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Alessandro Castiglioni

Publications and source records attributed to Alessandro Castiglioni.

10 recordsLinked to original sources
PubMed2006

Minimally invasive mitral valve repair as a routine approach in selected patients.

OBJECTIVE: To report our experience with minimally invasive mitral valve repair. METHODS: From 1999 to 2003,104 patients underwent mitral valve repair through a right anterolateral minithoracotomy. Most of them were in New York Heart Association functional class I-Il, had normal ejection fraction and were in sinus rhythm. Eighty-five patients suffered from severe mitral regurgitation due to degenerative disease (n = 82) or healed endocarditis (n = 3) and 19 patients had severe mitral stenosis. Sixty-two patients underwent edge-to-edge repair due to anterior/bileaflet prolapse, 23 had a quadrangular resection of the posterior leaflet and 19 a commissurotomy. RESULTS: No conversions to sternotomy were necessary. Mean cardiopulmonary bypass and aortic cross-clamp times were 75 +/- 14 and 54 +/- 8 min, respectively. Median mechanical ventilation and intensive care unit stay times were 6 and 13 h, respectively. No in-hospital deaths and no major postoperative complications occurred. At a mean follow-up of 27.4 +/- 10.6 months, all patients but two were in New York Heart Association functional class I. The survival rate was 100% and freedom from reoperation was 95.2 +/- 3.3% at 4 years. No or mild residual mitral regurgitation was detected at echocardiography in 100 patients (96%) and moderate insufficiency was found in two (1.9%). The degree of satisfaction in terms of cosmetic result and postoperative discomfort was very high. CONCLUSIONS: Mitral valve repair can be effectively performed through a minimally invasive approach achieving excellent mid-term results and a high degree of patient satisfaction in terms of comfort, cosmetic result and prompt recovery. At our institution, this approach has now become the standard procedure for mitral valve disease in young and active patients.

Adolescent↗
PubMed2006

[Conventional surgery for congestive heart failure].

Congestive heart failure is a major public health problem in western countries. Although substantial efforts have been made in the last decades in the prevention, diagnosis and treatment of cardiovascular disease, the incidence of end-stage dilated cardiomyopathy is still increasing. Heart transplantation represents the most effective therapy in this setting, but due to shortage of donors, it remains a realistic option just for a very small number of patients. Therefore, conventional surgical treatment for end-stage heart disease has gained increasing attention in recent years and a variety of surgical interventions have been improved or optimized to manage the multifactorial pathophysiology of the heart failure picture. The aim of this review is to report our experience with more than 500 patients with advanced dilated cardiomyopathy, treated with conventional surgical procedures such as myocardial revascularization, left ventricular restoration, mitral valve repair and surgical ablation of atrial fibrillation. Indications, results, controversial issues and future perspectives will be discussed.

Adult↗
PubMed2005

Automatic intraaortic balloon pump timing using an intrabeat dicrotic notch prediction algorithm.

PURPOSE: The efficacy of intraaortic balloon counterpulsation (IABP) during arrhythmic episodes is questionable. A novel algorithm for intrabeat prediction of the dicrotic notch was used for real time IABP inflation timing control. DESCRIPTION: A windkessel model algorithm was used to calculate real-time aortic flow from aortic pressure. The dicrotic notch was predicted using a percentage of calculated peak flow. Automatic inflation timing was set at intrabeat predicted dicrotic notch and was combined with automatic IAB deflation. EVALUATION: Prophylactic IABP was applied in 27 patients with low ejection fraction (< 35%) undergoing cardiac surgery. Analysis of IABP at a 1:4 ratio revealed that IAB inflation occurred at a mean of 0.6 +/- 5 ms from the dicrotic notch. In all patients accurate automatic timing at a 1:1 assist ratio was performed. Seventeen patients had episodes of severe arrhythmia, the novel IABP inflation algorithm accurately assisted 318 of 320 arrhythmic beats at a 1:1 ratio. CONCLUSIONS: The novel real-time intrabeat IABP inflation timing algorithm performed accurately in all patients during both regular rhythms and severe arrhythmia, allowing fully automatic intrabeat IABP timing.

Aged↗
PubMed2005

Acute decrease of left ventricular mechanical dyssynchrony and improvement of contractile state and energy efficiency after left ventricular restoration.

