Giacomo Ravenni - Academia.edu (original) (raw)

Papers by Giacomo Ravenni

European Journal of Cardio-Thoracic Surgery, 2022

OBJECTIVES The aim of this study was to test if the current general practice of surgical revascul... more OBJECTIVES The aim of this study was to test if the current general practice of surgical revascularization is comparable to the setting of International Study of Comparative Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial and to evaluate the comparative risk of cardiovascular events or death after coronary artery bypass grafting. METHODS We selected patients undergoing surgical revascularization and matching ISCHEMIA inclusion criteria. Chronic coronary syndrome patients were included if diagnosis of myocardial ischaemia by functional testing and coronary artery disease at angiography were detected. The primary end point was a composite of cardiovascular death, myocardial infarction, rehospitalization for unstable angina, heart failure and resuscitated cardiac arrest. Secondary end points were death by any cause, cardiovascular death, myocardial infarction and rehospitalization. RESULTS Among 353 patients, the primary outcome occurred in 62 (17.6%) patients. At 6 months, cumulative event-free survival was 97%, at 1 year 96%, at 5 years 89% and at 10 years 80%. Cumulative risk of the primary composite outcome at 5 years was 11%, 18% in the conservative arm of ISCHEMIA and 16% in the revascularization arm of ISCHEMIA (P < 0.001). Risk of myocardial infarction at 5 years was 7% in surgical patients and 12% and 10% in the conservative and invasive arms of the trial, respectively (P < 0.001). CONCLUSIONS Long-term results in surgical patients treated for chronic coronary syndromes showed that ISCHEMIA trial findings are not transferable in a 'real-world' scenario and have not changed previous medical practice. A patient-tailored approach, especially with diabetes and reduced left ventricle function, offers the best results in patients with stable coronary artery disease.

The Annals of Thoracic Surgery, 2012

This study evaluated the long-term clinical performance of the Mosaic bioprosthesis (Medtronic In... more This study evaluated the long-term clinical performance of the Mosaic bioprosthesis (Medtronic Inc, Minneapolis, MN) after aortic valve replacement. From 1995 to 2008, 178 patients (48 women; mean age, 74±6 years) had aortic valve replacement. Mean functional class was 2.3±0.5, and 157 patients (88%) were in sinus rhythm. Prosthetic sizes were 23 mm in 98 patients and 25 mm in 66. Follow-up was completed in December 2009 with a cumulative duration of 1,015 patient/years (mean, 5.7±3.5 years, maximum, 13.7 years). Early mortality was 4%, none being valve-related; of 38 late deaths 7 were valve-related. Actuarial survival at 13 years was 48%±8%. Mean functional class of current survivors was 1.2±0.6. Six embolic episodes occurred and four cases of endocarditis, with respective actuarial freedom of 92%±5% for embolism and 97%±2% for endocarditis at 13 years. Four patients required reoperations for endocarditis and 2 for structural deterioration. Actuarial freedom from structural deterioration and from reoperation for all causes was 89%±7% and 86%±7% at 13 years, with an actuarial freedom from prosthesis-related deaths of 86%±5%. Results of echocardiographic evaluation at 1 year were mean peak gradient, 20±6 mm Hg and mean effective orifice area index, 1.07±0.21 cm2/m2 for size 23 mm and 22±6 mm Hg and 1.11±0.26 cm2/m2 for size 25 mm; at 10 years, mean peak gradient and mean effective orifice area index were 28±13 mm Hg and 1.01±0.19 cm2/m2 for size 23 mm and 26±8 mm Hg and 1.08±0.18 cm2/m2 for size 25 mm. The Mosaic bioprosthesis showed good overall performance, with low incidence of structural valve deterioration and hemodynamic stability in the long-term. Expected increased durability of this device should be verified at longer follow-up intervals.

Aorta (Stamford, Conn.), 2017

Patients with annuloaortic ectasia may be surgically treated with modified Bentall or David I val... more Patients with annuloaortic ectasia may be surgically treated with modified Bentall or David I valve-sparing procedures. Here, we compared the long-term results of these procedures. A total of 181 patients with annuloaortic ectasia underwent modified Bentall (102 patients, Group 1) or David I (79 patients, Group 2) procedures from 1994 to 2015. Mean age was 62 ± 11 years in Group 1 and 64 ± 16 years in Group 2. Group 1 patients were in poorer health, with a lower ejection fraction and higher functional class. Early mortality was 3% in Group 1 and 2.5% in Group 2. Patients undergoing a modified Bentall procedure had a higher incidence of thromboembolism and hemorrhage, whereas those undergoing a David I procedure had a higher incidence of endocarditis. Actuarial survival was 70 ± 6% at 15 years in Group 1 and 84 ± 7% at 10 years in Group 2. Actuarial freedom from reoperation was 97 ± 2% at 15 years in Group 1 and 84 ± 7% at 10 years in Group 2. In Group 2, freedom from procedure-relat...

