| 1. |
- Perrotta, Sossio, 1975, et al.
(författare)
-
In patients with cardiac injuries caused by sewing needles is the surgical approach the recommended treatment?
- 2010
-
Ingår i: Interactive cardiovascular and thoracic surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 10:5, s. 783-92
-
Tidskriftsartikel (refereegranskat)abstract
- A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'In patients with sewing needle cardiac injuries is the surgical approach the recommended treatment?' The scientific literature was reviewed by searching Medline, using Ovid interface, from 1950 to August 2009. Six hundred and twenty-six papers were found, of which 24 were deemed relevant to this topic. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The cause of injury may delay the timing of presentation the diagnosis and consequently the therapeutic strategy. In nearly all the cases in the reviewed papers the authors surgically removed the needle from the heart. However, out of the 24 papers, four patients had a conservative treatment. Most of the authors recommend early removal of the needle to prevent migration and further anatomical damage. The early surgical removal of foreign bodies in the heart is considered an effective approach to prevent complications. The heart is more vulnerable to serious injuries when the foreign body is extracardiac than when the foreign body is completely intracardiac. The unceasing motion of the heart against the sharp point of the fixed foreign body will result in repetitive wounding with bleeding and consequent cardiac tamponade. Due to the tendency of the needle to migrate, the preoperative use of computer tomography scan, trans-thoracic and trans-oesophageal echocardiography have been advocated to locate the exact position of the needle and its correlation with the surrounding tissues. The intraoperative use of epicardial ultrasound or fluoroscopy is also recommended. However, in cases of late diagnosis, in previously untreated patients, treatment can be individualized. If the symptoms are less severe it is reasonable to adopt a conservative approach as with time most foreign bodies become safely encysted and do no harm. Patients can remain asymptomatic for many years. However, they may present many years later with complications such as pericarditis, tamponade or endocarditis. Strict follow-up is useful in those patients.
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
|
|
| 6. |
|
|
| 7. |
- Lentini, S, et al.
(författare)
-
Surgical treatment of pericardial cyst through median sternotomy.
- 2009
-
Ingår i: Minerva chirurgica. - 0026-4733. ; 64:1, s. 105-9
-
Tidskriftsartikel (refereegranskat)abstract
- Pericardial cysts are an uncommon benign congenital anomaly in the middle mediastinum. They are thought to result from failure of fusion of one of the mesenchymal lacunae that form the pericardial sac. The authors present the case of a 77-year-old-man with a large pericardial cyst, treated by surgical resection trough a median sternotomy. They analyze the different diagnostic alternatives and the various management options in this pathology. In the reported case the authors used a surgical resection trough a median sternotomy, to facilitate the exposure of all of the cyst, extending around the great vessels area, and on the other side of the chest.
|
|
| 8. |
- Lindgren, Martin, et al.
(författare)
-
Beta blockers and long-term outcome after coronary artery bypass grafting: a nationwide observational study.
- 2022
-
Ingår i: European heart journal. Cardiovascular pharmacotherapy. - : Oxford University Press (OUP). - 2055-6837 .- 2055-6845. ; 8:5, s. 529-36
-
Tidskriftsartikel (refereegranskat)abstract
- Beta blockers are associated with improved outcomes for selected patients with cardiovascular disease. We assessed long-term utilization of beta blockers after coronary artery bypass grafting (CABG) and its association with outcome.All 35,184 patients in Sweden who underwent first-time isolated CABG between 1 January 2006 and 31 December 2017 and were followed for at least 6 months were included in a nationwide observational study. Multivariable Cox regression models using time-updated data on dispensed prescriptions were used to assess associations between different types of beta blockers and outcome. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause mortality, stroke and myocardial infarction (MI). Subgroup analyses were performed in patients with and without previous MI, heart failure, and reduced left ventricular ejection fraction (LVEF). Median follow-up was 5.2 years (range 0-11).At baseline, 33,159 (94.2%) of the patients were dispensed beta blockers, 32,225 (91.6%) of which were cardioselective beta blockers. After 10 years, the dispense of cardioselective beta blockers had declined to 73.7% of all patients. Ongoing treatment with cardioselective beta blockers was associated with a slight reduction in MACE (hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.89-0.98, p = 0.0063). The reduction was largely driven by a reduced risk of MI (HR 0.83, 95% CI 0.75-0.92, p = 0.0003), while there was no significant reduction in all-cause mortality (HR 0.99, 95% CI 0.93-1.05) and stroke (HR 0.96, 95% CI 0.87-1.05). The reduced risk for MI was consistent in all investigated subgroups.Ongoing treatment with cardioselective beta blockers after CABG is associated with a reduction in MACE, mainly because of reduced long-term risk for MI. The association between cardioselective beta blockers and MI was consistent in patients with and patients without previous MI, heart failure, atrial fibrillation, or reduced LVEF.
