Maisano Edge To Edge Tor Vergata
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This document summarizes the history and outcomes of the edge-to-edge (E2E) surgical technique for mitral regurgitation (MR) developed by Francesco Maisano. Key points include: - The E2E technique was first performed in 1991 and has accumulated over 1500 published cases worldwide with about 15 years of follow-up. It is technically simple, reproducible, and versatile. - Studies show the E2E technique provides similar results to conventional surgical techniques for MR, with 5-year freedom from reoperation and recurrence of MR/MS of 96.6% and 96.2% respectively. - Annuloplasty is routinely added to the E2E procedure to reduce
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This document summarizes anesthesia statistics from four departments - general surgery, neurosurgery, orthopedics, and the new TC1 operating theater - at a hospital in 2012. It provides data on the number of surgeries, patient demographics, types of anesthetic used, comorbidities, complications, and disposition. The department achieved successes such as establishing a pain team and managing difficult airway cases. Areas for improvement include needing a pre-anesthesia room.
@Cabg and mitral
Chronic ischemic mitral regurgitation is a common complication of myocardial infarction that severely impacts mortality and morbidity, with multiple pathophysiological mechanisms involved in its generation. The study compared early and late results of 157 patients who underwent CABG and repair of grade II or higher ischemic mitral regurgitation to 5124 patients who underwent isolated CABG. Early results showed higher mortality, complications, and longer hospital stays for the group that underwent CABG and mitral valve repair. Residual mitral regurgitation and the Alfieri edge-to-edge repair technique were predictors of higher hospital mortality. Late follow-up is still ongoing but showed higher recurrence and mortality rates for patients with residual reg
Percutaneous Mitral Repair The Truth
This document summarizes the current status of surgical and transcatheter mitral valve repair. It notes that mitral valve repair surgery has low risks and good outcomes when appropriate procedures are used. However, around 50% of symptomatic patients with severe mitral regurgitation are denied surgery. New transcatheter techniques are being developed as alternatives to surgery, including the MitraClip edge-to-edge repair device, annuloplasty devices, and future prospects for transcatheter mitral valve replacement. Early experiences with MitraClip show it reduces mitral regurgitation in many patients but long-term outcomes need further study. An individualized approach is needed to determine the best repair option based on a patient's anatomy,
MCC 2011 - Slide 27
This document discusses liver surgery after neoadjuvant chemotherapy for colorectal cancer metastases. It notes that survival rates have improved significantly with chemotherapy advances over the past decades. Several studies evaluating perioperative chemotherapy found improved progression-free survival compared to surgery alone. However, prolonged preoperative chemotherapy can cause liver injuries like steatosis and sinusoidal obstruction, increasing postoperative complications. The optimal timing between chemotherapy and surgery appears to be 4-6 weeks to balance tumor response and liver recovery. Strategies for extensive liver metastases include downsizing with chemotherapy followed by aggressive resection or ablation if the future liver remnant is insufficient.
H. Van Poppel - Kidney cancer - Surgery (including nephron-sparing surgery)
H. Van Poppel - Kidney cancer - Surgery (including nephron-sparing surgery)European School of Oncology
The document discusses treatment options for renal cell carcinoma (RCC), including surgery and ablative therapies. It notes that partial nephrectomy is now the standard of care for small renal masses (SRMs) under 4cm to preserve renal function. While open partial nephrectomy remains the gold standard, laparoscopic partial nephrectomy performed by experts can achieve similar oncologic outcomes with lower morbidity. Ablative therapies like radiofrequency ablation may be appropriate for high surgical risk patients with SRMs under 3cm who accept close monitoring.Veronesispeech-IORT
The document discusses the evolution of breast cancer treatment from radical mastectomies to more conservative local treatments like lumpectomy and sentinel node biopsy, as well as the use of accelerated partial breast irradiation techniques like intraoperative radiotherapy (ELIOT) to further reduce treatment times and exposure to radiation. It presents data from trials at the European Institute of Oncology demonstrating the safety and effectiveness of ELIOT compared to conventional external beam radiotherapy for early-stage breast cancer.
