Publications by authors named "Massimo Massetti"

173 Publications

Bicuspidized De Vega for functional tricuspid valve regurgitation: "De-Kay repair".

Ann Thorac Surg 2021 Apr 27. Epub 2021 Apr 27.

Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome.

Functional tricuspid valve regurgitation in the contest of mitral valve disease is a highly prevalent disease. We describe a ring-less technique that combines restrictive annuloplasty (De Vega) with posterior tricuspid leaflet obliteration (Kay) used for patients with less-than-severe functional tricuspid valve regurgitation undergoing mitral valve surgery. The technique has been in use at our centre since 2012, showing promising long-term echocardiographic results, with stable reduction of the annulus size and stable reduction of the degree of regurgitation.
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http://dx.doi.org/10.1016/j.athoracsur.2021.04.038DOI Listing
April 2021

Atherosclerotic Plaque Fissuration and Clinical Outcomes in Pre-Diabetics vs. Normoglycemics Patients Affected by Asymptomatic Significant Carotid Artery Stenosis at 2 Years of Follow-Up: Role of microRNAs Modulation: The ATIMIR Study.

Biomedicines 2021 Apr 8;9(4). Epub 2021 Apr 8.

Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80100 Naples, Italy.

Atherosclerotic plaque instability and rupture in patients with asymptomatic carotid artery stenosis (ACAS) is a leading cause of major adverse cardiac events (MACE). This could be mainly evidenced in patients with pre-diabetes. Indeed, the altered glucose homeostasis and insulin resistance could cause over-inflammation of atherosclerotic plaque, favoring its conversion to unstable phenotype with rupture and MACE. Notably, metformin therapy reducing the metabolic distress and the inflammatory burden could reduce MACE in ACAS patients with pre-diabetes. In this setting, the microRNAs (miRs) could be used as molecular biomarkers of atherosclerosis progression, plaque rupture, and worse prognosis in normoglycemics (NG) versus pre-diabetics metformin users (PDMU) versus pre-diabetics non-metformin users (PDNMU). However, our study aimed to investigate a wide miRNA panel in peripheral blood exosomes from patients with ACAS divided in NG versus PDMU versus PDNMU, and to associate the circulating miRNA expression profiles with MACE at 2 years of follow-up after endarterectomy. The study included 234 patients with ACAS divided into NG ( = 125), PDNMU ( = 73), and PDMU ( = 36). The miRs' expression profiles of circulating exosomes were determined at baseline and at 2 years of follow-up by Affymetrix microarrays from the patients' plasma samples from any study cohort. Then we collected and analyzed MACE at 2 years of follow-up in NG versus PDMU versus PDNMU. Prediabetics versus NG had over-inflammation ( < 0.05) and over expressed miR-24 and miR-27 at baseline. At 2 years of follow-up, PDNMU versus NG, PDMU versus NG, and PDNMU versus PDMU over-expressed inflammatory markers and miR-24, miR-27, miR-100, miR-126, and miR-133 ( < 0.05). Finally, at the end of follow-up, we observed a significant difference about MACE comparing PDNMU versus NG ( = 27 (36.9%) versus = 8 (6.4%); < 0.05), PDNMU versus PDMU ( = 27 (36.9%) versus = 6 (16.6%); < 0.05); and PDMU versus NG ( = 6 (16.6%) versus = 8 (6.4%); < 0.05). Admission glucose values (HR (hazard ratio) 1.020, CI (confidence of interval) 95% (1.001-1.038), = 0.029), atheromatous carotid plaque (HR 5.373, CI 95% (1.251-11.079), = 0.024), and miR-24 (HR 3.842, CI 95% (1.768-19.222), = 0.011) predicted MACE at 2 years of follow-up. Specific circulating miRs could be over-expressed in pre-diabetics and specifically in PDNMU versus PDMU after endarterectomy. MiR24, hyperglycemia, and atheromatous plaque could predict MACE at 2 years of follow-up.
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http://dx.doi.org/10.3390/biomedicines9040401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068301PMC
April 2021

Telemedicine for adult congenital heart disease patients during the first wave of COVID-19 era: a single center experience.

J Cardiovasc Med (Hagerstown) 2021 Apr 20. Epub 2021 Apr 20.

Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS Catholic University of the Sacred Heart Department of Pediatric Cardiology and Cardiac Surgery - Bambino Gesù Hospital, Rome, Italy.

Aim: To summarize our experience on the implementation of a telemedicine service dedicated to adult congenital heart disease (ACHD) patients during the lockdown for the first wave of COVID-19.

Methods: This is a prospective study enrolling all ACHD patients who answered a questionnaire dedicated telematic cardiovascular examination.

Results: A total of 289 patients were enrolled, 133 (47%) were male, 25 (9%) were affected by a genetic syndrome. The median age was 38 (29-51) years, whereas the median time interval between the last visit and the telematic follow-up was 9.5 (7.5-11.5) months. Overall, 35 patients (12%) reported a worsening of fatigue in daily life activity, 17 (6%) experienced chest pain, 42 (15%) had presyncope and 2 (1%) syncope; in addition, 28 patients (10%) presented peripheral edema and 14 (5%) were orthopneic. A total of 116 (40%) patients reported palpitations and 12 had at least one episode of atrial fibrillation and underwent successful electrical (8) or pharmacological (4) cardioversion. One patient was admitted to the emergency department for uncontrolled arterial hypertension, five for chest pain, and one for heart failure. Two patients presented fever but both had negative COVID-19 nasal swab.