|
|
| 9. |
- Perrotta, Sossio, 1975
(författare)
-
Chronic ascending aorta dissection.
- 2016
-
Ingår i: Journal of cardiac surgery. - : Hindawi Limited. - 1540-8191 .- 0886-0440. ; 31:12, s. 747-749
-
Tidskriftsartikel (refereegranskat)
|
|
| 10. |
- Perrotta, Sossio, 1975, et al.
(författare)
-
In patients undergoing surgical repair of post-infarction ventricular septal defect, does concomitant revascularization improve prognosis?
- 2009
-
Ingår i: Interactive cardiovascular and thoracic surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 9:5, s. 879-87
-
Tidskriftsartikel (refereegranskat)abstract
- A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients undergoing surgical repair of post-infarction ventricular septal defect (VSD), does concomitant revascularization improve prognosis?'. The scientific literature was reviewed by searching Medline, using Ovid interface, from 1950 to April 2009. Four hundred and five papers were found, of which 18 were deemed relevant to the topics. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, and results of these papers were tabulated. Seven out of 18 papers showed statistical evidence of benefit of concomitant coronary artery bypass grafting (CABG) in patients undergoing surgical repair of VSD. They showed a benefit especially with complete revascularization. Another five papers recommended CABG with VSD even in the absence of statistical evidence. The reported papers showed a mortality benefit from 26.3% without revascularization down to 21.2% with revascularization and an actuarial survival at five years from 29 up to 72%. However, six out of 18 papers did not find any difference. The largest study in this area was by Jeppsson et al. where 119 patients underwent VSD repair with revascularization and 70 underwent VSD repair only, the mortality was 38% vs. 46% (P=0.29). Barker et al. compared a group of 23 patients undergoing repair of VSD only and 42 patients undergoing concomitant CABG. The in-hospital mortality was 39.2% vs. 26.2%, and the four-year survival rate was 33.2% and 88.2%, respectively. Lundblad et al. found that in 66 patients undergoing concomitant CABG out of 102 undergoing repair of VSD, complete revascularization and revascularization of the culprit artery, both resulted in improved 30-day survival and long-term survival. Muehrcke et al. reported on 75 patients undergoing surgical repair of post-infarction VSD. Out of those, 33 (44%) had a concomitant CABG. The authors found that concomitant CABG increases long-term survival when compared with patients with unbypassed coronary artery disease (CAD) (P=0.0015). We conclude that patients undergoing concomitant CABG to all the stenotic coronary arteries, supplying the non-infarcted area, fare better both in improved 30-day survival and long-term survival. The improvement of the collateral flow to the myocardium contributes to its better recovery.
|
|
| 11. |
- Perrotta, Sossio, 1975, et al.
(författare)
-
In patients with severe active aortic valve endocarditis, is a stentless valve as good as the homograft?
