Publications by authors named "Juan Crestanello"
Objective: Giant cell arteritis (GCA) may present as proximal aortic pathology requiring surgical intervention. We present our experience with surgical management of GCA in patients presenting with proximal aortic disease.
Methods: From January 1993 to May 2020, 184 adult patients were diagnosed with GCA on histopathology after undergoing cardiac surgery.
Objectives: Robotic-assisted mitral valve repair (MVr) is a well-established procedure for management of degenerative mitral valve disease. Limited data regarding concomitant robotic-assisted tricuspid valve repair (TVr) is available. This review investigates prevalence and outcomes of concomitant robotic-assisted mitral and tricuspid valve repair.
View Article and Find Full Text PDFObjective: There are limited data on the outcome of routine cardiac operations in patients with cardiac amyloidosis. This study studied the impact of amyloidosis on early and late results of cardiac operations.
Methods: This was a retrospective, propensity-matched, case-control study of patients with cardiac amyloidosis undergoing cardiac surgery.
Background: Aortic regurgitation (AR) is a prevalent valve disease with a long latent period to symptoms. Recent data has suggested the role of novel markers of myocardial overload in assessing onset of decompensation.
Method: We sought to evaluate the role of unsupervised cluster analyses in identifying different clinical clusters, including clinical status, and a large number of echocardiographic variables including left ventricular (LV) volumes, and their association with mortality.
Background: The ideal timing for surgery in asymptomatic chronic aortic regurgitation (AR) remains unclear. New thresholds for left ventricular ejection fraction (LVEF), left ventricular (LV) indexed end-systolic volume (iESV), and global longitudinal strain (GLS) have been associated with mortality in these patients. These represent markers of early LV dysfunction.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates how the timing of coronary artery bypass grafting (CABG) after an acute heart attack affects patient outcomes, focusing on both early and long-term mortality rates.
- Researchers analyzed data from 1,631 patients who had CABG, categorizing them based on whether surgery was performed within 24 hours, between 1 to 7 days, or more than 7 days post-heart attack.
- Results showed that while early mortality rates were similar across timing groups, those who had CABG more than 7 days after an attack faced significantly higher risks of late mortality, particularly in patients with non-ST-segment elevation myocardial infarction.
Background And Aims: Severe tricuspid regurgitation is associated with increased mortality rates, but benefit of its correction and ideal timing are not clearly determined. This study aimed to identify patient subsets who might benefit from the surgery.
Methods: In TRIGISTRY, an international cohort study of consecutive patients with severe isolated functional tricuspid regurgitation (33 centres, 10 countries), survival rates up to 10 years were compared between patients who underwent isolated tricuspid valve surgery (repair or replacement) and those conservatively managed, overall and according to TRI-SCORE category (low: ≤3, intermediate: 4-5, and high: ≥6).
Article Synopsis
- The study examines the occurrence of cardiac myxomas in patients with Carney complex (CNC) over a time span from 1970 to 2023, identifying 38 patients in total.
- Out of these, 24 patients (63.1%) developed cardiac myxomas, with a median onset age of 39 years, and more than half (54.1%) experienced recurrences post-surgery.
- The findings highlight the importance of regular echocardiogram monitoring for CNC patients, as surgical removal is crucial for managing these myxomas effectively.
Article Synopsis
- Limited data exist regarding the effects of cardiac surgery on pregnant individuals and their fetuses, prompting a study reviewing cases from 1978 to 2023.
- The study analyzed 29 pregnant patients undergoing cardiac surgery, revealing a maternal death rate of 3% and a fetal loss rate of 17%, with higher mortality in those undergoing surgery later in pregnancy.
- The findings suggest that cesarean delivery before surgery may help reduce fetal mortality if the fetus is viable, highlighting the need for careful planning in such cases.
Article Synopsis
- Recent advances in understanding pericardial diseases and the use of multimodal imaging have significantly improved the diagnosis and treatment approaches.
- Pericardiectomy is advised for serious cases like chronic constrictive pericarditis and requires a team of specialists for the best patient outcomes.
- Performing radical pericardiectomy at high-volume medical centers with skilled staff enhances the likelihood of a successful surgery and recovery.
Article Synopsis
- The study analyzed over 148,000 coronary artery bypass grafting (CABG) cases to assess risks associated with clopidogrel (a blood thinner) taken within 5 days prior to surgery.
- It found that patients who had used clopidogrel had slightly higher operative mortality and significantly higher rates of mediastinal reexploration for bleeding and blood product use compared to those who hadn't taken the drug.
- The risks decreased the longer the wait after stopping clopidogrel, reaching similar outcomes for surgeries performed 3 days after the last dose compared to 5 days, suggesting 3 days may be a sufficient waiting period before CABG.
