Cardiac Surgery
In order to provide each patient with the most appropriate surgery for their needs, the Cardiac Surgery Unit employs both traditional and cutting-edge techniques for the surgical treatment of adult heart diseases.
Coronary artery bypass surgery
Extensive experience with traditional techniques is complemented by mastery of the most cutting-edge techniques for treating ischaemic heart disease and its acute complications:
- Revascularization of the coronary arteries via sternotomy with extracorporeal circulation (traditional procedure);
- Revascularization of the coronary arteries via sternotomy without the use of extracorporeal circulation (“beating heart” surgery);
- Revascularization via left mini-thoracotomy (a few centimetre long skin incision) without extracorporeal circulation (minimally invasive coronary surgery) for the treatment of one- or two-vessel disease;
- Complete coronary revascularization via arterial conduits only;
- Coronary revascularization using multiple arterial “Y” anastomotic grafts without causing any trauma to the ascending aorta (aortic no-touch technique)
- Treatment of acute myocardial infarction complications: rupture of the interventricular septum, the free wall of the left ventricle, and papillary muscle rupture
Chronic complications of ischaemic heart disease are treated with aneurysmectomy and reconstruction of left ventricular geometry, as well as treatment of ischaemic mitral regurgitation.
Valve replacement surgery
Along with the traditional prosthetic heart valve placement, the most recent and well-established valve reconstruction techniques are used.
Mitral valve
- The traditional procedure involves replacing the valve with a mechanical or biological prosthesis through a sternotomy with extracorporeal circulation;
- Repair and reconstruction of the valve using the most advanced techniques via sternotomy with extracorporeal circulation (almost all cases of mitral valve insufficiency treated);
- Valve repair and reconstruction using extracorporeal circulation and a video-assisted technique via a right mini-thoracotomy (minimally invasive surgery);
- Valvular system repair and reconstruction using extracorporeal circulation and a video-assisted technique via a mini-sternotomy (minimally invasive surgery).
Aortic outflow region, aortic valve and ascending aorta
- The traditional procedure involves replacing the valve with a mechanical or biological prosthesis through a sternotomy with extracorporeal circulation;
- Valve repair and reconstruction via sternotomy with extracorporeal circulation using cutting-edge techniques;
- Valve repair or replacement via mini-access (minimally invasive surgery) with extracorporeal circulation;
- Replacement via sternotomy with extracorporeal circulation using cadaver tissue (homograft);
- Valve replacement without sternotomy using a catheter introduced through the femoral artery or ventricular apex to implant a prosthetic valve (transcatheter aortic valve implantation, TAVI), with no extracorporeal circulation (minimally invasive surgery);
- Replacement of the ascending aorta via sternotomy with extracorporeal circulation via a prosthetic conduit or cadaver tissue for the treatment of acute (dissection) or chronic (aneurysm) disorders using the most recent techniques that allow for the preservation of the native valve in certain cases;
- Aortic arch replacement via sternotomy with extracorporeal circulation via a prosthetic conduit.
Tricuspid valve
- Traditional intervention which involves replacing the valve with a mechanical or biological prosthesis through a sternotomy with extracorporeal circulation;
- Repair via sternotomy with extracorporeal circulation;
- Repair via sternotomy with “beating heart” extracorporeal circulation in the absence of cardioplegia.
Arrhythmia Surgery
Daily collaboration with electrophysiology specialists, as well as the development of shared diagnostic-therapeutic pathways, has enabled the development of commonly used procedures as well as the introduction and progression of novel surgical treatments:
- Ablation of atrial fibrillation during cardiac surgery (valve repair/replacement, aorto-coronary bypass);
- Thoracoscopy is used to ablate isolated atrial fibrillation and close the left atrial appendage;
- Ablation of ventricular arrhythmias originating in the epicardium and endocardium during surgical aneurysmectomy of the left ventricle;
- Epicardial and endocardial ablation of congenital and acquired complex ventricular arrhythmias via sternotomy or mini-thoracotomy;
- Implantation of a biventricular pacemaker via a left mini-thoracotomy (minimally invasive).
Adult correction of congenital heart defects
Interatrial defect
- Video-assisted repair with extracorporeal circulation via a right mini-thoracotomy (minimally invasive surgery) using the most advanced techniques;
- Video-assisted repair with extracorporeal circulation via a mini-sternotomy (minimally invasive surgery) using the most advanced techniques.
Interventricular septal defect
- Video-assisted repair with extracorporeal circulation via a right mini-thoracotomy (minimally invasive surgery) using the most advanced techniques.
