Risk Factors for Higher Postoperative Myocardial Injury in Minimally Invasive Mitral Valve Surgery Patients: A Cohort Study.

: Postoperative myocardial injury, as detected by an elevated concentration of high-sensitivity cardiac troponin I (hs-cTnI), is a common complication in cardiac surgery that may be linked to mortality. The primary aim of this study was to assess the risk factors associated with increased myocardial injury in patients undergoing minimally invasive mitral valve surgery. : In this retrospective monocentric cohort study, we analyzed all patients who underwent elective minimally invasive mitral valve surgery between January 2019 and December 2022 and were subsequently admitted to our intensive care unit.

Robotic-Assisted Epicardial Hybrid Ablation and Left Appendage Closure in Persistent Atrial Fibrillation: First European Experience.

Pulmonary vein isolation is currently considered to be the gold standard for ablating paroxysmal atrial fibrillation. However, its efficacy is limited in patients with persistent atrial fibrillation. The convergent procedure has emerged as a hybrid ablation.

Comparative myocardial protection of endoaortic balloon versus external clamp in minimally invasive mitral valve surgery.

Aims: Minimally invasive mitral valve surgery leads to shorter postoperative recovery time, cosmetic advantages and significant pain reduction compared with the standard sternotomy approach. Both an external aortic clamp and an endoaortic balloon occlusion can be used to manage the ascending aorta and the myocardial protection. In this study, we aimed to compare these two strategies in terms of effectiveness of myocardial protection and associated early postoperative outcomes.

Evaluation of robotic-assisted mitral surgery in a contemporary experience.

Aims: To evaluate the safety/effectiveness of a recently established robotic-assisted mitral surgery program.

Methods: Cohort study with prospective collection of clinical data of 59 consecutive recipients (May 2019-August 2021) of robotic-assisted (fourth-generation platform, DaVinci X) mitral valve repair for degenerative disease, using a totally endoscopic technique. Patients' selection was based on defined anatomical and clinical criteria.

Less invasive aortic valve replacement using the trifecta bioprosthesis.

. The safety and effectiveness of the Trifecta GT bioprosthesis (introduced in 2016) in less invasive aortic valve replacement are scarcely investigated. Our aim was to evaluate the immediate and initial follow-up results of this device in the context of less invasive surgery.

[Towards the age of computer-assisted surgery: how to establish a robotic-assisted mitral surgery program with a last-generation platform].

Mitral valve therapy is rapidly evolving. In this context, there is a clear evolution towards the diffusion of minimally invasive techniques for surgical mitral valve replacement or repair, namely in the context of primary mitral regurgitation. The robotic-assisted mitral surgery strategy allows the greatest reduction in surgical trauma to the patients, as well as improved ergonomics and video-assistance for performance of the mitral procedure.

A multicentre roadmap to restart elective cardiac surgery after COVID-19 peak in an Italian epicenter.

Background: During the Italian Phase-2 of the coronavirus pandemic, it was possible to restart elective surgeries. Because hospitals were still burdened with coronavirus disease 2019 (COVID-19) patients, it was focal to design a separate "clean path" for the surgical candidates and determine the possible effects of major surgery on previously infected patients.

Methods: From May to July 2020 (postpandemic peak), 259 consecutive patients were scheduled for elective cardiac surgery in three different centers.

[ANMCO/GISE/SICCH Inter-Society Consensus Document: Antithrombotic therapy after surgery or structural interventional procedures for valvular heart diseases: how to treat postoperative complications].

Continuous improvement of technologies, devices and drugs needs a renewal and update of current recommendations and guidelines on antithrombotic strategies, especially in those fields where literature lacks of established scientific evidences. Accordingly, the aim of this consensus statement is to provide support for antithrombotic therapy based on current guidelines and the most recent scientific evidences.After an overview on the currently available devices, the appropriate therapy according to type of procedure and implanted device is discussed.

Strategy-specific durability of mitral valve repair through the video-assisted right minithoracotomy approach.

Aims: We sought to analyze the early and follow-up results of minimally invasive video-assisted mitral valve repair. With particular focus on degenerative disease, results were stratified according to type of lesion, strategy of repair and surgical technique.

