Gabriele Di Giammarco - Academia.edu (original) (raw)
Papers by Gabriele Di Giammarco
![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/104346708/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.
International journal of cardiology, Jan 4, 2017
The aim of this large retrospective study was to provide a logistic risk model along an additive ... more The aim of this large retrospective study was to provide a logistic risk model along an additive score to predict early mortality after surgical treatment of patients with heart valve or prosthesis infective endocarditis (IE). From 2000 to 2015, 2715 patients with native valve endocarditis (NVE) or prosthesis valve endocarditis (PVE) were operated on in 26 Italian Cardiac Surgery Centers. The relationship between early mortality and covariates was evaluated with logistic mixed effect models. Fixed effects are parameters associated with the entire population or with certain repeatable levels of experimental factors, while random effects are associated with individual experimental units (centers). Early mortality was 11.0% (298/2715); At mixed effect logistic regression the following variables were found associated with early mortality: age class, female gender, LVEF, preoperative shock, COPD, creatinine value above 2mg/dl, presence of abscess, number of treated valve/prosthesis (with...
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%, ...
Journal of Cardiothoracic Surgery, 2015
The Journal of Thoracic and Cardiovascular Surgery, 2016
Objective: To verify the rate of thromboembolic and hemorrhagic complications during the first 6 ... more Objective: To verify the rate of thromboembolic and hemorrhagic complications during the first 6 months after mitral valve repair and to assess whether the type of antithrombotic therapy influenced clinical outcome. Methods: Retrospective data were retrieved from 19 centers. Inclusion criteria were isolated mitral valve repair with ring implantation. Exclusion criteria were ongoing or past atrial fibrillation and any combined intraoperative surgical procedures. The study cohort consisted of 1882 patients (aged 58 AE 15 years; 36% women), and included 1517 treated with an oral anticoagulant (VKA group) and 365 with antiplatelet drugs (APLT group). Primary efficacy outcome was the incidence of arterial thromboembolic events within 6 months and primary safety outcome was the incidence of major bleeding within 6 months. Propensity matching was performed to obtain 2 comparable cohorts (858 vs 286). Results: No differences were detected for arterial embolic complications in matched cohort (1.6% VKA vs 2.1% APLT; P ¼ .50). Conversely, patients in the APLT group showed lower incidence of major bleeding complications (3.9% vs 0.7%; P ¼ .01). Six-month mortality rate was significantly higher in the VKA group (2.7% vs 0.3%; P ¼ .02). Multivariable analysis in the matched cohort found VKA as independent predictor of major bleeding complications and mortality at 6 months. Conclusions: Vitamin K antagonist therapy was not superior to antiplatelet therapy to prevent thromboembolic complications after mitral valve repair. Our data suggest that oral anticoagulation may carry a higher bleeding risk compared with antiplatelet therapy, although these results should be confirmed in an adequately powered randomized controlled trial.
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2015
The surgical treatment of concomitant cardiac disease and lung cancer represents a challenge. We ... more The surgical treatment of concomitant cardiac disease and lung cancer represents a challenge. We report the case of a 66-year-old high-risk female patient with severe aortic stenosis as well as severely impaired left ventricular function associated with coronary artery disease involving the left anterior descending artery complicated from a severe functional mitral regurgitation in which an early-stage non-small cell carcinoma was incidentally discovered during workup. Because of the possibility of potential negative impact of cardiopulmonary bypass on the cancer prognosis and the severe impairment of systolic function of the left ventricle that impeded the treatment of lung cancer as the first step of such a complex treatment, we planned to treat all the diseases in a single-stage procedure. Using an automated delivering system composed of a ventricular connector (Correx AVB; Correx, Inc, Waltham, MA USA), we were able to perform an apicoaortic bypass as well as a left anterior des...
Italian heart journal : official journal of the Italian Federation of Cardiology, 2002
... The role of synergy between cardiology and cardiac surgery in the choice of the treatment of ... more ... The role of synergy between cardiology and cardiac surgery in the choice of the treatment of dilated cardiomyopathy. Di Giammarco G, Calafiore AM. Department of Cardiology and Cardiac Surgery, University G. d'Annunzio, Chieti, Italy. ...
Minerva cardioangiologica, 1988
Rays
The aim of the present study was to investigate the prevalence of carotid and/or peripheral ather... more The aim of the present study was to investigate the prevalence of carotid and/or peripheral atherosclerotic lesions in patients with chronic ischemic heart disease (previous acute myocardial infarction [AMI] or stable angina). We studied 248 patients (168 male and 80 female), mean age 63+/-10 years, which were investigated for traditional risk factors. Systolic blood pressure, body mass index, lipid profile, fasting glucose and plasma fibrinogen were also measured. We assessed the prevalence of atherosclerotic lesions in carotid and lower limb arteries, by ultrasound duplex scanning (UDS). Angina was present in 33% of the patients, a previous AMI in 67%, a previous transient ischemic attack in 4% and a previous ischemic stroke in 6% of patients. A total of 195 patients underwent coronary angiography: 1 vessel was involved in 48% of patients, 2 vessels in 33%, and 3 vessels in 19%. Detecting peripheral atherosclerotic lesions by UDS, increased intima-media thickness (IMT) or plaques in carotid arteries were found in 232 patients (94%) and carotid stenosis &amp;gt;70% in 13 patients (5%). In lower limb arteries, IMT or plaques were present in 202 patients (82%) and a stenosis &amp;gt;70% in 18 patients (7%). Severity of coronary artery disease (CAD) was correlated to extracoronary atherosclerosis: carotid and lower limb arterial atherosclerosis was detected in 73% of patients with 1 vessel, in 83% of patients with 2 vessel, in 87% of those with 3 vessel CAD. Our study suggests that in patients with CAD, it is useful to screen the peripheral circulation by non-invasive tests, such as UDS. Patients with the diagnosis of ischemic heart disease and combined extracoronary atherosclerosis need a careful follow-up and a more aggressive therapy for secondary prevention.
