Carlo Vincentiis - Academia.edu (original) (raw)
Papers by Carlo Vincentiis
International Journal of Cardiology
European Journal of Cardio-Thoracic Surgery
European Journal of Cardio-Thoracic Surgery
OBJECTIVES Endocarditis after the Bentall procedure is a severe disease often complicated by a ps... more OBJECTIVES Endocarditis after the Bentall procedure is a severe disease often complicated by a pseudoaneurysm or mediastinitis. Reoperation is challenging but conservative therapy is not effective. The aim of this study was to assess short- and midterm outcomes of patients reoperated on for Bentall-related endocarditis. METHODS Seventy-three patients with Bentall procedure-related endocarditis were recorded in the Italian registry. The mean age was 57 ± 14 years and 92% were men; preoperative comorbidities included hypertension (45%), diabetes (12%) and renal failure (11%). The logistic EuroSCORE was 25%; the EuroSCORE II was 8%. RESULTS Preoperatively, 12% of the patients were in septic shock; left ventricular-aortic discontinuity was present in 63% and mitral valve involvement occurred in 12%. The most common pathogens were Staphylococcus aureus (22%) and Streptococci (14%). Reoperations after a median interval of 30 months (1–221 months) included a repeat Bentall with a biocondui...
European Journal of Cardio-Thoracic Surgery
OBJECTIVES Our goal was to analyse a consecutive series of patients with solid organ tumours unde... more OBJECTIVES Our goal was to analyse a consecutive series of patients with solid organ tumours undergoing coronary artery bypass grafting (CABG) by defining the risk factors for early and long-term outcomes. METHODS Between 2005 and 2016, a consecutive series of 4079 patients underwent isolated CABG at our institution. Of 103 patients (2.5%) with active malignancy, we enrolled 82 patients (mean age 71 ± 7 years) with solid organ tumours, divided into 4 subgroups: lung (9 patients—11%), gastroenteric (16 patients—20%), urinary (48 patients—58%) and other solid tumours (9 patients—11%). A deterministic record linkage between the clinical database and the National Hospital Information System allowed identification of long-term survival rates and freedom from major adverse cardiovascular events (acute myocardial infarction, repeated admissions for percutaneous coronary intervention and heart failure). RESULTS The most common forms of cancer were prostate, colon and carcinoma of the lung. ...
Journal of the American College of Cardiology
Journal of the American Heart Association
Background The impact of the coronary artery bypass grafting ( CABG ) technique (on‐ versus off‐p... more Background The impact of the coronary artery bypass grafting ( CABG ) technique (on‐ versus off‐pump, single versus multiple aortic clamping) on postoperative neurological outcome remains a matter of controversy. The aim of this study was to assess the association between the incidence of postoperative stroke and the degree of aortic manipulation in one of the largest contemporary CABG series. Methods and Results A retrospective, multicenter, international study was conducted in 25 388 patients undergoing isolated CABG procedures with on‐pump CABG ( ONCAB ) or off‐pump CABG ( OPCAB ) technique including single or multiple aortic clamping. Postoperative stroke was defined as a postoperative neurological deficit lasting more than 24 hours and associated with evidence of a brain lesion on computed tomography. The degree of aortic manipulation was assumed to be higher for on‐pump versus off‐pump surgery and for multiple versus single or no aortic clamping. Logistic regression and propen...
