Piffaretti G, Lomazzi C, Grassi V
… +5 more, Böckler D, Gable DR, Milner R, Upchurch GR, Trimarchi S
Eur J Cardiothorac Surg
· 2026 Mar · PMID 41734269
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OBJECTIVES: To evaluate the results of thoracic endovascular aortic repair (TEVAR) in large (diameter ≥7 cm) aneurysms of the descending thoracic aorta. METHODS: This cohort has been extrapolated from the prospective, ob...OBJECTIVES: To evaluate the results of thoracic endovascular aortic repair (TEVAR) in large (diameter ≥7 cm) aneurysms of the descending thoracic aorta. METHODS: This cohort has been extrapolated from the prospective, observational (on-label and off-label), worldwide multicentre Global Registry for Endovascular Aortic Treatment (GREAT) (NCT01658787). Patients were divided into 2 groups based on the baseline aortic diameter: standard aneurysms (<7 cm) and larger aneurysms (≥7 cm). Primary outcomes were overall survival and freedom from TEVAR-related reintervention. Secondary outcomes were freedom from aortic-related mortality (ARM), as well as from type 1 endoleaks, and cumulative risk of TEVAR-related infection and/or aorto-bronchial/oesophageal fistulization. RESULTS: We analysed 613 (80.4%) patients with standard aneurysms and 149 (19.6%) with larger aneurysms. Demographic data and comorbidities were not different between the groups. At the 4- to 6-year window, 496 (65.1%) patients remained under follow-up (standard, n = 409 [66.7%] vs large, n = 87 [58.4%]; odds ratio [OR]: 1.4, P = .056). Large aneurysm diameter was independently associated with higher hazards for all-cause mortality (hazard ratio [HR]: 1.6, 95% CI, 1.19-2.20; P < .001), TEVAR-related reintervention (HR: 2.4, 95% CI, 1.52-3.65; P < .001), risk of ARM (HR: 2.2, 95% CI, 1.03-4.75; P = .026), cumulative risk of TEVAR-related infection/fistulization, and type 1 endoleaks (HR: 3.3, 95% CI, 1.89-5.65; P < .001). CONCLUSIONS: Preoperative descending thoracic aortic diameter seems to be an important determinant of outcomes after TEVAR, where patients presenting with aortic diameter ≤ 7 cm showed more favourable long-term outcomes.
Tagliafierro M, Kanade R, Kirilina D
… +12 more, Mitchell W, Ott N, Kitada Y, Nickles J, Mens AM, Kodali S, Hahn R, Geirsson A, Argenziano M, Kurlansky P, George I, Pirelli L
OBJECTIVES: Patients with concomitant severe aortic stenosis (AS) and moderate/severe mitral stenosis (MS) pose a complex therapeutic challenge. While double valve surgery (DVS) remains the gold standard, its high operat...OBJECTIVES: Patients with concomitant severe aortic stenosis (AS) and moderate/severe mitral stenosis (MS) pose a complex therapeutic challenge. While double valve surgery (DVS) remains the gold standard, its high operative risks have led to investigating novel strategies, chiefly transcatheter interventions. Due to the lack of commercially available transcatheter devices for MS, numerous high-risk patients undergo isolated transcatheter aortic valve replacement (I-TAVR). The long-term efficacy and durability of this single-valve approach in a multivalvular stenotic setting is not well established. METHODS: Retrospective analyses of consecutive patients treated for concomitant severe AS and moderate-to-severe MS at a single institution (2015-2025), divided according to treatment strategy (DVS vs I-TAVR). Propensity-score matching accounted for baseline differences, while univariable and multivariable analyses evaluated factors associated with recurrent heart failure (HF) readmissions. RESULTS: Ninety-seven patients underwent DVS and 129 I-TAVR. Both before and after propensity score matching, no differences were observed in short- nor mid-term incidence of all-cause mortality (unmatched, P = .078; matched, no events) nor stroke (unmatched, P = .783; matched, P = 1.00). However, I-TAVR was found to be associated with greater HF rehospitalizations (unmatched, P = .001; matched, P = .006). The univariable and multivariable analyses demonstrated I-TAVR to be an independent risk factor for HF rehospitalization, in both the unmatched and matched populations. CONCLUSIONS: In patients with high-grade concomitant AS and MS, addressing only AS with I-TAVR is an independent predictor of HF readmissions. While I-TAVR remains a valid therapeutic option in high-risk patients with high-grade multivalvular stenosis, DVS should be considered as the preferred treatment option in any patient that can tolerate surgery. INSTITUTIONAL REVIEW BOARD (IRB) NUMBER: IRB-AAAV5910. Consent was waived owing to the retrospective design of the study.
