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N Luciani

Publications and source records attributed to N Luciani.

At least 37 records · Page 2Linked to original sources
PubMed1998

Tepid systemic perfusion and intermittent isothermic blood cardioplegia in coronary surgery.

BACKGROUND: To evaluate the safety and effectiveness of tepid perfusion and isothermic blood cardioplegia in coronary surgery. METHODS: We studied 200 patients undergoing myocardial revascularization: 100 procedures were performed with moderate systemic hypothermia (28 degrees C) and cold crystalloid cardioplegia (4 degrees C); the other 100 patients received tepid systemic perfusion (TP) (34 degrees C) and intermittent blood cardioplegia at the same temperature according to the minicardioplegia technique (Group 2). The two groups were comparable with regards to age, extent of disease, preoperative left ventricular function and extra-corporeal circulation (ECC) time. RESULTS: In the tepid group we observed a higher incidence of spontaneous resumption of cardiac rhythm at cross-clamp removal compared to the hypothermic group (93% vs 34%; p<0.001). No difference was found in cardiac index at specified intervals, myocardial enzymes, inotrope requirements, arrhythmias, need for vasopressors and postoperative blood loss. Fluid balance at the end of ECC was significantly lower in the tepid group (343+/-635 ml vs 883+/-925 ml; p<0.001). Hospital mortality and morbidity were the same in the two groups. CONCLUSIONS: Our data suggest that TP and isothermic blood cardioplegia represent a simple, safe and effective method of systemic and myocardial protection which may be an alternative to traditional hypothermia.

Aged↗
PubMed1997

The internal mammary artery malperfusion syndrome: late angiographic verification.

BACKGROUND: Here we report our experience with the incidence and the surgical treatment of the internal mammary artery (IMA) malperfusion syndrome, evaluate the predictive role of previously described risk factors for the syndrome, and assess the late patency of IMA grafts in patients in whom an IMA malperfusion syndrome was diagnosed and treated by additional saphenous vein grafting of the left anterior descending coronary artery. METHODS: From June 1992 to November 1995, 969 IMAs were anastomosed to the left anterior descending coronary artery system. In 11 patients, IMA malperfusion syndrome was diagnosed and treated by additional saphenous vein grafting of the LAD. There were 8 men and 3 women with a mean age of 58.9 years. The angiographic and clinical data for each patient were reviewed, and all but 1 surviving patient underwent late angiographic control (mean follow-up, 18 months; range, 4 to 46 months). RESULTS: One patient died in the hospital. No previously described risk factor was strongly associated with the occurrence of IMA malperfusion syndrome. Late angiography revealed a malfunctioning IMA graft in 7 of the 9 patients. A string sign was observed in 1 patient and a normally functioning IMA anastomosed to a diagonal branch not connected to the LAD, in another. In no patient was a widely patent and normally functioning IMA graft observed. CONCLUSIONS: In our series, a high proportion of IMA grafts were found to be malfunctioning at late angiography. This observation, in contrast to previous reports, suggests that IMA malperfusion syndrome can often be attributable to technical problems in harvesting the IMA or in performing the IMA anastomosis. Functional IMA insufficiency seems to play only a marginal role in determining the IMA malperfusion syndrome.

Coronary Angiography↗
PubMed1997

Lesions of the target vessel during minimally invasive myocardial revascularization.

BACKGROUND: Minimally invasive coronary artery bypass grafting has recently been introduced into cardiac surgery. In this report we discuss the incidence of surgically induced distal target vessel stenosis in patients who undergo the minimally invasive coronary artery bypass grafting procedure, which represents a major drawback of the procedure in our experience. METHODS: Doppler evaluation of mammary artery flow was performed postoperatively in all 55 patients who underwent minimally invasive coronary artery bypass grafting at our institution. Angiography was performed in the first 35 consecutive patients for control purposes and in 2 patients who complained of angina recurrence. RESULTS: In 32 of the first 35 consecutive patients, the anastomosis was found to be functioning normally and the distal left anterior descending artery was normal; in the remaining 3 patients we found mammary artery occlusion, anastomotic stenosis, and stenosis of the anastomosis and the distal left anterior descending artery in 1 patient each. A distal left anterior descending artery stenosis was found in the only 2 patients who underwent late angiography. CONCLUSIONS: Surgically induced distal target vessel stenosis represents a major drawback of minimally invasive coronary artery bypass grafting in our experience. Further improvement in the means of achieving coronary artery occlusion, as well as in anticoagulant and antiplatelet therapy, is mandatory before minimally invasive coronary artery bypass grafting can be confidently accepted into clinical practice.

Adult↗
PubMed1997

Early results with the minimally invasive thoracotomy for myocardial revascularization.