OBJECTIVE: Surgical left ventricular restoration by means of endoventricular patch aneurysmectomy in patients with postinfarction aneurysm should result in acute improved left ventricular performance by decreasing mechanical dyssynchrony and increasing energy efficiency. METHODS: Nine patients with left ventricular postinfarction aneurysm were studied intraoperatively before and after ventricular restoration with a conductance volume catheter to analyze pressure-volume relationships, energy efficiency, and mechanical dyssynchrony. The end-systolic elastance was used as a load-independent index of contractile state. Left ventricular energy efficiency was calculated from stroke work and total pressure-volume area. Segmental volume changes perpendicular to the long axis were used to calculate mechanical dyssynchrony. Statistical analysis was performed with the paired t test and least-squares linear regression. RESULTS: Endoventricular patch aneurysmectomy reduced end-diastolic volume by 37% (P < .001), with unchanged stroke volume. Systolic function improved, as derived from increased +dP/dt(max), by 42% (P < .03), peak ejection rate by 28% (P < .02), and ejection fraction by 16% (P < .0002). Early diastolic function improved, as shown by reduction of -dP/dt(max) by 34% (P < .006) and shortened tau by 30% (P < .001). Left ventricular end-systolic elastance increased from 1.2 +/- 0.6 to 2.2 +/- 1 mm Hg/mL (P < .001). Left ventricular energy efficiency increased by 36% (P < .002). Left ventricular mechanical dyssynchrony decreased during systole by 33% (P < .001) and during diastole by 20% (P < .005). CONCLUSIONS: Left ventricular restoration induced acute improvements in contractile state, energy efficiency, and relaxation, together with a decrease in left ventricular mechanical dyssynchrony.

Aged↗
PubMed2004

Surgical options in ischemic cardiomyopathy.

The prevalence of ischemic dilated cardiomyopathy in western countries is increasing despite improvements in prevention, diagnosis, and treatment of cardiovascular disease. The management of patients with coronary artery disease and severe left ventricular dysfunction continues to be challenging and the mortality rate with medical therapy alone in this setting remains very high. Since heart transplantation represents a realistic option just for a very small number of patients, in recent years a variety of classic surgical interventions have been improved or optimized to address the complex and multifactorial pathophysiology of the ischemic heart failure picture. Myocardial revascularization, left ventricular restoration, mitral valve repair, passive containment device implantation, and surgical ablation of atrial fibrillation represent some of the "conventional" procedures which are currently in use or under development for the surgical treatment of ischemic cardiomyopathy. For several of them, the exact indications and results are not yet established and significant changes and improvements should reasonably be waited over the next few years. As techniques are refined and more data become available, the optimum surgical strategy for patients with advanced ischemic heart failure is likely to become clearer and more effective.

Atrial Fibrillation↗
PubMed2004

[Off-pump endovascular treatment of aortic arch aneurysms].

BACKGROUND: Traditional repair of aortic arch aneurysms requires cardiopulmonary bypass, hypothermia and circulatory arrest. Endovascular repair is an attractive, less invasive alternative that may change our therapeutic approach. The aim of this study was to review our clinical experience with endovascular treatment of aortic arch aneurysms and to address the new problems in this area. METHODS: In the last 5 years, we treated 21 patients for aortic arch pathology with an "off-pump" endovascular repair (18 men, 3 women, mean age 71.4 +/- 7.2 years). We used 26 stent grafts (5 Gore Excluder TAG, 3 Endomed Endofit, 6 Medtronic Talent, 12 Cook Zenith TX1) with a mean of 1.2 graft/patient. Proximal fixation of endograft was achieved by means of aortic "de-branching" in 11 cases. In 10 cases the left subclavian artery was intentionally covered without revascularization. Follow-up included clinical examination, chest X-ray and computed tomography at discharge and at 6-month intervals thereafter. RESULTS: Technical success was 85% (18/21). There was one in-hospital death (4.7%) due to endograft migration. We observed 2 cases of type I endoleak (9.5%). One surgical conversion was performed 2 weeks after the procedure, because of total collapse of the stent graft with rupture of three stents. No complications related to the coverage of the left subclavian artery were observed. At a mean follow-up of 18.7 +/- 12.8 months, no mortality or morbidity including new-onset endoleak, stent-graft migration and thrombosis of supra-aortic grafts were recorded. CONCLUSIONS: Endovascular treatment of aortic arch pathology is feasible even in elderly patients. However, accurate placement in the arch and aneurysm sealing with the currently available devices, may be challenging due to the involvement of supra-aortic vessels, the anatomical curvature of the arch, the high blood flow, and substantial movement of the aorta with each heartbeat.

Aged↗
PubMed2003

Cardiopulmonary bypass strategy during concomitant surgical treatment of mitral valve disease and atrial fibrillation.