Methods: We retrospectively built a database over 241 patients who received mitral repair for severe regurgitation through right minithoracotomy in the 2009-17 period.

Consensus Document of the Italian Association of Hospital Cardiologists (ANMCO), Italian Society of Cardiology (SIC), Italian Association of Interventional Cardiology (SICI-GISE) and Italian Society of Cardiac Surgery (SICCH): clinical approach to pharmacologic pre-treatment for patients undergoing myocardial revascularization procedures.

The wide availability of effective drugs in reducing cardiovascular events together with the use of myocardial revascularization has greatly improved the prognosis of patients with coronary artery disease. The combination of antithrombotic drugs to be administered before the knowledge of the coronary anatomy and before the consequent therapeutic strategies, can allow to anticipate optimal treatment, but can also expose the patients at risk of bleeding that, especially in acute coronary syndromes, can significantly weigh on their prognosis, even more than the expected theoretical benefit. In non ST-elevation acute coronary syndromes patients in particular, we propose a 'selective pre-treatment' with P2Y inhibitors, based on the ischaemic risk, on the bleeding risk and on the time scheduled for the execution of coronary angiography.

[ANMCO/SIC/SICI-GISE/SICCH Consensus document: Clinical approach to pharmacological pretreatment for patients undergoing myocardial revascularization].

The wide availability of drugs effective in reducing cardiovascular events and the use of myocardial revascularization have greatly improved the prognosis of patients with coronary artery disease. However, the combination of antithrombotic drugs to be administered before the exact knowledge of the coronary anatomy and before the consequent therapeutic strategy can, on one hand, allow to anticipate an optimal treatment but, on the other hand, may expose the patient to a bleeding risk not always necessary. In patients with ST-elevation acute coronary syndrome with an indication to primary angioplasty, the administration of unfractionated heparin and aspirin is considered the pre-procedural standard treatment.

[Acute results of left ventricular endocardial pacing for cardiac resynchronization therapy obtained with a transapical approach].

Although cardiac resynchronization therapy (CRT) is considered a milestone in the treatment of patients affected with chronic congestive heart failure, reduced left ventricular ejection fraction and enlarged QRS, up to 30% of patients can be considered clinical non-responders to this treatment. In these patients, optimization of atrioventricular and interventricular intervals could be of some help, but results of trials are not univocal on the benefit of this procedure. In the last years, left ventricular endocardial pacing for CRT has emerged as a possible solution in non-responders.

Reconstruction of two independent neo-atria after resection of recurrent leiomyosarcoma.

We describe a case of a patient with recurrent leiomyosarcoma involving both atria after a previous right pneumonectomy. The patient was treated with wide resection of the mass and separate reconstruction of the cardiac cavities with prosthetic material.

Atorvastatin attenuates post-implant tissue degeneration of cardiac prosthetic valve bovine pericardial tissue in a subcutaneous animal model.

Aims: The aim of our study was to examine the effects of statin therapy (atorvastatin) on post-implant structural changes of bovine pericardial tissue in a subcutaneous animal model.

Methods And Results: Sixty male C57BL/6 mice underwent subcutaneous dorsal implantation of bovine pericardial fragments. Animals were randomized to treatment with atorvastatin (50 mg/kg) (statin group - SG) or to vehicle (control group - CG).

Mitral valve periprosthetic leakage: Anatomical observations in 135 patients from a multicentre study.

Objective: Prosthetic valve dysfunction after mitral valve replacement (MVR) may be caused by several factors, which often lead to repeated surgery. One of the most frequent determinants of reoperation is periprosthetic leakage (PPL). A few published reports have analysed PPL incidence and postoperative results after MVR, but no specific attention has been paid towards the potential relation between anatomical factors and PPL occurrence, particularly not bacterial-related.

In vitro assessment of the vacuum-assisted venous drainage (VAVD) system: risks and benefits.

The vacuum-assisted venous drainage (VAVD) technique has been introduced with the utilization of small-bore venous cannulae to facilitate minimally invasive cardiac surgery and it has found widespread use for traditional surgical approaches. Although this technique was devised to increase venous return, it may cause a reduction of blood flow through a negative pressure effect on the raceway tubing. In this study, the potential of this system to increase the venous drainage was evaluated in vitro together with the measurements of delivered blood flow.