OBJECTIVE: We report the early results of the left anterior descending artery revascularization through a minimally invasive thoracotomy, examining the main technical aspects of the operation. METHODS: From January 1995 to September 1996, 51 patients underwent myocardial revascularization through a mini-thoracotomy on beating heart without cardiopulmonary bypass. The main indication to operation was limited lesions of the left anterior descending artery with contra-indications or high risk of failure of angioplasty. The position of the patient was the same than traditional surgery; the chest was opened on the fourth left intercostal space; the left internal mammary artery harvested under direct vision; temporary occlusion of the left anterior descending was obtained prevalently using 5-0 poliypropilene sutures; the anastomosis was performed with single or double 7-0 or 8-0 suture. In six patients the chest was closed and a conventional open-heart operation was performed due to internal mammary artery or left anterior descending unsuitability for minimally invasive revascularization. All the patients were submitted after operation to early angiographic control and/or a Doppler study of the mammary flow. RESULTS: There was no intra-operative mortality. One patient had a postoperative myocardial infarction of the anterior-lateral wall of the left ventricle, and died after an emergency open-heart operation. In one case the patient was reopened after a few hours for a bleeding. Three patients showed various degrees of anastomotic stenosis at the angiographic control. CONCLUSIONS: Several technical difficulties can play an important role in the operative outcome because a single repeated technical error could not fully explain these heterogeneous observed failures. The technique of myocardial revascularization through a left anterior small thoracotomy might present several critical points, particularly: (1) the harvesting of LIMA, meaning the preservation of integrity of the arterial wall and adequacy of the length; (2) the method of the temporary closure of the LAD during of the anastomosis; (3) the stabilization of the LAD and the surgical technique of the anastomosis; (4) the methods for intraoperative control of the patency of the anastomosis. All points mentioned have been thought in our experience to be causes of early failure.

Aged↗
PubMed1996

[Reintervention of myocardial revascularization by left thoracotomy in deep hypothermia. A clinical case].

Herewith we report a case of redo coronary-surgery which was approached through a left thoracotomy and in hypothermic arrest so as to avoid either a demanding dissection with its potential consequences over the functioning grafts and aortic cross-clamping thus making unnecessary any cardioplegia delivery. We describe the surgical procedure and analyze its advantages with respect to the usual median sternotomy approach.

Coronary Disease↗
PubMed1995

Stimulation of translation by reactive oxygen species in a cell-free system.

Wheat germ lysate was used as a model system for in vitro translation. We show that an increase of the exchange surface between the reaction mixture and the atmosphere enhanced the amount of incorporated cysteine, indicating that early arrest of protein synthesis previously observed in such a system was due to oxygen starvation in the reaction mixture. This hypothesis was confirmed since the amount of proteins synthesized and the rate of translation increased when oxygen was added. We show that an addition of hydrogen peroxide to the translation mixture had the same effect as oxygen, allowing us to postulate that stimulation could be due to a common property between both molecules: the oxidizing behaviour. Free radicals in in vitro translation were believed to be involved since the utilization of iron chelating agents inhibited translation. This hypothesis was emphasized by the positive effect of a free radical generating system and the negative effect of free radical scavengers. These experiments suggest that the superoxide radical plays an important role in in vitro translation.

Cell-Free System↗
PubMed1994

Composite arterial conduits for a wider arterial myocardial revascularization.

From October 1991 to May 1993, 130 patients were submitted to myocardial revascularization using complex preformed arterial conduits. The age ranged from 29 to 75 years (mean age, 60.1 years); 121 patients were male. One hundred twenty-six patients had double- or triple-vessel disease. The mean ejection fraction was 0.53 (range, 0.22 to 0.79); only 6 patients had an ejection fraction less than 0.35. In 6 cases the procedure was a reoperation. We used 360 arterial conduits, 163 of which as free grafts (3 left internal mammary arteries, 16 right internal mammary arteries, 86 inferior epigastric arteries, 57 radial arteries, and 1 right gastroepiploic artery). One hundred fifty-four free grafts were anastomosed to one or both internal mammary arteries and one to a radial artery. We constructed 136 complex arterial conduits (branched, lengthened, or both). In 6 cases a double arterial system had to be used in a single patient. There was no operative mortality, and no inotropic or mechanical supports were used. The overall mortality rate was 1.5%. Early angiographic controls (between the 7th and 15th postoperative days) demonstrated 100% patency; late angiographic controls (at a mean interval of 9.5 months after operation) documented a mean patency rate ranging from 94.1% of the radial arteries to 100% of the left internal mammary arteries and right gastroepiploic arteries. At a mean follow-up of 7.2 months (range, 1 to 15 months) all patients are alive without recurrence of symptoms.

Anastomosis, Surgical↗
PubMed1990

[Aortic valve replacement in a case of Takayasu's disease with polydistributed localization].

We report a case of a 49 year-old woman suffering from severe aortic regurgitation due to Takayasu's disease involving the ascending and abdominal aorta and the brachial arteries. The patient was managed successfully with aortic valve replacement. Considering the Literature data, the pathogenesis of the aortic insufficiency and the main surgical and anaesthesiologic problems related to the Takayasu's disease are discussed.

Adult↗
PubMed1990

[Infectious endocarditis. Role of surgical therapy].

