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Biomedical subjects

Davide Pacini

Publications and source records attributed to Davide Pacini.

24 records · Page 2Linked to original sources
PubMed2003

Brain protection using antegrade selective cerebral perfusion: a multicenter study.

BACKGROUND: To evaluate the results of antegrade selective cerebral perfusion as a method of brain protection during surgery of the thoracic aorta and to determine predictors of hospital mortality and adverse neurologic outcome. METHODS: Between October 1995 and March 2002, 588 patients underwent aortic surgery with the aid of antegrade selective cerebral perfusion. There were 334 men (56.8%); the mean age was 63.7 +/- 11.8 years. One hundred sixty-two patients (27.6%) underwent urgent operation. The separated graft technique was employed to reimplant the arch vessels in 230 patients (65.3%) of the 352 requiring aortic arch replacement. Associated procedures were performed in 254 patients (43.2%). One hundred twelve patients underwent elephant trunk procedure. The mean cerebral perfusion time was 67 +/- 37 minutes. RESULTS: The overall hospital mortality rate was 8.7%. A logistic regression analysis revealed urgent operation, recent central neurologic event, tamponade, unplanned coronary artery revascularization and pump time to be independent predictors of hospital mortality (p < 0.05). The permanent neurologic dysfunction rate was 3.8%. A logistic regression analysis showed tamponade to be independent predictor of permanent neurologic dysfunction (p < 0.05). The transient neurologic dysfunction rate was 5.6%. Recent central neurologic event, tamponade, coronary disease, and aortic valve replacement were indicated as independent predictors of transient neurologic dysfunction by logistic regression (p < 0.05). CONCLUSIONS: In our experience the utilization of antegrade selective cerebral perfusion resulted in encouraging results in terms of hospital mortality and brain complications. Neither the extent of the replacement nor the duration of the cerebral perfusion had an impact on hospital mortality and neurologic outcome.

Aorta, Thoracic↗
PubMed2003

Clinical outcome of aortic valve replacement in the elderly.

Since elderly patients are being referred for surgery in increasing numbers, we reviewed the clinical outcome of 459 consecutive patients aged 70 to 89 years, who had aortic valve replacement between 1993 and 2000. We subdivided the study population into three groups: in Group 1 we included patients aged 70-74 years old; in Group 2 patients aged 75-79 years old; and in Group 3 patients aged 80 years old or older. An isolated AVR was performed in 289 patients (63%), concomitant coronary artery bypass graft (CABG) in 168 patients (36.6%), an isolated ventricular septal defect (VSD) closure in one patient (0.2%) and an isolated atrial septal defect (ASD) closure in one patient (0.2%). The overall perioperative mortality rate was 7% (32 patients), without significant differences among the three groups (P=0.88). Our study confirms the good outcome of aortic valve replacement in elderly patients even in octagenarians and only concomitant CABG procedures increase the operative risk, reducing long-term survival (P<0.05).

Aged↗
PubMed2003

Cardiac anomalies in Turner Syndrome.

This is the case of a 30-year-old woman with Turner Syndrome, with Mosaicism, exhibiting a bicuspid aortic valve with aortic stenosis, ascending aortic dilatation, pseudocoarctation of the aorta, left superior vena cava and lusoria subclavian artery. The successful surgical procedure consisted of the replacement of the aortic root and ascending aorta with a composite valved graft.

Adult↗
PubMed2002

Indications for, timing of, and results of catheter-based treatment of traumatic injury to the aorta.

OBJECTIVE: The optimal treatment for and timing of surgery to repair traumatic aortic injury are still controversial. Endovascular treatment is a viable option in patients with both acute and chronic aortic trauma. However, appropriate patient selection criteria, treatment timing, and long-term durability of endovascular repair remain to be defined. We sought to identify appropriate selection criteria and optimal timing of treatment as well as to assess the long-term durability of endovascular repair. SUBJECTS AND METHODS: From July 1997 to December 2001, 19 patients with traumatic aortic injury (11 patients with acute and eight with chronic injuries) were selected for endovascular treatment. In all patients, the lesions were sited at the proximal segment of the descending aorta at a distance of 10 +/- 17 mm (mean +/- SD) from the left subclavian artery. Nine of the patients with acute injuries were treated after clinical stabilization of other severe associated lesions, whereas two patients, in whom hemodynamic and imaging findings suggested an impending rupture, received emergency treatment. Single-detector helical CT or MR imaging was used for patient selection and stent-graft customization before treatment and for evaluation of patients during the follow-up period. RESULTS: Endovascular stent positioning was successful in all patients. None of the patients developed complications. Aneurysm exclusion and shrinkage were confirmed at followup examinations. A partial covering of the subclavian artery occurred in six patients without interrupting the blood flow. All patients remain asymptomatic after a mean follow-up period of 20 months (range, 1-56 months). CONCLUSION: Endovascular repair represents an alternative, minimally invasive treatment, particularly suitable for use in patients with traumatic aortic injuries. The decision of whether to provide immediate emergency treatment or to delay treatment should be based on the lesion characteristics on imaging and clinical findings. The durability of treatment seems to be related to the absence of alteration to the aortic wall at the extremities.

Acute Disease↗
PubMed2002

[Non-bacterial thrombotic endocarditis: a rare case of recurrent embolic events].

Non bacterial thrombotic endocarditis is a rare disease. The real incidence is not known and seems to range from 0.9 to 9.3%. Generally it is associated with cancer and rarely diagnosed antemortem. We describe the case of a female patient who suffered from ictus cerebri and acute myocardial infarction. She was admitted with diagnosis of papillary fibroelastoma arising from the right aortic leaflet. Her past medical history was characterized by gastrectomy, splenectomy and partial pancreatectomy for gastric cancer. The patient underwent successful resection of the mass that was attached to the right leaflet of the aortic valve closed to the aortic annulus. The histopathological examination revealed a mass composed of only thrombotic material. At the follow-up 1 year later the patient was in good clinical conditions (NYHA functional class I). Transthoracic echocardiography showed a good ventricular function, a continent aortic valve without recurrent mass. The suspicion of non bacterial thrombotic endocarditis should be aroused when diagnosis of endocardial mass is made in patients with previous cancers.

Coronary Thrombosis↗