Publications by authors named "Riccardo Abbasciano"
The frozen elephant trunk (FET) technique is increasingly utilized for aortic arch replacement in cases of aortic dissections and aneurysms. This rise in usage has led to more patients needing redo aortic surgeries due to progression of existing conditions, FET-related complications, or new valvular/coronary diseases. This article aims to evaluate surgical techniques to minimize risks during these reoperations, including a case study of a complex redo surgery.
View Article and Find Full Text PDFIndication to perform surgical explantation of TAVR is becoming increasingly more frequent, due to the higher number of transcatheter procedures performed in patients with longer life expectancy. We proposed to perform a systematic review and meta-analysis with metaregression to identify potential factors that can determine an increase in the high mortality and morbidity that characterize these surgical procedures. MEDLINE and Embase were searched for relevant studies.
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- Cardiac surgery causes significant inflammation, and the use of corticosteroids is being examined as a way to reduce this inflammation and prevent complications post-surgery, but their safety and effectiveness remain uncertain.
- The study aims to compare the effects of corticosteroids versus no treatment in adults undergoing cardiac surgery, focusing on mortality, myocardial and pulmonary complications, among other outcomes like atrial fibrillation and length of hospital stay.
- The research involved comprehensive searches for randomised controlled trials and analyzed data using standard methods to assess various outcomes, with new studies added since the original 2011 review.
Background: Organ injury is a common and severe complication of cardiac surgery that contributes to the majority of deaths. There are no effective treatment or prevention strategies. It has been suggested that innate immune system activation may have a causal role in organ injury.
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- The study investigates the effects of concurrent aortic valve replacement (AVR) and coronary artery bypass grafting on patient outcomes, highlighting that combined surgeries may lead to higher risks compared to performing them separately.
- Data from over 51,000 patients over 23 years reveal that more bypass grafts correlate with increased mortality, particularly for those receiving two or more grafts alongside AVR, while a single arterial conduit decreases both mortality and the need for dialysis.
- A survey of 103 cardiac surgeons shows varying opinions on the influence of bypass graft numbers on patient outcomes, with some supporting the potential of staged or hybrid surgical approaches for complex cases.
Article Synopsis
- The long saphenous vein is commonly used in cardiac surgeries, but its long-term effectiveness is often compromised by vein graft disease (VGD), largely due to endothelial dysfunction.
- This study reviews existing research on how different preservation solutions used during vein harvesting affect endothelial health and contribute to VGD in vein grafts specifically for coronary artery bypass grafting (CABG).
- The findings suggest that standard saline can harm venous endothelium, while alternatives like TiProtec and DuraGraft show promising results, but overall research quality remains low and more rigorous trials are needed.
Objective: This study aimed to systematically review the effects of declared and undeclared conflicts of interest on randomised controlled trials (RCTs) of patient blood management (PBM) interventions.
Design: We performed a secondary analysis of a recently published meta-analysis of RCTs evaluating five common PBM interventions in patients undergoing major surgery.
Data Sources: The databases searched by the original systematic reviews were searched using subject headings and Medical Subject Headings terms according to search strategies from the final search time-points until 1 June 2019.
Article Synopsis
- - Coronary artery bypass grafting is still the preferred treatment for many patients with serious coronary artery disease, with the long saphenous vein being the most commonly used conduit despite issues with long-term graft success.
- - Saphenous vein grafts often face challenges due to intimal hyperplasia, a condition that causes narrowing and blockage due to chronic inflammation, making long-term graft patency a significant concern.
- - The paper reviews various studies utilizing large animal models to better understand vein graft disease and explores the effectiveness of different treatments, particularly the use of external stents or mesh in these models.
Aortic stenosis (AS) is the commonest valve lesion requiring surgery in the Western world. The presence of myocardial fibrosis is associated with mortality even after valve replacement. MicroRNAs could serve as biomarkers of fibrosis and risk stratify patients for earlier intervention.
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- Atherosclerosis is a chronic inflammatory disease responsible for high morbidity and mortality rates, and current treatments are inadequate, necessitating further research into its underlying mechanisms.
- This review analyzes 34 studies that employ single-cell and next-generation sequencing techniques to investigate the cellular and molecular aspects of atherosclerosis and vascular inflammation.
- Findings highlight significant contributions from smooth muscle cells, macrophages, and stem/progenitor cells, while noting considerable variability in study outcomes from single-cell sequencing approaches.
Article Synopsis
- Diseases of the thoracic aorta have a familial component, with up to 30% of cases being hereditary, but nonsyndromic types lack clear symptoms, making early detection difficult.
