Publications by authors named "Renato Gregorini"

34 Publications

A rare case of quadrileaflet mitral valve and ostium primum atrial septal defect.

Echocardiography 2021 Mar 28. Epub 2021 Mar 28.

Faculty of Medicine, University of Alexandria, Alexandria, Egypt.

A 60-year-old woman was referred to our clinic for evaluation of her rapidly progressive dyspnea, and she had no previous history of heart disease. A murmur was noted on her examination, and transthoracic echocardiography was so difficult to be performed due to poor acoustic windows so she was referred to do a transesophageal echocardiography that showed an ostium primum atrial septal defect (ASD) with left-to-right shunt and a quadrileaflet mitral valve with severe regurgitation. Later on, she underwent surgery with ostium primum ASD closure by a patch and double cleft repair by suture after right heart catheterization.
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http://dx.doi.org/10.1111/echo.15041DOI Listing
March 2021

Prospective Evaluation of Clinico-Pathological Predictors of Postoperative Atrial Fibrillation: An Ancillary Study From the OPERA Trial.

Circ Arrhythm Electrophysiol 2020 08 12;13(8):e008382. Epub 2020 Jul 12.

Brigham and Women's Hospital, Boston, MA (D.M.).

Background: Postoperative atrial fibrillation (POAF) occurs in 30% to 50% of patients undergoing cardiac surgery and is associated with increased morbidity and mortality. Prospective identification of structural/molecular changes in atrial myocardium that correlate with myocardial injury and precede and predict risk of POAF may identify new molecular pathways and targets for prevention of this common morbid complication.

Methods: Right atrial appendage samples were prospectively collected during cardiac surgery from 239 patients enrolled in the OPERA trial (Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation), fixed in 10% buffered formalin, and embedded in paraffin for histology. We assessed general tissue morphology, cardiomyocyte diameters, myocytolysis (perinuclear myofibril loss), accumulation of perinuclear glycogen, interstitial fibrosis, and myocardial gap junction distribution. We also assayed NT-proBNP (N-terminal pro-B-type natriuretic peptide), hs-cTnT, CRP (C-reactive protein), and circulating oxidative stress biomarkers (F2-isoprostanes, F3-isoprostanes, isofurans) in plasma collected before, during, and 48 hours after surgery. POAF was defined as occurrence of postcardiac surgery atrial fibrillation or flutter of at least 30 seconds duration confirmed by rhythm strip or 12-lead ECG. The follow-up period for all arrhythmias was from surgery until hospital discharge or postoperative day 10.

Results: Thirty-five percent of patients experienced POAF. Compared with the non-POAF group, they were slightly older and more likely to have chronic obstructive pulmonary disease or heart failure. They also had a higher European System for Cardiac Operative Risk Evaluation and more often underwent valve surgery. No differences in left atrial size were observed between patients with POAF and patients without POAF. The extent of atrial interstitial fibrosis, cardiomyocyte myocytolysis, cardiomyocyte diameter, glycogen score or Cx43 distribution at the time of surgery was not significantly associated with incidence of POAF. None of these histopathologic abnormalities were correlated with levels of NT-proBNP, hs-cTnT, CRP, or oxidative stress biomarkers.

Conclusions: In sinus rhythm patients undergoing cardiac surgery, histopathologic changes in the right atrial appendage do not predict POAF. They also do not correlate with biomarkers of cardiac function, inflammation, and oxidative stress. Graphic Abstract: A graphic abstract is available for this article.
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http://dx.doi.org/10.1161/CIRCEP.120.008382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457312PMC
August 2020

Right ventricular assessment can improve prognostic value of Euroscore II.

J Card Surg 2020 Jul 3;35(7):1548-1555. Epub 2020 Jun 3.

Dipartimento dell'Emergenza e Trapianti d'Organo, Sezione di Cardiochirurgia, Università di Bari Aldo Moro. Ospedale Santa Maria, GVM Care & Research, Bari, Italy.

Background: The aim of this multicenter prospective study was to evaluate the prognostic weight of preoperative right ventricular assessment on early mortality in cardiac surgery.

Methods: This is a multicenter prospective observational study performed by the Italian Group of Research for Outcome in Cardiac Surgery (GIROC) including 11 centers. From October 2017 to March 2019, out of 923 patients undergoing cardiac surgery, 28 patients with some missing data were excluded and 895 patients were enrolled in the study right ventricular dilatation was defined as a basal end-diastolic diameter >42 mm. The right ventricle (RV) function was assessed using the combination of three parameters: fractional area changing (FAC), tricuspid annular plane systolic excursion (TAPSE), and S'-wave using tissue Doppler imaging (TDI-S'); RV dysfunction was defined as the presence of at least two of the following cutoffs: FAC <35%, TAPSE <17 mm, and TDI S' <9.5 mm RESULTS: Among the entire cohort, 624 (70%) showed normal RV, 92 (10%) isolated RV dilatation, 154 (17%) isolated RV dysfunction, and 25 (3%) both RV dilatation and dysfunction. Non-surviving patients showed a significantly higher rate of RV alteration at multivariable analysis, RV status was found to be an independent predictor for higher in-hospital mortality beside Euroscore II.