Interactive CardioVascular and Thoracic Surgery, 2010
A best evidence topic in cardiac surgery was written according to a structured protocol. The ques... more A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was if transit-time flow measurement (TTFM) can improve graft patency and clinical outcome in patients undergoing coronary surgery. Altogether 102 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The papers considered for the analysis focus attention on three major topics: intraoperative graft verification with the aim of improving immediate graft patency; predictive power of early-and mid-term graft patency and clinical outcome. Among TTFM parameters, according to different authors, mean graft flow is set at 10 or 15 mlymin; pulsatility index is set at three or five; insufficiency ratio is set by 3 or 4%. We conclude that TTFM is a reliable method to verify intraoperative graft patency. There is some evidence that checking graft patency intraoperatively may improve mid-term outcomes.
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2003
A 79-year-old man refers to our echocardiolab for a normal follow-up after 2 years of biventricul... more A 79-year-old man refers to our echocardiolab for a normal follow-up after 2 years of biventricular pacing. Seven years before the present observation, the patient underwent a biological aortic valve replacement for severe valvular stenosis in the presence of marked systolic dysfunction of the left ventricle and advanced cardiac failure symptoms. The evaluation of the present and past clinical and echocardiographic parameters suggests that conventional surgery and full medical therapy did not elicit an improvement of both functional and clinical parameters, whereas cardiac resynchronization therapy dramatically improved in the mid term all the clinical and functional parameters.
Diagnostic Pathology, 2011
Aortic valve replacement (AVR) is the gold standard for the treatment of severe symptomatic aorti... more Aortic valve replacement (AVR) is the gold standard for the treatment of severe symptomatic aortic stenosis. Complications directly related to surgical procedure are relatively infrequent. Coronary ostial stenosis is, generally, referred as late complication. Anecdotal reports concern coronary ostial stenosis as acute complication. A unique fatal case of intraoperative, bilateral coronary ostial obstruction by prosthetic valve leading to an extensive myocardial infarction is reported. Surgeons must have a high level of vigilance regarding the occurrence of acute myocardial ischemia and sudden death soon after AVR. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4383994185667026.
The Journal of Thoracic and Cardiovascular Surgery, 2006
The aim of this retrospective study was to evaluate the possibility to predict postoperative graf... more The aim of this retrospective study was to evaluate the possibility to predict postoperative graft patency in coronary surgery by means of intraoperative transit-time flow measurement. Methods: Of 3567 patients submitted to isolated myocardial revascularization from June 1997 through June 2003, 157 (4.4%) underwent both intraoperative transittime flow measurement and angiography at follow-up. Thirty-six have been revascularized on a beating heart. Three hundred four grafts, 227 arterial conduits, and 77 saphenous vein grafts were checked. Results: No patients died, and none of them had an acute myocardial infarction within 12 months after the operation. After a mean of 6.7 Ϯ 4.8 months from the operation, 266 grafts (group A) were completely functioning, whereas 38 grafts (group B) had failed. The transit-time flow parameters recorded in the latter group had significantly lower mean flow and higher pulsatility index and percentage of backward flow values at both univariate and multivariate analysis. Moreover, mean flow values of 15 mL/min or less, pulsatility index values of 3.0 or greater, and percentage of backward flow values of 3.0% or greater were found to be independent variables for higher incidence of graft failure. Conclusions: Transit-time flow measurement represents a quick, easy, and reproducible method for intraoperative evaluation of graft function. The combination of the 3 major parameters (mean flow, pulsatility index, and percentage of backward flow) results in the chance to predict a graft failure (either anatomic or functional) within the first postoperative year. T he incidence of perioperative graft failure has been estimated to be from 5% to 11%. 1-5 Early graft patency can influence either early or late outcome after coronary artery bypass grafting (CABG). 6 Even if angiography still represents the gold standard for anatomic evaluation, the chance of intraoperative assessment of the quality of the anastomosis has been an unachieved goal since CABG was started. Several methods have been introduced over the last decade, 7-9 with the aim to check graft viability. Transit-time flow (TTF) measurement has been reported to be
The Journal of Thoracic and Cardiovascular Surgery, 2005
Objectives: We sought to evaluate whether early and late results in patients who underwent off-pu... more Objectives: We sought to evaluate whether early and late results in patients who underwent off-pump or on-pump myocardial revascularization with bilateral internal thoracic artery grafting were similar. Methods: From November 1994 through December 2001, 1835 patients underwent isolated myocardial revascularization with bilateral internal thoracic artery grafting. By applying propensity score pairwise matching, 1194 patients were selected and operated on either off pump (n ϭ 597) or on pump (n ϭ 597). Results: The overall 30-day mortality was 1.5% (1.2% in the off-pump group and 1.8% in the on-pump group, P ϭ .342). There was no difference for all the other complications between the 2 groups. Mean follow-up was 5.2 Ϯ 1.8 years. Fortytwo patients died over the follow-up period (22 in the off-pump group and 20 in the on-pump group), 15 of them of cardiac causes (7 in the off-pump group and 8 in the on-pump group). Six-year outcomes (freedom from death, cardiac death, acute myocardial infarction and reoperation in all or in the grafted area, target cardiac events, and any other event) were similar for both categories. After a mean of 30.7 Ϯ 20.1 months, 202 patients had a postoperative angiography showing similar results. Conclusions: Our results with extensive arterial revascularization clearly show that with the technical improvements achieved in the most recent years, off-pump operations can be performed safely with the same quality of late results as those obtained with on-pump operations. E arly results after myocardial revascularization without cardiopulmonary bypass (CPB) show, in the great majority of reports, a decrease in postoperative morbidity 1-8 and sometimes also in mortality in the general surgical population 4-8 or in subgroups of high-risk patients. 9,10 Long-term outcome is not yet well established, even though in the last 2 years some reports appeared showing basically similar results in the 2 groups of patients. 1,2,4,11,12 The better long-term outcome with bilateral internal thoracic artery (BITA) grafting over other myocardial revascularization strategies has been recently reported. 13-17 We analyzed retrospectively our results with on-pump and off-pump isolated coronary artery bypass grafting in which BITA grafting was used to evaluate whether off-pump coronary artery bypass grafting sacrifices a long-term benefit for a more attractive and fashionable strategy.