- A feasibility study was conducted on patients with nonsyndromic thoracic aorta diseases (NS-TADs) who underwent screening with imaging and genetic evaluations, including 16 patients and 54 of their relatives.
- Results showed that 24% of relatives had some aortic dilation, and 68% of family members in the familial group required further surveillance, highlighting the importance of genetic testing and family screening for early diagnosis.*
Objective: To review studies that assessed systemic hypothermia as an organ protection strategy in adults undergoing cardiac surgery with cardiopulmonary bypass.
Design: A systematic review and meta-analysis.
Setting And Participants: Randomized controlled trials, irrespective of blinding, language, publication status, and date of publication, were identified by searching the Cochrane Central register of Controlled Trials, MEDLINE, and Embase until November 2020.
Purpose: To develop evidence-based clinical practice recommendations regarding transfusion practices and transfusion in bleeding critically ill adults.
Methods: A taskforce involving 15 international experts and 2 methodologists used the GRADE approach to guideline development. The taskforce addressed three main topics: transfusion support in massively and non-massively bleeding critically ill patients (transfusion ratios, blood products, and point of care testing) and the use of tranexamic acid.
During cardiopulmonary bypass (CPB), high flows can allow an adequate perfusion to kidneys, but, on the other hand, they could cause emboli production, increased vascular pressure, and a more intense inflammatory response, which are in turn causes of renal damage. Along with demographic variables, other intra-operative management and post-operative events, this might lead to Acute kidney injury (AKI) in infants undergoing cardiac surgery. The aim of our study was to investigate if a CPB strategy with flow requirements based on monitoring of continuous metabolic and hemodynamic parameters could have an impact on outcomes, with a focus on renal damage.
View Article and Find Full Text PDFFrailty is a condition of global impairment due to depletion of physiological reserves. However, the underlying biological mechanisms are poorly understood. The aims of the current study were to identify the differences in mitochondrial function and iron metabolism between frail and nonfrail populations, and to investigate the contribution of different methodological approaches to the results.
View Article and Find Full Text PDFBackground: It is unclear whether the innate immune response represents a therapeutic target for organ protection strategies in cardiac surgery.
Methods: A systematic review of trials of interventions targeting the inflammatory response to cardiac surgery reporting treatment effects on both innate immune system cytokines and organ injury was performed. The protocol was registered at the International Prospective Register of Systematic Reviews: CRD42020187239.
Treatment guidelines recommend the routine use of point-of-care diagnostic tests for coagulopathy in the management of cardiac surgery patients at risk of severe bleeding despite uncertainty as to their diagnostic accuracy. We performed a systematic review and meta-analysis of studies that evaluated the diagnostic accuracy of viscoelastometry, platelet function tests, and modified thromboelastography (TEG) tests, for coagulopathy in cardiac surgery patients. The reference standard included resternotomy for bleeding, transfusion of non-red cell components, or massive transfusion.
View Article and Find Full Text PDFObjective: To review studies that have evaluated the effects of liberal or restrictive red cell transfusion thresholds on clinical outcomes in patients requiring extracorporeal membrane oxygenation (ECMO) support for cardiac or respiratory failure.
Design: A systematic review and meta-analysis.
Setting And Participants: The study comprised 1,070 patients from observational studies and randomized controlled trials analyzing transfusion policies in venoarterial (VA) and venovenous (VV) ECMO adult populations.
Article Synopsis
- The study aimed to find out what research is most important for heart surgery patients and their caregivers.
- It followed a process where surveys were used to collect questions and vote on the most important ones, with help from experts.
- Finally, a workshop decided on the top 10 questions to research, focusing on topics like recovery, care before surgery, and problems after surgery.
Background: The aim of this systematic review was to summarise the results of randomised controlled trials (RCTs) that have evaluated pharmacological interventions for renoprotection in people undergoing surgery.
Methods: Searches were conducted to update a previous review using the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE to August 23, 2019. RCTs evaluating the use of pharmacological interventions for renal protection in the perioperative period were included.
Background: Patient blood management (PBM) interventions aim to improve clinical outcomes by reducing bleeding and transfusion. We assessed whether existing evidence supports the routine use of combinations of these interventions during and after major surgery.
Methods: Five systematic reviews and a National Institute of Health and Care Excellence health economic review of trials of common PBM interventions enrolling participants of any age undergoing surgery were updated.
Objective: To develop evidence-based clinical practice recommendations regarding transfusion practices in non-bleeding, critically ill adults.
Design: A task force involving 13 international experts and three methodologists used the GRADE approach for guideline development.
Methods: The task force identified four main topics: red blood cell transfusion thresholds, red blood cell transfusion avoidance strategies, platelet transfusion, and plasma transfusion.