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Maurizio Cotrufo

Publications and source records attributed to Maurizio Cotrufo.

At least 37 records · Page 2Linked to original sources
PubMed2005

Transthoracic Doppler echocardiography of mammary artery grafts to assess graft function.

BACKGROUND: Transthoracic Doppler echocardiography of internal mammary artery grafts (MAGs) has been tested by the supraclavicular approach, but little information is available about the parasternal approach. OBJECTIVE: To evaluate the usefulness of parasternal transthoracic Doppler echocardiography to assess the patency of left and right MAGs. PATIENTS AND METHODS: Forty-eight patients with previous MAGs were divided into two groups on the basis of coronary angiography: 42 patients had patent MAGs and six patients had severe MAG stenosis. Doppler echocardiography of MAGs was performed on all patients, both at baseline and after low-dose dipyridamole infusion. Systolic and diastolic time-velocity integrals and their ratios were obtained, and MAG flow reserve was calculated. RESULTS: Patients with patent MAGs had a predominant diastolic flow, while a prominent systolic pattern was found in the presence of MAG stenosis. In patients with stenosis, baseline Doppler analysis showed a lower diastolic peak velocity (DPV) (P<0.01), diastolic time-velocity integral (P<0.05), and diastolic and systolic time-velocity integral ratios (both P<0.005), and a reduced MAG flow reserve (P<0.001). In the overall population, when adjusting for clinical variables, a multilinear regression analyis underscored MAG flow reserve (beta=0.38, P<0.01) and baseline DPV (beta=0.29, P<0.05) as independent determinants of MAG stenosis (cumulative R2=0.25, P<0.005). CONCLUSIONS: Doppler echocardiographic evaluation of MAGs is a reliable, noninvasive tool to assess MAG patency and functional status of the vessel. MAG blood flow reserve and baseline DPV are independent determinants of MAG stenosis.

Aged↗
PubMed2005

Can harvesting techniques modify postoperative results of the radial artery conduit?

BACKGROUND: Inappropriate harvesting of arterial conduits can lead to severe postoperative complications. We analyzed clinical and functional results of patients undergoing radial artery (RA) harvesting by means of three techniques. METHODS: From January 2001 to January 2004 188 patients undergoing coronary artery bypass graft with RA were divided into three groups: harmonic scalpel was employed in 61 (RA1), electrocautery in 63 (RA2), Potts-scissors and clips in 64 (RA3) patients. Harvesting time, local complications, number of clips employed, graft flowmetry, postoperative troponin I, incidence of re-exploration for bleeding due to the graft were analyzed. RESULTS: RA1 and RA2 showed a lower harvesting time (RA1 16.2 +/- 8.4 vs RA3 41.4 +/- 7.7 min, p = 0.0001; RA2 21.1 +/- 10.4 min, p = 0.001). Postoperative hand paresthesia was detected in RA1 (5/61; 8.2%) and RA2 (5/63; 7.9%), but not in RA3 (p = 0.048 and p = 0.05, respectively). More clips were necessary in RA3 compared to RA2 (p = 0.04) or RA1 (p = 0.0001 vs RA3; p = 0.001 vs RA2). RA1 showed significant higher values of maximum flow (RA1 59.4 +/- 37.5 vs RA2 22.1 +/- 7.7 ml/min, p = 0.0001; vs RA3 31.3 +/- 12.0 ml/min, p = 0.001), mean flow (RA1 23.4 +/- 17.3 vs RA2 10.2 +/- 5.7 mi/min, p = 0.001; vs RA3 11.6 +/- 8.9 ml/min, p = 0.001), minimum flow (RA1 11.6 +/- 6.5 vs RA2 4.2 +/- 3.7 ml/min, p = 0.01; vs RA3 4.7 +/- 3.3, p = 0.03), and pulsatility index (RA1 0.9 +/- 0.8 vs RA2 2.1 +/- 1.3, p = 0.03; vs RA3 1.7 +/- 2.1, p = 0.04). Troponin I was significantly lower in RA1, compared to RA2 and RA3 at 12 hours (p = 0.01 and p = 0.03, respectively) and 24 hours (p = 0.05 and p = 0.045, respectively). No RA1 patient underwent re-exploration for bleeding compared to RA2 (p = 0.011) and RA3 (p = 0.02). CONCLUSIONS: RA harvesting with ultrasounds is fast, determines high flowmetry values, low enzyme release and rarely causes local complications.

Aged↗
PubMed2004

Mechanical heart valves: are two leaflets better than one?