The Journal of Thoracic and Cardiovascular Surgery, 2000
L eft internal thoracic artery (ITA) grafting to the left anterior descending (LAD) artery is wid... more L eft internal thoracic artery (ITA) grafting to the left anterior descending (LAD) artery is widely recognized to be the most important single determinant for survival and for reduction of late cardiac events in patients who undergo coronary artery bypass grafting. 1,2 Recently, Pick and associates 3 showed better long-term outcome in patients in whom bilateral ITAs were used on the left coronary artery system in comparison with patients in whom only the left ITA was used to the LAD. Lytle and associates 4 also found that having 2 ITAs was advantageous for any patient, regardless of the position of the grafts, and that the advantage was already statistically significant 5 years after the operation. Background: We evaluated whether bilateral internal thoracic arteries provide the same long-term results when used as in situ grafts and as Y grafts. Methods and results: From October 1991 to February 2000, 1818 patients had bilateral internal thoracic arteries used as in situ (n = 1378, group A) or as Y grafts (n = 440, group B). The number of anastomoses per patient and the number of bilateral internal thoracic artery anastomoses per patient were higher in group B (3.1 ± 0.9 and 2.7 ± 0.9) than in group A (2.9 ± 0.8 and 2.2 ± 0.6) (both P < .001). The number of right internal thoracic artery anastomoses per patient rose from 1.0 ± 0.3 in group A to 1.4 ± 0.6 in group B (P < .001), and the number of sequential anastomoses per right internal thoracic artery graft rose from 4.1% to 34.3% (P < .001). Thirty-day mortality was 2.0% in group A versus 2.5% in group B (P = not significant). No difference in postoperative course was detected. Eight-year survivals were 95.8% ± 2.7% in group A versus 94.8% ± 4.0% in group B (P = not significant), and event-free survivals were 95.2% ± 2.9% in group A versus 93.6% ± 4.4% in group B (P = not significant). Early angiograms were obtained in 295 patients (945 anastomoses, 863 distal and 82 proximal Y grafts), 213 patients (611) in group A and 82 patients (334) in group B. Patency rate was 98.8% in group A and 96.0% in group B (P = not significant), whereas grade A patency rate was 97.2% in group A and 96.4% in group B (P = not significant). Late angiograms were obtained in 88 patients (25 in group A and 63 in group B) at a mean of 17.5 ± 18.4 months: patency rate was 100% in group A and 99.2 in group B (P = not significant), and grade A patency rate was 98.6% in group A and 98.8% in group B (P = not significant). No Y anastomosis was occluded or stenosed. Comment: Survival, incidence of cardiac events, and angiographic patency in the early and late phases are similar for bilateral internal thoracic arteries used either in situ or as Y grafts. However, Y grafting with bilateral internal thoracic arteries increases the number of anastomoses per bilateral thoracic artery, as well as the flexibility of the right internal thoracic artery.
Journal of Cardiac Surgery, 2003
Background: Septoexclusion is a technique described by Guilmet in the mid 1980s. Its indications ... more Background: Septoexclusion is a technique described by Guilmet in the mid 1980s. Its indications and midterm results are evaluated and compared to those obtained with the Dor operation. Methods: From January 1998 to April 2001, 79 patients had an exclusion of scars following myocardial infarction in left anterior descending artery (LAD) territory. Fifty of them (63.3%) had the Dor operation (Group D) and 29 (36.7%) the Guilmet operation (Group G). Dor technique was used when the involvement of the septum and the free wall was roughly similar. Guilmet technique was indicated when the septum was involved at a greater extent than the free wall. Ejection fraction (EF) was lower and end-diastolic volumes were higher in Group G. Incidence of functional mitral regurgitation was similar in both groups. Results: Thirty-day mortality was 7.6% (8.0% in Group D versus 6.9% in Group G, p = ns). After a mean of 21.0 ± 8.5 months, five patients (6.9%) died, two in Group D and three in Group G. Causes of death were cardiac related in four and not cardiac related in one. Mean follow-up of the 68 survivors was 24.3 ± 12.0 months (range: 4-38 months). Fifty patients (73.5% of the survivors) improved (28 in Group D and 22 in Group G, p = 0.026), whereas in 18, New York Heart Association (NYHA) class remained unchanged or worsened. Both groups showed an increase of EF and a volumetric reduction, whereas stroke volume remained unchanged. Fewer patients had mitral regurgitation than in the preoperative period (41.3% versus 65.8%, p = 0.013) and at a lesser extent (1.7 ± 0.7versus 0.7 ± 0.6, p < 0.001). Conclusions: Our results show that both Dor and Guilmet techniques are effective in the surgical treatment of left ventricular dyskinetic or akinetic areas related to LAD territory. Each technique has its own indications and has to be addressed to patients with different extension of septal scars.