Yankah AC, Nwiloh J, Mestres CA
… +21 more, Bouzid A, Mwambu TP, Duncan AJ, Debieche M, Omokhodion SI, Onakpoya UU, Angres M, Nademo SM, Oburu G, Yao NA, Entsua-Mensah K, Reddy D, Antunes M, Gomes WJ, Akamah JA, Yigitbasi M, Buys DG, Bokenkamp R, Koen W, Smit FE, Chikwe J
Eur J Cardiothorac Surg
· 2026 Feb · PMID 41725176
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The Pan-African Society for Cardiothoracic Surgery (PASCaTS) organized the 1st Pan-African Cardiothoracic Surgery Summit on 21 to 24 February 2025 in Accra, Ghana. The summit brought together leading specialists from acr...The Pan-African Society for Cardiothoracic Surgery (PASCaTS) organized the 1st Pan-African Cardiothoracic Surgery Summit on 21 to 24 February 2025 in Accra, Ghana. The summit brought together leading specialists from across Africa, China, Europe, South America and the USA to address the growing burden of cardiovascular disease, to share their vision for the fight against cardiovascular disease, to raise standards in the diagnosis, treatment and recovery of patients thereby improving procedural safety and clinical outcomes in Africa. The experts agreed on the need for cost effectiveness in cardiac surgery, simulation skills training, an African regional cardiothoracic surgery database, African heart team fellowship programs and specialized working groups to guide cardiovascular diagnostics and treatments focusing on critical areas such as congenital heart surgery, valve surgery and coronary artery bypass surgery (CABG) procedures which are becoming increasingly necessary in Africa due to the rise in cardiovascular emergencies, and finally explore solutions tailored to the continent's unique healthcare challenges. The incentives generated from the summit are formulated as the "2025 Accra Declaration" to serve as roadmaps and implementable guidelines for promoting high-level cardiovascular surgery and reforms in Africa in collaboration with cardiologists and other allied cardiovascular professionals.
OBJECTIVES: We aimed to evaluate the mid-term outcomes of cardiac resynchronization therapy (CRT) in patients with single ventricle (SV), heart failure, and ventricular dyssynchrony, which leads to heart failure and poor...OBJECTIVES: We aimed to evaluate the mid-term outcomes of cardiac resynchronization therapy (CRT) in patients with single ventricle (SV), heart failure, and ventricular dyssynchrony, which leads to heart failure and poor outcomes. METHODS: We retrospectively reviewed patients with SV who underwent CRT at our institution between 2010 and 2024. Dyssynchrony was defined as QRS duration ≥130 ms and qualitative mechanical dyssynchrony between the main and rudimentary ventricles assessed by echocardiography and cine-angiography. Cardiac resynchronization therapy indications were based on acute haemodynamic studies (shortened QRS duration and increased peak dP/dt). The patients were divided into Groups G (CRT after bidirectional Glenn) and F (after Fontan completion). Haemodynamic parameters, NYHA class, brain natriuretic peptide, survival, Fontan completion rate, and hepatic function were analysed. RESULTS: Group G included 9 and Group F included 11 patients. One year after CRT, the systemic ventricular ejection fraction improved in Groups G (30%-40%, P = .006) and F (30%-53%, P = .001), with corresponding increases in cardiac index and NYHA class. The median follow-up was 6.7 years (Group G) and 7.6 years (Group F). The 5-year survival rates were 89% and 82%, respectively. The Fontan completion rate was 76% at 5 years in Group G. In Group F, brain natriuretic peptide levels improved, hepatic function remained stable, and no protein-losing enteropathy was reported. CONCLUSIONS: Cardiac resynchronization therapy improved systemic ventricular function and heart failure symptoms. Cardiac resynchronization therapy might be a viable therapeutic option for patients with SV, ventricular dyssynchrony, and heart failure.
