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M Cotrufo

Publications and source records attributed to M Cotrufo.

At least 55 records · Page 3Linked to original sources
PubMed2001

Risk predictors of paroxysmal atrial fibrillation following aortic valve replacement.

BACKGROUND: Atrial fibrillation (AF) is the most frequently encountered arrhythmic complication associated with cardiac surgery. The aim of this paper was to identify the clinical predictors of AF occurrence following aortic valve replacement. METHODS: Three hundred and two patients were included in this study and divided into two groups according to the absence (SR group, 243 patients, mean age 55.6 +/- 15 years) or the evidence (AF group, 59 patients, mean age 63.8 +/- 11 years) of post-aortic valve replacement AF. Sixty-five perioperative variables (37 preoperative, 8 intraoperative and 20 postoperative) were considered. RESULTS: Post-aortic valve replacement paroxysmal AF occurred in 59 out of 302 patients (19%). At univariate analysis, post-aortic valve replacement AF was associated with advanced age, left atrial enlargement, preoperative episodes of paroxysmal AF, the use of a warm blood cardioplegic solution and normothermia, administration of inotropic agents, prolonged assisted ventilation but also with postoperative acidosis, electrolyte imbalance and atrioventricular and intraventricular conduction disorders. Stepwise forward multivariate logistic regression analysis identified age (p = 0.002, odds ratio--OR 1.04), left atrial enlargement (p = 0.004, OR 2.6), a prior history of paroxysmal AF (p = 0.0003, OR 10.9), and postoperative electrolyte imbalance (p = 0.01, OR 2.3) as independent correlates of AF, whereas the use of hypothermia appeared to be a protective factor (p = 0.0004, OR 0.26). CONCLUSIONS: According to our findings, post-aortic valve replacement AF seems to be associated with well-defined anatomical and electrical substrates generated by advanced age, increased left atrial dimensions, and a possible electrical remodeling consequent to prior repetitive episodes of paroxysmal AF. On these grounds, external factors such as postoperative electrolyte imbalance might enhance atrial ectopic activity and trigger postoperative sustained tachyarrhythmias, while the use of hypothermia might allow for better protection of the atrial myocardium against intraoperative ischemia.

Analysis of Variance↗
PubMed2001

Long term clinical and echocardiographic results of isolated aortic valve replacement in elderly patients.

Results after isolated aortic valve replacement with bileaflet prostheses in patients over 70 years old were reviewed. One-hundred-twenty-eight elderly patients were operated on between January 1988 and January 2000. Patients with associated heart disease were excluded from the study. Preoperative data, early and late postoperative mortality, all valve related complications and data concerning anticoagulation status were recorded. Hospital mortality was 9.3%. Mean follow-up time was 60.98 +/- 2.23 months. Twelve-year actuarial survival was 69.6 +/- 0.08%. Valve related and anticoagulation related complication rates (0.8% and 1.6% respectively) and actuarial freedom (99 +/- 0.009 both) were low, as well as the mean interval between consecutive INR checks (18.39 +/- 1.90 days) and the mean INR value (2.17 +/- 0.135). Late echocardiographic results showed low postoperative mean transprosthetic gradients (15.48 +/- 0.94). Bileaftlet prostheses in the elderly can achieve excellent results with a low incidence of anticoagulation related complications and low risk of reoperation. Older age can no longer be considered a contraindication to bileaftlet prosthesis implant.

Age Factors↗
PubMed2000

Ventricular tachyarrhythmias following coronary surgery: predisposing factors.