Journal of Heart Valve Disease, 2012

The Sorin Pericarbon Freedom (SPF) valve is a stentless bioprosthesis made from bovine pericardiu... more The Sorin Pericarbon Freedom (SPF) valve is a stentless bioprosthesis made from bovine pericardium, with a peculiar design aimed at preventing the mechanical failures observed with old models of stented pericardial bioprostheses. Herein, the case is described of a patient who presented with severe regurgitation of a SPF six years after aortic valve replacement, caused by commissural dehiscence. Both, microradiographic and histologic investigations, revealed mild calcific deposits and massive lipid infiltration, thus confirming that a patient-related mechanism such as 'atheromasia' can account for structural valve deterioration also in recipients of pericardial bioprostheses.

The Journal of heart valve disease, 2018

BACKGROUND Biological prostheses are widely employed for aortic valve replacement (AVR). The stud... more BACKGROUND Biological prostheses are widely employed for aortic valve replacement (AVR). The study aim was to evaluate the performance of the Mosaic porcine bioprosthesis in the aortic position over two decades. METHODS Between November 1995 and December 2016, a total of 254 patients (194 males, 60 females; mean age 74 ± 9 years) underwent AVR with a Mosaic bioprosthesis at the authors' institution. Among the patients, 14% were aged ≥80 years and 86% had pure or prevalent calcific aortic stenosis. Preoperatively, the mean NYHA functional class was 2.5 ± 1.0. RESULTS Overall hospital mortality was 5%. A total of 107 late deaths occurred, but only 15 were valve-related (0.72 ± 0.19% per patient-year). Actuarial survival at 15 years was 34 ± 7%. Fourteen embolic episodes occurred, with no cases of bioprosthetic thrombosis; freedom from thromboemboli was 88 ± 4% at 15 years. Eight cases of endocarditis occurred, with a freedom of 95 ± 2% at 15 years. Structural valve deterioration (...

The Journal of heart valve disease, 2011

DOI:€10.1016/j.athoracsur.2011.10.062 Ann Thorac Surg 2012;93:510-515 Carmela Nardi and Uberto Bo... more DOI:€10.1016/j.athoracsur.2011.10.062 Ann Thorac Surg 2012;93:510-515 Carmela Nardi and Uberto Bortolotti Michele Celiento, Giacomo Ravenni, Aldo D. Milano, Stefano Pratali, Giovanni Scioti,Follow-Up Aortic Valve Replacement With the Medtronic Mosaic Bioprosthesis: A 13-Yearhttp://ats.ctsnetjournals.org/cgi/content/full/93/2/510 located on the World Wide Web at: The online version of this article, along with updated information and services, is

L’Insufficienza tricuspidalica (IT) di tipo funzionale, secondaria a patologia delle sezioni sini... more L’Insufficienza tricuspidalica (IT) di tipo funzionale, secondaria a patologia delle sezioni sinistre del cuore, è la più frequente forma di patologia della valvola tricuspide nei paesi occidentali, mentre la forma organica, più spesso isolata, risulta meno frequente. Sebbene diversi studi abbiano recentemente dimostrato evidenze in favore di un approccio chirurgico più aggressivo nella correzione dell’insufficienza tricuspidale funzionale, solo una piccola parte di questi pazienti viene trattata; ancor più raro è il ricorso alla chirurgia in pazienti con malattia tricuspidale isolata, a causa dell’elevata mortalità ospedaliera, soprattutto in caso di sostituzione. Ciò evidenzia come sia necessario ridefinire i criteri di selezione dei pazienti e le tempistiche per le procedure chirurgiche isolate. Negli ultimi anni sono state sviluppate diverse opzioni di trattamento percutaneo simili a quelle usate per la patologia mitralica, ovvero con plicatura dei lembi, rimodellamento dell’anu...

