Franco Glieca

The Catholic University of America, Washington, Washington, D.C., United States

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Publications (80)296.3 Total impact

  • The Annals of thoracic surgery 06/2015; 99(6):2255-2256. DOI:10.1016/j.athoracsur.2015.01.025 · 3.65 Impact Factor
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    ABSTRACT: After repair of acute type A aortic dissection, aortic complications can develop, and reoperations might be necessary. In our retrospective study, we wanted to assess early and late outcomes in this cohort of patients. From September 2005 to July 2012, 21 consecutive patients previously operated on for acute type A aortic dissection underwent 27 redo aortic surgical procedures. Indications for redo procedures were: enlargement of the false lumen in the residual aorta (18 events), severe aortic regurgitation with or without aortic root dilatation (8 events), suture dehiscence and pseudoaneurysm at the proximal or distal aortic graft anastomosis (5 events) or at the coronary button anastomosis in patients who previously underwent a Bentall procedure (1 patient). In all cases, total or partial cardiopulmonary bypass was used. Hypothermic cardiocirculatory arrest was needed in 22 (81%) procedures. Hospital mortality was 3.7% (1/27), reexploration for bleeding and paraplegia rates were 7.4% and 7.4%, respectively. Marfan patients received 3.2 procedures per patient vs. 1.5 in non-Marfan patients (p < 0.01). At a mean follow-up of 6.5 years, 2 aortic events occurred: 1 aortic death, and 1 additional aortic redo surgery. When procedures are carried out on elective basis, redo aortic surgery can be performed in all segments of the aorta with good early and late outcomes. Close lifelong clinical and radiological follow-up is mandatory. After repair of acute type A aortic dissection, Marfan patients are more prone to develop late complications, with a more rapid evolution. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
    Asian cardiovascular & thoracic annals 05/2015; DOI:10.1177/0218492315584523
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    ABSTRACT: To evaluate the preoperative presence of C-reactive protein (CRP) and troponin T(hs-TnT) in patients with coronary artery disease (CAD) undergoing cardiopulmonary bypass (CPB) in order to better clarify the role of atrial inflammation and/or myocardial ischemia in the development of postoperative atrial fibrillation (POAF). Prospective, nonrandomized study. University hospital. Thirty-eight consecutive ischemic patients admitted to the authors' hospital for CAD undergoing elective on-pump coronary artery bypass grafting (CABG). Elective on-pump CABG. Peripheral blood samples were collected from all patients before and 24 hours after CABG to assess high sensitive (hs)-CRP and troponin T (hs-TnT) levels. The patients' heart rhythm was monitored by continuous ECG telemetry. Biopsies from the right atrial appendage were obtained at the beginning of the CABG procedure in order to perform immunohistochemistry for CRP and reverse transcription polymerase chain reaction for CRP mRNA expression. Fourteen patients out of 38 (36%) developed POAF. Atrial CRP was found in 31 patients (82%), 10 with POAF and 21 with sinus rhythm (71% v 87% respectively, p = ns). None of the atrial samples was positive for CRP mRNA. Atrial CRP did not correlate with serum hs-CRP levels and with occurrence of POAF, but with the incidence of diabetes (p = 0.010). Postoperative hs-TnT levels, but not hs-CRP levels, were identified as the only predictor of POAF occurrence (p = 0.016). In patients undergoing CABG, neither peripheral nor tissue preoperative CRP levels, but only postoperative hs-TnT levels, correlated with POAF, suggesting the primary role of an ischemic trigger of atrial fibrillation.
