Publications by authors named "Matteo Pettinari"
: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. The subjects of this analysis were 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD).
View Article and Find Full Text PDFMalperfusion syndrome in patients undergoing repair for acute type A aortic dissection: Presentation, mortality, and utility of the Penn classification.
J Thorac Cardiovasc Surg
November 2024
Background: The current study aims to report the presentation of the malperfusion syndrome in patients with acute type A aortic dissection admitted to surgery and its impact on mortality.
Methods: Data were retrieved from the multicenter European Registry of Type A Aortic Dissection. The Penn classification was used to categorize malperfusion syndromes.
Neurologic complications in patients receiving aortic versus subclavian versus femoral arterial cannulation for post-cardiotomy extracorporeal life support: results of the PELS observational multicenter study.
Crit Care
August 2024
Article Synopsis
- The study looks at how the location where doctors put tubes in the arteries for heart support affects brain health after surgery.
- They compared three methods: using the aorta, subclavian/axillary arteries, and femoral artery to see which had the least brain problems.
- Results showed that patients using the subclavian/axillary method had more major brain issues compared to the others, and also had more seizures after the surgery.
Article Synopsis
- The study investigated the outcomes for patients who had surgery for Stanford type A aortic dissection (TAAD) and spent time in the intensive care unit (ICU), analyzing data from 3,538 patients.
- Average ICU stays were around 9.9 days, with associated costs averaging €24,086, and observed in-hospital mortality was 14.8%, while five-year mortality was 30.5%.
- The analysis found that longer ICU stays (>5 days) linked to better survival rates, with lower in-hospital mortality (8.9% vs. 17.4%) and lower five-year mortality (28.2% vs. 30.7%) when compared to shorter stays (2-
Article Synopsis
- ECLS cannulation in post-cardiotomy patients is uncommon in general wards, with only 39 out of 2058 patients studied undergoing the procedure while at the hospital.
- The majority of these patients faced complications like acute kidney injury and arrhythmias, with a high in-hospital mortality rate of 84.6%, predominantly due to persistent heart failure.
- Findings suggest that ECLS cannulation mainly affects low-risk patients who experience cardiac arrest post-surgery, indicating a need for further research into improving outcomes.
Article Synopsis
- The study investigates gender differences in outcomes after type A aortic dissection (TAAD) surgery, focusing on both short- and long-term results.
- Data was collected from a multicenter European registry including 3902 TAAD surgery patients from 2005-2021, with a gender breakdown of 30.4% females.
- Results showed no significant early postoperative differences between genders, although males had a slightly better ten-year relative survival rate compared to females, despite advancements in surgical techniques over time.
Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study.
Crit Care Med
October 2024
Article Synopsis
- * Conducted across 34 centers globally from 2000 to 2020, the study included over 2,000 adult patients split into different ECMO duration groups, revealing higher complications and mortality rates associated with longer ECMO durations.
- * The findings suggest that while most in-hospital complications increase with ECMO duration, post-discharge survival rates remain similar across groups, with specific risk factors like age and pre-existing conditions affecting long-term survival for those on ECMO longer than 7 days.
The introduction of the Y(ang)-technique for aortic root enlargement has sparked a renewed interest in annular and root enlargement procedures world-wide. In order to execute these procedures proficiently however, it's important to understand the complex three-dimensional structure of the aortic root and left ventricular outflow tract, and also be familiar with the different enlargement techniques. Herein, we are providing a description of the aortic root anatomy and the most commonly utilized root enlargement procedures.
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- Extended aortic repair is essential for maintaining long-term surgical success in young patients with DeBakey type 1 aortic dissection, as they face higher risks of aortic degeneration due to their longer life expectancy.
- A study analyzed 1,199 patients under 60 who had aortic repair surgeries across Europe from 2005 to 2021, comparing outcomes between ascending aortic repair and total aortic arch repair techniques.
- Results showed no significant difference in the need for additional surgeries after 5 years between the two techniques, but total aortic arch repair had higher rates of postoperative complications like stroke and dialysis, while overall mortality rates were similar.
Objectives: Although cardiogenic shock requiring extracorporeal life support after cardiac surgery is associated with high mortality, the impact of sex on outcomes of postcardiotomy extracorporeal life support remains unclear with conflicting results in the literature. We compare patient characteristics, in-hospital outcomes, and overall survival between females and males requiring postcardiotomy extracorporeal life support.
Methods: This retrospective, multicenter (34 centers), observational study included adults requiring postcardiotomy extracorporeal life support between 2000 and 2020.
Objectives: The progressive increase in the use of implantable electronic devices, vascular access for dialysis and the increased life expectancy of patients with congenital heart diseases has led in recent years to a considerable number of right-side infective endocarditis, especially of the tricuspid valve (TV). Although current guidelines recommend TV repair for native tricuspid valve endocarditis (TVE), the percentage of valve replacements remains very high in numerous studies. The aim of our study is to analyse our experience in the treatment of TVE with a reparative approach.
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- The study investigates the effects of different arterial cannulation methods (femoral, supra-aortic, and direct aortic) on outcomes for patients undergoing surgery for acute Stanford type A aortic dissection (TAAD).
- Results show that in-hospital mortality rates for patients using femoral or supra-aortic cannulation are similar, while direct aortic cannulation yields lower mortality rates compared to femoral cannulation.
- Additionally, switching cannulation sites during surgery increases the risk of in-hospital mortality, while long-term outcomes (10-year mortality) remain consistent across the groups.
