Pub Date : 2023-08-24DOI: 10.20517/2574-1209.2023.42
A. Calafiore, S. Prapas, Stefano Guarracini, M. Di Marco, R. Lorusso, D. Paparella, Kostas Katsavrias, A. Totaro, M. di Mauro
The introduction of deep hypothermic circulatory arrest (CA) was the factor that contributed to the diffusion of aortic arch surgery in the surgical world. The progressive quest to improve the outcome of such a complex surgery included the introduction of different tools to better protect the brain, such as retrograde or antegrade cerebral perfusion. The increased experience not only resulted in a continuous improvement of the results, but also facilitated the widespread adoption of arch surgery across most of the cardiac Centers. The trend moved towards a gradual rise in the temperature (from ≤ 20 to 30 °C), coupled with a preference for selective/unilateral antegrade cerebral perfusion for brain protection. Nevertheless, results are not perfect and neurologic dysfunctions, temporary or permanent, remain a frequent complication. The spinal cord is not completely protected by cerebral perfusion and ischemia of the lower body can cause organ malfunctions with severe consequences. After decades, the field is still open for new strategies to minimize the damages intrinsic to the procedure. This review will briefly describe the energetics of the brain, the mechanisms of neurologic dysfunctions, and the advantages and disadvantages of the strategies of cerebral protection commonly used during CA for aortic arch surgery.
{"title":"Strategies of cerebral protection and neurologic dysfunctions after circulatory arrest: back to the future?","authors":"A. Calafiore, S. Prapas, Stefano Guarracini, M. Di Marco, R. Lorusso, D. Paparella, Kostas Katsavrias, A. Totaro, M. di Mauro","doi":"10.20517/2574-1209.2023.42","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.42","url":null,"abstract":"The introduction of deep hypothermic circulatory arrest (CA) was the factor that contributed to the diffusion of aortic arch surgery in the surgical world. The progressive quest to improve the outcome of such a complex surgery included the introduction of different tools to better protect the brain, such as retrograde or antegrade cerebral perfusion. The increased experience not only resulted in a continuous improvement of the results, but also facilitated the widespread adoption of arch surgery across most of the cardiac Centers. The trend moved towards a gradual rise in the temperature (from ≤ 20 to 30 °C), coupled with a preference for selective/unilateral antegrade cerebral perfusion for brain protection. Nevertheless, results are not perfect and neurologic dysfunctions, temporary or permanent, remain a frequent complication. The spinal cord is not completely protected by cerebral perfusion and ischemia of the lower body can cause organ malfunctions with severe consequences. After decades, the field is still open for new strategies to minimize the damages intrinsic to the procedure. This review will briefly describe the energetics of the brain, the mechanisms of neurologic dysfunctions, and the advantages and disadvantages of the strategies of cerebral protection commonly used during CA for aortic arch surgery.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42193430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Air pollution is a major concern for the global health crisis due to pulmonary diseases, which include asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pneumonia, lung infections, and lung cancer. Early diagnosis and novel drug delivery systems are the keys to their successful management. Asthma and COPD can be managed more effectively when treated with nanoformulations through the pulmonary route. In lung infections and cancer, targeted drug delivery is crucial in improving therapeutic effectiveness while minimizing systemic side effects. Cystic fibrosis can be treated with gene therapy. It serves as a prime example of the utilization of nanotechnology for developing nonviral vectors. This review provides an overview of the causes of different pulmonary diseases and examines the advancements in nanoscience and nanotechnology for their treatment.
