Radial artery in re-do coronary artery bypass grafting: our experience.

We evaluated our experience with the use of the radial artery as a key conduit in re-do coronary artery bypass surgery to determine the safety and efficacy and to compare this procedure to re-operations performed without the radial artery. Sixty-eight patients operated on re-do revascularization were studied: mean age was 67 years; 42 patients were in CCS III (62%) and 18 in CCS IV (26%); past myocardial infarction occurred in 12 patients (18%). We performed 116 anastomoses in all 68 patients (mean no. anastomoses/patient 1.7). Perioperative mortality was 4.4%. Three patients (4.4%) showed a transient postoperative low cardiac output syndrome; four (5.8%) had a respiratory failure and an acute renal failure occurred in 2 patients (2.9%). Four patients (5.8%) required re-operation for bleeding. The comparison of the radial re-do group (27 patients) with the non-radial re-do group (41 patients) showed a lower mortality and morbidity in the former, even if p value was not significant. We conclude that the use of the radial artery in re-do coronary operations is safe, effective, allowing an additional conduit choice and may avoid late vein graft failure.

Pericardial drainage for pericardial tamponade: surgical management criteria.

Aim of this study is the review of our experience in 82 patients treated by pericardial drainage for cardiac tamponade, to assess the efficacy and safety of different techniques and the related indications. The causes of pericardial effusion were: malignancy in 8 patients (9.7%), post-cardiac surgery in 12 (14.6%), while the others patients were admitted at our Institution with no identified preoperative diagnosis. Thirty-eight patients (46%) underwent subxiphoid pericardial drainage and 44 (54%) were operated on by catheter pericardiocentesis. There were no perioperative deaths. Two patients, who initially underwent pericardiocentesis, needed urgent sternotomy: the first patient developed a severe hypotension and bradicardia related to a vagal reaction and the other one because of accidental right ventricle puncture. Our experience indicates that subxiphoid pericardiocentesis provides expeditious, effective and durable treatment, with low morbidity, in case of pericardial effusions related to all causes. We believe that echocardiography is a powerful tool in the diagnosis and management of pericardial effusion. We conclude that pericardiocentesis seems to be the procedure of choice for patients with pericardial tamponade requiring an emergency treatment.

Ischaemic mitral valve regurgitation: a surgical approach.

UNLABELLED: The aim of this study IS to determine surgical results after surgical mitral valve repair in ischaemic mitral regurgitation. MATERIALS AND METHODS: Between January 1999 and June 2000, 64 patients (5.1% of overall patients) underwent myocardial revascularization and mitral valve surgery. A Cosgrove-Edwards mitral annuloplasty ring was used in 59 cases (92.2%). Average patient age was 64.3 +/- 12.4 years (38 males, 21 females). Average degree of mitral regurgitation was 2.8 +/- 0.6. Average NYHA class was 3.5 +/- 0.5. Average ejection fraction (EF) was 40 +/- 12.5 percent. RESULTS: Post-operative 30-day mortality was 3.4% (2 patients). The follow-up was complete for 95 percent (mean 20.4 +/- 4.8 months for patients) and data showed an improvement of NYHA class (mean value 1.8 +/- 0.2) (p = 0.01) and ejection fraction (mean value 51.7 +/- 10.2) (p = 0.05) with residual mitral regurgitation value of 0.6 +/- 0.7. CONCLUSIONS: Mitral valve repair in coronary artery disease improves left ventricular function, quality of life and survival rate with low operative risk. Perioperative transesophageal echocardiography has a central role in surgical decision making.

[Total arterial myocardial revascularization: surgical technique and mid-term results]. / La rivascolarizzazione miocardica arteriosa totale: tecnica chirurgica e risultati a medio termine.

The purpose of this study is to evaluate perioperative and mid-term results of total arterial coronary revascularization in our experience and to establish its safety. One-hundred and ninety-one patients underwent total arterial coronary revascularization at our Institution from February 1997 to August 2000. The mean age was 60.1 years. Of the patients, 45% had three coronary vessels disease, 12% a left main coronary artery disease and 2.6% of them were classified urgent. Mean ejection fraction was 59.6%. Three hundred and thirty-four comprehensive anastomoses were performed; mean grafts per patient was 1.8. A Y or T graft with the left internal thoracic artery was used in 21 patients. The in-hospital mortality rate was 1% (2 patients). Complications included low cardiac output syndrome in 2.8% of patients, acute myocardial infarction in 0.9% and acute renal insufficiency in 3.1%. Intraaortic balloon pump was used in 1.8% of patients. At a mean follow-up of 899 days the first 81 patients contacted are all free of angina but two (one experienced an acute myocardial infarction and another one died for a pulmonary neoplasia). We conclude that total arterial coronary revascularization is a safe surgical technique, providing excellent perioperative and mid-term results.