OBJECTIVES: Extent I open thoraco-abdominal aortic aneurysm repair remains essential for patients without endovascular options. This study evaluates outcomes and identifies factors associated with major adverse events. M...OBJECTIVES: Extent I open thoraco-abdominal aortic aneurysm repair remains essential for patients without endovascular options. This study evaluates outcomes and identifies factors associated with major adverse events. METHODS: This retrospective multicentre study included all patients who underwent open extent I thoraco-abdominal aortic aneurysm repair. Major adverse events were defined as operative death, stroke, paraplegia, paraparesis, or renal failure requiring renal replacement therapy. Univariable logistic regression analysis with odds ratios (OR) and 95% confidence intervals (CI) was used to identify risk factors for operative mortality and major adverse events. RESULTS: A total of 171 patients underwent extent I thoracoabdominal aortic aneurysm repair and were included. Emergency or urgent repair was performed in 14.6% of cases. Genetically triggered aortopathies were present in 16.5% of patients. In-hospital mortality occurred in 14.6%, with major adverse events in 23.3%. Stroke occurred in 4.6%, paraplegia in 2.9%, paraparesis in 5.2%, and permanent dialysis in 4.0%. Risk factors for operative mortality identified by univariable analysis included increasing age (OR, 1.074; 95% CI, 1.026-1.124) and previous myocardial infarction (MI) (OR, 5.920; 95% CI, 1.964-17.841). Factors associated with major adverse events included increasing age (OR, 1.053; 95% CI, 1.020-1.088), coronary artery disease (OR, 3.065; 95% CI, 1.274-7.376), previous MI (OR, 5.931; 95% CI, 2.012-17.488), and history of coronary artery bypass grafting (OR, 5.192; 95% CI, 1.161-23.223). Postoperative complications significantly associated with adverse outcomes included tracheostomy, ARDS, sepsis, and cardiac complications. The reintervention rate post-discharge was 15.8%. An overall 58.6% 5-year survival and 65.7% survival at 5 years following elective surgical repair were found. CONCLUSIONS: Extent I open thoraco-abdominal aortic aneurysm repair, while carrying significant risks of morbidity and mortality, is an established treatment for a subset of patients with no endovascular alternatives, with adequate long-term survival and low aortic reintervention rate during follow-up.
OBJECTIVES: Recent data suggest that 50% of patients ≤65 years of age undergo transcatheter aortic valve implantation (TAVI). It has also been suggested that these patients are typically high risk with poor life expectan...OBJECTIVES: Recent data suggest that 50% of patients ≤65 years of age undergo transcatheter aortic valve implantation (TAVI). It has also been suggested that these patients are typically high risk with poor life expectancy. We sought to evaluate predicted risk, procedural and longitudinal outcomes, and cost in patients ≤65 years who received TAVI in the Premier Healthcare Database. METHODS: All patients aged 65 and younger receiving TAVI (2017-2024) were assessed. A predicted risk of index surgical aortic valve mortality model, incorporating the Fried frailty index, was fitted to simulate the Society of Thoracic Surgeons risk model (AUC = 0.850). TAVI outcomes were stratified by predicted risk of mortality. RESULTS: A cohort of 6921 patients ≤65 years received TAVI. The median age was 60 years, 81.3% were elective, and 9.1% bicuspid. The average predicted risk was 4.3%, with 66.2% of patients having a predicted risk <4%. A total of 50 patients (0.7%) died within 30 days of the index procedure. Early complications included 41 (0.6%) emergent sternotomies, 182 (2.6%) unplanned coronary interventions, 32 (0.5%) femoral artery repairs, 77 (1.0%) strokes, and 485 (4.1%) new permanent pacemakers. With a median follow-up of 3.3 years, 5-year survival was 88% in low- and intermediate-risk patients and 78% in the high-risk cohort (>8% predicted). CONCLUSIONS: Most contemporary patients ≤65 years receiving TAVI outside of existing guidelines are of low surgical risk. These findings, in combination with the cumulative longitudinal risks of TAVI, highlight the need for careful heart team discussions for most young patients requiring AVR.