The perioperative factors potentially associated with post-coronary artery bypass grafting (CABG) ventricular tachyarrhythmias (VT) onset have not been deeply investigated. Monomorphic or polymorphic ventricular tachycardia and ventricular fibrillation represent the most dreadful arrhythmic events that can complicate the postoperative course of CABG. As a consequence, the aim of our paper was to identify which perioperative variables might predict post-CABG VT occurrence. One hundred and fifty-two consecutive patients who underwent CABG surgery at our Institution were included in the study. Post-CABG VT occurred in 13 out of 152 patients (8.5%, six cases of monomorphic ventricular tachycardia and seven cases of ventricular fibrillation). At univariate analysis, VT patients were significantly younger (54.8+/-6.6 vs. 60.1+/-8.8, P=0.038), exhibited a more severe coronary artery disease (CAD) (number of diseased vessels 2.92+/-0.3 vs. 2.45+/-0.7, P=0.023, and percentage of patients with three-vessel CAD 91.7% vs. 57.3%, P=0.043) and received a greater number of CABGs than those remaining in sinus rhythm (SR) (percentage of patients receiving three or more CABGs 76. 9% vs. 38.8%, P1000 76.9% vs. 38%, Pnormal range 72.7% vs. 30.7%, P=0.014), electrolyte derangement (84.6% vs. 45.6%, P=0.017) and a severe haemodynamic impairment (need for IABP 23% vs. 2.9%, P1000, postoperative electrolyte imbalance, the need for three or more CABGs and of IABP all were independent correlates for VT. In conclusion, post-CABG VT seem to be related to the preexistence of a severe underlying coronary artery disease along with perioperative triggering factors such as acute ischemia, electrolytic disorders and a sudden haemodynamic impairment.

Causality↗
PubMed2000

Determinants and prognostic value of ischemic necrosis in early biopsies following heart transplant.

To evaluate the impact of early ischemic necrosis (IN) on the early and late outcome of heart transplantation, we reviewed our 11-year experience. Between January 1988 and June 1999, 207 heart transplants were performed in 205 patients (174 male and 31 female). Criteria for donor and recipient selection, and protocols for postoperative immunosuppression and rejection monitoring have remained unchanged over this period. Three different cardioplegic solutions were employed in graft preservation: St. Thomas Hospital solution in the earliest 31 cases (15%), University of Wisconsin solution in 96 cases (46.4%), and Celsior solution in the last 80 cases (38.6%). All patients who underwent at least one endomyocardial biopsy (176 patients) were divided into two groups according to the findings of IN within the early 3 postoperative months (group A, 49 patients with IN; group B, 127 patients without IN). The following variables were estimated in each group: donor and recipient age, ischemic time, type of cardioplegia, late mortality for cardiac causes, incidence of grade >2 rejection within the first 6 postoperative months, late incidence of grade >2 rejection, late incidence of NYHA class >II. No significant difference was found in any parameter between the two groups, except for the type of cardioplegic solution. A significantly higher incidence of ischemic necrosis in hearts preserved with St. Thomas solution was found (P < 0.001). Although pathology findings show that extracellular solutions carried a higher risk of early IN, no associated significant impairment in terms of late survival and event-free rate was observed in recipients with early IN.

Adolescent↗
PubMed2000

Aortic dissection with fistula to left atrium: diagnosis by transesophageal echocardiography with successful repair.

The aorta-atria fistula is an infrequent complication of aortic dissection, and it is rarely diagnosed before death. A 41-year-old man who 8 years previously had undergone prosthetic aortic valve replacement had an aortic dissection complicated by aorta-left atrial fistula. This patient had acute left heart failure associated with a systolic and diastolic murmur at the lower left sternal border suggesting an aortic prosthetic malfunction. The cardiac diagnosis was made with transesophageal echocardiography and Doppler color flow imaging; it was notable that the cardiac lesions were not detected by transthoracic echocardiography. On the basis of the echocardiographic findings, the patient underwent successful emergency replacement of the dissecting ascending aorta with closure of the aorta-left atrial fistula. Transesophageal echocardiography is the procedure of choice for defining this abnormality. In this case a prompt surgical repair consisting of replacement of the affected segment of the aorta with the prosthesis and closure of the fistula provided optimum resolution of the clinical situation.

Adult↗
PubMed2000

Are blood and valve cultures predictive for long-term outcome following surgery for infective endocarditis?

