1,720,975 research outputs found
Bilateral mini-thoracotomy for combined minimally invasive direct coronary artery bypass and mitral valve repair
Full text linkConsistent evidence recognizes minimally invasive valve surgery as the top-tier surgical approach for heart valve pathology. Conversely, the overall adoption of minimally invasive coronary surgery remains low. Notwithstanding, excellent clinical outcomes have been recently reported, further consolidating a technique that addresses major concerns associated with the traditional approach for the most frequently performed cardiac operation, including sternal dehiscence (i.e sternal sparing) and stroke (i.e. no-touch aorta), but that also guarantees a reduced resort to blood transfusions, diminished pain and faster recovery. More to the point, the suitability of minimally invasive strategies for combined coronary and valve procedures remains debateable. Almost no reports of such combined procedures are available in literature and the very few published experiences appear scarce and heterogeneous about the surgical access (i.e. single versus bilateral mini-thoracotomy). However, bilateral mini-thoracotomy has been proposed as a feasible and safe strategy for different cardiac operations like surgical ablation and left ventricular assist device implantation, but also for isolated multivessel minimally invasive coronary surgery. Here, we describe the feasibility of combined minimally invasive mitral valve and coronary surgery performed through bilateral mini-thoracotomy and we report outcomes of our initial series of 3 cases.</p
Mechanical circulatory support and intravascular lithotripsy in high-risk patients undergoing percutaneous coronary intervention and transcatheter aortic valve replacement: a case series
No full textBackground: Patients undergoing transcatheter aortic valve replacement (TAVR) usually have multiple comorbidities, such as severely impaired left ventricular function (LVF) and heavily calcified coronary lesions. When they undergo pre-TAVR high-risk percutaneous coronary interventions (HR-PCIs) for severely calcified left main (LM) lesions, potential life-threatening intra-procedural complications associated with the different techniques available to treat calcified lesions can arise. In this setting, mechanical circulatory support proves its usefulness. However, the choice of device can be troublesome. Case summary: We report two clinical scenarios of intravascular lithotripsy (IVL) for the treatment of heavily calcified LM coronary lesions, wherein peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO), alone or combined with an intra-aortic balloon pump (IABP), were used as an upfront strategy to support the procedure. The use of these techniques was particularly effective during multi-vessel HR-PCIs and TAVR, and no complications occurred, which suggested their safety. Discussion: These cases provide multiple insights into the strategy of using IVL + VA-ECMO, alone or with IABP, to treat heavily calcified LM coronary lesions in patients with severely compromised LVF undergoing TAVR. IVL safely and effectively overcame shortcomings related to other plaque ablation techniques, and VA-ECMO proved to be effective when facing the combination of high-risk coronary and valve interventions
Sex-related differences in systemic inflammatory response and outcomes after cardiac surgery and cardiopulmonary bypass
No full textObjectives: Differences in inflammatory responses between men and women may contribute to sex disparities in cardiac surgery outcomes. We investigated how sex differences influence systemic inflammatory response syndrome (SIRS) and adverse outcomes after cardiac surgery. Methods: A single-centre retrospective cohort study of patients undergoing cardiac surgery from 2018 to 2020 was performed. SIRS was defined as per the American College of Chest Physicians/Society of Critical Care Medicine. Predictors of SIRS and composite adverse outcomes (death, transient ischaemic attack/stroke, renal therapy, bleeding, postcardiotomy mechanical circulatory support, prolonged Intensive Care Unit stay) were evaluated using multivariable logistic regression. Mediation effects of SIRS were assessed using structural equation modelling. Results: The cohort included 1005 patients, of whom 299 (29.8%) were women. SIRS occurred in 28.1% of patients, and 12.7% experienced the composite end point. Female sex was significantly associated with SIRS (odds ratio 1.56; 95% confidence interval 1.12-2.18, P = 0.009) and the composite outcome (odds ratio 1.72; 95% confidence interval 1.10-2.69, P = 0.017). Baseline left ventricular dysfunction and intraoperative hyperlactatemia were additional common predictors. SIRS mediated 50.8% of the effect of female sex, 17.0% of left ventricular dysfunction and 30.9% of intraoperative hyperlactatemia on the composite outcome. Conclusions: Female sex is independently associated with postoperative SIRS and poorer outcomes. Systemic inflammation, preoperative anaemia and procedural hyperlactatemia are potentially modifiable factors in the mechanisms through which female sex appears to worsen outcome after cardiac surgery
Early and mid-term results of minimally invasive direct coronary artery bypass (MIDCAB) surgery
No full textAim: This study aimed to evaluate the early and mid-term outcomes of minimally invasive direct coronary artery bypass (MIDCAB) surgery for isolated left anterior descending artery (LAD) disease, with a primary focus on revascularization-free survival. Methods: A retrospective analysis was conducted on 155 consecutive patients who underwent MIDCAB at Santa Maria Hospital, Bari, Italy, between May 2017 and December 2023. All patients received a direct anastomosis of the left internal thoracic artery (LITA) to the LAD, with sequential grafting performed for those with concurrent diagonal artery disease. The primary endpoint was revascularization-free survival. The secondary endpoint was in-hospital mortality. Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazards models were employed for statistical analysis. Results: The median follow-up duration was 36 months [12-48]. No 30-day postoperative deaths occurred. The 5-year revascularization-free survival rate was 84.2% [77.4-91.7], and the overall 5-year survival rate was 90.5% [85.1-96.2]. Predictors of the primary endpoint were preoperative New York Heart Association (NYHA) class III (HR 5.898 [1.187-29.311], P = 0.030) and postoperative atrial fibrillation (HR 3.405 [1.232-9.415], P = 0.018). The incidence of complications was low, with no cerebrovascular events reported. Conclusion: MIDCAB for isolated LAD disease is safe, with satisfactory postoperative outcomes and excellent midterm survival. These findings align with existing literature, underscoring the procedure’s reproducibility. Further multicenter studies are needed to validate these results and compare MIDCAB versus PCI in treating isolated LAD disease
Direct Transaortic TEVAR: An Alternative Option for Selected Patients With Unsuitable Peripheral Access
No full textDurability of Mitral Valve Bioprostheses: A meta-analysis of long-term follow-up studies
No full textPorcine and pericardial valves exhibited similar freedom from structural valve deterioration after aortic valve replacement. Limited data exists regarding their durability at long-term follow-up in the mitral position
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
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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