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Biomedical subjects

M A Mariani

Publications and source records attributed to M A Mariani.

At least 19 recordsLinked to original sources
PubMed2005

Endoventriculoplasty using autologous endocardium for anterior left ventricular aneurysms.

BACKGROUND: There is currently consensus that endoventriculoplasty is the treatment of choice for an anterior left ventricular aneurysm. We describe here a new technique of endoventriculoplasty using autologous endocardium for left ventricular anterior aneurysm. METHOD: From 1990 until 2003, 49 patients underwent endoventriculoplasty using autologous pericardium at the Thoraxcenter of the University Hospital of Groningen in the Netherlands (28 patients) and at the Department of Cardio Thoracic Surgery of the University Hospital of Pisa in Italy (21 patients). Mean logistic EuroSCORE and mean ejection fraction were 15.7 +/- 6.7 and 31 +/- 9 %, respectively. RESULTS: Overall 30-day mortality was 4.1 %. Causes of in-hospital mortality were low output syndrome (1 patient) and ventricular fibrillation (1 patient). Postoperative complications were myocardial infarct (4.1 %), low output syndrome (6.1 %), renal failure (4.1 %), neurological events (2.0 %), atrial fibrillation (14.3 %), ventricular fibrillation or tachycardia (6.1 %), ARDS (4.1 %), re-operation for bleeding (4.1 %), and major wound infection (2.0 %). CONCLUSION: Our analysis shows that endoventriculoplasty with autologous endocardium is a safe procedure and improves the outcome in high-risk patients with ventricular aneurysm.

Aged↗
PubMed2002

A high vascular count and overexpression of vascular endothelial growth factor are associated with unfavourable prognosis in operated small cell lung carcinoma.

It has been widely demonstrated that neo-angiogenesis and its mediators (i.e. vascular endothelial growth factor), represent useful indicators of poor prognosis in non small cell lung carcinoma. In order to verify whether neovascularization and vascular endothelial growth factor may be considered useful markers of clinical outcome also in the small cell lung cancer subgroup, we retrospectively investigated a series of 75 patients with small cell lung carcinoma treated by surgery between 1980 and 1990. Immunohistochemically-detected microvessels and vascular endothelial growth factor expressing cells were significantly associated with poor prognosis, as well as with nodal status and pathological stage. In fact, patients whose tumours had vascular count and vascular endothelial growth factor expression higher than median value of the entire series (59 vessels per 0.74 mm(2) and 50% of positive cells, respectively), showed a shorter overall and disease-free survival (P=0.001, P=0.001; P=0.008, P=0.03). Moreover, the presence of hilar and/or mediastinal nodal metastasis and advanced stage significantly affected overall and disease-free interval (P=0.00009, P=0.00001; P=0.0001, P=0.00001). At multivariate analysis, only vascular endothelial growth factor expression retained its influence on overall survival (P=0.001), suggesting that angiogenic phenomenon may have an important role in the clinical behaviour of this lung cancer subgroup.

Adult↗
PubMed2001

Current management of postoperative chylothorax.

BACKGROUND: This study was performed to review our experience with postoperative chylothorax and describe our current approach. In addition, we wanted to estimate the impact of video-assisted thoracoscopic surgery (VATS) on our current management policy. METHODS: From January 1991 to December 1999, 12 patients developed chylothorax after various thoracic procedures. Their mean age was 61.5 (range 31 to 80 years). The procedures were cardiac, aortic, and pulmonary operations. RESULTS: All patients were initially treated conservatively. In addition, 7 patients needed surgical intervention, including one thoracotomy and six VATS. The site of thoracic duct laceration was identified and treated with VATS in 4 patients. In 2 patients, the leak could not be localized by VATS, and fibrin glue or talcage were applied in the pleural space. All patients were discharged without recurrent chylothorax. CONCLUSIONS: VATS is an effective tool in the management of persisting postoperative chylothorax. Its easy use, low cost, and low morbidity rate suggest an earlier use of VATS in the treatment of postoperative chylothorax.

Adult↗
PubMed2001

Combined off-pump coronary surgery and right lung resections through midline sternotomy.