BACKGROUND AND AIM OF THE STUDY Concerns have recently been raised regarding postoperative decrea... more BACKGROUND AND AIM OF THE STUDY Concerns have recently been raised regarding postoperative decreases in platelet count (PC) after aortic valve replacement (AVR) with the Sorin Freedom Solo (SFS) stentless bioprosthesis. In order to assess the relevance and the clinical impact of this phenomenon, variations in PC were monitored in patients with SFS valves, and compared to changes of PC in patients after AVR with two other bioprostheses, the Medtronic Mosaic (MOS) porcine valve and the Sorin Mitroflow (MIT) pericardial valve. METHODS Three groups of patients (25 in each group) who had undergone AVR with a biological prosthesis were compared. The patients were similar in terms of their preoperative characteristics, including mean age, NYHA functional class, risk factors, EuroSCORE, and mean PC. The PC was monitored on postoperative days 1, 3, and 5, and again at discharge. Thrombocytopenia was considered to be 'present' when the PC was < 150,000/microl, and 'severe' ...

BACKGROUND AND AIM OF THE STUDY The study aim was to evaluate the long-term clinical outcomes of ... more BACKGROUND AND AIM OF THE STUDY The study aim was to evaluate the long-term clinical outcomes of the modified Bentall procedure (MBP) with a mechanical conduit. METHODS Between 1993 and 2014, a total of 249 patients (mean age 62 ± 12 years; range: 25-87 years) underwent a MBP at the authors' institution. The main indication was annuloaortic ectasia in 102 patients (41%), followed by acute aortic dissection in 82 patients (33%); moderate to severe aortic regurgitation was present in 79% of cases. A bicuspid aortic valve was found in 17% of patients, and Marfan syndrome in 7%. The mean NYHA functional class was 2.5 ± 1.1. Concomitant procedures were performed in 36 patients (14%). The mean follow up was 8.7 ± 5.0 years (range: 0.3-21.5 years) and was 99% complete. The total follow up was 6.475 patient-years (pt-yr). RESULTS Operative mortality was 3% in elective cases. Age, prolonged cardiopulmonary bypass times and mechanical ventilation >96 h were independent risk factors for...

Journal of Cardiovascular Medicine

Background and aim of the study: Biological prostheses are widely employed for aortic valve repla... more Background and aim of the study: Biological prostheses are widely employed for aortic valve replacement This study aims to evaluate the performance of the Mosaic porcine bioprosthesis in aortic position over two decades. Material and methods: From November 1995 to December 2016, 254 patients underwent aortic valve replacement with a Mosaic bioprosthesis. The mean age was 74 ± 9 years 14% being ≥ 80 years of age; 76% were males and 86% had pure or prevalent calcific aortic stenos. Mean preoperative functional class was 2.5 ± 1.0. Results: Overall hospital mortality was 5%. There were 107 late deaths only 15 being valve-related (0.72 ± 0.19 % pt-yrs). Actuarial survival at 15 years is 34 ± 7%. There were 14 embolic episodes with no cases of bioprosthetic thrombosis; freedom from thromboemboli is 88 ± 4% at 15 years. There were 8 cases of endocarditis with a freedom of 95 ± 2% at 15 years. Structural valve deterioration was observed in 4 patients who were successfully reoperated. Freedom from structural valve deterioration is 97 ± 2% at 15 and 96 ± 2 at 20 years. At last follow-up, 23 mm and 25 mm prostheses showed a mean gradient of 17 ± 6 mmHg and 15 ± 4 mmHg, respectively. In patients with aortic stenosis a significant reduction of left ventricular masses occurred. Conclusions: The Mosaic bioprosthesis has shown excellent durability over 2 decades of clinical use with a negligible incidence of valve degeneration and need for reoperation. Therefore it may be considered a valid option especially for elderly patients requiring aortic valve replacement.

ASAIO Journal

An increased need of Extracorporeal Membrane Oxygenation (ECMO) support is going to become eviden... more An increased need of Extracorporeal Membrane Oxygenation (ECMO) support is going to become evident as treatment of SARS-CoV-2 respiratory distress syndrome. This is the first report of Italian Society for Cardiac Surgery (SICCH) on preliminary experience with COVID-19 patients receiving ECMO support. Data from 12 Italian hospitals participating in SICCH were retrospectively analyzed. Between March 1st and September 15th, 2020, a veno-venous (VV) ECMO system was installed in 67 patients (94%) and a veno-arterio-venous (VAV) ECMO in four (6%). Five patients required VA ECMO after initial weaning from VV ECMO. Thirty (42.2%) patients were weaned from ECMO, while 39 (54.9%) died on ECMO, and six (8.5%) died after ECMO removal. Overall hospital survival was 36.6% (n=26). Main causes of death were multiple organ failure (n=14, 31.1%) and sepsis (n=11, 24.4%). On multivariable analysis, predictors of death while on ECMO support were older age (p=0.048), elevated pre-ECMO C-reactive protein level (p=0.048), higher positive end-expiratory pressure on ventilator (p=0.036) and lower lung compliance (p=0.032). If the conservative treatment is not effective, ECMO support might be considered as life-saving rescue therapy for COVID-19 refractory respiratory failure. However warm caution and thoughtful approaches for timely detection and treatment should be taken for such a delicate patients population.