    Journal of cardiothoracic and vascular anesthesia 10/2013; 28(3). DOI:10.1053/j.jvca.2013.06.002 · 1.48 Impact Factor
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    ABSTRACT: Epicardial adipose tissue (EAT) has a close functional and anatomic relationship with epicardial coronary arteries (1). Release of proinflammatory cytokines, associated with macrophage infiltration, have been demonstrated in EAT of patients with coronary artery disease (CAD), although without any distinction between chronic and acute manifestations of the disease. The present study aims to address whether a specific, immune-driven T-lymphocyte recruitment within EAT might be implicated in acute coronary syndrome (ACS) (1-3). We examined the T-cell receptor (TCR) repertoire using CDR3 BV-BC spectratyping (4-6) both in EAT samples (obtained during coronary artery bypass grafting) and in peripheral blood mononuclear cells of patients with either ACS (n=27) or CAD as chronic stable angina (n=26). Patients undergoing cardiac surgery for mitral insufficiency, with angiographically normal coronary arteries, served as control group (controls; n=10). We found T-cell clonotype expansions in EAT as compared with peripheral blood from each patient with ACS. The TCR repertoire in EAT samples of ACS patients was restricted, involving 6/21 (24%) analyzed TCR-BV families (BV3, BV6.2, BV7, BV9, BV10, BV12). In particular, we observed a disproportionately high expression of TCR-BV10 and BV6.2, as they were found in 12 (44%) and in 7 (26%) out of 27 EAT samples, respectively. Intriguingly, TCR-BV10 was strongly associated with the first clinical manifestation of ACS, as 11/18 (61%) patients at their first manifestation of ACS and 1/9 (11%) of those with previous acute coronary events expressed BV10 (P=0.019). Although the size of the repertoire used by CAD and control was comparable to that of ACS patients (7), it was characterized by different T-cell receptors. CAD patients expressed preferentially TCR-BV3 that was observed in 16/26 (62%) EAT samples, while BV10 and BV6.2 (both 8%) were less frequent (P<0.01 vs ACS). Controls expressed BV3 (30%) and BV9 (20%), but none had BV10 or BV6.2 (P<0.01 vs ACS). Thus, TCR-BV10 and BV6.2 usage was almost exclusively observed in patients at their first clinical manifestation of ACS, while TCR-BV3 was a prerogative of chronic CAD. For the first time, T-cell receptor repertoire was investigated directly into epicardial adipose tissue surrounding diseased coronary arteries. Using this approach, we demonstrated that coronary plaque instability in the setting of ACS is associated with immune-driven T-cell recruitment, not only within the plaque, but also in the surrounding adipose tissue, and that T-cells bearing selected TCRs might be involved in the pathogenesis of ACS.
    15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013.; 08/2013
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    ABSTRACT: The optimal cannulation site in repair of DeBakey type I aortic dissection is controversial, and malperfusion during cardiopulmonary bypass is facilitated by retrograde flow. We propose the use of a long arterial cannula through the femoral artery to achieve a proximal antegrade perfusion. The tip of the cannula is placed in the true lumen of the distal aortic arch through the common femoral artery (Seldinger technique and transesophageal echography guidance). In 9 patients, there was one case of operative mortality (cardiac death), and no cases of perioperative stroke, bowel ischemia, severe renal failure, or local complications. Proximal perfusion can achieved rapidly and through an easily accessible site.
    The Annals of thoracic surgery 02/2012; 93(2):e45-7. DOI:10.1016/j.athoracsur.2011.10.018 · 3.65 Impact Factor
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    ABSTRACT: Reoperations on the aortic root and the ascending aorta after previous aortic valve and proximal aortic surgery are increasingly frequent and highly demanding. The scarce comparability of the published series and the heterogeneity of clinical pictures contribute to the challenges of this subgroup. Forty-one patients (2004 to 2010) who were reoperated on the aortic root and the ascending aorta for aneurysmal, pseudoaneurysmal, or infectious disease were retrospectively analyzed from a prospectively filled-in database. Mean logistic European system for cardiac operative risk evaluation was 29.8%. At index reoperation, procedures were classic Bentall (51%), prosthesis-sparing operation (17%), supracoronary ascending aortic replacement plus aortic valve replacement-repair (22%), and root replacement using valved homografts (9.7%). Distally, the operation involved the arch in 51% of cases (17 hemiarch replacement, 4 total transverse arch, 3 elephant trunk). Operative mortality was 12% and rate of major operative morbidity was 17%. At a mean 26-months follow-up, the patients surviving the operation had a good survival and functional class. The rate of adverse events during the follow-up was acceptable. Reoperations on the aortic root-ascending aorta in the elective patients have respectable operative mortality-morbidity despite the high-risk profile, and are justified by the excellent follow-up survival. The mortality can be diminished by integrated surgical strategies and optimal myocardial protection. Our findings encourage complete resection of borderline dilated ascending aortic-root tissue at primary and redo operation.