Concomitant severe coronary artery disease and lung malignancies are uncommon. Combining conventional coronary surgery with cardiopulmonary bypass with lung resection is still a controversial issue. Conversely, combining off-pump coronary surgery with right lung resections through a midline sternotomy can be an attractive approach. Off-pump coronary surgery avoids the risks of cardiopulmonary bypass, reduces systemic inflammatory response and does not affect the immune system. We report a series of three patients successfully operated using this approach.

Adenocarcinoma↗
PubMed2001

Continued cigarette smoking after coronary artery bypass surgery reduces endothelium-dependent vasodilation in internal thoracic artery grafts.

BACKGROUND: Cigarette smoking is known to promote endothelial dysfunction, thus it can be responsible for an impaired endothelium-dependent vasomotility in arterial grafts late after coronary surgery. METHODS: Twenty consecutive patients (mean age 64.5 years), previously submitted to coronary bypass surgery with the internal thoracic artery, underwent quantitative angiography of the implanted graft at long-term follow-up (mean time 2.5 years). To assess both endothelium-dependent and independent vasomotility, angiograms were acquired before and after selective infusions of acetylcholine (10(-6) mmol/ml) and nitroglycerine (500 microg). The predictive value of risk factors, including previous and continued smoking, for an impairment in endothelium-dependent vasomotility was assessed. RESULTS: Continued smoking (p = 0.038), but not a previous history of smoking (p = 0.55) was the only predictor of a reduced endothelium-dependent vasodilation. While previous smokers and non-smokers showed a similar response to acetylcholine, current smokers showed a reduced endothelium-dependent vasodilation vs non-smokers (94.8 +/- 2.6 vs 99.6 +/- 2.3% of the maximal vasodilative capacity, p = 0.001). CONCLUSIONS: Although maintained, the vasodilative response to acetylcholine appears reduced in internal thoracic artery grafts of patients who continued smoking long term after coronary bypass surgery. Whether this could affect the long-term outcome of these patients has to be further investigated.

Acetylcholine↗
PubMed2001

Angiographic evidence of thrombosis after off-pump coronary surgery. A case report.

We report the case of a patient who underwent off-pump coronary surgery, whose postoperative (3 days) angiography showed the presence of a thrombus in the left internal mammary artery. The thrombus responded to an aggressive anticoagulant treatment, showing a perfect angiographic result 15 months later. According to our previous studies, we suggest that an adequate anti-coagulant treatment should be undertaken for patients undergoing off-pump coronary surgery in the early postoperative period.

Coronary Angiography↗
PubMed2000

Wedge carinal resection for closure of the main bronchus after pneumonectomy.

Closure of the bronchial stump after pneumonectomy can be challenging. Some special situations such as tumor extension, technical pitfalls, or poor tissue quality of the bronchial stump may preclude safe closure of the airway with standard techniques. We describe here a technique of wedge carinal resection that provides the surgeon an alternative whenever the standard closure of the stump is inapplicable. This technique has been successfully used in a series of 4 patients.

Aged↗
PubMed2000

Reversed-T upper mini-sternotomy for extended thymectomy in myasthenic patients.

A minimally invasive approach for extended thymectomy in myasthenic patients is described. Through an 8- to 10-cm midline skin incision with a reversed-T upper mini-sternotomy, an extended thymectomy was performed. The mediastinal fat was removed beginning from the diaphragm up to the thyroid gland, and to each phrenic nerve, laterally. Extended thymectomy through a reversed-T upper mini-sternotomy warrants complete excision of thymic tissue while allowing a short hospitalization and good cosmetic result.

Adult↗
PubMed2000

Functional integrity and aging of the left internal thoracic artery after coronary artery bypass surgery.

