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Biomedical subjects

N Spampinato

Publications and source records attributed to N Spampinato.

At least 55 records · Page 3Linked to original sources
PubMed1988

Bioprostheses at twelve years.

From January 1976 through December 1986, seven different types of bioprostheses have been implanted in our center. The following bioprostheses (total 1,414) were implanted in 1,098 patients: Carpentier-Edwards 567, Hancock 302, Liotta 268, Ionescu-Shiley 127, Angell-Shiley 72, Vascor 68, Implamedic 10. Follow-up ranged from 1 to 12 years, cumulative duration of follow-up was 6,747 patient-years and 8,637 valve-years, being 95.4% complete. Cumulative actuarial probability of being free from tissue valve failure (TVF) was 85.1% +/- 2.0% at 10 years, and 61.6% +/- 9.6% at 12 years. Actuarial probability of being free from TVF was 71.2% +/- 10.8% at 12 years for Carpentier-Edwards, 51% +/- 21.7% at 12 years for Hancock, 73.4% +/- 14.1% at 11 years for Angell-Shiley, 53% +/- 27.4% at 9 years for Liotta, 68% +/- 14.8% at 11 years for Ionescu-Shiley, 53.2% +/- 22.2% at 7 years for Vascor, 72.2% +/- 21.5% at 5 years for Implamedic bioprostheses. In this comparison of seven different bioprostheses, there is a large group of valves behaving in a very similar way. Only a few prostheses showed a constant and early negative trend.

Adolescent↗
PubMed1985

The bioprosthetic valve of choice for high-risk patients: long-term results (up to 10 years).

Patients with chronic atrial fibrillation, giant left atrium, left atrial thrombi, and previous embolic accidents are usually treated with life-long anticoagulation after bioprosthetic mitral valve replacement for fear of increased thromboembolic accidents. However, we studied 306 patients in whom we implanted 381 bioprostheses between January 1976 and May 1984, with variations of anticoagulation therapy. The patients' ages ranged between 19 and 68 years, with a mean of 46.2 years. Eighty-six patients were in the New York Heart Association Functional Class II (28.1%), 149 were in Class III (48.7%), and 71 were in Class IV (23.2%). In 90% of the cases, the lesions were rheumatic in origin; the remaining cases were due to bacterial endocarditis, and congenital or ischemic lesions. By analyzing our results, we concluded that high-risk patients with bioprosthetic mitral valves can be safely and advantageously managed with postoperative, temporary anticoagulation.

Journal Article↗
PubMed1983

[Effectiveness of the aorto-coronary by-pass procedure in elderly patients].

This study was undertaken to evaluate the efficacy of coronary artery by-pass grafting (CABG) in elderly patients with coronary artery disease. A consecutive series of 79 patients, 65 years of age and older, who underwent CABG from 1975 to 1981 was analysed and their follow up status ascertained. This group was compared with a consecutive series of 397 patients under the age of 65 who underwent CABG during the same period. The patients aged 65 years or greater had a higher incidence of unstable angina pectoris (p less than 0.05). Coronary angiographic and left ventriculographic features were comparable in both age groups; also comparable were the number of saphenous veins graft utilized and the number of left ventricular aneurysmectomies and mitral valve replacements performed. The hospital mortality rate for patients aged 65 years and older was 12.6%, for those aged less than 65, it was 8.3%; if the other cardiac procedures are excluded mortality rates become 12.5% and 6.0% respectively (n.s.). Survival at 6 years was 92% for patients in both age groups. However, the symptomatic status was less favourable in older patients, compared with that obtained in younger patients (p less than 0.05).

Aged↗
PubMed1981

Massive air embolism during cardiopulmonary bypass: successful treatment with immediate hypothermia and circulatory support.

Two patients experienced an episode of massive air embolism during extracorporeal circulation. Several emergency measures were taken. (1) The roller pump was reversed to take out air from the aorta. (2) The circuit was disconnected and recirculated to eliminate air bubbles. (3) Perfusion was restarted and the patient cooled to 24 degrees C for 40 minutes. (4) Pentothal (thiopental), steroids, and assisted ventilation were administered. The outcome was favorable in both patients, and there were no neurological sequelae. Immediate cooling and prolonged circulation seem to be a satisfactory approach to this problem.

Adult↗
PubMed1980

Exercise tolerance as evidence of quality of life in CAD patients after coronary artery bypass by comparison with medical treatment.

