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Article ; Online: Surgical treatment of infective endocarditis: is there a role for rapid deployment aortic valve replacement?

Berretta, Paolo / Malvindi, Pietro Giorgio / Alfonsi, Jacopo / Di Eusanio, Marco

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2022 Volume 61, Issue 5, Page(s) 1116–1117

MeSH term(s)	Aortic Valve/surgery ; Endocarditis/surgery ; Endocarditis, Bacterial/surgery ; Heart Valve Prosthesis ; Humans
Language	English
Publishing date	2022-04-20
Publishing country	Germany
Document type	Editorial ; Comment
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezac089
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Article ; Online: Modes of failure of Trifecta aortic valve prosthesis.

Malvindi, Pietro Giorgio / Kattach, Hassan / Luthra, Suvitesh / Ohri, Sunil

Interactive cardiovascular and thoracic surgery

2022 Volume 35, Issue 2

Abstract: Objectives: Several concerns have been recently raised regarding the durability of Trifecta prostheses. Different mechanisms of early failure were reported. Our aim was to study in a large population the modes of failure of Trifecta valves.: Methods: ...

Abstract	Objectives: Several concerns have been recently raised regarding the durability of Trifecta prostheses. Different mechanisms of early failure were reported. Our aim was to study in a large population the modes of failure of Trifecta valves. Methods: We conducted a retrospective analysis of patients who underwent surgical aortic valve replacement with a Trifecta prosthesis during the period 2010-2018. Details regarding the mode of failure and haemodynamic dysfunction were collected for patients who underwent reintervention for structural valve failure. The Kaplan-Meier method was used to calculate survival. Competing risk analysis was performed to calculate the cumulative risk of reintervention for structural valve failure. Results: The overall population comprises 1228 patients (1084 TF model and 144 TFGT model). Forty-four patients-mean patients' age at the time of the first implant 69 (standard deviation: 12) years and 61% female-underwent reintervention for structural valve failure after a median time of 63 [44-74] months. The cumulative incidence of reintervention for structural valve failure was 0.16% (SE 0.11%), 1.77% (SE 0.38%) and 5.11% (SE 0.98%) at 1, 5 and 9 years, respectively. In 24/44 patients (55%), a leaflet tear with dehiscence at the commissure level was found intraoperatively or described by imaging assessment. The cumulative incidence of reintervention for failure due to leaflet(s) tear was 0.16% (SE 0.11%), 1.08% (SE 0.29%) and 3.03% (SE 0.88%) at 1, 5 and 9 years, respectively. Conclusions: Leaflet(s) tear with dehiscence along the stent post was the main mode of early failure, up to 5 years, after Trifecta valves' implantation.
MeSH term(s)	Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Aortic Valve Stenosis/surgery ; Bioprosthesis ; Female ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation/adverse effects ; Heart Valve Prosthesis Implantation/methods ; Hemodynamics ; Humans ; Male ; Prosthesis Design ; Prosthesis Failure ; Retrospective Studies
Language	English
Publishing date	2022-03-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivac086
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Zs.A 5730: Show issues

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Article ; Online: Tissue aortic valve replacement: expectations and reality.

Malvindi, Pietro Giorgio / Berretta, Paolo / Alfonsi, Jacopo / Di Eusanio, Marco

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2022 Volume 61, Issue 4, Page(s) 897–898

MeSH term(s)	Aortic Valve/surgery ; Bioprosthesis ; Heart Valve Prosthesis ; Humans ; Motivation
Language	English
Publishing date	2022-02-03
Publishing country	Germany
Document type	Journal Article ; Comment
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezac030
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Article ; Online: Limitations. Reprise.

Malvindi, Pietro Giorgio / Kowalewski, Mariusz / Paparella, Domenico

The Annals of thoracic surgery

2021 Volume 114, Issue 1, Page(s) 350–351

MeSH term(s)	Humans ; Mitral Valve
Language	English
Publishing date	2021-08-24
Publishing country	Netherlands
Document type	Letter ; Comment
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2021.07.063
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Zs.A 252: Show issues

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Article ; Online: Surgical repair and replacement for native mitral valve infective endocarditis.

Malvindi, Pietro Giorgio / Luthra, Suvitesh / Zingale, Anna / Bifulco, Olimpia / Berretta, Paolo / Pierri, Michele Danilo / Ohri, Sunil K / Di Eusanio, Marco

Journal of cardiovascular medicine (Hagerstown, Md.)

2024 Volume 25, Issue 4, Page(s) 334–341

Abstract: Aims: The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis are not clearly established.: Methods: Data of patients who underwent cardiac surgery for infective endocarditis over a 20-year period ...