    The Annals of thoracic surgery 09/2011; 92(3):898-903. DOI:10.1016/j.athoracsur.2011.04.116 · 3.65 Impact Factor
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    ABSTRACT: This study was conceived to describe the evolution of aortic dimensions in patients with moderate post-stenotic ascending aorta dilation (50 to 59 mm) submitted to aortic valve replacement (AVR) alone. The appropriate treatment of post-stenotic ascending aorta dilation has been poorly investigated. Ninety-three patients affected by severe isolated calcific aortic valve stenosis in the tricuspid aortic valve accompanied by moderate dilation of the ascending aorta (50 to 59 mm) were submitted to AVR only. All patients were followed for a mean of 14.7 ± 4.8 years by means of periodic clinical evaluations and echocardiography and tomography scans of the thorax. Operative mortality was 1.0% (1 patient). During the follow-up, 16 patients died and 2 had to be reoperated for valve dysfunction. No patients experienced acute aortic events (rupture, dissection, pseudoaneurysm), and no patient had to be reoperated on the aorta. There was not a substantial increase in aortic dimensions: mean aortic diameter was 57 ± 11 mm at the end of the follow-up versus 56 ± 02 mm pre-operatively (p = NS). The mean ascending aorta expansion rate was 0.3 ± 0.2 mm/year. In the absence of connective tissue disorders, AVR alone is sufficient to prevent further aortic expansion in patients with moderate post-stenotic dilation of the ascending aorta. Aortic replacement can probably be reserved for patients with a long life expectancy.
    Journal of the American College of Cardiology 08/2011; 58(6):581-4. DOI:10.1016/j.jacc.2011.03.040 · 15.34 Impact Factor
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    ABSTRACT: We evaluated the prevalence of asymptomatic carotid artery disease in patients scheduled for valvular cardiac surgery. Preoperative screening of the carotid arteries was performed. Among 1012 patients scheduled for valvular cardiac surgery, 267 (26.4%) had carotid stenosis graded >50%; 37 had carotid stenosis >70% and underwent combined valvular surgery and carotid endarterectomy (CEA); and 230 (86%) had carotid stenosis >50% to ≤ 69% and received valvular cardiac surgery under hypothermic cardiopulmonary bypass. Operative mortality and the rate of perioperative adverse neurological events were comparable among the groups. During 6.8 years of follow-up, patients with carotid stenosis not exceeding 69% at the time of surgery had CEA more frequently (P < .05) and stroke/transient ischemic attack ([TIA] P < .05) versus patients treated with combined surgery. The prevalence of asymptomatic carotid stenosis is not negligible in patients undergoing isolated valvular surgery. Combined valvular and carotid surgery is safe and reduces the incidence of CEA and stroke/TIA during follow-up.