Annals of Cardiothoracic Surgery
it. The incidence of intramural hematomas (IMH) in acute dissection (AD) patients varies between ... more it. The incidence of intramural hematomas (IMH) in acute dissection (AD) patients varies between 6% and 30% in the literature, most frequently involving only the descending aorta (58%) than the arch or ascending aorta (42%). In this setting, IMH that initiate in the descending aorta, but extend into the arch or ascending aorta have been described, and referred to as a retrograde type A IMH. In these patients the risk of neurological or cardiac complications are high, and therefore an open surgical or hybrid approach has been proposed as the most appropriate. Nevertheless, the endovascular management of such lesions in surgically unfit patients for open surgery have been offered with acceptable outcomes, although the risk of landing in an unsuitable proximal landing zone is evident. In conclusion, retro-TAIMH is an acute aortic syndrome and should be managed as such. The recommended treatment strategy is open surgery for treating ascending or arch involvement, and TEVAR/medical, based on a complication-specific approach, for those with only descending localization. In those patients in whom retro-TAIMH is associated with an acute B dissection presenting with a proximal entry tear located into the descending aorta, a TEVAR represents an option treatment.
International Journal of Cardiology
The Journal of Thoracic and Cardiovascular Surgery
To analyze presentation, management, and outcomes of acute aortic dissections with proximal entry... more To analyze presentation, management, and outcomes of acute aortic dissections with proximal entry tear in the arch. Patients enrolled in the International Registry of Acute Aortic Dissection and entry tear in the arch were classified into 2 groups: arch A (retrograde extension into the ascending aorta with or without antegrade extension) and arch B (only antegrade extension into the descending aorta or further distally). Presentation, management, and in-hospital outcomes of the 2 groups were compared. The arch A (n = 228) and arch B (n = 140) groups were similar concerning the presence of any preoperative complication (68.4% vs 60.0%; P = .115), but the types of complication were different. Arch A presented more commonly with shock, neurologic complications, cardiac tamponade, and grade 3 or 4 aortic valve insufficiency and less frequently with refractory hypertension, visceral ischemia, extension of dissection, and aortic rupture. Management for both groups were open surgery (77.6% vs 18.6%; P < .001), endovascular treatment (3.5% vs 25.0%; P < .001), and medical management (16.2% vs 51.4%; P < .001). Overall in-hospital mortality was similar (16.7% vs 19.3%; P = .574), but mortality tended to be lower in the arch A group after open surgery (15.3% vs 30.8%; P = .090), and higher after endovascular (25.0% vs 14.3%; P = .597) or medical treatment (24.3% vs 13.9%; P = .191), although the differences were not significant. Acute aortic dissection patients with primary entry tear in the arch are currently managed by a patient-specific approach. In choosing the management type of these patients, it may be advisable to stratify them based on retrograde or only antegrade extension of the dissection.
Annals of cardiothoracic surgery, 2017
Between January 1996 and May 2017, the International Registry on Acute Aortic Dissections has col... more Between January 1996 and May 2017, the International Registry on Acute Aortic Dissections has collected information on a total of 6,424 consecutive patients with acute aortic dissection, including 258 individuals with a diagnosis of Marfan syndrome. Patients with Marfan syndrome presented at a significantly younger age compared to patients without Marfan syndrome (38.2±13.2 . 63.0±14.0 years; P<0.001) and in general had fewer comorbidities, although they more frequently had a known aortic aneurysm and history of prior cardiac surgery. We noted significantly larger diameters of the aortic annulus and root in the Marfan syndrome cohort, but no larger diameters more distally. The in-hospital mortality in type A dissection was not significantly different in patients with or without Marfan syndrome, despite the differences in age and comorbidities and the lower incidence of aortic rupture in the Marfan syndrome cohort. In contrast, the in-hospital mortality of Marfan syndrome patients...
![Research paper thumbnail of Corrigendum to "A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE". [Int. J. Cardiol. Aug 15 2017;241:97-102.]](https://attachments.academia-assets.com/73512557/thumbnails/1.jpg)
](International journal of cardiology, May 12, 2018
Corrigendum to "A predictive model for early mortality after surgical treatment of heart valve or... more Corrigendum to "A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis.
