Cardiac Surgery

The Cardiac Surgery Team boasts over 30 years of experience, with over 6,000 fully arterial revascularization procedures performed using bilateral internal mammary arteries and the radial artery. Since the activation of the Complex Operative Unit at Casa Sollievo in August 2016, over 700 aorto-coronary bypass surgeries employing bilateral internal mammary arteries have been successfully completed. In close collaboration with interventional cardiologists working within our hospital, a HYBRID coronary revascularization program has been developed. This approach combines aorto-coronary bypass surgery with PTCA procedures to minimize surgical invasiveness and enhance the outcomes of both techniques.

Coronary artery bypass surgery can also be performed on a beating heart, without the use of extracorporeal circulation. This technique is particularly suited to high-risk patients, aiming to lower operative risks and improve overall safety for clinically compromised individuals.

This procedure involves the endoscopic harvesting of the left internal mammary artery with the assistance of a high-definition camera and the creation of an aorto-coronary bypass on a beating heart through a small anterior incision (5–6 cm, minithoracotomy). This approach is designed to promote faster functional recovery and a shorter postoperative course.

With over 30 years of experience, the team has performed more than 3,000 complex mitral and tricuspid valve repair and replacement procedures.

At our center, more than 50% of mitral and tricuspid valve surgeries are carried out using a minimally invasive right minithoracotomy approach. These procedures leverage endoscopic visualization and percutaneous peripheral cannulation, eliminating the need for inguinal incisions. In select cases, surgeries can also be performed on a beating heart or with induced ventricular fibrillation.

The team has extensive expertise in both aortic valve replacement and, more recently, aortic valve repair, with over 5,000 procedures completed to date.

In recent years, more than half of all aortic valve surgeries have been performed using a minimally invasive anterior minithoracotomy through the second or third intercostal space, while the remaining procedures were completed via mini-sternotomy.
Aortic valve repair is primarily indicated in cases of congenital abnormalities (e.g., bicuspid aortic valve) or during reconstructive surgery of the aortic root (e.g., Tirone-David or CAVIAAR techniques).

The team has established expertise in the conservative and replacement management of the aortic root and ascending aorta using advanced techniques such as Bentall, Wheat, Cabrol, and T. David. Replacement of the aortic arch is performed under circulatory arrest with selective cerebral perfusion following the Kazui protocol, applicable in both elective and emergency cases (e.g., aortic dissection).

For aneurysms extending from the aortic root to the descending thoracic aorta, prosthetic replacement is carried out using the Frozen Elephant Trunk (FET) technique.
Minimally invasive endovascular treatments are available for aneurysms of the aortic arch and descending thoracic aorta, utilizing transcatheter approaches without the need for surgical incisions. These procedures are often performed in collaboration with the Vascular Surgery Unit (AORTIC TEAM).

Aortic pseudoaneurysms are treated either through traditional surgical methods or percutaneous techniques using devices such as coils, plugs, or endografts.

The team has extensive expertise in the percutaneous treatment of aortic stenosis and, more recently, aortic regurgitation, with over 1,800 cases successfully managed.
Aortic valve prostheses (TAVI) are implanted using all device types available on the market, including Edwards-Sapien, Medtronic-CoreValve, Abbott-Portico, and Boston-Acurate neo 2. The majority of procedures (91%) are performed via transfemoral access, with the remaining 9% carried out through transapical, transaortic, or axillary approaches.
These procedures are conducted without general anesthesia or intubation, with patients awake under conscious sedation.
All TAVI procedures are performed in a cutting-edge hybrid operating room.
The team also has extensive experience in VALVE IN VALVE procedures, used for reintervention on previously implanted biological aortic prostheses.

In addition to traditional surgical repair or replacement techniques, fully percutaneous solutions are available, including tricuspid valve repair (TRICLIP and PASCAL ACE) and re-replacement procedures (Valve-in-Valve).

Using a minimally invasive approach without surgical incisions, and with the support of endoscopic guidance, the left atrial appendage can be excluded via device implantation (ATRICLIP). This is recommended for patients with atrial fibrillation, a history of stroke, or intolerance to anticoagulant therapy.
Alternatively, the left atrial appendage can be excluded via percutaneous transcatheter techniques using endovascular devices such as Amplatzer or Amulet.
Paravalvular leaks (dehiscences) involving mitral or aortic valves can be treated using transfemoral or transseptal percutaneous techniques.
The team also has significant expertise in the closure of Patent Foramen Ovale (PFO) using Amplatzer-type devices.

With more than 20 years of experience, the team specializes in surgical treatment of "concomitant" atrial fibrillation (associated with mitral and/or aortic valve disease). This is achieved using bipolar irrigated radiofrequency ablation devices and the COX-MAZE technique.
For "isolated" atrial fibrillation, a minimally invasive approach is available through bilateral minithoracotomic or fully endoscopic subxiphoid access.
All surgical ablation procedures can be supplemented or preceded by hybrid percutaneous ablation techniques for enhanced outcomes.

Approximately 400 procedures are performed annually, including left ventricular reconstruction, remodeling, and aneurysmectomy (Dor procedure). These are often combined with myocardial revascularization, mitral valve annuloplasty or replacement, tricuspid annuloplasty, and biventricular resynchronization therapies.

In cases of severe, destructive bacterial endocarditis, complex procedures such as COMMANDO or UFO operations are performed to achieve optimal outcomes.

ECMO, or ExtraCorporeal Membrane Oxygenation, is an extracorporeal circulation technique used in critical care to manage patients with severe acute cardiac and/or respiratory failure that is often unresponsive to pharmacological treatment.

The hybrid operating room is a state-of-the-art technological facility, unique in Southern and Central Italy. It integrates the features of a cardiac surgery operating room with those of an interventional catheterization laboratory, enabling the execution of complex procedures supported by advanced multimodal imaging technologies. These include fluoroscopy, angiography, rotational angiography with 3D reconstructions, 2D and 3D ultrasound, as well as 2D, 3D, and 4K endoscopy.

This advanced setting facilitates collaborative interventions with interventional cardiologists for hybrid coronary revascularization (aorto-coronary bypass) and the treatment of valvular diseases (aortic, mitral, and tricuspid valves). It also enables electrophysiologists to address atrial fibrillation and vascular surgeons to manage conditions affecting the aorta and major vessels.
The objective is to reduce procedural invasiveness and optimize patient outcomes by combining SURGICAL AND PERCUTANEOUS APPROACHES.

A specialized heart team is composed of a multidisciplinary group of highly qualified healthcare professionals who collaborate to determine the most effective therapeutic plan for each patient. This team leverages the combined expertise of clinical cardiologists, interventional cardiologists, cardiac surgeons, imaging specialists, anesthesiologists, and the entire staff of the catheterization laboratory and operating room, ensuring a holistic and patient-centered approach to care.

The IRCCS Casa Sollievo della Sofferenza has established an Aortic Center, which encompasses an Aortic Team responsible for the comprehensive diagnostic and therapeutic management of acute aortic syndromes (AAS). This multidisciplinary team includes all specialists required for the full spectrum of care. The center also features a fully integrated Aortic Unit, comprising:

1 Full Hybrid Operating Room,

1 Cardiac Surgery Operating Room,

1 Vascular Surgery Operating Room,

1 Interventional Radiology Room.

Each facility is equipped with state-of-the-art technology to perform the entire range of procedures, including OPEN, HYBRID, and TRANSCATHETER techniques. These interventions address conditions affecting the ascending aorta, aortic arch, descending thoracic aorta, and abdominal aorta, as well as all major collateral branches originating from the aorta. This includes the management of organ complications caused by malperfusion.