{"title":"Applications of nanotechnology in the treatment of pulmonary diseases","authors":"Rahit Kumar Dey, Bachaspati Jana, Debabrata Ghosh Dastidar","doi":"10.20517/2574-1209.2023.06","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.06","url":null,"abstract":"Air pollution is a major concern for the global health crisis due to pulmonary diseases, which include asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pneumonia, lung infections, and lung cancer. Early diagnosis and novel drug delivery systems are the keys to their successful management. Asthma and COPD can be managed more effectively when treated with nanoformulations through the pulmonary route. In lung infections and cancer, targeted drug delivery is crucial in improving therapeutic effectiveness while minimizing systemic side effects. Cystic fibrosis can be treated with gene therapy. It serves as a prime example of the utilization of nanotechnology for developing nonviral vectors. This review provides an overview of the causes of different pulmonary diseases and examines the advancements in nanoscience and nanotechnology for their treatment.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41602730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-28DOI: 10.20517/2574-1209.2023.05
F. Squizzato, A. Spertino, F. Grego, M. Antonello, M. Piazza
Thoracic endovascular aortic repair (TEVAR) today represents the first option for the treatment of most pathologies involving the descending thoracic aorta. Proximal endograft failure, which includes endograft migration or type IA endoleak, represents the most frequent complication during the mid-term and long-term period. Proximal sealing length is the single most important factor affecting the technical success and durability of TEVAR. Other factors related to aortic arch anatomy, fluid dynamics, type of endograft, or type of pathology, may influence the risk of proximal endograft failure, and should be considered during the endovascular planning of the proximal sealing length. This review summarizes the evidence on the factors affecting the risk of proximal endograft failure, and provides the rationale for the choice of the proximal sealing length during TEVAR, based on specific patients’ characteristics.
{"title":"Optimization of the proximal sealing in thoracic endovascular aortic repair (TEVAR)","authors":"F. Squizzato, A. Spertino, F. Grego, M. Antonello, M. Piazza","doi":"10.20517/2574-1209.2023.05","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.05","url":null,"abstract":"Thoracic endovascular aortic repair (TEVAR) today represents the first option for the treatment of most pathologies involving the descending thoracic aorta. Proximal endograft failure, which includes endograft migration or type IA endoleak, represents the most frequent complication during the mid-term and long-term period. Proximal sealing length is the single most important factor affecting the technical success and durability of TEVAR. Other factors related to aortic arch anatomy, fluid dynamics, type of endograft, or type of pathology, may influence the risk of proximal endograft failure, and should be considered during the endovascular planning of the proximal sealing length. This review summarizes the evidence on the factors affecting the risk of proximal endograft failure, and provides the rationale for the choice of the proximal sealing length during TEVAR, based on specific patients’ characteristics.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43396183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-26DOI: 10.20517/2574-1209.2023.26
G. Andò, Giulia Alagna, S. De Rosa, F. Pelliccia, F. Gragnano, G. Niccoli, R. Piccolo, E. Moscarella, E. Fabris, R. Montone, S. Muscoli, C. Spaccarotella, G. Sinagra, C. Indolfi, I. Porto, P. Perrone Filardi, P. Calabrò
Severe coronary artery calcifications remain a challenge for the contemporary interventional cardiologist in the light of the growing demand for diagnostic procedures and interventions in elderly patients; in addition, the general prognostic improvement after percutaneous coronary intervention (PCI) is expanding the indications to PCI to increasingly complex anatomies. In the last decade, a renewed interest in the treatment of calcific lesions has been observed, with the aim to optimize the mechanic effects of balloon angioplasty and the expansion and apposition of DES to the vessel wall. However, patients with calcific coronary artery disease represent a subset with a high risk of adverse outcomes, both intra-procedural and in the long-term. The need to guarantee a targeted and tailored treatment based on the coronary anatomy of any individual patient is a current priority of the interventional community. The efficacy of rotational atherectomy in improving procedural success for the treatment of calcified lesions has been widely demonstrated. The advent of new technologies -especially of intravascular lithotripsy (IVL)-, the application of techniques and materials initially developed for as complex procedures as chronic total occlusions (CTO), the increasing experience of contemporary operators and the introduction of latest generation drug-eluting stents (DES) with excellent technical and structural properties, are further contributing to improving outcomes of current PCI for calcific lesions.