OBJECTIVE: To evaluate whether perioperative bacteria identification in blood and/or in valve cultures can predict early and late outcome of surgery for infective endocarditis, a retrospective study was performed. METHODS: Between January 1978 and December 1998, 232 patients, 79 (34.1%) female and 153 (65.9%) male with mean age of 44. 95+/-1.03 years (range 8-79) underwent surgery for infective endocarditis on a native (162 cases) or prosthetic (70 cases) valve. Patients were divided into three groups according to the perioperative x of microbiological tests: Group A: patients with preoperative positive blood cultures (83 cases); Group B: patients with positive valve cultures (35 cases); Group C: patients with negative blood and valve cultures (114 cases). Categorical values were compared by chi(2) analysis, whereas continuous data were compared by ANOVA and Bonferroni correction for post hoc comparisons. Analysis of late survival and complications was performed with Kaplan-Meier and Log Rank test. Late mortality, reoperation, perivalvular leak, recurrence of infection were considered as treatment failure. All data were presented as mean+/-standard error. RESULTS: Hospital mortality was 10.8% (9/83) in Group A, 8.6% (3/35) in Group B, and 14.9% (17/114) in Group C (P=0.52; not significant (NS)). Ten-year survival was 62.7+/-8% in Group A, 43.9+/-19% in Group B and 62.7+/-7% in Group C (P=0.38; NS). Ten-year freedom from reoperation was 85.2+/-6% in Group A, 37.9+/-20% in Group B and 80+/-6% in Group C (P=0.0034). Ten-year freedom from treatment failure was 56.3+/-8% in Group A, 31.6+/-16% in Group B and 55. 3+/-7% in Group C (P=0.46; NS). CONCLUSIONS: Positive blood and tissue cultures are not predictive for hospital mortality and late treatment failure in patients with infective endocarditis. Positive valve cultures, a common finding in patients with staphylococcal endocarditis, are predictive for a higher risk of reoperation.

Adolescent↗
PubMed2000

Improved outcome of pulmonary aspergillosis in heart transplant recipients with early diagnosis and itraconazole treatment.

Pulmonary aspergillosis is a severe complication in heart transplant recipients. The drug of choice for this infection is amphotericin B, but its use is limited because of its side effects. We observed six cases of pulmonary aspergillosis in a group of 200 patients who had received heart transplants from January 1988 to January 1999. Predisposing factors such as previous rejection, neutropenia and/or cytomegalovirus reactivation were present in all patients. The clinical presentation was characterized by fever and a non-productive cough. X-rays showed monolateral or diffuse infiltrate with or without nodular lesions. The median interval between symptoms and diagnosis was 5 d (range 4-7). Diagnosis was made by culturing trans-tracheal aspirate samples. Aspergillus fumigatus was isolated in 3 patients and A. niger in the other 3. All patients were treated with itraconazole at 200-400 mg/day for 20-60 d and all recovered. One patient treated with the lowest dosage for the shortest term had a recurrence after 1 month and needed a second 30-day course of itraconazole at a higher dosage. No significant side effects were registered. Itraconazole is effective in the therapy of pulmonary aspergillosis, particularly when an early diagnosis is made.

Adult↗
PubMed2000

Aortic dissection with fistula to right atrium after heart transplantation: diagnosis by transthoracic and transesophageal echocardiography.

Aortic dissection with rupture into the right atrium is an extremely rare and rapidly fatal condition that may occur after cardiac surgery. We report the case of a 59-year-old woman with a 6-year history of heart transplantation who presented with subacute illness characterized by chest pain and severe cardiac decompensation accompanied by a continuous murmur in the precordium. The diagnosis of aortic dissection complicated by right atrial fistula was made by the combination of transthoracic and transesophageal echocardiographic examination.

Aortic Dissection↗
PubMed2000

Long-term results of apico-aortic valved conduit for severe idiopathic hypertrophic subaortic stenosis.