OBJECTIVES: The availability and affordability of conduits have significantly challenged congenital heart surgery in low-resource settings. We present the intermediate-term outcomes of low-cost customized handmade condui...OBJECTIVES: The availability and affordability of conduits have significantly challenged congenital heart surgery in low-resource settings. We present the intermediate-term outcomes of low-cost customized handmade conduits at our institution. METHODS: Analysis of our surgical database and hospital information system (2016-2023) was done. Handmade conduits (cost: 30% of commercial conduits) were prepared in the operating room prior to surgery, using bovine pericardium for the conduit body tailored to the exact required diameter, with 0.1 mm polytetrafluoroethylene (PTFE) valve leaflets. RESULTS: Handmade conduits were implanted in 185 patients [median age: 1.58 years (0.75-6.92), weight: 8.40 kg (6.30-17.03); conduit diameter 15 mm (13-20); cardiopulmonary bypass time 191.5 minutes (160-238) and cross-clamp time 106.5 minutes (73.8-145)]. Median ventilation duration was 19 hours (7-39), intensive care unit (ICU) stay 72 hours (44-120), and hospital stay 15 days (IQR: 11-20); mortality was 3.8%. The median follow-up duration was 29.5 months (14-59.5) for 160 patients. Peak conduit gradient on follow-up was 40 mm Hg (IQR: 22.8-63.8). Significant conduit regurgitation was noted in 21.2%. Endocarditis occurred in 7 (4.3%) patients (late in 4, early in 3). Re-interventions included 22 transcatheter procedures [18 balloon, 4 stents] at a median of 24 (12.2-34.7) months from conduit implantation. Of the 160 patients on follow-up, 28 had their conduits replaced at a median of 37 months (21-65 months) from implantation. Freedom from the composite end-point of reintervention/reoperation/death was 94% at 1 year; 70% at 5 years. CONCLUSIONS: Handmade pericardial valved conduits are a potentially attractive low-cost alternative to commercially available conduits in low-resource settings.
OBJECTIVES: We described short- and mid-term outcomes of hybrid thoraco-abdominal aortic aneurysm repair (HTAR), combining visceral debranching and thoracic endovascular aortic repair (TEVAR). METHODS: This multicentric,...OBJECTIVES: We described short- and mid-term outcomes of hybrid thoraco-abdominal aortic aneurysm repair (HTAR), combining visceral debranching and thoracic endovascular aortic repair (TEVAR). METHODS: This multicentric, retrospective cohort study analysed prospectively collected data from 2 Italian referral centres on patients undergoing HTAR with at least one renal artery bypass between 2003 and 2024. These patients were deemed unfit for open surgery. Primary outcomes were early (≤30 days) and mid-term survival, and freedom from aorta-related mortality (ARM). Secondary outcomes included spinal cord injury (SCI), freedom from reintervention, and bypass patency. RESULTS: The population included 86 patients, 12 (13.9%) of which were urgent. Median age was 69 years. In-hospital mortality occurred in 20 patients (23.3%), with major complications in 33 (38.4%), mainly acute kidney injury (AKI) (20; 23.3%) and pneumonia (9; 10.5%). Spinal cord injury rate was 5.8%. A 2-stage strategy was used in 68 patients (79.1%). Median follow-up was 17.5 months. At 1-, 2-, and 5-years, survival was 68.6%, 67%, and 50.9%, freedom from ARM was 82.4%, 82.4%, and 82.4%; freedom from reintervention was 97.4%, 97.4%, and 87.7%, and patency was 95%, 89%, and 84%. Late reintervention occurred in 12.1% of patients. Female gender and rupture were significant predictors of reintervention and mortality, respectively. Quartile of experience correlated with improved outcomes. CONCLUSIONS: HTAR provides an alternative to open repair in high-risk thoracoabdominal aortic aneurysm (TAAA) patients, with acceptable early and mid-term outcomes. While in-hospital mortality remains notable, SCI rates are low thanks to the 2-stage approach, and freedom from ARM and bypass patency are satisfactory. IRB APPROVAL: No. 121/2022/Disp/AUOBo/10/2023.
