Giuseppe Bozzetti - Academia.edu (original) (raw)
Uploads
Papers by Giuseppe Bozzetti
Aortic valve-sparing operations have provided very good clinical outcomes. However, the absence o... more Aortic valve-sparing operations have provided very good clinical outcomes. However, the absence of the sinuses of Valsalva might limit valve durability. The Gelweave Valsalva prosthesis, which presents pre-fashioned neo-sinuses, has been designed in order to avoid early leaflets deterioration. We report our results in 63 patients who underwent valve-sparing operations (reimplantation technique) using the Gelweave Valsalva graft. The main indication was ascending aorta aneurysm or annuloaortic ectasia, with or without aortic insufficiency. The operation was performed also in cases of Marfan syndrome, Bicuspid Aortic Valve (BAV), and acute Type A dissection. In-hospital mortality was of 4.7%, and two thirds were acute Type A dissection patients (Ps0.01). There were no late deaths. Three years freedom from grade 3-4 AI and freedom from late aortic valve replacement were 91.7"4.3% and 93.8"5.1%, respectively. Aortic valve-sparing operations show good results in patients electi...
Interactive Cardiovascular and Thoracic Surgery, 2006
XXIII Congresso della Società Italiana di Chirurgia Cardiaca, 2006
Interactive CardioVascular and Thoracic Surgery, 2006
Aortic valve-sparing operations have provided very good clinical outcomes. However, the absence o... more Aortic valve-sparing operations have provided very good clinical outcomes. However, the absence of the sinuses of Valsalva might limit valve durability. The Gelweave Valsalvaீ prosthesis, which presents pre-fashioned neo-sinuses, has been designed in order to avoid early leaflets deterioration. We report our results in 63 patients who underwent valve-sparing operations (reimplantation technique) using the Gelweave Valsalvaீ graft. The main indication was ascending aorta aneurysm or annuloaortic ectasia, with or without aortic insufficiency. The operation was performed also in cases of Marfan syndrome, Bicuspid Aortic Valve (BAV), and acute Type A dissection. In-hospital mortality was of 4.7%, and two thirds were acute Type A dissection patients (Ps0.01). There were no late deaths. Three years freedom from grade 3-4 AI and freedom from late aortic valve replacement were 91.7"4.3% and 93.8"5.1%, respectively. Aortic valve-sparing operations show good results in patients electively operated for aortic root ectasia. Aortic cusps repair may lead to late failure. Even if the Gelweave Valsalvaீ prosthesis is easy to implant and it also reproduces pseudosinuses, a long-term follow up is necessary to determine if this graft may reduce leaflets deterioration.
Journal of Cardiology and Cardiovascular Sciences, 2020
Enhanced Recovery After Surgery (ERAS) incorporates multi-modal interventions that synergisticall... more Enhanced Recovery After Surgery (ERAS) incorporates multi-modal interventions that synergistically improve patient outcome. Its goals include improving patients functionally pre-operatively, reducing the stress of surgery intra-operatively to facilitate early return to daily activities. We conducted a pilot study at our unit recruiting patients undergoing elective coronary artery bypass grafting (CABG) into the Cardiac ERAS (C-ERAS) pilot and compared them with the patients undergoing CABG meeting the ERAS criteria but who not included the C-ERAS pilot (Control). Materials and Methods: 122 C-ERAS patients were compared to 91 control patients who underwent CABG only from the period of July 2015 to September 2016. All C-ERAS patients received pre-operative counselling by a dedicated ERAS Practitioner to manage expectations of the patient journey, health promotion and pre-operative optimisation advice. Emphasis was made on educating the patient on daily goals for recovery and patients were followed up daily by the ERAS practitioner post-operatively. Results: There were 122 patients in the C-ERAS group and 91 patients in the control group. The mean age was 63.6±9.9 years. 181(85%) of the patients were males. After adjusting for the abovementioned confounders, C-ERAS patients had a shorter length of stay that was statistically significant. (2.36 days shorter (95% CI; 1.01-3.7 days; p<0.01). The difference in mean bed day costs was £1153.70 (95% CI, £553.70-£1753.7; p<0.01) less in the C-ERAS cohort. Conclusion: This study highlighted that C-ERAS is a safe and feasible pathway to reduce in-hospital stay with no difference in complications and readmission rates compared to routine management of patients. There was also a significant cost saving with the C-ERAS pathway mimicking the results in enhanced recovery programmes in the other surgical specialities.
Heart, 2017
Conclusion GP auscultation has only moderate accuracy for diagnosing valvular heart disease in an... more Conclusion GP auscultation has only moderate accuracy for diagnosing valvular heart disease in an unselected population, and the presence of an isolated murmur would not be a reliable indicator of valve disease. This study did not include patients with cardiovascular symptoms however, in whom the presence of a murmur may be more significant, and for whom echocardiography might be more appropriate.
