[Minimally invasive trans-axillary approach and ultra-fast-track management: a new paradigm for mitral valve disease treatment].

Background: The introduction of transcatheter procedures has focused on patient expectations for treatments with a less invasive approach and faster recovery. The aim of this study was to assess the short- and medium-term results in patients who underwent trans-axillary mitral valve repair with application of the ultra-fast-track protocol.

Methods: Data from 431 patients undergoing isolated trans-axillary mitral valve repair or associated with tricuspid valve treatment between January 2018 and December 2023 were prospectively collected.

Impact of preoperative computed tomography scan on neurological outcomes in coronary artery bypass grafting patients: A propensity-score analysis.

Introduction: Neurological complications pose significant risks in coronary artery bypass grafting (CABG). This study explores the potential benefits of preoperative chest computed tomography (CT) in optimizing outcomes and reducing neurological events in high-risk CABG patients.

Methods: From January 2017 to June 2023, a retrospective cohort study of CABG patients categorized groups based on preoperative chest CT use.

Marfan and Loeys-Dietz aortic phenotype: A potential tool for diagnosis and management.

Objective: In heritable aortic diseases, different vascular involvement may occur with potential variable implications in aortic dilation/dissection risk. This study aimed to analyze the aortic anatomy of individuals with Marfan syndrome and Loeys-Dietz syndrome to identify possible morphological differences.

Methods: Computed tomography and magnetic resonance imaging of the thoracoabdominal aorta from the proximal supra-aortic vessels to the femoral bifurcation level of 114 patients with Marfan and Loeys-Dietz syndromes and 20 matched control subjects were examined.

Frozen elephant use in type a dissection: fundamentals, innovations, and pitfalls.

Introduction: Type A acute aortic dissection (TA-AAD) is a great challenge for aortic surgeons. The establishment of a standardized surgical approach, particularly the determination of whether and when to address the aortic arch and the distal aorta in the same operation as the proximal aorta, is still unclear.

Areas Covered: Frozen elephant trunk (FET) has emerged as a valuable treatment for TA-AAD over the last decade.

The Enhanced Recovery after Surgery Approach in Heart Valve Surgery: A Systematic Review of Clinical Studies.

Enhanced recovery after surgery (ERAS) protocols aim to reduce postoperative complications and promote earlier recovery. Although it is well established in noncardiac surgery fields, the ERAS approach has only recently been adopted in cardiac surgery. The aim of this review is to evaluate the status and implementation of ERAS protocols in patients undergoing heart valve surgery and to summarise associated clinical results.

Minimally Invasive Trans-Axillary versus Full Sternotomy Mitral Valve Repair: A Propensity Score-Matched Analysis on Mid-Term Outcomes.

: Minimally invasive cardiac surgery is an established approach for the treatment of heart valve pathologies and is associated with excellent technical and early postoperative outcomes. Data from medium- and long-term longitudinal evaluation of patients who underwent mitral valve repair (MVr) through transaxillary approach (TAxA) are still lacking. The aim of this study is to investigate mid-term results in patients who underwent TAxA MVr.

Normothermic frozen elephant trunk without circulatory arrest.

Unlabelled: We describe our technique for total aortic arch replacement with stenting of the descending thoracic aorta allowing normothermic cardiopulmonary bypass and avoiding hypothermic circulatory arrest.

Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-023-01536-1.

Improved Early Outcomes in Women Undergoing Aortic Valve Interventions.

Surgical aortic valve replacement (SAVR) in female patients has been associated with higher mortality (up to 3.3-8.9%) and postoperative complication rates when compared with their male counterparts.

del Nido versus blood cardioplegia in adult cardiac surgery: a meta-analysis.

Aims: Initially developed for myocardial protection in immature cardiomyocytes, del Nido cardioplegia has been increasingly used over the past decade in adult patients. Our aim is to analyse the results from randomized controlled trials and observational studies comparing early mortality and postoperative troponin release in patients who underwent cardiac surgery using del Nido solution and blood cardioplegia.

Methods: A literature search was performed through three online databases between January 2010 and August 2022.

Results and insights after 413 TAVI procedures performed by cardiac surgeons on their own.

Objectives: Current evidence on transcatheter aortic valve implantation (TAVI) has been generated exclusively by cardiology studies and no operative data from cardiac surgeons are available. Here, we describe the development of our TAVI programme and report the results of transfemoral (TF) TAVI done by cardiac surgeons on their own.

Methods: This study included all the TAVI procedures on native valve performed at Cardiac Surgery Unit, Ospedali Riuniti di Ancona, during the period October 2018 to July 2022.

del Nido and Histidine-Tryptophan-Ketoglutarate cardioplegia in minimally invasive mitral valve surgery: A propensity-Match study.

Introduction: In the last decade, del Nido cardioplegia has been embedded in adult cardiac surgery involving CABG and aortic valve surgical procedures. We reviewed our early experience with del Nido cardioplegia in the setting of minimally invasive mitral valve surgery.

Methods: Data on 120 consecutive patients operated between 03/2021 and 06/2022 were retrieved from our internal database (infective endocarditis and urgent operations were excluded).

Normothermic frozen elephant trunk: our experience and literature review.

