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Papers by Gianluca Lucchese

Intensive Care Medicine

Dear Editor, Acute kidney injury (AKI) remains a common and significant complication in criticall... more Dear Editor, Acute kidney injury (AKI) remains a common and significant complication in critically ill patients. As no curative treatment exists, prevention of AKI is paramount, especially in high-risk patients. Several randomized controlled trials suggest that a biomarker-guided implementation of the Kidney Disease Improving Global Outcomes (KDIGO) care bundle reduces the incidence of AKI postoperatively [1-3]. Implementation of this care bundle is recommended in high-risk patients after cardiac surgery [4]. This comprises regular monitoring of kidney function, hemodynamic optimization, and consideration of advanced hemodynamic monitoring, as well as avoidance of hyperglycemia, nephrotoxic drugs, and radiocontrast agents, if possible. So far, the impact of each individual component of the bundle is unclear. Better understanding would enable prioritization, resource-allocation and clinical management of those at high risk of AKI. To investigate the treatment effects of individual bundle components, we combined data of the two PrevAKI-trials including 554 cardiac surgery patients at high risk for AKI, as defined by elevated urinary biomarkers TIMP2*IGFBP7 [1, 2]. Patients were randomized to standard care versus implementation of the care bundle (Supplementary S1). Univariate logistic regression of the bundle's components was performed as a risk factor analysis of the whole cohort. Following this, individual treatment effects were analyzed, using the same method for the intervention group only (Fig. 1a). Hypotension, low cardiac

Circulation, 2016

Hypothesis: The benefits of ‘off-pump’ coronary artery bypass grafting (OPCABG) remain controvers... more Hypothesis: The benefits of ‘off-pump’ coronary artery bypass grafting (OPCABG) remain controversial. The ‘gold standard’ for surgical coronary revascularization remains ‘on-pump’ CABG. In selected...

Open Heart, 2021

Aims Durability of transcatheter aortic valve implantation (TAVI) is key to its expansion. We sou... more Aims Durability of transcatheter aortic valve implantation (TAVI) is key to its expansion. We sought to identify incidence of valve thrombosis and predictors of valve thrombosis in our single centre with associated coagulation testing pre-TAVI and post-TAVI. Methods and results This single-centre observational study comprised patients undergoing transfemoral TAVI discussed in the Heart Team meeting . Patients were followed up with echocardiography at 120 days to identify incidence of elevated transvalvular gradient and multivariable analysis was performed to identify factors associated with an increased odds of developing valve thrombosis. In addition, 11 patients underwent baseline, day 1 and day 120 post-TAVI coagulation testing. Between August 2017 and August 2019, 437 consecutive patients underwent transfemoral TAVI. Of these patients, 207/437 (47.4%) had 3-month follow-up echo data available and were analysed. Of these patients, 26/207 (12.6%) had elevated transvalvular gradien...

Structural Heart, 2021

Objective: To investigate and identify the prognostic indicators of cardiac surgical outcomes in ... more Objective: To investigate and identify the prognostic indicators of cardiac surgical outcomes in patients with pulmonary hypertension (PH) with or without right ventricle (RV) dysfunction. Methods: In this retrospective observational study, all the patients with preoperative PH who underwent isolated mitral valve and tricuspid valve surgery from May 2011 to December 2019, were enrolled in the study (n=80, age 66.7±13.4 yo). This cohort was then classified as Group 1 (RV dysfunction; n=27, 34%) and Group 2 (RV normal; n=53, 66%), according to the function of the RV. PH was defined as a mean pulmonary arterial pressure (mPAP)≥25mmHg, or pulmonary artery systolic pressure (PASP)≥38mmHg. RV dysfunction was defined based on American Society of Echocardiography guidelines. Results: The cumulative mortality at 30 days was 11% (n=9) with no statistical difference between the two groups (Group 1: n=4, 15%; Group 2: n=5, 9%; x2= 1.23, p=0.266). Instead, a significant difference in the mortali...

International Journal of Surgery

Tumori Journal

Background: For stage III or IVa thymic tumours, a multimodality approach is recommended. The rol... more Background: For stage III or IVa thymic tumours, a multimodality approach is recommended. The role of surgery is to achieve complete resection. Aim: To present the outcomes of patients undergoing surgery for stage III or IVa thymoma. Methods: Retrospective review of patients undergoing open surgery for stage III or IVa thymoma between 2016 and 2020 at a single centre was performed. Preoperative imaging, treatment plan, surgical approach, and postoperative outcomes were analyzed. Results: Forty-seven patients underwent surgery for thymoma. Patients with clinical stage I/II thymoma or minimally invasive thymectomy were excluded. Thirteen patients with clinical stage III or IVa were included. Median sternotomy approach was used in four patients, of which one was redo sternotomy; a hemi-clamshell in four; and a combination of approaches in the remaining five patients. There was no postoperative mortality. Four patients had postoperative complications. Complete resection was achieved in ...

Seminars in Thoracic and Cardiovascular Surgery

Catheterization and Cardiovascular Interventions

Journal of Thoracic Disease

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 28, 2017

Texas Heart Institute journal, 2016

Temporary tricuspid valve detachment improves the operative view of certain congenital ventricula... more Temporary tricuspid valve detachment improves the operative view of certain congenital ventricular septal defects (VSDs), but its long-term effects on tricuspid valve function are still debated. From 2002 through 2012, we performed a prospective study of 68 children (mean age, 1.28 ± 1.01 yr) who underwent transatrial closure of VSDs following temporary tricuspid valve detachment. Sixty patients had conoventricular and 8 had mid-muscular VSDs. All were in sinus rhythm. Seventeen patients had systemic pulmonary artery pressures. Preoperative echocardiograms showed trivial-to-mild tricuspid regurgitation in 62 patients and tricuspid dysplasia with severe regurgitation in 6 patients. Patients were clinically and echocardiographically monitored at 30 postoperative days, 3 months, 6 months, every 6 months thereafter for the first 2 years, and then once a year. No in-hospital or late death was observed at the median follow-up evaluation of 5.9 years. Mean intensive care unit and hospital ...

The Thoracic and Cardiovascular Surgeon, 2016

Transcatheter aortic valve implantation (TAVI) is now routinely performed to treat inoperable and... more Transcatheter aortic valve implantation (TAVI) is now routinely performed to treat inoperable and high-risk patients with severe aortic stenosis (AS). Transapical or transaortic approaches are alternative routes used when peripheral accesses are unsuitable.Correct placement of the device is achieved with the help of an angiography performed with a pigtail catheter to identify the deployment view. However, in patients with severe vascular disease, placement of a pigtail catheter may not be possible.We report a modified single-puncture technique, whereby a single access point is used to perform both angiography and TAVI by using visible calcification landmarks as reference points.

Artificial Organs, May 3, 2013

Annals of translational medicine, 2016

International Journal of Cardiology, 2016

The Annals of Thoracic Surgery, 2016

Circulation, Nov 26, 2013