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Dive into the research topics where Fabrizio Settepani is active.

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Featured researches published by Fabrizio Settepani.


The Journal of Thoracic and Cardiovascular Surgery | 2010

Use of the Valsalva graft and long-term follow-up.

Ruggero De Paulis; Raffaele Scaffa; Saverio Nardella; Daniele Maselli; Luca Weltert; Fabio Bertoldo; Davide Pacini; Fabrizio Settepani; Giuseppe Tarelli; Roberto Gallotti; Roberto Di Bartolomeo; Luigi Chiariello

OBJECTIVE The Valsalva graft is a specifically designed Dacron graft that, on implantation and pressurization, generates pseudosinuses of Valsalva. We reviewed a multicenter experience of the reimplantation procedure with the Valsalva graft in patients with aneurysms involving the aortic root. METHODS A total of 278 patients underwent valve-sparing aortic root replacement using the Valsalva graft at 4 different Italian cardiac surgery centers and were studied by clinical assessment and echocardiography. Of the 278 patients, 220 were men (79%), with a mean age of 56 ± 15 years. Of the patients, 42 (15%) had Marfan syndrome, 31 (11%) had a bicuspid aortic valve, 13 (5%) had acute aortic dissection, and 136 (49%) had grade 3 or 4+ aortic insufficiency. Concomitant cardiac procedures were performed in 78 patients (28%). Additional aortic leaflet repair was necessary in 25 patients (9%). The mean crossclamp time was 120 ± 27 minutes. RESULTS There were 5 (1.8%) operative and 5 (1.8%) late deaths. The mean follow-up was 52 ± 28 months (range, 2-112 months) and was 100% complete. The cumulative actuarial survival was 95.2% (268 patients). A total of 32 patients (11%) had grade 3 to 4+ aortic insufficiency, and 17 of these required late aortic valve replacement (range, 3-78 months). At 10 years of follow-up, the freedom from aortic valve reoperation rate was 91%, and the rate of freedom from residual aortic insufficiency not needing reoperation was 88%. CONCLUSIONS The reimplantation type of valve-sparing procedure can be facilitated by the use of the Valsalva graft and can be performed with satisfactory perioperative and midterm results. How an optimal root reconstruction will affect the second decade of follow-up has yet to be determined.


European Journal of Cardio-Thoracic Surgery | 2003

Intracerebellar hematoma following thoracoabdominal aortic repair: an unreported complication of cerebrospinal fluid drainage

Fabrizio Settepani; Eric P. van Dongen; Marc A.A.M. Schepens; Wim J. Morshuis

Cerebrospinal fluid (CSF) drainage is a routinely used adjunct in thoracoabdominal aortic aneurysm (TAAA) surgery which may reduce the incidence of perioperative paraplegia by improving the spinal cord perfusion. However, a small but evident complication rate of lumbar drainage should be considered. We present two rare cases of intracerebellar hematoma possibly due to excessive CSF drainage after TAAA repair.


Journal of Vascular Surgery | 2016

Outcome of open total arch replacement in the modern era

Fabrizio Settepani; Antioco Cappai; Alessio Basciu; Alessandro Barbone; Giuseppe Tarelli

OBJECTIVE To shed light on contemporary results of open total aortic arch surgery, we undertook a systematic review to identify all reports on this procedure published in the last 10 years. METHODS Extensive electronic literature search was undertaken to identify all published articles from 2004 to 2014 that provided results on total aortic arch replacement. According to inclusion and exclusion criteria, 21 relevant studies were selected and meta-analyzed to assess outcomes. RESULTS The pooled estimate for operative mortality was 5.3%. Permanent and transient neurologic deficit occurred postoperatively at a pooled rate of 3.4% and 5.2%, respectively. Pooled rate of irreversible spinal cord injury was 0.6%, whereas renal failure occurred at a pooled rate of 4.1%. Prolonged intubation occurred at pooled rate of 15.4%. Among elective patients, pooled rate of mortality and permanent neurologic deficit was 2.9% and 2.2%, respectively, with a significant difference compared with urgent/emergency surgery cases. CONCLUSIONS The main findings from this meta-analysis indicate that total aortic arch replacement can be performed with satisfactory mortality and morbidity. The pooled rates of mortality and permanent neurologic deficit among elective cases were surprisingly low, and these data have an even greater prominence when they are compared with outcomes of hybrid arch series. Under urgent/emergency surgery, early mortality and neurologic complications showed an about threefold higher rate. Moderate hypothermic circulatory arrest and early rewarming seem to provide proper renal protection, with an intermediate risk of prolonged intubation.