OBJECTIVE: We sought to compare the long-term clinical outcomes of patients who underwent isolated aortic valve replacement with single-disc and bileaflet mechanical heart valves. METHODS: From May 1975 through October 2001, 590 single-disc valves (7 models) were used for isolated valve replacement, and from November 1980 through July 2002, 1283 bileaflet valves (10 models) were used for isolated valve replacement. Detailed follow-up was performed to a maximum of 27.4 and 21.9 years with a total of 6872 and 5811 patient-years for single-disc valves and bileaflet valves, respectively. Survival and valve-related events were analyzed. RESULTS: Single-disc valves were mainly implanted from 1975 through 1995, whereas bileaflet valves were mainly implanted from 1987 through 2002; thus the years of concurrent use were 1987 through 1995. The bileaflet valve had a significantly lower explantation rate, whereas the single-disc valve had a significantly lower thromboembolism rate. No significant differences were detected in early mortality, long-term survival, and other valve-related complications. When limiting the comparison to the concurrent period of 1987 through 1995, no significant difference was detected in survival or in any valve-related complication. CONCLUSION: Single-disc and bileaflet valves provide similar clinical performance. The predominant use of bileaflet valves is not based on clinical outcomes.

Adult↗
PubMed2004

Marfan syndrome as a predisposing factor for traumatic aortic insufficiency.

Despite the increase in car accidents, aortic valve injury from blunt trauma remains rare. In one case, a 30-year-old Marfan male, who was under observation at our outpatient clinic, suffered from aortic regurgitation due to a tear in the left coronary cusp of a previously echocardiographically normal valve. Acute ventricular failure demanded surgical management within 3 days after an automobile accident. The case was successfully treated by replacement of the aortic valve with a no. 23 Sorin Bicarbon prosthesis. The patient fully recovered and experienced an uneventful 6 months of follow-up.

Accidents, Traffic↗
PubMed2004

Perioperative enoximone infusion improves cardiac enzyme release after CABG.

OBJECTIVE: To assess whether routine postoperative enoximone infusion compared with dobutamine improved clinical and biochemical results after coronary artery bypass grafting with cardiopulmonary bypass. DESIGN: Prospective nonrandomized study. Data collection was blinded to the choice of inotrope. SETTING: Double-institutional clinical investigation. PARTICIPANTS: Two hundred sixteen consecutive patients undergoing myocardial revascularization between May 2000 and December 2002. INTERVENTIONS: Seventy-two patients underwent myocardial revascularization and were treated with enoximone, 5 microg/kg/min (group A). They were compared in a ratio of 1:2 to 144 patients treated with dobutamine at the same dose (group B) after aortic cross-clamp removal. The groups proved to be homogenous in preoperative and intraoperative characteristics. MEASUREMENTS AND MAIN RESULTS: Hospital outcome, electrocardiogram, echocardiography, further inotropic support, and biochemical markers of ischemia were compared. Subsets of patients with comorbidities and total arterial revascularization were analyzed. Perioperative myocardial infarction, postoperative low-output syndrome, intra-aortic balloon pump, atrial fibrillation, ST-segment changes, postoperative echocardiographic findings, and intensive care and hospital durations were similar between groups. In the postoperative course, more patients belonging to group A maintained low-dose inotropic support, whereas more patients belonging to group B required higher doses. Troponin I and creatine kinase-MB values were higher in patients of group B, especially when subgroups with diabetes, left ventricular hypertrophy, or total arterial revascularization were included. CONCLUSION: Postoperative enoximone reduced troponin I release and need for inotropic support in patients undergoing on-pump myocardial revascularization. Subgroup data were confirmed in diabetes, left ventricular hypertrophy, and total arterial revascularization.

Cardiopulmonary Bypass↗
PubMed2004

Mechanical valve prosthesis is a valid option for aortic valve replacement in the elderly.

BACKGROUND AND AIM OF THE STUDY: Thromboembolism and hemorrhage related to anticoagulation remain a major concern in elderly patients with mechanical valves. Clinical results following isolated aortic valve replacement (AVR) with tilting disk and bileaflet prostheses in patients aged over 70 years were analyzed and compared with results in patients aged <45 years. METHODS: Between January 1980 and August 2002, 319 consecutive older patients (group A) and 497 young patients AVR. Preoperative clinical data, early and late mortality, valve-related complications and data related to anticoagulation status (including mean INR and mean interval between INR assays) were compared between groups. RESULTS: Hospital mortality was lower in group B (3.4%) than in group A (10.7%; p <0.0001). Twelve-year actuarial survival was lower in older patients (54% in group A versus 78% in group B; p <0.001). The two groups showed similar 12-year actuarial freedom from hemorrhage (99.6% versus 99.5%; p = 0.69), endocarditis (99.6% versus 98.43%; p = 0.25) and perivalvular leak (99.6% versus 97.9%; p = 0.21). However, actuarial freedom from thromboembolism was lower in older patients (98.8% versus 99.7%; p = 0.041). CONCLUSION: Despite lower rates of long-term mortality and thromboembolism (the latter because of advanced atherosclerosis) in group A, there were no differences in rates of other valve-related complications. Hence, older age cannot be considered a contraindication to implantation of mechanical valves in the aortic position.