Conclusions: This prospective multicenter observation study shows the importance to assess RV preoperatively and to include both RV function and dimension in a risk score model such as Euroscore II to implement its predictivity, since PH cannot always mirror the status of the right ventricle.
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http://dx.doi.org/10.1111/jocs.14672DOI Listing
July 2020

Aortic valve endocarditis complicated by proximal false aneurysm.

Ann Cardiothorac Surg 2019 Nov;8(6):667-674

Cardiac Surgery, Santa Maria Hospital, Bari, Italy.

Background: Aortic valve endocarditis remains a life-threatening condition, especially in cases of periannular complications. Aorto-ventricular discontinuity associated with proximal false aneurysm represents a severe picture caused by extensive tissue disruption and is usually associated with prosthetic valve infection. Complex surgical repair is required in these cases and continues to be associated with high mortality and morbidity rates.

Methods: We retrieved information for 32 patients undergoing operation for infective aortic valve/prosthetic valve endocarditis complicated by pseudoaneurysm arising from aorto-ventricular discontinuity. Patients were relatively young, mostly male and most of them had a prior cardiac operation. Aortic root replacement with valve graft conduit was performed in all cases; it was associated with other procedures in seven patients: CABG (n=2), MV surgery (n=3), MV surgery + CABG (n=1) and pulmonary valve replacement (n=1). We reported and analysed patient outcomes at early and mid-term follow-up.

Results: Pre-discharge mortality was 22% (n=7). The postoperative course was complicated in 24 (75%) cases. Eighteen patients (56%) sustained low cardiac output resulting in multiple organ failure syndrome and death in five cases. One patient (3%) experienced a major neurologic deficit with a permanent cerebral stroke. Acute kidney injury complicated the course in 12 cases (37%), continuous renal replacement therapy was necessary in four patients (12%). Overall survival and freedom from endocarditis and reoperation at 5-year was 59% and 89%, respectively.

Conclusions: Patients with complicated aortic valve endocarditis presented generally in a poor preoperative state. Surgical treatment poses a non-negligible risk of postoperative mortality and morbidity but provides an acceptable survival rate and a satisfactory recovery at mid-term.
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http://dx.doi.org/10.21037/acs.2019.05.17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892728PMC
November 2019

Current trends in mitral valve surgery: A multicenter national comparison between full-sternotomy and minimally-invasive approach.

Int J Cardiol 2020 05 26;306:147-151. Epub 2019 Nov 26.

Anthea Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari, Italy; Maria Cecilia Hospital, Department of Cardiac Surgery, GVM Care & Research, Cotignola, Italy.

Background: Mitral valve surgery (MVS) is evolving. Compared to standard sternotomy (S-MVS), minimally invasive method (Mini-MVS) has been increasingly adopted in the last years with encouraging results for both repairs and replacements. We evaluated trends of surgical approaches and operative outcomes in a multicenter study involving 10 cardiac surgical centers in Italy.

Methods: Patients who received isolated mitral valve surgery, including only a concomitant tricuspid valve repair, from January 2011 up to December 2017. Minimally invasive approach (right anterior mini-thoracotomy) and standard sternotomy was performed in 2602 and 1947 patients, respectively. Stratifying by surgery, 1493 patients per group were paired using a propensity matching procedure.

Results: The minimally invasive approach has been progressively more frequent over the years (from 27.5% in 2011 to 71.7% in 2017). Compared to S-MVS, Mini-MVS patients were younger with less preoperative comorbidities and less frequently operated for valve replacement or in association with tricuspid repair. The 30-day mortality was lower in the Mini-MVS (overall 1.2% vs 2.7%; p < 0.001) as well as the incidence of most postoperative complications. Subjects paired by propensity score had similar 30-day mortality (1.9% vs 1.8%, p = 0.786) but lower blood transfusion and permanent pace-maker insertion. Cardiopulmonary bypass and cross-clamp time, initially longer in the Mini-MVS patients, became shorter in recent years for the minimally invasive approach.

Conclusions: In a large multi-institutional recent cohort, minimally invasive mitral valve surgery has drastically increased being the preferred technique and appears to be safe with procedural duration shorter than the beginning.
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http://dx.doi.org/10.1016/j.ijcard.2019.11.137DOI Listing
May 2020

Minimally invasive surgical versus transcatheter aortic valve replacement: A multicenter study.

Int J Cardiol Heart Vasc 2019 Jun 28;23:100362. Epub 2019 Apr 28.

Anthea Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari, Italy.

