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Giovanni Battista Luciani

Publications and source records attributed to Giovanni Battista Luciani.

14 recordsLinked to original sources
PubMed2006

Clinical presentation is the main predictor of in-hospital death for patients with acute type A aortic dissection admitted for surgical treatment: a 25 years experience.

BACKGROUND: This retrospective analysis assessed the hypothesis that clinical status on admission more than other variables related to surgical or post-operative management may influence in-hospital mortality after surgical treatment of acute type A aortic dissection. METHODS: Between January 1979 and April 2004, 311 patients, mean age of 59.5+/-13 years (range, 18 to 88 years), with acute type A aortic dissection were referred for surgery. Logistic regression analysis was applied to demographics, etiological, clinical, and surgical variables, to identify independent predictors of in hospital death. RESULTS: In hospital mortality rate was 23%. Univariate analysis showed older age (p=0.03, OR1.02/yrs), cardiac tamponade (p=0.001; OR 2.43), hypotension (p=0.0001; OR 8), myocardial ischemia (p=0.005; OR 7), acute renal failure (p=0.0001; OR 4.16), limb ischemia (p=0.0002; OR 3.3), neurological deficits pre-op (p=0.0001; OR 8.5), and mesenteric ischemia (p=0.003) as independent predictors of in-hospital death. Multivariate analysis identified the following presenting variables as predictors of in-hospital death: hypotension (p=0.003; OR 7.4), myocardial ischemia (p=0.03; OR 5.8), mesenteric ischemia (p=0.009), acute renal failure (p=0.0001; OR 3.9), neurological deficits (p=0.0001; OR 7.7). In-hospital mortality for the group of patients presenting with at least one of the tested pre-operative complications (N=158; 51%) was 33% vs 12% (p=00001). No other variables emerged as significant for in-hospital death. CONCLUSION: In an era of standardized surgical technique, expeditious referral and intervention by lowering preoperative dissection-related complications and co-morbidities might represent the most efficacious tool to improve results.

Acute Disease↗
PubMed2006

Survival and quality of life after repair of acute type A aortic dissection in patients aged 75 years and older justify intervention.

OBJECTIVE: Controversy still exists about averting expenditure of health care resources on the growing elderly population. This study evaluates clinical outcome of patients aged 75 years and older operated upon for acute type A aortic dissection. METHODS: Between January 1990 and April 2004, of 247 patients undergoing emergency operation for acute type A aortic dissection at our Institution, 40 patients (16%) were aged 75 years and older (mean 78+/-3 years, range 75-88 years) and represent the study population. On admission, 9 (22.5%) had cardiogenic shock/hypotension, 20 (50%) cardiac tamponade, 14 (35%) kidney failure, 11 (27.5%) limb ischemia, 3 (7.5%) neurologic deficit, and 1 (2.5%) myocardial ischemia. Surgical procedures included isolated replacement of the ascending aorta in 34 patients (85%), associated with total root replacement in 5 (12.5%), and with aortic valve replacement in 1 (2.5%). Eleven patients (27.5%) underwent aortic arch replacement (hemiarch: n=8, 20%; total arch: n=3, 7.5%). RESULTS: In-hospital mortality was 30% (12 patients). Mortality tended to be higher (8/21, 38% vs 4/19, 21%; p=NS) for patients presenting with any one of the following complications: tamponade, shock, brain and/or myocardial, renal, limb malperfusion. Actuarial survival at 1, 5, and 7 years was 93+/-5%, 80+/-8%, and 80+/-8%, respectively, and freedom from reoperation 97+/-2%, 97+/-2%, and 97+/-2%, respectively. Actuarial event-free rates were 94+/-3%, 90+/-5%, and 90+/-5%. Seventy-four percent of survivors are in NYHA FC I, and quality of life test (RAND SF-36) revealed a generalized perception of independency and well-being, comparable to an age-matched population. CONCLUSIONS: Overall results for emergency repair of acute type A aortic dissection in the elderly justify intervention, particularly in uncomplicated cases. Expeditious referral and intervention by lowering pre-operative dissection-related complications and comorbidities might help to improve results. Survivors show functional status and quality of life similar to contemporary individuals.

Acute Disease↗
PubMed2006

Aortic root disease after the Ross procedure.