    Angiology 06/2011; 63(3):171-7. DOI:10.1177/0003319711409921 · 2.37 Impact Factor
  • Atherosclerosis Supplements 06/2011; 12(1):7-7. DOI:10.1016/S1567-5688(11)70030-7 · 9.67 Impact Factor
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    ABSTRACT: We aimed to give an overview of the contemporary status of aortic valve replacement. This single-center prospective study was initiated in January 2003. From this date on, every patient with aortic valve disease admitted to our hospital was reviewed by a cardiologist and a surgeon to determine eligibility for replacement. In no instance was the operation denied in the absence of surgical consultation. All operations were performed using a median sternotomy, with cardiopulmonary bypass and cardioplegic arrest. A total of 873 cases were screened until the end of the study. We identified three groups of patients: Group 1 (inoperable cases) consisted of 15 patients (1 %); Group 2 (high-risk cases) included 99 patients with an additive EuroSCORE ≥ 10 or an expected mortality > 20 % (logistic model); Group 3 (moderate- to low-risk cases) consisted of 759 patients with an additive EuroSCORE < 10 or an expected mortality < 20 %. In-hospital mortality was 6.0 % (6/99) for Group 2 and 0.3 % (3/759) for Group 3. Major complications occurred in 5 patients of Group 2 (5 %) and in 9 patients of Group 3 (1.1 %). At predischarge echocardiography, 99.3 % of the implanted valves were perfect. At a follow-up of 28.9 ± 12.3 months 798/849 patients were alive; 89 % of them (711) were in NYHA 1-2. Surgical aortic valve replacement provides excellent results and has a low operative mortality even in high-risk patients. Surgical consultation for every aortic patient resulted in an extremely low rate of surgery refusals. Our data should be regarded as a benchmark for transcatheter techniques.
    The Thoracic and Cardiovascular Surgeon 03/2011; 59(4):229-32. DOI:10.1055/s-0030-1250640 · 1.08 Impact Factor
  • Journal of endocrinological investigation 02/2011; 34(2):164-5. DOI:10.1007/BF03347050 · 1.55 Impact Factor
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    ABSTRACT: (J Card Surg 2010;25:696-697)
    Journal of Cardiac Surgery 10/2010; 25(6):696-7. DOI:10.1111/j.1540-8191.2010.01082.x · 0.89 Impact Factor
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    ABSTRACT: Immune-driven T-lymphocyte recruitment within epicardial adipose tissue EAT might be implicated in acute coronary syndrome (ACS).We examined the T-cell receptor (TCR) repertoire using CDR3 BV-BC spectratyping both in EAT samples (obtained during coronary artery bypass grafting) and in PBMC of patients with either ACS (27) or chronic stable angina (SA; 26). Patients undergoing cardiac surgery for mitral insufficiency, with angiographically normal coronary arteries, served as control group (10). The TCR repertoire in EAT samples of ACS patients was restricted, involving 24% analyzed TCR-BV families. In particular, we observed a disproportionately high expression of TCR-BV10 and BV6.2, as they were found in 44% and 26% out of 27 EAT samples, respectively. Intriguingly, TCR-BV10 was strongly associated with the first clinical manifestation of ACS: 61% of patients at their first manifestation and 11% with previous acute coronary events (P=0.019). Although the size of the repertoire used by SA and control was comparable to that of ACS patients, 62% SA patients expressed preferentially TCR-BV3 in EAT samples, while BV10 and BV6.2 (both 8%) were less frequent (P<0.01 vs ACS). Controls expressed BV3 (30%) and BV9 (20%), but none had BV10 or BV6.2 (P<0.01 vs ACS). Using an approach of investigation of TCRs directly into EAT, we demonstrated that coronary plaque instability in the setting of ACS is associated with immune-driven T-cell recruitment, not only within the plaque, but also in the surrounding adipose tissue, and that T-cells bearing selected TCRs might be involved in the pathogenesis of ACS.