Endovascular Repair of Thoracoabdominal Aneurysm
This document discusses total endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) using fenestrated and branched endovascular aneurysm repair (F-EVAR/B-EVAR) techniques. It summarizes outcomes from 86 high-risk patients treated with F-EVAR/B-EVAR for TAAA between 2007-2014, finding a 30-day mortality of 2.3%, 1-year survival of 91%, and 3-year survival of 88%. The use of staged procedures was associated with reducing spinal cord ischemia from 10% to 0%. The conclusion is that F-EVAR/B-EVAR provides good outcomes for high-risk TAAA patients when
Medium and long term results following evar success or disappointment
1. EVAR was found to have a 3% reduced 30-day mortality but increased long-term reintervention rates compared to open repair in trials. However, the rate of reintervention continues to increase over time for both methods.
2. Trials found that EVAR patients had improved short-term survival but similar long-term survival and aneurysm-related survival compared to open repair patients. EVAR was also associated with higher reintervention rates.
3. The document concludes that open repair remains the gold standard treatment currently, as EVAR is associated with increased long-term reintervention rates. Patient anatomy and life expectancy should be strongly considered to determine the best repair method.
Medium and long term results following evar success or disappointment
1. EVAR was found to have a 3% reduced 30-day mortality but increased long-term reintervention rates compared to open repair in trials. However, the rate of reintervention continues to increase over time for both methods.
2. While EVAR provides an initial survival benefit for ruptured AAA, the results are inconclusive due to heterogeneity and many patients still require open repair due to anatomical limitations.
3. Open repair remains the gold standard treatment for AAA due to the increasing long-term reintervention rates with EVAR and concerns about the overuse and liberal guidelines for device usage not aligning with patient risk factors and life expectancy.
Ca larynx management
This document discusses the management of laryngeal cancers. It covers evaluation by a multidisciplinary team and treatment options depending on the location and stage of the cancer. For early glottic cancers, options include radiation therapy, endoscopic laser resection, or open partial laryngectomy. More advanced cancers typically require total laryngectomy, with postoperative chemoradiation an option. Voice rehabilitation after laryngectomy can involve esophageal speech, an electrolarynx, or tracheoesophageal puncture. Close follow-up is important after any treatment to monitor for recurrence.
21 Century Management Of Colorectal Cancer
This document summarizes the management of colorectal cancer from the perspective of a colorectal surgeon. Key points discussed include the importance of total mesorectal excision surgery, developments in less invasive surgical techniques like laparoscopic surgery, the roles of radiotherapy and chemotherapy, and the increased focus on sphincter preservation and quality of life outcomes for patients. Advances in staging techniques such as endorectal ultrasound and MRI are also reviewed.
Gastric Cancer Evidence Based Management
Perioperative chemotherapy has been shown to improve outcomes for resectable gastric cancer compared to surgery alone. Multiple large randomized controlled trials have found that perioperative chemotherapy results in higher R0 resection rates, improved progression-free survival, and overall survival compared to surgery alone. The addition of preoperative chemoradiotherapy to perioperative chemotherapy did not provide additional benefits in overall survival or progression-free survival compared to perioperative chemotherapy alone in one large trial. Ongoing trials are evaluating whether preoperative chemoradiotherapy can be safely added to improve outcomes further.
History and Future of Transcatheter Mitral Valve Interventions
Invited lecture at the Scandinavian Society of Cardiothoracic Surgeons on transcathter mitral valve interventions (2009)
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Carcinome Hépatocellulaire : Résection ou Transplantation pour un CHC de peti...
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PERCUTANEOUS TREATMENT STRATEGIES OF VALVULAR HEART DISEASE
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H. Van Poppel - Kidney cancer - Surgery (including nephron-sparing surgery)
H. Van Poppel - Kidney cancer - Surgery (including nephron-sparing surgery)
Medium and long term results following evar success or disappointment
Medium and long term results following evar success or disappointment
Medium and long term results following evar success or disappointment
Medium and long term results following evar success or disappointment
History and Future of Transcatheter Mitral Valve Interventions
History and Future of Transcatheter Mitral Valve Interventions
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new technologies for Mitral regurgitation
This document discusses potential treatments for mitral regurgitation beyond the MitraClip procedure. It notes that while the MitraClip is effective for selected patients, other options are needed to treat a wider range of patients. These include open heart surgery, combining approaches synergistically, and new technologies such as annuloplasty, neochordae implantation, and mitral valve replacement. Several new transcatheter techniques are discussed such as devices to implant neochordae or reshape the coronary sinus. The document emphasizes tailoring the treatment approach to each individual patient based on their anatomy, comorbidities, and goals of care.