Objectives: Treatment of aortic valve stenosis is evolving, indications for transcatheter approach (TAVI) have increased but also surgical valve replacement has changed with the use of minimally invasive approaches. Comparisons between TAVI and surgery have rarely been done with minimally invasive techniques (mini-SAVR) in the surgical arm. Aim of the present study is to compare mini-SAVR and TAVI in a multicenter recent cohort.

Methods: Evaluated were 2904 patients undergone mini-SAVR (2407) or TAVI (497) in 10 different centers in the period 2011-2016. The Heart Team approved treatment for complex cases. The primary outcome is the incidence of 30-day mortality following mini-SAVR and TAVI. Secondary outcomes are the occurrence of major complications following both procedures. Propensity matched comparisons was performed based on multivariable logistic regression model.

Results: In the overall population TAVI patients had increased surgical risk (median EuroSCORE II 3.3% vs. 1.7%, p ≤ 0.001) and 30-day mortality was higher (1.5% and 2.8% in mini-SAVR and TAVI respectively, p = 0.048). Propensity score identified 386 patients per group with similar baseline profile (median EuroSCORE II ~3.0%). There was no difference in 30-day mortality (3.4% in mini-SAVR and 2.3% in TAVI; p = 0.396) and stroke, surgical patients had more blood transfusion, kidney dysfunction and required longer ICU and hospital length of stay while TAVI patients had more permanent pace maker insertion.

Conclusions: Mini-SAVR and TAVI are both safe and effective to treat aortic stenosis in elderly patients with comorbidities. A joint evaluation by the heart-team is essential to direct patients to the proper approach.
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http://dx.doi.org/10.1016/j.ijcha.2019.100362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487354PMC
June 2019

Sutureless Aortic Valve and Pacemaker Rate: From Surgical Tricks to Clinical Outcomes.

Ann Thorac Surg 2019 07 23;108(1):99-105. Epub 2019 Jan 23.

Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy; Paracelsus Medical University, Nuremberg, Germany.

Background: Several studies reported high rates of postoperative permanent pacemaker (PPM) implantation, which has been described as the "Achilles' heel" of sutureless aortic valve replacement (AVR).

Methods: From July 2010 to December 2017, 3,158 patients with symptomatic, severe aortic valve stenosis were referred to the Department of Cardiac Surgery (Klinikum Nürnberg - Paraclesus Medical University, Nuremberg, Germany), and 512 received a Perceval sutureless bioprosthesis (LivaNova PLC, London, United Kingdom). Thirty-nine patients who had been discharged with concomitant PPM implantation were reevaluated.

Results: After a cumulative follow-up of 1,534 months (100% complete, median 50 months, interquartile range 30 months, maximum 76 months, minimum 3 months), a total of 22 patients were still pacemaker dependent. Kaplan-Meier analysis showed pacemaker-dependent rhythm in 92.0%, 80.0%, 49.4%, and 32.3% of patients at 1, 2, 4, and 5 years, respectively. At Cox regression analysis, pressure during valve deployment (hazard ratio, 79.41; p = 0.0003) and "late-onset" atrioventricular block were found to be independent predictors of sinus rhythm restoration (hazard ratio, 0.16; p = 0.0061). Log-rank test showed significantly lower pacemaker dependency rates in patients with "low-pressure" prosthesis implantation (p < 0.0001).

Conclusions: This study shows that several technical measures, including appropriate annulus decalcification, precise positioning of guiding sutures, release of traction sutures applied to the valve commissures, and ballooning with reduced pressure, all reduce the rate of PPM implantation after sutureless AVR. Furthermore, a high proportion of patients were found to be no longer pacemaker dependent at follow-up.
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http://dx.doi.org/10.1016/j.athoracsur.2018.12.037DOI Listing
July 2019

Aortic valve therapies: Different approaches and outcomes.

J Thorac Cardiovasc Surg 2018 12;156(6):2135

Città di Lecce Hospital-GVM Care & Research, Lecce, Italy.

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http://dx.doi.org/10.1016/j.jtcvs.2018.06.087DOI Listing
December 2018

Comparison of Unmatched Pairs and Possible Impact on Result Interpretation.

Ann Thorac Surg 2018 07;106(1):311-312

Department of Cardiac Surgery, University Hospital of Münster, Münster, Germany.

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http://dx.doi.org/10.1016/j.athoracsur.2017.11.017DOI Listing
July 2018

Is There Still Room for the Prophylactic Use of Levosimendan in Cardiac Surgery?

Ann Thorac Surg 2018 11 5;106(5):1590. Epub 2018 Jun 5.

Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Strada per Arnesano Km 4, 73100 Lecce, Italy; Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany. Electronic address:

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http://dx.doi.org/10.1016/j.athoracsur.2018.05.007DOI Listing
November 2018

"Transcatheter aortic valve implantation for everyone": Yes, of course, but how much is that?

J Thorac Cardiovasc Surg 2018 06;155(6):2425

Heart Center, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy.

