1,721,089 research outputs found
Edge-to-edge Alfieri technique for mitral valve repair: which indications?
No full textPURPOSE OF REVIEW: To outline the current indications to the edge-to-edge technique for mitral valve repair. Indeed, after its introduction in the early 1990s, criteria for appropriate patient selection and technical issues of this approach have been progressively refined over the years and are now rather standardized.
RECENT FINDINGS: The long-term results (up to 17 years) of this approach in the setting of degenerative mitral regurgitation with bileaflet and anterior leaflet prolapse have been recently reported and confirm the important role of this method in the surgical armamentarium of mitral valve reconstruction. In addition, recent data support the use of this method in new special situations and settings (systolic anterior motion prevention/treatment, congenital atrioventricular valve incompetence, as a 'rescue' procedure in case of suboptimal conventional repair).
SUMMARY: In mitral regurgitation competence of the mitral valve can be restored by using a 'functional' rather than a conventional 'anatomical' repair. This 'functional' repair is realized by means of the edge-to-edge technique that consists in suturing together the facing portions of the anterior and posterior mitral valve leaflets in correspondence to the location of the regurgitant jet. The edge-to-edge technique was introduced in the early 1990s and has provided a useful contribution to the surgical armamentarium of mitral valve repair. Appropriate indications and awareness of the important technical aspects of the procedure are prerequisites for a good outcome. In this review the present role of the edge-to-edge repair, particularly in terms of indications and contraindications, will be outlined and discussed
Advances in Cardiac Surgery
No full textCardiac surgery roots date back to the first half of the last century. Subsequently, thanks to the heart-lung machine development, which allowed to operate within the cardiac chambers under direct vision, the huge potentials of this discipline in cardiovascular disease treatment have fully manifested. In the following years, until the end of the last century, the surgical treatment of heart disease progressed steadily and consistently. From the beginning of the millennium, the discipline of cardiac surgery underwent a strong evolutionary process with the advent of minimally invasive procedures and transcatheter techniques. In this article we will briefly review the history of the evolution of cardiac surgery. Finally, possible future perspectives will be outlined
Myoblast transplantation for heart failure: where are we heading? Alfieri O, Livi U, Martinelli L, Arpesella G, Valfrè C, Lapenna E, Desnos M, Hagège AA, Menasché P
No full textSpinal cord stimulation for refractory chronic angina pectoris: 100 patients treated in our 12-year experience
No full textBACKGROUND:
The aim of this study was to evaluate the quality of life (QoL) benefit of patients with chronic refractory angina treated with spinal cord stimulation (SCS) in our experience.
METHODS:
Between February 1998 and August 2010, 100 patients with chronic refractory angina who could not benefit from myocardial revascularization underwent SCS at the San Raffaele Scientific Institute of Milan (Italy). All patients were prospectively followed up at our outpatient clinic. The Spitzer index was used to evaluate QoL of patients before the procedure and at follow-up.
RESULTS:
Mean age was 66 ± 8 years (range 46-79). Ninety-four patients (94%) were in CCS class III-IV (mean CCS class 3.5 ± 0.1) and 62 patients (62%) were in NYHA class III-IV (mean NYHA class 2.6 ± 0.1). The preoperative Spitzer index was 4.4 ± 1.4. Mean angina episodes per week were 12.6 ± 9.3 and mean consumption of sublingual nitrates was 11.0 ± 9.4. At follow-up, overall mortality was 11% (n = 11), and cardiovascular death was 3%. A reduction in angina episodes per week >50% was observed in 88% of patients (from 12.6 ± 9.3 to 2.7 ± 1.13; p<0.0001). Mean consumption of sublingual nitrates decreased from 11.0 ± 9.4 to 2.3 ± 0.1 (p<0.0001). The Spitzer index significantly improved (from 4.4 ± 0.1 to 2.3 ± 0.1; p<0.0001). NYHA class and CCS class decreased from 2.6 ± 0.1 to 2.0 ± 0.1 and from 3.5 ± 0.1 to 1.7 ± 0.1, respectively (both p<0.0001).
CONCLUSIONS:
SCS is an effective and safe therapeutic option for patients with chronic refractory angina and it is associated with improved functional status and QoL at follow-u
Aortic and mitral valve surgery through a superior ministernotomy in pectus excavatum associated with Marfan's syndrome
No full textThe combination of chest wall abnormalities such as pectus excavatum and cardiac disease requiring operative correction represents a clinical challenge to the surgeon. We report two cases of patients with Marfan's syndrome and severe pectus excavatum in whom cardiac operations were successfully performed using a superior 'T inverted' ministernotomy. This approach allowed safe isolation of the target cardiac structures, provided excellent operative exposure and enhanced chest wall stability by preserving the integrity of the lower sternum
Degenerative Mitral Valve Repair
No full textDegenerative mitral regurgitation (MR) is a rather common pathology. If untreated, severe MR leads to left ventricular failure, pulmonary hypertension, atrial fibrillation and death. Correction of MR can be associated with a life expectancy and a quality of life similar to those of the normal healthy population, when performed appropriately and timely.
In many patients, degenerative MR is characterised by an excess of valve tissue with elongated or ruptured chordae (Barlow’s disease) , while in others, the leaflets are thinner and translucent and chordae are very fragile (fibroelastic deficiency). Mitral valve prolapse is the consequence of these anatomical alterations affecting primarily the leaflets and the subvalvular apparatus.
American and European guidelines for the treatment of heart valve disease indicate the criteria for appropriate management of patients with degenerative MR.
The aim of this editorial is to briefly explore the optimal management of patients affected by degenerative MR
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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