The Freedom Solo (FS) bovine pericardial valve (Sorin Group, Milan, Italy) is a stentless bioprosthesis that was introduced in 2004 and approved by the United States Food and Drug Administration in ...2014. No long-term follow-up series are available to date. We report the multicenter experience of 4 European institutions that began implanting FS extensively from its introduction, providing the largest series with long-term follow-up.
From 2004 to 2009, 565 patients (242 women 42.8%; mean age, 74.6 ± 8.3 years) underwent isolated (n = 350) or combined (n = 215) aortic valve replacement with the FS. Mean follow-up, including clinical and strict echocardiographic evaluation, was 6.9 ± 3.7 years (maximum, 11.8 years; cumulative 2,965 patient-years). Primary end point was freedom from structural valve deterioration (SVD), and secondary end points were freedom from reoperation and overall survival.
Mean logistic European System for Cardiac Operative Risk Evaluation I was 10.3% ± 6.7%. Overall 30-day mortality was 3.7%, and no deaths were valve related. There was no severe prostheses-patient mismatch, and moderate prostheses-patient mismatch occurred only in 1 patient (0.17%). Twenty-eight patients (5.2%) underwent reoperation (20 surgical replacements, 8 transcatheter aortic valve-in-valve replacements) due to endocarditis in 9, blunt trauma in 1, and SVD in 18. SVD was reported in 5 other patients alive at time of censoring. Freedom from SVD and reoperation was 90.8% (95% confidence interval, 89.1% to 92.5%) and 87.3% (95% confidence interval, 85.6% to 89.0%), respectively, at 10 years of follow-up, and the overall actuarial survival was 56.4% (95% confidence interval, 53.3% to 59.5%).
The FS valve provided excellent long-term durability and hemodynamic performance in this large, multicenter European experience. Moreover, the FS, given the low rate of SVD, along with a simple implantability, proved to be a reliable bioprosthesis in the aortic position as a valid alternative to stented bioprostheses.
Sweet Heart and Light Heart represent the first two educational formats of ITACARE-P, a recently established scientific association that joins various professionals with the aim of promoting all ...activities related to Cardiac Prevention and Rehabilitation. These educational formats represent opportunities for updating, comparing and sharing ideas among experts in order to standardize behaviors on hot topics. Pathologies in the metabolic field were chosen: diabetes mellitus and obesity, especially due to the cardiologist's possibility of prescribing drugs belonging to the SGLT2-i and GLP-RA classes, which have been shown to have a cardioprotective and nephroprotective effect, thus carrying a favorable influence on cardiovascular mortality. Sweet Heart and Light Heart were structured in a series of lectures alternated with “peer-to-peer” discussions; the possibilities offered by Italian National Health Service refundability in the prescription of these drugs and the difficulties that can be encountered in communicating this therapy to patients, particularly in the case of obesity where the purchase of the drug is at the patient's own expense, were examined. The results of this initiative was the drafting and publication of a position paper involving the entire Scientific Committee of the Association concerning the management of the patient suffering from diabetes mellitus in Cardiac Rehabilitation, with the peculiarities that concern the approach to the patient in this setting, such as the prescription of physical exercise in the same way as a drug, the introduction of process and outcome indicators, and the search for an anti-atherogenic or rather hemodynamic effect.
Cardiovascular diseases (CVD) have a lower prevalence in women than men; although, a higher mortality rate and a poorer prognosis are more common in women. However, there is a misperception of CVD ...female risk since women have commonly been considered more protected so that the real threat is vastly underestimated. Consequently, female patients are more likely to be treated less aggressively, and a lower rate of diagnostic and interventional procedures is performed in women than in men. In addition, there are substantial sex differences in CVD, so different strategies are needed. This review aims to evaluate the main gender-specific approaches in CVD.
Abstract Objective Stentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. The aim of the current multi-institutional study was to ...compare hemodynamics of transcatheter (TAVR) and the Freedom SOLO Stentless (FS) valve in an intermediate risk population undergoing surgical aortic valve replacement. Methods From 2010 to 2014, 420 consecutive patients underwent isolated surgical aortic valve replacement with FS and 375 patients underwent TAVR. Only patients with intermediate operative risk (Society of Thoracic Surgeons score 4-10) and small aortic annulus (≤23 mm) were included. After a propensity matched analysis 142 patients in each group were selected. Thirty-day postoperative clinical and echocardiographic parameters were evaluated. Results Mean prosthesis diameter was 22.2 ± 0.9 mm for FS and 22.4 ± 1.0 mm for TAVR. In-hospital mortality was 2.1% for FS and 6.3% for TAVR ( P = .02). Postoperative FS peak gradients were 19.1 ± 9.6 mm Hg (mean 10.8 ± 5.9 mm Hg); TAVR peak gradients were 20.2 ± 9.5 mm Hg (mean 10.7 ± 6.9 mm Hg) P = .57 ( P = .88). Postoperative effective orifice area was 1.93 ± 0.52 cm2 for FS and 1.83 ± 0.3 cm2 for TAVR ( P = .65). There was no prostheses-patient mismatch in either group. Postoperative grade 2-3 paravalvular leak was present in 3.5% for TAVR and 0.7% for FS. Postoperative permanent pacemaker implant rate was 12% for TAVR and only 1 case (0.7%) in the FS group ( P < .001). Conclusions In patients with small aortic annulus and intermediate risk, both FS and TAVR demonstrated similar excellent hemodynamic performance. TAVR demonstrated greater mortality and rates of pacemaker insertion. Further studies are warranted to validate TAVR indications in this subset of patients.
