Biomedical subjects

Massimo Caputo

Publications and source records attributed to Massimo Caputo.

26 records · Page 2Linked to original sources

PubMed2002

Intracoronary shunts reduce transient intraoperative myocardial dysfunction during off-pump coronary operations.

BACKGROUND: This study investigated the hemodynamic changes in patients undergoing multiple vessel beating heart coronary revascularization in the presence or absence of an intracoronary shunt. METHODS: Forty patients were randomized to off-pump with a shunt (n = 20) or with the proximal coronary artery occluded by a soft snare (n = 20). Hemodynamic measurements were recorded at base line, during construction, and after completion of each distal anastomosis. RESULTS: Grafting of the left anterior descending coronary artery anastomosis was associated with a significant decrease in stroke volume, cardiac index, and mean arterial pressure, and an increase in pulmonary capillary wedge pressure and systemic vascular resistance in the snare but not in the shunt group. During grafting of the posterior descending coronary artery there was a marked decrease in stroke volume and cardiac index, and an increase in central venous pressure in both groups, and an increase in heart rate, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, and systemic vascular resistance only in the snare group. The most extensive changes were observed during the circumflex coronary artery anastomosis with a reduction in stroke volume, cardiac index, and mean arterial pressure, and an increase in central venous pressure, pulmonary capillary wedge pressure, pulmonary arterial pressure, and systemic vascular resistance in both groups. In all settings, these changes were transient and recovered after the heart was returned to its anatomical position in the shunt group, whereas stroke volume and cardiac index remained reduced, and systemic vascular resistance was elevated in all settings in the snare group. CONCLUSIONS: Stabilization of the left anterior descending coronary artery to perform the anastomosis resulted in temporary hemodynamic changes, which are prevented by the use of an intracoronary shunt. The hemodynamic deterioration during the construction of the posterior descending coronary artery and circumflex coronary artery anastomoses is transient in the shunt group, whereas the snaring technique is associated with an impairment of early functional recovery.

Aged↗

PubMed2002

Cold blood versus cold crystalloid cardioplegia for repair of ventricular septal defects in pediatric heart surgery: a randomized controlled trial.

BACKGROUND: There is little evidence in the literature on the benefits of cold blood cardioplegia in pediatric cardiac surgery. This study investigates the effects of cold crystalloid versus cold blood cardioplegia on myocardial metabolism, reperfusion injury, and clinical outcomes in patients undergoing ventricular septal defect (VSD) repair. METHODS: Patients were randomly assigned to receive antegrade cold (4 to 6 degrees C) St Thomas's I crystalloid (CCC) or blood (CBC) cardioplegia. Changes in myocardial adenine nucleotides and purine levels were monitored in right ventricular biopsies and postoperative serum troponin I (TnI) and lactate release were measured. RESULTS: Forty patients were randomly assigned to CCC (n = 21; age 21.1 +/- 40.8 months) or to CBC (n = 19; age 27.4 +/- 39.3 months). Patient characteristics were similar in the two groups and there was no mortality. After the ischemic period there was a significant drop in adenosine triphosphate levels compared with control values in the CCC (40.4 +/- 9.9 versus 27.5 +/- 12.5 nmol/mg protein, p = 0.01) but not in the CBC group (40.3 +/- 23.2 versus 37.3 +/- 18.9 nmol/mg protein). The fall was more marked in infants compared with children (40% versus 10%, respectively, p = 0.01). Mean total TnI release was 42% lower in the CBC than the CBC group (95% confidence interval 10% to 62%, p = 0.015). Total TnI release was significantly associated with age (p < 0.001) but as levels in infants in the CBC group were the same as for children, the reduction with age was seen almost entirely in the CCC group. There were no differences in the duration of inotropic support, ventilation time, intensive care unit, or hospital stay in the two groups. CONCLUSION: The use of CBC is associated with less metabolic myocardial ischemic stress and reperfusion injury when compared with CCC in pediatric patients undergoing VSD repair.

Bicarbonates↗

PubMed2002

The evolution of training in off-pump coronary surgery in a single institution.