Abstract	Aims: The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis are not clearly established. Methods: Data of patients who underwent cardiac surgery for infective endocarditis over a 20-year period (2001-2021) at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest-neighbour propensity-score matching was performed to account for differences in patients' profile between the repair and replacement subgroups. Results: Mitral valve replacement was performed in 186 patients, while in 96 cases patients underwent mitral valve repair. Propensity match analysis provided 89 well matched pairs. Mean age was 60 ± 15 years; 75% of the patients were male. Mitral valve replacement was more commonly performed in patients with involvement of both mitral leaflets, commissure(s) and mitral annulus. Patients with lesion(s) limited to P2 segment formed the majority of the cases undergoing mitral valve repair. There was no difference in terms of microbiological findings. In-hospital mortality was 7% with no difference between the repair and the replacement cohorts. Survival probabilities at 1, 5 and 10 years were 88%, 72% and 68%, respectively after mitral repair, and 88%, 78% and 63%, respectively after mitral replacement (log-rank P = 0.94). Conclusions: Mitral valve repair was more commonly performed in patients with isolated single leaflet involvement and provided good early and 10-year outcomes. Patients with annular disruption, lesion(s) on both leaflets and commissure(s) were successfully served on early and mid-term course by mitral valve replacement.
MeSH term(s)	Humans ; Male ; Middle Aged ; Aged ; Female ; Mitral Valve/diagnostic imaging ; Mitral Valve/surgery ; Heart Valve Prosthesis Implantation/adverse effects ; Treatment Outcome ; Endocarditis, Bacterial/microbiology ; Endocarditis/diagnostic imaging ; Endocarditis/surgery ; Mitral Valve Insufficiency/surgery
Language	English
Publishing date	2024-02-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2223461-5
ISSN	1558-2035 ; 1558-2027
ISSN (online)	1558-2035
ISSN	1558-2027
DOI	10.2459/JCM.0000000000001599
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Zs.A 5210: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 559: Show issues

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Article: Endocarditis in Patients with Aortic Valve Prosthesis: Comparison between Surgical and Transcatheter Prosthesis.

De Palo, Micaela / Scicchitano, Pietro / Malvindi, Pietro Giorgio / Paparella, Domenico

Antibiotics (Basel, Switzerland)

2021 Volume 10, Issue 1

Abstract: The interventional treatment of aortic stenosis is currently based on transcatheter aortic valve implantation/replacement (TAVI/TAVR) and surgical aortic valve replacement (SAVR). Prosthetic valve infective endocarditis (PVE) is the most worrisome ... ...

Abstract	The interventional treatment of aortic stenosis is currently based on transcatheter aortic valve implantation/replacement (TAVI/TAVR) and surgical aortic valve replacement (SAVR). Prosthetic valve infective endocarditis (PVE) is the most worrisome complication after valve replacement, as it still carries high mortality and morbidity rate. Studies have not highlighted the differences in the occurrence of PVE in SAVR as opposed to TAVR, but the reported incidence rates are widely uneven. Literature portrays different microbiological profiles for SAVR and TAVR PVE: Staphylococcus, Enterococcus, and Streptococcus are the pathogens that are more frequently involved with differences regarding the timing from the date of the intervention. Imaging by means of transoesophageal echocardiography, and computed tomography (CT) Scan is essential in identifying vegetations, prosthesis dysfunction, dehiscence, periannular abscess, or aorto-ventricular discontinuity. In most cases, conservative medical treatment is not able to prevent fatal events and surgery represents the only viable option. The primary objectives of surgical treatment are radical debridement and the removal of infected tissues, the reconstruction of cardiac and aortic morphology, and the restoration of the aortic valve function. Different surgical options are discussed. Fast diagnosis, the adequacy of antibiotics treatment, and prompt interventions are essential in preventing the negative consequences of infective endocarditis (IE).
Language	English
Publishing date	2021-01-06
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2681345-2
ISSN	2079-6382
ISSN	2079-6382
DOI	10.3390/antibiotics10010050
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Article: Normothermic frozen elephant trunk: our experience and literature review.

Malvindi, Pietro Giorgio / Alfonsi, Jacopo / Berretta, Paolo / Cefarelli, Mariano / Gatta, Emanuele / Di Eusanio, Marco

Cardiovascular diagnosis and therapy

2022 Volume 12, Issue 3, Page(s) 262–271

Abstract: Background and objective: The frozen elephant trunk (FET) technique has undoubtable advantages in treating complex and extensive disease of the aortic arch and the thoracic descending aorta. Despite several improvements in cardiopulmonary bypass ... ...