[Endoluminal repair of aortic aneurysms. Our experience]. / Correzione endoluminale degli aneurismi aortici. Nostra esperienza.

From February 1998 and March 2000 fourteen patients underwent "custom made" aortic self-expanding endoprostheses implantation (World Medical Talent Sunrise): nine of them for dilative pathology of thoracic aorta and 5 for abdominal aortic aneurysm below renal arteries. The etiology was degenerative in 8 patients, false aneurysm in 2, chronic dissection in 2 cases, acute dissection in one patient and post traumatic in the last one. All patients underwent preoperative Computed Tomography and Substraction Angiography studies. Stent-graft implantation was successful in all cases but one who required the conversion of the endovascular procedure in traditional surgery for technical problems. There were no perioperative deaths or major complications. We registered 2 cases of dissection of the femoral artery used to introduce the stent-graft, and treated with an iliac-femoral prosthetic bypass. There were no cases of paraplegia or renal failure or bowel ischemia. With the exception of one patient, died for a car accident, the others are alive and continue their scheduled follow-up controls. Our experience shows that this procedure is safe, allowing favorable results, if compared to traditional surgery, even if it requires further long-term evaluations.

[Heart transplantation 1985-1995: 10 years experience at the "Angelo De Gasperis" center. Improvement of results by progress in operative criteria]. / Trapianto cardiaco 1985-1995: 10 anni di esperienza al Centro "Angelo De Gasperis". Miglioramento dei risultati mediante l'evoluzione dei criteri operativi.

BACKGROUND: At 10-years from beginning of transplant experience in our Center we analyzed the overall results in an attempt to identify risk factors for early (3 months) and late (over 3 months) mortality after heart transplantation (HTx). METHODS: The data of 313 patients transplanted from November 1985 to June 1995 were studied and analyzed with a multivariate logistic regression and Cox's proportional hazard model. Seventy pre, intra and postoperative variables were considered: demographics, clinical status, hemodynamic parameters, donor characteristics, donor-recipient mismatch, complications, immunosuppressive protocols. In this paper we compared results in patients operated on from 1985 to 1990 (Group I) and from 1991 to 1995 (Group II) in order to assess improvements due to changes in HTx indication and in perioperative treatments. RESULTS: Overall mortality in the entire group was 19.8% (62/313): 30-days, 3 months and late mortality rates were 8.0%, 10.2%, 10.7% respectively. In Group II mortality rates were 7.1%, 8.6% and 2.8% respectively despite significant increase in Status I patients (21.5% in Group I vs 40.1% in Group II, p = 0.0008). Main causes of early death were: graft failure (46.9%), infection (28.1%), acute- rejection (12.5%). Main causes of late death were: cardiac allograft vasculopathy (40.0%) and neoplasm (23.3%). The mean follow-up of the 281 survivors more than 3 months is 45.6 +/- 30.0 months (range 3 to 120 months). Actuarial survival is 86.9 +/- 1.9%, 78.4 +/- 2.7% and 70.7 +/- 3.9% at 1, 5 and 10 years respectively. The difference in the 5-years actuarial survival between Group I and Group II patients is statistically significant (70.7 +/- 4.2% vs 84.5 +/- 4.5%, p = 0.005). TPG (OR 1.19), RAP (OR 1.13) and MD-HD inotropic support of donor (OR 3.81) were identified as independent risk factors for early mortality. Number of moderate rejection at biopsy (OR 1.56) and early postTx infection (OR 3.37) were identified as independent risk factors for late mortality. CONCLUSIONS: The overall results of our ten-year experience are very satisfying in relation to early and late mortality, with a significant favourable trend between patients transplanted in the early era (1985-1990) and those transplanted in the recent era (1991-1995). The study confirm that morbidity and mortality have the highest incidence during the early post-transplantation phase. Pulmonary hypertension and elevated preoperative right filling pressure appear to indicate a significantly increased risk of early death and only marginally influence late survival that is principally related to the severe postoperative complications. Differently from other observations, among the donor-related and recipient-donor matching variables, this analysis evidenced as significant only the need for MD-HD catecolamines during donor-management.