[Experimental results of the use of hyaluronic acid based materials (CV Seprafilm and CV Sepracoat) in postoperative pericardial adhesions]. / Risultati sperimentali sull'uso di materiale a base di acido ialuronico (CV Seprafilm e CV Sepracoat) nelle aderenze pericardiche post-chirurgiche.

Repeat cardiac surgical procedures are associated with increased technical difficulty and risk related to the presence of dense adhesions between the heart and the surrounding tissues. We examined the efficacy of a bioabsorbable membrane containing hyaluronic acid in the prevention of pericardial adhesions in 23 rabbits. After thoracotomy and pericardiotomy the animals were divided in three groups: Group 1 (9 animals) in which the epicardial surfaces were covered by Seprafilm membrane, Group 2 (9 animals) treated with both Seprafilm membrane and Sepracoat solution, and Group 3 (5 animals) as controls. The animals were reexplored at 10, 30 and 60 days: no intrapericardial adhesions were found in all the animals of Group 2. In 4 animals (44%) of Group 1 localized post-operative adhesions were detected, in absence of epicardial hyperplasia; in contrast, dense and diffuse adhesions were present in all the control animals. The use of the bioabsorbable membrane Seprafilm significantly reduces adhesion formation even if better results are possible with the previous intrapericardial administration of Sepracoat solution. Application of these biocompatible products could reduce the technical difficulty and risk of repeat surgical procedures.

[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.

[Surgical therapy of post-infarct aneurysm of the left ventricle. Immediate and long-term results]. / Terapia chirurgica dell'aneurisma post-infartuale del ventricolo sinistro. Risultati immediati ed a distanza.

Between January 1982 and December 1986, 62 patients (59 male and 3 female) ranging in age from 37 to 69 years (mean 53) underwent resection of postinfarction left ventricular aneurysm. The indication for operation was angina in 23 cases (37%), congestive heart failure (CHF) in 7 (11.2%), angina and CHF in 29 (46.8%), rupture in 1; 2 patients were low symptomatic. Ventricular arrhythmias were present in 6 (9.7%) cases and previous systemic embolism in 4 (6.4%). Forty-seven (75.8%) patients had lesions of three coronary arteries with involvement of left main coronary artery in 4 cases; 10 (16.1%) had lesions of two vessels [left anterior descending (LAD) and/or right coronary artery]; 4 (6.4%) had only LAD artery involvement, and 1 had no significant coronary artery stenoses. Left ventricular ejection fraction (EF) was less than 0.30 in 22% of cases, between 0.30 and 0.40 in 25.4% and greater than 0.40 in 50%. The location of the aneurysm was anterolateral or apical (83.8%), posterior (14.5%) and lateral (1.6%). Left ventricular aneurysmectomy with myocardial revascularization was performed in 61 patients (bypass/patient = 2.7), with ventricular septoplasty in 20 and concomitant mitral valve replacement in 3 patients. LAD was grafted in 59.6% of anterior aneurysm. Operative mortality (30 days) was 4.8%, the late mortality, with a follow-up between 12 and 72 months (mean 38), was 6.7% and the actuarial 5 year survival rate was 85% (91% without operative mortality). In our experience, despite no evidence of any operative risk factors, no improvement was noted in radionuclide left ventricular ejection fraction in patients undergoing aneurysmectomy with ventricular septoplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

[Blood saving in heart surgery. Personal experience with 232 patients]. / Risparmio di sangue in cardiochirurgia. Esperienze personali su 232 pazienti.

In order to minimize the need of homologous blood transfusion during cardiac surgery four different blood sparing methods have been tested in four groups of patients. In 62 patients (group A) blood from operative field has been collected and processed by the Autotrans (Dideco (R)) apparatus. Intraoperative autotransfusion has been performed in 50 patients (group B). Prostacyclin (Pgh2) has been administered to 36 patients (group C), starting before systemic heparinization, and continuing during extracorporeal circulation. Standard techniques have been employed in a control group of 84 patients (group D). The following parameters have been examined: preoperative blood counts; length of extracorporeal circulation postoperative bleeding (including I.C.U); homologous blood volume transfused; and only in group A the mean number of blood units collected. Significant reduction of bank-blood consumption has been achieved only in B group (intraoperative autotransfusion) while in the remaining groups blood saving was not statistically significant.

Surgical treatment of left main coronary stenosis. Notes on 179 consecutive patients.

The authors report the clinical haemodynamic and angiographic data and early and late postoperative results of 179 patients consecutively operated on for left main coronary artery stenosis. Operative mortality was 3.9%; incremental risk factors were identified by univariate analysis and included female sex, unstable angina pectoris and congestive heart failure. Late postoperative mortality was 4.9%. After a mean follow-up of 31 months overall survival is 91.6%; the great majority of survivors are doing well, free from anginal pain, while 16.4% of patients experience recurrent angina pectoris of lesser severity than before operation (I-II C.C.S. class) and well controlled by medical treatment alone.

[Water-electrolyte and acid-base changes during extracorporeal circulation]. / Variazioni idroelettrolitiche ed acido-basiche durante circolazione extracorporea.