Journal of Cardiac Surgery | 2008

Reoperation for Aortic False Aneurysms: Our Experience and Strategy for Safe Resternotomy

Fabrizio Settepani; Mirko Muretti; Alessandro Barbone; Enrico Citterio; Alessandro Eusebio; Diego Ornaghi; Giuseppe Silvaggio; Roberto Gallotti

Abstract  Background and aim of the study: To review our experience with reoperation for aortic false aneurysms (FA) and to present an analysis of the relevant surgical approaches and risks. Methods: From May 1999 to June 2006, 11 patients underwent a total of 13 reoperations due to aortic false aneurysms, with an incidence of 3% of all thoracic aortic cases. Cardiopulmonary bypass (CPB) and cooling were started before sternotomy in all cases. Three different strategies were adopted for patients depending on the position of the FA in the mediastinum as indicated by a preoperative CT scan. These included: deep hypothermic circulatory arrest (18°C), moderate hypothermia (28°C), and mild hypothermia (32°C). In two patients, the sternotomy ruptured the FA causing profuse hemorrhaging. In all the other cases sternotomy was performed without complication. The repair consisted in simple repair by direct suture (10 cases) or extensive repair by refashioning the anastomosis (three cases). Results: Two hospital deaths occurred with a hospital mortality rate of 16.7%. Permanent neurological deficit developed in one patient. Transient neurological deficit in the form of left lower limb weakness was observed in one patient. False aneurysm recurrence developed in two cases. Among patients present at follow‐up (nine survivors), four are in NYHA class I and five in class II. Conclusions: Aortic false aneurysms carry a high mortality and morbidity rate. Nevertheless, we believe that selecting the right strategy according to the position of the FA in the chest can reduce surgical risk, thus permitting relatively safe resternotomy.


Journal of Cardiac Surgery | 2012

Aortic Valve Replacement for Paraprosthetic Leak After Transcatheter Implantation

Giuseppe Maria Raffa; Pietro Giorgio Malvindi; Fabrizio Settepani; Diego Ornaghi; Alessio Basciu; Antioco Cappai; Giuseppe Tarelli

Abstract  Conversion to surgical aortic valve replacement (AVR) has been described as a complication following transcatheter aortic valve implantation. This complication occurs in up to 8% of cases and, to the best of our knowledge, preoperative data and surgical outcomes of such patients have not been properly evaluated. Mild paraprosthetic regurgitation is commonly observed after transcatheter aortic valve implantation and usually leads to a benign clinical course. Unequal distribution of valve calcifications is described as a potential mechanism. We report a case of a perioperative paraprosthetic regurgitation that underwent successful urgent surgical AVR and review the incidence and results of paraprosthetic leaks following transcatheter implantation. (J Card Surg 2012;27:47–51)


Artificial Organs | 2012

6 Months of “Temporary” Support by Levitronix Left Ventricular Assist Device

Alessandro Barbone; Pietro Giorgio Malvindi; Robert Sorabella; Graziano Cortis; Paolo F. Tosi; Alessio Basciu; Pietro Ferrara; Giuseppe Maria Raffa; Enrico Citterio; Fabrizio Settepani; Diego Ornaghi; Giuseppe Tarelli; Ettore Vitali

An otherwise healthy 47-year-old man presented to the emergency department in cardiogenic shock after suffering a massive myocardial infarction due to left main occlusion. He was initially supported by extracorporeal membrane oxygenation and subsequently was converted to paracorporeal support with a Levitronix left ventricular assist device. He experienced multiple postoperative complications including renal failure, respiratory failure, retroperitoneal hematoma requiring suspension of anticoagulation, and fungal bloodstream infection precluding transition to an implantable device. He was reconditioned and successfully underwent orthotopic heart transplant 183 days after presentation. A discussion of the relevant issues is included.