- 2010
-
Ingår i: Interactive cardiovascular and thoracic surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 11:3, s. 309-13
-
Tidskriftsartikel (refereegranskat)abstract
- A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients with severe active aortic valve endocarditis, is a stentless valve as good as a homograft?' The scientific literature was reviewed by searching Medline, using the OVID interface, from 1950 to March 2010. One hundred and eight papers were found. Twelve papers were used in the writing of the article, of which 10 were deemed relevant to the topic. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, and results of these papers were tabulated. In the homograft series, literature review reports a reinfection rate from 3.8% to 6.8%. Yankah, in studying 161 patients with endocarditis, reports 91% freedom from reinfection at 10 and 17 years and 70% survival at 17-year follow-up. Sabik, in studying 103 consecutive patients with prosthetic endocarditis, reports a 3.8% reinfection rate and 95% freedom from reinfection at 10 years, with 56% survival at 10 year. In the stentless series: Musci, in studying 255 patients with endocarditis, reports a 8.6% reinfection rate, 83% freedom from reinfection at five years and 46% five-year survival. He finds a non-significant difference between survival and freedom from reinfection in patients with native valve endocarditis compared to those with prosthetic valve endocarditis (PVE) (P=0.1371 and P=0.8356). The same author, in 221 patients treated with a homograft, reports a 5.4% reinfection rate and 10-year freedom from reoperation, with a reinfection rate in native and PVE of 92%. Ten-year survival was better in native than in PVE (P=0.029). Siniawski, comparing two groups of patients treated with stentless valves and homografts, finds an equal reinfection rate of 4% and lower mortality for the stentless group (12% vs. 16%, respectively). He finds the reinfection rate to be lower for the homograft and stentless groups than for the patients treated with standard prostheses, respectively, 5.8%, 3.7% and 33%. The stentless valve offers a reinfection rate and postoperative echocardiographic data comparable to those achieved with homografts. Further follow-up is required to determine the stentless valve durability and long-term freedom from valve-related complications.
|
|
| 12. |
- Perrotta, Sossio, 1975, et al.
(författare)
-
Ministernotomy approach for surgery of the aortic root and ascending aorta.
- 2009
-
Ingår i: Interactive cardiovascular and thoracic surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 9:5, s. 849-58
-
Tidskriftsartikel (refereegranskat)abstract
- Different minimally invasive approaches have been proposed for cardiac surgery. Between those, the ministernotomy finds wide consensus for the treatment of the aortic disease, being both the upper reversed T and the upper J the mostly used type of incisions. The authors review the literature on the use of ministernotomy in the treatment of the ascending aorta and arch pathology. The scientific literature was reviewed by searching Medline, the Cochrane Library and the CINAHL database. A total of 1411 papers were found in Medline, 186 in the Cochrane database and 514 in CINAHL database; 50 papers were used to write the article; of which seven represent the most significant papers on the subject. The authors, journal, date and country of publication, patients group studied, relevant outcomes, and the results of these papers are tabulated. The ministernotomy is gaining consensus among surgeons. The indication to surgery, initially restricted only to selected elective patients, is now extended to more complex surgeries, including both the aortic root and aortic arch, redo-operations and, in minor cases, to emergency patients. Furthermore, the use of ministernotomy in redo aortic surgery with patent left internal mammary artery (LIMA) to left anterior descending (LAD) artery is a promising alternative. However, the use of this technique is still limited to few institutions and there are still a limited number of studies comparing this approach to full sternotomy in a prospective, randomized fashion. Even with those limitations, from the review of the literature, it seems that ministernotomy approach for aortic root and ascending aorta surgery is a feasible alternative, showing some advantages compared to full sternotomy. Those advantages include: reduced postoperative bleeding and pain, lower risk of mediastinitis, better aesthetic results, and faster respiratory function recovery. This is true not only for first time surgery, but also, and especially, for redo cases, where the limited exposure will reduce risks correlated to the surgical dissection of redo surgery. The ministernotomy approach for aortic root and ascending aorta surgery could in the future be more extensively used, offering greater benefits to cardiac surgical patients.
|
|
| 13. |
- Perrotta, Sossio, 1975, et al.