Conclusion: During the COVID-19 pandemic, the use of telemedicine dramatically increased and here we report a positive experience in ACHD patients. The postpandemic role of telemedicine will depend on permanent regulatory solutions and this early study might encourage a more systematic telematic approach for ACHD patients.
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http://dx.doi.org/10.2459/JCM.0000000000001195DOI Listing
April 2021

Heart valve critical pathway and heart valve clinic: novel benchmarks for modern management of valvular heart disease.

Crit Pathw Cardiol 2021 Mar 31. Epub 2021 Mar 31.

Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia Università Cattolica del Sacro Cuore, Roma, Italia.

The growing burden of Valvular Heart Disease (VHD) in Western countries represents a challenge for the daily clinical practice, especially in the light of the ever-increasing number of therapeutic options. The Euro Heart Survey showed that, among elderly subjects with severe, symptomatic valve dysfunction, surgery is denied for 33% of patients with aortic stenosis and for 50% of patients with mitral regurgitation. Current management (from diagnosis to follow-up) is often fragmented in multiple - sometimes unnecessary- steps. Such a "patchy" approach may translate into a suboptimal management, especially in the geriatric population. New healthcare models exist, that can coordinate care, reduce fragmentation, limit costs and, ultimately, improve outcomes: the clinical pathways.
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http://dx.doi.org/10.1097/HPC.0000000000000260DOI Listing
March 2021

A new device to treat mitral valve regurgitation: a proof of concept in bench test study.

J Med Eng Technol 2021 Apr 23;45(3):197-206. Epub 2021 Mar 23.

Neurosciences and Rehabilitation Department, University of Ferrara, Ferrara, Italy.

Mitral valve repair is typically performed by implanting a ring-like device at the valve annulus to reshape the annulus and to improve leaflet coaptation. In most cases, some additional procedures are needed, including leaflet resection and artificial chordae implantation. However, artificial chordae implantation could be technically challenging and postoperative left ventricular remodeling could increase the risk of recurrent mitral regurgitation. We propose an innovative annular device made of chromo-cobalt, finalized not only to reshape the annulus but also to enable anchoring of leaflets to a fixed intraventricular structure. Durability evaluation of the device was tested by applying eight radial force vectors equally spaced along the ring and related fatigue analysis. To evaluate the efficacy of the mitral valvuloplasty using the tested ring, the device was implanted in five adult swine hearts. Functional analysis of the ring was performed by measuring left ventricular pressure and fluid volume loss, following implantation in normal and dysfunctional mitral valve leaflets. Both fatigue and functional analysis showed satisfactory and promising results in terms of durability and efficacy of mitral valve repair. Because of its favorable durability and functional characteristics this device appears promising and provides good results in terms of valve competence, thus avoiding both manipulations of papillary muscles and interference in left ventricular hemodynamics. However, an test is mandatory to fully understand the impact of the device on subvalvular apparatus.
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http://dx.doi.org/10.1080/03091902.2021.1891312DOI Listing
April 2021

Platelet hyaluronidase 2 enrichment in acute coronary syndromes: a conceivable role in monocyte-platelet aggregate formation.

J Enzyme Inhib Med Chem 2021 Dec;36(1):785-789

Catholic University of the Sacred Heart, Rome, Italy.

Acute Coronary Syndromes (ACS) with plaque erosion display dysregulated hyaluronan metabolism, with increased hyaluronidase-2 (HYAL2) expression. However, the expression and the role of this enzyme on platelets has never been explored. We evaluated the platelet's HYAL2 (HYAL2) levels on I) stable angina (SA) and II) ACS patients, furtherly sub-grouped in Intact-Fibrous-Cap (IFC) and Ruptured-Fibrous-Cap (RFC), according to Optical Coherence Tomography. We assessed the HYAL2 role through an model setting of co-cultured monocytes and platelets, before and after treatment with low-molecular-weight hyaluronic acid (HA) as pro-inflammatory stimulus and with or without HYAL2-antibody to inhibit HYAL2 activity. ACS patients exhibit higher HYAL2 levels comparing to SA, with the higher expression for IFC group. The addition of HYAL2-antibody significantly reduced the percentage of monocyte-platelet binding, suggesting that HYAL2 enrichment at the site of the culprit lesion is a key mediator in the systemic thrombo-inflammatory status of ACS presenting with plaque erosion.
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http://dx.doi.org/10.1080/14756366.2021.1900159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993372PMC
December 2021

[Cardiac contractility modulation: a treatment option for patients with refractory heart failure].

G Ital Cardiol (Rome) 2021 Mar;22(3):212-220

Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma - Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma.

