Improving hemostasis during replacement of the ascending aorta and aortic valve with a composite graft.

The use of a composite graft is an established treatment for patients with aortic valve disease and ascending aortic aneurysms. Since bleeding from suture lines is a potential complication of this procedure, we modified the technique and evaluated the effect on hemostasis. From January 1994 through December 1998, 35 patients underwent composite aortic graft replacement for chronic aortic disease.

The Edwards Prima stentless valve: hemodynamic performance at one year.

Background: The Edwards Prima stentless valve (EPSV) is a porcine aortic root cylinder with resected coronary ostia, fixed in glutaraldehyde at low pressure. The purpose of this study was to evaluate the hemodynamic performance of the EPSV 1 year after aortic valve replacement.

Methods: From December 1994 to February 1996, 29 patients underwent aortic valve replacement with EPSV used in the subcoronary position (group 1, n = 23) or as a root replacement (group 2, n = 6).

Psychological and symptom distress in terminal cancer patients with met and unmet needs.

This study identified the needs of terminal cancer patients, investigated the factors associated with unmet needs, and assessed psychological and symptom distress associated with unsolved needs. Ninety-four patients were randomly selected from 324 patients admitted for palliative care in 13 Italian centers. Two self-administered questionnaires (the Symptom Distress Scale and the Psychological Distress Inventory) were administered to all the patients.

Valve-related complications in elderly patients with biological and mechanical aortic valves.

Background: Controversy still exists about the choice of aortic prosthesis in elderly patients. This study investigates valve- and anticoagulant-related morbidity and mortality in elderly patients after aortic valve replacement (AVR) with a biologic (BP) or mechanical prosthesis (MP).

Methods: Between 1981 and 1995, 355 consecutive patients aged 70 years or older (mean, 74+/-4 years; range, 70 to 87 years) underwent isolated AVR.

Predicting outcome after myocardial revascularization in patients with left ventricular dysfunction.

In order to identify the risk factors which could predict outcome after coronary artery bypass grafting in patients with left ventricular dysfunction, 80 consecutive patients with an ejection fraction < or = 30%, who underwent isolated coronary artery bypass grafting at the authors' centre between January 1994 and May 1996 were evaluated. Preoperatively, mean(s.d.

Ascending aorta dissection after aortic valve replacement.

Background And Aims Of The Study: The surgical management of patients with aortic valve disease associated with ascending aortic dilatation is a controversial issue. Structural abnormalities of the aortic wall predispose to further aortic enlargement and possibly to ascending aortic dissection (AAD). Indications to concomitant replacement of aortic valve and ascending aorta have not yet been clearly defined.

[Myocardial revascularization in patients with ischemic cardiomyopathy and left ventricular dysfunction].

In this study we evaluated the outcome of coronary artery bypass grafting (CABG) in patients with coronary artery disease and left ventricular dysfunction. The aim of the study was to identify the risk factors for operative and medium-term mortality. We evaluated 117 consecutive patients (98 men, 19 women, aged 42 to 84 years, mean 65 +/- 9) with ejection fraction (EF) < 40%, operated on from January 1994 to December 1995.

Hemodynamic performance of the Edwards Prima stentless valve.

Background And Aim Of The Study: Stentless porcine valves are considered to have a superior hemodynamic performance when compared with stented bioprostheses. In the present study we report our initial experience with the Edwards Prima stentless valve (EPSV), focusing on the hemodynamic performance of this device evaluated by means of transthoracic two-dimensional (2D) Doppler echocardiography.

Methods: Between December 1994 and August 1995, 23 patients underwent aortic valve replacement with the EPSV implanted in the subcoronary position.

Surgical angioplasty for isolated coronary ostial stenosis.

Patch angioplasty has been reported as a suitable surgical option for patients with isolated coronary ostial stenosis, but controversy still exists concerning its effectiveness. We report the cases of 4 additional patients in whom this procedure was performed, including that of a patient with bilateral ostial stenosis; and we review the literature pertaining to bilateral ostial stenosis. Four patients, 3 with isolated stenosis of the left main coronary ostium and 1 with bilateral ostial stenosis, had direct surgical ostioplasty from January through November 1994.

Role of dipyridamole-echocardiography test in the evaluation of coronary reserve after coronary artery bypass grafting.

The object of this study was to assess the usefulness of the dipyridamole-echocardiography test in the early evaluation of coronary artery bypass grafting, when the use of an exercise stress test is precluded. We studied 39 consecutive patients (37 men and two women, mean age 57.3 years) referred to our institute for elective coronary artery bypass.

Early assessment of coronary reserve after bypass surgery by dipyridamole transesophageal echocardiographic stress test.

The evaluation of coronary reserve within a few hours of aortocoronary bypass surgery could be of extreme utility for the follow-up or therapeutical management of these patients. In 11 men patients who underwent aortocoronary bypass surgery, a dipyridamole echocardiography stress test was carried out before (1 to 3 days), early after (68 to 130 minutes), and 1 week after surgery. The first and third tests were performed using a standard transthoracic approach, while the second was performed by a transesophageal approach.