Abstract	Background and objective: The frozen elephant trunk (FET) technique has undoubtable advantages in treating complex and extensive disease of the aortic arch and the thoracic descending aorta. Despite several improvements in cardiopulmonary bypass conduction and surgical strategy, operative times and the institution of systemic circulatory arrest remain the main determinants of early mortality, cerebral/spinal cord injury and visceral organs dysfunction. We have conducted this review to highlight the recent technical advances in arch and FET surgery aiming at the reduction/avoidance of systemic circulatory arrest, and their impact on early outcomes. Methods: A literature search (from origin to January 2022), limited to publications in English, was performed on online platforms and database (PubMed, Google, ResearchGate). After a further review of associated or similar papers, we found 4 experiences, described by 11 peer-reviewed published papers, which focused on minimising or avoiding systemic circulatory arrest during total arch replacement plus stenting of the descending thoracic aorta. Key content and findings: Recent experiences reported the use of an antegrade endoaortic balloon, advanced and inflated into the stent graft, to provide an early systemic reperfusion soon after the deployment of the stented portion of the FET prosthesis and minimize the circulatory arrest time (down to a mean of 5 minutes), thus avoiding the need of moderate or deep hypothermia (mean systemic temperature 28-30 °C) while allowing a complete arch and FET repair. Our approach, based on off-pump retrograde vascular stent graft deployment in distal arch/descending thoracic aorta, and the use of a retrograde endoballoon, allows the repair of extensive aortic pathologies during uninterrupted normothermic cerebral and lower body perfusion. Conclusions: The use of endoballoon occlusion has emerged in recent years as a safe and effective strategy to allow distal perfusion during FET repair. This technique minimizes or avoids the detrimental effects of hypothermia and systemic circulatory arrest and significantly reduces the operative times.
Language	English
Publishing date	2022-06-21
Publishing country	China
Document type	Journal Article ; Review
ZDB-ID	2685043-6
ISSN	2223-3660 ; 2223-3652
ISSN (online)	2223-3660
ISSN	2223-3652
DOI	10.21037/cdt-22-73
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Article ; Online: Transaxillary approach enhances postoperative recovery after mitral valve surgery.

Malvindi, Pietro Giorgio / Wilbring, Manuel / De Angelis, Veronica / Bifulco, Olimpia / Berretta, Paolo / Kappert, Utz / Di Eusanio, Marco

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2023 Volume 64, Issue 1

Abstract: Objectives: Several thoracic incisions have been described and different techniques used for cardiopulmonary bypass, myocardial protection, and valve exposure in minimally invasive mitral valve surgery. The aim of this study is to compare the early ... ...

Abstract	Objectives: Several thoracic incisions have been described and different techniques used for cardiopulmonary bypass, myocardial protection, and valve exposure in minimally invasive mitral valve surgery. The aim of this study is to compare the early outcomes of patients operated using a simplified minimally invasive approach through a right transaxillary (TAxA) access with those achieved with conventional full sternotomy (FS) operations. Methods: Prospectively collected data of patients who underwent mitral valve surgery between 2017 and 2022 at 2 academic centres were reviewed. Among them, 454 patients were operated through minimally invasive mitral valve surgery TAxA access and 667 patients through FS; associated aortic and coronary arteries surgery (CABG) procedures, infective endocarditis, redo and urgent operations were excluded. A propensity-matched analysis was performed using 17 preoperative variables. Results: Two well-balanced cohorts including a total of 804 patients were analysed. The rate of mitral valve repair was similar in both groups. Operative times were shorter in the FS group; nevertheless, in patients operated with a minimally invasive approach, there was a trend towards decreasing cross-clamp time over the study period (P = 0.07). In the TAxA group, 30-day mortality was 0.25%, and postoperative cerebral stroke rate was 0.7%. TAxA mitral surgery was associated with shorter intubation time (P < 0.001) and intensive care unit stay (P < 0.001). After a median hospital stay of 8 days, 30% of patients who had TAxA surgery were discharged home versus 5% in the FS group (P < 0.001). Conclusions: When compared with FS access, TAxA approach provides at least similar excellent early outcomes in terms of perioperative morbidity and mortality and allows shorter mechanical ventilation time, intensive care unit and postoperative hospital stay with a higher rate of patients able to be discharged home without any further period of cardiopulmonary rehabilitation.
MeSH term(s)	Humans ; Mitral Valve/surgery ; Postoperative Complications ; Cardiac Surgical Procedures/adverse effects ; Cardiac Surgical Procedures/methods ; Sternotomy/methods ; Thoracotomy/methods ; Minimally Invasive Surgical Procedures/adverse effects ; Minimally Invasive Surgical Procedures/methods ; Treatment Outcome ; Retrospective Studies ; Heart Valve Prosthesis Implantation/methods
Language	English
Publishing date	2023-05-23
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezad207
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Article ; Online: Results and insights after 413 TAVI procedures performed by cardiac surgeons on their own.

