Vincenzo Gallucci: Memories of a Surgeon, Scientist, and Teacher.

Thirty years ago, Vincenzo Gallucci, MD, head of the Cardiovascular Surgery Institute of the University of Padua Medical School in Italy, died in a car accident at the age of 55 years. Vincenzo Gallucci was one of the most authoritative Italian cardiac surgeons, a fine, gentle, and extremely talented surgeon. He is credited with the first implant of a glutaraldehyde-fixed, stented porcine Hancock bioprosthesis in 1970 and with the first orthotopic heart transplantation performed in Italy in 1985.

Morphological and chemical study of pathological deposits in human aortic and mitral valve stenosis: a biomineralogical contribution.

Aim of this study was to investigate heart valve calcification process by different biomineralogical techniques to provide morphological and chemical features of the ectopic deposit extracted from patients with severe mitral and aortic valve stenosis, to better evaluate this pathological process. Polarized light microscopy and scanning electron microscopy analyses brought to light the presence of nodular and massive mineralization forms characterized by different levels of calcification, as well as the presence of submicrometric calcified globular cluster, micrometric cavities containing disorganized tissue structures, and submillimeter pockets formed by organic fibers very similar to amyloid formations. Electron microprobe analyses showed variable concentrations of Ca and P within each deposit and the highest content of Ca and P within calcified tricuspid aortic valves, while powder X-ray diffraction analyses indicated in the nanometer range the dimension of the pathological bioapatite crystals.

The impact of drug eluting stents availability on the treatment choice among medical therapy, percutaneous or surgical revascularisation and on 4-year clinical outcome in patients with coronary artery disease: a cohort study.

Objective: To investigate the influence of the availability of drug eluting stents (DES) on treatment choice (TC) among medical therapy (MT), coronary by-pass surgery (CABG) or percutaneous coronary interventions (PCI) and the consequent clinical outcomes in patients hospitalised because of coronary artery disease (CAD).

Design: Observational study comparing two cohorts hospitalised immediately before, and 3 years after DES availability.

Setting: Thirteen hospitals with cardiology facilities.

Biofeedback assisted control of respiratory sinus arrhythmia as a biobehavioral intervention for depressive symptoms in patients after cardiac surgery: a preliminary study.

The current study investigated whether biofeedback training aimed at increasing respiratory sinus arrhythmia (RSA), a measure of cardiac vagal modulation, can reduce depressive symptoms in patients after cardiac surgery. This randomized controlled study enrolled 26 patients after first-time cardiac surgery. The patients were randomly assigned to an RSA-biofeedback group (N = 13) or to a treatment as usual group (N = 13).

Association between depression and heart rate variability in patients after cardiac surgery: a pilot study.

Objective: Depression is a risk factor for cardiovascular diseases. Reduced heart rate variability (HRV), which reflects altered autonomic nervous system activity, has been suggested as one of the mechanisms linking depression to cardiovascular diseases. However, the relationship between depression and HRV has not yet been investigated in patients undergone cardiac surgery.

Left ventricular remodeling, hemodynamics and early clinical outcomes after aortic valve replacement with the Pericarbon Freedom stentless bioprosthesis: results from the Italian Prospective Multicenter Trial.

Background And Aim Of The Study: The aims of this multicenter prospective observational trial were to evaluate: (i) the left ventricular remodeling, hemodynamics and early clinical outcomes of patients undergoing aortic valve replacement (AVR) with the Pericarbon Freedom (PF) stentless bioprosthesis; and (ii) the impact of the two suture techniques--continuous and interrupted--on the hemodynamic performance of the bioprosthesis.

Methods: Between November 2001 and April 2004, a total of 226 patients (131 females, 95 males; mean age 73.2 +/- 8.

Multimodal brain monitoring reduces major neurologic complications in cardiac surgery.

Objective: Although adverse neurologic outcomes are common complications of cardiac surgery, intraoperative brain monitoring has not received adequate attention. The aim of the present study was to evaluate the effectiveness of multimodal brain monitoring in the prevention of major brain injury and reducing the duration of mechanical ventilation, intensive care unit, and postoperative hospital stays after cardiac surgery.