European heart journal, Jan 12, 2017
The age, creatinine, and ejection fraction (ACEF) score was introduced in 2009 and is presently i... more The age, creatinine, and ejection fraction (ACEF) score was introduced in 2009 and is presently included in the guidelines for myocardial revascularization of the European Society of Cardiology and Association for Cardio-Thoracic Surgery as a risk stratification tool for surgical and percutaneous myocardial revascularization. The present study introduces an updated version of the ACEF (ACEF II) inclusive of emergency surgery and pre-operative anaemia. The development series includes 7011 consecutive cardiac surgery patients operated at a single institution. The validation series includes 1687 consecutive cardiac surgery patients operated in a different institution. The five factors included in the ACEF II were assessed in a multivariable logistic regression model testing their independent role as predictors of operative (in hospital or 30 days after surgery) mortality. Based on the odds ratio of each predictor, the ACEF II score is calculated as age(years)/ejection fraction (%). Add...
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 13, 2017
We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assesse... more We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design. Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study. Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P < 0.001), consistent with increasing mean patient age (56 ± 14, 64 ± 15, 65 ± 14 years, respectively, P < 0.001) and median logistic EuroSCORE (14%, 21%, 23%, ...
Giornale Italiano Di Cardiologia, Oct 1, 2010
Cardiac rupture is a fatal complication of myocardial infarction that may involve especially the ... more Cardiac rupture is a fatal complication of myocardial infarction that may involve especially the left ventricular free wall, the ventricular septum and the papillary muscle, but also the right ventricular free wall and more rarely the atrium. This complication is responsible for 10-15% of in-hospital deaths after ST-elevation myocardial infarction. Advanced age, female sex, first infarction and hypertension (in the acute phase of infarction) are the most important risk factors for cardiac rupture. It occurs typically between 4 and 7 days after the infarction but it may also develop within the first 24-48h, particularly in patients undergoing fibrinolytic therapy and in cardiac patients with the following characteristics: 1) recent coronary artery occlusion, 2) transmural necrosis, 3) poor collateral circulation, and 4) minimal or absent myocardial fibrosis. Cardiac rupture should be suspected when sudden or rapidly progressive hemodynamic deterioration occurs. After prompt diagnosis and stabilization, the patient can be operated. The high mortality rate between 5 and 14 days post-infarction justifies the urgency of surgical repair, which includes infartectomy and the employment of a Dacron patch and biological glues. Also percutaneous strategies have recently been used in patients with high surgical risk. The most frequently performed surgical techniques for the treatment of cardiac rupture are described below. By now early diagnosis and surgical treatment are crucial for successful outcome.
The Journal of Heart Valve Disease, Nov 1, 2012
A number of sutureless bioprosthetic aortic valves have been recently introduced in clinical prac... more A number of sutureless bioprosthetic aortic valves have been recently introduced in clinical practice, their main advantage being a reduction in the aortic cross-clamp time (AXCT). The study aim was to investigate if AXCT was a determinant of cardiovascular morbidity in patients undergoing surgical aortic valve replacement (AVR) to treat aortic valve stenosis, and to identify any subset of patients who might benefit from a reduction in AXCT. A retrospective analysis was conducted of 979 consecutive patients with aortic valve stenosis who underwent surgical AVR. The AXCT was analyzed as an independent predictor of severe cardiovascular morbidity, defined as the presence of a low cardiac output, stroke, acute kidney injury, or operative mortality. Subgroups of patients who benefited more from a reduction in AXCT were investigated. The AXCT was an independent predictor of severe cardiovascular morbidity, with an increased risk of 1.4% per 1 min increase. Patients with a left ventricular ejection fraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 40%, and also diabetic patients, showed the most relevant clinical benefits induced by a reduction in AXCT. In selected patient populations at high risk of systolic dysfunction, the use of sutureless aortic valve bioprostheses may be considered. However, the routine use of such bioprostheses should be pondered within a cost-benefit analysis.