Cardiovascular Tissue Bank
The Cardiovascular Tissue Bank at Centro Cardiologico Monzino, along with the bank in Treviso, is Italy’s oldest cardiovascular tissue bank.
The Cardiovascular Tissue Bank’s activity consists in procuring of human heart valves and vessels from multiorgan or cadaveric donors, as well as their processing, cryopreservation, distribution and clinical use.
Tissues are commonly used in bacterial endocarditis, pediatric cardiac surgery, aortic ring abscess, heart valve substitution (insufficiency and valve degeneration), aortic ectasia, small aortic annulus, sinus Valsalve aneurysm, native vessel infections, prosthetic infections, artero-venous fistula for haemodialisis as well as other procedures.
The tissue bank’s activity, which is inextricably linked with the CIR/CRR activity (Centro Interregionale di Riferimento/Centro Regionale di Riferimento), adheres to both European (2004/23/CE) and Italian (July 2013) guidelines.
The Cardiovascular Tissue Bank has been ISO 9001-2008 and CNT (Centro Nazionale Trapianti) certified since 2005. It is also listed in the European Registry of Cardiovascular Banks. It has been a founding member and member of the Scientific Committee of the Italian Tissue Bank Association (AIBAT) since 2016.
Diabetes, Endocrinology and Metabolic Diseases
The Diabetes, Endocrinology, and Metabolic Diseases Unit deals with a number of important diseases that are common in cardiac patients or that increase the risk of developing cardiovascular diseases.
Diabetology
Diabetes mellitus is strongly linked to cardiovascular disease. Diabetics have a two to four times higher risk of having a heart attack or stroke than the general population. This is why a diabetic patient’s cardiovascular risk is similar to that of a patient who has already had a cardiovascular event.
For these reasons, a diabetologist’s expertise is a critical component of multidisciplinary prevention programs, as it completes the diagnostic classification of the cardiologic patient and integrates therapeutic options, as the new generation of diabetes drugs has a positive effect, lowering mortality.
Clinical areas of interest in diabetes:
- Type 1 diabetes mellitus diagnosis and treatment, with special expertise in the use of “gold standard” technology (insulin pumps, integrated systems with continuous glucose monitoring);
- Diagnosis and treatment of type 2 diabetes, with a focus on the use of novel drugs (including those in clinical trials);
- A multidisciplinary approach to the diagnosis and treatment of obesity and metabolic syndrome, with a focus on secondary forms and second-level therapies.
Clinical areas of interest in endocrinology
Patients with cardiovascular disease are frequently affected by changes in the main hormonal systems. For example, thyroid dysfunction can cause arrhythmias, pituitary and adrenal diseases can cause more resistant forms of arterial hypertension, and electrolyte imbalances, particularly hyponatraemia, which are common in hospitalized patients and those after surgery.
Furthermore, the endocrinologist’s expertise fits perfectly into the “Monzino Women” project, both because of the interest in Gender Medicine and because of menopausal-related hormonal alterations, with special attention to metabolic bone diseases and the opening of an osteoporosis clinic.
Clinical areas of interest in endocrinology:
- Diagnosis and treatment of osteoporosis and metabolic bone diseases, with emphasis on secondary forms and second-line therapies;
- Secondary arterial hypertension screening, diagnosis, and treatment (pituitary and adrenal gland diseases);
- Thyroid disease diagnosis and treatment, with a focus on thyroid abnormalities associated with cardiac arrhythmias;
- Electrolyte disorder diagnosis and treatment, particularly hyponatraemia
Electrophysiology
The Monzino Cardiology Centre’s Arrhythmia Unit is highly specialized in the diagnosis and treatment of all cardiac arrhythmias and is notable for the following activities:
- Electrophysiological evaluation and ablation assessment of atrial fibrillation patients
- Transcatheter mapping and ablation in ventricular tachycardia patients
- Endomyocardial biopsy for the diagnosis of myocardial diseases causing rhythm disturbances (genetic, viral, and histological).
- Investigation of the relationship between rhythm disorders and neurodystrophic diseases
- Biventricular device implantation for patients with various types of heart failure
- Anti-arrhythmia heart surgery
- Implantation of leadless pacemakers (electrode-free pacemakers)
- Cardiovascular stimulation
A Ventricular Intensive Care (VIC) Unit was established in December 2009, following a pilot project that began in 2007 in response to the need to improve care for patients with heart disease who had severe arrhythmias.