OBJECTIVE: To study the endothelial function in the left internal thoracic artery after coronary artery bypass surgery and to identify predictors of early dysfunction, we performed a provocative test with acetylcholine in 23 male patients who underwent routine postoperative coronary angiography. METHODS: The change in mean diameter of the proximal thoracic artery was assessed by quantitative angiography after selective injections of acetylcholine and nitroglycerin. RESULTS: The thoracic artery showed a 6.8% (P <. 001) and 9.0% (P <.001) increase in mean diameter after acetylcholine and nitroglycerin administration, respectively. Vasodilative responses to acetylcholine and nitroglycerin administration were strongly correlated (R: 0.88; P <.001). Among the common risk factors, only age was associated with an impairment in the vasodilative response of the arterial graft (P =.001), and acetylcholine-induced vasodilation was inversely correlated to the age of the patient (R: 0.69; P <.001). CONCLUSIONS: Endothelium-dependent vasodilative response to acetylcholine administration seems well preserved in the left internal thoracic artery after surgery. Common risk factors, except for age, do not affect the functional integrity of the arterial graft. The vasodilative properties of the graft depend on the age of the patient and do not deteriorate over time after operation.

Acetylcholine↗
PubMed2000

Arterial conduits for myocardial revascularization: single-institutional results.

BACKGROUND: Bilateral internal mammary artery (IMA) grafting is associated with an improved long-term survival, low rates of recurrence of angina and late myocardial infarction. This suggested the usefulness of a complete arterial revascularization in patients with three-vessel disease using IMAs in conjunction with other arterial conduits. METHODS: Between September 1989 and September 1999, 1,052 patients underwent myocardial revascularization with the use of the gastroepiploic artery and one or two IMAs. Among them 561 patients with three-vessel disease underwent myocardial revascularization with the use of the gastroepiploic artery and both the IMAs. In this report the operative results up to hospital discharge obtained in the first 500 patients were considered. In total 1,850 anastomoses were performed using 1,500 arterial grafts; a mean number of 3.7 anastomoses per patient and 1.2 anastomoses per graft were performed. RESULTS: Twelve patients (2.4%) died during hospitalization. Perioperative myocardial infarction developed in 12 patients (2.4%). Twenty patients (4%) required temporary support with intra-aortic balloon pump. Repeat thoracotomy for bleeding was required in 33 patients (6.6%). Four patients (0.8%) developed mediastinitis and 4 (0.8%) aseptic sternal dehiscence. Gastrointestinal bleeding occurred in 3 patients (0.6 %) and was treated conservatively, cerebrovascular accidents in 4 (0.8%), and abdominal wound herniation in 5 (1%). CONCLUSIONS: According to our experience, systematic total arterial revascularization is feasible with a low complication rate and may contribute to the improvement of long-term outcome.

Aged↗
PubMed1999

Reversed-J inferior sternotomy for beating heart coronary surgery.

Median sternotomy or combined multiple minimally invasive approaches are currently used to revascularize patients with multivessel coronary artery disease on the beating heart. We present here a new alternative approach for minimally invasive coronary surgery on the beating heart: the reversed-J inferior sternotomy. Through this approach, the left anterior descending, diagonal, and right coronary arteries can be revascularized via a single minimally invasive approach.

Coronary Disease↗
PubMed1999

Procoagulant activity after off-pump coronary operation: is the current anticoagulation adequate?

BACKGROUND: Hemostasis is preserved after off-pump coronary operations compared with conventional coronary procedures. However, this preserved hemostasis may result in a procoagulant activity. METHODS: We prospectively studied coagulation in 22 patients who underwent off-pump coronary operation either through a midline sternotomy (n = 14) or with minimally invasive anterolateral thoracotomy (n = 8). RESULTS: Procoagulant activity, represented by prothrombin factor 1 and 2, remained at baseline levels during operation but increased significantly on postoperative day 1. Factor VII remained at baseline levels during the operation but decreased significantly on postoperative day 1. Fibrinolysis was increased as indicated by the fibrin degradation products on postoperative day 1. A promoted hemostasis attributable to endothelial activation was indicated by the increase in von Willebrand factor on postoperative day 1. Platelets counts and platelet activation (beta-thromboglobulin) remained at baseline levels after the operation. No adverse clinical events occurred. CONCLUSIONS: Patients undergoing off-pump coronary operation show an increased procoagulant activity in the first postoperative 24 hours regardless of the surgical approach (midline sternotomy or anterolateral thoracotomy). This procoagulant activity is not mediated by platelet-related factors. Therefore, a specific perioperative prophylactic pharmacologic regimen is advisable.

Adult↗
PubMed1999

Predicting outcome after cardiac surgery: comparison of global haemodynamic and tonometric variables.