We report our long-term results of apico-aortic conduit implantation in patients with isolated idiopathic hypertrophic subaortic stenosis. Between December 1977 and July 1983, apico-aortic prosthetic-valved conduits were implanted in 4 such patients (age range, 24-65 years) who had severe left ventricular hypertrophy and small left ventricular chambers. In this procedure, the distal end of the conduit was anastomosed to the ascending aorta in 3 patients and to the upper abdominal aorta in 1. Postoperative echocardiography showed relief of the left ventricle-aortic gradient and enlargement of the left ventricular chamber in all cases. One patient died of perioperative wound infection. One patient died of unnatural causes 13 years after the initial operation; in his case, the conduit was known to be occluded. Two patients are alive 15 and 19 years, respectively, after the initial operation. Three instances of conduit obstruction due to bioprosthetic calcification were observed. Despite the high incidence of reoperation due to conduit valve failure, apicoaortic conduit implantation has produced good hemodynamic outcome and has improved the quality of life in patients who have idiopathic hypertrophic subaortic stenosis and anatomic features unsuitable for Morrow's operation. Improvements in bioprostheses and in apical implantation techniques may allow a revival of apico-aortic conduit implantation in selected patients with idiopathic hypertrophic subaortic stenosis.

Adult↗
PubMed2000

Mitral and aortic valve endocarditis due to Staphylococcus lugdunensis.

Staphylococcus lugdunensis is a recently described coagulase negative staphylococcal species involved in human infections. Endocarditis caused by Staphylococcus lugdunensis has been reported rarely: fewer than 50 cases have been described so far. The infection is frequently complicated by embolic events and carries a high mortality rate. We report a case of endocarditis due to Staphylococcus lugdunensis in which the native mitral and aortic valves were infected. The bacterium was isolated on cultures from the aortic and mitral vegetations. Appropriate medical and surgical treatment led to a good outcome of the infection. At 6-year follow-up, there was no evidence of recurrence, and the patient showed good functional recovery. He was in New York Heart Association functional class I.

Aortic Valve↗
PubMed2000

Treatment of recurrent postoperative mediastinitis with granulated sugar.

BACKGROUND: The authors report their experience with granulated sugar as dressing technique in the treatment of postoperative mediastinitis refractory to a closed irrigation system. METHODS: Between January 1990 and January 1998, mediastinitis developed in 61 (0,93%) of 6521 patients who had undergone open heart surgery. Diagnosis of sternal infections was based on wound tenderness, drainage, cellulitis, fever associated with sternal instability. All of them were initially treated with surgical debridement and closed chest irrigation. Nine patients with postcardiotomy mediastinitis refractory to closed chest irrigation underwent open dressing with granulated sugar. All of them were febrile with leukocytosis and positive wound cultures. RESULTS: Bacteria isolated were staphylococcus aureus in 6 cases, staphylococcus epidermidis in 2 and pseudomonas in 1. Redebridement was performed in all cases and the wound was filled with granulated sugar four times a day. Fever ceased within 4.3+/-1.3 days from the beginning of treatment and WBC became normal after 6.6+/-1.6 days. Three patients had hyperbaric therapy as associated treatment. Complete wound healing was achieved in 58.8+/-32.9 days (three patients underwent successful pectoralis muscle flaps). CONCLUSIONS: Sugar treatment is a reasonable and effective option in patients with mediastinitis refractory to closed irrigation treatment. It may be used either as primary treatment or as a bridge to pectoralis muscle flaps.

Aged↗
PubMed1999

Intravascular hemolysis after mitral and aortic valve replacement with different types of mechanical prostheses.