Journal of Cardiac Surgery

Brazilian Journal of Cardiovascular Surgery

Introduction: Negative pressure wound therapy (NPWT) has significantly improved outcomes in indiv... more Introduction: Negative pressure wound therapy (NPWT) has significantly improved outcomes in individuals with superficial and deep sternal wound dehiscence (SWD). We report our experience with NPWT to evaluate factors influencing effectiveness, duration of treatment and postoperative hospital stay. Methods: We reviewed 92 patients with postoperative SWD following a median sternotomy. Patients were divided into 2 groups: those with a superficial SWD (Group 1; 72, 78%) and those with a deep SWD (Group 2; 20, 28%). Group 1 was further divided into 3 subgroups based on NPWT duration. Results: In both groups, none of the preoperative characteristics examined showed a significant association with longer NPWT duration. In Group 2, there was a trend for postoperative bleeding and neurological complications to be associated with longer treatment duration. In the entire series, staph infection resulted a weak predictor of NPWT duration. In each Group 1 subgroup and in Group 2, treatment days were compared with duration of hospitalization until discharge. Mean post-NPWT hospital stay was 6 days in subgroup 1, 12 days in subgroup 2 and 20 days in subgroup 3 (P<0.0001). At a median 3-year follow-up, there were 4 late deaths, none related to wound complications. No cases of SWD recurrence were observed. Conclusion: Our results confirm the effectiveness of NPWT in SWD management, while excessive treatment duration might have a negative impact on the length of hospital stay. Further studies are needed to define an optimal use of NPWT protocol.

The Thoracic and Cardiovascular Surgeon

Background The Mitroflow pericardial bioprosthesis (MPB) has been recently associated with a high... more Background The Mitroflow pericardial bioprosthesis (MPB) has been recently associated with a high incidence of early structural failures, questioning its validity as cardiac valve substitute. We have therefore reviewed our experience with this device. Materials and Methods A total of 398 patients with a mean age of 75 ± 7 years (58% above the age of 75 years) had aortic valve replacement with a Mitroflow prosthesis (2005–2015). Most patients had calcific aortic stenosis (86%) and were in sinus rhythm (89%). Mean EuroSCORE II was 5.5 ± 6.2. Mean follow-up was 4 ± 2 years (range: 4 months to 10 years), which was 100% complete. Results Hospital mortality was 6.5%; at discharge, 25% of patients had a moderate patient–prosthesis mismatch and none had a severe mismatch. Cumulative incidence of structural valve deterioration in the entire series was 2% (95% confidence interval [CI]: 1–4) at 5 years and 7% (95% CI: 4–14) at 8 years. Significant factors influencing MPB durability were age ≤ ...

Indian Journal of Thoracic and Cardiovascular Surgery

The Journal of heart valve disease, 2016

The study aim was to evaluate the long-term clinical outcomes of the modified Bentall procedure (... more The study aim was to evaluate the long-term clinical outcomes of the modified Bentall procedure (MBP) with a mechanical conduit. Between 1993 and 2014, a total of 249 patients (mean age 62 ± 12 years; range: 25-87 years) underwent a MBP at the authors' institution. The main indication was annuloaortic ectasia in 102 patients (41%), followed by acute aortic dissection in 82 patients (33%); moderate to severe aortic regurgitation was present in 79% of cases. A bicuspid aortic valve was found in 17% of patients, and Marfan syndrome in 7%. The mean NYHA functional class was 2.5 ± 1.1. Concomitant procedures were performed in 36 patients (14%). The mean follow up was 8.7 ± 5.0 years (range: 0.3-21.5 years) and was 99% complete. The total follow up was 6.475 patient-years (pt-yr). Operative mortality was 3% in elective cases. Age, prolonged cardiopulmonary bypass times and mechanical ventilation >96 h were independent risk factors for early mortality. Actuarial survival at 15 and 2...

The Journal of Heart Valve Disease, Jul 1, 2012