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http://dx.doi.org/10.1016/j.jtcvs.2018.02.006DOI Listing
June 2018

Does surgical ventricular restoration still represent a valuable option in the surgeon's armamentarium in the post-STICH era?

J Cardiovasc Surg (Torino) 2018 Jun 9;59(3):305-306. Epub 2018 Jan 9.

Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy.

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http://dx.doi.org/10.23736/S0021-9509.18.10343-0DOI Listing
June 2018

Sutureless aortic valve replacement vs. transcatheter aortic valve implantation: a review of a single center experience.

Minerva Cardioangiol 2018 04 31;66(2):160-162. Epub 2017 Oct 31.

Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.

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http://dx.doi.org/10.23736/S0026-4725.17.04549-2DOI Listing
April 2018

Early outcomes in re-do operation after acute type A aortic dissection: results from the multicenter REAAD database.

Heart Vessels 2017 May 21;32(5):566-573. Epub 2016 Oct 21.

Department of Cardiac Surgery, San Martino University Hospital, University of Genova, Genoa, Italy.

This study provides early results of re-operations after the prior surgical treatment of acute type A aortic dissection (AAD) and identifies risk factors for mortality. Between May 2003 and January 2014, 117 aortic re-operations after an initial operation for AAD (a mean time from the first procedure was 3.98 years, with a range of 0.1-20.87 years) were performed in 110 patients (a mean age of 59.8 ± 12.6 years) in seven European institutions. The re-operation was indicated due to a proximal aortic pathology in ninety cases: twenty aortic root aneurysms, seventeen root re-dissections, twenty-seven aortic valve insufficiencies and twenty-six proximal anastomotic pseudoaneurysms. In fifty-eight cases, repetitive surgical treatment was subscripted because of distal aortic pathology: eighteen arch re-dissections, fifteen arch dilation and twenty-five anastomotic pseudoaneurysms. Surgical procedures comprised a total of seventy-one isolated proximals, thirty-one isolated distals and fifteen combined interventions. In-hospital mortality was 19.6 % (twenty-three patients); 11.1 % in patients with elective/urgent indication and 66.6 % in emergency cases. Mortality rates for isolated proximal, distal and combined operations regardless of the emergency setting were 14.1 % (10 pts.), 25.8 % (8 pts.) and 33.3 % (5 pts.), respectively. The causes of death were cardiac in eight, neurological in three, MOF in five, sepsis in two, bleeding in three and lung failure in two patients. A multivariate logistic regression analysis revealed that risk factors for mortality included previous distal procedure (p = 0.04), new distal procedure (p = 0.018) and emergency operation (p < 0.001). New proximal procedures were not found to be risk factors for early mortality (p = 0.15). This multicenter experience shows that the outcome of REAAD is highly dependent on the localization and extension of aortic pathology and the need for emergency treatment. Surgery in an emergency setting and distal re-do operations after previous AAD remain a surgical challenge, while proximal aortic re-operations show a lower mortality rate. Foresighted decision-making is needed in cases of AAD repair, as the results are essential preconditions for further surgical interventions.
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http://dx.doi.org/10.1007/s00380-016-0907-xDOI Listing
May 2017

Surgery of the Ascending Aorta with or without Combined Procedures through an Upper Ministernotomy: Outcomes of a Series of More Than 100 Patients.

Ann Thorac Cardiovasc Surg 2016 13;22(1):44-8. Epub 2015 Nov 13.

Cardiac Surgery Unit, Cardiovascular Department, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy.

Background: Use of a minimally invasive approach for isolated aortic valve surgery is increasing. However, management of the root and/or ascending aorta through a mini-invasive incision is not so frequent. The aim of this study is to report our initial experience with surgery of the ascending aorta through a ministernotomy approach.

Methods: We retrospectively analyzed 102 patients treated for ascending aorta disease through a ministernotomy. Several types of surgeries were performed, including isolated or combined surgical procedures. Pre-operative and operative parameters and in-hospital clinical outcomes were retrospectively analyzed.

Results: Patient mean age was 63.9 ± 13.6 years (range 29-85). There were 33 (32.4%) female and 69 (67.6%) male patients. Preoperative logistic EuroSCORE I was 7.4% ± 2.1%. Mean cardiopulmonary bypass and aortic cross-clamp time were 123.7 ± 36.9 and 100.8 ± 27.5 min, respectively. In-hospital mortality was 0%.

Conclusions: Our experience shows that surgery of the ascending aorta with or without combined procedures can be safely performed through an upper ministernotomy, without compromising surgical results. Although our series is not large, we believe that the experience gained on the isolated aortic valve through a ministernotomy can be safely reproduced in ascending aorta surgery as a routine practice.
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http://dx.doi.org/10.5761/atcs.oa.15-00245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981780PMC
December 2016

Development and results of Puglia adult cardiac surgery registry.