Background And Objective: The frozen elephant trunk (FET) technique has undoubtable advantages in treating complex and extensive disease of the aortic arch and the thoracic descending aorta. Despite several improvements in cardiopulmonary bypass conduction and surgical strategy, operative times and the institution of systemic circulatory arrest remain the main determinants of early mortality, cerebral/spinal cord injury and visceral organs dysfunction. We have conducted this review to highlight the recent technical advances in arch and FET surgery aiming at the reduction/avoidance of systemic circulatory arrest, and their impact on early outcomes.

Minimally invasive approach: is this the future of aortic surgery?

Unlabelled: Median sternotomy incision has shown to be a safe and efficacious approach in patients who require thoracic aortic interventions and still represents the gold-standard access. Nevertheless, over the last decade, less invasive techniques have gained wider clinical application in cardiac surgery becoming the first-choice approach to treat heart valve diseases, in experienced centers. The popularization of less invasive techniques coupled with an increased patient demand for less invasive therapies has motivated aortic surgeons to apply minimally invasive approaches to more challenging procedures, such as aortic root replacement and arch repair.

Conduction disorders after aortic valve replacement: what is the real impact of sutureless and rapid deployment valves?

Background: Although sutureless and rapid deployment aortic valve replacement (SURD-AVR) has been associated with an increased rate of permanent pacemaker (PPM) implantation compared to conventional AVR (c-AVR), the predictors of new conduction abnormalities remain to be clarified. This study aimed to identify risk factors for conduction disorders in patients undergoing AVR surgery.

Methods: Data from 243 patients receiving minimally invasive AVR were prospectively collected.

[Transcatheter cerebral embolic protection in open heart surgery: our initial experience in Ancona, Italy].

Background: Neurological events after cardiac surgery or transcatheter aortic valve implantation (TAVI) have a dramatic effect on patients' prognosis. Recent development of transcatheter cerebral protection systems aims to reduce their incidence, even if their use is currently limited to TAVI. Here we report our initial experience with transcatheter cerebral protection devices used in patients at high brain embolic risk undergoing cardiac surgery.

COVID 19- Perspective of an Italian Center.

Italy has been hard hit by severe acute respiratory syndrome coronavirus 2 infection with more than 240,000 cases and 35,000 deaths. During the acute phase of the pandemic, the Italian government decided on the lockdown which lasted about 2 months. During this period, all surgical activities were limited to nondeferable procedures only.

Bioconduit subannular implantation for aortic root endocarditis after previous cardiac surgery: Results from two Italian centers.

Objectives: Infective endocarditis (IE) with extensive peri-annular abscesses and aortic root involvement is a life-threatening disease. Aortic root replacement with a valved conduit is the most common intervention in this setting and represents a serious challenge for the surgeon. In the present two-center study we analyzed early and midterm outcomes of a high-risk series of IE patients undergoing aortic root reconstruction with a sub-annular implantation of a totally biological valved conduit at our centers.

Devices for thoracic endovascular aortic repair of type B aortic dissection: is there any chance for Marfan syndrome?

Introduction: Type B aortic dissection (TBAD) is a threatening event that may lead to death for aortic rupture or multivisceral malperfusion in the acute phase and offers a poor prognosis for long term survivors. Thoracic endovascular aortic repair (TEVAR) has become the preferential therapy in acute and chronic complicated cases for its less invasivity compared to open surgery. However TEVAR is still encumbered by a significant number of reinterventions, caused by aortic neck aneurysmal degeneration, endoleaks and stent-graft induced new entry (SINE).

Intramural Hematoma as Unexpected Complication of COVID-19 Infection.

Novel coronavirus disease-2019 (COVID-19) is an ominous infectious disease that seems capable to attack any organ system, leading in the most severe cases to patient death. COVID-19 has been associated with multiple cardiovascular complications of inflammatory and immune origin, leading to a wide spectrum of vascular damage, myocardial injury, stroke, and pulmonary obstruction. We report the case of a patient with COVID-19 infection who developed an acute aortic syndrome with the characteristics of aortic intramural hematoma.

Catheter-based cerebral protection system in open cardiac surgery: An example of true hybrid surgery.

Postoperative stroke after cardiac surgery is an ominous complication. Clinical manifestations range from cognitive disturbances and altered states of consciousness to focal neurological deficits. Stroke is also a well-documented risk of catheter-based cardiac interventions.

Arch Surgery for Type Ia Endoleak: How to Remain Normothermic and Avoid Circulatory Arrest.

Type Ia endoleak after thoracic endovascular aortic repair is an ominous complication that requires an aggressive treatment. Total arch replacement with a distal suture taking the native distal aorta, the stent graft, and the arch graft, by allowing a perfect closure of the proximal endoleak, represents the most common treatment in this setting. Nevertheless, such intervention continues to carry significant mortality and morbidity that are mostly related to prolonged extracorporeal circulation time and hypothermic circulatory arrest.

Minimally invasive aortic valve replacement: extracorporeal circulation optimization and minimally invasive extracorporeal circulation system evolution.

Treatment of aortic valve disease has become less and less invasive during the last years, thanks to progress in anesthesiology, surgical techniques, and perfusion management. In fact, it has been demonstrated that shorter skin incision, combined with ultra-fast-track anesthesia and minimized extracorporeal circuit could improve clinical outcomes. Current evidence shows that minimally invasive extracorporeal circulation system is associated with reduced red blood cells' transfusion rate, improved end-organ perfusion, decreased incidence of postoperative atrial fibrillation, air embolism leakage, and so less cerebral accidents with better neurological outcomes.