OBJECTIVES: Cytomegalovirus (CMV) predisposes lung transplant (LTx) recipients to acute rejections and chronic lung allograft dysfunction (CLAD). Guidelines recommend standard-dose valganciclovir (VGCV, 900 mg daily) pro...OBJECTIVES: Cytomegalovirus (CMV) predisposes lung transplant (LTx) recipients to acute rejections and chronic lung allograft dysfunction (CLAD). Guidelines recommend standard-dose valganciclovir (VGCV, 900 mg daily) prophylaxis, while evidence for low-dose VGCV (450 mg daily) in CMV seropositive recipients remains limited. We evaluated the efficacy and safety of low-dose VGCV prophylaxis in this population. METHODS: We analysed 137 adult CMV seropositive primary LTx recipients receiving triple-drug immunosuppression without induction therapy. Recipients received low-dose VGCV (450 mg daily for ≥6 months), or standard-standard dose (900 mg daily for ≥6 months), if > 80% of the prophylaxis period was completed at the respective dose. Routine CMV monitoring was performed during prophylaxis and 3 months after discontinuation. RESULTS: Of 120 eligible seropositive LTx recipients, 97 (80.8%) received low-dose and 23 (19.2%) received standard-dose VGCV with median durations of 272 and 246 days, respectively. Seventeen recipients (12%) with mixed dosing were excluded. One patient in each group discontinued prophylaxis due to severe leucopenia. Breakthrough CMV-DNAemia occurred in 3.1% of low-dose patients. Post-prophylaxis CMV episodes were common but occurred independently of VGCV dose or duration. No VGCV resistance was detected. Leucopenia was frequent and similarly unrelated to dose or duration. Rates of acute rejections (P = .358) or overall survival (P = .889) were similar, while low-dose VGCV prophylaxis was associated with improved CLAD-free survival (HR 2.30, 95% CI 1.33-3.97, P = .003). CONCLUSIONS: In CMV-seropositive adult LTx recipients without induction therapy, low-dose VGCV prophylaxis was as safe and effective as standard-dose prophylaxis and was associated with superior CLAD-free survival. Future randomized clinical trial is warranted.
Martínez-Hernández NJ, Cabañero-Sánchez A, Córcoles-Padilla JM
… +8 more, Chacón-Del Pino E, Fraile-Olivero C, Giménez-Moolhuyzen E, Miñana-Aragón E, Gorina M, Pires N, Álvarez-Orozco M, Garutti I
OBJECTIVES: Despite advancements in minimally invasive techniques, lung resection surgery for lung cancer still carries a significant risk of complications. Enhanced recovery after surgery (ERAS) protocols offer strategi...OBJECTIVES: Despite advancements in minimally invasive techniques, lung resection surgery for lung cancer still carries a significant risk of complications. Enhanced recovery after surgery (ERAS) protocols offer strategies to improve outcomes, yet their adoption is still inconsistent. This study aims to develop a series of evidence-based recommendations for ERAS strategies, incorporating insights from thoracic surgeons, anaesthetists, nurses, physiotherapists, and patients. METHODS: A 2-round Delphi consensus process was conducted with experts in the management of thoracic surgery patients. A scientific committee established 62 recommendations across 3 phases: preoperative (n = 12), intraoperative (n = 30), and postoperative (n = 20). Consensus was defined as ≥66% agreement (Likert scale 6-7) or disagreement (Likert 1-2) among panellists. RESULTS: Consensus was reached for 91.7% of preoperative, 86.7% of intraoperative, and 85% of postoperative recommendations. Key recommendations include structured prehabilitation programmes, multimodal analgesia strategies with opioid-sparing approaches, minimally invasive thoracic surgery, early chest drain removal, and pre- and postoperative physiotherapy with early mobilization. CONCLUSIONS: This study establishes a structured, consensus-based perioperative management protocol for thoracic surgery patients. By optimizing perioperative care and standardizing interventions, these recommendations aim to improve clinical outcomes, enhance recovery, and raise the quality of care during thoracic surgery. They may also facilitate the broader adoption of ERAS strategies, ultimately improving patient recovery and resource utilization.