Design: A retrospective, observational, controlled study.

Biomedical and psychological risk in cardiac surgery: is EuroSCORE a more comprehensive risk measure than Stroke Index?

Objective: Several composite risk score indices, the most common being the Stroke Index and the European System for Cardiac Operative Risk Evaluation (EuroSCORE), have been developed to predict perioperative events such as cerebrovascular accidents or death. The main aim of the present study was to compare the preoperative associations between the Stroke Index or the EuroSCORE with anxiety, depression, memory, attention, and executive functions scores in patients undergoing cardiac surgery.

Methods: Ninety-one patients were required to perform a preoperative psychological evaluation.

Infective endocarditis in patients with diabetes mellitus.

Background And Aim Of The Study: Numerous studies have been conducted to investigate the conditions associated with poor outcome among patients with infective endocarditis (IE). Yet, diabetes mellitus alone has rarely been analyzed as participating in the prognosis, and few data are available relating to the clinical characteristics of IE in diabetics. The study aim was to assess the influence of diabetes mellitus on the characteristics and prognosis of IE, and to identify predictors of poor outcome among diabetic patients with this condition.

The fate of Hancock II porcine valve recipients 25 years after implant.

Objective: The Hancock II (HII) is a second-generation porcine bioprosthesis introduced into clinical use in 1982. This study aimed to evaluate very long-term outcomes for the HII valve in a large patient population.

Methods: Between May 1983 and November 1993, 517 consecutive patients (pts) (309 male, mean age: 64+/-9 years) underwent valve replacement (VR) surgery with HII, with 302 (58.

Lower perfusion pressure during hypothermic cardiopulmonary bypass is associated with decreased cerebral blood flow and impaired memory performance 6 months postoperatively.

Objectives: We undertook to determine the influence of perfusion pressure during hypothermic cardiopulmonary bypass (CPB) on cerebral blood flow (CBF) and cognitive memory outcome at 6 months postoperatively.

Methods: Nineteen patients who underwent hypothermic nonpulsatile CPB for elective coronary artery bypass (CAB) surgery were evaluated by (133)Xe measurement of the CBF and by the Incidental Memory Assessment for evaluating cognitive memory (IMTscore), both at baseline before the operation (T(1)) and again at 5 to 6 months postoperatively (T(2)).

Results: Overall, the mean CBF fell significantly from 39 +/- 5 mL.

Microembolic signals and strategy to prevent gas embolism during extracorporeal membrane oxygenation.

Background: Extracorporeal membrane oxygenation (ECMO) supplies systemic blood perfusion and gas exchange in patients with cardiopulmonary failure. The current literature lacks of papers reporting the possible risks of microembolism among the complications of this treatment.In this study we present our preliminary experience on brain blood flow velocity and emboli detection through the transcranial Doppler monitoring during ECMO.

Epicardial real-time 3-dimensional echocardiography with the use of a pediatric transthoracic probe: a technical approach.

Objective: The aim of the present study was to suggest a simple and comprehensive method for performing real-time 3-dimensional (3D) epicardial echocardiography with a pediatric probe small enough for the surgical field. Intraoperative echocardiography is a necessary tool for planning and performing cardiac surgery. Although epicardial intraoperative echocardiography is intended for few patients, it is a part of an exhaustive approach to intraoperative echocardiography.

Microbubbles detection during cardiopulmonary bypass with transoesophageal echocardiography: a case report.

Introduction: Microembolic signals are usually detected with transcranial doppler during cardiac surgery.This report focuses on suggesting the transesophageal echocardiography as a different diagnostic approach to detect microemboli during cardiopulmonary bypass.

Case Presentation: A 58 year old male patient, caucasian race, was operated on video assisted minimally invasive mitral valve repair using right minithoracotomy approach.

Brain function monitoring during off-pump cardiac surgery: a case report.

