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La chirurgia dello scompenso cardiaco mau

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La chirurgia dello scompenso cardiaco

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La chirurgia dello scompenso cardiaco mau

  1. 1. II Giornate Cardiologiche Ragusane SSccoommppeennssoo CCaarrddiiaaccoo OOggggii Nuove strategie dello ssccoommppeennssoo ccaarrddiiaaccoo:: SSppeecciiaalliissttii aa ccoonnffrroonnttoo IIll CCaarrddiioocchhiirruurrggoo MMaauurriizziioo GGeennttiillee CCeennttrroo CCuuoorree MMoorrggaaggnnii -- PPeeddaarraa
  2. 2. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO IInncciiddeennzzaa ee PPrreevvaalleennzzaa  PPrreevvaalleennzzaa – MMoonnddiiaallee,, 2222 mmiilliioonnii ((11)) – UU..SS..AA.. 55 mmiilliioonnii ((22))  IInncciiddeennzzaa – MMoonnddiiaallee,, 22 mmiilliioonnii nnuuoovvii ccaassii // aannnnoo ((11)) – UU..SS..AA.. ddaa 4400..000 aa 7700..000 nnuuoovvii ccaassii // aannnnoo ((22))  LLoo ssccoommppeennssoo ccoollppiissccee 11000 pp.. ooggnnii 1100..000 oollttrree ii 6655 aannnnii ddii eettàà nneeggllii UU..SS..AA..((22)) 11 WWoorrlldd HHeeaalltthh SSttaattiissttiiccss,, WWoorrlldd HHeeaalltthh OOrrggaanniizzaattiioonn,, 11999955.. 22 AAmmeerriiccaann HHeeaarrtt AAssssoocciiaattiioonn,, 220011 HHeeaarrtt aanndd SSttrrookkee SSttaattiissttiiccaall UUppddaattee..
  3. 3. MEN WOMEN No HTN or CHD Hypertension alone CHD+HTN CHD alone 19% 11% 40% CHD = coronary heart disease HTN = hypertension 30% 40% 7% 15% 37% LA CHIRURGIA DELLO SCOMPENSO CARDIACO Etiologia
  4. 4. LLAA CCHHIIRRUURRGGIIAA DDEELLLLOO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO MALATTIA ISCHEMICA 11.. RRiivvaassccoollaarriizzzzaazziioonn eec coorroonnaarriiccaa 22.. TTrraattttaammeennttoo iinnssuuffff.. mmiittrraalliiccaa 33.. RRiimmooddeellllaammeennttoo vveennttrriiccoollaarree 44.. TTrraattttaammeennttoo ffiibbrriillll.. aattrriiaallee 55.. RReessiinnccrroonniizzzzaazziioonn eev veennttrriiccoollaarree
  5. 5. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RIVASCOLARIZZAZIONE CORONARICA FE del VS // mortalità e SBP post-op  Sindrome da bassa portata  mortalità Yau TM J Thorac Cardiovasc Surg 1999
  6. 6. LLAA CCHHIIRRUURRGGIIAA DDEELLLLOO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIVVAASSCCOOLLAARRIIZZZZAAZZIIOONNEE CCOORROONNAARRIICCAA REVASCULARIZATION IN PTS WITH LV DYSFUNCTION MIOCARDIO ISCHEMICO MIOCARDIO IBERNATO BAC RIDUZIONE DEGLI EVENTI Giuseppe Tarelli ISCHEMICI MIGLIORAMENTO DELLA FUNZIONE VS QUALITA’ di VITA SOPRAVVIVENZA  ECO-DOBUTAMINA TALLIO-201 scan  PET con F-18 FDG Utilizzati per valutare la quantità di miocardio ibernato = Miglioramento previsto dopo la rivascolarizzazione