The Journal of Thoracic and Cardiovascular Surgery, 2009
Objective: It is unclear (1) whether the use of 2 arterial conduits rather than a single conduit ... more Objective: It is unclear (1) whether the use of 2 arterial conduits rather than a single conduit in multivessel coronary artery bypass grafting significantly improves results despite the concomitant use of saphenous vein grafts and (2) whether any among different configurations of composite grafts (left/right thoracic arteries and radial artery) offers an advantage over the others. Methods: Eight hundred fifteen patients were randomized to one of 3 different strategies of revascularization by using the left thoracic artery plus the right thoracic artery or using the left thoracic artery plus the radial artery. Venous grafts were used for the remaining targets. Patients randomized to receive 1 arterial graft served as control subjects. Operative mortality and morbidity were comparable among groups. Results: The rate of cerebrovascular complications was not statistically lower among patients receiving 2 arterial grafts. At 2 years, overall survival was not significantly different among groups (P ¼ .59). Cardiac event-free survival was significantly better in patients receiving 2 arterial grafts versus control subjects (P < .0001), even among elderly patients (P ¼ .022). The 3 investigated strategies using 2 arterial conduits were similar concerning early and midterm results. Conclusions: Revascularization with 2 arterial conduits offers better midterm event-free survival than a single arterial graft, irrespective of which second-choice arterial conduit is used (radial artery or right thoracic artery), the simultaneous use of saphenous vein grafts, and the patient's age.
Journal of Cardiothoracic and Vascular Anesthesia, 2008
T a c t T d ( H q ULMONARY HYPERTENSION and vasoplegia syndrome are very difficult conditions to ... more T a c t T d ( H q ULMONARY HYPERTENSION and vasoplegia syndrome are very difficult conditions to treat when they resent independently of each other but are even more complex hen they occur simultaneously. Therefore, the authors report case describing a young patient who developed pulmonary ypertension and vasoplegia syndrome after a heart transplant rocedure. The combination of these 2 challenging conditions equired a complex therapeutic approach.
The Annals of Thoracic Surgery, 2008
Background. Surgical reexploration due to postoperative bleeding occurs in 2% to 6% of cardiac su... more Background. Surgical reexploration due to postoperative bleeding occurs in 2% to 6% of cardiac surgical patients and is accompanied by increased morbidity and mortality. In this study, we addressed the postoperative course of patients needing surgical reexploration, with specific respect to the timing of reexploration and the transfusional needs as determinants of morbidity and mortality. Methods. This was a retrospective study of 232 patients having undergone surgical reexploration owing to postoperative bleeding after cardiac operations, compared with a control, propensity-matched group. Results. Patients in the surgical reexploration group had greater morbidity (low cardiac output, acute renal failure, sepsis) and longer mechanical ventilation time and intensive care unit stay than did control patients, and a significantly higher mortality rate (14.2% versus 3.4%, p ؍ 0.001). The timing of surgical reexploration was not associated with morbidity or mortality. The amount of packed red cells transfused was significantly associated with increased morbidity (acute renal failure, low cardiac output syndrome, sepsis), with mechanical ventilation time and intensive care unit stay, and with the mortality rate (0.25% increase for each unit transfused). Conclusions. The main determinant of morbidity and mortality for patients requiring a surgical reexploration after cardiac operations is the amount of packed red cells transfused. Delaying the timing of reexploration may represent a risk factor only when the delay creates the need for an excessive use of allogeneic blood products, or in the presence of clinical signs of cardiac tamponade.
The Annals of Thoracic Surgery, 2008
Background. Small body size, female gender, and transfusions are traditionally considered morbidi... more Background. Small body size, female gender, and transfusions are traditionally considered morbidity and mortality risk factors in coronary surgery. Because these clinical conditions are interrelated, we designed a study to investigate their respective roles in determining adverse outcomes after coronary operations. Methods. A retrospective study on 4,546 consecutive patients who underwent coronary surgery was performed. The outcome (hospital mortality and length of stay in the intensive care unit) was evaluated according to body surface area, gender, and the presence of allogeneic blood transfusions. Results. Female gender is not a risk factor for hospital mortality or prolonged intensive care unit stay. Small body surface area in men and large body surface area in women are associated with a prolonged intensive care unit stay. Transfusions are independent risk factors for both mortality and prolonged intensive care unit stay. Fresh-frozen plasma and platelet transfusion carry a higher mortality risk (odds ratio, 12) than transfusions of packed red blood cells (odds ratio, 5). Conclusions. Female gender and small body surface area are associated with severe intraoperative hemodilution, and this may trigger blood transfusions, which are true determinants of adverse outcomes. A large body surface area in women is frequently associated with obesity (68%) and may prolong the intensive care unit stay, whereas it is not a risk factor in men. Conversely, a small body surface area is accompanied by a prolonged intensive care unit stay in men but not in women.
