Publications by authors named "Silvana Marasco"

Article Synopsis
  • The study investigates long-term survival outcomes for patients with severe ischaemic cardiomyopathy who underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) due to a lack of recent trial data.
  • Using records from Australian and New Zealand cardiac registries between 2005 and 2018, researchers analyzed data from 2042 patients, with 1451 treated by CABG and 591 by PCI, adjusting for various risk factors.
  • Results showed CABG patients had significantly lower long-term mortality compared to those who received PCI, although there were no differences in in-hospital mortality; however, CABG was associated with a higher risk of peri-procedural strokes and a longer hospital stay
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Trans-radial access for coronary angiography and percutaneous coronary intervention (PCI) has gained popularity due to its advantages over the traditional transfemoral approach. However, radial artery occlusion (RAO) remains a common complication following trans-radial procedures. This study aimed to investigate the incidence of early and late RAO along with their risk factors.

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Background: Implantation of bioprosthetic valves is more common as the population ages and there is a shift towards implanting bioprosthetic aortic valves in an increasingly younger surgical population. Bioprosthetic heart valve insertion, however, carries the long-term risk of valve failure through structural valve degeneration. Re-operative surgical aortic valve replacement has historically been the only definitive management option for patients with prosthetic valve dysfunction, however, data on the short- and long-term outcomes following re-operative surgery in Australia and New Zealand is limited.

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Article Synopsis
  • - Chronic thromboembolic pulmonary disease (CTEPD), especially when complicated by pulmonary hypertension (CTEPH), is a serious condition linked to venous blood clots that can lead to high morbidity and mortality if left untreated.
  • - Treatment options for CTEPD and CTEPH include pulmonary endarterectomy (PEA), balloon pulmonary angioplasty, and medical therapy, with the choice depending on factors like disease severity and patient health.
  • - The manuscript reviews the history and outcomes of PEA in Australasia, offering guidance on its use in treatment and discussing future challenges and opportunities in diagnosing and managing CTEPD and CTEPH in that region.
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  • - This study investigated the predictors and timing of late atrial fibrillation (AF) recurrence in patients who underwent cardiac surgery, focusing on those without prior AF.
  • - Out of 1,031 patients analyzed, 14% experienced late AF recurrence, with a significant link found between early postoperative AF (POAF) lasting more than 48 hours and later AF episodes.
  • - The findings suggest that a longer POAF duration increases the risk of future AF, highlighting the need for further research on monitoring and treatment strategies for these patients.
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Article Synopsis
  • Rib fixation is a common treatment for patients with flail chest who are on ventilators, but its effectiveness for other groups is less clear and not well-studied.
  • This new meta-analysis focused only on randomized controlled trials and included 752 patients to assess the true benefits of rib fixation compared to non-operative treatments.
  • Results showed that rib fixation significantly lowers the rates of pneumonia and reduces hospital and ICU stays, although it didn’t show any major quality of life improvements at the 6-month mark.
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Catheter ablation for atrial fibrillation (AF) has increased exponentially in many developed countries, including Australia and New Zealand. This Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation from the Cardiac Society of Australia and New Zealand (CSANZ) recognises healthcare factors, expertise and expenditure relevant to the Australian and New Zealand healthcare environments including considerations of potential implications for First Nations Peoples. The statement is cognisant of international advice but tailored to local conditions and populations, and is intended to be used by electrophysiologists, cardiologists and general physicians across all disciplines caring for patients with AF.

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Background: Adult congenital heart disease (ACHD) services increasingly encounter heart failure (HF) in the ageing ACHD population. Optimal timing of referral for heart transplant (HTx) evaluation in this heterogeneous population is complex and ill-defined. We aim to outline the characteristics and outcomes of ACHD patients referred for HTx from a large Australian ACHD centre.

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Objectives: Right ventricular failure following implantation of a durable left ventricular assist device (LVAD) is a major driver of mortality. Reported survival following biventricular (BiVAD) or total artificial heart (TAH) implantation remains substantially inferior to LVAD alone. We report our outcomes with LVAD and BiVAD HeartMate 3 (HM3).