Esc patient selection for Mitraclip
This document discusses proposed criteria for patient selection for transcatheter mitral valve repair using the MitraClip device. It outlines anatomical and clinical considerations for both degenerative and functional mitral regurgitation. Experience from high-volume centers indicates MitraClip can be effective for selected patients at high risk for surgery, though longer-term data is still needed, especially for functional MR. A multidisciplinary team approach is important to thoroughly evaluate each patient's suitability and discuss risks versus benefits of MitraClip versus surgery.
Adjustable chords adjustable rings
This document discusses minimally invasive and percutaneous treatments for mitral valve disease. It describes adjustable surgical devices that can be used through minimally invasive or image-guided approaches, as well as percutaneous devices that closely reproduce surgical techniques. The goal is to simplify procedures, optimize results, and expand treatment to all patients by minimizing invasiveness and allowing for physiological fine-tuning of devices.
Pt Selection For Mitraclip Eacts 2010
This document discusses patient selection criteria for mitral valve interventions. It provides an overview of the risks of surgical mitral valve repair compared to the newer percutaneous Mitraclip procedure. Specifically, it notes that while surgical repair has low recurrence rates when performed by experienced centers, age and comorbidities increase surgical risk. The Mitraclip procedure has a lower initial risk but long-term durability is still being studied. The document recommends individualizing treatment based on a patient's anatomy, comorbidities, and life expectancy, while also preserving the option for future surgery if needed. The key factors in treatment choice are comparing the risks of each option and the probability of successfully correcting the mitral regurgitation.
Surgery For Aortic Stenosis
State of the art aortic valve surgery in the era of percutaneous valve interventions. (invited lecture 2009)
Mitraclip procedure A to Z
A 66 year old male with a history of cardiomyopathy, myocardial infarction, and congestive heart failure underwent a MitraClip procedure to treat functional mitral regurgitation. The procedure was performed using echocardiography guidance to place clips on the mitral valve to reduce regurgitation. In the days following the procedure, the patient's condition improved and he was discharged from the hospital. At a 3 month follow up, the mitral regurgitation was still mildly reduced and the patient's heart function and symptoms had improved.
How to learn the catheter skill techniques
The document discusses the need for cross-training of surgeons and interventional cardiologists in percutaneous heart valve treatment. It states that the procedure requires skills independent of one's base discipline, and that specific training is required. Those undergoing the procedural training should be experienced interventionalists or surgeons. The document then outlines various pathways for acquiring the necessary skills through simulation, proctoring, visiting other centers, and industry-supported opportunities.
Tachosil Case Pictures
An angiogram and CT scan were performed in preparation for an upcoming operation. The planned operation was to replace the ascending aorta and hemiarch under cardiopulmonary bypass with axillary artery cannulation and hypothermic circulatory arrest at 26°C with antegrade cerebral perfusion. During the operation, diffuse oozing was observed from the back-side of the anastomosis.