Heart failure is the cardiovascular epidemic of the 21st century, with poor prognosis and quality of life despite optimized medical treatment. In the past two decades, only two new drugs have been added to therapeutic strategies for patients with symptomatic heart failure and even less progresses have been made on devices, with the implantable defibrillator indicated for patients with ejection fraction ≤35% and cardiac resynchronization therapy for those with QRS >130 ms and evidence of left bundle branch block. Nevertheless, only a third of patients meet these criteria and a high percentage of patients are non-responders in terms of improving symptoms. Nowadays, in patients with symptomatic heart failure with ejection fraction between 25% and 45% and QRS <130 ms, not eligible for cardiac resynchronization therapy, cardiac contractility modulation represents a concrete treatment option, having proved to be safe and effective in reducing hospitalizations for heart failure and improving symptoms, functional capacity and quality of life.The aim of this review is therefore to summarize the pathophysiological mechanisms, the current indications and the recent developments regarding the new applications of cardiac contractility modulation for patients with chronic heart failure.
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http://dx.doi.org/10.1714/3557.35341DOI Listing
March 2021

Outcomes of Lower Extremity Endovascular Revascularization: Potential Predictors and Prevention Strategies.

Int J Mol Sci 2021 Feb 18;22(4). Epub 2021 Feb 18.

Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.

Peripheral artery disease (PAD) is a manifestation of atherosclerosis, which may affect arteries of the lower extremities. The most dangerous PAD complication is chronic limb-threatening ischemia (CLTI). Without revascularization, CLTI often causes limb loss. However, neither open surgical revascularization nor endovascular treatment (EVT) ensure long-term success and freedom from restenosis and revascularization failure. In recent years, EVT has gained growing acceptance among all vascular specialties, becoming the primary approach of revascularization in patients with CLTI. In clinical practice, different clinical outcomes after EVT in patients with similar comorbidities undergoing the same procedure (in terms of revascularization technique and localization of the disease) cause unsolved issues that need to be addressed. Nowadays, risk management of revascularization failure is one of the major challenges in the vascular field. The aim of this literature review is to identify potential predictors for lower extremity endovascular revascularization outcomes and possible prevention strategies.
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http://dx.doi.org/10.3390/ijms22042002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922574PMC
February 2021

TEVAR for traumatic thoracic injury with the first-generation stent graft.

J Vasc Surg Cases Innov Tech 2021 Mar 28;7(1):16-20. Epub 2020 Nov 28.

Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

Thoracic endovascular aortic repair (TEVAR) is a life-saving treatment for blunt thoracic aortic injury. We report long-term outcomes of two young patients who underwent TEVAR for blunt thoracic aortic injury with first-generation thoracic stent grafts. The off-label use of the endograft affected the outcomes: one case of open surgery conversion due to an aortoesophageal fistula and one case of endovascular relining for a voluminous pseudoaneurysm associated with a type III endoleak. Long-term follow-up is crucial in TEVAR, especially in case of a first-generation device used in an urgent setting.
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http://dx.doi.org/10.1016/j.jvscit.2020.08.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903297PMC
March 2021

Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey.

Eur J Cardiothorac Surg 2021 04;59(4):901-907

Cardiac Surgery Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.

Objectives: Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak. Accordingly, hospitals had to implement strategies to profoundly reshape both non-COVID-19 medical care and surgical activities. Knowledge about the impact of the COVID-19 pandemic on cardiac surgery practice is pivotal. The goal of the present study was to describe the changes in cardiac surgery practices during the health emergency at the national level.

Methods: A 26-question web-enabled survey including all adult cardiac surgery units in Italy was conducted to assess how their clinical practice changed during the national lockdown. Data were compared to data from the corresponding period in 2019.

Results: All but 2 centres (94.9%) adopted specific protocols to screen patients and personnel. A significant reduction in the number of dedicated cardiac intensive care unit beds (-35.4%) and operating rooms (-29.2%), along with healthcare personnel reallocation to COVID departments (nurses -15.4%, anaesthesiologists -7.7%), was noted. Overall adult cardiac surgery volumes were dramatically reduced (1734 procedures vs 3447; P < 0.001), with a significant drop in elective procedures [580 (33.4%) vs 2420 (70.2%)].

Conclusions: This national survey found major changes in cardiac surgery practice as a response to the COVID-19 pandemic. This experience should lead to the development of permanent systems-based plans to face possible future pandemics. These data may effectively help policy decision-making in prioritizing healthcare resource reallocation during the ongoing pandemic and once the healthcare emergency is over.
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http://dx.doi.org/10.1093/ejcts/ezaa436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989504PMC
April 2021

The treatment of mitral insufficiency in refractory heart failure.

Eur Heart J Suppl 2020 Nov 18;22(Suppl L):L93-L96. Epub 2020 Nov 18.

Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.

Secondary mitral insufficiency (SMI) is caused by dilatation and left ventricular dysfunction and is a frequent finding in patients with heart failure (HF). It is associated with a mortality of between 40% and 50% at 3 years. The first-line treatment is represented by medical therapy, possibly associated, when indicated, with cardiac re-synchronization. If the patient remains symptomatic, corrective action should be considered. Surgery is indicated in cases of severe SMI with ejection fraction >30% and the need for myocardial revascularization. The management of patients in whom revascularization is not an option remains extremely complex and the evidence in this field is extremely limited. Percutaneous transcatheter therapies, reparative or replacement, are rapidly emerging as valid alternatives in cases of patients at high surgical risk. In particular, edge-to-edge repair (MitraClip) has proven effective in improving symptoms and reducing hospitalizations for HF. However, neither transcatheter nor surgical mitral repair or replacement has been shown to significantly improve prognosis, with mortality remaining high (14-20% at 1 year). Randomized trials aimed at assessing the effect of these treatments and establishing their long-term outcomes are urgently required.
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http://dx.doi.org/10.1093/eurheartj/suaa143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904083PMC
November 2020

organized neovascularization induced by 3D bioprinted endothelial-derived extracellular vesicles.

