Biomedical subjects

Carlo Maria De Filippo

Publications and source records attributed to Carlo Maria De Filippo.

4 recordsLinked to original sources

PubMed2005

Thoracic radiation therapy and suitability of internal thoracic arteries for myocardial revascularization.

INTRODUCTION AND BACKGROUND: Myocardial revascularization using internal thoracic arteries (ITAs) has been associated with superior clinical outcome. This study addresses the question of whether internal mammary arteries are unsuitable for grafting due to radiation-based damage in patients with history of thoracic radiation therapy. We review our experience in this subset of surgical candidates. PATIENTS AND METHODS: Forty-nine patients undergoing elective coronary artery bypass grafting with use of at least one ITA were enrolled and matched to 49 comparable nonirradiated individuals by propensity scoring system. Preoperative and postoperative data were collected and compared. A 18-month clinical follow-up was performed. RESULTS: Intraoperative mammary artery flow was assessed by transthoracic Doppler echocardiography probe, and there was no significant difference between irradiated and nonirradiated individuals (36 +/- 8.3 mL/min vs 39 +/- 7.2 mL/min, p = 0.15). The two study groups were also comparable in terms of survival (overall mortality, 2%) and recurrence of angina and perfusion defect at control stress perfusion nuclear scan (p = 0.99 and p = 0.77, respectively). One arterial graft showed stenosis at postoperative angiography. The dose of radiation therapy administered did not correlate with graft flow values after anastomosis. CONCLUSION: Our data suggest that the use of a monolateral or bilateral ITA is not associated with early graft failure in patients with history of chest/mediastinal irradiation. Skeletonization harvesting technique might be recommended because of the frequent presence of fibrous tissue around the in situ vessel. Arterial graft stenosis in thorax-irradiated patients should be attributed to the primary atherosclerotic disease rather than to irradiation itself.

Aged↗

PubMedDate not supplied

Repair of acute postinfarct posterior ventricular septal rupture without left ventriculotomy: a stable suture preserving left ventricular geometry.

The present article describes the case of a man operated upon for emergency closure of an acute postinfarction defect in the posterior septum. We used a novel technique. The rupture was approached by disconnection of the right ventricular posterior free wall with the exposure of the right side of the septum. First, the edges of the defect were joined together by a single purse-string pledgetted suture. Then an on-site tailored double-folded patch was applied with the aim of closing both the septal defect and the RV access. In our limited experience the technique proved to be safe and effective, allowed optimal exposure of the defect and placement of stable stitches, reducing postoperative complications.

Acute Disease↗

PubMedDate not supplied

Topical cooling for myocardial protection: the results of a prospective randomized study of the "shallow technique".

INTRODUCTION AND BACKGROUND: Respiratory distress following cardiac surgery is a troublesome complication. In several cases it is associated to cool-related phrenic nerve injury (PNI) after adoption of iced slush or hypothermic cardiopulmonary bypass. We compare two different strategies for myocardial protection: the "shallow technique" (ST) (dripping and prompt removal of cold saline solution from the epicardial surface) plus normothermic cardiopulmonary bypass, versus mild hypothermic cardiopulmonary bypass plus iced slush. METHODS: Two hundred forty-nine patients undergoing elective cardiac surgery were randomly assigned to receive either ST (Group A) or iced slush (Group B). Occurrence of postoperative PNI (abnormal diaphragmatic movement plus alteration of nerve conduction) was evaluated. Multivariate analysis was performed for identification of factors associated to PNI. Patients had a 6-month follow-up. RESULTS: PNI and failure of extubation occurred more frequently in Group B (p = 0.009 and p = 0.034, respectively), but there was no statistically significant difference in mean intensive care unit stay. Diabetes and the use of iced slush were independent predictors of phrenic dysfunction, while internal thoracic artery (ITA) harvest was a significant risk factor only among Group B patients. Abnormal diaphragmatic movement was persistent at 6 months only in 30% of Group B individuals who suffered this complication in the early postoperative. CONCLUSIONS: ST likely reduces the incidence of postoperative PNI and might be protective mainly in the event of ITA harvest. It should be considered as a valuable tool for myocardial protection protocols.

Aged↗

PubMedDate not supplied

The "button inside" technique for the aortic root replacement: a modified button technique.

Modified button technique for reattachment of coronary arteries in the aortic root replacement is reported. Anastomosis of the coronary buttons is performed from the inside of the composite valve graft previously including the coronary buttons in the composite valve graft. Reduced tension is present between coronary arteries and the composite valve graft once the heart is beating and the systemic pressure is increasing. In this way coronary buttons are reinforced directly by the composite aortic wall graft prosthesis. The coronary ostia are perfused with lower tension at the site of the coronary anastomoses. No bleeding from the suture line of the coronary buttons occurs using this new surgical approach.

Aged↗