PURPOSE OF REVIEW: Autograft root pathology is the most common adverse event late after the Ross operation. Therefore, characterization of prevalence, risk factors and natural history of root disease, as well as identification of preventive and therapeutic strategies, is warranted. RECENT FINDINGS: Autograft root pathology affects up to one third of long-term survivors of the Ross operation. Root replacement technique and preoperative aortic aneurysm are recurrent risk factors. Any age group, except for infants, may be affected. Dilatation is often progressive leading to valve regurgitation, true aneurysm, and, rarely, dissection. Primary prevention involves avoidance of root technique, graft repalcement of aneurysmal aorta, or modifications of the root technique. Use of beta-receptor antagonist or angiotensin converting enzyme-inhibitors for secondary prevention is still empirical. Indications to resection of root aneurysm are based on maximum root area indexed to body height. Reintervention prior to appearance of relevant valve insufficiency increases likelihood of pulmonary valve preservation. Definition of functional outcome after autograft valve-sparing procedures needs longer follow-up. SUMMARY: Over a decade after worldwide embracement of the root replacement technique for the Ross procedure, autograft root pathology is emerging as a prevalent complication. Prophylactic and therapuetic strategies are proposed to mitigate the current and future impact of this phenomenon.

Aortic Aneurysm↗
PubMed2005

Tricuspid valve repair in an infant with multiple obstructive Candida mycetomas.

Neonatal fungal valve endocarditis is an uncommon and highly lethal disease. The ideal management strategy is still controversial. Current options include antifungal chemotherapy and surgical intervention, the latter being often limited by risks inherent with valve operations in low body weight infants. We present a case of a premature infant with multiple Candida tricuspid valve mycetomas. Eradication of infection was achieved by combined liposomal amphotericin therapy and complex tricuspid valve repair. Indications, technical aspects, and outcome of treatment in infants are reviewed.

Candida↗
PubMed2005

Ross operation in the young: a ten-year experience.

BACKGROUND: The Ross operation is an alternative to mechanical aortic valve replacement in the young. However, early and late complications after operation have been reported. In order to assess the role of the Ross operation in children and young adults, a 10-year clinical experience was reviewed. METHODS: Ninety male and 22 female patients, aged 29 +/- 10 years (range, 6-49) underwent cross-sectional clinic and echocardiographic examination. Indication for Ross operation was aortic regurgitation in 79 patients, stenosis in 11, and mixed lesion in 22; 82 (73%) had a bicuspid valve. Endpoints of the study were survival and freedom from autograft dilatation, from autograft and homograft dysfunction, and from reoperation. RESULTS: There was 1 (1%) hospital and 1 late (1%) death, during an average follow-up of 5.1 +/- 1.9 years (range, 0.1-10.6). At 10 years, survival was 98 +/- 2%. Late autograft dilatation was identified in 32 (29%) patients and regurgitation in 15 (14%), 7 of whom had autograft dilatation. Ten-year freedom from autograft dilatation was 43 +/- 8% and from regurgitation was 75 +/- 8%. Multivariate analysis showed younger age (p = 0.05), preoperative aortic root dilatation (p = 0.02), root replacement technique (p = 0.03), and absence of pericardial strip buttressing (p = 0.04) to be predictive of autograft dilatation. Eleven (10%) patients required reoperation on the autograft (8 prosthetic valve replacement, 3 autograft root repair). Ten-year freedom from reoperation was 72 +/- 10% and from replacement of the autograft was 88 +/- 5%. Pulmonary homograft obstruction was identified in 6 (5%) patients, requiring homograft replacement in 1. All but 2 (2%) patients were in New York Heart Association class I, with a return to regular school grade or active employment. CONCLUSIONS: Late outcome for the Ross procedure is excellent in terms of survival and quality of life. Late root dilatation, autograft regurgitation, and homograft stenosis, however, show increasing prevalence with time. Technical modifications of the procedure, yearly aortic root imaging, and early reintervention on the dilated neoaortic root may further enhance the durability of the autologous pulmonary valve.

Adolescent↗
PubMed2005

Reoperations for aortic aneurysm after the Ross procedure.