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1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
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7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
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Maisano Edge To Edge Tor Vergata
- 1. Francesco Maisano San Raffaele Scientific Institute and University Hospital Milano
- 2. First case performed in 1991 Over 1500 published cases accumulated worldwide About 15 yrs follow-up Technically simple and reproducible Versatile Criticized by some surgeons Did not apply correctly Used only as a bailout
- 3. Alfieri O et al. JTCVS 2001 Performed in diverse clinical settings: High risk patients Complex anatomy Functional MR Used to correct anterior and posterior lesions Annuloplasty has been added whenever possible (90%)
- 4. Alfieri O et al. JTCVS 2001; Maisano F et al. EJCTS 1998 Freedomfrom reoperation Recurrence ofMR/MS 5 yrs follow-up of 82 pts with severe Barlow’s disease and bileaflet prolapse Overall Etiology subgroups
- 5. Debonis et al. JTCVS 2005 years 14121086420 Freedomfromreoperation 1,00 ,90 ,80 ,70 ,60 ,50 ,40 ,30 ,20 ,10 ALP: 96,6 ± 1,74% PLP: 96.2 ± 2.0% E2E offers the same results as conventional techniques n.s. MayoMayo ClevelandCleveland
- 6. The suture must incorporate the diseased segment(s) completely Respect symmetry Suture lenght should be kept to the minimum effective to correct MR in order to avoid stenosis Depth of suture bites is variable according to the nature of the MR
- 7. Maisano F et al. EJCTS 1998
- 8. Stenosis / Gradients Suture dehiscence Role of annuloplasty
- 9. Hemodynamics are not influenced by a two orifice configuration of the valve Pressure gradients are related to the sum of the two orifices area 0 2 4 6 8 (mmHg) Double (1:1) Double (1:2)Single Q = 11 l/min Area = 2.25 cm2 Maisano F et al. EJCTS 1999
- 10. Stresses on the suture are maximum at diastole Stresses depend on annular size Redaelli et al. J. Biomechanics 2001 - 647 - 520 - 394 - 267 - 140 - 134 + 113 + 240 + 367 + 493 + 620 + 747 +873 +1000 SI (kPa)
- 11. Annuloplasty has been routinely added to the Alfieri procedure Absence of annuloplasty is associated with increased stresses on the suture and on the valve structures Absence of annuloplasty may be associated with accelerated failure (but not in multivariate analysis) - 647 - 520 - 394 - 267 - 140 - 134 + 113 + 240 + 367 + 493 + 620 + 747 +873 +100 0 SI (kPa) Alfieri et al. JTCVS 2001, Maisano et al JTCVS 2003, Nielsen et al Circulation 2005
- 12. Maisano F et al. Eurointervention 2006
- 14. Guide Steerable sleeve Clip delivery handle Stabilizer Atrial Septum
- 15. Enrollment Population n EVEREST I Feasibility (completed) Registry patients 55 EVEREST II Randomized n=244 Roll-in Randomized Clip Randomized Surgery 60 172 88 EVEREST II High Risk Registry 78 Total enrolled 453
- 18. 79 pts
- 19. SURGERY FREE 76/104 Surgery After Clip Implanted (n = 20) • 15 (75%) Repairs (0 - 562 days) • 5 (25%) Replacements Surgery After No Clip (n = 8) • 5 (63%) Repairs • 3 (37%) Replacements 71% Repaired
- 20. Applicable only to central MR originating from A2-P2 Not applicable in case of wide prolapse Not applicable in case of annular dilatation mid esophageal 120° mid esophageal 90° mid esophageal 120° Maisano F, et al Am J Cardiol 2007;99:1434–1439 SL AL <10% of current surgical candidates
- 21. When performed according to surgical principles, the E2E technique provides results at least non inferior to other surgical techniques Precision of the repair is mandatory for efficacy and durability Pt selection + include all diseased segments + respect symmetry Patients with normal annular function may undergo ringless repair, although lower durability may be expected Percutaneous approach is feasible also in FMR Addition of annuloplasty should be an option also for percutaneous patients
- 22. 66 aa, maschio, 64 Kg, 164 cm, BSA 1.7 m2, BMI 24 IM 4+, FE 15-20%, PAPs 75 mmHg, disfunzione VDx, IT 3+ 1994 IMA anteriore; 2001 PTCA e successivo CABG (LIMA—LAD); successive plurime PTCA con stents medicati 2005 AlloTx di midollo per AML, inizia CsA 2006 stenting a. carotide comune e interna destra 1/2008: recidiva di IMA per trombosi intrastent POBA su LAD 4/2008 EPA PM-ICD biv AAA sottorenale; CCS II, NYHA II, labile compenso emodinamico Anamnesi-1 Paziente n. 1Paziente n. 1