Biofabrication 2021 Jan 12. Epub 2021 Jan 12.

Dipartimento Scienze Biomediche , Institute of Biomedical Technologies, National Research Council of Italy (ITB-CNR) , Via Fratelli Cervi, 93, Segrate, Milan, 20090, ITALY.

Extracellular vesicles (EVs) have become a key tool in the biotechnological landscape due to their well-documented ability of mediating intercellular communication. Such feature has been explored and, actually, it is under constant investigation by researchers, who have unraveled the important role of EVs in several research fields ranging from oncology, immunology and diagnostics to regenerative medicine. Unfortunately, there are still some limits to overcome before a clinical application, including the inability to confine the EVs to strategically defined sites of interest, to avoid side effects. In this study, for the first time, EVs application is supported by 3D bioprinting technology to develop a new strategy for applying the angiogenic cargo of HUVEC-derived EVs in regenerative medicine. EVs, derived from human endothelial cells and grown under different stressed conditions, were collected and used as bio-additives for the formulation of advanced bioinks. After in vivo sub-cutaneous implantation, we demonstrated that the bioprinted 3D structures, loaded with EVs, supported the formation of a new functional vasculature in situ, consisting of blood-perfused microvessels recapitulating the printed pattern. The results obtained in this study favor the development of new therapeutic approaches for critical clinical conditions, such as the need for prompt revascularization of ischemic tissues, which represents the fundamental substrate for advanced regenerative medicine applications.
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http://dx.doi.org/10.1088/1758-5090/abdacfDOI Listing
January 2021

A nontrivial differential diagnosis in COVID-19 pandemic: a case report and literary review of amiodarone induced interstitial pneumonia.

Future Cardiol 2020 Dec 17. Epub 2020 Dec 17.

Catholic University of Sacred Heart, Rome, Italy.

Amiodarone is a drug commonly used to treat and prevent cardiac arrhythmias, but it is often associated with several adverse effects, the most serious of which is pulmonary toxicity. A 79-year-old man presented with respiratory failure due to interstitial pneumonia during coronavirus disease 2019 (COVID-19) pandemic. The viral etiology was nevertheless excluded by repeated nasopharyngeal swabs and serological tests and the final diagnosis was amiodarone induced organizing pneumonia. The clinical and computed tomography findings improved after amiodarone interruption and steroid therapy. Even during a pandemic, differential diagnosis should always be considered and pulmonary toxicity has to be taken into account in any patient taking amiodarone and who has new respiratory symptoms.
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http://dx.doi.org/10.2217/fca-2020-0168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745655PMC
December 2020

Minimally Invasive Aortic Valve Surgery in Octogenarians: Reliable Option or Fallback Solution?

Innovations (Phila) 2021 Jan-Feb;16(1):34-42. Epub 2020 Dec 15.

60234 Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.

Objective: Aortic valve disease is more and more common in western countries. While percutaneous approaches should be preferred in older adults, previous reports have shown good outcomes after surgery. Moreover, advantages of minimally invasive approaches may be valuable for octogenarians. We sought to compare outcomes of conventional aortic valve replacement (CAVR) versus minimally invasive aortic valve replacement (MIAVR) in octogenarians.

Methods: We retrospectively collected data of 75 consecutive octogenarians who underwent primary, elective, isolated aortic valve surgery through conventional approach (41 patients, group CAVR) or partial upper sternotomy (34 patients, group MIAVR).

Results: Mean age was 81.9 ± 0.9 and 82.3 ± 1.1 years in CAVR and MIAVR patients, respectively ( = 0.09). MIAVR patients had lower 24-hour chest drain output (353.4 ± 207.1 vs 501.7 ± 229.9 mL, < 0.01), shorter mechanical ventilation (9.6 ± 2.4 vs 11.3 ± 2.3 hours, < 0.01), lower need for blood transfusions (35.3% vs 63.4%, = 0.02), and shorter hospital stay (6.8 ± 1.6 vs 8.3 ± 4.3 days, < 0.01). Thirty-day mortality was zero in both groups. Survival at 1, 3, and 5 years was 89.9%, 80%, and 47%, respectively, in the CAVR group, and 93.2%, 82.4%, and 61.8% in the MIAVR group, with no statistically significant differences (log-rank test, = 0.35).

Conclusions: Aortic valve surgery in older patients provided excellent results, as long as appropriate candidates were selected. MIAVR was associated with shorter mechanical ventilation, reduced blood transfusions, and reduced hospitalization length, without affecting perioperative complications or mid-term survival.
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http://dx.doi.org/10.1177/1556984520974467DOI Listing
December 2020

Cardiac resynchronization therapy and its effects in patients with type 2 DIAbetes mellitus OPTimized in automatic vs. echo guided approach. Data from the DIA-OPTA investigators.