Anemia is one of the most frequent comorbidities found in patients with coronary artery disease and chronic heart failure (CHF) who are being followed in cardiac rehabilitation facilities. The more ...frequent type of anemia is caused by iron deficiency (IDA, iron-deficiency anemia): this review summarizes the state of the art of this topic. First of all, the mechanisms of IDA will be analyzed. Subsequently, a description of the main conditions where IDA can unfavorably affect the clinical course, and of its more frequent complications, will be presented (percutaneous interventions, heart surgery, CHF). Special attention will be paid in the description of anemia in the setting of CHF. To this regard, in recent years a relevant amount of research has been carried out, to determine whether treating anemia (either by directly stimulating erythropoiesis or by correcting iron deficiency by oral or intravenous route) is of any clinical and prognostic relevance in patients with CHF. The results of this research will, therefore, be summarized and critically discussed. Finally, we will outline the promising role of cardiac rehabilitation facilities and of its network of experts in the diagnosis, prognostic stratification, and treatment of anemia and iron deficiency.
Minimally invasive coronary artery bypass: Twenty-year experience Repossini, Alberto; Di Bacco, Lorenzo; Nicoli, Flavia ...
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
July 2019, 2019-07-00, 20190701, Letnik:
158, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Minimally invasive direct coronary artery bypass for the left thoracic artery on the left anterior descending artery is a safe and less traumatic surgical technique. We retrospectively evaluated ...long-term outcomes in a large series of patients undergoing minimally invasive direct coronary artery bypass.
From 1997 to 2016, 1060 patients underwent minimally invasive direct coronary artery bypass: 646 patients (61%) with isolated proximal left anterior descending disease and 414 patients (39%) with multivessel disease as a part of hybrid coronary revascularization or in association with medical therapy. Long-term follow-up, major cardiac and cerebral adverse events, and freedom from angina were analyzed.
Mean age of patients was 71 ± 12.5 years, and median European System for Cardiac Operative Risk Evaluation II was 3.2% (interquartile range, 0.6%-7.8%). Postoperative death occurred in 9 patients (0.8%), and perioperative stroke occurred in 3 patients (0.3%). An angiogram or computed tomography scan was performed and was available in patients within 10 years of follow-up (n = 696), demonstrating a 96.8% graft patency rate. At 13.9 ± 5.6 years of follow-up, no surgical reintervention was performed for left thoracic artery on left anterior descending artery graft failure, but 14 patients underwent left anterior descending or left thoracic artery on left anterior descending artery percutaneous coronary intervention. Kaplan–Meier survival curve shows 87.1% at 5 years (95% confidence interval, 81-92.5), 84.3% at 10 years (95% confidence interval, 77.1-91.4), and 79.8% at 15 years (95% confidence interval, 72.2-87.3). Survival freedom from major adverse events was 87.0% (95% confidence interval, 85.9-88.1) at 5 years and 70.5% (95% confidence interval, 66.4-74.6) at 15 years.
Minimally invasive direct coronary artery bypass can be safely performed with low postoperative mortality and morbidity with excellent short- and long-term survival and freedom from major adverse events and angina with a reduced surgical invasiveness.
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Single–suture line placement of a pericardial stentless valve Repossini, Alberto; Kotelnikov, Igor; Bouchikhi, Riad ...
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
11/2005, Letnik:
130, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Implantation of bioprostheses in the supra-annular position with the single suture line was first applied by O’Brien to porcine stentless valves. The aim of this study was to evaluate the clinical ...performance of the Pericarbon Freedom stentless bioprosthesis (Sorin Biomedica Cardio, Saluggia, Italy) implanted in supra-annular position with the single–suture line technique. The single-suture approach for the Pericarbon Freedom stentless bioprosthesis is obtained by trimming away all the extra tissue of the valve inflow side and scalloping the outflow side.
Between February 2002 and August 2004, a total of 65 consecutive patients at our institution (48% male, mean age 69 ± 12 years) underwent aortic valve replacement with Pericarbon Freedom stentless bioprostheses implanted with a single suture line. Most recurrent etiology was senile degeneration (80%). Pericarbon Freedom 25-mm and 27-mm valves were the most frequently implanted. Thirty patients had concomitant procedures (mainly coronary artery bypass grafting, 16 patients). Overall crossclamp time was 76 ± 21 minutes.