  7. 7. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIVVAASSCCOOLLAARRIIZZZZAAZZIIOONNEE CCOORROONNAARRIICCAA SOPRAVVIVENZA A DISTANZA DOPO BAC  Età  Vasi scarsamente visualizzati  Lunga storia di scompenso classe IV  Dilatazione VS (VTSVS > 100 ml/m2)  Aumento della PTSVS a riposo  Aumento della PAP Funzione VD depressa  Instabilità emodinamica  Pregresso intervento Trachiotis GD Ann Thorac Surg 1998 J Thorac Cardiovasc Surg 2000
  8. 8. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIVVAASSCCOOLLAARRIIZZZZAAZZIIOONNEE CCOORROONNAARRIICCAA  pts con BASSA FE ed ANGINA - SOPRAVVIVENZA TEST + TEST - IN PZ CON ANGINA + MIOCARDIO VITALE IL BAC AUMENTA LA SOPRAVVIVENZA RISPETTO AL TRATTAMENTO MEDICO IN PZ CON ANGINA ED ASSENZA DI Di Carli J Thorac Cardiovasc Surg 1998 MIOCARDIO VITALE IL BAC AUMENTA LA SOPRAVVIVENZA GRAZIE ALLA PREVENZIONE DEL DANNO ISCHEMICO
  9. 9. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIVVAASSCCOOLLAARRIIZZZZAAZZIIOONNEE CCOORROONNAARRIICCAA pts con BASSA FE – ASSENZA di ANGINA IL BAC MIGLIORA LA SOPRAVVIVENZA SOLO NEI pts CON MIOCARDIO VITALE TEST-TEST+ Di Carli J Thorac Cardiovasc Surg 1998
  10. 10. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIVVAASSCCOOLLAARRIIZZZZAAZZIIOONNEE CCOORROONNAARRIICCAA pts con BASSA FE – ASSENZA di ANGINA IL MIGLIORAMENTO POST-OP DELLA FE (6 months) E’ PROPORZIONALE AL NUMERO DI SEGMENTI DI MIOCARDIO VITALE Pagano D Curr Op Cardiol 1999 IL BAC MIGLIORA LA SOPRAVVIVENZA SE LA QUANTITA’ DI MIOCARDIO IBERNATO E’ AMPIA
  11. 11. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIVVAASSCCOOLLAARRIIZZZZAAZZIIOONNEE CCOORROONNAARRIICCAA  pts con BASSA FE ed ANGINA – QUALITA’ DI VITA IL BAC OFFRE LIBERTA’ DURATURA DA ANGINA (80% dopo 5 anni) IL BAC NON OFFRE LIBERTA’ DURATURA DA SCOMPENSO CARDIACO (50% dopo 5 anni) Luciani GB J Thorac Cardiovasc Surg 2000 Comparsa di scompenso Inversamente correlata a :  impiego di a. mammaria  numero di by-pass
  12. 12. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIVVAASSCCOOLLAARRIIZZZZAAZZIIOONNEE CCOORROONNAARRIICCAA CONCLUSIONI IL BAC può migliorare •Sopravvivenza e qualità di vita in pts con angina • Sopravvivenza in pts con solo scompenso se c’è una buona quantità di miocardio vitale ed il miocardio ibernato recuperabile è oltre la metà di quello disfunzionante Pts non selezionati alto rischio op rsl a lungo termine non soddisfacenti pts selezionati basso rischio op rsl a lungo termine soddisfacenti
