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Roberto Gallotti

Publications and source records attributed to Roberto Gallotti.

9 recordsLinked to original sources
PubMed2006

Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study.

BACKGROUND: This study evaluates the midterm clinical results of valve-preserving aortic root reconstruction by means of a modified conduit incorporating sinuses of Valsalva. METHODS: During a 5-year period, 151 patients with aneurysm of the aortic root underwent a reimplantation type of valve-sparing procedure using the Gelweave Valsalva prosthesis that incorporates sinuses of Valsalva. There were 121 males (80.1%), and the mean age was 56.4 +/- 14.4 years (range, 14 to 83). Fourteen percent of the patients had Marfan syndrome and 8.6% had bicuspid aortic valve. Seven patients (4.6%) suffered from acute aortic dissection. Aortic replacement was extended to the arch in 14 patients (9.3%). Sixteen patients (10.6%) had associated cusp repair. RESULTS: In-hospital mortality was 3.3%, and it was significantly higher among patients operated on for acute dissection (p = 0.001) and in symptomatic patients (III-IV New York Heart Association class; p = 0.021). Follow-up (mean, 18 months; range, 1 to 60) was 100% complete. There were 2 late deaths. Ten patients (6.8%) had 3 to 4+ aortic regurgitation, and 8 of these required late aortic valve replacement. Cusp repair was associated with a high incidence of late aortic valve replacement (p = 0.005). At 5 years, freedom from aortic valve replacement and freedom from grade 3 to 4 aortic insufficiency was 90.8% +/- 3.3% and 88.7% +/- 3.6%, respectively. CONCLUSIONS: The reimplantation valve-sparing procedure with the Gelweave Valsalva prosthesis provides satisfactory results for patients with aortic root aneurysm. Aortic cusp repair may lead to late aortic insufficiency. Proper leaflet evaluation is of paramount importance in preventing residual valve regurgitation.

Adolescent↗
PubMed2004

Linear cryoablation of the left atrium versus pulmonary vein cryoisolation in patients with permanent atrial fibrillation and valvular heart disease: correlation of electroanatomic mapping and long-term clinical results.

BACKGROUND: The aim of this study was to clarify the role of pulmonary vein isolation (PVI) alone versus left atrial linear lesions in the treatment of permanent atrial fibrillation (AF) in patients with left atrial dilatation and valvular disease. The primary end point was to assess the persistence of sinus rhythm (SR) off antiarrhythmic drugs (AADs) at 2-year follow-up and to correlate clinical outcome with surgical results validated with electroanatomic mapping (EAM). METHODS AND RESULTS: A total of 105 patients with permanent AF undergoing valve surgery were assigned to 3 different groups: in groups "U" and "7," left atrial linear cryoablation was performed, whereas in group "PV" patients, anatomic cryoisolation of pulmonary veins only was performed. In groups U and 7, SR was achieved in 57% of patients, whereas it was achieved in 20% of PV patients during 2-year follow-up. In the first 51 patients, the ablation schemes were validated with EAM. The EAM showed that the U lesion was never obtained: in 59% of these patients, a complete 7 lesion was achieved instead; in the 7 group, a complete 7 lesion was present in 65% of patients, whereas a complete PVI was obtained in 71% of patients. Considering patients in whom a complete 7 lesion was demonstrated with the EAM, SR without AADs was achieved in 86% of patients, whereas only 25% of patients with complete PVI were in SR without AADs. CONCLUSIONS: In patients with permanent AF, left atrial dilatation and valvular heart disease linear lesions in the posterior region of the left atrium are more effective than PVI alone. With cryoablation, the surgical intent is fulfilled in only approximately 65% of the cases. Knowing the real anatomic and electrophysiological effects of surgical ablation is necessary to correctly interpret the clinical outcome.

Aged↗
PubMed2004

Aspergillus left ventricular assist device endocarditis.

Left ventricular assist device (LVAD) support is an established therapy for patients with end-stage heart failure as a bridge to transplant; its usage as an alternative for those patients not eligible for transplant is not an established therapy yet. A 68-year-old male had a Thoratec-Heartmate LVAD implanted as destination therapy. After an uneventful (apart from early fever) recovery in the intensive care unit, the patient developed an intractable high temperature, and generalized sepsis and died 21 days following implant. The white cell blood count never exceeded the guard limits, and the patient succumbed with severe LVAD valve malfunction. At post-mortem examination friable material consisting of fungal hyphae was found on the inflow and outflow valves. According to published clinical trials, infection accounts for more than 40% of mortality in LVAD supported patients. Fungal LVAD endocarditis is a particularly deadly disease. Successful management requires a high level of suspicion and timely institution of antifungal therapy to control the infection. This has led some authors to recommend empiric antifungal therapy in LVAD recipients with culture-negative sepsis unresponsive to broad-spectrum antibiotics.

Aged↗
PubMed2003

Left main coronary arterial lesion after microwave epicardial ablation.

We present a case of left main coronary arterial lesion in a 62-year-old man who had undergone mitral valve replacement and microwave epicardial ablation. On postoperative day 90, the patient had an anterior myocardial infarction. The coronary angiography displayed the diagnosis of the left main trunk lesion. A myocardial revascularization was urgently performed, the postoperative course was uneventful, and the patient was in sinus rhythm. The left atrial epicardial ablation represents the ultimate step in the surgical treatment of chronic atrial fibrillation; nevertheless, the left main trunk lesion may occur as an extremely severe complication. The incorrect placement of the microwave probe may be responsible for the development of critical coronary artery stenosis.

Atrial Fibrillation↗
PubMed2003

Cryoablation of the left posterior atrial wall: 95 patients and 3 years of mean follow-up.