    ESC, Stockolm, Sweden; 08/2010
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    ABSTRACT: To analyze the clinical features, surgical management and oncologic results of a series of six patients undergoing seven operations for resection of uterine leiomyoma extending into the right cardiac chambers. A retrospective review of patients operated on for surgical resection of a pelvic leiomyomatous mass originating from the uterus and extending into the right cardiac chambers was performed. The most common symptoms at presentation were syncope and dyspnea; two patients were asymptomatic. Four patients had been misdiagnosed as having intracardiac thrombus or primary cardiac tumor. The intracardiac and upper intracaval portion was removed under circulatory arrest in moderate hypothermia; the remaining portion was removed by caval incision. In one patient with cardiogenic shock, the sole intracardiac portion of the mass was removed at primary surgery. A mean of 2.8 +/- 1.5 years of follow-up was available, consisting of clinical and radiological tests (computed tomography scan, echocardiography). There were no cases of operative mortality in the present series. No recurrence was observed at the end of the follow-up in all cases of complete resection of the mass from its intracardiac to its pelvic end. Conversely, in the only case in which partial resection was performed due to the patient's clinical condition, recurrence of the intracardiac involvement was observed 6 months after primary surgery. Radical resection is curative for uterine leiomyomatosis extending into the right cardiac chambers. Surgery can be afforded with acceptable risks. A high level of suspicion for intracardiac extension of pelvic leiomyomatosis should be retained in the presence of a floating mass within the right cardiac chambers. Such a finding should prompt radiographic evaluation of the abdomen and the pelvis.
    Journal of Cardiovascular Medicine 02/2010; 11(8):583-6. DOI:10.2459/JCM.0b013e328337d856 · 1.51 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 06/2009; 139(3):785-7. DOI:10.1016/j.jtcvs.2009.04.009 · 3.99 Impact Factor
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    ABSTRACT: A computed tomography scan in a 43-year-old woman with a nonsignificant previous medical history demonstrated an inferior caval mass prolapsing through the right atrium and the tricuspid valve. The mass was misdiagnosed as a thrombus-in-transit, and heparin was started. The clinical picture suddenly evolved into cardiogenic shock, and the patient underwent an emergency resection of the intracardiac portion of the mass. Macroscopic and microscopic features were consistent with leiomyoma. In the presence of an inferior caval mass, historical elements and computed tomography imaging that do not corroborate the hypothesis of caval thrombosis should raise the suspicion of intracaval tumor originating from an abdominal or pelvic organ. The preferred treatment strategy is an elective combined thoracic and abdominal resection.
    The Annals of thoracic surgery 06/2009; 87(5):1589-92. DOI:10.1016/j.athoracsur.2008.09.077 · 3.65 Impact Factor
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    ABSTRACT: To evaluate a hemodynamic method for the assessment of the position of the retrograde cardioplegia catheter (RCC) versus conventional Manual Assessment. We randomized 200 patients undergoing aortic valve surgery to Manual (n = 101) or Hemodynamic Assessment (n = 99). In the Hemodynamic group a 25% pressure increase at the tip of the RCC when a fistula with the ascending aorta was created via a luer-lock was considered indicative of correct RCC placement. Transesophageal echocardiography was used as a comparison evaluation method. The Hemodynamic and Manual Assessment considered the RCC positioning successful in 89.9% versus 85.1% of cases. Echocardiography confirmed these results in Hemodynamic group but revealed 23 cases of misrecognized incorrect placement in the Manual group (p < 0.0001). Manual maneuvers resulted in 18 cases of secondary displacement and 19 cases of hemodynamic instability (p < 0.0001). The Hemodynamic Method is quantitative, reproducible, highly reliable, and safer than palpation in the posterior atrioventricular groove.
    Journal of Cardiac Surgery 11/2008; 23(6):638-41. DOI:10.1111/j.1540-8191.2008.00678.x · 0.89 Impact Factor
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    ABSTRACT: Myocardial apoptosis has been implicated in heart failure and post-infarct remodeling. In some patients with severe aortic stenosis, delayed valvular replacement is associated with a poor in-hospital outcome. The study aim was to evaluate the impact of cardiomyocyte apoptosis on the postoperative course after aortic valve replacement (AVR) for severe aortic stenosis. During elective AVR, myocardial biopsies were obtained from the left ventricle of 11 patients with severe left ventricular hypertrophy (LVH), and the samples analyzed for apoptosis. The mean apoptotic rate was 10.4 +/- 3.7 per thousand. (range: 5-16 per thousand). The apoptotic rate correlated directly with preoperative NYHA functional class, duration of intensive care unit (ICU) stay, number of days of postoperative acute renal insufficiency, and serum level of troponin T at 24 h; the apoptotic rate correlated inversely with cardiac index at 24 h postoperatively. At multivariate analysis, the apoptotic rate and left ventricular mass index were independent predictors of prolonged ICU stay. The apoptotic rate and duration of cardiopulmonary bypass were predictive of the duration of postoperative acute renal insufficiency. The study results showed an association between myocardial apoptosis and postoperative outcome in patients with severe LVH submitted for AVR. Non-invasive correlates of apoptosis may be introduced as a means of identifying patients at a higher operative risk, and may help in the evaluation of asymptomatic patients with severe aortic stenosis. Anti-apoptotic strategies before and during surgery would possibly ameliorate the surgical results.