  13. 13. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO TTRRAATTTTAAMMEENNTTOO DDEELLLL’’IINNSSUUFFFFIICCIIEENNZZAA MMIITTRRAALLIICCAA LL’’iinnssuuffffiicciieennzzaa mmiittrraalliiccaa èè uunnaa ccoommpplliiccaannzzaa ssiiggnniiffiiccaattiivvaa ddeellllaa CCMMDD He and al.Circulation 1997;96:1826-34 IImmppaattttoo ssuullllaa ssoopprraavvvviivveennzzaa IIMM nneellllaa CCMMDD Blondheim et al. Am Heart J. 1991;122:763-771 IImmppaattttoo ssuullllaa ssoopprraavvvviivveennzzaa IIMM ddooppoo IIMMAA Lamas and al. Circulation.1997;96:827-833
  14. 14. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO TTRRAATTTTAAMMEENNTTOO DDEELLLL’’IINNSSUUFFFFIICCIIEENNZZAA MMIITTRRAALLIICCAA MMeeccccaanniissmmoo ddeellllaa IIMM IIsscchh//FFuunnzz Ipo/acinesia posteriore Dislocamento apicale dei papillari Tethering dei lembi
  15. 15. LLAA CCHHIIRRUURRGGIIAA DDEELLLLOO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO TTRRAATTTTAAMMEENNTTOO DDEELLLL’’IINNSSUUFFFFIICCIIEENNZZAA MMIITTRRAALLIICCAA RRUUOOLLOO DDEELLLL’’EECCOO  DDIIAAGGNNOOSSII DDII IIMM  PPRREECCIISSAARREE IILL GGRRAADDOO DDII IIMM  PPRREECCIISSAARREE IILL MMEECCCCAANNIISSMMOO EE GGUUIIDDAARREE LLAA RRIIPPAARRAAZZIIOONNEE  VVAALLUUTTAARREE LLAA FFUUNNZZIIOONNEE VVSS  CCOONNTTRROOLLLLAARREE IILL RRIISSUULLTTAATTOO
  16. 16. LA CHIRURGIA DDEELLLLOO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO TTRRAATTTTAAMMEENNTTOO DDEELLLL’’IINNSSUUFFFFIICCIIEENNZZAA MMIITTRRAALLIICCAA RAZIONALE del trattamento della IM RRiippaarraazziioonnee mmiittrraalliiccaa ccoonn IImmppiiaannttoo ddii aanneelllloo pprrootteessiiccoo ddiimmiinnuuttiivvoo.. 1. La competenza della mitrale è correlata al volume e alla morfologia del VS 2. Il VS dilatato ed ipocinetico trattiene la mitrale durante la sistole in posizione “DIASTOLICA” 3. L’anello protesico mitralico trattiene la mitrale in permanente posizione“SYSTOLICA”
  17. 17. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIMMOODDEELLLLAAMMEENNTTOO VVEENNTTRRIICCOOLLAARREE SSNN ((DDoorr)) ANEURISMA – DILATAZIONE DEL VS
  18. 18. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIMMOODDEELLLLAAMMEENNTTOO VVEENNTTRRIICCOOLLAARREE SSNN ((DDoorr)) ANEURISMA – DILATAZIONE DEL VS
  19. 19. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIMMOODDEELLLLAAMMEENNTTOO VVEENNTTRRIICCOOLLAARREE SSNN ((DDoorr)) ANEURISMA – DILATAZIONE DEL VS ddiissffuunnzziioonnee VVSS r t h TECNICA – RRiidduuzziioonnee ddeell vvoolluummee vveennttrriiccoollaarree.. – MMiigglliioorraammeennttoo ddeellllaa ggeeoommeettrriiaa vveennttrriiccoollaarree.. – TTrraattttaammeennttoo ddeellll’’ iisscchheemmiiaa ccoonn llaa rriivvaassccoollaarriizzzzaazziioonnee..