Adult↗
PubMed2004

Native versus primary prosthetic valve endocarditis: comparison of clinical features and long-term outcome in 353 patients.

BACKGROUND AND AIM OF THE STUDY: The study aim was to compare preoperative and intraoperative features, and long-term outcome of patients operated on for native (NVE) and primary prosthetic valve endocarditis (PVE). METHODS: Between January 1978 and December 2002, 258 patients (mean age 47.5 +/- 16 years) were referred for NVE, and 95 for PVE. Demographics, clinical preoperative conditions, indications to surgery, microbiological data, surgical pathology, early postoperative course and long-term outcome were compared via hospital chart review and outpatient clinic follow up. RESULTS: Female sex prevailed in the PVE group (49.5%) versus NVE (27.1%; p < 0.0001). Mitral valve involvement was more common in PVE (46.3% versus 24.8%, p = 0.0001), and multivalvular in 16.3% of NVE patients versus 4.2% of PVE (p = 0.001). Active endocarditis (80.6% versus 58.9%, p = 0.00004) and preoperative embolism (29.5% versus 11.6%, p = 0.0002) were significantly prevalent in the NVE group. Emergency operation (21.1% versus 10.5%, p = 0.009) and preoperative NYHA class IV or V (40% versus 19.8%, p < 0.0001) were significantly more frequent in PVE. Overall hospital mortality was 11.3% (n = 40), with 6.6% among NVE patients and 24.2% among PVE (p < 0.0001). Mean follow up (94% complete) was 5.8 +/- 5.3 years (6.0 +/- 5.5 years for NVE versus 5.1 +/- 4.6 years for PVE, p = 0.191), and total follow up was 1,707.85 patient-years. Actuarial survival at 1, 5, 10 and 15 years was respectively 91, 82, 67.5 and 48.8% in NVE, and 79.7, 64.2, 33.5 and 33.5% in PVE (p = 0.0016). A significantly lower survival in PVE versus NVE was found for the mitral site subgroup (p = 0.018), but not for the aortic site (p = 0.14). Actuarial freedom from reoperation for recurrent endocarditis at 1, 5, 10 and 15 years was 97.5, 91.4, 80.5 and 49.4% in NVE versus 90.8, 84.9, 59.4 and 43.9% in PVE (p = 0.015). CONCLUSION: PVE patients were older, presented with more compromised clinical conditions, and had worse early and long-term outcomes than NVE patients. PVE had a higher incidence of recurrence and worse prognosis, especially if the mitral valve was involved.

Adult↗
PubMed2004

Ten-year outcome with the sorin bicarbon and Baxter Mira bileaflet prostheses in the aortic position.

BACKGROUND AND AIM OF THE STUDY: Sorin Bicarbon (SB) and Baxter Mira (BM) are almost identical bileaflet prostheses that share the same mechanical design, the only difference being in the sewing cuff. Hence, the long-term clinical performance of the two prostheses, when implanted in the aortic position, was evaluated in a combined population of patients. METHODS: Between January 1992 and December 2002, 714 patients (454 males, 260 females; mean age 60 +/- 13 years) underwent single aortic valve replacement with SB (n = 392) or BM (n = 322) valves. Concomitant non-valve procedures were performed in 64 patients (9.5%). Follow up was 95.7% complete, with a mean of 3.1 +/- 2.4 years. RESULTS: Operative mortality was 5.4% (39/714). Overall patient survival at five and 10 years was 89.3 +/- 1.4% and 77.7 +/- 4.3%, respectively; the linearized rate was 3.37% per pt-yr. Overall freedoms from complications at 10 years and valve group freedoms at four years were: thromboembolism 92.9 +/- 3.6% (SB 96.8 +/- 1.2% versus BM 98.4 +/- 0.8%); bleeding 94.5 +/- 3.5% (SB 97.5 +/- 1.1% versus BM 98.5 +/- 0.5%); nonstructural dysfunction 85.8 +/- 7.5% (SB 97.1 +/- 1.2% versus BM 99.3 +/- 0.07%); endocarditis 98.0 +/- 1.2% (SB 98.6 +/- 0.9% versus BM 100%); reoperation 95.1 +/- 3% (SB 98.6 +/- 0.9% versus BM 100%). Neither structural dysfunction nor valve thrombosis were observed. At the end of follow up, 78.3% of survivors were in NYHA class I, 17.3% in class II, 3.6% in class III, and 0.8% in class IV. CONCLUSION: Experience with Sorin Bicarbon and Baxter Mira valve prostheses shows that these valves, when implanted in the aortic position, provide a satisfactory clinical performance, with low complication rates.