Giornale Italiano Di Cardiologia, Oct 1, 2010
The Journal of Heart Valve Disease, 2014
The Bentall operation is a 40-year-old standardized procedure for treating aortic valve diseases ... more The Bentall operation is a 40-year-old standardized procedure for treating aortic valve diseases and aneurysms involving the aortic root. The study aim was to analyze the results and predictors of long-term outcome after the Bentall procedure for aortic root diseases. Between January 1990 and December 2007, a total of 375 patients (296 males, 79 females) underwent the Bentall operation at the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; institution. Bicuspid aortic valve (BAV) was present in 91 patients, and Marfan syndrome in 13. Thirty-six patients were treated as emergencies, and 30 for acute dissection. A concomitant surgical procedure was performed in 78 patients. The operative procedure included both classic Bentall and button techniques. Follow up data were obtained from hospital and office records and from telephone contacts. Kaplan-Meier survival analysis and Cox regression analysis were performed to investigate the predictors of long-term outcome. The overall in-hospital mortality was 4.5%, and after elective operations was 2.3%. A 20-year long-term follow up included 32 late deaths, of which 14 were cardiac-related. Freedom from late all-cause mortality at 5, 10, and 15 years was 97.1%, 81.9%, and 53.9%, respectively. At univariate analysis, long-term mortality was associated with age, diabetes, BAV, NYHA class III/IV, emergency treatment, cardiopulmonary bypass time, and coronary artery bypass grafting. Independent predictors of long-term mortality were age (OR 1.16; CI: 1.08-1.23), emergency surgery (OR 28; CI: 4-192) and BAV (OR 3; CI: 1.3-6.9). The Bentall procedure is a safe and durable operation, with a very good early and long-term results and a low rate of reoperation. In the present series, age, BAV and emergency surgery were important independent predictors of mortality.
International journal of …, 1992
Among 1179 post-rheumatic cases, mixed mitral stenosis and incompetence was the most frequent mal... more Among 1179 post-rheumatic cases, mixed mitral stenosis and incompetence was the most frequent malfunction (747, 58%). Isolated mitral incompetence was diagnosed in 72 (6.11%) cases only, and isolated stenosis in 360 cases. In 52 valves, excised because of chronic ...
Journal of Cardiothoracic and Vascular Anesthesia, 2015
International Journal of Cardiology
European Journal of Cardio-Thoracic Surgery
European Journal of Cardio-Thoracic Surgery
OBJECTIVES Endocarditis after the Bentall procedure is a severe disease often complicated by a ps... more OBJECTIVES Endocarditis after the Bentall procedure is a severe disease often complicated by a pseudoaneurysm or mediastinitis. Reoperation is challenging but conservative therapy is not effective. The aim of this study was to assess short- and midterm outcomes of patients reoperated on for Bentall-related endocarditis. METHODS Seventy-three patients with Bentall procedure-related endocarditis were recorded in the Italian registry. The mean age was 57 ± 14 years and 92% were men; preoperative comorbidities included hypertension (45%), diabetes (12%) and renal failure (11%). The logistic EuroSCORE was 25%; the EuroSCORE II was 8%. RESULTS Preoperatively, 12% of the patients were in septic shock; left ventricular-aortic discontinuity was present in 63% and mitral valve involvement occurred in 12%. The most common pathogens were Staphylococcus aureus (22%) and Streptococci (14%). Reoperations after a median interval of 30 months (1–221 months) included a repeat Bentall with a biocondui...
European Journal of Cardio-Thoracic Surgery
OBJECTIVES Our goal was to analyse a consecutive series of patients with solid organ tumours unde... more OBJECTIVES Our goal was to analyse a consecutive series of patients with solid organ tumours undergoing coronary artery bypass grafting (CABG) by defining the risk factors for early and long-term outcomes. METHODS Between 2005 and 2016, a consecutive series of 4079 patients underwent isolated CABG at our institution. Of 103 patients (2.5%) with active malignancy, we enrolled 82 patients (mean age 71 ± 7 years) with solid organ tumours, divided into 4 subgroups: lung (9 patients—11%), gastroenteric (16 patients—20%), urinary (48 patients—58%) and other solid tumours (9 patients—11%). A deterministic record linkage between the clinical database and the National Hospital Information System allowed identification of long-term survival rates and freedom from major adverse cardiovascular events (acute myocardial infarction, repeated admissions for percutaneous coronary intervention and heart failure). RESULTS The most common forms of cancer were prostate, colon and carcinoma of the lung. ...