Article Synopsis
- Patients with congenital heart disease often require reoperative surgeries, especially for valve issues, and a study tracked 1960 adult patients undergoing repeat surgeries from 1993 to 2022 to analyze outcomes.* -
- Among the 502 patients studied, most underwent surgeries involving multiple valves, with low early mortality rates of 4.2%, particularly for elective operations.* -
- Key factors influencing mortality included patient age, heart function, and the urgency of the surgery, indicating that timely referrals can improve surgical outcomes.*
Objective: The selection of valve prostheses for patients undergoing surgical aortic valve replacement remains controversial. In this study, we compared the long-term outcomes of patients undergoing aortic valve replacement with biological or mechanical aortic valve prostheses.
Methods: We evaluated late results among 5762 patients aged 45 to 74 years who underwent biological or mechanical aortic valve replacement with or without concomitant coronary artery bypass from 1989 to 2019 at 4 medical centers.
Article Synopsis
- - The study aimed to explore the occurrence of restricted cusp motion (RCM) during bioprosthetic tricuspid valve replacement (TVR) and its risk factors and effects on patient outcomes.
- - Out of 476 patients analyzed from 2012 to 2022, 31.5% exhibited RCM, with 13.2% having complete immobility and 18.3% showing limited movement of the valve cusp.
- - The research found that certain factors, like the type of valve used and patient-specific measurements, significantly influenced the likelihood of RCM, which was linked to a higher mortality risk, highlighting the importance of careful prosthesis selection.
Article Synopsis
- - This study reviews patients who had tricuspid valve (TV) repair during surgery for degenerative mitral valve (MV) disease, focusing on the need for permanent pacemaker (PPM) implantation after the procedure across 404 cases from 2001 to 2022.
- - The findings revealed that 8.7% of patients required PPM implantation post-surgery, primarily due to high-degree AV block, with older age identified as a significant risk factor for this complication.
- - The conclusions suggest that while PPM needs are relatively common after TV repair during MV surgery, careful patient selection and surgical techniques might help to lower the associated risks and improve patient outcomes.
Background: Limited data exist on the long-term outcomes of transcatheter aortic valve insertion (TAVI) in nonagenarian patients. This study investigated the relationship between patient baseline comorbidity and frailty on the long-term outcome of the nonagenarian population.
Methods: A retrospective analysis was conducted of 187 consecutive nonagenarian patients who underwent TAVI from 2009 to 2020.
Article Synopsis
- Limited data on the outcomes of delayed sternal closure (DSC) in adults with congenital heart disease have been gathered from a review of 159 patients over 30 years.
- Among the 112 patients undergoing DSC, those closed within 4 days had lower early mortality (6.8%) compared to those closed after 4 days (32%), and higher ages and specific medical conditions were linked to worse outcomes.
- Despite the risks, hospital survivors showed no significant difference in late survival between those with brief DSC (≤4 days) and prolonged DSC (>4 days), indicating that a shorter DSC duration may lead to better initial outcomes.
Background: Transthoracic aortic cross-clamp and endoaortic balloon occlusion have both been shown to have comparable safety profiles for aortic occlusion. Because most surgeons use only one technique, we sought to compare the outcomes when a homogeneous group of surgeons changed their occlusion technique from aortic cross-clamp to balloon occlusion.
Methods: We changed our technique from aortic cross-clamp to balloon occlusion in November 2022.
Article Synopsis
- Volume overload from mitral regurgitation can lead to left ventricular (LV) dysfunction, making timely surgical intervention crucial, though the best timing is still debated.
- A study analyzed data from 243 patients who underwent mitral valve repair, comparing predictors of post-operative LV systolic dysfunction using both CT-based and 2D echocardiographic methods.
- Results showed that CT measurements of ejection fraction and LV end systolic volume were more effective predictors of post-operative dysfunction compared to echocardiographic measures, pointing to the potential superiority of CT in this context.
Article Synopsis
- Previous studies on enhanced recovery after surgery (ERAS) protocols in cardiac surgery showed positive outcomes, but comprehensive data from randomized studies were lacking, prompting this analysis of randomized controlled trials (RCTs) comparing ERAS-like protocols to standard care.* -
- The meta-analysis included 13 RCTs with 1,704 participants, finding no significant difference in in-hospital mortality between ERAS and standard groups, but ERAS was linked to shorter ICU and hospital stays and lower overall complication rates, particularly stroke.* -
- The results indicate that while ERAS-like protocols do not affect short-term survival, they facilitate quicker recovery and discharge from the hospital while potentially reducing complications.*
Background: Acute ischemic stroke complicates 2% to 3% of transcatheter aortic valve replacements (TAVRs). This study aimed to identify the aortic anatomic correlates in patients after TAVR stroke.
Methods And Results: This is a single-center, retrospective study of patients who underwent TAVR at the Mayo Clinic between 2012 and 2022.