Journal of Cardiac Surgery, 2010
Between July 1992 and May 1994, 148 patients (18 females) underwent myocardial revascularization ... more Between July 1992 and May 1994, 148 patients (18 females) underwent myocardial revascularization with a radial artery (RA) graft. The left RA was used in 97.3% of cases. All but two patients received at least one additional arterial conduit: 137 left and 59 right internal mammary arteries (IMA); 23 inferior epigastric arteries; and 21 right gastroepiploic arteries. Total arterial revascularization was achieved in 127 patients (85.8%). An average of 3.0 anastomoses/patient were constructed, 2.8 of which were arterial. RA proximal anastomoses were placed on the IMA in 75% of cases, while direct anastomosis to the aorta (23.7%) or to a saphenous vein (1.3%) was performed in the remainder. When anastomosed to an IMA, the RA was subsequently infused intraluminally with 10 mg of papaverine (1 mg/mL). The target artery was the left anterior descending or one of its branches in 14.7% of cases, the circumflex system in 76.3%, and the native right coronary or one of its branches in the remaining 9%. An infusion of diltiazem (4 mg/hour) was started once the aorta was unclamped, and patients were maintained on oral diltiazem for 6 months postoperatively. Operative mortality was 1.4% (2 patients), with the additional late deaths from noncardiac causes. In one patient there was a prolonged serous drainage from the RA donor site. Of the 144 survivors 140 are asymptomatic. Follow-up angiography demonstrated 100% early patency (< 30 days, 41 patients), and 94% late patency (6 to 20 months, mean 14 months, 30/32 patients). This study suggests the RA can be used safely as an alternative to saphenous vein in coronary bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
International Journal of Cardiology, 2011
Patients with catheter fragments that were entrapped during percutaneous transluminal coronary an... more Patients with catheter fragments that were entrapped during percutaneous transluminal coronary angioplasty remain a particular challenge because little is known about the clinical outcome. Absolutely unique is the partially cutting of the dilator and the pushing of the fragment by the guidewire advancing into the femoral artery to the coronary tree. We describe this exceptionally complication with a complete coronary obstruction and an anterior myocardial infarction sustained by the retained fragment into the left main branch.
Heart, Lung and Circulation, 2000
I n the last decade arterial myocardial revascularisation became more popular following the routi... more I n the last decade arterial myocardial revascularisation became more popular following the routine use of the left internal mammary artery (LIMA). Left internal mammary artery grafting to the left anterior descending (LAD) artery is widely recognised to be the most important single determinant for survival and for reduction of late cardiac events in patients who undergo coronary artery bypass grafting (CABG). 1,2 However, the use of venous conduits to supplement the LIMA and the possibility of progression of disease in the coronary bed leave open the possibility of cardiac events during the years following the first operation. As survival is assured by the LIMA on the LAD, the question is can we reduce late events or further increase survival using other arterial conduits in a territory different from LAD or increase globally the number of arterial anastomoses per patient? The answer is not easy; arterial anastomoses in coronary vessels different from LAD can increase the quality of the late result, but this assumption is only speculative as long-term results are lacking. However,
European Journal of Cardio-Thoracic Surgery, 2003
Objective: To evaluate 30-day and late results in high risk patients (European score (EuroSCORE) ... more Objective: To evaluate 30-day and late results in high risk patients (European score (EuroSCORE) $ 6) who underwent isolated myocardial revascularization with and without cardiopulmonary bypass (CPB). Methods: From November 1994 to December 2001, 1266 patients with EuroSCORE $ 6 underwent isolated myocardial revascularization. Among them, applying the propensity score, we were able to select 1020 patients operated on without CPB (group A, n ¼ 510) and with CPB (group B, n ¼ 510) with the same preoperative characteristics. The only differences were the higher incidence of patients with age between 61 and 65 years (9.4% in group A vs. 13.9% in group B, P ¼ 0:025) and the lower number of anastomoses/patient in group A (1.8^0.9 vs. 2.8^0.9, P , 0:001). EuroSCORE were identical in both groups (7.8%). Results: Thirty-day mortality was higher in group B (5.9 vs. 3.1%, P ¼ 0:035). Group A showed a lower incidence of cerebrovascular accidents (CVAs) (0.6 vs. 3.1%, P ¼ 0:003), whereas incidence of acute myocardial infarction (AMI) was similar (2.0% in group A vs. 2.5% in group B, P ¼ ns). Early negative primary end-points and early major events incidences were higher in group B (8.2 vs. 3.9%, P ¼ 0:004, and 14.5 vs. 7.1%, P , 0:001, respectively). Stepwise logistic regression confirmed that CPB was an independent predictor for higher early mortality (Odds ratio (OR) 2.0) and CVA, negative primary end-points and early major events incidences (OR 4.6, 2.3 and 2.4, respectively). Five-year freedom from the events explored (death due to any cause, cardiac death, AMI, AMI on a grafted area, redo/percutaneous transluminal coronary angioplasty (PTCA), redo/PTCA on a grafted area, target cardiac events (cardiac death, AMI in a grafted area and redo/PTCA in a grafted area) and any event were similar in both groups. Conclusions: In high risk patients myocardial revascularization without CPB shows better early outcome and similar clinical late results.