OBJECTIVES: Revascularization of the left subclavian artery (LSCA) is routinely required during total aortic arch replacement. In situ reconstruction may be technically difficult in cases with large aneurysms or posterio...OBJECTIVES: Revascularization of the left subclavian artery (LSCA) is routinely required during total aortic arch replacement. In situ reconstruction may be technically difficult in cases with large aneurysms or posterior vessel displacement. Extra-anatomic aorto-axillary bypass has been proposed as an alternative, but its long-term patency relative to in situ repair remains uncertain. This study compared LSCA patency between the 2 techniques. METHODS: We retrospectively analysed 436 consecutive patients (median age 69.0 years [interquartile range (IQR) 62.0-75.0]; 347 men) who underwent total arch replacement with LSCA revascularization: 240 in situ and 196 extra-anatomic. Postoperative CT imaging (1853 scans; median 3 [IQR 1-6] per patient) was reviewed to determine immediate and long-term patency. Kaplan-Meier analysis was used for time-to-event comparison. A small descriptive subgroup of 18 patients undergoing concomitant left internal thoracic artery (LITA) to left anterior descending artery (LAD) bypass was also reviewed. RESULTS: Perioperative outcomes, including mortality and major complications, were similar between groups. Subclavian wound infection occurred in 3 extra-anatomic cases (1.5%), all managed successfully with local care. Immediate LSCA patency was higher after extra-anatomic bypass (100% vs 92.9%, P < .001). At 5 years, patency remained superior with extra-anatomic bypass (97.7% vs 87.8%; log-rank P = .0002). In the descriptive LITA-LAD subgroup, CT follow-up demonstrated 100% LSCA and LITA graft patency; however, interpretation is limited by the small sample size. CONCLUSIONS: Compared with in situ reconstruction, extra-anatomic LSCA bypass provides equivalent perioperative safety and superior long-term patency. These findings support extra-anatomic bypass as a reliable and technically straightforward option for LSCA revascularization during total arch replacement.
OBJECTIVES: This study aimed to evaluate and compare the long-term outcomes of 3 different surgical techniques (McGoon, Doty, and Brom) for supra-valvular aortic stenosis (SVAS) and to identify the risk factors affecting...OBJECTIVES: This study aimed to evaluate and compare the long-term outcomes of 3 different surgical techniques (McGoon, Doty, and Brom) for supra-valvular aortic stenosis (SVAS) and to identify the risk factors affecting mortality and morbidity. METHODS: We performed a single-centre retrospective analysis of all patients who underwent surgery for SVAS between August 1974 and January 2025. The outcomes were analysed using survival and competing risk analysis, and risk factors were identified using Cox regression models. RESULTS: A total of 75 patients were identified, 26 (35%) profited from the McGoon technique, 33 (44%) patients received a Doty repair, and 16 (21%) underwent Brom repair. Williams-Beuren syndrome was associated with 45 (60%) patients. Associated anomalies included pulmonary stenosis in 40 (53%) patients, aortic coarctation in 24 (32%), and abnormal coronary arteries in 14 (19%). Transplant-free survival at 15 years was 92%, and no difference was found between surgical techniques (P = .339). Abnormal coronary arteries were a risk factor for major adverse cardiac events (odds ratio 8.666, P = .011) and mortality (hazard ratio [HR] 4.285, P = .030). Cumulative incidence of reoperation at 15 years was 18%, with no difference between surgical techniques (P = .299). However, patients with pulmonary stenosis (HR 3.450, P = .020) had a higher risk of reoperation. CONCLUSIONS: Survival after surgical repair of SVAS is over 90% at 15 years regardless of the surgical technique. Abnormal coronary arteries are responsible for higher operative mortality. Concomitant pulmonary artery stenosis is at a higher risk of reoperation, suggesting more severe arterial disease.
