Publications by authors named "Ruggero de Paulis"

Objective: Restoring the anatomic relationships among the aortic root components is important to achieve durable valve competence. We previously analyzed the in vivo anatomy of the aortic root after reimplantation with the Valsalva graft. This study aims to evaluate if the topographic relationship among the neoroot components varies over time.

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Objectives: This study investigated the gnder-based difference in three-year clinical outcomes, left ventricular (LV) regression, and quality-of-life (QoL) following surgical aortic valve replacement (SAVR) by propensity score matching (PSM).

Methods: A prospective multicentre study on combined data from two prospective registries, INDURE and IMPACT, resulted in 993 patients (735 males and 258 females). PSM yielded 689 patients: 442 males and 247 females undergoing first-time SAVR using Edwards INSPIRIS RESILIA.

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Objectives: Aortic valve repair procedures for aortic valve regurgitation have been progressively adopted in the last decades. We analysed our results with an external ring annuloplasty and/or leaflet repair.

Methods: From April 2014 to December 2023, 61 consecutive patients underwent aortic valve repair with external Teflon ring annuloplasty.

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A 23-year-old woman underwent valve-sparing root replacement for an asymmetric aneurysm affecting the sinuses of Valsalva (SVA). Genetic analysis revealed a novel variant in the FLNA gene leading to frameshift and a premature stop codon in Filamin A. SVA, typically multiple and affecting the coronary sinus, is a cardinal feature and a handle for diagnosis of FLNA deficiency.

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Objective: Reported outcomes in patients with bicuspid aortic valves (BAVs) undergoing valve-sparing aortic root replacement (VSRR) are scarce. This study aims to evaluate outcomes in patients with BAV using the reimplantation (David) technique.

Methods: Consecutive adult patients with BAV, aortic root aneurysm, and/or aortic valve insufficiency (AI) undergoing VSRR (reimplantation) were included from 5 centers experienced in reimplantation procedures.

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Severe aortic valve regurgitation, if not timely treated, can significantly impact patients' survival both for tricuspid aortic valve and bicuspid aortic valve patients, with the latter being significantly younger. Increased understanding of the root anatomy and its physiology has opened the way to techniques of aortic valve repair surgery. The techniques mainly relate to re-establishing a correct root and annular geometry and eliminating leaflet prolapse.

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Minimally invasive mitral valve surgery (MIMVS) has been increasingly adopted worldwide as an alternative to conventional sternotomy, especially for young patients. The remarkable results gained by MIMVS have encouraged its application in more complex and fragile patients, such as the elderly, though results in this subgroup remain controversial. It is the aim of this study to assess the postoperative outcomes of patients older than 75 years old undergoing MIMVS, and to compare these results to those of younger patients.

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Background: Oxidative stress and inflammation are typically implied in atherosclerosis pathogenesis and progression, especially in coronary artery disease (CAD). Our objective was to investigate the oxidative stress and inflammation burden directly associated with atherosclerotic plaque in patients with stable coronary disease undergoing coronary artery bypass graft (CABG) surgery. Specifically, markers of oxidative stress and inflammation were compared in blood samples obtained from the atherosclerotic left anterior descending artery (LAD) and blood samples obtained from the healthy left internal thoracic artery (LITA), used as a bypass graft, within the same patient.

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Article Synopsis
  • A study evaluated the effectiveness of a commercial sponge diffuser versus a custom-made cannula and no CO2 in preventing neurological events after aortic valve replacement surgery.
  • Three patient groups were compared based on their CO2 delivery method, with a focus on outcomes like stroke, dizziness, and mechanical ventilation duration.
  • Results showed that the sponge diffuser group had a significantly lower duration of mechanical ventilation, decreased 30-day mortality, and fewer neurological events compared to the other methods.
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  • The mitris valve combines features of two existing valves—the Carpentier-Edwards PERIMOUNT Magna Mitral Ease valve and INSPIRIS RESILIA tissue—for enhanced hemodynamic performance and durability.
  • Its design includes a more flexible, saddle-shaped sewing cuff that fits the mitral valve better, reducing risks of complications during double-valve replacements.
  • The valve also benefits from advanced technology that minimizes free aldehyde levels, suggesting improved long-term durability and reliability compared to earlier models.
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Annuloplasty should always accompany mitral valve repair in order to achieve proper annular remodeling and stabilization. Numerous types of annuloplasty rings-that differ from rigid to semi-rigid and flexible devices, from complete to partial, and from flat to saddle-shaped rings-are clinically available. A deeper understanding of mitral valve function, in conjunction with several recent studies, suggest it is advisable to prefer annuloplasty rings that mimic the physiological mitral annulus shape and three-dimensional (3D) dynamic changes in order to reduce haemodynamic stress on valve components and optimize leaflet coaptation, perhaps improving valve repair durability too.

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Article Synopsis
  • The study aimed to explore differences in characteristics and 2-year outcomes after surgical aortic valve replacement (SAVR) between males and females, using data from two registries involving 933 patients.
  • Females had certain clinical differences such as lower body mass index, higher surgical risk scores, and smaller valves compared to males, but these disparities largely disappeared after adjusting for similar baseline characteristics.
  • Ultimately, despite a higher initial surgical risk profile, both sexes had comparable outcomes 2 years post-SAVR, indicating no significant differences in overall results based on sex.
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  • The study investigates optimal sizes of the annular and sinotubular junctions in aortic valve repair while keeping the cusp height constant through computer simulations.
  • A computational model created 125 virtual anatomies, finding that changes to the annular diameter had a more significant effect on valve performance than alterations in the sinotubular junction diameter.
  • Results indicate that an ideal valve configuration occurs when the sinotubular junction is 2-4 mm larger than the annulus, which leads to better coaptation height and lower stress on the valve cusps.
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Article Synopsis
  • - This document serves as an evidence-based guideline for naming and classifying congenital bicuspid aortic valve and its associated conditions, aimed at a wide range of medical professionals.
  • - It is designed for use by pediatricians, cardiologists, surgeons, and researchers, ensuring clarity across various healthcare fields.
  • - The consensus is subject to updates as new research and key findings emerge, highlighting its dynamic nature in adapting to evolving medical knowledge.
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As a result of increasing adoption of imaging screening, the number of adult patients with a diagnosis of anomalous aortic origin of the coronary arteries (AAOCA) has grown in recent years. Existing guidelines provide a framework for management and treatment, but patients with AAOCA present with a wide range of anomalies and symptoms that make general recommendations of limited applicability. In particular, a large spectrum of interventions can be used for treatment, and there is no consensus on the optimal approach to be used.

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As a result of increasing adoption of imaging screening, the number of adult patients with a diagnosis of anomalous aortic origin of the coronary arteries (AAOCA) has grown in recent years. Existing guidelines provide a framework for management and treatment, but patients with AAOCA present with a wide range of anomalies and symptoms that make general recommendations of limited applicability. In particular, a large spectrum of interventions can be used for treatment, and there is no consensus on the optimal approach to be used.

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Valvular heart disease (VHD) is common and poses important challenges from the standpoints of diagnosis and therapeutic management. Clinical practice guidelines have been developed to help health care professionals to overcome these challenges and provide optimal management to patients with VHD. The American College of Cardiology, in collaboration with the American Heart Association, and the European Society of Cardiology, in collaboration with the European Association for Cardio-Thoracic Surgery, recently updated their guidelines on the management of VHD.

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Aortic annuloplasty has been clearly demonstrated to have a protective influence in aortic valve repair. Over the past 20 years, different annuloplasty concepts have been proposed by different groups. However, the most appropriate approach to enable long-term annular stability remains highly controversial.

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