Aortic valve-sparing operations have provided very good clinical outcomes. However, the absence o... more Aortic valve-sparing operations have provided very good clinical outcomes. However, the absence of the sinuses of Valsalva might limit valve durability. The Gelweave Valsalva prosthesis, which presents pre-fashioned neo-sinuses, has been designed in order to avoid early leaflets deterioration. We report our results in 63 patients who underwent valve-sparing operations (reimplantation technique) using the Gelweave Valsalva graft. The main indication was ascending aorta aneurysm or annuloaortic ectasia, with or without aortic insufficiency. The operation was performed also in cases of Marfan syndrome, Bicuspid Aortic Valve (BAV), and acute Type A dissection. In-hospital mortality was of 4.7%, and two thirds were acute Type A dissection patients (Ps0.01). There were no late deaths. Three years freedom from grade 3-4 AI and freedom from late aortic valve replacement were 91.7"4.3% and 93.8"5.1%, respectively. Aortic valve-sparing operations show good results in patients electi...
Interactive Cardiovascular and Thoracic Surgery, 2006
XXIII Congresso della Società Italiana di Chirurgia Cardiaca, 2006
Interactive CardioVascular and Thoracic Surgery, 2006
Aortic valve-sparing operations have provided very good clinical outcomes. However, the absence o... more Aortic valve-sparing operations have provided very good clinical outcomes. However, the absence of the sinuses of Valsalva might limit valve durability. The Gelweave Valsalvaீ prosthesis, which presents pre-fashioned neo-sinuses, has been designed in order to avoid early leaflets deterioration. We report our results in 63 patients who underwent valve-sparing operations (reimplantation technique) using the Gelweave Valsalvaீ graft. The main indication was ascending aorta aneurysm or annuloaortic ectasia, with or without aortic insufficiency. The operation was performed also in cases of Marfan syndrome, Bicuspid Aortic Valve (BAV), and acute Type A dissection. In-hospital mortality was of 4.7%, and two thirds were acute Type A dissection patients (Ps0.01). There were no late deaths. Three years freedom from grade 3-4 AI and freedom from late aortic valve replacement were 91.7"4.3% and 93.8"5.1%, respectively. Aortic valve-sparing operations show good results in patients electively operated for aortic root ectasia. Aortic cusps repair may lead to late failure. Even if the Gelweave Valsalvaீ prosthesis is easy to implant and it also reproduces pseudosinuses, a long-term follow up is necessary to determine if this graft may reduce leaflets deterioration.
Journal of Cardiology and Cardiovascular Sciences, 2020
Enhanced Recovery After Surgery (ERAS) incorporates multi-modal interventions that synergisticall... more Enhanced Recovery After Surgery (ERAS) incorporates multi-modal interventions that synergistically improve patient outcome. Its goals include improving patients functionally pre-operatively, reducing the stress of surgery intra-operatively to facilitate early return to daily activities. We conducted a pilot study at our unit recruiting patients undergoing elective coronary artery bypass grafting (CABG) into the Cardiac ERAS (C-ERAS) pilot and compared them with the patients undergoing CABG meeting the ERAS criteria but who not included the C-ERAS pilot (Control). Materials and Methods: 122 C-ERAS patients were compared to 91 control patients who underwent CABG only from the period of July 2015 to September 2016. All C-ERAS patients received pre-operative counselling by a dedicated ERAS Practitioner to manage expectations of the patient journey, health promotion and pre-operative optimisation advice. Emphasis was made on educating the patient on daily goals for recovery and patients were followed up daily by the ERAS practitioner post-operatively. Results: There were 122 patients in the C-ERAS group and 91 patients in the control group. The mean age was 63.6±9.9 years. 181(85%) of the patients were males. After adjusting for the abovementioned confounders, C-ERAS patients had a shorter length of stay that was statistically significant. (2.36 days shorter (95% CI; 1.01-3.7 days; p<0.01). The difference in mean bed day costs was £1153.70 (95% CI, £553.70-£1753.7; p<0.01) less in the C-ERAS cohort. Conclusion: This study highlighted that C-ERAS is a safe and feasible pathway to reduce in-hospital stay with no difference in complications and readmission rates compared to routine management of patients. There was also a significant cost saving with the C-ERAS pathway mimicking the results in enhanced recovery programmes in the other surgical specialities.
Heart, 2017
Conclusion GP auscultation has only moderate accuracy for diagnosing valvular heart disease in an... more Conclusion GP auscultation has only moderate accuracy for diagnosing valvular heart disease in an unselected population, and the presence of an isolated murmur would not be a reliable indicator of valve disease. This study did not include patients with cardiovascular symptoms however, in whom the presence of a murmur may be more significant, and for whom echocardiography might be more appropriate.
