------------------------ Specific surgical Skills | Mauro Cassese ------------------------

1. Coronary Artery Bypass Graft(CABG).
Tested experience in totally arterial re-vascularisation by utilising the double mammary artery (both in situ and as composite graft), of the right gastroepiploic artery and radial artery. He led more than 3,000 aortocoronary bypass interventions with double mammary artery and 200 using the right gastroepiploic artery. He developed a minimally invasive video assisted techniques surgery programme for totally endoscopic collection of the left mammary artery with associated bypass, executed in all facilities where he has worked. On agreement with the heart surgeons in his facility, over the last two years he has been running a hybrid coronary revascularisation. This method provides for combining aortocoranary bypass with the PTCA procedure with the aim of reducing surgery invasiveness simultaneously or step-by step, hence optimising the results of the two methods.
2. Off-pump coronary surgery (with the heart beating).
The coronary revascularisation may also be carried out “off-pump”, without using the extracorporeal circulation. Vast experience in various techniques for performing the aortocoronary bypass surgery without cardiopulmonary bypass.
3. Conservative (plastic) surgery of the mitral and tricuspid valve
Vast experience (more than 400 cases) in making complex plastic valves of the anterior leaflet and the posterior leaflet (all techniques) for curing mitral inefficiency with degenerative aetiology and for the implantation of ring prosthesis for curing functional insufficiency.
4. Right mini-thoracotomy for mitral valve surgery
 Over the last years he has performed about 50% of the mitral and tricuspid repair/replacement via right minimally invasive mini-thoracotomy, via direct aortic clamping. In some cases, the intervention was also carried out off-pump or with induced ventricular fibrillation.
5. Conservative surgery of the aortic root
 Tested experience in aortic root repair surgery with conservation of the native aortic valve using the technique described by Tirone E. David (about 150 interventions carried out as lead operator) optimised over the last years by the associated plasty of aortic cusps.
6. Conservative surgery of the aortic valve
 He was involved in aortic valve repair surgery, even in presence of congenital malformations (aortic bicuspidy), by using raphe resection techniques with possible patch positioning, shaving, reinforcement and resuspension of the free margin, triangular resection, cusp plication and subcommissural annuloplasty. Up to date, he has performed 46 interventions with good mid-term results.
7. Aortic and mitral valve replacement surgery
Use of all mechanical and biological valves in the market, including those defined as “stentless” as well as the latest ones in the market referred to as “sutureless”. More than 1000 interventions in single, double or triple valve replacement.
8. Mini-sternotomy aortic surgery
 Over the last years, more than 50% of all aortic valve interventions was carried out via minimally invasive access.
9. Bipolar radiofrequency ablation of atrial fibrillation
 He carried out about 140 simultaneous atrial fibrillation surgical interventions (with mitral and/or aortic pathology) via radiofrequency bipolar devices. All were both right and left ablation interventions (complete MAZE). As regards “isolated” atrial fibrillation interventions, he recently started a minimally invasive surgery programme, carrying out 10 cases as the lead surgeon. The interventions were carried out both with the bilateral mini-thoracotomy and total endoscopic approach (among the first in Italy).
10. Non-implantation heart failure surgery
 Among the first in Italy to provide a multi-disciplinary approach to heart failure which provides for the use of the left ventricular remodelling techniques (450 left ventricular reconstruction-remodelling-aneurysmectomy procedures according to Dor), associated to myocardial revascularisation, annuloplasty or mitral valve replacement, tricuspid annuloplasty procedures as well as biventricular tricameral resynchronisation procedure.
11. IMA mechanical complications emergency surgery
 The experience acquired in the surgery treatment of cardiac emergencies allowed improving the surgery technique in presence of post infarction ventricular septal defect (by using multiple patches and biological glue) or heart rupture.
12. Endoprosthesis tic and/or hybrid treatment of aortic thoracic aneurysm
A tutt’oggi sono state eseguite 100 procedure sotto la sua direzione. In presenza di aneurisma esteso dalla radice aortica fino all’aorta toracica discendente, ha eseguito, in 15casi, sostituzione della radice aortica, dell’aorta ascendente e dell’arco aortico (Elephant Trunk Technique),in arresto di circolo con perfusione selettiva dei tronchi sovra-aortici (TSA), de branching dei TSA e successivo impianto di endoprotesi toracica con esclusione del tratto aneurismatico.
13. Replacement surgery of the aortic root, ascending aorta and aortic arch
 Tested experience in the replacement treatment of the aortic root and ascending aorta (Bentall, Wheat and Cabrol techniques) and the aortic arch both in election and emergency regime (aortic dissection). He was the lead surgeon in more than 300 procedures. 
14. Acute dissection surgery
 More than 120 cases treated personally using all surgical techniques described in literature.
15. Trans-catheter aortic valve implantation (TAVI).
He performed more than 300 aortic valve prosthesis implantation (70% via trans-femoral and 30% via trans-apical or trans-aortic approach) of the Edwards-Sapien and Medtronic-Enpger? Valve type, in a hybrid theatre carried out in his Department from December 2009 in Catanzaro to the current one at the Santa Maria Hospital in Bari.” state=”closed”] Da sempre molto attento all’introduzione di nuove tecnologie in ambito cardochirurgico al fine di migliorare la “performance” dell’atto operatorio e ridurne l’invasività a carico del paziente. Ne sono testimonianza: l’ampissima esperienza maturata con la TAVI, le tecniche di chirurgia mini-invasiva per il trattamento delle patologie valvolari aortiche e mitraliche, la tecnica off-pump per il by-pass orto-coronarico e la tecnica mini-toracotomica per il trattamento della fibrillazione atriale isolata e ibrida.
16. Use of new technologies
 Cassese has always been keen in the introduction of new cardiac surgery technologies with the aim of improving surgical performance and reduce the invasiveness on the patient. This is proven by the vast experience acquired in TAVI, the minimally invasive surgery techniques for the treatment of aortic and mitral diseases, the off-pump technique for the aortocoronary bypass and the mini-thoracotomy technique for the treatment of isolated and concomitant fibrillation.
17. Hybrid operating theatre surgery
 Hybrid theatre operations are a strong point of Mauro’s professional experience. The ability to share (as a “heart team”) information on coronary revascularisation as well as endoprosthetic and TAVI intervention procedures was the foundation for maximum professional commitment over the last years. This, with the aim of reducing surgical invasiveness and obtain maximum benefit for the patient from the combination of the surgical and percutaneous approach in the treatment of valve and coronary diseases.