Care for the VIC patient in the critical and post-operative phases entails more than just specific technical skills in a dedicated environment outfitted with exclusive forms of monitoring and semi-intensive or intensive assistance. Above all, it refers to the medical and nursing teams providing special attention to the patient, with a strong emphasis on psychological aspects and pain control.
Heart Failure and Clinical Cardiology
The Heart Failure, Clinical Cardiology, and Rehabilitation Unit is dedicated to the care of patients suffering from decompensated cardiac dysfunction.
The Heart Failure Unit employs cutting-edge diagnostic, assessment, and therapeutic equipment (cardiopulmonary exercise testing, respiratory function tests, gas diffusing studies, in collaboration with the Cardiovascular Imaging Unit, ultra/haemofiltration, counter-stimulation in collaboration with the Intensive Coronary Care Unit, and electrostimulation in collaboration with the Arrhythmia Unit).
Doctors in the Heart Failure Unit collaborate with the Section of Cardiovascular System Diseases at the University of Milan’s Department of Clinical and Community Sciences. The Unit’s doctors also teach at the Specialisation School and attend numerous cardiopulmonary exercise testing training courses in Italy, Europe, and America. Finally, doctors from various Italian and foreign institutes visit the Unit on a regular basis for educational purposes.
The Unit is involved in the development of many national (Italian Cardiology Federation) and international (European Society of Cardiology) guidelines on heart failure and cardiopulmonary stress tests.
Interventional Cardiology
Monzino’s Interventional Cardiology Unit uses the most recent technologies for the diagnosis of cardiovascular diseases, including computerized quantitative angiography, intravascular ultrasonography and intracoronary Doppler flow measurements.
The following treatments are performed for atherosclerotic disorders of coronary and peripheral vessels, congenital heart diseases in adults and acquired pathologies of the heart valves:
- Angioplasty of the coronary arteries or the peripheral arteries with stent placement,
- Rotational coronary angioplasty,
- Percutaneous closure of intracardiac shunts (atrial septal defect, foramen ovale, patent ductus arteriosus) with occlusive devices,
- Percutaneous endograft implantation obliterates both thoracic and abdominal aortic aneurysms as well as aneurysms in other peripheral arteries (subclavian, iliac, popliteal).
- Repair of the pulmonary and mitral valves, as well as the percutaneous implantation of prosthetic aortic valves
- In patients with atrial fibrillation, the left atrial appendage is obliterated to prevent cardiogenic embolisation.
- In hypertrophic cardiomyopathy, alcohol ablation of the interventricular septum,
- Caval filter systems are implanted to prevent pulmonary embolism.
Among the forementioned activities, the Institute specialises in performing coronary angioplasty in high-risk patients and those who have had an acute myocardial infarction. In fact, the Monzino Cardiology Centre’s interventional cardiologists have extensive experience in the use of cardio-circulatory support techniques such as aortic counterpulsation and percutaneous cardiopulmonary bypass during percutaneous myocardial revascularization procedures in patients with compromised cardiac functions.
Vascular Surgery
The Vascular Surgery and Endovascular Unit treats thoracic and abdominal aortic, carotid, peripheral, and visceral artery disorders with the most advanced surgical, endovascular, and hybrid (surgical + endovascular) techniques. It also treats venous disorders (varicose veins and lower limb superficial and deep vein thrombosis).
Outpatient services for studying vascular pathologies by echo-Doppler are available at the Vascular Surgery and Endovascular Unit, as is an operating theatre for surgical operations and another with fixed radiological equipment for endovascular and hybrid interventions.
The pathologies treated are thoracic and thoracic-abdominal aortic aneurysms, aortic dissections, congenital abnormalities of the thoracic aorta, abdominal aortic aneurysms, disorders of the iliac arteries, visceral vessels (renal arteries, splenic artery, superior mesenteric artery and coeliac trunk) and vessels of the upper limbs, carotid stenoses, peripheral vessel diseases, and varicose veins of the lower limbs.
The Unit also treats “vascular foot” (a pathology characterized by ulcers of varying extension and depth caused by vascular insufficiency) with surgical or interventional revascularization, ulcer treatment with ultrasound, and apposition of synthetic dermis or skin grafting. This condition is more common in diabetic patients, which is why a diabetes specialist is always consulted to ensure the most thorough evaluation possibile of the patient.
Prosthetic aortic valves are implanted in collaboration with the Heart Surgery Unit using a percutaneous approach, an innovative technique performed in a multifunctional operating theatre.
