Giulio Rizzoli - Academia.edu (original) (raw)
Papers by Giulio Rizzoli
The Annals of Thoracic Surgery, 1993
Journal of the American College of Cardiology, Mar 1, 1995
Objectives. This study was designed to evaluate and compare the patterns of arrhythmogenic right ... more Objectives. This study was designed to evaluate and compare the patterns of arrhythmogenic right ventricular cardiomyopathy in young people and adults. Background. Few data are available on this cardiomyopathy in young people because clinical and morphologic findings considered pathognomonic are normally based on observations in adults. However, a familial occurrence with a probable genetic transmission led to the study of children and to early detection of this disease, in which sudden death has been reported even in young people. Methods. Seventeen young patients with arrhythmogenic right ventricular cardiomyopathy diagnosed at a mean age-+ SD of 14.9-+ 4.9 years were studied. Clinical, electrocardiographic, echocardiographic, cineangiographic and biopsy findings were compared with those of 19 adult patients whose condition was diagnosed at a mean age of 38.1 + 13.4 years. Results. Syncope occurred in 23.5% of the young patients but in none of the adults (odds ratio of familial sudden death 5.54, p = 0.1). Ventricular couplets (odds ratio 16.0, p = 0.004) and subtricuspid bulging on echocardiography (odds ratio 5.95, p = 0.036) were prevalent in the young group. Cineangiographic data in the two groups were similar, except that more hypokinetic areas were found in adults (odds ratio 4.44, p = 0.05). Morphometric analysis of biopsy sections showed a greater amount of fibrous tissue in the young patients (p = 0.04) and a prevalence of fatty tissue in the adults (odds ratio 12, p = 0.005). During an equivalent follow-up time (mean 7 years), two young patients died suddenly, and two had ventricular fibrillation in the absence of antiarrhythmic therapy. Conclusions. The pathognomonic criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy in adults are also valid for young people. Sudden or aborted death occurred frequently in young untreated patients.
The Journal of Thoracic and Cardiovascular Surgery, Nov 1, 2003
We sought to assess the efficiency of 2 different sternal wiring techniques in preventing deep st... more We sought to assess the efficiency of 2 different sternal wiring techniques in preventing deep sternal wound infection or sternal instability. Methods: Seven hundred patients were randomized to 2 different groups according to chest-closure techniques. Three hundred fifty patients who underwent a peristernal double crisscross wire closure were included in group X, whereas 350 patients who underwent a standard transsternal closure were included in group T. After sternal closure, the technique for wound suturing was the same for both groups, namely triple-layer sutures up to the intracutaneous skin. All data were prospectively collected and entered in our institute database. Results: The 2 groups of patients were comparable for sex, age, preoperative risk factors, and operative procedures. The overall mortality rate was 4.3% in group X and 4.6% in group T. Postoperative morbidity and mortality were comparable between the 2 groups, unlike for sternal wound complications. None of the patients included in group X had superficial or deep wound complications, whereas in group T 7 (2%) patients presented with a superficial sternal wound infection, 6 (1.7%) presented with a deep chest wound infection with sternal instability requiring re-exploration (P Ͻ .05), and 3 presented with a sternal instability caused by sternum disruption without infection. Among patients with deep wound infection and sternal instability, 1 patient died, resulting in a mortality rate of 16.7%. Conclusions: The peristernal double crisscross wiring technique achieved a greater sternal stability, resulting in a lower incidence of wound infection in association with triple-layer closure of suprasternal tissues.
European Heart Journal, 2010
Italian Journal of Vascular and Endovascular Surgery, 2010
PubMed, Dec 1, 1997
Background: Aortic dissection with rupture into the right atrium is an extremely rare condition a... more Background: Aortic dissection with rupture into the right atrium is an extremely rare condition and rapidly lethal. The authors report their experience in the treatment of two complicated aortic dissections observed at 85 and 93 months after previous cardiac operations. These were redo mitral valve replacement and saphenous vein coronary artery bypass grafts. Methods: Both cases underwent hospital admission on an emergency basis because of severe chest pain and cardiac failure. One case had a history of hypertension. The aortography revealed aortic dissection and a fistulous communication into the right atrium. At surgery dissection repair and closure of the fistula was performed. Furthermore in one case vein grafts were reimplanted into the vascular graft. Results: Both patients survived the operation without complications, were rapidly extubated and were asymptomatic and fully active at late follow-up. Conclusions: In the light of these results we conclude by affirming that aortic dissection with rupture into the right atrium is an extremely rare condition, rapidly lethal. Patient survival is strictly dependent on the time interval between fistulization of the dissection and the operation.
