G Marchetto

Ospedale Maggiore di Lodi, Lodi, Lombardy, Italy

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Publications (14)22.47 Total impact

  • Pino Fundarò, Giovanni Marchetto
    Italian heart journal: official journal of the Italian Federation of Cardiology 04/2004; 5(3):245; author reply 245-6.
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2004; 43(5).
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    ABSTRACT: The efficacy and safety of surgical anteroseptal ventricular endocardial restoration (a procedure that excludes non-contracting scarred segments) in the left ventricle with chronic dilation and remodeling secondary to an anterior myocardial infarction are well established. We present a small series and discuss the indication for early left ventricular restoration in the setting of complicated acute myocardial infarction. Early ventricular restoration was performed in 8 patients (4 males, 4 females, mean age 70 +/- 8 years). A postinfarction ventricular septal defect was diagnosed in 3 cases. All patients were operated, on an urgent or emergent basis, between 1 and 16 days following the onset of infarction. Surgical coronary revascularization was associated in 7 patients. There was one operative death. At discharge, echocardiographic morphofunctional assessment revealed: a reduction of the left ventricular end-diastolic and end-systolic volume indexes, an increase of the ejection fraction, and, most importantly, an improvement of remote myocardial shortening fraction. At a mean follow-up of 15.6 months (range 2-21 months), there were no late deaths and all survivors are in NYHA functional class I or II. Left ventricular restoration may represent an effective adjunct to the surgical management of patients with an acute extensive anterior myocardial infarction complicated by severe heart failure, with or without septal rupture.
    Italian heart journal: official journal of the Italian Federation of Cardiology 05/2003; 4(4):252-6.
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    Journal of Thoracic and Cardiovascular Surgery 10/2000; 120(3):609-10. · 3.53 Impact Factor
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    ABSTRACT: Surgical repair of anterior leaflet prolapse has evolved and widely expanded over the past decade. A number of surgical techniques have been developed. In this study a review of all reparative techniques has been provided. A classification has been proposed according to the involvement of valve components and, eventually, to graft employment. For each technique the following points have been detailed: a) advantages and drawbacks; b) likelihood of effective valve repair based on morpho-pathologic variability of degenerative mitral disease; c) long-term outcome as freedom from reoperation. The authors provide indications for early surgical anterior leaflet prolapse repair and recommend that surgeons should be familiar with many reparative procedures to select the right option and improve their operative results.
    Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology 08/2000; 1(7):880-7.
  • CARDIOVASCULAR SURGERY. 01/2000; 8:17-17.
  • The Journal of heart valve disease 01/2000; 9(5):738-739. · 1.07 Impact Factor
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    ABSTRACT: Severe ventricular dysfunction and concomitant infection are considered absolute contraindications for major thoracic operations and immunosuppressive therapy, respectively. However, cardiac transplantation represents the first-choice treatment in advanced heart failure. We report the case of a patient with dilated cardiomyopathy and severe left ventricular dysfunction (ejection fraction = 25%), initially not considered as a potential heart transplant candidate due to the presence of a lung abscess. The patient subsequently underwent atypical pulmonary resection with intraoperative and perioperative intraaortic balloon counter-pulsation for circulatory support and was then listed for cardiac transplant. Pitfalls and intra/postoperative strategy, all of which are potentially important aspects in minimizing operative risk, are discussed.
    Giornale italiano di cardiologia 11/1999; 29(11):1331-3.
  • M Triggiani, G Marchetto, O Alfieri
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    ABSTRACT: Progression of coronary artery disease that causes recurrent angina in patients who have already undergone coronary artery bypass grafting (CABG) is a challenge to cardiac surgeons. The presence of myocardial ischemia that is not due to bypass grafts occlusion, but to the quality of the coronary vessels characterized by diffuse atherosclerotic peripheral disease, makes the situation even more difficult, since it is not possible to perform myocardial revascularization either by percutaneous transluminal angioplasty (PTCA) or by means of new grafts. We report the case of a patient who, 4 years after triple CABG, developed refractory angina despite patency of bypass grafts (to left anterior descending artery, obtuse marginal branch and posterior descending) and maximally tolerated conventional medical treatment. Native coronary arteries were occluded. Because of the exiguous caliber of the distal portion of epicardial vessels and poor run-off, a redo CABG was judged to be unfeasible. Transmyocardial laser revascularization (TMLR) was performed through left anterior thoracotomy, minimizing the risk of damage to the grafts. Clinical improvement (from CCS class IV to 0) and scintiscan showing improved myocardial perfusion to the laser-treated regions confirm the effectiveness of TMLR in otherwise inoperable coronary artery disease.