The Journal of Thoracic and Cardiovascular Surgery, 2009
Objective: It is unclear (1) whether the use of 2 arterial conduits rather than a single conduit ... more Objective: It is unclear (1) whether the use of 2 arterial conduits rather than a single conduit in multivessel coronary artery bypass grafting significantly improves results despite the concomitant use of saphenous vein grafts and (2) whether any among different configurations of composite grafts (left/right thoracic arteries and radial artery) offers an advantage over the others. Methods: Eight hundred fifteen patients were randomized to one of 3 different strategies of revascularization by using the left thoracic artery plus the right thoracic artery or using the left thoracic artery plus the radial artery. Venous grafts were used for the remaining targets. Patients randomized to receive 1 arterial graft served as control subjects. Operative mortality and morbidity were comparable among groups. Results: The rate of cerebrovascular complications was not statistically lower among patients receiving 2 arterial grafts. At 2 years, overall survival was not significantly different among groups (P ¼ .59). Cardiac event-free survival was significantly better in patients receiving 2 arterial grafts versus control subjects (P < .0001), even among elderly patients (P ¼ .022). The 3 investigated strategies using 2 arterial conduits were similar concerning early and midterm results. Conclusions: Revascularization with 2 arterial conduits offers better midterm event-free survival than a single arterial graft, irrespective of which second-choice arterial conduit is used (radial artery or right thoracic artery), the simultaneous use of saphenous vein grafts, and the patient's age.
Journal of Cardiothoracic and Vascular Anesthesia, 2008
T a c t T d ( H q ULMONARY HYPERTENSION and vasoplegia syndrome are very difficult conditions to ... more T a c t T d ( H q ULMONARY HYPERTENSION and vasoplegia syndrome are very difficult conditions to treat when they resent independently of each other but are even more complex hen they occur simultaneously. Therefore, the authors report case describing a young patient who developed pulmonary ypertension and vasoplegia syndrome after a heart transplant rocedure. The combination of these 2 challenging conditions equired a complex therapeutic approach.
The Annals of Thoracic Surgery, 2008
Background. Surgical reexploration due to postoperative bleeding occurs in 2% to 6% of cardiac su... more Background. Surgical reexploration due to postoperative bleeding occurs in 2% to 6% of cardiac surgical patients and is accompanied by increased morbidity and mortality. In this study, we addressed the postoperative course of patients needing surgical reexploration, with specific respect to the timing of reexploration and the transfusional needs as determinants of morbidity and mortality. Methods. This was a retrospective study of 232 patients having undergone surgical reexploration owing to postoperative bleeding after cardiac operations, compared with a control, propensity-matched group. Results. Patients in the surgical reexploration group had greater morbidity (low cardiac output, acute renal failure, sepsis) and longer mechanical ventilation time and intensive care unit stay than did control patients, and a significantly higher mortality rate (14.2% versus 3.4%, p ؍ 0.001). The timing of surgical reexploration was not associated with morbidity or mortality. The amount of packed red cells transfused was significantly associated with increased morbidity (acute renal failure, low cardiac output syndrome, sepsis), with mechanical ventilation time and intensive care unit stay, and with the mortality rate (0.25% increase for each unit transfused). Conclusions. The main determinant of morbidity and mortality for patients requiring a surgical reexploration after cardiac operations is the amount of packed red cells transfused. Delaying the timing of reexploration may represent a risk factor only when the delay creates the need for an excessive use of allogeneic blood products, or in the presence of clinical signs of cardiac tamponade.
The Annals of Thoracic Surgery, 2008
Background. Small body size, female gender, and transfusions are traditionally considered morbidi... more Background. Small body size, female gender, and transfusions are traditionally considered morbidity and mortality risk factors in coronary surgery. Because these clinical conditions are interrelated, we designed a study to investigate their respective roles in determining adverse outcomes after coronary operations. Methods. A retrospective study on 4,546 consecutive patients who underwent coronary surgery was performed. The outcome (hospital mortality and length of stay in the intensive care unit) was evaluated according to body surface area, gender, and the presence of allogeneic blood transfusions. Results. Female gender is not a risk factor for hospital mortality or prolonged intensive care unit stay. Small body surface area in men and large body surface area in women are associated with a prolonged intensive care unit stay. Transfusions are independent risk factors for both mortality and prolonged intensive care unit stay. Fresh-frozen plasma and platelet transfusion carry a higher mortality risk (odds ratio, 12) than transfusions of packed red blood cells (odds ratio, 5). Conclusions. Female gender and small body surface area are associated with severe intraoperative hemodilution, and this may trigger blood transfusions, which are true determinants of adverse outcomes. A large body surface area in women is frequently associated with obesity (68%) and may prolong the intensive care unit stay, whereas it is not a risk factor in men. Conversely, a small body surface area is accompanied by a prolonged intensive care unit stay in men but not in women.