(författare)
-
Short- and long-term outcome after surgical aortic valve replacement in patients on dialysis.
- 2022
-
Ingår i: Journal of thoracic disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 14:2, s. 269-277
-
Tidskriftsartikel (refereegranskat)abstract
- There is no consensus on the choice of aortic valve prosthesis for patients with end-stage renal failure. We analyzed short- and long-term complications in dialysis patients who underwent aortic valve replacement (AVR) with either a biological (bAVR) or a mechanical (mAVR) prosthesis.All patients on dialysis who underwent bAVR or mAVR in Sweden from 1995 to 2017 (n=335) were included in a nationwide, population-based, observational, cohort study. Short and long-term complications were compared. Long-term mortality was compared with multivariable Cox regression analysis adjusted for age, sex, comorbidities, and a propensity score-matched model. Median follow-up was 2.8 (range, 0-16) years.Biological and mechanical valves were implanted in 253 (75.5%) and 82 (24.5%) patients, respectively. The bAVR patients were older and had more comorbidities. There was no significant difference in early complication rate. Thirty-day mortality was 9.1% in bAVR and 7.3% in mAVR patients (P=0.62). The multivariable Cox regression model did not show significant difference in mortality risk between bAVR and mAVR patients [adjusted hazard ratio (aHR) 1.33; 95% CI: 0.84-2.13; P=0.22]. The results were confirmed in the propensity-score matched model. The rate of aortic valve reoperations did not differ significantly between the bAVR and mAVR group.The short- and long-term complication rate is high, and the expected life expectancy limited, in dialysis patients undergoing AVR, without significant difference between biological and mechanical prostheses. The results suggest that biological valve prosthesis, avoiding systemic anticoagulation, is appropriate in most dialysis patients.
|
|
| 14. |
- Perrotta, Sossio, 1975, et al.
(författare)
-
Surgical Treatment for Infective Endocarditis: A Single-Centre Experience.
- 2017
-
Ingår i: The Thoracic and cardiovascular surgeon. - : Georg Thieme Verlag KG. - 1439-1902 .- 0171-6425. ; 65:3, s. 166-173
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectiveA considerable proportion of patients with acute infective endocarditis require surgical treatment. The aim of this study was to collate our short- and medium-term results of surgical treatment of infective endocarditis and to compare the results in native and prosthetic endocarditis. DesignTotal 254 operations for infective endocarditis from January 2008 to May 2015 were included in this retrospective study. There were 182 operations for native valve endocarditis and 72 for prosthetic valve endocarditis. Patient characteristics, operative details, complications, and mortality were registered. ResultsThe endocarditis was left sided in 247 operations (146 aortic, 78 mitral, and 23 double-valve) and right-sided in 7 (5 tricuspid and 2 pulmonary). Twenty-two patients (8.7%) died within 30 days (7.7% with native valve endocarditis and 11.1% with prosthetic valve endocarditis, p=0.31). Severe perioperative complications occurred in 99 of 254 operations (39%). Overall cumulative survival at 1 and 5 years was 86% and 75%, respectively, and it was not significantly different for native and prosthetic endocarditis (p=0.31). Eighteen patients (8%) had one (n=16) or two (n=2) recurrent episodes of endocarditis requiring surgery. ConclusionSurgery for infective endocarditis is still associated with a high early mortality rate and a considerable complication rate. Long-term outcome is acceptable. In our study population, morbidity and mortality were not significantly different in native and prosthetic endocarditis.
|
|
| 15. |
- Perrotta, Sossio, 1975, et al.