The problem of infectious endocarditis (IE) is approached through a review of personal experience. The series examined consists of patients, 17 with active and 21 dormant infection. Furthermore 12 in the first group, 18 in the second had natural heart valves, while 5 in group I, 3 in group II had been given artificial ones. After an analysis of the aetiopathogenic, clinical and diagnostic aspects of the condition with emphasis on the fact that Staphylococcus aureus is currently more responsible for infections in natural valves and the epidermidis for acute prosthesis infections which have a higher early and late mortality rate (40% in hospital, 33.3% long-term), the paper discusses the criteria for surgical intervention. In line with opinions expressed in the literature, it is pointed out that, while the patient's haemodynamic status is certainly the main criterion for any decision, other factors such as embolism, impaired conduction, kidney failure and expansion of the infection to contiguous tissues, should not be under-estimated.

Endocarditis, Bacterial↗
PubMed1990

[What is the best treatment in massive pulmonary embolism: anticoagulants, thrombolytics or surgical embolectomy?].

The aim of this work was to identify the best treatment available for massive pulmonary thromboembolism which still remains a frequent and sometimes lethal complication for surgical and non-surgical patients. The Authors underline the difficulties of diagnosis and the need for therapy at the earliest possible stage. At present, clinical management involves the use of: anticoagulants, thrombolytic agents and surgical embolectomy. In conclusion, the authors state that pulmonary thromboembolism, even when massive, has been transformed into a medically interesting pathology which can be cured using heparin and thrombolytic agents. However, surgical treatment is mandatory when patients reveal adverse effects to drug therapy, when medical therapy is insuccessful, or when patients are seriously ill with recurrent cardiac arrest.

Anticoagulants↗
PubMed1990

[Aneurysms of the abdominal aorta].

The authors report 73 cases of abdominal aortic aneurysms with particular emphasis to early and long-term results as well as postoperative complications: 4 patients died at admission, 16 were treated with medical therapy, and 53 underwent surgery. Surgical patients were stratified in two groups: 18 emergency cases (group 1) and 35 elective cases (group 2). Early results showed the highest mortality in group 1 cases presenting with shock. Late results, at the end of the follow up, (6 months-8 years), showed a 56.6% 5-year survival rate, with overlapping survival rates after the immediate postoperative period. The most frequent postoperative complications were thrombosis of prosthesis and lymphorrhea. Survival rates of emergency cases were influenced by early diagnosis and prompt aorta clamping. Before surgery an haemodynamic evaluation of all vascular districts seems necessary in elective cases to prevent complications of atherosclerotic disease.

Aged↗
PubMed1989

[Reversibility of left ventricular functional damage after valve replacement in patients with chronic aortic valve insufficiency].

The authors study retrospectively some preoperative echocardiographic findings and their importance as predictors of reversible myocardial dysfunction. The functional status of 57 survivors after isolated aortic valve replacement was evaluated with exercise testing and on this ground the patients, were divided into three groups: A (28 pts) greater than 60%; C (10 pts) less than 40%; B (19 pts) from 40% to 60%. The authors conclude that the postoperative improvement in functional status is strictly correlated with some preoperative echocardiographic indexes (end-diastolic dimension, end-systolic dimension, shortening fraction, mean end-systolic radius/thickness ratio, end-systolic wall stress, myocardial mass, ejection fraction) with are also predictive of operative mortality. The authors consider the principal values of beginning left ventricular impairment: a) end-systolic dimension greater than or equal to 5.5 cm; b) shortening fraction less than 27%; c) mean end-systolic radius/thickness ratio greater than 2.5; d) end-systolic wall stress greater than 240 mmHg.

Aortic Valve Insufficiency↗
PubMed1987

[Operative risk in coronary bypass. A multivariate analysis of prognostic factors].

In order to determine the predictors of operative risk in coronary bypass surgery, we have studied 2112 consecutive patients who underwent isolated coronary bypass surgery between January 1979 and September 1984. The overall operative mortality (OM) was 4.4 percent (3.5 percent during the last 3 years). OM increases significantly with age (from O before the age of 30 to 12.3 percent after 70), the functional class (FC) of angina, the FC of dyspnea (NYHA), the creatinine blood level (23.5 percent if greater than 200 mumol/l), the left ventricular end-diastolic pressure and in case of reoperation (16.7 percent), as well as in women (11.6 percent). There is a trend toward higher OM in case of past history of ventricular tachycardia or arterial hypertension, atherosclerotic disease of the lower extremities, left ventricular dysfunction or severe stenosis of the left main coronary artery. OM is not increased in patients with multivessel disease, diabetes or with a past history of myocardial infarction, and is even decreased in obese patients. The variables selected by multivariate analysis were: creatinine blood level, then angina FC, sex, dyspnea FC, age, the absence os obesity, left ventricular dysfunction, the year of surgery and finally reoperation. These results, mainly based on simple clinical variables, should facilitate the therapeutic decisions in borderline indications of coronary bypass surgery.

Aged↗