replacement: short-term efficacy of sutureless compared with stented bioprostheses

Sutureless aortic valve prostheses have been introduced to facilitate the implant process, speed up the operating time and improve haemodynamic performance. The goal of this study was to assess the potential advantages of using sutureless prostheses during minimally invasive aortic valve replacement in a large multicentre population

Safety of Salvaged Blood and Risk of Coagulopathy in Cardiac Surgery.

Cardiac surgery patients are prone to anemia from several mechanisms: intraoperative blood loss, preexisting anemia, and hemodilution. Patients are very frequently transfused with allogeneic red blood cells (RBC), which in itself is associated with harm. The use of RBC salvage technology has been advocated to salvage blood lost in the operative field and to reduce the need of homologous blood transfusion. Direct cardiotomy suction from the surgical field and unprocessed blood retransfusion is a common practice during cardiopulmonary bypass, but which is associated with a powerful activation of the coagulation and inflammatory systems: thrombin generation, excessive fibrinolysis, and release of proinflammatory cytokines. Compared with direct cardiotomy suction, the use of RBC salvage technology is able to reduce the amount of microparticles and activated proteins of autologous blood before retransfusion. However, when compared with no retransfusion of blood from the operative field, processed blood also triggers coagulopathy and inflammation. Clinical studies are discordant regarding the benefit of RBC salvage use during and after cardiac operations. Meta-analysis suggests reduced need of homologous blood transfusion, but no effects on mortality and morbidity