Aged↗
PubMed2003

Stenosis progression after surgical injury in Milan hypertensive rat carotid arteries.

BACKGROUND: Milan hypertensive rats (MHS) are characterised by an increase in renal sodium reabsorption mainly related to adducin mutations. Interest in this model relies on the genetic link between adducin polymorphisms and primary hypertension, observed also in a subset of patients. OBJECTIVES: To investigate the molecular and morphological events involved in carotid stenosis and triggered by surgery in MHS model. METHODS: Stenosis was induced through arteriotomy. At different times after injury, the expression profiles of various gene families were investigated by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR), while histological techniques were used to follow morphometric and morphological changes. Apoptotic nuclei were revealed by terminal deoxynucleotidyl transferase-dUTP nick end labelling (TUNEL). RESULTS: mRNAs coding for transcription factors c-jun, c-fos and c-myc were rapidly induced by injury. Analysis of apoptosis-related genes revealed a decrease of the Bcl-2/Bax ratio 4 h after vascular trauma (P<0.05), followed by a recovery of antiapoptotic factors 24 and 48 h later. ET(A) and receptor mRNAs decreased after the injury and were replaced by ET(B) and AT2 mRNAs. Both ET(A) and AT1 turned to basal level 48 h after injury. Expression profiles of chatepsins B and D were also determined. A marked neoadventitia led to maximal 60+/-9% lumen reduction (P<0.05) 30 days after surgery. Media substitution by fibrotic and granulomatous tissue was also evident. Maximal 47+/-2% apoptotic nuclei were detected 48 h after the injury (P<0.05). CONCLUSIONS: The injury applied to MHS carotids induces negative remodelling and a limited apoptotic reaction. These findings could arise from the balancing among proliferative factors, apoptosis-related molecules and relaxant anti-proliferative receptors, all stimulated by the injury.

Angiotensin I↗
PubMed2003

Treatment of recurrent staphylococcal mediastinitis: still a controversial issue.

BACKGROUND: Although surgical management with early debridement and closed mediastinal irrigation has proved successful in reducing early mortality following poststernotomy deep sternal wound infection, recurrence rates are still up to 20%. This study compared the effectiveness and safety of wound dressing with granulated sugar versus early muscle flap surgery in the management of recurrent postoperative Staphylococcal mediastinitis. METHODS: Between January 1995 and January 2002, 25 patients with severe recurrent staphylococcal mediastinitis were treated with granulated sugar wound dressing (group A) or with wound debridement, v-shape sternectomy and associated muscle flap surgery (group B). Clinical outcomes and perioperative data were analyzed. Outcomes were compared between the groups evaluating the length of time for normalization of white blood cell (WBC) count and of body temperature and length of hospital stay. Patient characteristics determining best treatment option were identified. Survival and incidence of recurrence at follow-up were also analyzed. RESULTS: Study groups proved homogenous as to preoperative characteristics. Complete cure was achieved earlier in group A than in group B (defervescence: p = 0.0005; WBC normalization: p = 0.0001, respectively). Hospital stay was shorter in group A. A statistically significant difference was found in hospital mortality (16% overall) between the two groups with better outcomes in group A (p = 0.039). In the patient subset with the most severe preoperative profile (hemodialysis, tracheostomy, inotropic support) surgical treatment produced worse results than the sugar dressing method (p 0.048). No case of recurrence was observed. CONCLUSIONS: Both treatments proved effective in recurrent type IV A Staphylococcal mediastinitis. Granulated sugar proved a safer option in severely compromised patients.

Aged↗
PubMed2003

Postinfarction ventricular septal defect in a patient without coronary lesions.

A 46-year-old man with polycystic kidney disease was referred to our institution for ventricular septal defect complicating myocardial infarction. Cardiac catheterization disclosed normal coronary arteries and absence of myocardial bridging. None of the more frequent causes of thrombosis were present, and histopathology proved negative for acute myocarditis. The surgical procedure was successful and the 11-month follow-up uneventful.

Coronary Vessels↗