Heart Lung and Circulation, 2012
Background: Double antiplatelet therapy plays a crucial role in the management of acute coronary ... more Background: Double antiplatelet therapy plays a crucial role in the management of acute coronary syndrome (ACS) and the prevention of coronary artery and stent thrombosis. Current teaching holds that such therapy increases the risk of perioperative bleeding in coronary artery bypass graft surgery (CABG). We undertook a prospective observational study of 100 consecutively-enrolled patients undergoing CABG to investigate the determinants of major bleeding post-CABG Methods: Two groups of CABG patients were studied: Group A, treated with aspirin alone (n = 50), and Group B treated with aspirin and clopidogrel (n = 50). Both had similar preoperative, clinical, and biologic characteristics and operative management. Classic coagulation parameters and ROTEM profiles were determined preoperatively for both groups and the same heparin treatment was administered to all. ROTEM profiles (INTEM and EXTEM assays) were analysed, both for traditional parameters, and thrombin generation potential, expressed by Area-Under-Curve (AUC). Results: Major bleeding was more frequent with double treatment: eight patients in group B (16%) compared with six patients in group A (12%), although this did not reach statistical significance (p = 0.77). In these 14 cases of major bleeding, classic coagulation and traditional ROTEM parameters were comparable. Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders (5030 ± 1115 mm × 100) than non-bleeders (6568 ± 548 mm × 100) (p < 0.0001). Conclusions: Patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC, regardless of treatment. This suggests that thrombin generation potential, irrespective of the degree of platelet inhibition, correlates with surgical bleeding.
The Journal of Thoracic and Cardiovascular Surgery, Jul 1, 1985
ABSTRACT
European Heart Journal, 2010
Circulation, 2012
Objective: Aim of this retrospective multicenter study was to assess how the introduction of tran... more Objective: Aim of this retrospective multicenter study was to assess how the introduction of transcatheter aortic valve implantation (TAVI) influenced the characteristics and the outcomes of patien...
Cardiologia (Rome, Italy), 1983
![Research paper thumbnail of [Early hemodynamic changes after mitral valve replacement with the Hancock prosthesis]](https://attachments.academia-assets.com/110646585/thumbnails/1.jpg)
](PubMed, 1981
In mitral valve replacement for mitral stenosis the persistence of a depressed cardiac performanc... more In mitral valve replacement for mitral stenosis the persistence of a depressed cardiac performance immediately after operation has been outlined by several authors. The choice of a porcine central flow prosthesis, that has several theoretical advantages, should allow better acute hemodynamic results. Therefore ten patients have been studied by thermodilution methods and the variations in their hemodynamic parameters has been evaluated with a paired T-Test. Results confirm the persistence of a depressed cardiac function throughout the time span of the study (36 hours). This behaviour could be related to the use of Kirsch solution for myocardial protection. Therefore the authors compare a similar group of nine patients that underwent mitral valve replacement with differently designed prosthesis and the use of a St Thomas analogue cardioplegic solution. They conclude for the persistence, in the acute postoperative period, of an intrinsic myocardial dysfunction.
The American Journal of Cardiology, 1995
The Annals of Thoracic Surgery, 2006
Background. TRI Technologies (TT) valves evidenced a propensity to structural failure, consisting... more Background. TRI Technologies (TT) valves evidenced a propensity to structural failure, consisting in fracture of the pivoting system, leading to leaflet escape. At our institution, between 2000 and 2002, 36 TT valves were implanted in 34 patients. Here we report the final results of the Tritech survey program. Methods. In February 2002, the first valve-related death occurred. After the event, patients were enrolled in the TT valve survey program and strictly followed up. The option of a reintervention was advised to each patient and weighed against the redo operative risk. The prophylactic TT valve replacement program took place in two time frames, dependent on each patient's personal choice: between September 2002 and October 2003 (first phase), and between September 2004 and October 2004 (second phase). Overall, 22 (10 women, 12 men) patients underwent reoperation. Mean time interval between TT valve implantation and replacement was 23 ؎ 11 months. Patients' mean age was 59 ؎ 11 years (median age, 64 years). Results. All recipients adhering to the program successfully underwent reoperation. Operative mortality was 0%. Conclusions. We believe that the timing of the second surgery was fundamental for the favorable outcome of each patient and the absence of operative mortality. We are convinced that the tailored programming of the reintervention, together with the strong motivation of each patient, contributed in minimizing the risks related to surgery. The circumscribed cohort of patients involved was compatible with a tailored therapeutic plan. We strongly advise prophylactic reoperation of recipients of TT valves.