Interactive Cardiovascular and Thoracic Surgery | 2009

Reimplantation valve-sparing aortic root replacement with the Valsalva graft: what have we learnt after 100 cases?

Fabrizio Settepani; Marcello Bergonzini; Alessandro Barbone; Enrico Citterio; Alessio Basciu; Diego Ornaghi; Roberto Gallotti; Giuseppe Tarelli

OBJECTIVES Reimplantation valve-sparing aortic root replacement has been increasingly performed with improving perioperative and mid-term results. The success of this operation primarily depends on preserving the highly sophisticated dynamic function of the aortic valve by recreating an anatomical three-dimensional configuration similar to the normal aortic root, thus minimizing the mechanical stress and strain on the cusps. Over the years several techniques have been proposed to reproduce the sinuses of Valsalva. We reviewed our experience with aortic valve reimplantation by means of a modified Dacron graft that incorporates sinuses of Valsalva, in a series of 100 consecutive patients. METHODS During a 60-month period, 100 patients with aortic root aneurysm underwent aortic valve reimplantation using the Gelweave Valsalva prosthesis. There were 74 males and the mean age was 60+/-12 years (range 28-83 years). Five patients had the Marfans syndrome, 15 had a bicuspid aortic valve. Cusp repair was performed in five patients. The mean follow-up time was 28.6 months (range 1-60). Transesophageal echocardiogram was performed at the end of each procedure to assess the aortic valve in terms of competence, dynamic motion and level of coaptation within the graft. RESULTS There was one hospital death and two late deaths. Overall survival at 60 months was 91.7+/-5.1%. Five patients developed severe aortic incompetence (AI) during follow-up requiring aortic valve replacement (AVR). The 60 months freedom from re-operation due to AI was 90.9+/-4.4%. One patient had moderate AI at latest echocardiographic study. The 60 months freedom from AI>2+ was 91.6+/-7.9%. Cox regression identified cusps repair as independent risk factor (P=0.001) for late reimplantation failure (AVR or AI>2+). There were no episodes of endocarditis and the majority of the patients (88%) were in New York Heart Association functional class I. CONCLUSIONS The aortic valve reimplantation with the Gelweave Valsalva prosthesis provided satisfactory mid-term results. An accurate assessment of the level of coaptation of the aortic cusps in respect to the lower rim of the Dacron graft by means of intraoperative transesophageal echocardiogram at the end of each procedure is mandatory in order to avoid early reimplantation failure. Cusps repair may play an important role in the development of late AI. However, long-term results are needed in order to define the durability of this technique.


Interactive Cardiovascular and Thoracic Surgery | 2012

Bicuspidy does not affect reoperation risk following aortic valve reimplantation

Pietro Giorgio Malvindi; Giuseppe Maria Raffa; Alessio Basciu; Enrico Citterio; Antioco Cappai; Diego Ornaghi; Giuseppe Tarelli; Fabrizio Settepani

Aortic valve reimplantation has been shown to be a safe procedure. However, evidences of durability in bicuspid aortic valves (BAVs) are limited in the literature. Between 2002 and 2011, 132 patients (mean age 61 ± 12 years) underwent aortic valve reimplantation. In 24 patients (18%), aortic valve was bicuspid. Mean follow-up was 50 ± 26 months (range 1-102 months) and was 99% complete. In-hospital mortality was 0.8% (1 patient). Survival at 1 and 5 years was 99 and 94%, respectively. Overall freedom from aortic valve reoperation at 1 and 5 years was 96 and 90%, respectively, without significant difference between patients with bicuspid and tricuspid aortic valve. Freedom from aortic valve regurgitation >2+/4+, excluding patients reoperated, was at 1 and 5 years of 100 and 99%, respectively. Patients with valve cusp repair showed a higher rate of aortic valve reoperation; however, only postoperative aortic regurgitation >2+/4+ was significant risk factor for redo procedure at multivariate analysis. Aortic valve reimplantation in BAV without cusp repair provides excellent mid-term results. Further observations and longer follow-up are necessary to determine if BAV sparing, even in the presence of cusps alterations, could allow satisfying durability.