Cardiovasc Diabetol 2020 11 28;19(1):202. Epub 2020 Nov 28.

Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80131, Naples, Italy.

Objectives: To evaluate the effects of cardiac resynchronization therapy (CRTd) in patients with type 2 diabetes mellitus (T2DM) optimized via automatic vs. echocardiography-guided approach.

Background: The suboptimal atrio-ventricular (AV) and inter-ventricular (VV) delays optimization reduces CRTd response. Therefore, we hypothesized that automatic CRTd optimization might improve clinical outcomes in T2DM patients.

Methods: We designed a prospective, multicenter study to recruit, from October 2016 to June 2019, 191 consecutive failing heart patients with T2DM, and candidate to receive a CRTd. Study outcomes were CRTd responders rate, hospitalizations for heart failure (HF) worsening, cardiac deaths and all cause of deaths in T2DM patients treated with CRTd and randomly optimized via automatic (n 93) vs. echocardiography-guided (n 98) approach at 12 months of follow-up.

Results: We had a significant difference in the rate of CRTd responders (68 (73.1%) vs. 58 (59.2%), p 0.038), and hospitalizations for HF worsening (12 (16.1%) vs. 22 (22.4%), p 0.030) in automatic vs. echocardiography-guided group of patients. At multivariate Cox regression analysis, the automatic guided approach (3.636 [1.271-10.399], CI 95%, p 0.016) and baseline highest values of atrium pressure (automatic SonR values, 2.863 [1.537-6.231], CI 95%, p 0.006) predicted rate of CRTd responders. In automatic group, we had significant difference in SonR values comparing the rate of CRTd responders vs. non responders (1.24 ± 0.72 g vs. 0.58 ± 0.46 g (follow-up), p 0.001), the rate of hospitalizations for HF worsening events (0.48 ± 0.29 g vs. 1.18 ± 0.43 g, p 0.001), and the rate of cardiac deaths ( 1.13 ± 0.72 g vs. 0.65 ± 0.69 g, p 0.047).

Conclusions: Automatic optimization increased CRTd responders rate, and reduced hospitalizations for HF worsening. Intriguingly, automatic CRTd and highest baseline values of SonR could be predictive of CRTd responders. Notably, there was a significant difference in SonR values for CRTd responders vs. non responders, and about hospitalizations for HF worsening and cardiac deaths. Clinical trial ClinicalTrials.gov Identifier NCT04547244.
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http://dx.doi.org/10.1186/s12933-020-01180-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700711PMC
November 2020

Extracorporeal membrane oxygenation for COVID-19: effective weapon or futile effort?

Minerva Cardioangiol 2020 Oct;68(5):365-367

Department of Cardiovascular Sciences, IRCCS A. Gemelli University Policlinic Foundation, Rome, Italy.

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http://dx.doi.org/10.23736/S0026-4725.20.05377-3DOI Listing
October 2020

Successful Transcatheter Treatment of Left Pulmonary Artery to Left Atrium Communication Diagnosed in Adulthood.

Circ Cardiovasc Imaging 2020 11 6;13(11):e010668. Epub 2020 Nov 6.

Department of Cardiovascular and Thoracic Sciences (R.L., F.G., F.B., G.L., C.A., E.R., M.G., E.P., R.S., F.I., M.M., C.T.) Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

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http://dx.doi.org/10.1161/CIRCIMAGING.120.010668DOI Listing
November 2020

Unexpected diagnosis following screening breast ultrasound.

Clin Case Rep 2020 Oct 1;8(10):2073-2075. Epub 2020 Jun 1.

Department of Cardiovascular Sciences Cardiac Surgery Unit Fondazione Policlinico Universitario "A. Gemelli" IRCCS Rome Italy.

Any instrumental examination may lead to unexpected diagnosis that in turn can radically change the clinical pathway of a patient.
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http://dx.doi.org/10.1002/ccr3.3014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7562835PMC
October 2020

Minimally Invasive vs Conventional Aortic Valve Replacement With Rapid-Deployment Bioprostheses.

Ann Thorac Surg 2020 Oct 9. Epub 2020 Oct 9.

Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy.

Background: The aim of this multicenter retrospective study was to compare early and midterm clinical and hemodynamic results of aortic valve replacement with rapid-deployment bioprostheses performed through conventional full-sternotomy vs mini-sternotomy.

Methods: Data from the Italian multicenter registry of aortic valve replacement with rapid-deployment bioprostheses (INTU-ITA registry) were analyzed. Patients were divided into 2 groups: full sternotomy (FS) and ministernotomy (MS). Primary endpoint was the comparison of early and midterm mortality. Secondary endpoints were: comparison of intraoperative variables, complications, and hemodynamic performance. A propensity score weighting approach was used for data analysis.