  20. 20. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIMMOODDEELLLLAAMMEENNTTOO VVEENNTTRRIICCOOLLAARREE SSNN ((DDoorr)) ANEURISMA – DILATAZIONE DEL VS TECNICA
  21. 21. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIMMOODDEELLLLAAMMEENNTTOO VVEENNTTRRIICCOOLLAARREE SSNN ((DDoorr)) ANEURISMA – DILATAZIONE DEL VS RISULTATI
  22. 22. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RRIIMMOODDEELLLLAAMMEENNTTOO VVEENNTTRRIICCOOLLAARREE SSNN ((DDoorr)) ANEURISMA – DILATAZIONE DEL VS IInnddiiccaazziioonnii  IIMMAA AANNTTEERROO--SSEETTTTAALLEE ee VVSS DDIILLAATTAATTOO (( vvoolluummee tteelleeddiiaassttoolliiccoo iinnddiicciizzzzaattoo >> 110000 mmLL//mm22))  FFEE DDEEPPRREESSSSAA  AANNGGIINNAA,, SSCCOOMMPPEENNSSOO,, AARRIITTMMIIEE..  IISSCCHHEEMMIIAA IINNDDUUCCIIBBIILLEE ..  AASSIINNTTOOMMAATTIICCII:: mmoonniittoorriizzzzaazziioonnee eeccooccaarrddiiooggrraaffiiccaa ((ddiillaattaazziioonnee eedd ssccaaddiimmeennttoo ddeellllaa ffuunnzziioonnee VVSS)) CCoonnttrrooiinnddiiccaazziioonnii reellaattiivvee ::  PPRREESSSSIIOONNEE AARRTTEERRIIOOSSAA PPOOLLMMOONNAARREE >>6600 mmmm HHgg  SSEEVVEERRAA DDIISSFFUUNNZZIIOONNEE VVEENNTTRRIICCOOLLAARREE DDXX  AASSIINNEERRGGIIAA RREEGGIIOONNAALLEE IINN AASSSSEENNZZAA DDII DDIILLAATTAAZZIIOONNEE DDEELL VVSS ((rriisscchhiioo ddii ccaavviittàà rreessiidduuaa rreessttrriittttiivvaa))..
  23. 23. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO AABBLLAAZZIIOONNEE DDEELLLLAA FFAA EEPPIIDDEEMMIIOOLLOOGGIIAA FISIOPATOLOGIA Prevalence 00..55 -- 11%% ( JACC 2001; 37: 371-8) EEffffeettttii eemmooddiinnaammiiccii ddeellllee TTaacchhiiaarriittmmiiee aattrriiaallii  PPeerrddiittaa ddeellllaa ssiinnccrroonniiaa AA--VV  DDeeppoollaarriizzzzaazziioonnee vveennttrriiccoollaarree aalltteerraattaa  IInnaaddeegguuaattoo aauummeennttoo ddeellllaa FFCC dduurraannttee ssffoorrzzoo RRiidduuzziioonnee ddeellllaa ppoorrttaattaa ccaarrddiiccaa
  24. 24. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO AABBLLAAZZIIOONNEE DDEELLLLAA FFAA MMAAZZEE PPRROOCCEEDDUURREE 11998899:: DDrr JJaammeess CCooxx iinnttrroodduuccee llaa MMaazzee:: mmuullttiippllee iinncciissiioonnii ee ssuuttuurree ppeerr rriidduurrrree llaa mmaassssaa aattrriiaallee eedd iinntteerrrroommppeerree ii cciirrccuuiittii ddii rriieennttrroo ee ddiirreezziioonnaarree ggllii iimmppuullssii ddeell sseennoo aall nnooddoo AAVV ..
  25. 25. 100 90 80 70 60 50 40 30 20 10 0 LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO Maze RRAADDIIOOFFRREEQQUUEENNCCYY CCRRYYOOTTHHEERRMMYY MMIICCRROOWWAAVVEE LLAASSEERR UULLTTRRAASSOOUUNNDD Control AABBLLAAZZIIOONNEE DDEELLLLAA FFAA 0 1 2 3 Freedom from atrial fibrillation (%) Post-op years Kawaguchi, et. al.; JACC Vol. 28, No. 4, October 1996:985-90
  26. 26. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO AABBLLAAZZIIOONNEE DDEELLLLAA FFAA S.O. T.I. Rep. Dim. F.U. Procedura atriale sn RADIOFREQUENZA Monopolare 92 Bipolare 11 93% 79% 43% 65% 75% AL FOLLOW-UP 86 % PTS IN RS CONTRATTILITA’ BI-ATRIALE 102 PTS (7/99 - 8/05)