BACKGROUND AND AIM OF THE STUDY: Among late complications after the Ross operation, autograft dilatation is likely the most common. In order to define prevalence, consequences and management of autograft dilatation, a 10-year clinical experience was reviewed. METHODS: A total of 112 patients (mean age 29 +/- 10 years) underwent cross-sectional echocardiographic follow up. End-points of the study were freedom from autograft dilatation (diameter >4 cm, indexed as 0.21 cm/m2) and from reoperation for dilatation. Risk factors for autograft dilatation were also identified. RESULTS: There were 110 late survivors; average follow up was 5.1 +/- 1.9 years (range: 0.3 to 10.6 years). At 10 years, autograft dilatation was identified in 32 patients (29%), compatible with aortic aneurysm (>5.0 cm) in seven patients (6%). Seven of 32 patients (22%) presented moderate or greater autograft insufficiency. Ten-year freedom from dilatation was 43 +/- 8%, and from regurgitation was 75 +/- 8%. At multivariate analysis, preoperative aneurysm (p = 0.02), root replacement technique (p = 0.03) and absence of root buttressing (p = 0.04) were predictive of dilatation. Reoperation for autograft aneurysm was performed in five patients at a mean of 7.3 +/- 0.8 years after the Ross procedure, while two patients await reintervention. Two patients had root replacement and three remodeling with valve preservation (two root replacements, one sinotubular junction replacement): all survived reoperation. Ten-year freedom from root reoperation was 81 +/- 6%, and from full root replacement was 94 +/- 2%. CONCLUSION: With increasing follow up after the Ross operation, the incidences of root dilatation and reoperation are likely to rise. Graft replacement of coexisting aneurysm, avoidance of root replacement technique and the use of root-stabilization measures may reduce the prevalence of late root pathology. Early replacement of dilated autograft roots may allow preservation of the autologous pulmonary valve.

Adult↗
PubMed2004

Stentless aortic valve replacement: current status and future trends.

Stentless aortic xenografts were introduced into clinical practice as aortic valve substitutes over a decade ago. Stentless prosthetic valves were expected to provide enhanced durability and more physiologic hemodynamic behavior when compared with stented bioprostheses. Whilst the former expectation has not been fulfilled, partly due to concomitantly improved durability of second-generation stented bioprostheses, the latter has consistently been satisfied in early and late clinical observation. Evidence is accumulating suggesting improved long-term survival due to more timely and thorough regression of ventricular hypertrophy. In addition, stentless xenografts have shown extreme versatility when adopted in a variety of complex clinical conditions associated with aortic valve disease, including small aortic anulus, ascending aortic aneurysm, endocarditis and left ventricular dysfunction. Future research in the form of prospective, multicenter, randomized trials must address the issues of very long-term durability and survival, while simplification in valve design is required to promote wider use of stentless valves.

Aortic Valve↗
PubMed2004

Survival after stentless and stented xenograft aortic valve replacement: a concurrent, case-match trial.

BACKGROUND: In order to compare the long-term outcome of stented vs stentless aortic xenografts, a non-randomized, concurrent case-match trial was conducted on all consecutive patients operated between January 1992 and April 2000. METHODS: Two hundred and ninety-two patients had stented (group 1) and 376 stentless (group 2) xenograft aortic valve replacement (AVR). Group 1 patients were older (75.0 +/- 4.1 vs 70.4 +/- 6.7 years, p = 0.01), while male gender and aortic stenosis were equally prevalent. NYHA functional class III-IV (85 vs 78%, p = 0.03) and associated procedures (53 vs 41%, p = 0.01) were more common in group 1. The aortic cross-clamping (79.7 +/- 27.8 vs 96.1 +/- 23.3, p = 0.001) and bypass (91.4 +/- 57.5 vs 128.5 +/- 34.0, p = 0.002) times were shorter in group 1. A case-match analysis identified 113 identical patient pairs, on the basis of age, gender, diagnosis, NYHA class, associated cardiac disease, and valve size. RESULTS: The early mortality was higher in group 1 (5.3 vs 2.7%, p = 0.3), though not significantly. During follow-up (37 +/- 30 vs 43 +/- 35 months, p = 0.6), 26 late deaths were recorded (10.3 vs 13.6%, p = 0.4). The 8-year survival was comparable (76 +/- 7 vs 75 +/- 5%, p = 0.2), but freedom from cardiac (77 +/- 7 vs 90 +/- 4%, p = 0.02) and from valve-related death (78 +/- 7 vs 91 +/- 4%, p = 0.02) was higher in group 2. Freedom from structural deterioration (99 +/- 1 vs 98 +/- 2%, p = 0.7) and from reoperation (99 +/- 1 vs 95 +/- 3%, p = 0.2) at 8 years was similar. The late functional status was equally satisfactory (NYHA class I-II 92.7 vs 94.7%, p = 0.06). CONCLUSIONS: The survival free from cardiac and valve-related mortality when stentless xenografts for AVR are used is superior to that achieved with stented grafts. Stentless AVR has the potential of conferring selective survival advantages late after operation.

Aged↗
PubMed2003

Fate of the aortic root late after Ross operation.