Results: A total of 1057 patients were analyzed: 435 (41.2%) and 622 (58.8%) in group FS and MS, respectively. Thirty-day mortality was 1.6% and 0.6% in FS and MS groups, respectively (P = .074). cardiopulmonary bypass time was 78.5 minutes and 83 minutes in FS and MS groups, respectively (P = .414). In the overall cohort, the incidence of intraoperative complications and of device success was 3.8% (40 patients) and 95.9% (1014 patients), respectively, with no significant differences between groups. Survival at 1, 3, and 5 years was 94.1%, 98.1%, 88.5% and 91.8%, 85.2%, and 84.8% in FS and MS groups, respectively (P = .412). The 2 groups showed similar postoperative gradients (median mean gradient, FS: 10.0 mm Hg, MS: 11.0 mm Hg; P = .170) and also similar incidence of patient-prosthesis mismatch (FS: 7%, MS: 6.4%, P = .647).

Conclusions: According to our data, rapid-deployment bioprostheses allow the performance of minimally invasive aortic valve replacement with similar surgical times and similar clinical and hemodynamic outcomes to conventional surgery and should be considered the first choice in these procedures.
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http://dx.doi.org/10.1016/j.athoracsur.2020.06.150DOI Listing
October 2020

Myocardial perfusion improvement by preoperative intra-aortic balloon pump.

Rev Esp Cardiol (Engl Ed) 2021 Apr 3;74(4):346. Epub 2020 Oct 3.

Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

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http://dx.doi.org/10.1016/j.rec.2020.09.001DOI Listing
April 2021

Psychological Effects of Skin Incision Size in Minimally Invasive Valve Surgery Patients.

Innovations (Phila) 2020 Nov/Dec;15(6):532-540. Epub 2020 Sep 28.

Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy.

Objective: Clinical benefits of minimally invasive cardiac valve surgery (MIVS) have been reported. Improved postoperative mental status was never analyzed with dedicated psychological tests. In the present study we intend to investigate potential benefits of MIVS for patient psychological well-being, with special attention to the relevance of the patient perception of the chest surgical scar, of the self body image and cosmetic aspects.

Methods: Between 2016 and 2017, 87 eligible patients, age 66.5 ± 14.5 years, operated on for heart valve surgery, underwent either conventional full sternotomy (CS; = 48) or MIVS by V-shape hemi-sternotomy approach ( = 39). Before selection of the surgical approach, patients had undergone preoperative evaluation of their psychological status using Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory Form Y (STAI-Y), and EuroQol-5D (EQ-5D) psychological tests. Six months postoperatively, patients filled in dedicated questionnaires to assess their psychological status, quality of life, and subjective perception, thus repeating the above-mentioned tests and adding the Body Image Questionnaire (BIQ) and Patient and Observer Scar Assessment Scale (POSAS) v2.0 tests for scar-healing process evaluation.

Results: No patient died during the study.The 4 post-test scales of psychological well-being (BDI-II = 0.04, STAI-Y = 0.04, 2 indices of EQ-5D = 0.03, = 0.01) showed significant differences between the MIVS group and CS group, with MIVS-small incision patients having lower level of depression and anxiety symptoms and better quality of life. Mean score differences of scar perception (BIQ and POSAS v2.0) were significant, with MIVS patients having evaluated the scar quality significantly better than CS patients.

Conclusions: MIVS appears associated with significant esthetical and related psychological benefits, as documented by technical tests. These findings should be considered when selecting the most appropriate technique for heart valve surgery.
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http://dx.doi.org/10.1177/1556984520956980DOI Listing
September 2020

Cardiac contractility modulation for patient with refractory heart failure: an updated evidence-based review.

Heart Fail Rev 2021 Mar 24;26(2):227-235. Epub 2020 Sep 24.

Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, Italy.

Heart failure is the cardiovascular epidemic of the twenty-first century, with poor prognosis and quality of life despite optimized medical treatment. Despite over the last decade significant improvements, with a major impact on morbidity and mortality, have been made in therapy for heart failure with reduced ejection fraction, little progress was made in the development of devices, with the implantable defibrillator indicated for patients with left ventricle ejection fraction ≤ 35% and cardiac resynchronization therapy for those with QRS ≥ 130 ms and evidence of left bundle branch block. Nevertheless, only a third of patients meet these criteria and a high percentage of patients are non-responders in terms of improving symptoms. Nowadays, in patients with symptomatic heart failure with ejection fraction between 25% and 45% and QRS < 130 ms, not eligible for cardiac resynchronization, the cardiac contractility modulation (CCM) represents a concrete therapeutic option, having proved to be safe and effective in reducing hospitalizations for heart failure and improving symptoms, functional capacity, and quality of life. The aim of this review is therefore to summarize the pathophysiological mechanisms, the current indications, and the recent developments regarding the new applications of the CCM for patients with chronic heart failure.
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http://dx.doi.org/10.1007/s10741-020-10030-4DOI Listing
March 2021

Blood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem registry.

Intern Emerg Med 2021 Mar 9;16(2):463-470. Epub 2020 Aug 9.

Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy.

