[Immediate results of surgical treatment of proximal aortic dissection]. / Risultati immediati nel trattamento chirurgico della dissecazione aortica prossimale.

From 1984 to 1997, 112 patients have been operated at the Department of Cardiac Surgery of the Azienda Ospedaliera of Parma for acute dissection of ascending aorta. They were 73 males and 39 females of mean age 59.2 years (range 19-79); in the majority they presented a history of essential hypertension and atherosclerotic disease: the first diagnostic suspicion has been confirmed either by angio-CT scan or by CT scan plus aorthography and, from 1994, with transesophageal color doppler echocardiography that is becoming a valuable and precise tool wich can be used in emergency room. Bentall type composite repair or modified Bentall technique has been possible in 37 patients, while in the remaning 75, surgical aortic repair has been achieved by interposition of a dacron vascular prosthesis. Cardiac procedures that were performed in addition were coronary bypass grafthing, resuspension of the aortic valve, AVR. Total arch replacement with reimplantation of brachiocephalic vessels were performed in 6 patients and partial in 10, when intimal tear extended into the arc. Thirthythree in hospital deaths (29.4%) occurred (15 in S.O. and 18 in UCI). Follow up of the hospital survivors was conducted at a mean postoperative interval of 55 months (range 2 to 149 months with 6 late death related to aortic dissection). Our experience shows an increased incidence hypertension and aortic atherosclerosis, compared with marfan's syndrome as a source of acute aortic dissection in the late years, transesophageal echocardiography is a excellent tool for aortic dissection but it may miss dissection localized in other aortic portion, the need of an individualized and conservative surgical approach tailored to the pathology encountered.

[Recent myocardial infarction and heart wall rupture: analysis of 21 cases surgically treated]. / Infarto miocardico recente e rottura della parete del cuore: analisi di ventuno casi trattati chirurgicamente.

Left ventricular free wall rupture is a catastrophic complication of acute myocardial infarction and prognosis will depend on the prompt diagnosis by echocardiography, extension of infarct size and prompt surgical treatment. From november 1984, 21 patients (14 M, 7 F, mean age 68.4 +/- 6 years) underwent emergency operation at our Institution. Surgical technique included resection of necrotic or scarred myocardium and repair by Teflon strips-reinforced sutures, or by patching with Dacron or autologous pericardium. Associated procedures were LV aneurysmectomy, CABG, LV endoaneurysmorraphy and mitral valve replacement. Hospital mortality was 33% (7/17 pts). The postoperative course was prolonged in one patient, who needed hemodialysis and in 5 patients who needed IAPB counterpulsation. The mean length of stay in UCI was 3-10 days. Mean follow up is 70.4 +/- 41 months and 3 patients died of non cardiac related death. We conclude that despite high hospital mortality, satisfactory results may be obtained by surgical repairy under emergency condition, with good-long term survival, depending on prompt diagnosis and infarct size extension.

[Surgical treatment of saccular aneurysm of the left anterior descending coronary artery]. / Trattamento chirurgico di aneurisma sacciforme della coronaria discendente anteriore.

We report a case of a 74 old man presenting unstable angina and history of previous myocardial infarction. Coronary angiography showed significant stenoses of the left main and right coronary arteries and saccular aneurysm of the left anterior descending coronary artery. The patient underwent surgical treatment consisting in coronary artery bypass grafts and aneurysm resection. This procedure appears indicated, in author's opinion, when coronary aneurysm is saccular as in the described case.

[Autotransfusion of the blood drained from mediastinum in the course of myocardial revascularization]. / L'autotrasfusione di sangue drenato dal mediastino negli interventi di rivascolarizzazione miocardica.

To determine if autotransfusion of unwashed shed mediastinal blood led to a reduction in the postoperative banked blood requirements were analyzed in a prospective study 82 patients undergoing myocardial revascularization during 1994 at Cardiovascular Surgery Center of Parma, randomized to receive (ATS) or not (noATS) the system. No differences were noted between two groups in terms of clinical parameters; likewise the operative characteristics were similar for the two groups. The mean 24-hours postoperative blood loss was 719.5 +/- 196 ml in the ATS group and 843 +/- 292 ml in the nonATS group (p = 0.027); the mean volume autotransfused in the ATS group was 416 +/- 167 ml. There were no reoperations for bleeding. In the nonATS group 65.8% of patients required postoperative homologous transfusions compared with 41.5% in the ATS group (p = 0.05). The mean immediate and 24-hour postoperative hemoglobin values were similar in the two groups, but at hospital discharge were 21.1 +/- 1.4 g/dL in the nonATS group and 11.3 +/- 1.4 g/dL in the ATS (p = 0.015). By logistic stepwise multiple analysis were identified as risk factors for banked blood requirement the variables: age, preoperative blood drawing patient, blood drawing before institution of cardiopulmonary bypass and postoperative blood loss. Non use of ATS was not a significant incremental risk factor for banked blood requirement, furthermore we think that use of ATS system is a primary blood volume support and confers to reduce homologous transfusions and their related complications after cardiac operations.

[Myocardial protection during extracorporeal circulation. Preliminary results with different techniques]. / La protezione miocardica durante circolazione extracorporea. Risultati preliminari ottenuti con metodiche diverse.

Great advances in surgical techniques, perfusion technology and cardiac anesthesia have made heart surgery safer. However, the mayor advance over the past 15 years has been in the field of myocardial protection. Much remains to be done in this field and there is not complete agreement about the different methods of myocardial protection. At the Institute of Cardiac Surgery of Parma a research is developing to concern three different cardioprotective strategies, of which preliminary results are showing. Three groups of patients with the same clinical, surgical, anesthesiological features, who underwent cardiac surgery have been selected. In patients of group A intermittent cold hyperkalemic crystalloid cardioplegia has been used, in those of group B intermittent cold blood cardioplegia and in those of group C intermittent cold blood cardiolegia associated a warm glucose blood cardioplegic reperfusion before aortic unclamping. In all patients enzyme levels (CPK; CPK-MB; LHD; SGOT; SGPT) were measured 12, 24, 72, 120 hours postoperatively; data were collected, also, on spontaneous return to sinus rhythm, perioperative myocardial infarction and the need or not for inotropic agents. All data at first and then those of patients who underwent only coronary rivascularization (75% of patients) were statistically analyzed (one-way Fischer's test). It appears that the use of antegrade cold intermittent blood cardioplegia with reperfusion is more optimal for myocardial protection, how show lower levels of CPK-MB especially in the first postoperative period. In group C remains greater spontaneous resumption of normal sinus rhythm compare to group A and this suggests a best preservation of cellula-integrity and function with use of blood cardioplegia.

[Considerations regarding surgical treatment of massive pulmonary thromboembolism]. / Considerazioni sulla terapia chirurgica dell'embolia polmonare massiva.

In this work have been reported the results about surgical treatment of 15 patients with massive pulmonary thromboembolism, treated with or without extracorporeal circulation. Despite the importance of drug therapy, surgical embolectomy has still mandatory indications that in Author's opinion could be much more extended.