Journal of the American College of Cardiology
Journal of the American Heart Association
Background The impact of the coronary artery bypass grafting ( CABG ) technique (on‐ versus off‐p... more Background The impact of the coronary artery bypass grafting ( CABG ) technique (on‐ versus off‐pump, single versus multiple aortic clamping) on postoperative neurological outcome remains a matter of controversy. The aim of this study was to assess the association between the incidence of postoperative stroke and the degree of aortic manipulation in one of the largest contemporary CABG series. Methods and Results A retrospective, multicenter, international study was conducted in 25 388 patients undergoing isolated CABG procedures with on‐pump CABG ( ONCAB ) or off‐pump CABG ( OPCAB ) technique including single or multiple aortic clamping. Postoperative stroke was defined as a postoperative neurological deficit lasting more than 24 hours and associated with evidence of a brain lesion on computed tomography. The degree of aortic manipulation was assumed to be higher for on‐pump versus off‐pump surgery and for multiple versus single or no aortic clamping. Logistic regression and propen...
Annals of Cardiothoracic Surgery
it. The incidence of intramural hematomas (IMH) in acute dissection (AD) patients varies between ... more it. The incidence of intramural hematomas (IMH) in acute dissection (AD) patients varies between 6% and 30% in the literature, most frequently involving only the descending aorta (58%) than the arch or ascending aorta (42%). In this setting, IMH that initiate in the descending aorta, but extend into the arch or ascending aorta have been described, and referred to as a retrograde type A IMH. In these patients the risk of neurological or cardiac complications are high, and therefore an open surgical or hybrid approach has been proposed as the most appropriate. Nevertheless, the endovascular management of such lesions in surgically unfit patients for open surgery have been offered with acceptable outcomes, although the risk of landing in an unsuitable proximal landing zone is evident. In conclusion, retro-TAIMH is an acute aortic syndrome and should be managed as such. The recommended treatment strategy is open surgery for treating ascending or arch involvement, and TEVAR/medical, based on a complication-specific approach, for those with only descending localization. In those patients in whom retro-TAIMH is associated with an acute B dissection presenting with a proximal entry tear located into the descending aorta, a TEVAR represents an option treatment.
International Journal of Cardiology
The Journal of Thoracic and Cardiovascular Surgery
To analyze presentation, management, and outcomes of acute aortic dissections with proximal entry... more To analyze presentation, management, and outcomes of acute aortic dissections with proximal entry tear in the arch. Patients enrolled in the International Registry of Acute Aortic Dissection and entry tear in the arch were classified into 2 groups: arch A (retrograde extension into the ascending aorta with or without antegrade extension) and arch B (only antegrade extension into the descending aorta or further distally). Presentation, management, and in-hospital outcomes of the 2 groups were compared. The arch A (n = 228) and arch B (n = 140) groups were similar concerning the presence of any preoperative complication (68.4% vs 60.0%; P = .115), but the types of complication were different. Arch A presented more commonly with shock, neurologic complications, cardiac tamponade, and grade 3 or 4 aortic valve insufficiency and less frequently with refractory hypertension, visceral ischemia, extension of dissection, and aortic rupture. Management for both groups were open surgery (77.6% vs 18.6%; P &amp;amp;amp;amp;amp;lt; .001), endovascular treatment (3.5% vs 25.0%; P &amp;amp;amp;amp;amp;lt; .001), and medical management (16.2% vs 51.4%; P &amp;amp;amp;amp;amp;lt; .001). Overall in-hospital mortality was similar (16.7% vs 19.3%; P = .574), but mortality tended to be lower in the arch A group after open surgery (15.3% vs 30.8%; P = .090), and higher after endovascular (25.0% vs 14.3%; P = .597) or medical treatment (24.3% vs 13.9%; P = .191), although the differences were not significant. Acute aortic dissection patients with primary entry tear in the arch are currently managed by a patient-specific approach. In choosing the management type of these patients, it may be advisable to stratify them based on retrograde or only antegrade extension of the dissection.