All patients survived intervention. One patient died early of multiorgan failure (postoperative day 16). There were 4 early non–valve-related complications and no late complications at a mean follow-up of 491 ± 270 days. Four patients showed trivial central prosthetic regurgitation at intraoperative transesophageal echocardiography; among these cases, only 1 was confirmed at 6-month transthoracic echocardiography. At postoperative echocardiographic assessment, mean pressure gradient for the 25- through 29-mm size group was 10.2 ± 7.1 mm Hg, and peak pressure gradient was 18.1 ± 12.3 mm Hg.
Our initial experience combined a well-established supra-annular implantation technique with the Pericarbon Freedom stentless bioprosthesis, a latest-generation pericardial stentless valve. The combination showed excellent results in terms of safety and reliability, although this technique required adequate experience. Clinical outcomes are similar to those obtained with other techniques, with satisfactory hemodynamic performance.
There are sex differences in vulnerability to Coronavirus disease 2019 (COVID-19). The coronavirus S protein mediates viral entry into target cells employing the host cellular serine protease TMPRSS2 ...for S-protein priming. The TMPRSS2 gene expression is responsive to androgen stimulation and it could partially explain sex differences. We hypothesized that men chronically exposed to 5-alpha reductase inhibitors (5ARIs) for benign prostate hyperplasia (BPH) have a lower risk of hospitalization for COVID-19.
This is a population-based case-control study on consecutive patients positive for SARS-CoV-2 virus who required hospitalization for COVID-19 (cases), age-matched to beneficiaries of the Lombardy Regional Health Service (controls). Data were collected by two high-volume COVID-19 regional centers of Lombardy (Italy). The primary outcome was to compare the prevalence of patients chronically exposed to 5ARIs, who required hospitalization for COVID-19, with the one of controls.
Overall, 943 males were enrolled; 45 (4.77%) were exposed to 5ARI. COVID-19 patients aged >55 years under 5ARI treatment were significantly less than expected on the basis of the prevalence of 5ARI treatment among age-matched controls (5.57 vs. 8.14%; P=0.0083, 95% CI: 0.75-3.97%). This disproportion was higher for men aged >65 (7.14 vs. 12.31%; P=0.0001, 95% CI: 2.83-6.97%). Eighteen 5ARIs-patients died; the mean age of men who died was higher than those who did not: 75.98±9.29 vs. 64.78±13.57 (P<0.001). Cox-regression and multivariable models did not show correlation between 5ARIs exposure and protection against intensive care unit admission/death.
Men exposed to 5ARIs might be less vulnerable to severe COVID-19, supporting its use in disease prophylaxis.
The utilization of cardiovascular rehabilitation (CR) programmes in patients with Lower Extremity Peripheral Artery Disease (LEPAD) is generally poor, with limited evidence of current policies for ...referral. The aim of the study was to evaluate, within a cohesive network of CR and vascular surgery facilities with facilitated referral process, the clinical characteristic of LEPAD patients referred to CR and related outcomes, as compared to patients not referred. The present is an observational prospective study of consecutive patients recruited at vascular surgery facilities. Out of 329 patients observed, the average referral rate to CR was 34% (28% and 39% in patients with and without recent peripheral revascularization, p<0.05). LEPAD patients entering the CR programme were similar to those who did not according to sex, age, the vascular surgery setting of evaluation, and localization of arterial lesions. Patients with moderate intermittent claudication and patients with acute limb ischemia as index event were more represented among those who attended CR (41% vs 21% and 9% vs 2% respectively, p<0.05). Patients referred to CR had five times more episodes of acute coronary syndrome and heart failure as complication of the index event. The cardiovascular risk profile (obesity 29.5% vs 11%, p<0.05; hypercholesterolemia 80% vs 61%, p<0.05) was much worse in LEPAD patients referred to CR, but conversely, they better achieved secondary prevention targets, particularly for blood pressure control (97% vs 57%, p<0.05). All-cause 2-year mortality in the whole patients' population was 6%. Patients entering the CR programme displayed less events (13.5% vs 37.7%, p<0.05), mainly death (3.1% vs 11.3%, p<0.05) and limb-related events (4.2% vs 15.2%, p<0.05). The results of our study suggest that when a cohesive network of vascular surgery and CR facilities becomes available, the referral rate to rehabilitation may increase up to one third of eligible patients. Patients with higher comorbidity and cardiovascular risk seem to have priority in the referral process, nevertheless those with peripheral revascularization are still underestimated. Entering CR may ensure better cardiovascular risk profile and cardiovascular prognosis in LEPAD patients, and consequently the systematic adoption of this care model needs to be strongly recommended and facilitated.
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