J Cardiovasc Med (Hagerstown) 2014 Nov;15(11):810-6

aDivision of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro bPuglia Health Regional Agency cDepartment of Cardiac Surgery, Villa Bianca Hospital dDepartment of Cardiac Surgery, Santa Maria Hospital, Bari eDepartment of Cardiac Surgery, Villa Verde Hospital, Taranto fDepartment of Cardiac Surgery, Città di Lecce Hospital gDepartment of Cardiac Surgery, Vito Fazzi Hospital, Lecce hDepartment of Cardiac Surgery, Anthea Hospital iDivision of Anesthesia, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.

Aims: To evaluate the feasibility of a cardiac surgery registry and to describe patients' characteristics, type of procedures performed, incidence of postoperative complications with short and middle-term mortality.

Methods: A database with clinical information and details on cardiac surgical operations was implemented by Puglia Health Regional Agency to collect data of each cardiac surgery procedure performed in the seven adult cardiac surgery centres of the region. Health regional agency personnel guaranteed data accuracy and quality control procedures. Mortality after the discharge was evaluated for residents in Puglia by linking clinical data to the Health Information System.

Results: From January 2011 to December 2012, 6429 operations were performed. All operations were included in the registry with very high completeness of collected data (95.3% per patient). The majority of the operations performed were coronary artery bypass graft alone (41.1%), valve surgery alone (26.2%), coronary artery bypass graft and valve surgery (11.4%), or valve with other surgery (11.8%). During a median follow-up of 12 months (interquartile range 6-18 months), 211 deaths were detected after the discharge. Overall, cumulative mortality from the operation was 8.2% at 6 months and 9.5% at 12 months.

Conclusion: Implementation of a regional clinical registry of cardiac surgery is feasible with a great level of accuracy and the evaluation of mid-term mortality overcomes the limited value of hospital mortality. An accurate cardiac surgery registry elicits epidemiologic evaluations, comparisons between expected and observed mortality, incidence of postoperative complications and encourages a reliable public reporting.
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http://dx.doi.org/10.2459/JCM.0000000000000115DOI Listing
November 2014

Risk stratification for in-hospital mortality after cardiac surgery: external validation of EuroSCORE II in a prospective regional registry.

Eur J Cardiothorac Surg 2014 Nov 30;46(5):840-8. Epub 2014 Jan 30.

Division of Anesthesia, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.

Objectives: To evaluate performance of the European System for Cardiac Operation Risk Evaluation (EuroSCORE II), to assess the influence of model updating and to derive a hierarchical tree for modelling the relationship between EuroSCORE II risk factors and hospital mortality after cardiac surgery in a large prospective contemporary cohort of consecutive adult patients.

Methods: Data on consecutive patients, who underwent on-pump cardiac surgery or off-pump coronary artery bypass graft intervention, were retrieved from Puglia Adult Cardiac Surgery Registry. Discrimination, calibration, re-estimation of EuroSCORE II coefficients and hierarchical tree analysis of risk factors were assessed.

Results: Out 6293 procedures, 6191 (98.4%) had complete data for EuroSCORE II assessment with a hospital mortality rate of 4.85% and EuroSCORE II of 4.40 ± 7.04%. The area under the receiver operator characteristic curve (0.830) showed good discriminative ability of EuroSCORE II in distinguishing patients who died and those who survived. Calibration of EuroSCORE II was preserved with lower predicted than observed risk in the highest EuroSCORE II deciles. At logistic regression analysis, the complete revision of the model had most of re-estimated regression coefficients not statistically different from those in the original EuroSCORE II model. When missing values were replaced with the mean EuroSCORE II value according to urgency and weight of intervention, the risk score confirmed discrimination and calibration obtained over the entire sample. A recursive tree-building algorithm of EuroSCORE II variables identified three large groups (55.1, 17.1 and 18.1% of procedures) with low-to-moderate risk (observed mortality of 1.5, 3.2 and 6.4%) and two groups (3.8 and 5.9% of procedures) at high risk (mortality of 14.6 and 32.2%). Patients with low-to-moderate risk had good agreement between observed events and predicted frequencies by EuroSCORE II, whereas those at greater risk showed an underestimation of expected mortality.

Conclusions: This study demonstrates that EuroSCORE II is a good predictor of hospital mortality after cardiac surgery in an external validation cohort of contemporary patients from a multicentre prospective regional registry. The EuroSCORE II predicts hospital mortality with a slight underestimation in high-risk patients that should be further and better evaluated. The EuroSCORE II variables as a risk tree provides clinicians and surgeons a practical bedside tool for mortality risk stratification of patients at low, intermediate and high risk for hospital mortality after cardiac surgery.
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http://dx.doi.org/10.1093/ejcts/ezt657DOI Listing
November 2014

Hybrid management of acute type A aortic dissection presenting as acute coronary syndrome.

Int J Cardiol 2013 Aug 8;167(4):e85-7. Epub 2013 May 8.