BACKGROUND: The Ross operation is an alternative to mechanical aortic valve replacement in the young. Early dilatation of the pulmonary autograft root exposed to the systemic circulation has been reported. To define the prevalence of, risk factors for, and consequences of late autograft dilatation, outcome in all consecutive patients operated since May 1994 was reviewed. METHODS AND RESULTS: Ninety one patients, 77 males and 14 females, with at least 1 year of follow-up underwent cross-sectional clinical and echocardiographic examination. Age at operation was 27+/-10 years (range 6 to 49), and the indication was aortic regurgitation in 54 (59%) patients and bicuspid valve was present in 62 (68%). End-points of the study were freedom from autograft dilatation (root diameter >4 cm or 0.21 cm/m2), from (moderate) autograft regurgitation and from reoperation. Follow-up (4.0+/-1.9, range 1 to 8 years) autograft root diameters were anulus, 29+/-4 mm (18-39); sinus of Valsalva, 38+/-7 mm (24-53); sinotubular junction, 37+/-6 mm (23-54); and ascending aorta, 37+/-5 mm (27-54). Late autograft dilatation was identified in 31 (34%) patients and regurgitation in 13 (14%), 7 of whom had autograft dilatation. At 7 years, freedom from dilatation was 42+/-8%, freedom from regurgitation was 75+/-8%, and freedom from reoperation was 85+/-10%. Cox proportional hazard analysis identified younger age (P=0.05), preoperative sinus of Valsalva (P=0.02), root replacement technique (P=0.03), and absence of pericardial buttressing (P=0.04) as predictive of autograft dilatation, whereas female sex (P=0.002), follow-up sinus of Valsalva (P=0.003), and sinotubular junction diameter (P=0.02) as predictive of autograft regurgitation. CONCLUSIONS: Autograft dilatation is common late after the Ross procedure, particularly in younger patients, in those with preoperative aortic aneurysm, and those having root replacement without support of anulus and sinotubular junction. Bicuspid aortic valve is not a risk factor. Significant autograft valve dysfunction affects a minority of patients, but it is more prevalent in those with autograft dilatation.

Adolescent↗
PubMed2002

Survival after stentless and stented xenograft aortic valve replacement: a concurrent, controlled trial.

BACKGROUND: To define the impact of stentless versus stented valve design on survival late after xenograft aortic valve replacement, a retrospective analysis of all consecutive patients operated on between January 1992 and April 2000 was undertaken. METHODS: Two hundred ninety-two patients had stented (group 1) and 376 stentless (group 2) xenograft aortic valve replacements. Age was older in group 1 (75 +/- 4 vs 70 +/- 7 years, p = 0.01), whereas male gender and aortic stenosis were equally prevalent. Advanced New York Heart Association class III-IV (85% vs 78%, p = 0.03) and associated procedures (53% vs 41%, p = 0.01) were more common in group 1. Aortic cross-clamp (80 +/- 28 vs 96 +/- 23 minutes, p = 0.01) and bypass (91 +/- 56 vs 129 +/- 34 minutes, p = 0.01) times were shorter in group 1. Logistic regression and Cox proportional hazard methods were used to define the role of demographic and operative variables on hospital and late survival, freedom from valve-related mortality, and reintervention. RESULTS: Early mortality was higher in group 1 (6.2% vs 2.6%, p = 0.02). Smaller aortic anulus (p = 0.008), aortic cross-clamp (p = 0.03), and coronary disease requiring bypass (p = 0.03) were associated with hospital mortality. During follow-up (37 +/- 30 vs 43 +/- 35 months, p = NS), 66 late deaths were recorded (12% vs 9%, p = NS). At 8 years, survival (70 +/- 5% vs 81 +/- 3%, p = 0.01), freedom from cardiac- (85 +/- 1% vs 92 +/- 3%, p = 0.02), and valve-related death (79 +/- 5% vs 95 +/- 2%, p = 0.004) were higher in group 2. Freedom from structural deterioration was similar (92 +/- 5% vs 93 +/- 3%, p = NS), but freedom from reoperation was lower in group 2 (99 +/- 1% vs 90 +/- 4%, p = 0.009). Multivariate analysis showed female gender (p = 0.02), age (p = 0.03), and smaller valve size (p = 0.05) to be associated with late mortality; age (p = 0.06) and diagnosis of aortic stenosis (p = 0.008) with cardiac mortality; longer intensive care unit stay (p = 0.001) and stented xenografts (p = 0.05) with valve-related mortality; and younger age (p = 0.01) and stentless xenograft (p = 0.05) with reoperation. CONCLUSIONS: Use of stentless xenografts correlates with better survival and freedom from cardiac- and valve-related mortality than stented valves. However, bias favoring stented valves in older and sicker patients exists. Selective survival advantage of stentless xenograft is confined to valve-related mortality. Stentless valves are more likely to be replaced for dysfunction.