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.
International journal of cardiology, Jan 4, 2017
The aim of this large retrospective study was to provide a logistic risk model along an additive ... more The aim of this large retrospective study was to provide a logistic risk model along an additive score to predict early mortality after surgical treatment of patients with heart valve or prosthesis infective endocarditis (IE). From 2000 to 2015, 2715 patients with native valve endocarditis (NVE) or prosthesis valve endocarditis (PVE) were operated on in 26 Italian Cardiac Surgery Centers. The relationship between early mortality and covariates was evaluated with logistic mixed effect models. Fixed effects are parameters associated with the entire population or with certain repeatable levels of experimental factors, while random effects are associated with individual experimental units (centers). Early mortality was 11.0% (298/2715); At mixed effect logistic regression the following variables were found associated with early mortality: age class, female gender, LVEF, preoperative shock, COPD, creatinine value above 2mg/dl, presence of abscess, number of treated valve/prosthesis (with...
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%, ...
Journal of Cardiothoracic Surgery, 2015
The Journal of Thoracic and Cardiovascular Surgery, 2016
Objective: To verify the rate of thromboembolic and hemorrhagic complications during the first 6 ... more Objective: To verify the rate of thromboembolic and hemorrhagic complications during the first 6 months after mitral valve repair and to assess whether the type of antithrombotic therapy influenced clinical outcome. Methods: Retrospective data were retrieved from 19 centers. Inclusion criteria were isolated mitral valve repair with ring implantation. Exclusion criteria were ongoing or past atrial fibrillation and any combined intraoperative surgical procedures. The study cohort consisted of 1882 patients (aged 58 AE 15 years; 36% women), and included 1517 treated with an oral anticoagulant (VKA group) and 365 with antiplatelet drugs (APLT group). Primary efficacy outcome was the incidence of arterial thromboembolic events within 6 months and primary safety outcome was the incidence of major bleeding within 6 months. Propensity matching was performed to obtain 2 comparable cohorts (858 vs 286). Results: No differences were detected for arterial embolic complications in matched cohort (1.6% VKA vs 2.1% APLT; P ¼ .50). Conversely, patients in the APLT group showed lower incidence of major bleeding complications (3.9% vs 0.7%; P ¼ .01). Six-month mortality rate was significantly higher in the VKA group (2.7% vs 0.3%; P ¼ .02). Multivariable analysis in the matched cohort found VKA as independent predictor of major bleeding complications and mortality at 6 months. Conclusions: Vitamin K antagonist therapy was not superior to antiplatelet therapy to prevent thromboembolic complications after mitral valve repair. Our data suggest that oral anticoagulation may carry a higher bleeding risk compared with antiplatelet therapy, although these results should be confirmed in an adequately powered randomized controlled trial.
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2015
The surgical treatment of concomitant cardiac disease and lung cancer represents a challenge. We ... more The surgical treatment of concomitant cardiac disease and lung cancer represents a challenge. We report the case of a 66-year-old high-risk female patient with severe aortic stenosis as well as severely impaired left ventricular function associated with coronary artery disease involving the left anterior descending artery complicated from a severe functional mitral regurgitation in which an early-stage non-small cell carcinoma was incidentally discovered during workup. Because of the possibility of potential negative impact of cardiopulmonary bypass on the cancer prognosis and the severe impairment of systolic function of the left ventricle that impeded the treatment of lung cancer as the first step of such a complex treatment, we planned to treat all the diseases in a single-stage procedure. Using an automated delivering system composed of a ventricular connector (Correx AVB; Correx, Inc, Waltham, MA USA), we were able to perform an apicoaortic bypass as well as a left anterior des...
Italian heart journal : official journal of the Italian Federation of Cardiology, 2002
... The role of synergy between cardiology and cardiac surgery in the choice of the treatment of ... more ... The role of synergy between cardiology and cardiac surgery in the choice of the treatment of dilated cardiomyopathy. Di Giammarco G, Calafiore AM. Department of Cardiology and Cardiac Surgery, University G. d'Annunzio, Chieti, Italy. ...
Minerva cardioangiologica, 1988
Rays
The aim of the present study was to investigate the prevalence of carotid and/or peripheral ather... more The aim of the present study was to investigate the prevalence of carotid and/or peripheral atherosclerotic lesions in patients with chronic ischemic heart disease (previous acute myocardial infarction [AMI] or stable angina). We studied 248 patients (168 male and 80 female), mean age 63+/-10 years, which were investigated for traditional risk factors. Systolic blood pressure, body mass index, lipid profile, fasting glucose and plasma fibrinogen were also measured. We assessed the prevalence of atherosclerotic lesions in carotid and lower limb arteries, by ultrasound duplex scanning (UDS). Angina was present in 33% of the patients, a previous AMI in 67%, a previous transient ischemic attack in 4% and a previous ischemic stroke in 6% of patients. A total of 195 patients underwent coronary angiography: 1 vessel was involved in 48% of patients, 2 vessels in 33%, and 3 vessels in 19%. Detecting peripheral atherosclerotic lesions by UDS, increased intima-media thickness (IMT) or plaques in carotid arteries were found in 232 patients (94%) and carotid stenosis &amp;gt;70% in 13 patients (5%). In lower limb arteries, IMT or plaques were present in 202 patients (82%) and a stenosis &amp;gt;70% in 18 patients (7%). Severity of coronary artery disease (CAD) was correlated to extracoronary atherosclerosis: carotid and lower limb arterial atherosclerosis was detected in 73% of patients with 1 vessel, in 83% of patients with 2 vessel, in 87% of those with 3 vessel CAD. Our study suggests that in patients with CAD, it is useful to screen the peripheral circulation by non-invasive tests, such as UDS. Patients with the diagnosis of ischemic heart disease and combined extracoronary atherosclerosis need a careful follow-up and a more aggressive therapy for secondary prevention.