    Giornale italiano di cardiologia 02/1999; 29(1):72-5.
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    ABSTRACT: Surgical intervention for coronary artery disease (CAD) is determined by the viability of coronary artery branches. When peripheral coronary artery disease is present, conventional bypass grafting is not suitable. Research has recently been done on alternative methods such as transmyocardial laser revascularization (TMLR). TMLR works through the vascular connections that are present between the cardiac chambers and the myocardial muscle in the human heart. The creation of 1-mm transmural cardiotomies through a CO2 laser should improve myocardial perfusion. From February to June of 1996, twelve patients (9 males and 3 females with a mean age of 67.8 +/- 4.6) with CAD (mean n0 of diseased vessels 2.7), angina (mean CCS class 3.5 +/- 0.5), mean ejection fraction 47.8% and viable ischemic myocardium on scintiscan in segments without graftable coronary branches, underwent TMLR at our institute. Nine of the 12 patients also underwent associated CABG (mean number of anastomoses per patient: 2.5). Cardiopulmonary bypass was never used, since coronary anastomoses and laser cardiotomies were performed on the beating heart. Perioperative mortality was 2/12 (16.6%). Postoperative inotropic support and diuretic therapy was required in most cases. At a mean follow-up period of 4.2 months, all remaining patients are still alive: 5/10 are angina-free (CCS 0), 4/10 are in CCS class 1 and 1/10 is in CCS class 2 (mean 0.6 +/- 0.7). We believe that TMLR could be considered an effective mean to treat symptomatic myocardial ischemic disease in which coronary bypass grafting is not suitable. During the immediate postoperative period, contractile myocardial dysfunction occurs in a high percentage of patients treated using TMLR and consequently it would be worthwhile to invest in further research.
    Giornale italiano di cardiologia 06/1997; 27(5):430-5.
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    ABSTRACT: In this paper we describe the preliminary results of a prospective operative protocol designed in order to define the role of emergent myocardial revascularization in extensive acute myocardial infarction and in post-infarction cardiogenic shock. Entry criteria are: age < 75 years; anterior acute myocardial infarction with ST segment elevation > 4 leads, infero-postero-lateral or inferior and right ventricular within 6 h from onset of chest pain; post-infarction cardiogenic shock within 3 h from onset of shock. From November 1994 to July 1995, after emergency coronary arteriography, 23 patients were treated by coronary artery bypass grafting. Fifteen were operated for extensive acute myocardial infarction (group A, mean age 54.1 +/- 9.4 years) and eight for post-infarction cardiogenic shock (group B mean age 65.0 +/- 8.7 years). Mean time from onset was 4.4 +/- 1.3 h in group A and 2.2 +/- 0.8 h in group B. Mean left ventricular ejection fraction was 39.3 +/- 12.7% in group A and 22.6 +/- 3.5% in group B. Six out of eight group B patients needed intraaortic balloon counterpulsation preoperatively, and 2/8 cardiopulmonary resuscitation. Myocardial revascularization consisted in 3.4 +/- 1.1 grafts in group A (vein grafts, except for 8 patients who also received a left internal thoracic artery graft) and 3.3 +/- 1.1 vein grafts in group B. All patients in group B and 3/15 (20%) in group A underwent intraaortic balloon counterpulsation. In-hospital death occurred in 1/15 (6.7%) patients of group A and in 4/8 (50%) patients of group B. At a mean follow-up of 4.1 +/- 3.4 months for group A and 3.9 +/- 2.2 months for group B left ventricular ejection fraction was 43.4 +/- 9.0% in group A and 35.7 +/- 13.1% in group B. Experience of 9 months with this prospective protocol showed its effectiveness in the management of critically ill patients with acute coronary occlusion leading to low mortality rate in acute myocardial infarction and improved survival rate in post-infarction cardiogenic shock.
