Publications (3)4.55 Total impact
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Article: Fate of the aortic valve after root reconstruction in type A aortic dissection: a 20-year follow up.
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ABSTRACT: The study aim was to evaluate the fate of the aortic valve after root reconstruction in acute type A aortic dissection. Between 1982 and 2006, a total of 373 consecutive patients underwent emergency surgery for acute type A aortic dissection at the authors' institution. Of these patients, 298 (mean age 63 +/- 11 years; range: 22-85 years) underwent replacement of the supracoronary aorta with root reconstruction. The mean follow up period was 6.9 +/- 5.2 years (range: 2 months to 23 years), and was 98% complete. Aortic valve function was assessed by the incidence of aortic valve reoperation and transthoracic echocardiography. The 30-day mortality was 27% (82/298). Survival was 80%, 57% and 49% at five, 10 and 15 years, respectively. For survivors at the latest follow up, freedom from moderate or severe aortic regurgitation (AR) was 93%, 84% and 72% at five, 10 and 15 years, respectively. Four patients had severe AR but were not reoperated on. Among 200 patients discharged, 13 (6.5%) were reoperated on for severe AR, with an operative mortality of 15% (n = 2). Freedom from aortic valve replacement was 97%, 92% and 84% at five, 10 and 15 years, respectively. Cox regression analysis identified age < or = 59 years (p = 0.0201) and 'low-volume surgeon' (p = 0.0004) as risk factors for recurrent moderate or severe AR. The study results showed that, when the aortic dissection involves the aortic root, supracoronary replacement of the ascending aorta with a root reconstruction allows preservation of the aortic valve in the majority of patients, with a satisfactory long-term outcome.The Journal of heart valve disease 09/2009; 18(5):507-13. · 0.81 Impact Factor -
Article: Outcomes after surgical treatment for type A acute aortic dissection in octogenarians: a multicenter study.
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ABSTRACT: Management of octogenarian patients with acute type A acute aortic dissection is controversial. This study analyzed the surgical outcomes to identify patients who should undergo operations. Beginning January 2000, we established a registry including all octogenarian patients operated on for type A acute aortic dissection. We evaluated 57 consecutive patients enrolled up to December 2006. Their median age was 82 (range, 80 to 89 years). Compassionate indication operations were attempted in 2 moribund patients and in 5 presenting with shock associated with neurologic symptoms or renal failure, or both. Operations followed the standard procedure recommended in younger patients. Follow-up was 100% complete (mean, 3.9 +/- 2 years; range, 5 months to 8 years). There were 26 (45.6%) in-hospital and 6 late deaths. Multivariate analysis identified compassionate indication (p < or = 0.0001) and total arch replacement (p = 0.0060) as risk factors for in-hospital mortality. Postoperative complications occurred in 36 patients (69.2%) and were associated with a higher mortality (p = 0.0001). Overall survival was 51% at 1 year and 44% at 5 years. Excluding patients with compassionate indication and those who underwent total arch replacement, or both, overall survival was 66% at 1 year and 57% at 5 years. Surgical treatment for type A acute aortic dissection in octogenarians shows satisfactory midterm results among survivors. However, the high mortality rate imposes a requirement for better perioperative management. Compassionate cases should be managed medically. A less aggressive approach should improve outcomes of surgical treatment.The Annals of thoracic surgery 08/2009; 88(2):491-7. · 3.74 Impact Factor -
Article: [Endoscopic vein harvesting. Impact of learning curve on results and rehabilitation].
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ABSTRACT: The tendency of modern surgery is towards the reduction of invasiveness. The aim of this study is to evaluate the impact of the learning curve, the reliability, the short term results and the advantages in terms of rapid rehabilitation of endoscopic vein harvesting (EVH) in a consecutive series of 20 patients operated on of aorto-coronary bypass surgery. Between February and June 2005, 20 patients between 61 e 82 years of age underwent EVH with the use of Vasoview 5 (Guidant Corporation, Indianapolis, USA). To evaluate the impact of learning curve on the total operative time, patients were divided in 4 chronologically consecutive groups (G1, G2, G3, G4). Intraoperative characteristics and short term results were evaluated. The mean velocity and the mean time of harvesting in G4 were 0,68 cm/min and 45 min. respectively, similar to the time required for a scheletonized left internal mammary artery harvesting. In the first 5 patients 2 conversions were required, one of them related to the EVH technique. No bleeding, functional impairment or infective complications are reported. Active mobilization was possible in every case in the first post-operative day. EVH is a reliable technique and the learning curve can be limited to the first 5 cases. The foreseeble reduction of infectious complications, the absence of pain and the immediate mobilization of the leg allow a rapid and effective rehabilitation.Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 07/2005; 64(2):105-9.