Cardiovascular Department, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy.

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http://dx.doi.org/10.1016/j.ijcard.2013.03.160DOI Listing
August 2013

Aortic valve surgery and an anomalous origin of the intramural right coronary artery from the ascending aorta.

Eur J Cardiothorac Surg 2013 Jun 19;43(6):e199. Epub 2013 Feb 19.

Department of Cardiovascular Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy.

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http://dx.doi.org/10.1093/ejcts/ezt087DOI Listing
June 2013

Freestyle aortic root bioprosthesis is a suitable alternative for aortic root replacement in elderly patients: a propensity score study.

Ann Thorac Surg 2012 Oct 28;94(4):1185-90. Epub 2012 Jun 28.

Department of Cardiac Surgery, Mazzini Hospital, Teramo, Italy.

Background: The aim of this retrospective study was to compare the early and midterm clinical outcomes of aortic root replacement in elderly patients receiving the Freestyle stentless bioprosthesis (FSB) (Medtronic Inc, Minneapolis, MN) with younger patients receiving a mechanical valve conduit.

Methods: From January 2001 to December 2010, 185 consecutive patients underwent aortic root replacement. Of these, 79 (43%) patients received the Freestyle bioroot (Medtronic Inc, Minneapolis, MN) (group F) and 106 (57%) patients received a mechanical valve conduit (group M). Target endpoints were 30-day mortality, 5-year survival, 5-year freedom from cardiac death, and 5-year freedom from major adverse valve-related and cardiovascular events (MAVCE) (cardiac death, cerebrovascular accident, myocardial infarction, heart failure, valve prosthesis dysfunction requiring reoperation, and thromboembolic and hemorrhagic events). A propensity score model was built to adjust the results according to preoperative and operative characteristics of both groups.

Results: Thirty-day mortality was similar in both groups (F group, 2.5% versus M group, 5.7%; p=0.407). Unadjusted analysis showed no differences between groups, whereas adjusted analysis showed a significantly higher 5-year freedom from cardiac death and MAVCE in group F (group F, 98.6±1.9 versus group M, 88.0%±3.0%; p=0.038; group F, 97.4%±2.6% versus group M, 81.2%±3.6%; p=0.010). Multivariate analysis confirmed a significantly higher risk for 5-year MAVCE in patients who did not undergo implantation with the Freestyle bioprosthesis (hazard ratio [HR], 6.87; 95% confidence limit [CL], 1.43-15.09; p=0.016).

Conclusions: In elderly patients, the FSB seems to be as safe as mechanical composite grafts in the perioperative period but results in superior freedom from MAVCE at 5 years postoperatively.
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http://dx.doi.org/10.1016/j.athoracsur.2012.05.015DOI Listing
October 2012

Hybrid one-stage approach to extensive atherosclerotic aneurysm of thoracoabdominal aorta.

Ann Thorac Surg 2011 May;91(5):1599-601

Cardiovascular Department, Città di Lecce Hospital, GVM Hospitals Care and Research Foundation, Lecce, Italy.

We report a 62-year-old man with an atherosclerotic Crawford type II aneurysm involving both common iliac arteries who underwent surgical revascularization of the visceral vessels and renal arteries from the ascending aorta and subsequent endovascular aneurysmal exclusion. Computed tomography imaging at 2 years showed complete exclusion of the aneurysm throughout the thoracoabdominal aorta, confirming the successful antegrade revascularization of visceral vessels and renal arteries. A hybrid approach to thoracoabdominal aneurysms using antegrade visceral and renal revascularization from the ascending aorta before endovascular repair is technically feasible and might constitute an attractive alternative to conventional surgical treatment.
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http://dx.doi.org/10.1016/j.athoracsur.2010.10.026DOI Listing
May 2011

Cardiac hemangioma of the left atrial appendag: a case report and discussion.

J Card Surg 2009 Sep-Oct;24(5):522-3

Department of Cardiac Surgery, G. Mazzini Hospital, Teramo, Italy.

Cardiac hemangioma is an extremely rare, benign vascular tumor of the heart. In contrast to myxoma, hemangioma rarely involves left atrial tissue in adults and little information about the tumor is available. We encountered a 65-year-old woman with a left atrial hemangioma arising in the appendage and growing like an extracardiac mass. The tumor was removed from the left atrium with all the left appendage under cardiopulmonary bypass. Histopathological examination revealed that it was a cavernous-type hemangioma. Among the five described cases, this case was the only one in which the tumor arose from the appendage and grew into the pericardial cavity with resultant paroxystic atrial fibrillation.
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http://dx.doi.org/10.1111/j.1540-8191.2009.00850.xDOI Listing
September 2010

Multiple triangular resection: a reliable technique for correction of multiple prolapse of the mitral valve.

J Cardiovasc Med (Hagerstown) 2009 Oct;10(10):804-5

Department of Cardiac Surgery, Giuseppe Mazzini Hospital, Teramo, Italy.