Background: Early postoperative stroke is an adverse syndrome after coronary bypass surgery. This report focuses on overcoming of cerebral ischemia as a result of haemodynamic instability during heart enucleation in off-pump procedure.

Case Presentation: A 67 year old male patient, Caucasian race, with a body mass index of 28, had a recent non-Q posterolateral myocardial infarction one month before and recurrent instable angina.

A 20-year experience with mitral valve repair with artificial chordae in 608 patients.

Objective: Mitral valve repair with artificial chordae for degenerative mitral regurgitation is widely adopted. We evaluated long-term results of mitral repair with expanded polytetrafluoroethylene sutures (GORE-TEX CV-5; W. L.

Clinical and anatomical characteristics of subtle-discrete dissection of the ascending aorta.

Subtle or discrete (class 3 in the classification of the European Society of Cardiology) dissection is the most neglected variant of aortic dissection. This study was conducted to define the clinical manifestations, diagnostic findings, and outcomes of subtle or discrete dissection involving the ascending aorta. The clinical and surgical records, preoperative studies, and outcomes of 109 consecutive patients with ascending aortic dissection observed from 1995 to 2005 were reviewed.

Epicardial real-time three-dimensional echocardiography in cardiac surgery: a preliminary experience.

Purpose: Intraoperative two-dimensional transesophageal echocardiography (2DTEE) is a widely accepted method to guide cardiac valve surgery. The aim of our study was to evaluate the feasibility, effectiveness, and incremental value of intraoperative epicardial real-time three-dimensional echocardiography (RT3DE).

Description: Thirty consecutive patients (18 aortic and 12 mitral valve diseases) underwent intraoperative 2DTEE and RT3DE before and after cardiopulmonary bypass.

Clinical results of Hancock II versus Hancock Standard at long-term follow-up.

Objective: We performed a multi-institutional study to compare the long-term structural valve deterioration of isolated Hancock Standard versus Hancock II bioprostheses.

Methods: From 1983 to 2002, 714 Hancock Standard and 1293 Hancock II bioprostheses were implanted at hospitals of the Venetian territory (Padova, Treviso, and Venice). Follow-up on January 1, 2003, included 14,749 patient-years with a median of 12 years and was 96% complete: 115 Hancock Standard and 53 Hancock II bioprostheses were at risk at 15 years.

High take-off of the right coronary artery with intramural course associated with the persistence of the left superior vena cava.

We describe the case of a coronary artery with an intra-aortic course (a rare coronary anomaly) associated with the persistence of the left superior vena cava. The first finding could represent an important surgical risk factor and should be recognized before cardiac surgery; the latter is not yet reported in the literature. A modified surgical technique is described.

Biological fate of tissue-engineered porcine valvular conduits xenotransplanted in the sheep thoracic aorta.

The ideal prosthesis to replace the diseased human aortic valve is not yet available. We have previously shown that porcine acellular aortic-valve conduits, obtained by detergent-enzymatic method, display hemodynamic performances similar to those of their native counterparts. Hence, it seemed worthwhile to ascertain whether these tissue-engineered prostheses can be successfully xenotransplanted.

Ten-year experience with cryopreserved aortic allografts in the surgical treatment of aortic valve pathologies.

Background: The aim of this study was to evaluate the performance of cryopreserved aortic allografts (CAA) in the treatment of adult aortic valve pathologies.

Methods: Between May 1992 and October 2002, 122 CAA were implanted in 119 adult patients with pathologies of the aortic valve. The mean age of the patients was 38.

Left atrial radiofrequency ablation during cardiac surgery in patients with atrial fibrillation.

Introduction: Intraoperative left atrial radiofrequency (RF) ablation recently has been suggested as an effective surgical treatment for atrial fibrillation (AF). The aim of this study was to verify the outcome of this technique in a controlled multicenter trial.

Methods And Results: One hundred three consecutive patients (39 men and 65 women; age 62 +/- 11 years) affected by AF underwent cardiac surgery and RF ablation in the left atrium (RF group).