The Annals of Thoracic Surgery, 1998
Background. Incidence of tricuspid prosthesis replacement was 1.9% of all valvular operations per... more Background. Incidence of tricuspid prosthesis replacement was 1.9% of all valvular operations performed between June 6, 1966 and April 18, 1996. Many series report similar figures, but institutional experience is limited and the consensus on treatment modalities is lacking. Methods. One hundred tricuspid operations were performed on 83 patients (46 female). A primary operation was performed in 64 cases, 13 patients had one previous operation, 4 patients had two previous operations, and 2 patients had three previous operations. Seventeen patients required a tricuspid prosthetic valve rereplacement. There were 2 emergent and 17 urgent operations. The New York Heart Association class was IV in 13 patients (mean pulmonary artery pressure, 41 mm Hg), III in 66 patients (mean pressure, 38 mm Hg), and II in 21 patients. The most frequent operation was simultaneous replacement of the mitral and tricuspid valve (41 patients). Seventy biological and 30 mechanical prostheses were used. Total follow-up time was 613 years, mean 7.4 years (median 4.2 years), with a maximum of 27.8 years, and was 92% complete. Results. Operative mortality was 24%. Survival was 0.54 (0.48 to 0.59, n ؍ 39) at 5 years, 0.38 (0.32 to 0.44, n ؍ 27) at 10 years, 0.31 (0.25 to 0.36, n ؍ 19) at 15 years, 0.29 (0.23 to 0.34, n ؍ 11) at 20 years, and 0.17 (0.098 to 0.26, n ؍ 3) at 25 years. Early mortality was increased from higher New York Heart Association class (hazard ratio ؍ 2.2), congenital disease (hazard ratio ؍ 6.9), and valvuloplasty failure (hazard ratio ؍ 4.3). The constant risk phase (4%/patient-year) after 2 years was enhanced by older operative age (hazard ratio ؍ 1.4). Prosthetic type had no independent effect. Biological prostheses were at risk for 300 years and had a reoperation incidence of 4.7%/ patient-year (14 events); mechanical prosthesis were at risk for 137 years with a rate of 2.2%/patient-year (3 events) (p ؍ 0.21). Three valve thromboses were observed in old-design mechanical prosthesis. Bioprosthetic degeneration showed a steeper rate after 7 years. Conclusions. This study does not show a clear superiority of biological versus mechanical prostheses. In the long run survival with mechanical prostheses could be superior, given the high rate of bioprosthetic degeneration after 7 years.
Journal of Clinical & Experimental Cardiology
Journal of Thoracic and Cardiovascular Surgery, 2007
Cardiovascular …, 2007
A 46-year-old man presenting with fever, peripheral edema, and chest pain was admitted to the eme... more A 46-year-old man presenting with fever, peripheral edema, and chest pain was admitted to the emergency department. Electrocardiogram showed sinus tachycardia and first-degree atrioventricular block. Transesophageal echocardiogram showed infective endocarditis in bicuspid aortic valve, complicated with severe aortic regurgitation, ring abscess, and sinus-of-Valsalva aneurysm extending to mitroaortic fibrous continuity. The patient, who was unaware of his bicuspid aortic valve condition, reported having undergone an orthodontic procedure complicated with dental abscess 1 month prior, which was treated with combined clavulanate-amoxicillin antibiotic therapy. Blood cultures were positive for Bacteroides fragilis resistant to metronidazole. Intravenous antibiotic therapy was undertaken, with rapid resolution of fever. He eventually underwent successful aortic homograft implantation and mitral valve repair with residual first-degree atrioventricular block.