Interactive CardioVascular and Thoracic Surgery, 2010
A best evidence topic in cardiac surgery was written according to a structured protocol. The ques... more A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was if transit-time flow measurement (TTFM) can improve graft patency and clinical outcome in patients undergoing coronary surgery. Altogether 102 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The papers considered for the analysis focus attention on three major topics: intraoperative graft verification with the aim of improving immediate graft patency; predictive power of early-and mid-term graft patency and clinical outcome. Among TTFM parameters, according to different authors, mean graft flow is set at 10 or 15 mlymin; pulsatility index is set at three or five; insufficiency ratio is set by 3 or 4%. We conclude that TTFM is a reliable method to verify intraoperative graft patency. There is some evidence that checking graft patency intraoperatively may improve mid-term outcomes.
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2003
A 79-year-old man refers to our echocardiolab for a normal follow-up after 2 years of biventricul... more A 79-year-old man refers to our echocardiolab for a normal follow-up after 2 years of biventricular pacing. Seven years before the present observation, the patient underwent a biological aortic valve replacement for severe valvular stenosis in the presence of marked systolic dysfunction of the left ventricle and advanced cardiac failure symptoms. The evaluation of the present and past clinical and echocardiographic parameters suggests that conventional surgery and full medical therapy did not elicit an improvement of both functional and clinical parameters, whereas cardiac resynchronization therapy dramatically improved in the mid term all the clinical and functional parameters.
Diagnostic Pathology, 2011
Aortic valve replacement (AVR) is the gold standard for the treatment of severe symptomatic aorti... more Aortic valve replacement (AVR) is the gold standard for the treatment of severe symptomatic aortic stenosis. Complications directly related to surgical procedure are relatively infrequent. Coronary ostial stenosis is, generally, referred as late complication. Anecdotal reports concern coronary ostial stenosis as acute complication. A unique fatal case of intraoperative, bilateral coronary ostial obstruction by prosthetic valve leading to an extensive myocardial infarction is reported. Surgeons must have a high level of vigilance regarding the occurrence of acute myocardial ischemia and sudden death soon after AVR. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4383994185667026.
The Journal of Thoracic and Cardiovascular Surgery, 2006
The aim of this retrospective study was to evaluate the possibility to predict postoperative graf... more The aim of this retrospective study was to evaluate the possibility to predict postoperative graft patency in coronary surgery by means of intraoperative transit-time flow measurement. Methods: Of 3567 patients submitted to isolated myocardial revascularization from June 1997 through June 2003, 157 (4.4%) underwent both intraoperative transittime flow measurement and angiography at follow-up. Thirty-six have been revascularized on a beating heart. Three hundred four grafts, 227 arterial conduits, and 77 saphenous vein grafts were checked. Results: No patients died, and none of them had an acute myocardial infarction within 12 months after the operation. After a mean of 6.7 Ϯ 4.8 months from the operation, 266 grafts (group A) were completely functioning, whereas 38 grafts (group B) had failed. The transit-time flow parameters recorded in the latter group had significantly lower mean flow and higher pulsatility index and percentage of backward flow values at both univariate and multivariate analysis. Moreover, mean flow values of 15 mL/min or less, pulsatility index values of 3.0 or greater, and percentage of backward flow values of 3.0% or greater were found to be independent variables for higher incidence of graft failure. Conclusions: Transit-time flow measurement represents a quick, easy, and reproducible method for intraoperative evaluation of graft function. The combination of the 3 major parameters (mean flow, pulsatility index, and percentage of backward flow) results in the chance to predict a graft failure (either anatomic or functional) within the first postoperative year. T he incidence of perioperative graft failure has been estimated to be from 5% to 11%. 1-5 Early graft patency can influence either early or late outcome after coronary artery bypass grafting (CABG). 6 Even if angiography still represents the gold standard for anatomic evaluation, the chance of intraoperative assessment of the quality of the anastomosis has been an unachieved goal since CABG was started. Several methods have been introduced over the last decade, 7-9 with the aim to check graft viability. Transit-time flow (TTF) measurement has been reported to be
The Journal of Thoracic and Cardiovascular Surgery, 2005
Objectives: We sought to evaluate whether early and late results in patients who underwent off-pu... more Objectives: We sought to evaluate whether early and late results in patients who underwent off-pump or on-pump myocardial revascularization with bilateral internal thoracic artery grafting were similar. Methods: From November 1994 through December 2001, 1835 patients underwent isolated myocardial revascularization with bilateral internal thoracic artery grafting. By applying propensity score pairwise matching, 1194 patients were selected and operated on either off pump (n ϭ 597) or on pump (n ϭ 597). Results: The overall 30-day mortality was 1.5% (1.2% in the off-pump group and 1.8% in the on-pump group, P ϭ .342). There was no difference for all the other complications between the 2 groups. Mean follow-up was 5.2 Ϯ 1.8 years. Fortytwo patients died over the follow-up period (22 in the off-pump group and 20 in the on-pump group), 15 of them of cardiac causes (7 in the off-pump group and 8 in the on-pump group). Six-year outcomes (freedom from death, cardiac death, acute myocardial infarction and reoperation in all or in the grafted area, target cardiac events, and any other event) were similar for both categories. After a mean of 30.7 Ϯ 20.1 months, 202 patients had a postoperative angiography showing similar results. Conclusions: Our results with extensive arterial revascularization clearly show that with the technical improvements achieved in the most recent years, off-pump operations can be performed safely with the same quality of late results as those obtained with on-pump operations. E arly results after myocardial revascularization without cardiopulmonary bypass (CPB) show, in the great majority of reports, a decrease in postoperative morbidity 1-8 and sometimes also in mortality in the general surgical population 4-8 or in subgroups of high-risk patients. 9,10 Long-term outcome is not yet well established, even though in the last 2 years some reports appeared showing basically similar results in the 2 groups of patients. 1,2,4,11,12 The better long-term outcome with bilateral internal thoracic artery (BITA) grafting over other myocardial revascularization strategies has been recently reported. 13-17 We analyzed retrospectively our results with on-pump and off-pump isolated coronary artery bypass grafting in which BITA grafting was used to evaluate whether off-pump coronary artery bypass grafting sacrifices a long-term benefit for a more attractive and fashionable strategy.