In recent years, the popularity of simplified intraoperative ablation approaches to treat atrial fibrillation (AF) has been progressively increasing. Our group has described a left atrial procedure based on epicardial radio frequency ablation on cardiopulmonary bypass (CPB). We report our CPB and myocardial protection strategy in 157 patients who underwent AF ablation combined with open-heart surgery from February 1998 to February 2002. Since epicardial ablations are performed on CPB on the beating heart, the CPB strategy is crucial. Total normothermic CPB allows a safe dissection around the pulmonary veins on the decompressed heart; after the ablating catheter has been positioned, an adequate filling of the left atrium favours a uniform contact with the atrial wall. After crossclamping, low-flow retrograde cardioplegia delivery is administered while ablating endocardially to protect the main coronary arteries in the atrio-ventricular groove from radio frequency-related trauma. All patients were successfully weaned from CPB. Sinus rhythm was restored in 152 of 157 (96.8%) patients immediately after surgery. No procedure-related complications were recorded. Epicardial ablations allowed us to reduce significantly the aortic crossclamping time required for ablations. The conduct of CPB and myocardial protection play a central role in the surgical strategy by improving intraoperative feasibility and effectiveness of radio frequency ablation and preventing some of the potential postoperative complications related to the procedure.

Aged↗
PubMed2002

Surgical restoration of the left ventricle for postinfarction aneurysm.

BACKGROUND: Surgical left ventricular reduction is under investigation as an alternative to, or a bridge for, heart transplantation in patients with a left ventricular aneurysm. In fact, acute myocardial infarction can result in the development of a dyskinetic or akinetic left ventricular aneurysm which may in turn cause congestive heart failure, ventricular arrhythmias, and the formation of mural thrombi. The aim of this study was to evaluate the current operative risk of surgical restoration of the left ventricle and the early and late clinical results. METHODS: From January 1997 to December 2001, 94 patients (84 males and 10 females) presenting with a postinfarction aneurysm were submitted to surgical restoration of the left ventricle. All patients presented with symptoms of heart failure and/or angina. The preoperative NYHA functional class was: I in 6 patients, II in 22 patients, and III in 66 patients. No patient was in NYHA class IV at the time of surgery. The preoperative ejection fraction was 30 +/- 7.9%. In 25 patients mural thrombi were identified and surgically removed. In patients with preoperative evidence of ventricular arrhythmias the Harken procedure was performed intraoperatively. The ventricular preoperative and postoperative performances were also studied in 10 patients using P-V loops obtained through a conductance catheter. RESULTS: The in-hospital mortality was 3.2%. The mean length of hospitalization was 7 +/- 2.9 days. At follow-up (mean 26 +/- 14.8 months) we observed an early improvement in the ejection fraction (30 +/- 7.9 vs 48 +/- 8.0%) and a decrease in the end-diastolic and end-systolic volumes and mean pulmonary pressure (139 +/- 37 vs 84 +/- 17 ml/m2, 105 +/- 39 vs 52 +/- 20 ml/m2, 35 +/- 8.4 vs 23 +/- 4.3 mmHg). CONCLUSIONS: These results suggest that ventricular restoration is indicated in all patients with a postinfarction dyskinetic or akinetic aneurysm. The operation, if performed appropriately, is associated with a low in-hospital mortality and morbidity. A postoperative improvement in the early and long-term cardiac functions was demonstrated. An improvement in symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.

Cardiac Surgical Procedures↗
PubMedDate not supplied

Performance of a real-time dicrotic notch detection and prediction algorithm in arrhythmic human aortic pressure signals.

A novel algorithm for real-time detection and prediction of the dicrotic notch from aortic pressure waves was evaluated in arrhythmic aortic pressure signals from heart failure patients. A simplified model of the arterial tree was used to calculate real-time aortic flow from aortic pressure. The dicrotic notch was detected at the first negative dip from the calculated flow, prediction of the notch was performed using a percentage of the decreasing flow. The performance of the real-time dicrotic notch detection algorithm (RTDND) was evaluated during severe arrhythmia from aortic pressure signals of 12 patients. The RTDND was able to detect the dicrotic notch in 98.1%. No false positive dicrotic notch identifications were observed. Prediction of the dicrotic notch was tested at 40%, 20%, and 0% of the decreasing calculated aortic flow. The mean time-delays to the notch were 68 +/- 14 ms, 55 +/- 12 ms, and 43 +/- 8 ms, respectively. Given these small variability, intra-beat prediction of the dicrotic notch may be used for real-time intra-aortic balloon counterpulsation inflation timing.

Aged↗