The International journal of artificial organs, Jan 16, 2017
The aim of our study was to compare 2 surgical and anesthetic approaches during ventricular assis... more The aim of our study was to compare 2 surgical and anesthetic approaches during ventricular assist device implantation. 68 patients (50.4 ± 17.1 years old) were supported with the HeartWare® HVAD (32 patients) and the Jarvik 2000 VAD (36 patients) between January 2010 and August 2016. Two surgical techniques were applied: a minimally invasive approach with the aid of paravertebral-block (mini-invasive group, 41 patients) and a standard-surgical-approach with the aid of general anesthesia (27 patients). The minimally invasive approach allowed faster postoperative recovery by significantly reducing the duration of surgery (p<0.05), anesthesia (p<0.05), mechanical ventilation (p<0.05), inotropic support (p<0.05), ICU and in-hospital stay (p<0.05), and time to first mobilization (p<0.05). No case of epidural hematoma was observed. Eleven patients died (16%) at 30 days, 3 in the mini-invasive group (7.3%) and 8 in the invasive group (29.6%). Minimally invasive approache...
The Annals of Thoracic Surgery, 2016
Background. This single-center retrospective study assessed the variation of left ventricular eje... more Background. This single-center retrospective study assessed the variation of left ventricular ejection fraction (LVEF) after transapical transcatheter aortic valve implantation and its effect on survival. We also evaluated the effect of sheath diameter on LVEF. Methods. We analyzed data of all consecutive patients who underwent transapical transcatheter aortic valve implantation with the Sapien (Edwards Lifesciences, Irvine, CA) device (and its evolutions) between 2009 and 2015. We analyzed the difference between preoperative LVEF and LVEF at discharge (DEF [ LVEFpost-op-LVEFpre-op) and considered its interquartile range (±5%) as the cutoff. Patients were divided in three groups: (1) improved LVEF (DEF ‡ D5%); (2) unchanged LVEF (DEF-5% to D5%), and (3) worsened LVEF (DEF £-5%). Survival was evaluated with Kaplan-Meier analysis, and logistic regression multivariable analysis was used to determine independent predictors of LVEF improvement. Results. Data of 122 patients were analyzed. Patients in the three groups were distributed as follows: (group 1) 27 patients (22.1%), (group 2) 69 (56.6%), and (group 3) 26 (21.3%). The mean DEF was 12.7% ± 4.7% in group 1 and-10.8% ± 3.9% in group 3. The DEF was more likely to improve in patients with preoperative LVEF of less than 0.35 (p [ 0.014). There were no significant differences in survival (p [ 0.41), rehospitalization (p [ 0.472), and New York Heart Association Functional Classification (p [ 0.307) among the groups. The use of the smallest available sheath (18F) was not associated with a significant change of DEF.
The Annals of Thoracic Surgery, 1993
Journal of the American College of Cardiology, Mar 1, 1995
Objectives. This study was designed to evaluate and compare the patterns of arrhythmogenic right ... more Objectives. This study was designed to evaluate and compare the patterns of arrhythmogenic right ventricular cardiomyopathy in young people and adults. Background. Few data are available on this cardiomyopathy in young people because clinical and morphologic findings considered pathognomonic are normally based on observations in adults. However, a familial occurrence with a probable genetic transmission led to the study of children and to early detection of this disease, in which sudden death has been reported even in young people. Methods. Seventeen young patients with arrhythmogenic right ventricular cardiomyopathy diagnosed at a mean age-+ SD of 14.9-+ 4.9 years were studied. Clinical, electrocardiographic, echocardiographic, cineangiographic and biopsy findings were compared with those of 19 adult patients whose condition was diagnosed at a mean age of 38.1 + 13.4 years. Results. Syncope occurred in 23.5% of the young patients but in none of the adults (odds ratio of familial sudden death 5.54, p = 0.1). Ventricular couplets (odds ratio 16.0, p = 0.004) and subtricuspid bulging on echocardiography (odds ratio 5.95, p = 0.036) were prevalent in the young group. Cineangiographic data in the two groups were similar, except that more hypokinetic areas were found in adults (odds ratio 4.44, p = 0.05). Morphometric analysis of biopsy sections showed a greater amount of fibrous tissue in the young patients (p = 0.04) and a prevalence of fatty tissue in the adults (odds ratio 12, p = 0.005). During an equivalent follow-up time (mean 7 years), two young patients died suddenly, and two had ventricular fibrillation in the absence of antiarrhythmic therapy. Conclusions. The pathognomonic criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy in adults are also valid for young people. Sudden or aborted death occurred frequently in young untreated patients.