Heart valve replacement with mechanical prosthesis is associated with mild intravascular hemolysis. In this study we evaluated the incidence of hemolysis in patients with different combinations of two mechanical valves. Between 1974 and 1996, 680 patients underwent mitral and aortic valve replacement with mechanical prostheses; we selected 90 patients, divided into six groups according to the prosthetic model (Group A, ball and tilting disc; Group B, ball and bileaflet; Group C, tilting disc and tilting disc; Group D, tilting disc and bileaflet; Group E, bileaflet and tilting disc; Group F, bileaflet and bileaflet; respectively, in mitral and aortic position). Blood tests were performed to check blood hemoglobin, serum lactic dehydrogenase, percent-correlated reticulocyte fraction, serum haptoglobin, and schistocytes. Chi square test was performed for categorical data. ANOVA and Bonferroni tests were performed in order to evaluate significant statistical differences between media and variance of the hematological data. A mild degree of intravascular hemolysis was observed in 30% of patients with double mechanical prostheses. LDH values were above the normal values in all groups, although a significant difference was found only between Group B versus Groups C and D. Reticulocytes and schistocytes and serum haptoglobin values were within the normal range and no differences were found between the groups. Low levels of blood hemoglobin were found in Groups D and F. The difference was statistically significant when compared with Groups A and E. In conclusion, hemolysis is frequent but never severe in patients with mitral and aortic mechanical prostheses. A higher incidence of subclinical hemolysis was found in patients with bileaflet valves regardless of the position of the implant.

Analysis of Variance↗
PubMed1999

Perioperative correlates of malignant ventricular tachyarrhythmias complicating coronary surgery.

Sustained ventricular tachyarrhythmias (VT), such as monomorphic or polymorphic ventricular tachycardia, and ventricular fibrillation, represent the most serious arrhythmic events that can complicate the postoperative course of coronary artery bypass grafting (CABG). The perioperative factors potentially associated with post-CABG sustained VT onset have not been thoroughly investigated. As a consequence, the aim of our study was to identify which perioperative variables might predict post-CABG VT occurrence. One hundred and fifty-two consecutive patients who underwent CABG surgery at our Institute were included in the study. Post-CABG VT occurred in 13 out of 152 patients (8.5%, six cases of monomorphic ventricular tachycardia and seven cases of ventricular fibrillation). Univariate analysis revealed that VT patients were significantly younger (54.8 +/- 6.6 vs 60.1 +/- 8.8, P = 0.038), exhibited more severe coronary artery disease (CAD) (no. of diseased vessels, 2.92 +/- 0.3 vs 2.45 +/- 0.7, P = 0.023; and percentage of patients with three-vessel CAD, 91.7 vs 57.3%, P = 0.043), and received a greater number of CABGs than those remaining in sinus rhythm (SR) (percentage of patients receiving three or more CABGs, 76.9 vs 38.8%, P = 0.018) Moreover, VT patients more frequently developed intra- or postoperative myocardial infarction (total CK > 1,000, 76.9 vs 38%, P = 0.016; and MB-CK > normal range, 72.7 vs 30.7%, P = 0.014), electrolyte derangement (84.6 vs 45.6%, P = 0.017), and a severe hemodynamic impairment (need for intra-aortic balloon pump (IABP), 23 vs 2.9%, P = 0.009). On multivariate analysis, total CK > 1,000, postoperative electrolyte imbalance, the need for three or more CABGs, and for IABP all were independent correlates for VT. In conclusion, post-CABG VT seem to be related to the preexistence of a severe underlying coronary artery disease along with perioperative triggering factors, such as acute ischemia, electrolytic disorders, and sudden hemodynamic impairment.

Coronary Artery Bypass↗
PubMed1999

Surgery for tricuspid valve endocarditis: a selective approach.