Quadrangular resection of the posterior leaflet of the mitral valve is a well-established technique for the treatment of mitral regurgitation from prolapse of P2. Recently, Suri described triangular resection of the prolapsing scallop, a technique that, avoiding the plication of the annulus corresponding to the resected leaflet, maintains the geometry of the mitral annulus, allowing a more physiologic function of the mitral valve. In this paper, we report multiple triangular resection for the treatment of multiple prolapse of the posterior leaflet.
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http://dx.doi.org/10.2459/JCM.0b013e32832d55e7DOI Listing
October 2009

Echocardiographic assessment of mitral valve morphology and performance after triangular resection of the prolapsing posterior leaflet for degenerative myxomatous disease.

Interact Cardiovasc Thorac Surg 2009 Aug 4;9(2):287-90. Epub 2009 May 4.

Department of Cardiac Surgery, Giuseppe Mazzini Hospital, Piazzale San Padre Pio, 64100 Teramo, Italy.

The gold standard for the surgical treatment of prolapse of the posterior leaflet of the mitral valve (MV) for degenerative myxomatous disease has been represented by the quadrangular resection of the leaflet, according to the Carpentier technique. Since 2006 we performed a triangular resection of the prolapsing leaflet in 20 patients with myxomatous mitral regurgitation (MR). Seventeen patients (85%) underwent the triangular resection of P2; one patient (5%) had a triple scallops triangular resection (P1, P2, P3) and two (10%) a double scallops (P2, P3) resection. In this study, we report the immediate and mid-term clinical and echocardiographic results of a cohort of 20 patients, who underwent this technique. Thirty-day mortality was 0. Acute renal failure occurred in three patients (15%) and they resolved with conservative management. One patient (5%) required re-exploration for bleeding. At the mean follow-up of 13.1+/-4.2 months survival was 95%; one patient died of lymphoma during the follow-up time. All the cases were in New York Heart Association (NYHA) class I. Nineteen survivors underwent transthoracic echocardiography (TTE) (5), or transesophageal echocardiography (TEE) (13), performed by two skilled cardiologists. All patients showed no or trivial MV regurgitation. We believe that triangular resection of posterior MV leaflet (PMVL) provides excellent mid-term results providing the surgeon with a reliable and reproducible surgical option for myxomatous degenerative MV regurgitation.
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http://dx.doi.org/10.1510/icvts.2009.204776DOI Listing
August 2009

Early and long-term outcome of mitral valve repair with a Cosgrove band combined with coronary revascularization in patients with ischemic cardiomyopathy and moderate-severe mitral regurgitation.

J Heart Valve Dis 2008 Jul;17(4):396-401

Division of Cardiac Surgery, Giuseppe Mazzini Hospital, Teramo, Italy.

Background And Aim Of The Study: Clinical and echocardiographic results were investigated to evaluate mitral valve repair in patients undergoing coronary artery bypass grafting (CABG) for ischemic cardiomyopathy (ICM) with moderately severe mitral regurgitation (MR).

Methods: A total of 78 patients (21 women, 57 men; mean age 69.5 +/- 7.8 years) with ischemic mitral regurgitation underwent mitral valve repair and CABG. The mean left ventricular ejection fraction (LVEF) was 42.4 +/- 12.4%. Among the patients, 19 (24.4%) had preoperative congestive heart failure (CHF). This surgery constituted a second such operation in five patients (6.4%). The MR was grade 3+ in 28 patients (35.9%) and 4+ in 50 (64.1%). The mean number of grafts was 3.6 per patient.

Results: Hospital mortality was 11.5% (n = 9). Risk factors for early mortality were preoperative NYHA class > or = III (p = 0.014), preoperative heart failure (p <0.001) and reoperation (p = 0.002). The five-year survival was 82.6 +/- 5.9%, and freedom from grade > or =2+ MR was 93.1 +/- 4.1%. Postoperatively, 66 patients (89.6%) were in NYHA class I and seven (9.4%) in class II, demonstrating a statistically significant improvement (p = 0.03). Late echocardiography showed a significant improvement in LVEF (from 42.4 +/- 12.4% to 51.7 +/- 10.9%; p = 0.01) and a reduction in pulmonary artery pressure (from 37.6 +/- 11.9 mmHg to 29.3 +/- 7.4 mmHg; p = 0.004).

Conclusion: It is concluded that in patients with ICM, mitral valve repair combined with CABG provides a dramatic improvement in ejection fraction and in CHF, with excellent long-term survival, even in patients with a low LVEF.
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July 2008

Embolization of an Amplatzer atrial septal closure device to the pulmonary artery.

J Card Surg 2008 Mar-Apr;23(2):164-7

Department of Cardiac surgery, G.Mazzini Hospital, Teramo, Italy.