Changes in fluid, electrolyte and acid-base balance were evaluated in 8 patients during extracorporeal circulation. H2O increase and osmolarity and colloid osmotic pressure decrease, due to priming and perfusion technique used for cardiopulmonary by pass, were found. Mild respiratory alkalosis was also present. K+ serum, because of KCL supplements, was always maintained within the normal values, while Na+ serum concentration was low, despite of large amounts of Na+ infused during perfusion. After examination of disturbances in fluid, electrolyte and acid-base balance, the Authors report the performed corrections and emphasize the importance of a prompt recognition and the immediate therapy of these changes to avert serious cardiac impairments during extracorporeal circulation or during the immediate postoperative period.

[Gore-Tex prostheses in arterial reconstructive procedures (author's transl)]. / La protesi di Gore-Tex nella chirurgia arteriosa riparativa.

The early and long-term results using the polytetrafluorethylene (Gore-Tex) are reported. In 20 patients, 12 ilio-femoral bypasses, 10 femoro-popliteal and 2 aorto-subclavian bypasses have been performed; 5 of these patients underwent simultaneously femoro-popliteal bypasses with Gore-Tex and ilio-femoral bypasses with Dacron. Only once the Gore-Tex was used as patch. The results have been satisfactory. However, longer follow-up and many more patients are needed to determine if the Gore-Tex will be the substitute for the autogenous saphenous vein in peripheral vascular reconstruction.

[Prostheses reimplantation with porcine xenograft. Our experience (author's transl)]. / La sostituzione valvolare con heterograft porcina. Esperienza personale.

The Authors explain the experience about the porcine xenograft, the results of the application of 98 bio-prostheses implanted between January 1976 and November 1979. The distribution of the implantations is: 52 mitral valve reimplantation; 16 aortic valve reimplantation, 2 tricuspid valve reimplantation, 26 xenograft were implanted with the association of another prosthesis or aorto coronary by-pass graft. The patients were selected for clinical criteria (age, sex, geographic provenance) and haemodinamic criteria. Three early embolism were checked, one lethal. The total mortality is of 9 patients: 4 patients were submitted to multiple surgical operation. The running of porcine xenograft is good on the middle term.

[Our experience with mitral valve surgery (author's transl)]. / La nostra esperienza nella chirurgia della valvola mitrale.

Our experience is based on 323 surgical operations on the mitral valve. Prosthetic valves were substituted in 308 patients and in 15 an anulo-valvulo-plastic operation. Mitral valve operation was associated with the correction of other heart lesions in 132 patients and in 197 patients, (objects of this study) surgery was carried out on the left atrio-ventricular valve. A detail report of the types of lesions found is made: 78 patients had massive calcification and 15 had a process of acute and subacute endocarditis. Mechanical prosthesis (Starr-Edwards 51; Björk-Shiley 77) were used 128 times and biologic prosthesis (Hancock 44; Carpentier-Edwards 7; Angell-Shiley) 54 times. Preference was given to the use of porcine prosthesis in patients presenting generic or specific controindications to anticoagulant therapy. Total mortality rate was 9,9% and in the last two years this fell to 5%. In our opinion, the sharp fall in mortality could be attributed to refined technic, better selection of cases, better myocardial protection consequent to the clinical use of cardioplegia and hypothermia.

[Behavior of the blood calcium in operations during extracorporeal circulation]. / Comportamento del calcio ematico negli interventi in circolazione extracorporea.

The Authors analyse the variation of the calcium plasmatic concentration during extra corporeal circulation (E.C.C.). The Authors remind the importance of the calcium plasmatic concentration preserving a good cardiac output. They say that amount of calcium given assures a good plasmatic concentration and aid the cardiac output after E.C.C. The possible hypercalcemia after A.C.D. blood transfusion doesn't compromit the cardiovascular function.

[Aldosterone-Na-K interactions after operations with extracorporeal circulation]. / Interazioni aldosterone Na-K dopo interventi in circolazione extra-corporea.

The Authors, valuing the interrelationships with aldosterone and idrosalin retention and potassium depletion after E.C.C., study all the factors affecting the loss of potassium particularly the secondary iperaldosteronism. The preoperatory heart failure, duration of the E.C.C. and low cardiac output increase the secundary iperaldosteronism. They also say that the plasmatic potassium concentration is not a good index of body potassium depletion, and there is a good ratio between urinary log. Na/k and aldosteronic activity; at the end the Authors say that there needs several potassium administration.

[Prevention and treatment of infections in open heart surgery (author's transl)]. / Prevenzione e trattamento delle infezioni nella chirurgia a cuore aperto

The incidence of bacterial infections in 207 patients who underwent cardiopulmonary bypass surgery is reported. The effectiveness of various prophylactic antibiotic therapies is debated on the basis of performed antibiograms and the results are compared with that obtained by other Authors using different treatments.

[Effect of cardiopulmonary bypass on serum digoxin concentration (author's transl)]. / Influenza della circolazione extracorporea sul tasso ematico della digitale: osservazioni preliminari

The use of digitalis following cardiopulmonary bypass is studied by digitalemia's radioimmunoassay. The Authors does not find relation between digitalis and post operative arrhytmias. They think digitalis's tolerance is very good but suggest that further studies are necessary to state the correct use of the drug after open heart surgery.

[Extracorporeal circulation. Considerations on the methods adopted]. / La circolazione extracorporea. Considerazioni sulle metodiche adottate

This paper described the various types of procedures used for cardiopulmonary bypass related to the operative procedures. The Authors emphasize emodiluition and hypothermia as local as general recommend a limited use of coronary perfusion.