[The early angiographic follow-up of myocardial revascularization in a minithoracotomy: the results of the first 100 consecutive cases].

The use of the left internal thoracic artery anastomized to the left anterior descending coronary artery via a small left thoracotomy to revascularize the anterior wall of the left ventricle has gained wide acceptance since its introduction into clinical practice a few years ago. A mandatory, postoperative angiographic control was suggested in order to check the surgical results of this new method of revascularization. We herein analyze the results of the in-hospital angiographic control of a series of 100 consecutive patients who underwent minimally invasive coronary artery bypass.

Aprotinin and deep hypothermic circulatory arrest: there are no benefits even when appropriate amounts of heparin are given.

Objective: To evaluate retrospectively the effect of 'high-dose' aprotinin on blood losses, donor blood requirements and morbid events on patients undergoing ascending aorta and/or aortic arch procedures with the employ of deep hypothermic circulatory arrest (HCA).

Methods: During the period 1987-1994, 39 patients underwent a thoracic aorta procedure with the employ of circulatory arrest; of these 18 (46.2%) were operated on during the period 1990-1994 and were given aprotinin intraoperatively following the 'high-dose' protocol (group I), while 21 (53.

[Heart surgery, cardiopulmonary bypass, and organic inflammatory response. Part II: changes in leukocytes, arachidonic acid derivatives, and hormones].

The use of cardiopulmonary bypass for surgical cardiac procedures is characterized by a whole-body inflammatory reaction due to the contact of blood through nonendothelialized surfaces; this stimulates the organism to recognize the cardiopulmonary bypass system as "nonself" and to activate specific (immune) and nonspecific (inflammatory) responses. These responses are then related with postoperative damage to many body systems of the body, like pulmonary, renal or brain dysfunction, excessive bleeding and postoperative sepsis. In this paper, present knowledge on untoward responses of the patient to cardiopulmonary bypass in cardiac surgery is reviewed and discussed, particularly focusing on the perturbation of the leukocytes, of the hormones and of the products of the arachidonic acid cascade.

Acute effects of dynamic cardiomyoplasty on ventricular geometry and left ventricular filling detected by transesophageal doppler echocardiography.

We investigated 7 patients with chronic congestive heart failure undergoing dynamic cardiomyoplasty with intraoperative transesophageal echocardiography. Biventricular wrapping acutely modified right or left ventricular geometry, but did not induce acute restriction to left ventricular filling.

The effect of multiple blood conservation techniques on donor blood exposure in adult coronary and valve surgery performed with a membrane oxygenator: a multivariate analysis on 1310 patients.

The object of the study was to retrospectively evaluate protective and risk factors for receiving donor blood products and red cell transfusions after coronary and valve surgery performed with a hollow-fiber oxygenator and with multiple blood-saving techniques. During the period of January 1991 to June 1993, 1310 patients underwent primary coronary and valve surgery using a hollow-fiber oxygenator at our institution; the mean age of this population was 61 +/- 10 years; 977 patients were men (74.6%).

One month follow-up of haemostatic variables in patients undergoing aortocoronary bypass surgery. Effect of aprotinin.

It is already known that activation of the coagulation and fibrinolytic system occurs in patients undergoing cardiopulmonary bypass (CPB). We have thus studied twenty patients (10 treated with aprotinin during CPB and 10 untreated) both during the intraoperative period and during thirty days follow up. In untreated patients D-dimer levels increased 4-fold during CPB and the levels were above baseline for the whole follow up (p < 0.

Composite valve graft replacement of the ascending aorta and the aortic valve by a modified button technique: the influence of aortic pathology on early mortality and late survival.

The risk factors for in-hospital mortality and mid-term survival in patients undergoing composite graft replacement of the aortic root with reimplant or coronary arteries by a modified button technique were evaluated with special emphasis on the underlying aortic pathology. Between 1985 and 1993 74 patients underwent replacement of the ascending aorta and the aortic valve following a modified button technique. The patients were divided into three groups according to aortic pathology: annuloaortic ectasia (43.