Malvindi, Pietro Giorgio / Berretta, Paolo / Capestro, Filippo / Bifulco, Olimpia / Alfonsi, Jacopo / Cefarelli, Mariano / Pierri, Michele Danilo / Di Eusanio, Marco

Interdisciplinary cardiovascular and thoracic surgery

2023 Volume 36, Issue 6

Abstract: Objectives: Current evidence on transcatheter aortic valve implantation (TAVI) has been generated exclusively by cardiology studies and no operative data from cardiac surgeons are available. Here, we describe the development of our TAVI programme and ... ...

Abstract	Objectives: Current evidence on transcatheter aortic valve implantation (TAVI) has been generated exclusively by cardiology studies and no operative data from cardiac surgeons are available. Here, we describe the development of our TAVI programme and report the results of transfemoral (TF) TAVI done by cardiac surgeons on their own. Methods: This study included all the TAVI procedures on native valve performed at Cardiac Surgery Unit, Ospedali Riuniti di Ancona, during the period October 2018 to July 2022. Relevant prospectively collected preoperative, intraprocedural and postoperative data were retrieved from the Institutional database. Results: A total of 413 patients were included in the study. Mean patients' age was 82 years and among them 44% (180/413) were male. STS score was 3.1% (2.2-4.4). Eighty patients underwent transapical TAVI and 333 patients had a TF approach. We progressively moved from transapical TAVI towards TF procedures that are now routinely performed on conscious sedation and using a fully percutaneous approach. After TF TAVI, 30-day mortality rate was 1%, cerebral stroke occurred in 2% of the cases, permanent pacemaker implantation was necessary in 23% of the patients and in 6% of the cases there was a moderate/severe degree of aortic regurgitation. There was no association between operators performing TAVI and 30-day mortality. Conclusions: The acquisition of catheter-based skills and an adequate training allowed cardiac surgeons to perform on their own awake and fully percutaneous TF TAVI with similar results when compared with major randomized clinical trials and registries' experiences.
Language	English
Publishing date	2023-05-11
Publishing country	England
Document type	Journal Article
ISSN	2753-670X
ISSN (online)	2753-670X
DOI	10.1093/icvts/ivad074
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Article ; Online: del Nido and Histidine-Tryptophan-Ketoglutarate cardioplegia in minimally invasive mitral valve surgery: A propensity-Match study.

Malvindi, Pietro Giorgio / Bifulco, Olimpia / Berretta, Paolo / Silvano, Raffaele / Alfonsi, Jacopo / Cefarelli, Mariano / Zingaro, Carlo / Di Eusanio, Marco

Perfusion

2023 , Page(s) 2676591231161920

Abstract: Introduction: In the last decade, del Nido cardioplegia has been embedded in adult cardiac surgery involving CABG and aortic valve surgical procedures. We reviewed our early experience with del Nido cardioplegia in the setting of minimally invasive ... ...

Abstract	Introduction: In the last decade, del Nido cardioplegia has been embedded in adult cardiac surgery involving CABG and aortic valve surgical procedures. We reviewed our early experience with del Nido cardioplegia in the setting of minimally invasive mitral valve surgery. Methods: Data on 120 consecutive patients operated between 03/2021 and 06/2022 were retrieved from our internal database (infective endocarditis and urgent operations were excluded). Patients were divided into two groups according to the use of Histidine-Tryptophan-Ketoglutarate or del Nido cardioplegia. A propensity match analysis was performed using thirteen preoperative and intraoperative variables. Several intraoperative data and early postoperative outcomes were investigated, including cardiac enzymes (Troponin I HS and CK-MB) measured upon arrival in the Intensive Care Unit (ICU), after 12 hours and everyday thereafter. Results: There was no difference in preoperative characteristics and surgical techniques between both unmatched and matched Histidine-Tryptophan-Ketoglutarate and del Nido populations. Patients in the del Nido group received a lower volume of cardioplegia ( Conclusions: del Nido cardioplegia in the setting of minimally invasive mitral valve surgery seemed safe with acceptable myocardial protection and excellent early outcomes.
Language	English
Publishing date	2023-03-07
Publishing country	England
Document type	Journal Article
ZDB-ID	645038-6
ISSN	1477-111X ; 0267-6591
ISSN (online)	1477-111X
ISSN	0267-6591
DOI	10.1177/02676591231161920
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