The Journal of Thoracic and Cardiovascular Surgery, 2000
L eft internal thoracic artery (ITA) grafting to the left anterior descending (LAD) artery is wid... more L eft internal thoracic artery (ITA) grafting to the left anterior descending (LAD) artery is widely recognized to be the most important single determinant for survival and for reduction of late cardiac events in patients who undergo coronary artery bypass grafting. 1,2 Recently, Pick and associates 3 showed better long-term outcome in patients in whom bilateral ITAs were used on the left coronary artery system in comparison with patients in whom only the left ITA was used to the LAD. Lytle and associates 4 also found that having 2 ITAs was advantageous for any patient, regardless of the position of the grafts, and that the advantage was already statistically significant 5 years after the operation. Background: We evaluated whether bilateral internal thoracic arteries provide the same long-term results when used as in situ grafts and as Y grafts. Methods and results: From October 1991 to February 2000, 1818 patients had bilateral internal thoracic arteries used as in situ (n = 1378, group A) or as Y grafts (n = 440, group B). The number of anastomoses per patient and the number of bilateral internal thoracic artery anastomoses per patient were higher in group B (3.1 ± 0.9 and 2.7 ± 0.9) than in group A (2.9 ± 0.8 and 2.2 ± 0.6) (both P < .001). The number of right internal thoracic artery anastomoses per patient rose from 1.0 ± 0.3 in group A to 1.4 ± 0.6 in group B (P < .001), and the number of sequential anastomoses per right internal thoracic artery graft rose from 4.1% to 34.3% (P < .001). Thirty-day mortality was 2.0% in group A versus 2.5% in group B (P = not significant). No difference in postoperative course was detected. Eight-year survivals were 95.8% ± 2.7% in group A versus 94.8% ± 4.0% in group B (P = not significant), and event-free survivals were 95.2% ± 2.9% in group A versus 93.6% ± 4.4% in group B (P = not significant). Early angiograms were obtained in 295 patients (945 anastomoses, 863 distal and 82 proximal Y grafts), 213 patients (611) in group A and 82 patients (334) in group B. Patency rate was 98.8% in group A and 96.0% in group B (P = not significant), whereas grade A patency rate was 97.2% in group A and 96.4% in group B (P = not significant). Late angiograms were obtained in 88 patients (25 in group A and 63 in group B) at a mean of 17.5 ± 18.4 months: patency rate was 100% in group A and 99.2 in group B (P = not significant), and grade A patency rate was 98.6% in group A and 98.8% in group B (P = not significant). No Y anastomosis was occluded or stenosed. Comment: Survival, incidence of cardiac events, and angiographic patency in the early and late phases are similar for bilateral internal thoracic arteries used either in situ or as Y grafts. However, Y grafting with bilateral internal thoracic arteries increases the number of anastomoses per bilateral thoracic artery, as well as the flexibility of the right internal thoracic artery.
Journal of Cardiac Surgery, 2003
Background: Septoexclusion is a technique described by Guilmet in the mid 1980s. Its indications ... more Background: Septoexclusion is a technique described by Guilmet in the mid 1980s. Its indications and midterm results are evaluated and compared to those obtained with the Dor operation. Methods: From January 1998 to April 2001, 79 patients had an exclusion of scars following myocardial infarction in left anterior descending artery (LAD) territory. Fifty of them (63.3%) had the Dor operation (Group D) and 29 (36.7%) the Guilmet operation (Group G). Dor technique was used when the involvement of the septum and the free wall was roughly similar. Guilmet technique was indicated when the septum was involved at a greater extent than the free wall. Ejection fraction (EF) was lower and end-diastolic volumes were higher in Group G. Incidence of functional mitral regurgitation was similar in both groups. Results: Thirty-day mortality was 7.6% (8.0% in Group D versus 6.9% in Group G, p = ns). After a mean of 21.0 ± 8.5 months, five patients (6.9%) died, two in Group D and three in Group G. Causes of death were cardiac related in four and not cardiac related in one. Mean follow-up of the 68 survivors was 24.3 ± 12.0 months (range: 4-38 months). Fifty patients (73.5% of the survivors) improved (28 in Group D and 22 in Group G, p = 0.026), whereas in 18, New York Heart Association (NYHA) class remained unchanged or worsened. Both groups showed an increase of EF and a volumetric reduction, whereas stroke volume remained unchanged. Fewer patients had mitral regurgitation than in the preoperative period (41.3% versus 65.8%, p = 0.013) and at a lesser extent (1.7 ± 0.7versus 0.7 ± 0.6, p < 0.001). Conclusions: Our results show that both Dor and Guilmet techniques are effective in the surgical treatment of left ventricular dyskinetic or akinetic areas related to LAD territory. Each technique has its own indications and has to be addressed to patients with different extension of septal scars.