BACKGROUND: This study analyses the development of off-pump coronary artery bypass (OPCAB) surgery training at a single institution, and compares the early and midterm clinical outcomes of OPCAB and conventional coronary artery bypass grafting (CABG) procedures performed by trainees with or without direct consultant cardiothoracic surgeon supervision. METHODS: Analysis was undertaken on data prospectively recorded on a computer database (Patient Analysis and Tracking System). Of the 2,422 CABG operations performed between January 1999 and December 2001, 969 (40%) were carried out by trainees either off pump (422) or on pump (547). RESULTS: Although the total number of CABG operations performed by trainees remained constant, there was a significant increase in the number of OPCAB operations during the study period compared with conventional CABG, as well as an increase in the average number of grafts per patient in the OPCAB group (both p < 0.05). Furthermore, a significant trend towards using two or more arterial conduits in the OPCAB group was observed in the study period. The number of OPCAB operations performed by trainees as independent operators without direct consultant supervision also increased significantly (p < 0.05). Early and midterm clinical outcomes were similar between patients operated by trainees on pump or off pump as independent operators versus under direct consultant supervision. CONCLUSIONS: The significant increase in OPCAB operations performed by trainees as independent operators or under direct consultant supervision, as well as the increase in the number of grafts per patient and arterial conduits used for myocardial revascularization, demonstrate a progression of training in beating heart surgery for cardiothoracic trainees. Improvements in the techniques have made it safe to teach trainees off-pump multivessel coronary artery revascularization.

Anesthesia, General↗

PubMed2002

Effect of off-pump coronary surgery with right ventricular assist device on organ function and inflammatory response: a randomized controlled trial.

BACKGROUND: Right ventricular assist devices (RVADs) have been proposed to improve exposure of the coronary arteries in off-pump surgery. In this study we investigated the impact of the A-Med RVAD on inflammatory response and organ function in patients undergoing coronary artery bypass grafting. METHODS: Sixty patients were prospectively randomized to conventional surgery with cardiopulmonary bypass (CPB) and cardioplegic arrest, beating heart surgery (off-pump), or beating heart surgery with the RVAD. Serial blood samples were collected postoperatively, for analysis of inflammatory markers, troponin I, protein S100, and free hemoglobin. Renal tubular function was assessed by measuring urine N-acetyl-glucosaminidase activity. RESULTS: No hospital deaths or major postoperative complications occurred in the study population. Interleukin-6, interleukin-8, C3a, and troponin I levels after surgery were significantly higher in the CPB group compared with the off-pump and RVAD groups. Free hemoglobin levels immediately after the operation, peak and total S100 levels, and N-acetyl-glucosaminidase activity were also significantly higher in the CPB group. CONCLUSIONS: Off-pump coronary revascularization, with or without RVAD, reduces inflammatory response, myocardial, neurologic, and renal injury, and decreases hemolysis when compared with conventional surgery with CPB and cardioplegic arrest.

Acetylglucosaminidase↗

PubMed2002

Cardiac troponin I in neonates undergoing the arterial switch operation.

BACKGROUND: Cardiac troponin I (TnI) is a sensitive and specific marker of myocardial injury, but little is known about its release after complex congenital heart surgery. We investigated whether TnI correlates with early clinical outcome in neonates undergoing the arterial switch operation (ASO) for transposition of the great arteries (TGA). METHODS: Troponin I was measured serially up to 48 hours postoperatively in 31 neonates undergoing the ASO alone (simple TGA) and 9 neonates undergoing the ASO combined with other procedures (complex TGA) (eg, closure of a ventricular septal defect) and correlated with intraoperative and postoperative clinical parameters. RESULTS: There was no mortality. Troponin I peaked at either 4 or 12 hours postoperatively in all patients (median for simple TGA = 3.4 ng/mL, interquartile range 2.4 to 4.6; median for complex TGA = 4.7 ng/mL, interquartile range 3.2 to 6.8, p = 0.20). Peak TnI correlated with the durations of inotropic support (r = 0.54, p < 0.001), ventilation (r = 0.51, p < 0.01), and intensive care unit stay (r = 0.50, p < 0.01). The duration of cardiopulmonary bypass, aortic cross-clamping, and circulatory arrest did not correlate with the peak or total TnI release. The duration of aortic cross-clamping correlated poorly with the duration of inotropic support (r = 0.40, p < 0.05). The complex TGA group had longer aortic cross-clamp times, required more postoperative inotropic support, and had significantly higher total TnI release compared with the simple TGA group. CONCLUSIONS: There are weak but statistically significant correlations between peak TnI and clinical outcome. Complexity of the defect and ischemic times may be as useful to predict outcome in this group of patients.