The effects of coronary artery bypass (CAB) by comparison with medical treatment were evaluated on exercise tolerance in 68 patients with stable angina on effort, who underwent coronary and left ventricular cineangiography. Stress tests were performed by bicycle ergometer before medical and surgical treatment, and 6 and 12 months thereafter. Thirty-five patients (31 males and 4 females; 7 with one 70% stenosed vessel, 12 with two, 16 with three) underwent CAB; 33 (30 males and 3 females; 9 with one 70% stenosed vessel, 11 with two, 13 with three), having refused CAB, only underwent medical treatment. Both groups were given long-acting oral nitrates, none received digitalis and/or propranolol; antiarrhythmic drugs were only administered in 5% of medical and 4% of surgical patients. Both groups at 6 and 12 months follow-up showed a significant improvement in exercise tolerance. Surgical patients showed a significant increase in exercise tolerance with lower angina incidence (from the preoperative 100% to 26% and 22%, respectively), higher work load (P < .001), and a significant reduction of S-T segment depression (P < .001). Medical treatment induced an increase of exercise tolerance; angina on effort decreased (from 100% to 74% and 72%, respectively) with higher work load, and a significant reduction of S T depression (in both cases P < .001). Comparing the data of the two groups, we observed that surgical patients showed higher exercise tolerance (P < .01), lower S-T depression (P < .001) and angina incidence. Our results suggest that surgical treatment is able to improve exercise tolerance more remarkably than medical treatment.

Adult↗
PubMed1980

[Combined valvular and coronary artery surgery (author's transl)].

Between January 1st, 1976 and October 31st, 1978 ten patients underwent simultaneour replacement or repair of a cardiac valve and coronary revascularization surgery. Six patients age ranged within 45 and 66 years presented mitral insufficiency, subsequent to myocardial infarction in five and rheumatic disease in one. Aortic valvular disease was present in four patients, it was atherosclerotic in three and congenital in one. All patients had both symptoms and signs of coronary insufficiency. Fifteen aortocoronary bypass grafts were inserted. Five mitral valve and four aortic valve replacements were performed; one patient underwent mitral valve annuloplasty. Best results were achieved in the aortic group, in which no deaths occurred; three deaths occurred in the mitral group. At the follow-up evaluation (average 14.2 months) all but one surviving patients showed marked symptomatic improvement, having moved to the upper functional class. The frequent incidence of coronary occlusive disease in patients with valvular heart disease recommends extensive use of selective coronary arteriography in preoperative evaluation. Simultaneous repair of all significant heart lesions is recommended.

Aged↗
PubMed1980

Left ventricular function after coronary artery bypass. Non-invasive study by systolic time intervals.

Left ventricular function was evaluated with serial recording of STI intervals in 78 patients with stable angina on effort undergoing coronary and left ventricular cineangiography. On the basis of these data the patients were divided into four groups: OV) nor or mild coronary disease (n. 11); 1V) 70% stenosed vessel; 2V) two significantly affected vessels (n. 32); 3V) three significantly affected vessels (n. 18). Thirty-six patients (9 with one stenosis, 17 with 2, 10 with 3) underwent coronary artery bypass. Thirty-one 8 with one, 15 with 2, 8 with 3) refused the treatment in spite of the same clinical situation and were medically treated. Recordings were performed before medical and surgical treatment and after 6 and 12 months. Initial average values of the patients of 2V and 3V groups showed a shorter LVETI, longer PEPI and higher PEP/LVET ratio than those of 1V and 0V groups. Subjects of 2V group and abnormal left ventricular wall motion showed longer PEPI and higher PEP/LVET than patients of 2V without abnormal wall motion. On first evaluation no differences were observed between surgical and medical groups. The latter did not show any difference after 6 and 12 months. Surgical patients of 2V and 3V showed a longer LVETI, shorter PEPI and a lower PEP/LVET than the medical group. In the surgical group PEPI and PEP/LVET were significantly decreased after surgery while LVETI was prolonged. Our results suggest an improvement of left ventricular performance by coronary artery bypass in patients with coronary artery disease.

Coronary Artery Bypass↗
PubMed1980

[Postoperative complications and therapeutic management after aneurysmectomy of the left ventricle].

51 patients underwent left ventricular aneurismectomy between 1975 and 1980. In 37 patients a Mitral Valve Replacement and/or Myocardial Revascularization were associated. Low cardiac output and ventricular arrhythmias accounted for more than 50% of the problems encountered. Hospital mortality was 11.7%. Low cardiac output and ventricular fibrillation were the only causes of death, and 60% of the times they affected patients who had a Mitral Valve Replacement + Myocardial Revascularization associated to the aneurysmectomy. Left ventricular aneurysmectomy profoundly alters the geometry of the left ventricle which tends to be in a negative oxygen balance during the first postoperative hours with ischemia and possible cardiac failure ensuing. The thorough monitoring of the filling pressures of the left ventricle and the prompt and aggressive therapy of the complications are a must and strongly contributed to lower the hospital mortality after left ventricular aneurysmectomy.