    The Journal of heart valve disease 08/2007; 16(4):344-8. · 0.73 Impact Factor
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    ABSTRACT: This study was designed to evaluate if patients in whom in-stent restenosis developed had an higher risk of early venous graft failure compared with normal patients. The study cohort comprised 120 patients (60 with previous in-stent restenosis and 60 controls) who received a total of 165 complementary venous grafts on the circumflex or right coronary artery system (84 in the restenosis group and 81 in the control group). All patients were prospectively followed-up and underwent reangiography at 5-years follow-up. In the restenosis group, 28 venous grafts (33.%) were perfectly patent, 10 showed major irregularities, and 46 were occluded. In the control patients, 50 grafts (61.7%) were perfectly patent (p < 0.001 compared with the restenosis series), 12 showed major irregularities (p = .74), and 19 were occluded (p < 0.0001). In contrast, the 5-year outcome of internal thoracic artery grafts was not affected by history of in-stent restenosis. Patients who developed in-stent restenosis have an higher risk of early venous graft failure compared with the control patients. Arterial grafts should probably be preferred in these patients.
    The Annals of thoracic surgery 09/2006; 82(3):802-4. DOI:10.1016/j.athoracsur.2006.04.084 · 3.65 Impact Factor
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    ABSTRACT: Repeat heart valve operations have become a quite common procedure. We reviewed our experience with reoperative valvular surgery during a 6-year period to assess the risk factors affecting in-hospital mortality and medium-term survival. A series of 316 redo procedures performed on a total of 290 patients in the period between 1997 and 2002 at our institution was retrospectively analyzed. Univariate and multivariable analyses were performed. In-hospital mortality was 3.8%; overall mortality at the end of a 30-month follow-up was 9.3%. We identified advanced New York Heart Association class, advanced age, depressed ejection fraction, emergent or urgent presentation, impairment of renal function, and involvement of tricuspid valve as predictors of mortality. In contrast, duration of cardiopulmonary bypass and multiple valve procedure were not associated with increased short-term risk. The present study is characterized by particular attention in reducing confounding variables and biases correlated to heterogeneities. The main determinants of mortality are related to the degree of patients' illness rather than to inherent technical factors of reoperations. Although highest-risk individuals (previous coronary artery bypass grafting or coexistence of aortic aneurysm) were excluded from the study, our data suggest that patients undergoing isolated redo valvular procedures now face operative risks that are comparable to primary intervention.
    The Annals of thoracic surgery 05/2006; 81(4):1279-83. DOI:10.1016/j.athoracsur.2005.11.030 · 3.65 Impact Factor

Publication Stats

1k Citations
296.30 Total Impact Points

Institutions

  • 1997–2015
    • The Catholic University of America
      Washington, Washington, D.C., United States
  • 1998–2013
    • Catholic University of the Sacred Heart
      • School of Cardiac Surgery
      Milano, Lombardy, Italy
  • 1997–2002
    • Sacred Heart University
      Феърфилд, Connecticut, United States
  • 1990
    • Università degli Studi G. d'Annunzio Chieti e Pescara
      Chieta, Abruzzo, Italy