{"title":"Severely calcified coronary artery lesions: focus on interventional management","authors":"G. Andò, Giulia Alagna, S. De Rosa, F. Pelliccia, F. Gragnano, G. Niccoli, R. Piccolo, E. Moscarella, E. Fabris, R. Montone, S. Muscoli, C. Spaccarotella, G. Sinagra, C. Indolfi, I. Porto, P. Perrone Filardi, P. Calabrò","doi":"10.20517/2574-1209.2023.26","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.26","url":null,"abstract":"Severe coronary artery calcifications remain a challenge for the contemporary interventional cardiologist in the light of the growing demand for diagnostic procedures and interventions in elderly patients; in addition, the general prognostic improvement after percutaneous coronary intervention (PCI) is expanding the indications to PCI to increasingly complex anatomies. In the last decade, a renewed interest in the treatment of calcific lesions has been observed, with the aim to optimize the mechanic effects of balloon angioplasty and the expansion and apposition of DES to the vessel wall. However, patients with calcific coronary artery disease represent a subset with a high risk of adverse outcomes, both intra-procedural and in the long-term. The need to guarantee a targeted and tailored treatment based on the coronary anatomy of any individual patient is a current priority of the interventional community. The efficacy of rotational atherectomy in improving procedural success for the treatment of calcified lesions has been widely demonstrated. The advent of new technologies -especially of intravascular lithotripsy (IVL)-, the application of techniques and materials initially developed for as complex procedures as chronic total occlusions (CTO), the increasing experience of contemporary operators and the introduction of latest generation drug-eluting stents (DES) with excellent technical and structural properties, are further contributing to improving outcomes of current PCI for calcific lesions.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43740799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-18DOI: 10.20517/2574-1209.2023.08
M. Troncone, Jonathan C. Hong
Descending thoracic and thoracoabdominal aortic replacement is a complex and high-risk surgery. Deep hypothermic circulatory arrest (DHCA) is a surgical technique that is useful in large distal aortic arch aneurysms or chronic dissections that require fenestration where proximal cross clamping would be difficult. It can also be used as part of a multimodal strategy for end-organ protection. However, DHCA has potential adverse effects on the myocardial, cerebral, pulmonary, and coagulation systems. The use of DHCA is guided by the experience and preferences of the surgical team as well as the technical demands of the proposed surgery.
{"title":"Descending thoracic and thoracoabdominal aortic aneurysm repair using deep hypothermic circulatory arrest","authors":"M. Troncone, Jonathan C. Hong","doi":"10.20517/2574-1209.2023.08","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.08","url":null,"abstract":"Descending thoracic and thoracoabdominal aortic replacement is a complex and high-risk surgery. Deep hypothermic circulatory arrest (DHCA) is a surgical technique that is useful in large distal aortic arch aneurysms or chronic dissections that require fenestration where proximal cross clamping would be difficult. It can also be used as part of a multimodal strategy for end-organ protection. However, DHCA has potential adverse effects on the myocardial, cerebral, pulmonary, and coagulation systems. The use of DHCA is guided by the experience and preferences of the surgical team as well as the technical demands of the proposed surgery.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48241092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-12DOI: 10.20517/2574-1209.2023.11
H. Onea, Florin L Lazăr, D. Olinic, B. Cortese
Drug-coated balloons (DCB) have emerged as a valid alternative for drug-eluting stents in the treatment of in-stent restenosis and de-novo lesions in small vessels. In the past years, a significant effort has been made to investigate the role of this strategy in larger vessel disease, with promising preliminary results being reported for several clinical scenarios, including complex lesions, such as bifurcations, chronic total occlusions and diffuse, long lesions. A DCB strategy appears to be of significant interest in diffuse coronary disease, as the total stent length represents an independent predictor for target-vessel failure and a surgical approach does not seem to improve mid- and long-term results compared to optimal medical treatment. Several studies have investigated the safety and efficacy of a non-stent-based approach in this complex setting, and as promising results have been reported, it is fair to assume that reducing the amount of implanted metal in diffusely affected vessels could become the standard of care for these patients if a full or blended therapy with DCB is adopted. However, long-term results from large-scale studies are awaited to confirm these preliminary and intriguing results.