OBJECTIVES: This study aimed to describe the outcomes of a new custom-made inner-branch device, also suitable as off-the shelf stent graft, for the endovascular repair of complex aortic lesions and to evaluate the result...OBJECTIVES: This study aimed to describe the outcomes of a new custom-made inner-branch device, also suitable as off-the shelf stent graft, for the endovascular repair of complex aortic lesions and to evaluate the results also in narrowed patent aortic lumen (<25 mm) at the level of visceral aorta. METHODS: This multicentre study (2021-2024) included patients treated with this new inner-branched device for complex aortic lesions. Endpoints were: technical success, early (<30 days) mortality, late (>30-days) survival, and freedom from aorta-related mortality (ARM), aortic adverse events, and target visceral vessels (TVVs) patency. RESULTS: This study included 46 patients and 184 target vessels. Technical success was 100%, and no cases of ARM were recorded. Three cases (6.5%) of spinal cord ischaemia (SCI) were registered. Overall 30-day mortality rate was 8.7%. The mean follow-up was 10.5 ± 9 months. Overall survival rate was 97.4% (95% CI, 76-99) at 3 months, 94% (95% CI, 71-98) at 6 months, 85.1% (95% CI, 54-96) at 12 months, and 76% (95% CI, 41-92) at 24 months. Late deaths occurred in 3 patients (8.3%) after a median of 8 months (interquartile range [IQR], 4-12 months). No late ARM, type I or III endoleak were registered. The primary bridge-stent patency was 98.9% (95% CI, 73-99). No late SCI were registered. The subgroup characterized by narrow aortic patent lumen did not showed bridge-stent instability, reintervention, death, and ARM. CONCLUSIONS: Endovascular repair of thoraco-abdominal aortic aneurysms (TAAAs) and complex aortic lesions with this new custom/off-the shelf stent graft was technically safe and effective with promising results both in elective and urgent cases.
OBJECTIVES: Data on the role of obesity in patients undergoing minimally invasive cardiac surgery are sparse, and the longitudinal observations after minimally invasive mitral valve repair (MI-MVr) in obese patients are...OBJECTIVES: Data on the role of obesity in patients undergoing minimally invasive cardiac surgery are sparse, and the longitudinal observations after minimally invasive mitral valve repair (MI-MVr) in obese patients are lacking. METHODS: This retrospective propensity-score-matched analysis compared the outcomes of MI-MVr in obese patients (body mass index [BMI] ≥30 kg/m2), with those in individuals with normal body weight (BMI 19-25 kg/m2), focusing on overall survival. RESULTS: In 501 analysed matched pairs, BMI ranged 30-60 kg/m2 in obese group and 19-24.9 kg/m2 in normal-BMI group. There were no baseline differences among matched cohorts, except for higher incidence of hypertension (78% vs 57%, P < .001) and hypercholesterolaemia (35% vs 28%, P = .02) in obese patients, and slightly worse renal function. All patients received MI-MVr through right lateral mini-thoracotomy. The median total operative time (by 11 minutes) and cardiopulmonary by-pass time (by 5 minutes) were longer in obese patients (P = .001), but the cross-clamp times did not differ. There were no intergroup differences in the early complication rates or hospitalization lengths. After a median follow-up of 9.3 years, the overall survival was similar. Actuarial survival at 15 years was 59% for obese patients and 57% for those with normal BMI (log-rank, P = .38). A multivariable model identified diabetes (HR [95% CI], 1.65 [1.26-2.16], P = .0003), chronic lung disease (1.81 [1.31-2.51], P = .0004), left ventricular ejection fraction (LVEF) <50% (2.28 [1.78-2.93], P ≤ .0001), and older age (1.08 [1.07-1.10], P ≤ .0001) as independent predictors of mortality. CONCLUSIONS: Obesity alone does not influence the outcomes of MI-MVr, but diabetes, chronic lung disease, and impaired pump function do affect the overall survival.