The Journal of Thoracic and Cardiovascular Surgery, Nov 1, 2003
We sought to assess the efficiency of 2 different sternal wiring techniques in preventing deep st... more We sought to assess the efficiency of 2 different sternal wiring techniques in preventing deep sternal wound infection or sternal instability. Methods: Seven hundred patients were randomized to 2 different groups according to chest-closure techniques. Three hundred fifty patients who underwent a peristernal double crisscross wire closure were included in group X, whereas 350 patients who underwent a standard transsternal closure were included in group T. After sternal closure, the technique for wound suturing was the same for both groups, namely triple-layer sutures up to the intracutaneous skin. All data were prospectively collected and entered in our institute database. Results: The 2 groups of patients were comparable for sex, age, preoperative risk factors, and operative procedures. The overall mortality rate was 4.3% in group X and 4.6% in group T. Postoperative morbidity and mortality were comparable between the 2 groups, unlike for sternal wound complications. None of the patients included in group X had superficial or deep wound complications, whereas in group T 7 (2%) patients presented with a superficial sternal wound infection, 6 (1.7%) presented with a deep chest wound infection with sternal instability requiring re-exploration (P Ͻ .05), and 3 presented with a sternal instability caused by sternum disruption without infection. Among patients with deep wound infection and sternal instability, 1 patient died, resulting in a mortality rate of 16.7%. Conclusions: The peristernal double crisscross wiring technique achieved a greater sternal stability, resulting in a lower incidence of wound infection in association with triple-layer closure of suprasternal tissues.
European Heart Journal, 2010
Italian Journal of Vascular and Endovascular Surgery, 2010
PubMed, Dec 1, 1997
Background: Aortic dissection with rupture into the right atrium is an extremely rare condition a... more Background: Aortic dissection with rupture into the right atrium is an extremely rare condition and rapidly lethal. The authors report their experience in the treatment of two complicated aortic dissections observed at 85 and 93 months after previous cardiac operations. These were redo mitral valve replacement and saphenous vein coronary artery bypass grafts. Methods: Both cases underwent hospital admission on an emergency basis because of severe chest pain and cardiac failure. One case had a history of hypertension. The aortography revealed aortic dissection and a fistulous communication into the right atrium. At surgery dissection repair and closure of the fistula was performed. Furthermore in one case vein grafts were reimplanted into the vascular graft. Results: Both patients survived the operation without complications, were rapidly extubated and were asymptomatic and fully active at late follow-up. Conclusions: In the light of these results we conclude by affirming that aortic dissection with rupture into the right atrium is an extremely rare condition, rapidly lethal. Patient survival is strictly dependent on the time interval between fistulization of the dissection and the operation.
Heart Lung and Circulation, 2012
Background: Double antiplatelet therapy plays a crucial role in the management of acute coronary ... more Background: Double antiplatelet therapy plays a crucial role in the management of acute coronary syndrome (ACS) and the prevention of coronary artery and stent thrombosis. Current teaching holds that such therapy increases the risk of perioperative bleeding in coronary artery bypass graft surgery (CABG). We undertook a prospective observational study of 100 consecutively-enrolled patients undergoing CABG to investigate the determinants of major bleeding post-CABG Methods: Two groups of CABG patients were studied: Group A, treated with aspirin alone (n = 50), and Group B treated with aspirin and clopidogrel (n = 50). Both had similar preoperative, clinical, and biologic characteristics and operative management. Classic coagulation parameters and ROTEM profiles were determined preoperatively for both groups and the same heparin treatment was administered to all. ROTEM profiles (INTEM and EXTEM assays) were analysed, both for traditional parameters, and thrombin generation potential, expressed by Area-Under-Curve (AUC). Results: Major bleeding was more frequent with double treatment: eight patients in group B (16%) compared with six patients in group A (12%), although this did not reach statistical significance (p = 0.77). In these 14 cases of major bleeding, classic coagulation and traditional ROTEM parameters were comparable. Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders (5030 ± 1115 mm × 100) than non-bleeders (6568 ± 548 mm × 100) (p < 0.0001). Conclusions: Patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC, regardless of treatment. This suggests that thrombin generation potential, irrespective of the degree of platelet inhibition, correlates with surgical bleeding.
The Journal of Thoracic and Cardiovascular Surgery, Jul 1, 1985
ABSTRACT
European Heart Journal, 2010
Circulation, 2012
Objective: Aim of this retrospective multicenter study was to assess how the introduction of tran... more Objective: Aim of this retrospective multicenter study was to assess how the introduction of transcatheter aortic valve implantation (TAVI) influenced the characteristics and the outcomes of patien...