{"title":"Diffuse coronary artery disease management with drug-coated balloons","authors":"H. Onea, Florin L Lazăr, D. Olinic, B. Cortese","doi":"10.20517/2574-1209.2023.11","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.11","url":null,"abstract":"Drug-coated balloons (DCB) have emerged as a valid alternative for drug-eluting stents in the treatment of in-stent restenosis and de-novo lesions in small vessels. In the past years, a significant effort has been made to investigate the role of this strategy in larger vessel disease, with promising preliminary results being reported for several clinical scenarios, including complex lesions, such as bifurcations, chronic total occlusions and diffuse, long lesions. A DCB strategy appears to be of significant interest in diffuse coronary disease, as the total stent length represents an independent predictor for target-vessel failure and a surgical approach does not seem to improve mid- and long-term results compared to optimal medical treatment. Several studies have investigated the safety and efficacy of a non-stent-based approach in this complex setting, and as promising results have been reported, it is fair to assume that reducing the amount of implanted metal in diffusely affected vessels could become the standard of care for these patients if a full or blended therapy with DCB is adopted. However, long-term results from large-scale studies are awaited to confirm these preliminary and intriguing results.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48662799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.20517/2574-1209.2022.51
L. Escolà-Vergé, A. Roque, M. N. Pizzi, J. González-López, B. Almirante, N. Fernández-hidalgo
Infective endocarditis (IE) is a complex disease whose prognosis depends on the causative microorganism, among other factors. The latter can be difficult to identify and/or treat. In this narrative review, we identify knowledge gaps in the diagnosis and antimicrobial treatment of IE, and attempt to shed light on current questions. Specifically, we: (1) analyze the factors that may hinder the microbiological diagnosis of blood culture-negative IE, as well as the role of new imaging techniques, such as 18F-fluorodeoxyglucose ([18F]FDG PET/CT), in the diagnostic capacity of this disease, understanding their advantages and assuming their limitations; (2) discuss the therapeutic approach to various difficult-to-treat microorganisms. In particular, we focus on the treatment of staphylococcal IE since, at present, staphylococci are the most frequent cause of IE in developed countries and staphylococcal IE is one of those with the highest short- and long-term mortality. We critically evaluate the current evidence on combination therapy and address the occurrence of serious side effects, an aspect that is often overlooked owing to the severity of the infection; and (3) emphasize the need for home antimicrobial treatment of patients with IE, as these are fragile people who benefit from an early return to their environment. This poses undoubted logistical challenges and requires robust evidence to ensure the best short- and long-term outcomes.
{"title":"Complex pathogens in infective endocarditis","authors":"L. Escolà-Vergé, A. Roque, M. N. Pizzi, J. González-López, B. Almirante, N. Fernández-hidalgo","doi":"10.20517/2574-1209.2022.51","DOIUrl":"https://doi.org/10.20517/2574-1209.2022.51","url":null,"abstract":"Infective endocarditis (IE) is a complex disease whose prognosis depends on the causative microorganism, among other factors. The latter can be difficult to identify and/or treat. In this narrative review, we identify knowledge gaps in the diagnosis and antimicrobial treatment of IE, and attempt to shed light on current questions. Specifically, we: (1) analyze the factors that may hinder the microbiological diagnosis of blood culture-negative IE, as well as the role of new imaging techniques, such as 18F-fluorodeoxyglucose ([18F]FDG PET/CT), in the diagnostic capacity of this disease, understanding their advantages and assuming their limitations; (2) discuss the therapeutic approach to various difficult-to-treat