Refractory cardiogenic shock (RCS) or refractory cardiac arrest (RCA) complicating acute coronary syndrome (ACS) is associated with extremely high mortality rate. Veno-arterial extracorporeal life support (VA-ECLS) represents a valuable therapeutic option to stabilize patients' condition before or at the time of emergency revascularization. We analyzed 29 consecutive patients with RCS or RCA complicating ACS, and implanted with VA-ECLS in two centers who have adopted a similar, structured approach to ECLS implantation. Data were collected from January 2010 to December 2015 and ECLS had to be percutaneously implanted either before (within 48 h) or at the time of attempted percutaneous coronary revascularization (PCI). We investigated in-hospital outcome and factors associated with survival. Twenty-one (72%) were implanted for RCA, whereas 8 (28%) were implanted on ECLS for RCS. All RCA were witnessed and no-flow time was shorter than 5 min in all cases but one. All patients underwent attempted emergency PCI, using radial access in ten cases (34.5%), whereas in three patients a subsequent CABG was performed. Overall, ten patients (34.5%) survived, nine of them with a good neurological outcome. Life threatening complications, including stroke (4 pts), leg ischemia (4 pts), intestinal ischemia (5 pts), and deep vein thrombosis 2 pts), occurred frequently, but were not associated with in-hospital death. Main cause of death was multi-organ failure. PCI variables did not predict survival. Survivors were younger, with shorter low-flow time, and with ECLS mainly implanted for RCS. At multivariate analysis, levels of lactate at ECLS implantation (OR 4.32, 95%CI 1.01-18.51, p = 0.049) emerged as the only variable that independently predicted survival. In patients with RCA or RCS complicating ACS who are percutaneously implanted with ECLS before or at the time of coronary revascularization, in hospital survival rate is higher than 30%. Level of lactate at ECLS implantation appears to be the most important factor to predict survival.
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http://dx.doi.org/10.1007/s11739-020-02459-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952335PMC
March 2021

Telemedicine, Artificial Intelligence and Humanisation of Clinical Pathways in Heart Failure Management: Back to the Future and Beyond.

Card Fail Rev 2020 Mar 15;6:e16. Epub 2020 Jun 15.

Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy.

New technologies have been recently introduced to improve the monitoring of patients with chronic syndromes such as heart failure. Devices can now be employed to gather large amounts of data and data processing through artificial intelligence techniques may improve heart failure management and reduce costs. The analysis of large datasets using an artificial intelligence technique is leading to a paradigm shift in the era of precision medicine. However, the assessment of clinical safety and the evaluation of the potential benefits is still a matter of debate. In this article, the authors aim to focus on the development of these new tools and to draw the attention to their transition in daily clinical practice.
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http://dx.doi.org/10.15420/cfr.2019.17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312813PMC
March 2020

Weathering the Cytokine Storm in COVID-19: Therapeutic Implications.

Cardiorenal Med 2020 29;10(5):277-287. Epub 2020 Jun 29.

Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) recently emerged in Wuhan, Hubei-China, as responsible for the coronavirus disease 2019 (COVID-19) and then spread rapidly worldwide. While most individuals remain asymptomatic or develop only mild symptoms, approximately 5% develop severe forms of COVID-19 characterized by acute respiratory distress syndrome (ARDS) and multiple-organ failure (MOF) that usually require intensive-care support and often yield a poor prognosis.

Summary: The pathophysiology of COVID-19 is far from being completely understood, and the lack of effective treatments leads to a sense of urgency to develop new therapeutic strategies based on pathophysiological assumptions. The exaggerated cytokine release in response to viral infection, a condition known as cytokine release syndrome (CRS) or cytokine storm, is emerging as the mechanism leading to ARDS and MOF in COVID-19, thus endorsing the hypothesis that properly timed anti-inflammatory therapeutic strategies could improve patients' clinical outcomes and prognosis. Key Messages: The objective of this article is to explore and comment on the potential role of the promising immunomodulatory therapies using pharmacological and nonpharmacological approaches to overcome the dysregulated proinflammatory response in COVID-19.
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http://dx.doi.org/10.1159/000509483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360507PMC
September 2020

The extended heart: cardiac surgery serving more hospitals.

Eur Heart J Suppl 2020 Jun 24;22(Suppl E):E91-E95. Epub 2020 Mar 24.

Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

The Heart Team is becoming ever more central in delivering cardiovascular care, embodying a modern aspect of medical practice, designed to place the patient at the 'center' of a team with different specialists, all contributing to the definition of the most appropriate therapeutic actions. We prospectively analyzed 200 consecutive patients (2015-2017). Patients were evaluated independently by a cardiologist and a cardiac surgeon, each deciding the most appropriate therapeutic action. At a later time, the same patient, was evaluated by the Heart Team. For the first 100 patients the rate of concurrence between cardiologist and cardiac surgeon as well as among each specialist and the Heart Team, was relatively low (51 and 42% respectively). For the following 100 patients the concurrence rate was significantly higher (75 and 70% respectively). The systematic and collegial discussion of the patients in the contest of the Heart Team, steered toward an evolution of each specialist in the group settings. The Electronic Heart Team (e-Heart Team) employing video conference support, applied to the first 65 patients with promising results, represent a further advancement in the delivery of care, by reducing the from the 'Hub' center, and the specialist in the 'Spoke' facility, who from simple of the patient, now becomes an essential part of the therapeutic decision process. The Heart Team environment can deeply affect patients management and improve treatment results, by sharing the expertise and overcoming the limitations of the individual disciplines, thus reaching the common goal of the patient's best available treatment.
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http://dx.doi.org/10.1093/eurheartj/suaa069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270971PMC
June 2020

Undiagnosed Severe Late Complications of Repaired Tetralogy of Fallot.