Adult↗
PubMed1979

[The demand for blood in open-heart surgery (author's transl)].

Because of the continous increase of utilization of open heart surgery, whenever possible a more conservative use of blood is desirable. During 1977, 262 consecutive patients were operated upon using the hemodilution technique of cardiopulmonary bypass. Thirtyone operative deaths occurred (11.8%) and were not related to lack of blood administration. Mean hematocrit values were 32.4% two hours after surgery and between 31 and 32.5% in the following postoperative course. Hemoglobin concentration averaged from 9.9 to 10.4 g/100 ml during the first postoperative week. The estimated amount of blood transfused averaged 872 +/- 66 ml (+/- SE) per patient. Sixtyone patients (23%) didn't receive any transfusion. A conservative attitude towards blood administration is justified by transfusion related many risks and by the current shortage of blood.

Adolescent↗
PubMed1979

[Routine clinical use of a new disposable bubble oxygenator: a comparative study (author's transl)].

The new bubble Oxybel oxygenator (Bellco Laboratories) has been used for routine clinical perfusions in this Institution. A comparison has been made between two groups of 51 patients each, one group perfused with on Oxybel oxygenator (OXY) and the other with the Harvey H 1000 oxygenator (H-H). Among these patients a wide range of acquired and congenital cardiac lesions have been encountered. Both series were comparable for patients' age, sex distribution, body weight, procedures performed, perfusion time and preoperative values of hematocrit, serum creatinine, platelet count, plasma hemoglobin. The gas/blood flow ratio was 2.09 +/- 0.07 (+/- SE) for the H-H oxygenator and 1.38 +/- 0.06 for the OXY series (P < 0.001). Serum-creatinine 24-hrs postoperative values (mg/100 ml) were 1.58 +/- 0.17 for the H-H and 1.30 +/- 0.06 for the OXY series (NS); 48-hrs postoperative values were 1.28 +/- 0.11 for the H-H and 1.20 +/- 0.11 for the OXY (NS). The 60 minutes postoperative platelet count was 127.9 +/- 7 X 10(3) for the H-H and 120.9 +/- 6 X 10(3) for the OXY series (NS). Fourtyeight-hrs postoperative platelet count was 153.0 +/- 5 X 10(3) for the H-H and 151.8 +/- 6 X 10(3) for the OXY series (NS). Postoperative plasma hemoglobin values (mg/100 ml) were 91.55 +/- 7.18 for H-H and 117 +/- 17.8 for the OXY series (NS). Total postoperative bleeding was 1037.9 +/- 94 ml in the H-H and 1056.7 +/- 98.9 ml in the OXY series (NS). The more favorable gas/blood flow ratio observed with the Oxybel oxygenator did not affect clinical and haematologic results. These were comparable in both series.

Adult↗
PubMed1979

[Iatrogenic ostial stenosis of the left coronary artery. Report of a case with Starr-Edwards aortic prosthesis (author's transl)].

A case of a 41 years-old-man, who had undergone surgical intervention ten years previously for aortic valve replacement in ECC with the coronary perfusion technique, is reported. This patient was studied because of the appearance of angina pectoris three months after the intervention and its progressive development. Selective left coronary angiography showed an ostial subocclusive stenosis; the run-off from the right coronary artery provided distal blood supply to the left coronary artery. A venous bypass was implanted between the aorta and the left anterior descending branch; the prosthesis was substituted because it was altered and caused hemolysis' problems. In accordance with most Authors late ostial coronary stenosis is a complication of the coronary perfusion technique, which is adopted for myocardial protection during surgical interventions for aortic valve replacement.

Adult↗
PubMed1977

Total body wash-out in patients with fulminant hepatitis.

Two patients with fulminant hepatic necrosis and in stage IV coma were treated with a rapid infusion of refrigerated buffered albumin electrolyte solution combined with simultaneous total body wash-out in order to remove the circulating neurotoxins and to provide additional time for liver regeneration. Both patients awoke from the coma following treatment. One patient recovered completely, the other died on the second day as a result of massive gastro-intestinal bleeding. The clinical value and the technical problems of the procedure are investigated.

Adult↗