microorganisms. In particular, we focus on the treatment of staphylococcal IE since, at present, staphylococci are the most frequent cause of IE in developed countries and staphylococcal IE is one of those with the highest short- and long-term mortality. We critically evaluate the current evidence on combination therapy and address the occurrence of serious side effects, an aspect that is often overlooked owing to the severity of the infection; and (3) emphasize the need for home antimicrobial treatment of patients with IE, as these are fragile people who benefit from an early return to their environment. This poses undoubted logistical challenges and requires robust evidence to ensure the best short- and long-term outcomes.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67655699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.20517/2574-1209.2022.62
{"title":"The “Y”-configuration of double Neuroform Atlas assisted coil embolization for treatment of cerebral bifurcation wide-neck aneurysms: very long-term follow-up of a multicentric experience","authors":"","doi":"10.20517/2574-1209.2022.62","DOIUrl":"https://doi.org/10.20517/2574-1209.2022.62","url":null,"abstract":"","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67656492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.20517/2574-1209.2022.49
{"title":"Total endovascular aortic arch repair: is it for everyone and where is its evidence?","authors":"","doi":"10.20517/2574-1209.2022.49","DOIUrl":"https://doi.org/10.20517/2574-1209.2022.49","url":null,"abstract":"","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67655686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.20517/2574-1209.2022.54
Roberto Perezgrovas-Olaria, G. Soletti, M. Rahouma, A. Dimagli, Lamia G. Harik, Gianmarco Cancelli, Mohammad Yaghmour, Hillary Polk, Brian F. Closkey, Jessica Wright, M. Gaudino, L. Girardi, hristopher Lau
Objective: To assess follow-up mortality and reoperation rate in patients undergoing Bentall-De Bono operation according to the type of composite valve graft used. Methods: All consecutive adult patients operated on between May 1997 and December 2019 at our institution were included in the analysis and classified according to the use of a biological or a mechanical composite valve graft (bCVG or mCVG). The primary outcomes were follow-up mortality and reoperation rate. Secondary outcomes were operative mortality and major adverse events (MAEs) including operative mortality, myocardial infarction, cerebrovascular accident, dialysis, tracheostomy, and re-exploration for bleeding. Kaplan-Meier and competing risk analyses were used. Propensity matching analysis was used to balance differences in baseline characteristics between procedures. Results: Of 1,210 included patients, 798 received a bCVG and 412 a mCVG. The mean follow-up was 6.64 ± 0.21 years. The ten-year mortality rate was higher in the mCVG group (25.3% vs. 16.4%, P = 0.023). The ten-year reoperation rate was higher in the bCVG group (7.4% vs. 1.1%, P < 0.001). Overall operative mortality was 0.7%, and MAEs occurred in 6.2% of patients, with no significant differences between groups. Older age (hazard ratio [HR] 1.06, 95% confidence interval [CI: 1.04-1.08], P < 0.01), chronic obstructive pulmonary disease (HR 1.63, 95%CI: [1.01-2.64], P = 0.04), preoperative renal dysfunction (HR 3.08, 95%CI: [1.98-4.78], P < 0.001), New York Heart Association Class III/IV (HR 1.48, 95%CI: [1.04-2.10], P = 0.031), and mCVG (HR 2.15, 95%CI: [1.42-3.26], P < 0.001) were associated with higher risk of follow-up mortality. After propensity matching, the differences in mortality and reoperation remained significant. Conclusions: The Bentall-De Bono operation can be performed with consistently good results in experienced centers. Early outcomes are excellent regardless of the valve choice. In our study, the Bentall-De Bono operation with bCVG was associated with lower 10-year mortality but carried a higher risk of aortic reoperation. While the risk of reoperation is largely tied to valve choice, follow-up mortality is more likely to be influenced by patient comorbidities and risk factors.