The authors report their 18-year experience in the surgical treatment of infective tricuspid endocarditis. Between January 1981 and January 1999, 238 cases of infective endocarditis were seen. with a tricuspid involvement in 21 cases (8.8%). Tricuspid valve repair was performed in 9 patients with infective lesions involving one single leaflet. The surgical principle of the repair was to avoid any prosthetic material implantation. Posterior leaflet vegetectomy was performed in another 2 patients with infected intracavitary leads. Tricuspid valve replacement was performed in 10 patients with involvement of the whole valvular apparatus. One patient died of septic shock 3 days postoperatively. All the other patients had a good postoperative recovery. Follow-up ranged between 12 and 155 months (mean 68.9 +/- 55 months). Five cases of late mortality were observed: 3 for cardiac reasons and 2 of cancer. All the other patients are alive. Late postoperative echocardiography in the patients with tricuspid repair showed tricuspid regurgitation to be absent in 6 patients, mild in 2, moderate in 1, and severe in 1. No recurrent infections were observed either in patients with valve repair or in those with valve replacement. Good early and long-term results can be achieved in the surgical treatment of tricuspid endocarditis as long as complete excision of the infected tissue is performed and risk factors are controlled.

Adult↗
PubMed1999

Late complications of heart transplantation: an 11-year experience.

Advances in donor and recipient selection and postoperative management of patients undergoing a heart transplant have improved survival after cardiac transplantation; nevertheless, late complications are still the main cause of mortality. Between January 1988 and March 1999, 200 heart transplants and 2 retransplants were performed at our Institution. The actuarial survival rate was 84.45% at 1 month, 75.22% at 1 year, and 69.48% at 5 years. One-hundred forty-five patients reached at least 6 months of follow-up. In this group of patients we reviewed all available pathological specimens from endomyocardial biopsies, autopsies, and hearts retrieved at retransplantation. The most frequent late complications have been: malignancies (9 patients), allograft coronary artery disease (ACAD) (6 patients), and infections (6 patients). All patients with ACAD had serological evidence of cytomegalovirus (CMV) infection and 5 of them (83.3%) of hepatitis C virus (HCV) infection. Squamous cell lung carcinoma and Kaposi's sarcoma were the most frequent neoplasms (3 patients). Twenty-six out of 145 patients died during the follow-up: sudden death occurred in 10 patients (38.46%), infections caused death in 6 patients (23.08%). ACAD in 4, and cancer in 4. Causes and rates of late mortality in patients with a cardiac transplant differ from those of early mortality. Development of infections, ACAD, or cancer is associated with a high late mortality rate. A striking correlation has been found between ACAD and HCV and/or CMV positivity. suggesting that such viruses may play a role in the development of vascular late complications in transplanted hearts.

Adolescent↗
PubMed1999

Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves.

OBJECTIVES: The purpose of this study was to assess the incidence of warfarin fetal complications and whether they are dose-dependent. BACKGROUND: Gravid patients with mechanical heart valves require long-term anticoagulant therapy. Controversy exists concerning the appropriate treatment of these patients. METHODS: Forty-three women on warfarin carrying out 58 pregnancies were studied. For each patient with full-term pregnancy a caesarian section was scheduled for the 38th week during brief warfarin discontinuation. Maternal and fetal complications were evaluated. Fetal complications were divided according to the warfarin dosage < or = 5 mg and > 5 mg necessary to keep an international normalized ratio (INR) of 2.5 to 3.5, and analyzed subsequently. RESULTS: A total of 58 pregnancies were observed: 31 healthy babies (30 full term, 1 premature) and 27 fetal complications (22 spontaneous abortions, 2 warfarin embryopathies, 1 stillbirth, 1 ventricular septal defect, 1 growth retardation) were recorded. Two maternal valve thromboses occurred. No fetal or maternal bleeding was observed during caesarian sections or premature vaginal delivery. Patients whose warfarin doses during pregnancy were > 5 mg had 22 fetal complications, whereas those taking a dose < or = 5 mg had only five fetal complications (p = 0.0001). For an increase of the warfarin dose there was a substantially increased probability of fetal complications (p < 0.0001; p < 0.7316). CONCLUSIONS: There is a close dependency between warfarin dosage and fetal complications. Patients on warfarin anticoagulation may be delivered by planned caesarian section at the 38th week while briefly interrupting anticoagulation.

Abnormalities, Drug-Induced↗