  27. 27. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO AABBLLAAZZIIOONNEE DDEELLLLAA FFAA • MMAANNTTEENNIIMMEENNTTOO ddeell RRSS IINN OOLLTTRREE 7700 %% DDEEII PPTTSS PPOOSSSSIIBBIILLEE IINNTTEERRRROOMMPPEERREE LL’’ AANNTTIICCOOAAGGUULLAAZZIIOONNEE • LLAA MMIINNII--MMAAZZEE ““LLEEFFTT SSIIDDEE OONNLLYY ““ EE LLEE NNUUOOVVEE TTEECCNNOOLLOOGGIIEE (( RRFF,, MMWW,, LLAASSEERR,, CCRRYYOO)) SSEEMMPPLLIICCII EE RRAAPPIIDDEE • IINNDDIICCAATTIIOONNEE AAMMPPIIAA DDUURRAANNTTEE CCHHIIRRUURRGGIIAA MMIITTRRAALLIICCAA • IINNDDIICCAAZZIIOONNEE AANNCCHHEE DDUURRAANNTTEE CCHHIIRRUURRGGIIAA AAOO EE CCAABBGG ((aabbllaazziioonnee bbiippoollaarree)) • AAFF IISSOOLLAATTAA ?? AABBLLAATTIIOONNEE TTRRAANNSS--CCAATTEETTEERREE PPEERRCCUUTTAANNEEAA CCHHIIRRUURRGGIIAA MMIINNII--IINNVVAASSIIVVAA -- CCUUOORREE BBAATTTTEENNTTEE
  28. 28. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RESINCRONIZZAZIONE VENTRICOLARE Dissincronia ventricolare Conduzione ventricolare anormale risultante in un ritardo meccanico - QRS largo (IVCD): morfologia tipica da BBSin. - Cattiva funzione sistolica - Funzione diastolica deteriorata ECG con ritardo di conduzione intraventricolare
  29. 29. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RESINCRONIZZAZIONE VENTRICOLARE Prevalenza della dissincronia ventricolare nello scompenso Left Bundle Branch Block More Prevalent with Impaired LV Systolic Function 38% 24% 8% Preserved LVSF (1) Impaired LVSF (1) Moderate/Severe HF (2) 1. Masoudi, et al. JACC 2003;41:217-23 2. Aaronson, et al. Circ 1997;95:2660-7
  30. 30. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RESINCRONIZZAZIONE VENTRICOLARE 100% 90% 80% 70% 60% 0 60 120 180 240 300 360 Days in Trial Cumulative Survival Durata QRS ms < 90 90-120 120-170 170-220 > 220 Gottipaty V. ACC 1999; 847-4 QRS largo Aumento proporzionale della mortalità
  31. 31. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RESINCRONIZZAZIONE VENTRICOLARE Indicazione all’impianto chirurgico di catetere stimolatore epicardico - Fallimento di impianto endocardico Difficoltoso approccio venoso Posizionamento non ottimale del catetere - Dislocamento di cateteri endocardici - Chirurgia cardiaca associata Rivascolarizzazione coronarica Chirurgia valvolare Rimodellamento ventricolare Right Atrial Lead Left Ventricular Lead Right Ventricular Lead
  32. 32. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RESINCRONIZZAZIONE VENTRICOLARE Registro Italiano - 88 Pazienti arruolati 1 1 1 1 1 2 2 2 2 2 3 4 4 5 14 16 27 0 5 10 15 20 25 30 Niguarda (MI) Gemelli (Roma) HSR (MI) Poliambulanza (BS) S. Gaudenzio (NO) Riuniti (TS) Sacco (MI) Centro Cuore Morgagni (CT) S. M. Della Misericordia (UD) San Sebastiano (CS) San Camillo (Roma) Policlinico (Monza -MI) Multimedica (MI) Molinette (TO) Mauriziano (TO) S. Maria (BA) V. Fazzi (LE)