Circ Cardiovasc Imaging 2020 06;13(6):e010273

Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (R.L., E.P., F.G., A.M.L., M.G., F.C., M.M.).

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http://dx.doi.org/10.1161/CIRCIMAGING.119.010273DOI Listing
June 2020

Delayed massive subcutaneous emphysema following Robicsek closure.

Clin Case Rep 2019 Dec 3;7(12):2588-2589. Epub 2019 Nov 3.

Department of Cardiovascular Sciences Cardiac Surgery Unit Fondazione Policlinico Universitario "A.Gemelli" IRCCS Catholic University of the Sacred Heart Rome Italy.

A surgical procedure may lead to unusual and unexpected clinical scenario. Good medical practice should always keep it in mind. So, a broken sternal steel wire was the rare cause of massive emphysema.
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http://dx.doi.org/10.1002/ccr3.2518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935661PMC
December 2019

Prognostic Value of Right Ventricular Dysfunction and Tricuspid Regurgitation in Patients with Severe Low-Flow Low-Gradient Aortic Stenosis.

Sci Rep 2019 10 10;9(1):14580. Epub 2019 Oct 10.

Department of Cardiology, Medical University of Vienna, Vienna, Austria.

Long and mid-term data in Low-Flow Low-Gradient Aortic Stenosis (LFLG-AS) are scarce. The present study sought to identify predictors of outcome in a sizeable cohort of patients with LFLG-AS. 76 consecutive patients with LFLG-AS (defined by a mean gradient <40 mmHg, an aortic valve area ≤1 cm and an ejection fraction ≤50%) were prospectively enrolled and followed at regular intervals. Events defined as aortic valve replacement (AVR) and death were assessed and overall survival was determined. 44 patients underwent AVR (10 transcatheter and 34 surgical) whilst intervention was not performed in 32 patients, including 9 patients that died during a median waiting time of 4 months. Survival was significantly better after AVR with survival rates of 91.8% (CI 71.1-97.9%), 83.0% (CI 60.7-93.3%) and 56.3% (CI 32.1-74.8%) at 1,2 and 5 years as compared to 84.3% (CI 66.2-93.1%), 52.9% (CI 33.7-69.0%) and 30.3% (CI 14.6-47.5%), respectively, for patients managed conservatively (p = 0.017). The presence of right ventricular dysfunction (HR 3.47 [1.70-7.09]) and significant tricuspid regurgitation (TR) (HR 2.23 [1.13-4.39]) independently predicted overall mortality while the presence of significant TR (HR 3.40[1.38-8.35]) and higher aortic jet velocity (HR 0.91[0.82-1.00]) were independent predictors of mortality and survival after AVR. AVR is associated with improved long-term survival in patients with LFLG-AS. Treatment delays are associated with excessive mortality, warranting urgent treatment in eligible patients. Right ventricular involvement characterized by the presence of TR and/or right ventricular dysfunction, identifies patients at high risk of mortality under both conservative management and after AVR.
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http://dx.doi.org/10.1038/s41598-019-51166-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787042PMC
October 2019

Improved Patient Recovery With Minimally Invasive Aortic Valve Surgery: A Propensity-Matched Study.

Innovations (Phila) 2019 Oct 21;14(5):419-427. Epub 2019 Aug 21.

Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.

Objective: Despite conflicting evidence available, minimally invasive aortic valve replacement (MIAVR) is increasingly used as an alternative to full sternotomy. We sought to compare early outcomes of aortic valve replacement through a full sternotomy (conventional aortic valve replacement [CAVR]) and upper ministernotomy (MIAVR).

Methods: We analyzed 297 patients having undergone primary, elective, isolated MIAVR or CAVR between January 2014 and June 2018. Following propensity score matching, 120 patients remained in each group.

Results: MIAVR required longer bypass (93 ± 26 vs 81 ± 24 minutes, < 0.01) and operative times (214 ± 39 vs 182 ± 37 minutes, < 0.01). However, aortic cross-clamp times were comparable (57 ± 17 vs 54 ± 14 minutes for MIAVR and CAVR, respectively, = 0.14). MIAVR had less 24-hour blood loss (253 ± 204 vs 323 ± 296 mL, = 0.03), less red blood cells transfusions [1.4 packs (1.1 o 1.9) vs 2.1 packs (1.8 to 2.7), = 0.01], and shorter assisted ventilation time (7.1 ± 3.3 vs 9.7 ± 3.8 hours, < 0.01) when compared to CAVR. These results led to significantly shorter intensive care unit and hospital stays for MIAVR patients (2.5 ± 1.3 vs 3.4 ± 1.1 days, < 0.01 and 6.9 ± 4.1 vs 8.2 ± 4.8 days, = 0.03, respectively). Thirty-day mortality and clinical outcomes did not differ significantly among groups.

Conclusions: MIAVR through upper ministernotomy was shown to be as safe and reliable as CAVR. Patient recovery time was improved by shortening mechanical ventilation and reducing blood loss and transfusions. These results may be significant for high-risk patients undergoing aortic valve surgery.
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http://dx.doi.org/10.1177/1556984519868715DOI Listing
October 2019