    European Journal of Cardio-Thoracic Surgery 03/1997; 11(2):228-33. · 2.67 Impact Factor
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    ABSTRACT: Objective: In this paper we describe the preliminary results of a prospective operative protocol designed in order to define the role of emergent myocardial revascularization in extensive acute miocardial infarction and in post-infarction cardiogenic shock. Methods: Entry criteria are: age 4 leads, infero-postero-lateral or inferior and right ventricular, within 6 h from onset of chest pain; post-infarction cardiogenic shock within 3 h from onset of shock. From November 1994 to July 1995, after emergency coronary arteriography, 23 patients were treated by coronary artery bypass grafting. Fifteen were operated for extensive acute myocardial infarction (group A, mean age 54.1±9.4 years) and eight for post-infarction cardiogenic shock (group B mean age 65.0±8.7 years). Mean time from onset was 4.4±1.3 h in group A and 2.2±0.8 h in group B. Mean left ventricular ejection fraction was 39.3±12.7% in group A and 22.6±3.5% in group B. Six out of eight group B patients needed intraaortic balloon counterpulsation preoperatively, and 2/8 cardiopulmonary resuscitation. Results: Myocardial revascularization consisted in 3.4±1.1 grafts in group A (vein grafts, except for 8 patients who also received a left internal thoracic artery graft) and 3.3±1.1 vein grafts in group B. All patients in group B and 3/15 (20%) in group A underwent intraaortic balloon counterpulsation. In-hospital death occurred in 1/15 (6.7%) patients of group A and in 4/8 (50%) patients of group B. At a mean follow-up of 4.1±3.4 months for group A and of 3.9±2.2 months for group B left ventricular ejection fraction was 43.4±9.0% in group A and 35.7±13.1% in group B. Conclusions: Experience of 9 months with this prospective protocol showed its effectiveness in the management of critically ill patients with acute coronary occlusion leading to low mortality rate in acute myocardial infarction and improved survival rate in post-infarction cardiogenic shock.
    European Journal of Cardio-thoracic Surgery - EUR J CARDIO-THORAC SURG. 01/1997; 11(2):228-233.
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    ABSTRACT: In this paper we describe 1-year experience with a perspective operative protocol of emergency myocardial revascularization in extensive acute myocardial infarction (AMI). Entry criteria were: age < 75 years; anterior AMI with ST segment elevation > 4 leads, infero-postero-lateral or inferior and right ventricular AMI, within 6 hours from symptom onset. After coronary arteriography, an emergency staff, composed by cardiologists and cardiac surgeons, addresses the patients to coronary artery bypass grafting (CABG) or to percutaneous transluminal coronary angioplasty (PTCA). From November 1994 to November 1995, 35 patients were enrolled: 19 (mean age 54.3 +/- 9.7 years) underwent CABG and 16 were treated with PTCA. Myocardial protection was such as to restore energetic substrates and to prevent reperfusion injury: surgical technique consisted of antegrade-retrograde substrate-enriched blood cardioplegic solution delivery, early cardioplegic delivery on the infarcting area via a saphenous graft, retrograde controlled reperfusion before aortic unclamping and then prolonged reperfusion of the infarcted myocardium. In 8 patients (mean age 50.9 +/- 8.6 years), with anterior AMI and stable hemodynamics, a left internal thoracic artery graft was used, performing the prolonged controlled reperfusion retrogradely before aortic unclamping. In hospital death occurred in 1/19 (5.3%) patients because of cerebral hemorrhage. At a mean follow-up of 5.1 +/- 3.7 months 17 patients (94.4%) were in NYHA functional class I-II and 1 patient (5.6%) complained of effort angina, that was well controlled with medical therapy. Left ventricular ejection fraction calculated by echocardiography preoperatively, before discharge and at follow-up was respectively 39.3 +/- 12.7, 43.1 +/- 8.9 and 43.4 +/- 9.0%. In the last 8 consecutive patients thermodilution and transesophageal echocardiography monitoring were performed preoperatively and 12 hours after CABG: in all cases ejection fraction and cardiac index increased after CABG, from 42.2 +/- 13.5 to 48.6 +/- 14.3% (p = 0.01) and from 2.8 +/- 0.5 to 3.4 +/- 0.6 l/min/m2 (p = 0.005), respectively. The preliminary results show the effectiveness of this perspective protocol in the management of critically ill patients with extensive AMI.
    Cardiologia (Rome, Italy) 12/1996; 41(11):1089-95.
  • Circulation 01/1996; 94(8):2787-2787. · 15.20 Impact Factor