OBJECTIVE: Endocardial ablation of the left atrial posterior wall has been used to treat atrial fibrillation. Aim of the study was to evaluate its efficacy looking for the ablation pattern allowing a fast execution with limited interference on atrial contractility. Moreover a statistical analysis to identify predictors of long-term sinus rhythm recovery has been provided. METHODS: From April 1998 to May 2002, 95 patients with permanent (mean duration 65 months) or persistent (33%) atrial fibrillation have undergone three different ablation patterns, only 1 patient being affected by lone atrial fibrillation. Mean antero-posterior left atrial diameter was 76.2 mm. The prospective study collected information regarding variables related to patients' demographics, disease's characteristics and type of surgical ablation employed. Dependent variables were presence of sinus rhythm either at discharge and at 6 months. A logistic regression analysis was used to estimate the association between the collected variables and sinus rhythm restoration. RESULTS: In-hospital and late mortality rate were 3.2 and 6.3% respectively. At discharge 67 patients (72.8%) were in sinus rhythm while at a mean follow-up of 3 years, 81.4% of 86 surviving patients are in sinus rhythm. Major adverse events rate including cardiac reoperation, pace-maker implantation and cerebrovascular accident were 8.5, 6.3 and 4.2%, respectively. Pre-operative atrial fibrillation duration, left atrial dimension and type of mitral disease did not show any correlation with long term success while the lesion pattern and the rhythm at discharge were significant predictive factors. Survival is significantly higher in patients who converted to sinus rhythm at discharge (P=0.014) with respect to those who remained in atrial fibrillation. CONCLUSIONS: Permanent and persistent atrial fibrillation associated to a major cardiac disease can be safely treated with a linear ablation of the left atrial posterior wall. Satisfactory results in terms of rhythm restoration may be achieved regardless of the duration of the arrhythmia and its effects on atrial diameter. Any effort should be prompted to discharge patients in sinus rhythm. Life expectancy is longer if sinus rhythm is restored.

Aged↗
PubMed2003

Surgical treatment of atrial fibrillation in the beating heart: a novel approach.

Up to 50% of patients undergoing mitral valve surgery have concomitant atrial fibrillation. An epicardial approach may offer the benefit of reducing the aortic cross-clamping time and avoiding an undue left atriotomy. During the last year we have been developing a simple technique to reproduce epicardially the same lesion pattern we had previously achieved endocardially. Two patients with chronic atrial fibrillation received atrial ablation using a microwave energy probe (Flex-10, AFx Inc., Fremont, CA, USA) immediately before undergoing a concomitant cardiac procedure. The procedure is relatively quick to perform and with appropriate care can be conducted with a low risk of perioperative adverse events.

Atrial Fibrillation↗
PubMed2002

Surgical approaches to atrial fibrillation.

Atrial fibrillation (AF) remains an unsurmounted hurdle toward the cure of supraventricular arrhythmias. Despite its high prevalence, a definitive treatment approach has not been established. AF is triggered in most cases by early premature atrial beats and is maintained by anomalies of the substrate. Elimination or modification of either one or both may be effective in the cure of AF. Surgical ablation, which originated with the favorable results of the Maze procedure developed by Cox, has an important role in the cure of AF associated with heart diseases that require cardiac surgery. This is due to the high success rate and to the simplification of the procedure now used which has resulted in reduction of the procedural time and complications. Various techniques have been proposed, however, it is noteworthy that the posterior part of the left atrium and the ostia of pulmonary veins are involved in all approaches despite the different energy sources used (radiofrequency or cryo energy) and the different design of the intended lesion. These results imply that the posterior part of the left atrium is crucial in the genesis and maintenance of atrial fibrillation. On the other hand, it is not clear if the results of the ablation are due to the linear lesions that modify the substrate or to the electrical isolation that eliminate the triggers. A thorough electrophysiological evaluation post ablation has been performed only in few cases. Greater understanding of the mechanism of success of surgical ablation may advance the development and success of other approaches. Considering that surgical ablation is usually performed in patients with permanent AF, linear lesions modifying the substrate together with pulmonary vein isolation have shown better results than the elimination of the triggers with a pure electrical isolation of the pulmonary veins. Prevention of AF recurrences has been relatively good, however some severe complications (atrioesophagus fistula, coronary artery damage, etc.) have been reported. Considering the relatively benignity of AF in absence of associated cardiopathy, the risk of complications should discourage widespread application of surgical ablation in patients with lone AF. On the contrary it should be routinely proposed in most patients with permanent or paroxysmal AF undergoing cardiac surgery.

Atrial Fibrillation↗
PubMed2002

A video-assisted thoracoscopic technique to encircle the four pulmonary veins: a new surgical intervention for atrial fibrillation ablation.

BACKGROUND: Atrial fibrillation (AF) is the most common of the so-called benign arrhythmias. It affects not only life expectancy but also quality of life. Until recently, surgeons have most often encountered AF in association with ischemic or valvular disease but rarely as lone atrial fibrillation (LAF). For the subset of LAF patients, a minimally invasive procedure is recommended. METHODS: Using an animal model, we have developed a video-assisted thoracoscopic approach to atrial ablation whereby the ablation is performed encircling the four pulmonary veins as through a median sternotomy. RESULTS: Fifteen animals were used, and in 5 a complete encircling of the pulmonary veins was accomplished using the thoracoscopic approach. DISCUSSION: Video-assisted thoracoscopy is a feasible and safe approach for epicardial pulmonary vein ablation. This technique offers the option of surgery to a class of patients who are resistant to medical therapy but for whom the presence of LAF contraindicates the open chest approach.

Animals↗