Aged↗
PubMed2002

The CarboMedics prosthetic heart valve: experience with 1,084 implants.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate our clinical experience with the CarboMedics heart valve prosthesis. METHODS: Between October 1991 and December 2000, 942 consecutive patients (514 males, 428 females; mean age 58+/-11 years; range: 6-78 years) underwent mechanical valve implantation with the CarboMedics prosthesis. Preoperatively, 47% of patients were in NYHA class III and 22% in class IV; in addition, 134 patients (14.2%) had undergone a previous cardiac operation. Aortic valve replacement (AVR) was performed in 469 patients (49.8%), mitral valve replacement (MVR) in 330 (35.0%), double valve replacement (DVR) in 142 (15.1%), and isolated tricuspid valve replacement (TVR) in one patient. Eighty-eight patients (9.3%) underwent associated myocardial revascularization. Mean cardiopulmonary bypass and aortic cross-clamp times for the entire group were 107+/-39 min and 74+/-24 min, respectively. RESULTS: Overall early mortality was 2.3% (6/469 AVR, 1.2%; 12/330 MVR, 3.6%; 4/142 DVR, 2.8%). Late mortality was 3.1% (n = 29; including 17 cardiac deaths (10 were valve-related). Mean follow up was 66+/-31 months (range: 1-109 months), and was 98% complete yielding a total follow up of 4959 years. Actuarial survival at five years for the entire group was 89.3+/-1.6% (AVR 91.1%, MVR 86.4%, DVR 90.5%). Thromboembolism occurred in 26 patients (2.8%, 0.52%/pt-year) and major hemorrhagic events in 20 (2.1%, 0.4%/pt-year). Nine patients (0.9%) required a reoperation, in three cases (0.3%) after Staphylococcus epidermidis-mediated endocarditis. No structural deterioration occurred. Among 891 survivors, 94% of the patients are currently in NYHA classes I or II (p <0.05). CONCLUSION: This study confirmed the safety and reliability of the CarboMedics mechanical valve prosthesis, even in old age groups. This bileaflet prosthesis showed no structural deterioration, and a low incidence of overall complications.

Adolescent↗
PubMed2002

The ross procedure for replacement of the bicuspid aortic valve: mid-term results from 55 consecutive cases.

BACKGROUND AND AIM OF THE STUDY: A congenitally dysfunctioning bicuspid aortic valve may require surgical treatment in children and young adults. This retrospective study evaluated mid-term clinical results obtained with the Ross procedure in this patient group. METHODS: Between July 1994 and December 2000, 55 patients (48 males, seven females; mean age 27+/-10 years; range: 7-49 years) underwent replacement of a diseased bicuspid aortic valve (stenosis in six cases (11%); insufficiency in 36 (65%); mixed lesion in 13 (24%)) with a pulmonary autograft. Mean NYHA functional class was 1.7. Five patients (9%) had healed endocarditis and six (11%) had previous cardiac surgery. The autograft was inserted as a subcoronary implant in two cases (4%), as a root in 40 (73%), and as a cylinder in 13 (23%). The right ventricular outflow tract was reconstructed with a cryopreserved pulmonary homograft in all cases. Mean cardiopulmonary bypass and aortic cross-clamp times were 207+/-34 min and 162+/-18 min, respectively. RESULTS: No early or late deaths had occurred at a mean follow up of 31+/-19 months. Two patients (4%) were re-explored for bleeding. Four patients (7%) experienced intraoperative coronary complications which resolved without sequelae. Two-dimensional echocardiographic evaluation of neoaortic valve competence at six months revealed no evidence of aortic valve regurgitation in 46 patients (84%), trivial regurgitation in seven (13%), mild regurgitation in one patient (2%), and moderate regurgitation in one patient. The latter patient (subcoronary implant) required reoperation. At six months, the degree of regression of left ventricular mass compared (versus preoperative) was 34+/-13% (p <0.05). Three patients (5%) showed mild dilatation (>4 cm) of the neoaortic root after two years follow up. All patients are currently asymptomatic, in NYHA class I, and enjoy a normal social lifestyle. CONCLUSION: The Ross procedure may be offered as a low-risk alternative in adolescents and young adults with a bicuspid aortic valve. Although the inclusion cylinder technique might help to prevent root dilatation, continued patient evaluation with regard to root sizing, evidence of neoaortic valve degeneration and homograft dysfunction is required in the long term.

Adolescent↗