Biomarkers↗

PubMed2002

The use of off pump surgery for management of penetrating coronary artery injury.

Penetrating trauma to the chest leading to coronary artery injury is associated with a high mortality rate, especially in the case of injury to the left anterior descending (LAD) coronary artery. The mortality rate remains high whether they are managed with primary ligation or with coronary artery bypass grafting using conventional cardiopulmonary bypass techniques. We report a case of proximal LAD coronary artery injury successfully treated with off pump coronary revascularisation.

Adult↗

PubMed2002

Prospective randomized comparison of CarboMedics and St Jude Medical bileaflet mechanical heart valve prostheses: an interim report.

OBJECTIVE: This is a midterm report of a study comparing the clinical performance of CarboMedics and St Jude Medical heart valve prostheses through a projected 10-year period. METHODS: Between 1992 and 1996, a total of 485 patients undergoing mechanical valve replacement were prospectively randomly assigned to receive either CarboMedics (n = 234) or St Jude Medical (n = 251) prostheses for aortic (n = 288), mitral (n = 160), or double (n = 37) valve replacements and were followed up annually. RESULTS: Baseline and operative characteristics were similar between the two groups with respect to major demographic characteristics, preoperative clinical status, and operative data. Mean follow-up was 50 +/- 22 months for the CarboMedics group (97% complete) and 47 +/- 20 months for the St Jude Medical group (96% complete), yielding a total of 1959 patient-years. The 30-day mortality, and 5-year actuarial survival, and linearized survival were 6.0%, 82.4% +/- 2.6%, and 4.3% per patient-year in the CarboMedics group and 4.4%, 79.9% +/- 2.8%, and 4.7% per patient-year in the St Jude Medical group (log-rank P =.7). Freedom at 5 years from valve-related mortality, major thromboembolism, hemorrhage, and other nonstructural valve dysfunction was, respectively, 96.7% +/- 1.4% (0.7% per patient-year), 90.9% +/- 2.1% (2.2% per patient-year), 87.3% +/- 2.5% (3.6% per patient-year), and 96.1% +/- 1.4% (0.7% per patient-year) in the CarboMedics group and 95.9% +/- 1.5% (1.0% per patient-year), 92.5% +/- 1.8% (2.0% per patient-year), 82.6% +/- 2.8% (4.3% per patient-year), and 96.0% +/- 1.3% (0.6% per patient-year) in the St Jude Medical group, with no overall intergroup differences. No statistically significant intergroup differences in international normalized ratio values were detected during the study period. CONCLUSIONS: This study shows no significant differences in the early and midterm clinical outcomes between patients who received CarboMedics valve prostheses and those who received St Jude Medical mechanical prostheses. Choices with respect to valve type can be based on considerations other than patient outcome.

Adolescent↗

PubMedDate not supplied

Pathology-related troponin I release and clinical outcome after pediatric open heart surgery.

BACKGROUND: Perioperative myocardial injury is determined by the ischemic duration, pathology, and preoperative myocardial status. Our aim was to evaluate pathology-related differences in troponin I (TnI) release, a sensitive and specific marker of myocardial injury, and its relation to clinical outcome after pediatric open heart surgery. METHODS: Troponin I was measured serially postoperatively in 133 children undergoing repair of atrial (ASD, n = 41) and ventricular septal defects (VSD, n = 46), and tetralogy of Fallot (TOF, n = 46). The length of the right ventricular outflow tract (RVOT) incision in the latter was classified as either minimum(n = 33) or extended(n = 13). RESULTS: Postoperative TnI levels were lesion specific and did not correlate with clinical outcome for ASDs. Peak TnI correlated with inotropic duration for VSD (r = 0.69, p < 0.0001) and TOF (r = 0.51, p = 0.0004). Significant correlations were also observed for the durations of ventilation (r = 0.64 and 0.36, respectively) and ICU stay (r = 0.60 and 0.55). Younger age (<1 year old) in children with VSDs and an extended incision into the RVOT in TOF were associated with greater TnI release and worse clinical outcome. CONCLUSIONS: Postoperative TnI release is pathology related and reflects myocardial damage from both ischemia-reperfusion injury and direct myocardial trauma.

Child, Preschool↗