Annals of cardiothoracic surgery, 2017
Between January 1996 and May 2017, the International Registry on Acute Aortic Dissections has col... more Between January 1996 and May 2017, the International Registry on Acute Aortic Dissections has collected information on a total of 6,424 consecutive patients with acute aortic dissection, including 258 individuals with a diagnosis of Marfan syndrome. Patients with Marfan syndrome presented at a significantly younger age compared to patients without Marfan syndrome (38.2±13.2 . 63.0±14.0 years; P<0.001) and in general had fewer comorbidities, although they more frequently had a known aortic aneurysm and history of prior cardiac surgery. We noted significantly larger diameters of the aortic annulus and root in the Marfan syndrome cohort, but no larger diameters more distally. The in-hospital mortality in type A dissection was not significantly different in patients with or without Marfan syndrome, despite the differences in age and comorbidities and the lower incidence of aortic rupture in the Marfan syndrome cohort. In contrast, the in-hospital mortality of Marfan syndrome patients...
International journal of cardiology, May 12, 2018
Corrigendum to "A predictive model for early mortality after surgical treatment of heart valve or... more Corrigendum to "A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis.
European heart journal, Jan 12, 2017
The age, creatinine, and ejection fraction (ACEF) score was introduced in 2009 and is presently i... more The age, creatinine, and ejection fraction (ACEF) score was introduced in 2009 and is presently included in the guidelines for myocardial revascularization of the European Society of Cardiology and Association for Cardio-Thoracic Surgery as a risk stratification tool for surgical and percutaneous myocardial revascularization. The present study introduces an updated version of the ACEF (ACEF II) inclusive of emergency surgery and pre-operative anaemia. The development series includes 7011 consecutive cardiac surgery patients operated at a single institution. The validation series includes 1687 consecutive cardiac surgery patients operated in a different institution. The five factors included in the ACEF II were assessed in a multivariable logistic regression model testing their independent role as predictors of operative (in hospital or 30 days after surgery) mortality. Based on the odds ratio of each predictor, the ACEF II score is calculated as age(years)/ejection fraction (%). Add...
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 13, 2017
We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assesse... more We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design. Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study. Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P < 0.001), consistent with increasing mean patient age (56 ± 14, 64 ± 15, 65 ± 14 years, respectively, P < 0.001) and median logistic EuroSCORE (14%, 21%, 23%, ...
Giornale Italiano Di Cardiologia, Oct 1, 2010
Cardiac rupture is a fatal complication of myocardial infarction that may involve especially the ... more Cardiac rupture is a fatal complication of myocardial infarction that may involve especially the left ventricular free wall, the ventricular septum and the papillary muscle, but also the right ventricular free wall and more rarely the atrium. This complication is responsible for 10-15% of in-hospital deaths after ST-elevation myocardial infarction. Advanced age, female sex, first infarction and hypertension (in the acute phase of infarction) are the most important risk factors for cardiac rupture. It occurs typically between 4 and 7 days after the infarction but it may also develop within the first 24-48h, particularly in patients undergoing fibrinolytic therapy and in cardiac patients with the following characteristics: 1) recent coronary artery occlusion, 2) transmural necrosis, 3) poor collateral circulation, and 4) minimal or absent myocardial fibrosis. Cardiac rupture should be suspected when sudden or rapidly progressive hemodynamic deterioration occurs. After prompt diagnosis and stabilization, the patient can be operated. The high mortality rate between 5 and 14 days post-infarction justifies the urgency of surgical repair, which includes infartectomy and the employment of a Dacron patch and biological glues. Also percutaneous strategies have recently been used in patients with high surgical risk. The most frequently performed surgical techniques for the treatment of cardiac rupture are described below. By now early diagnosis and surgical treatment are crucial for successful outcome.