To compare how outcome can be predicted from global haemodynamic compared with regional perfusion-related variables (gastric intramucosal pH (pHi) and intramucosal-arterial PCO2 difference (delta PCO2)), we measured global haemodynamics, gastric pHi and delta PCO2 in 68 haemodynamically compromised patients after cardiac surgery on admission to the intensive care unit (ICU) and 12 h later. Overall mortality rate in the ICU was 19.1%. In non-survivors, mean arterial pressure on admission (P = 0.03) and at 12 h (P = 0.02) was lower, and mean pulmonary artery pressure on admission (P = 0.006) and at 12 h (P = 0.004) was higher than in survivors. Gastric pHi on admission and at 12 h did not differ between non-survivors and survivors (7.37 (SD 0.1) vs 7.39 (0.09), and 7.37 (0.1) vs 7.41 (0.09), respectively). delta PCO2 on admission and at 12 h did not differ between non-survivors and survivors (0.52 (0.52) kPa vs 0.47 (1.01) kPa and 0.59 (0.7) kPa vs 0.62 (0.9) kPa, respectively). Our data showed that global, routinely monitored, haemodynamic variables are better early predictors of outcome after cardiac surgery than regional, tonometric variables. This conclusion does not support hypoperfusion of the gastrointestinal tract as an early determinant of outcome after cardiac surgery.

Adult↗
PubMed1999

Complement activation in coronary artery bypass grafting patients without cardiopulmonary bypass: the role of tissue injury by surgical incision.

STUDY OBJECTIVES: Complement activation is a trigger in inducing inflammation in patients who undergo coronary artery bypass grafting (CABG) and is usually thought to be induced by the use of cardiopulmonary bypass (CPB). In this study, we examined whether tissue injury caused by chest surgical incision per se contributes to complement activation in CABG patients. DESIGN: Prospective study. SETTING: Thorax center in university hospital. PATIENTS: Twenty-two patients undergoing CABG without CPB were prospectively divided into two groups: a small chest incision via an anterolateral thoracotomy representing a minimized tissue injury (lateral group, n = 8), and a conventional median sternotomy representing a large tissue injury (median group, n = 14). Biochemical markers indicating complement activation as well as systemic inflammatory response were determined before, during, and after the operation. MEASUREMENTS AND RESULTS: Plasma concentrations of complement 3a increased in both the lateral and median groups right after chest incision (p < 0.01 and p < 0.05, respectively) and by the end of operation increased only in the median group (p < 0.01). The terminal complement complex 5b-9 did not increase in the lateral group, but it did increase in the median group both after incision and by the end of the operation (p < 0.05 and p < 0.05, respectively). During surgery, complement 4a did not increase, suggesting that it is the alternative rather than the classic pathway that is involved in complement activation by tissue injury. Postoperatively, interleukin-6 production was greater in the median group (p < 0.01) than the lateral group (p < 0.05), suggesting a more pronounced inflammatory response to a larger chest incision. CONCLUSIONS: Tissue injury caused by surgical incision contributes to complement activation in CABG patients who are operated on without CPB. A small anterolateral thoracotomy is associated with reduced complement activation in comparison with a median sternotomy.

Adult↗
PubMed1999

Aortic valve replacement via ministernotomy: early results of a two-center study.

BACKGROUND: The reversed T ministernotomy has been proposed by Gundry to perform different congenital and common acquired heart valve operations. In this study we assessed the technical aspects of this approach for aortic valve replacement before starting a prospective randomized study. We evaluated the results of a two-Center study on the technical feasibility of aortic valve replacement via the reversed T ministernotomy according to the Gundry's approach. METHODS: From January to October 1998 aortic valve replacement via ministernotomy was successfully accomplished in 16 patients at the Catholic University of the Sacred Heart of Rome (Italy) and the Academisch Ziekenhuis of Groningen (The Netherlands). RESULTS: No complications were reported, except for the damage to the internal mammary artery during the opening of the sternum. The mean postoperative stay was 5.1 days. The postoperative respiratory recovery was easy and fast. CONCLUSIONS: Prospective randomized studies are needed to evaluate the effectiveness of the minimally invasive approach compared to standard sternotomy.

Aortic Valve Insufficiency↗