Article Synopsis
- Surgery for type A aortic dissection (TAAD) often leads to neurological complications, which were analyzed in a study of 3,902 patients from the European Registry of Type A Aortic Dissection.
- Out of these patients, 18.5% experienced strokes or global brain ischemia during hospitalization, with significant increases in in-hospital mortality linked to these complications: 25.6% for ischemic stroke, 48.7% for hemorrhagic stroke, and 74.0% for global brain ischemia.
- Although neurologic complications sharply increased early and midterm mortality, this negative impact on survival tended to diminish about one year post-surgery.
Background: Surgery for Stanford type A aortic dissection (TAAD) is associated with an increased risk of late aortic reoperations due to degeneration of the dissected aorta.
Methods: The subjects of this analysis were 990 TAAD patients who survived surgery for acute TAAD and had complete data on the diameter and dissection status of all aortic segments.
Results: After a mean follow-up of 4.
Article Synopsis
- Surgery for type A aortic dissection (TAAD) has a high early mortality risk, with in-hospital mortality rates increasing based on the urgency of the procedure, ranging from 10% for urgent surgeries to over 57% for the most critical salvage procedures.
- A multicenter study using data from the European Registry of TAAD (ERTAAD) found that preoperative arterial lactate levels correlate with procedure urgency, indicating that more critical cases are associated with poorer outcomes.
- The urgency classification enhances the ability to predict patient risk, suggesting that despite high mortality in severe cases, salvage surgeries are often justified as many patients can still survive to discharge.
Long-term survival after surgical treatment for post-infarction mechanical complications: results from the Caution study.
Eur Heart J Qual Care Clin Outcomes
December 2024
Article Synopsis
- Mechanical complications (MCs) following acute myocardial infarction (AMI) are rare but serious, with surgery being the recommended treatment; this study evaluated outcomes of patients who underwent such surgeries from 2001 to 2019.
- Among 720 patients analyzed, the average age was 70, with the majority being male; the most frequent complication was ventricular septal rupture, leading to a significant in-hospital mortality rate of 37.4%.
- Despite high immediate mortality, long-term survival rates for hospital survivors were promising, showing 65.7% survival at 10 years, with older age and postoperative low cardiac output syndrome being key factors influencing overall mortality.
Background: Surgery for type A aortic dissection (TAAD) is associated with high risk of mortality. Current risk scoring methods have a limited predictive accuracy.
Methods: Subjects were patients who underwent surgery for acute TAAD at 18 European centers of cardiac surgery from the European Registry of Type A Aortic Dissection (ERTAAD).
Article Synopsis
- Patients undergoing postcardiotomy V-A-ECMO have a high risk of early mortality, with a 66.7% in-hospital mortality rate found in the analysis of 1269 patients across 25 hospitals.
- The study utilized a systematic review and methods like propensity score matching to identify performance differences among hospitals, revealing that some hospitals had significantly higher mortality rates than others.
- The research indicates that lower annual volumes of V-A-ECMO procedures may lead to worse outcomes, and it highlights the potential for improvement in many hospitals' results for this treatment.
Background: Acute type A aortic dissection (TAAD) is associated with significant mortality and morbidity. In this study we evaluated the prognostic significance of preoperative arterial lactate concentration on the outcome after surgery for TAAD.
Methods: The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) at 18 European centers of cardiac surgery.
This data article presents the details of the Live Road Assessment Custom Dataset (LiRA-CD), an open-source dataset for road condition modelling and research. The dataset captures GPS trajectories of a fleet of electric vehicles and their time-series data from 50 different sensors collected on 230 km of highway and urban roads in Copenhagen, Denmark. Additionally, road condition measurements were collected by standard survey vehicles, which serve as high-quality reference data.
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- A study compared direct aortic cannulation to supra-aortic cannulation methods during surgery for type A aortic dissection to see which leads to better patient outcomes.
- Data from 3,902 patients in the European registry showed that direct aortic cannulation resulted in lower in-hospital mortality (12.7% vs. 18.1%) and fewer postoperative complications, including issues like paralysis and infections.
- The findings suggest that direct aortic cannulation is a safer option for patients undergoing surgery for acute type A aortic dissection.
Objective: Current guidelines advise using prophylactic tricuspid valve annuloplasty during mitral valve surgery, especially in the presence of annular diameter enlargement. However, several retrospective studies and a prospective randomized study from our department could not confirm that diameter enlargement is predictive of late regurgitation. We examined whether 2- and 3-dimensional echocardiographic and clinical characteristics could identify patients who will develop moderate or severe recurrent tricuspid regurgitation.
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- The study examines the use of extracorporeal membrane oxygenation (ECMO) in adults experiencing cardiogenic shock after heart surgery, noting significant in-hospital mortality rates (60.5%).
- Conducted across 34 centers from 2000 to 2020, the research analyzes patient characteristics and factors affecting both in-hospital and long-term survival.
- Despite high initial mortality, approximately 66% of hospital survivors can expect to live for a decade post-discharge, with age and certain postoperative complications influencing long-term outcomes.
Article Synopsis
- Postcardiotomy venoarterial extracorporeal membrane oxygenation (VA ECMO) shows a gap between the rates of successful weaning from the device and actual survival after discharge, prompting an analysis of patient outcomes.
- A study of 2058 adult patients revealed that 62.7% could be weaned off VA ECMO, but only 39.6% survived to be discharged; major causes of death included multiorgan failure and persistent heart failure, with significant differences in mortality rates during and after ECMO support.
- Key risk factors for on-ECMO mortality included emergency surgery and preoperative cardiac issues, while postweaning mortality was linked to complications like diabetes and septic shock.