The Journal of Heart Valve Disease, Nov 1, 2012
A number of sutureless bioprosthetic aortic valves have been recently introduced in clinical prac... more A number of sutureless bioprosthetic aortic valves have been recently introduced in clinical practice, their main advantage being a reduction in the aortic cross-clamp time (AXCT). The study aim was to investigate if AXCT was a determinant of cardiovascular morbidity in patients undergoing surgical aortic valve replacement (AVR) to treat aortic valve stenosis, and to identify any subset of patients who might benefit from a reduction in AXCT. A retrospective analysis was conducted of 979 consecutive patients with aortic valve stenosis who underwent surgical AVR. The AXCT was analyzed as an independent predictor of severe cardiovascular morbidity, defined as the presence of a low cardiac output, stroke, acute kidney injury, or operative mortality. Subgroups of patients who benefited more from a reduction in AXCT were investigated. The AXCT was an independent predictor of severe cardiovascular morbidity, with an increased risk of 1.4% per 1 min increase. Patients with a left ventricular ejection fraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 40%, and also diabetic patients, showed the most relevant clinical benefits induced by a reduction in AXCT. In selected patient populations at high risk of systolic dysfunction, the use of sutureless aortic valve bioprostheses may be considered. However, the routine use of such bioprostheses should be pondered within a cost-benefit analysis.
Giornale Italiano Di Cardiologia, Oct 1, 2010
The Journal of Heart Valve Disease, 2014
The Bentall operation is a 40-year-old standardized procedure for treating aortic valve diseases ... more The Bentall operation is a 40-year-old standardized procedure for treating aortic valve diseases and aneurysms involving the aortic root. The study aim was to analyze the results and predictors of long-term outcome after the Bentall procedure for aortic root diseases. Between January 1990 and December 2007, a total of 375 patients (296 males, 79 females) underwent the Bentall operation at the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; institution. Bicuspid aortic valve (BAV) was present in 91 patients, and Marfan syndrome in 13. Thirty-six patients were treated as emergencies, and 30 for acute dissection. A concomitant surgical procedure was performed in 78 patients. The operative procedure included both classic Bentall and button techniques. Follow up data were obtained from hospital and office records and from telephone contacts. Kaplan-Meier survival analysis and Cox regression analysis were performed to investigate the predictors of long-term outcome. The overall in-hospital mortality was 4.5%, and after elective operations was 2.3%. A 20-year long-term follow up included 32 late deaths, of which 14 were cardiac-related. Freedom from late all-cause mortality at 5, 10, and 15 years was 97.1%, 81.9%, and 53.9%, respectively. At univariate analysis, long-term mortality was associated with age, diabetes, BAV, NYHA class III/IV, emergency treatment, cardiopulmonary bypass time, and coronary artery bypass grafting. Independent predictors of long-term mortality were age (OR 1.16; CI: 1.08-1.23), emergency surgery (OR 28; CI: 4-192) and BAV (OR 3; CI: 1.3-6.9). The Bentall procedure is a safe and durable operation, with a very good early and long-term results and a low rate of reoperation. In the present series, age, BAV and emergency surgery were important independent predictors of mortality.
International journal of …, 1992
Among 1179 post-rheumatic cases, mixed mitral stenosis and incompetence was the most frequent mal... more Among 1179 post-rheumatic cases, mixed mitral stenosis and incompetence was the most frequent malfunction (747, 58%). Isolated mitral incompetence was diagnosed in 72 (6.11%) cases only, and isolated stenosis in 360 cases. In 52 valves, excised because of chronic ...
Journal of Cardiothoracic and Vascular Anesthesia, 2015