  33. 33. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RESINCRONIZZAZIONE VENTRICOLARE Casistica : 88 pazienti Età: 69 ± 7 (47-85) Sesso: 58 M – 29 F NYHA: 4 II - 66 III – 11 IV Pregresso IMA: 31 QRS (msec): 151 ± 25 (70-210) Dati Eco: FE%: 29 ± 6 (15-46) LVEDD (mm): 67 ± 10 (40-104) IM: 26%+ 26%++ 26%+++ 23%++++ Eziologia dello scompenso: Ischemica: 57 Idiopatica: 13 Valvolare: 18 Tipo intervento CCH: CABG: 38 Plastica Valvola Mitrale PVM: 22 Sostituzione Valvola Aortica: 7 CABG + PVM: 13 Rimodellamento Vsx: 2 CABG + rimodellamento: 5 Asportazione mixoma: 1 Terapia farmacologica: Diuretici: 72 ACE-inibitori: 59 b-bloccante: 52 Antiaggreganti: 12 Anticoagulanti: 15 Nitrati: 12 Statine: 13
  34. 34. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO RESINCRONIZZAZIONE VENTRICOLARE 50 45 40 35 30 25 20 15 10 5 0 40 P=0.002 P=0.015 35 P=0.011 30 25 20 15 10 5 Arruolamento Ultimo Follow-Up 0 P=0.09 Arruolamento Pre-impianto CRT Ultimo Follow-Up 70 60 50 40 30 20 10 0 P=0.194 P=0.026 Arruolamento Ultimo Follow-Up 70 60 50 40 30 20 10 0 P=0.725 Arruolamento Pre-impianto CRT Ultimo Follow-Up F.E. Tempi Eiezione Ao-Polm Impianto durante l’ospedalizzazione Impianto a 2/3 mesi
  35. 35. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO TTrraappiiaannttoo CCaarrddiiaaccoo
  36. 36. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO TTrraappiiaannttoo CCaarrddiiaaccoo 189 317 669 1185 2160 2718 3157 3383 4031 4196 4219 4389 4435 4358 4251 4157 3818 3547 3402 3340 3252 3135 4500 4000 3500 3000 2500 2000 1500 1000 500 0 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Number of Transplants . 237 242 304 402 367 377 356 348 299 450 400 350 300 250 200 150 100 50 0 1992 1993 1994 1995 1996 1997 1998 1999 2000 Registro Nazionale Italiano 2001 ISHLT 2005
  37. 37. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO ISHLT 2005 TTrraappiiaannttoo CCaarrddiiaaccoo 100 80 60 40 20 0 All comparisons significant at p < 0.01 40 35 30 25 20 15 10 5 0 1 2 3 4 5 6 7 8 9 10 11 12 Years 1982-1988 (N=9,148) 1989-1993 (N=17,898) 1994-1998 (N=18,714) 1999-6/2003 (N=13,480) HALF-LIFE 1982-1988: 8.1 years; 1989-1993: 9.5 years; 1994-1998: 9.8 years 0 0-9 10-19 20-29 30-39 40-49 50-59 60+ Recipient Age % of transplants 1982-1988 (N = 9,718) 1989-1993 (N = 19,602) 1994-1998 (N = 20,587) 1999-2003 (N = 16,657)
  38. 38. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO AAssssiisstteennzzee mmeeccccaanniicchhee
  39. 39. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO AAssssiisstteennzzee mmeeccccaanniicchhee
  40. 40. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO AAssssiisstteennzzee mmeeccccaanniicchhee
  41. 41. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO AAssssiisstteennzzee mmeeccccaanniicchhee R.E.M.A.T.C.H. - STUDY
  42. 42. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO CCOONNCCLLUUSSIIOONNII LA CHIRURGIA ESSENZIALMENTE TROVA INDICAZIONE NELLO SCOMPENSO CARDIACO SECONDARIO ALLA MALATTIA CORONARICA IN FASE AVANZATA: • IPOCINESIA DISFUNZIONE DEL VS • DILATAZIONE ANEURISMATICA DEL VS • INSUFFICIENZA MITRALICA, FA, BBsin I RISULTATI SONO : MIGLIORI SE SI INTERVIENE SU MIOCARDIO ISCHEMICO RIVASCOLARIZZABILE • TRAPIANTO CARDIACO • CUORE ARTIFICIALE
  43. 43. LA CHIRURGIA DELLO SSCCOOMMPPEENNSSOO CCAARRDDIIAACCOO

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