(författare)
-
Surgical treatment for isolated mitral valve endocarditis: a 16-year single-centre experience
- 2018
-
Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940 .- 1873-734X. ; 53:3, s. 576-581
-
Tidskriftsartikel (refereegranskat)abstract
- Despite progress in management, mitral valve endocarditis (MVE) is still a life-threatening disease. We report our experience in surgical treatment of infective isolated MVE. A total of 140 operations in 128 patients for MVE performed between January 2000 and December 2015 were included in a retrospective study. There were 109 (78%) operations for native and 31 (22%) operations for prosthetic valve endocarditis. Preoperative and postoperative characteristics and mortality of patients were registered. Cox regression identified factors associated with mortality. Mean follow-up period was 68 months (range 1-168 months) and 100% complete. There were 13 deaths within 30 days after the 140 operations (9%). Severe perioperative complications occurred in 59 (42%) operations. Overall cumulative survival was 73% +/- 4 at 5 years and 62 +/- 5% at 10 years after the first operation. Age, diabetes, EuroSCORE II and perivalvular abscess were independent predictors for long-term mortality. Valve repair was performed in 76 (54%) operations and replacement in 64 (46%) operations. Thirty-day mortality for repair was 1%, and 5-year and 10-year cumulative survival was 86 +/- 4% and 77 +/- 6%, respectively. In the replacement group the 30-day mortality was 19% and cumulative survival at 5 years and 10 years was 55 +/- 7% and 41 +/- 8%, respectively. Postoperative complications occurred in 21% and 67%, respectively, after operations for repair and replacement. Ten (8%) patients had 12 reoperations for recurrent endocarditis. MVE requiring surgical treatment is a challenging disease with high hospital mortality after valve replacement. Mitral valve repair can be performed in suitable endocarditis patients with excellent results. Age, diabetes and EuroSCORE were independently associated with mortality in a multivariable model.
|
|
| 16. |
- Perrotta, Sossio, 1975, et al.
(författare)
-
Surgical Treatment of Aortic Prosthetic Valve Endocarditis: A 20-Year Single-Center Experience.
- 2016
-
Ingår i: The Annals of thoracic surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 101:4, s. 1426-1432
-
Tidskriftsartikel (refereegranskat)abstract
- Despite progress in diagnostic methods and treatment, aortic prosthetic valve endocarditis (PVE) remains a life-threatening disease. We report the outcome of all operations for aortic PVE performed at our institution over the past 20 years.
|
|
| 17. |
- Perrotta, Sossio, 1975, et al.
(författare)
-
Survival and quality of life after aortic root replacement with homografts in acute endocarditis.
- 2010
-
Ingår i: The Annals of thoracic surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 90:6, s. 1862-7
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Treatment of prosthetic aortic valve endocarditis and native aortic valve endocarditis with abscess formation is associated with high mortality and morbidity. Aortic root replacement with a freestanding aortic homograft is an attractive alternative. We report outcome and quality of life after homograft replacement for infective endocarditis. METHODS: Sixty-two patients with infective prosthetic valve endocarditis (n = 31) or native valve endocarditis with abscess (n = 31), operated with homograft replacement were included. Thirty-day mortality, severe operative complications (dialysis, stroke, pacemaker implantation, myocardial infarction, and prolonged mechanical ventilation), midterm survival, reoperations, and quality of life were assessed after a mean follow-up of 37 ± 11 months. RESULTS: Nine patients (15%) died within 30 days and 22 patients (35%) had severe perioperative complications. Preoperative and perioperative variables univariately associated with early mortality were higher (Cleveland Clinic risk score [p = 0.014], extracorporeal circulation time [p = 0.003], prolonged inotropic support [p = 0.03], reoperation for bleeding [p = 0.01], and perioperative myocardial infarction [p < 0.001].) Cumulative survival was 82%, 78%, 75%, and 67% at one, three, five, and ten years, respectively. One patient was reoperated due to recurrence of endocarditis nine months after surgery and one after five years due to homograft failure. Quality of life, as assessed by the 36 item short-form health survey scales for physical and mental health, was not significantly different to an age-matched and gender-matched healthy control group. CONCLUSIONS: Severe acute aortic endocarditis treated with homograft replacement is still associated with a substantial early complication rate and mortality. Long-term survival and quality of life are satisfactory in patients surviving the immediate postoperative period.
|
|