Journal of Cardiovascular Medicine | 2015

Minimally invasive direct coronary artery bypass in the era of percutaneous coronary intervention.

Giuseppe Maria Raffa; Pietro Giorgio Malvindi; Diego Ornaghi; Enrico Citterio; Antioco Cappai; Alessio Basciu; Alessandro Barbone; Francesca Fossati; Giuseppe Tarelli; Fabrizio Settepani

Aim Minimally invasive coronary artery bypass (MIDCAB) allows revascularization of the left anterior descending coronary (LAD) artery through a less traumatic surgical approach. However, the procedure is technically challenging and concern still exists, mainly based on graft patency. The purpose of this study is to critically evaluate short and long-term benefits of this surgical treatment. Methods Between June 1997 and July 2012, 306 patients underwent MIDCAB on LAD. The mean age was 62 ± 10 years (range, 32–87 years) and 264 patients (86.3%) were men. Mean ejection fraction was 54%. Eighty-nine procedures (29.1%) were performed using a hybrid approach by means of MIDCAB and postoperative (60 patients, 67.4%) or preoperative (29 patients, 32.6%) percutaneous interventions on non-LAD vessels. A EuroScore more than 6 was found in 43 (14%) patients. The average follow-up time was 9.5 ± 3.2 years and was 89% complete. Results Six patients (1.9%) required intraoperative conversion to sternotomy, whereas cardiopulmonary bypass institution after the sternotomy was necessary in one. Postoperative acute myocardial infarction occurring nine patients (2.9%), low output syndrome in four (1.3%). Postoperative mortality was 1.6% (n = 5), and perioperative stroke rate 0.6% (n = 2). Five and 10-year survival were 94.1 and 86.9%, respectively. Freedom from death due to cardiac events and major cardiac and cerebral events at 10 years was, respectively, 97.1 and 92.1%. Conclusions The results confirm the favorable short and long-term results of the MIDCAB procedure. MIDCAB, in experienced centers, can represent an alternative treatment option for LAD disease.


Journal of Cardiovascular Medicine | 2015

Cusp repair during aortic valve-sparing operation: technical aspects and impact on results.

Fabrizio Settepani; Antioco Cappai; Giuseppe Maria Raffa; Alessio Basciu; Alessandro Barbone; Daniele Berwick; Enrico Citterio; Diego Ornaghi; Giuseppe Tarelli; Pietro Giorgio Malvindi

Aims Aortic valve-sparing operations are nowadays considered safe and reliable procedures in terms of mid-term and long-term results. Although surgical techniques regarding the modality of grafts’ implantation have been properly addressed, the modality of cusp repair, when needed, is still open to debate. We sought to review the literature to try to shed light on when the cusp repair is required and how it should be performed. Methods We searched the PubMed database using the keywords aortic valve-sparing operation, aortic valve-sparing reimplantation, valve-sparing aortic root replacement, aortic valve repair, and aortic cusp repair. Only studies that included and described in detail the technique of cusp repairs in adjunct to aortic valve-sparing operation were considered. Results Bicuspid aortic valve more often requires correction when compared with tricuspid valve. The range of the techniques varies from the ‘simple’ free margin plication to the more complex triangular resection with patch repair. Results in the literature seem to be encouraging, showing that, in most of the cases, cusp repair does not affect valve competence in the mid-term and long-term. Conclusion Correction of the cusp is a delicate balance between undercorrection that could lead to residual prolapse and overcorrection that could lead to cusp restriction. Although complex repair of the aortic valve in addition to root replacement provided satisfactory results, it should be reserved for experienced centers with a large volume of patients.

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Pietro Giorgio Malvindi

University Hospital Southampton NHS Foundation Trust

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Luigi Chiariello

Sapienza University of Rome

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Eric Manasse

Catholic University of the Sacred Heart

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