目的:评价不同复合瓣膜移植类型本特尔-德博诺手术患者的随访死亡率和再手术率。方法:将我院1997年5月至2019年12月期间连续接受手术的所有成人患者纳入分析，并根据使用生物或机械复合瓣膜移植物(bCVG或mCVG)进行分类。主要观察指标为随访死亡率和再手术率。次要结局是手术死亡率和主要不良事件(MAEs)，包括手术死亡率、心肌梗死、脑血管意外、透析、气管切开术和再次探查出血。采用Kaplan-Meier和竞争风险分析。倾向匹配分析用于平衡不同程序之间基线特征的差异。结果:在1210例纳入的患者中，798例接受bCVG, 412例接受mCVG。平均随访时间为6.64±0.21年。mCVG组10年死亡率较高(25.3% vs. 16.4%， P = 0.023)。bCVG组10年再手术率较高(7.4%比1.1%，P < 0.001)。总手术死亡率为0.7%，MAEs发生率为6.2%，组间无显著差异。年龄较大(风险比[HR] 1.06, 95%可信区间[CI: 1.04-1.08]， P < 0.01)、慢性阻塞性肺疾病(HR 1.63, 95%CI: [1.01-2.64]， P = 0.04)、术前肾功能不全(HR 3.08, 95%CI: [1.98-4.78]， P < 0.001)、纽约心脏协会III/IV级(HR 1.48, 95%CI: [1.04-2.10]， P = 0.031)、mCVG (HR 2.15, 95%CI: [1.42-3.26]， P < 0.001)与随访死亡风险较高相关。倾向匹配后，死亡率和再手术的差异仍然显著。结论:在经验丰富的中心，本特尔-德博诺手术可获得一致的良好效果。无论选择何种瓣膜，早期结果都是非常好的。在我们的研究中，Bentall-De Bono手术合并bCVG的10年死亡率较低，但主动脉再手术的风险较高。虽然再次手术的风险很大程度上与瓣膜选择有关，但随访死亡率更可能受到患者合并症和危险因素的影响。
{"title":"Mortality and reoperation rate of biological versus mechanical Bentall-De Bono operation: a propensity-matched study","authors":"Roberto Perezgrovas-Olaria, G. Soletti, M. Rahouma, A. Dimagli, Lamia G. Harik, Gianmarco Cancelli, Mohammad Yaghmour, Hillary Polk, Brian F. Closkey, Jessica Wright, M. Gaudino, L. Girardi, hristopher Lau","doi":"10.20517/2574-1209.2022.54","DOIUrl":"https://doi.org/10.20517/2574-1209.2022.54","url":null,"abstract":"Objective: To assess follow-up mortality and reoperation rate in patients undergoing Bentall-De Bono operation according to the type of composite valve graft used. Methods: All consecutive adult patients operated on between May 1997 and December 2019 at our institution were included in the analysis and classified according to the use of a biological or a mechanical composite valve graft (bCVG or mCVG). The primary outcomes were follow-up mortality and reoperation rate. Secondary outcomes were operative mortality and major adverse events (MAEs) including operative mortality, myocardial infarction, cerebrovascular accident, dialysis, tracheostomy, and re-exploration for bleeding. Kaplan-Meier and competing risk analyses were used. Propensity matching analysis was used to balance differences in baseline characteristics between procedures. Results: Of 1,210 included patients, 798 received a bCVG and 412 a mCVG. The mean follow-up was 6.64 ± 0.21 years. The ten-year mortality rate was higher in the mCVG group (25.3% vs. 16.4%, P = 0.023). The ten-year reoperation rate was higher in the bCVG group (7.4% vs. 1.1%, P < 0.001). Overall operative mortality was 0.7%, and MAEs occurred in 6.2% of patients, with no significant differences between groups. Older age (hazard ratio [HR] 1.06, 95% confidence interval [CI: 1.04-1.08], P < 0.01), chronic obstructive pulmonary disease (HR 1.63, 95%CI: [1.01-2.64], P = 0.04), preoperative renal dysfunction (HR 3.08, 95%CI: [1.98-4.78], P < 0.001), New York Heart Association Class III/IV (HR 1.48, 95%CI: [1.04-2.10], P = 0.031), and mCVG (HR 2.15, 95%CI: [1.42-3.26], P < 0.001) were associated with higher risk of follow-up mortality. After propensity matching, the differences in mortality and reoperation remained significant. Conclusions: The Bentall-De Bono operation can be performed with consistently good results in experienced centers. Early outcomes are excellent regardless of the valve choice. In our study, the Bentall-De Bono operation with bCVG was associated with lower 10-year mortality but carried a higher risk of aortic reoperation. While the risk of reoperation is largely tied to valve choice, follow-up mortality is more likely to be influenced by patient comorbidities and risk factors.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67655777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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