Cardiologia (Rome, Italy), 1983
PubMed, 1981
In mitral valve replacement for mitral stenosis the persistence of a depressed cardiac performanc... more In mitral valve replacement for mitral stenosis the persistence of a depressed cardiac performance immediately after operation has been outlined by several authors. The choice of a porcine central flow prosthesis, that has several theoretical advantages, should allow better acute hemodynamic results. Therefore ten patients have been studied by thermodilution methods and the variations in their hemodynamic parameters has been evaluated with a paired T-Test. Results confirm the persistence of a depressed cardiac function throughout the time span of the study (36 hours). This behaviour could be related to the use of Kirsch solution for myocardial protection. Therefore the authors compare a similar group of nine patients that underwent mitral valve replacement with differently designed prosthesis and the use of a St Thomas analogue cardioplegic solution. They conclude for the persistence, in the acute postoperative period, of an intrinsic myocardial dysfunction.
The American Journal of Cardiology, 1995
The Annals of Thoracic Surgery, 2006
Background. TRI Technologies (TT) valves evidenced a propensity to structural failure, consisting... more Background. TRI Technologies (TT) valves evidenced a propensity to structural failure, consisting in fracture of the pivoting system, leading to leaflet escape. At our institution, between 2000 and 2002, 36 TT valves were implanted in 34 patients. Here we report the final results of the Tritech survey program. Methods. In February 2002, the first valve-related death occurred. After the event, patients were enrolled in the TT valve survey program and strictly followed up. The option of a reintervention was advised to each patient and weighed against the redo operative risk. The prophylactic TT valve replacement program took place in two time frames, dependent on each patient's personal choice: between September 2002 and October 2003 (first phase), and between September 2004 and October 2004 (second phase). Overall, 22 (10 women, 12 men) patients underwent reoperation. Mean time interval between TT valve implantation and replacement was 23 ؎ 11 months. Patients' mean age was 59 ؎ 11 years (median age, 64 years). Results. All recipients adhering to the program successfully underwent reoperation. Operative mortality was 0%. Conclusions. We believe that the timing of the second surgery was fundamental for the favorable outcome of each patient and the absence of operative mortality. We are convinced that the tailored programming of the reintervention, together with the strong motivation of each patient, contributed in minimizing the risks related to surgery. The circumscribed cohort of patients involved was compatible with a tailored therapeutic plan. We strongly advise prophylactic reoperation of recipients of TT valves.
The Annals of Thoracic Surgery, 1998
Background. Incidence of tricuspid prosthesis replacement was 1.9% of all valvular operations per... more Background. Incidence of tricuspid prosthesis replacement was 1.9% of all valvular operations performed between June 6, 1966 and April 18, 1996. Many series report similar figures, but institutional experience is limited and the consensus on treatment modalities is lacking. Methods. One hundred tricuspid operations were performed on 83 patients (46 female). A primary operation was performed in 64 cases, 13 patients had one previous operation, 4 patients had two previous operations, and 2 patients had three previous operations. Seventeen patients required a tricuspid prosthetic valve rereplacement. There were 2 emergent and 17 urgent operations. The New York Heart Association class was IV in 13 patients (mean pulmonary artery pressure, 41 mm Hg), III in 66 patients (mean pressure, 38 mm Hg), and II in 21 patients. The most frequent operation was simultaneous replacement of the mitral and tricuspid valve (41 patients). Seventy biological and 30 mechanical prostheses were used. Total follow-up time was 613 years, mean 7.4 years (median 4.2 years), with a maximum of 27.8 years, and was 92% complete. Results. Operative mortality was 24%. Survival was 0.54 (0.48 to 0.59, n ؍ 39) at 5 years, 0.38 (0.32 to 0.44, n ؍ 27) at 10 years, 0.31 (0.25 to 0.36, n ؍ 19) at 15 years, 0.29 (0.23 to 0.34, n ؍ 11) at 20 years, and 0.17 (0.098 to 0.26, n ؍ 3) at 25 years. Early mortality was increased from higher New York Heart Association class (hazard ratio ؍ 2.2), congenital disease (hazard ratio ؍ 6.9), and valvuloplasty failure (hazard ratio ؍ 4.3). The constant risk phase (4%/patient-year) after 2 years was enhanced by older operative age (hazard ratio ؍ 1.4). Prosthetic type had no independent effect. Biological prostheses were at risk for 300 years and had a reoperation incidence of 4.7%/ patient-year (14 events); mechanical prosthesis were at risk for 137 years with a rate of 2.2%/patient-year (3 events) (p ؍ 0.21). Three valve thromboses were observed in old-design mechanical prosthesis. Bioprosthetic degeneration showed a steeper rate after 7 years. Conclusions. This study does not show a clear superiority of biological versus mechanical prostheses. In the long run survival with mechanical prostheses could be superior, given the high rate of bioprosthetic degeneration after 7 years.