Journal of Cardiac Surgery, 2010
Between July 1992 and May 1994, 148 patients (18 females) underwent myocardial revascularization ... more Between July 1992 and May 1994, 148 patients (18 females) underwent myocardial revascularization with a radial artery (RA) graft. The left RA was used in 97.3% of cases. All but two patients received at least one additional arterial conduit: 137 left and 59 right internal mammary arteries (IMA); 23 inferior epigastric arteries; and 21 right gastroepiploic arteries. Total arterial revascularization was achieved in 127 patients (85.8%). An average of 3.0 anastomoses/patient were constructed, 2.8 of which were arterial. RA proximal anastomoses were placed on the IMA in 75% of cases, while direct anastomosis to the aorta (23.7%) or to a saphenous vein (1.3%) was performed in the remainder. When anastomosed to an IMA, the RA was subsequently infused intraluminally with 10 mg of papaverine (1 mg/mL). The target artery was the left anterior descending or one of its branches in 14.7% of cases, the circumflex system in 76.3%, and the native right coronary or one of its branches in the remaining 9%. An infusion of diltiazem (4 mg/hour) was started once the aorta was unclamped, and patients were maintained on oral diltiazem for 6 months postoperatively. Operative mortality was 1.4% (2 patients), with the additional late deaths from noncardiac causes. In one patient there was a prolonged serous drainage from the RA donor site. Of the 144 survivors 140 are asymptomatic. Follow-up angiography demonstrated 100% early patency (< 30 days, 41 patients), and 94% late patency (6 to 20 months, mean 14 months, 30/32 patients). This study suggests the RA can be used safely as an alternative to saphenous vein in coronary bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
International Journal of Cardiology, 2011
Patients with catheter fragments that were entrapped during percutaneous transluminal coronary an... more Patients with catheter fragments that were entrapped during percutaneous transluminal coronary angioplasty remain a particular challenge because little is known about the clinical outcome. Absolutely unique is the partially cutting of the dilator and the pushing of the fragment by the guidewire advancing into the femoral artery to the coronary tree. We describe this exceptionally complication with a complete coronary obstruction and an anterior myocardial infarction sustained by the retained fragment into the left main branch.
Heart, Lung and Circulation, 2000
I n the last decade arterial myocardial revascularisation became more popular following the routi... more I n the last decade arterial myocardial revascularisation became more popular following the routine use of the left internal mammary artery (LIMA). Left internal mammary artery grafting to the left anterior descending (LAD) artery is widely recognised to be the most important single determinant for survival and for reduction of late cardiac events in patients who undergo coronary artery bypass grafting (CABG). 1,2 However, the use of venous conduits to supplement the LIMA and the possibility of progression of disease in the coronary bed leave open the possibility of cardiac events during the years following the first operation. As survival is assured by the LIMA on the LAD, the question is can we reduce late events or further increase survival using other arterial conduits in a territory different from LAD or increase globally the number of arterial anastomoses per patient? The answer is not easy; arterial anastomoses in coronary vessels different from LAD can increase the quality of the late result, but this assumption is only speculative as long-term results are lacking. However,
European Journal of Cardio-Thoracic Surgery, 2003
Objective: To evaluate 30-day and late results in high risk patients (European score (EuroSCORE) ... more Objective: To evaluate 30-day and late results in high risk patients (European score (EuroSCORE) $ 6) who underwent isolated myocardial revascularization with and without cardiopulmonary bypass (CPB). Methods: From November 1994 to December 2001, 1266 patients with EuroSCORE $ 6 underwent isolated myocardial revascularization. Among them, applying the propensity score, we were able to select 1020 patients operated on without CPB (group A, n ¼ 510) and with CPB (group B, n ¼ 510) with the same preoperative characteristics. The only differences were the higher incidence of patients with age between 61 and 65 years (9.4% in group A vs. 13.9% in group B, P ¼ 0:025) and the lower number of anastomoses/patient in group A (1.8^0.9 vs. 2.8^0.9, P , 0:001). EuroSCORE were identical in both groups (7.8%). Results: Thirty-day mortality was higher in group B (5.9 vs. 3.1%, P ¼ 0:035). Group A showed a lower incidence of cerebrovascular accidents (CVAs) (0.6 vs. 3.1%, P ¼ 0:003), whereas incidence of acute myocardial infarction (AMI) was similar (2.0% in group A vs. 2.5% in group B, P ¼ ns). Early negative primary end-points and early major events incidences were higher in group B (8.2 vs. 3.9%, P ¼ 0:004, and 14.5 vs. 7.1%, P , 0:001, respectively). Stepwise logistic regression confirmed that CPB was an independent predictor for higher early mortality (Odds ratio (OR) 2.0) and CVA, negative primary end-points and early major events incidences (OR 4.6, 2.3 and 2.4, respectively). Five-year freedom from the events explored (death due to any cause, cardiac death, AMI, AMI on a grafted area, redo/percutaneous transluminal coronary angioplasty (PTCA), redo/PTCA on a grafted area, target cardiac events (cardiac death, AMI in a grafted area and redo/PTCA in a grafted area) and any event were similar in both groups. Conclusions: In high risk patients myocardial revascularization without CPB shows better early outcome and similar clinical late results.