A 44-year-old woman with a history of transient ischemic attack underwent closure of atrial septal defect with a 26 mm Amplatzer device. The device was released without residual shunt or impingement on intracardiac structures. Within seconds, the transesophageal echocardiography showed the initial dislodgement of the device from the atrial septum and its consequent slipping back into the right atrium close to the tricuspid valve. Soon after the device disappeared from the right atrium and it could be founded into the right ventricle under the tricuspid valve. The patient was transferred in the operating room for an emergency operation. The device could not be found in the right ventricle because its downstream migration. The Amplatzer septal occluder was identified by palpation into the pulmonary artery trunk: it was retrieved from the right ventricle through the pulmonary valve and the atrial septal defect was closed by running suture.
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http://dx.doi.org/10.1111/j.1540-8191.2007.00510.xDOI Listing
May 2008

Bilateral axillary artery inflow in the treatment of a rare case of pseudocoarctation of the aortic arch.

Interact Cardiovasc Thorac Surg 2007 Oct 15;6(5):652-3. Epub 2007 Jun 15.

Cardiac Surgery Department, Ospedale Giuseppe Mazzini, Piazzale San Padre Pio, 64100 Teramo, Italy.

The axillary artery is the preferred site for arterial cannulation in operations for ascending aorta and aortic arch replacement in order to reduce perfusion-related morbidity in acute dissection and to prevent cerebral embolism in atherosclerotic aneurysm. We present the case of a patient with a chronic dissection presenting as pseudocoarctation of the aortic arch in which bilateral axillary artery inflow was necessary to perfuse both ascending and descending aorta.
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http://dx.doi.org/10.1510/icvts.2007.158097DOI Listing
October 2007

Cavoatrial tumor thrombectomy with systemic circulatory arrest and antegrade cerebral perfusion.

Ann Thorac Surg 2007 Apr;83(4):1564-5

Department of Cardiac Surgery, Giuseppe Mazzini Hospital, Teramo, Italy.

Renal carcinoma extending into the inferior vena cava can be excised with a good early-term and long-term prognosis. Cardiopulmonary bypass and deep hypothermic circulatory arrest are used to resect intracardiac extension of the tumor. We propose antegrade selective cerebral and cardiac perfusion associated with systemic circulatory arrest to protect the brain and the abdominal viscera while obtaining a bloodless surgical field for tumor thrombus removal.
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http://dx.doi.org/10.1016/j.athoracsur.2006.04.028DOI Listing
April 2007

Limitations and discrepancies of transthoracic and transoesophageal echocardiography compared with surgical findings in patients submitted to surgery for complications of infective endocarditis.

J Cardiovasc Med (Hagerstown) 2006 Sep;7(9):660-6

Division of Cardiology, Civic Hospital, Castiglione delle Stiviere (MN), Italy.

Objective: Transoesophageal echocardiography (TEE) is recognized to be superior to transthoracic echocardiography (TTE) in evaluating complications of infective endocarditis (IE). The aim of this study was to compare results from TTE and TEE with surgical findings, and to assess limitations and discrepancies of TEE as compared with surgical findings.

Methods: A retrospective analysis was carried out in 63 consecutive patients undergoing surgical intervention for IE-related complications. All patients were submitted to TTE and TEE before surgery. Clinical, anaesthesiological and surgical data were reviewed for all patients as well as the TTE and TEE examinations recorded on S-VHS videotape. Patients were divided into two groups according to the time elapsed from TEE to surgery (> 72 h in group A and < 72 h in group B).

Results: The study population included 44 patients with native valve endocarditis and 19 patients with prosthetic valve endocarditis for a total of 76 affected valves (54 native and 22 prosthetic valves). No significant differences were observed between groups in number of patients (31 vs. 32; P = NS), of native valves (29 vs. 27; P = NS), and of prosthetic valves (10 vs. 12; P = NS). Discrepancies between TEE and surgical findings were found in 14 cases (11/31 in group A vs. 3/32 in group B; P = 0.01).

Conclusions: Time between TEE and surgery seems to be an important factor affecting comparison. Lesion characteristics appear to be more precise and concordant with surgical findings the shorter the time elapsed from TEE to surgery. Changes resulting from disease progression require repeat TEE evaluation prior to surgical intervention for IE-related complications. This could be useful in providing the surgeon with a more accurate definition of valvular lesions for optimal planning of intervention.
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http://dx.doi.org/10.2459/01.JCM.0000242998.74923.4dDOI Listing
September 2006

Effective method to control catastrophic hemorrhage during redo sternotomy.

Ital Heart J 2005 Dec;6(12):984-6

Department of Cardiac Surgery, G. Mazzini Hospital, Teramo, Italy.

Redo sternotomy is a challenging surgical procedure performed with increasing frequency; catastrophic hemorrhage is a rare but highly lethal complication. We report our experience in treating this complication in 3 cases of 307 reoperations and propose a simple method to control catastrophic hemorrhage during sternal reentry.
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December 2005