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Background: Hyperlactatemia (HL) is a common phenomenon after cardiac surgery which is related to tissue hypoperfusion and hypoxia and associated with poor outcomes. It is also often seen in the postoperative period after orthotopic heart transplantation (OHTx), but the association between HL and outcomes after OHTx is not well known. We evaluated the incidence and outcome of HL after OHTx.

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Aim: The small aortic annulus is a surgical challenge in patients undergoing aortic valve replacement which may lead to patient prosthesis mismatch. Management options include aortic root enlargement, aortic root replacement, and the use of sutureless valves. In this case series, we report our results with aortic root enlargement, sutureless valve implantation, and benchtop modelling of the radial forces exerted.

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Background: Cold static storage preservation of donor hearts for periods longer than 4 hours increases the risk of primary graft dysfunction (PGD). The aim of the study was to determine if hypothermic oxygenated perfusion (HOPE) could safely prolong the preservation time of donor hearts.

Methods: We conducted a nonrandomized, single arm, multicenter investigation of the effect of HOPE using the XVIVO Heart Preservation System on donor hearts with a projected preservation time of 6 to 8 hours on 30-day recipient survival and allograft function post-transplant.

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Coronary artery fistulae are an uncommon abnormality of the coronary arteries, but when hemodynamically significant can present as angina, dyspnea, and arrhythmia as a rare cause of functional myocardial ischemia via 'coronary steal phenomenon'.

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Article Synopsis
  • Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a critical treatment for patients experiencing severe early graft dysfunction after heart transplant, and the study aims to analyze mortality rates, complications, and prognostic factors associated with its use.
  • The research involved a systematic review of 49 studies and included individual patient data from 448 patients, revealing a 30-day mortality rate of 33% and a 1-year mortality rate of 50% in those receiving VA-ECMO.
  • The findings highlight the need for further research to improve VA-ECMO strategies, as factors like older age and prior surgeries are linked to higher mortality rates.
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Purpose: The purpose of this study was to assess trends in management of flail chest injuries over time and to determine impact on patient outcomes.

Methods: A retrospective review of data from a prospectively collated database of all trauma patients admitted to a level 1 trauma service in Victoria was conducted. All trauma patients admitted to the hospital between July 2008 and June 2020 with an Abbreviated Injury Scale (AIS) code for flail chest injury were included.

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Background: The presence of six or more rib fractures or a displaced rib fracture due to cardiopulmonary resuscitation (CPR) has been associated with longer hospital and intensive care unit (ICU) length of stay (LOS). Evidence on the effect of surgical stabilization of rib fractures (SSRF) following CPR is limited. This study aimed to evaluate outcomes after SSRF versus nonoperative management in patients with multiple rib fractures after CPR.

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We present the case of acute myocardial infarction secondary to spontaneous coronary artery dissection in a patient 2 weeks post orthotopic heart transplantation. ().

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Heart-lung transplantation is a mature therapy but has perioperative complications, such as phrenic nerve dysfunction and mediastinal bleeding. We report our technical modifications to simplify the procedure.

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Article Synopsis
  • The study aimed to evaluate whether there are sex-specific differences in mortality rates after coronary artery bypass graft surgery (CABGS) compared to other procedures.
  • A systematic review and meta-analysis of randomized controlled trials found that while women's mortality risks were initially similar to men's, they experienced a significant increase in risk over longer time frames, particularly after 2-5 years post-surgery.
  • Researchers concluded that current studies show inconsistent results regarding sex differences in CABGS outcomes, emphasizing the need for more trials focused on sex-specific data to tailor treatment approaches.
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Postinfarct ventricular septal defect (PIVSD) is associated with high mortality and the management of these patients has been a challenge with little improvement in outcomes. We commenced a protocol of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for those patients who present in cardiogenic shock with the aim to improve end-organ function before definitive surgical repair to reduce postoperative mortality. This study reviewed the results of this strategy.

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