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Paul L DiGiorgi

Publications and source records attributed to Paul L DiGiorgi.

4 recordsLinked to original sources
PubMed2006

Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization.

BACKGROUND: Mild and moderate functional ischemic mitral insufficiency present at the time of surgical revascularization present clinical uncertainty. It is unclear whether the relatively poor outcomes in this cohort are dependent on valvular function or related to left ventricular dysfunction. The purpose of this study was to examine the early and late outcomes in patients with less-than-severe functional ischemic mitral insufficiency at the time of isolated coronary artery bypass grafting (CABG). METHODS AND RESULTS: From 1996 through 2004, 2242 consecutive patients undergoing isolated CABG were identified as having none to moderate mitral regurgitation (MR) and no valve leaflet pathology. All of the patients at this single institution routinely had an intraoperative transesophageal echocardiography, prospectively quantified MR, and ejection fraction (EF). The New York State Cardiac Surgery Reporting System infrastructure was used to prospectively collect in-hospital patient variables and outcomes. Social Security Death Benefit Index was used to determine long-term survival. Odds ratio and significance (P value) are presented for each determined risk factor. There were 841 patients (37.5%) with no MR, 1137 (50.7%) with mild MR, and 264 (11.8%) with moderate MR. The patients with moderate MR were more likely to be older, female, and have more renal disease, previous MI, congestive heart failure, previous cardiac surgery, and lower EFs. Hospital mortality was independently and significantly associated with renal disease, decreasing EF, increasing age, previous cardiac operation, and cerebral vascular disease. Multivariable analysis revealed decreased survival with increasing age, previous operation, congestive heart failure, diabetes, nonelective operation, decreasing EF, and the presence of moderate MR (expbeta = 1.49; P=0.007) and mild MR (expbeta = 1.34; P=0.033). CONCLUSIONS: Independent of ventricular function, mild and moderate functional mitral insufficiency are associated with significantly decreased survival in patients undergoing CABG. Whether correction of moderate functional MR at the time of CABG improves outcome still needs to be determined.

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PubMed2004

In vitro characterization of aortic retrograde and antegrade flow from pulsatile and non-pulsatile ventricular assist devices.

BACKGROUND: Many advances have been made in left ventricular assist device (LVAD) development including the introduction of smaller, non-pulsatile pumps. However, controversy exists over the potential significance of non-pulsatile blood flow. In addition, some newer LVADs incorporate descending aortic anastomosis (and therefore retrograde ascending aortic flow) for outflow rather than the traditional ascending aortic anastomosis. This, combined with non-pulsatile flow, may significantly increase the risks of ascending aortic thrombus formation, especially if native cardiac function is negligible and the aortic valve remains closed. The purpose of this study was to compare pulsatile and non-pulsatile flow generated by LVADs with outflow to the ascending aorta and descending aorta. METHODS: An in vitro mock circulatory loop, driven by either a pulsatile or a non-pulsatile LVAD, was anastomosed to transparent aortic models at either the ascending or descending aortic position. The aortic valve was kept closed, modeling no native cardiac output. Normal saline was used as a blood analog. Methylene blue dye was injected into the ascending aorta and aortic arch to demonstrate flow patterns. Dye washout time (in seconds) was used as a marker of flow stagnation and potential thrombogenicity. LVAD flow, rate, after-load and coronary flow were measured. RESULTS: Dye washout times at a flow rate of 5 liters/min were 1.7 +/- 0.75, 2.1 +/- 0.71, 4.7 +/- 0.82 and 9.9 +/- 4.4 seconds for pulsatile ascending (PA), non-pulsatile ascending (NPA), pulsatile descending (PD) and non-pulsatile descending flow (NPD), respectively. Coronary flow averaged 294 ml/min over all set-ups. Dye washout times at a flow rate of 4-liters/min were 3.0 +/- 1.0, 3.0 +/- 0.8, 14.0 +/- 3.8 and 25.0 +/- 9.1 seconds for PA, NPA, PD and NPD, respectively. Coronary flow averaged 227 ml/min over all set-ups. Ascending aortic anastomoses were associated with shorter dye washout times compared with descending aortic anastomoses, regardless of flow type (p < 0.001). There was no difference in washout time between pulsatile and non-pulsatile flow in the ascending aortic position (p = 0.23 and 0.12 for 5 and 4 liters/min, respectively). Pulsatile flow in the descending aorta had shorter washout times than non-pulsatile flow in the descending aorta (p < 0.001 and p = 0.004 for 5 and 4 liters/min, respectively). CONCLUSIONS: LVAD descending aortic anastomosis and retrograde aortic flow is associated with increased flow stagnation in the ascending aorta. This may increase the risk for thrombus formation in patients relying solely on retrograde aortic flow, especially if cardiac function and antegrade blood flow returns.

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