giuseppe Vite

and 7 more

Marco Moscarelli

and 9 more

Background. The effect of metabolic syndrome (MetS), defined as insulin resistance along with two or more of: obesity, atherogenic dyslipidaemia and elevated blood pressure, on post-operative complications after isolated heart valve intervention remains controversial. We hypothesized that MetS may negatively influence the post-operative course in these patients. Methods. Patients from 10 cardiac units who underwent isolated valve intervention (mitral ± tricuspid repair/replacement (MVS) or aortic valve replacement (SAVR), or transcatheter aortic valve replacement (TAVR) were included. MetS was defined according to the WHO criteria. Primary outcome was in-hospital mortality and overall post-operative length of stay. Relevant post-operative complications were also recorded. Results. From 2010 to 2019, 17283 patients underwent valve intervention. The MVS, SVAR and TAVR accounted for the 39.4%, 48.2% and 12.3% respectively of the whole. MetS compared to no-MetS was associated to higher mortality in the MVS group (6.5% vs. 2%, p<0.001), but not in the SAVR and TAVR group. In both surgical cohorts, MetS was associated with increased complications including red blood cells transfusion, renal failure, mechanical ventilation time, intensive care and overall post-operative length of stay (11 (9) vs. 10 (6), p<0.001 and 10 (6) vs. 10 (5) days, p=0.002, MVS and SAVR)). No differences were found in the TAVR cohort, with similar mortality and complications. Conclusion. MetS was associated to more post-operative complications, with higher mortality in the MVS group. In the TAVR cohort, post-operative complications and mortality rate did not differ between patients with and without MetS, however length of stay was longer in the MetS group.

Marco Moscarelli

and 1 more

The use of radial artery (RA) grafts for coronary bypass surgery has recently gained newer attention since it has been associated with significant reduction in the risk of midterm cardiac events. Surprisingly the use on the RA graft as second ‘best’ conduit has been limited among the surgical community. There may be several explanations for the little popularity of the RA graft; one of the reasons that could prevent surgeons to include the RA in the daily surgical armamentarium it is that patients with RA grafts may require postoperative calcium-channel blocker (CB) therapy. Due to the thick muscular wall, it seems possible that the RA would needs CB in order to prevent spasm and ameliorate patency. CBs are, however, associated with important side effects; also they have hypotensive effect that can hamper the use of other therapy such as beta-blocker or angiotensin-converting enzyme inhibitors. The evidence supporting the use of CB after RA graft (either in the early phase or as chronic calcium-blocker (CCB)) is weak. A the post-hoc analysis from the ‘RADIAL’ (Radial Artery Database International ALliance), showed that in patients with RA, the use of CB for at least 12 months was associated with better clinical and angiographic outcomes at mid-term follow-up, but confounders and bias may be responsible for the reported findings (as healthier patients are more likely to tolerate CB) . This review aims to summarize current evidences available on the topic and to serve as benchmark for evidence-based decision-making for CB prescription after RA grafting.

Marco Moscarelli

and 9 more

Objective: Cardiac tumors are rare conditions. The vast majority of them are benign yet they may lead to serious complications. Complete surgical resection is the gold standard treatment and should be performed as soon as the diagnosis is made. Median sternotomy (MS) is the standard approach and provides excellent early outcomes and durable results at follow-up. However, minimally invasive (MI) is gaining popularity and its role in the treatment of cardiac tumors needs further clarification. Methods: A systematic literature review identified 12 candidate studies; of these, 11 met the meta-analysis criteria. We analyzed outcomes of 653 subjects (294 MI and 359 MS) with random effects modeling. Each study was assessed for heterogeneity. The primary endpoints were mortality at follow-up and tumor relapse. Secondary endpoints included relevant intra- and post-operative outcomes; tumor size was also considered. Results: There were no significant between-group differences in terms of late mortality (incidence rate ratio (IRR): MI vs. MS, 0.98 [95% CI: 0.25¬–3.82], p = 0.98). Few relapses and redo surgery were observed in both groups (IRR: 1.13[0.26-4.88], p=0.87);( IRR: 1.92 [95% CI: 0.39-9.53], p=0.42); MI was associated to prolonged operation time yet with no effects on clinical outcomes. Tumor size did not significantly differ between groups. Conclusions: Both MI and MS are associated with excellent early and late outcomes with acceptable survival rate and low incidence of recurrences. This study confirms that cardiac tumor may be approached safely and radically with a MI approach.