Journal of Clinical & Experimental Cardiology
Journal of Thoracic and Cardiovascular Surgery, 2007
Cardiovascular …, 2007
A 46-year-old man presenting with fever, peripheral edema, and chest pain was admitted to the eme... more A 46-year-old man presenting with fever, peripheral edema, and chest pain was admitted to the emergency department. Electrocardiogram showed sinus tachycardia and first-degree atrioventricular block. Transesophageal echocardiogram showed infective endocarditis in bicuspid aortic valve, complicated with severe aortic regurgitation, ring abscess, and sinus-of-Valsalva aneurysm extending to mitroaortic fibrous continuity. The patient, who was unaware of his bicuspid aortic valve condition, reported having undergone an orthodontic procedure complicated with dental abscess 1 month prior, which was treated with combined clavulanate-amoxicillin antibiotic therapy. Blood cultures were positive for Bacteroides fragilis resistant to metronidazole. Intravenous antibiotic therapy was undertaken, with rapid resolution of fever. He eventually underwent successful aortic homograft implantation and mitral valve repair with residual first-degree atrioventricular block.
The International journal of artificial organs, Jan 16, 2017
The aim of our study was to compare 2 surgical and anesthetic approaches during ventricular assis... more The aim of our study was to compare 2 surgical and anesthetic approaches during ventricular assist device implantation. 68 patients (50.4 ± 17.1 years old) were supported with the HeartWare® HVAD (32 patients) and the Jarvik 2000 VAD (36 patients) between January 2010 and August 2016. Two surgical techniques were applied: a minimally invasive approach with the aid of paravertebral-block (mini-invasive group, 41 patients) and a standard-surgical-approach with the aid of general anesthesia (27 patients). The minimally invasive approach allowed faster postoperative recovery by significantly reducing the duration of surgery (p<0.05), anesthesia (p<0.05), mechanical ventilation (p<0.05), inotropic support (p<0.05), ICU and in-hospital stay (p<0.05), and time to first mobilization (p<0.05). No case of epidural hematoma was observed. Eleven patients died (16%) at 30 days, 3 in the mini-invasive group (7.3%) and 8 in the invasive group (29.6%). Minimally invasive approache...
The Annals of Thoracic Surgery, 2016
Background. This single-center retrospective study assessed the variation of left ventricular eje... more Background. This single-center retrospective study assessed the variation of left ventricular ejection fraction (LVEF) after transapical transcatheter aortic valve implantation and its effect on survival. We also evaluated the effect of sheath diameter on LVEF. Methods. We analyzed data of all consecutive patients who underwent transapical transcatheter aortic valve implantation with the Sapien (Edwards Lifesciences, Irvine, CA) device (and its evolutions) between 2009 and 2015. We analyzed the difference between preoperative LVEF and LVEF at discharge (DEF [ LVEFpost-op-LVEFpre-op) and considered its interquartile range (±5%) as the cutoff. Patients were divided in three groups: (1) improved LVEF (DEF ‡ D5%); (2) unchanged LVEF (DEF-5% to D5%), and (3) worsened LVEF (DEF £-5%). Survival was evaluated with Kaplan-Meier analysis, and logistic regression multivariable analysis was used to determine independent predictors of LVEF improvement. Results. Data of 122 patients were analyzed. Patients in the three groups were distributed as follows: (group 1) 27 patients (22.1%), (group 2) 69 (56.6%), and (group 3) 26 (21.3%). The mean DEF was 12.7% ± 4.7% in group 1 and-10.8% ± 3.9% in group 3. The DEF was more likely to improve in patients with preoperative LVEF of less than 0.35 (p [ 0.014). There were no significant differences in survival (p [ 0.41), rehospitalization (p [ 0.472), and New York Heart Association Functional Classification (p [ 0.307) among the groups. The use of the smallest available sheath (18F) was not associated with a significant change of DEF.