Abstract:

Transcatheter aortic valve implantation (TAVI) is a truly minimally invasive technique allowing for off-pump aortic valve implantation in selected high-risk patients. Potential advantages are the avoidance of cardiopulmonary bypass, aortic cross-clamping, and sternotomy. Feasibility has been proven for a retrograde transfemoral, retrograde trans-subclavian, and antegrade trans-apical approach. Superiority of one of these delivery routes is as yet unproven. Given the excellent outcome following conventional aortic valve replacement even in octogenarians and the lack of prospectively randomized trials proving the effectiveness of TAVI, this new innovative technique should be restricted to selected high-risk patients at present. Nevertheless, TAVI has already evolved into a routine procedure in selected specialized centers providing a safe and reproducible treatment option for high-risk elderly patients suffering from severe symptomatic aortic stenosis.

Authors:

Jörg Kempfert, M.D., Resident, Heart Center, University of Leipzig, Clinic for Cardiac Surgery, Leipzig, Germany, Sven Lehmann, M.D., Consultant, Heart Center, University of Leipzig, Clinic for Cardiac Surgery, Leipzig, Germany, Axel Linke, M.D., Ph.D., Consultant, Heart Center, University of Leipzig, Clinic for Cardiology, Leipzig, Germany, Ardawan Rastan, M.D., Ph.D., Consultant, Heart Center, University of Leipzig, Clinic for Cardiac Surgery, Leipzig, Germany, Arnaud Van Linden, M.D., Resident, Heart Center, University of Leipzig, Clinic for Cardiac Surgery, Leipzig, Germany, Johannes Blumenstein, M.D., Resident, Heart Center, University of Leipzig, Clinic for Cardiac Surgery, Leipzig, Germany, Gerhard Schuler, M.D., Ph.D., Chief, Heart Center, University of Leipzig, Clinic for Cardiology, Leipzig, Germany, Friedrich W. Mohr, M.D., Ph.D., Chief, Heart Center, University of Leipzig, Clinic for Cardiac Surgery, Leipzig, Germany, Thomas Walther, M.D., Ph.D., Consultant, Heart Center, University of Leipzig, Clinic for Cardiac Surgery, Leipzig, Germany

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Abstract:

Aortic injury from sudden deceleration is the most common traumatic condition of the thoracic aorta encountered clinically. Open surgical repair is still associated today with a high-risk setting. Recently, stent-graft treatment is emerging as an alternative to conventional surgery due to its less traumatic nature in patients affected by traumatic aortic lesions, especially in concomitance with multiple associated lesions. From March 1999 to June 2009, 57 patients admitted with a diagnosis of acute and chronic aortic lesions underwent endovascular repair. In 38 cases, traumatic aortic rupture was detected in the acute phase and associated lesions were present at various grade in all patients, whereas in 19 cases aortic injury was identified in the chronic phase. The endovascular treatment was successful in all cases affected both by acute and chronic aortic injury. None of the patients died during the follow-up, as well as no cases of perigraft leakage have been detected so far. Endovascular repair represents the first choice of treatment in patients with traumatic aortic lesions. Indeed, the severity of co-existing lesions could be adversely affected by conventional surgical treatment, also with consideration of its high morbidity rate due to thoracotomy.

Authors:

Emanuela de Cillis, M.D., Ph.D. Candidate, Interventional Cardiologist, Institute of Cardiac Surgery, Vito Paradiso, M.D., Cardiac Surgeon, Assistant Professor, Institute of Cardiac Surgery, Ayman Elmeghory, M.D., Research Fellow of Interventional Laboratory, Institute of Cardiac Surgery, Francesco Tunzi, M.D., Research Fellow of Interventional Laboratory, Institute of Cardiac Surgery, Gianni Raguso, B.A.N., Nurse Coordinator, Institute of Cardiac Surgery, Alessandro Santo Bortone, M.D., Ph.D., Assistant Professor, Chief of Interventional Laboratory , Institute of Cardiac Surgery, Department of Emergency and Organs Transplantation, University of Bari, Bari, Italy

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Abstract:

The aim of our study is to investigate the molecular mechanisms of diabetic cardiomyopathy through the identification of remarkable genes for the myocardial function that are expressed differently between diabetic and normal subjects. Moreover, we intend to characterize both in human myocardial tissue and in the related cardiac progenitor cells the pattern of gene expression and the levels of expression and protein activation of molecular effectors involved in the regulation of the myocardial function and differentiation to clarify whether in specific human pathological conditions (type 2 diabetes mellitus, cardiac failure, coronary artery disease) specific alterations of the aforementioned factors could take place. Thirty-five patients scheduled for coronary artery bypass grafting (CABG) or for aortic or mitral valve replacement were recruited into the study. There were 13 men and 22 women with a mean age of 64.8 ± 13.4 years. A list of anamnestic, anthropometric, clinical, and instrumental data required for an optimal phenotypical characterization of the patients is reported. The small cardiac biopsy specimens were placed in the nourishing buffer, in a sterile tube provided the day of the procedure, to maintain the stability of the sample for several hours at room temperature. The cells were isolated by a dedicated protocol and then cultured in vitro. The sample was processed for total RNA extraction and levels of gene expression and protein activation of molecular effectors involved in the regulation of function and differentiation of human myocardium was analyzed. In particular, cardiac genes that modulate the oxidative stress response or the stress induced by pro-inflammatory cytokines (p66Shc, SOCS-1, SOCS-3) were analyzed. From a small sample of myocardium cardiac stem cells and cardiomyoblasts were also isolated and characterized. These cells showed a considerable proliferative capacity due to the fact that they demonstrate stability up to the eleventh passage. Analysis of gene expression in a subgroup of subjects showed the trend of a decrease in levels of expression of cardiac-specific transcription genes and oxidative stress-related proteins in tissues of diabetic patients compared with controls subjects. This trend is not confirmed in isolated cells. As for the coronary artery disease, diabetic cardiomyopathy could be associated with a reduction of the cardiac stem and progenitor cells pool. The expansion of the cardiac resident cells pool could be associated with a preservation of cardiac performance, suggesting that a preserved stamina compartment can counteract the impact of diabetes on the myocardium.

Authors:

Emanuela de Cillis, M.D., Interventional Cardiologist, Ph.D. Candidate, Institute of Cardiac Surgery, Department of Emergency and Organs Transplantation, Anna Leonardini, M.D., Department of Internal Medicine, Endocrinology, and Metabolic Diseases, Luigi Laviola, M.D., Ph.D., Department of Internal Medicine, Endocrinology, and Metabolic Diseases, Francesco Giorgino, M.D., Ph.D., Director of Department of Internal Medicine, Endocrinology, and Metabolic Diseases, Luigi de Luca Tupputi Schinosa, M.D., Director of Institute of Cardiac Surgery, Alessandro Santo Bortone, M.D., Ph.D., Assistant Professor, Chief of Interventional Laboratory, Institute of Cardiac Surgery, Department of Emergency and Organs Transplantation, University of Bari, Bari, Italy

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