Medium-term results of systematic off-pump coronary surgery performed by trainee surgeons.

Objective: Our unit has used off-pump coronary artery bypass (OPCAB) surgery since 1998, and has consequently developed teaching methods for surgical trainees. This study aimed to compare the medium-term results of OPCAB performed by experts or supervised trainees.

Methods: We retrospectively analysed the data relating to 1333 OPCAB operations performed between January 1998 and January 2006 (mean patient age: 65.

'Let's twist again': surgically induced renewal of left ventricular torsion in ischemic cardiomyopathy.

Objectives: To test the potential of the heart to be surgically restored at a near-normal global condition, granted that its physiological characteristics are respected (working volumes, chamber geometry, fiber orientation, opposite rotation of apex and base, global torsion and strain).

Methods: From May 2007 to December 2008, 12 consecutive patients with ischemic cardiomyopathy were included in this study. All patients underwent modified surgical anterior ventricular restoration combined with complete coronary revascularization and, when indicated, mitral anuloplasty.

A new no-touch aorta technique for arterial-source, off-pump coronary surgery.

The possibility of avoiding the manipulation of the ascending aorta plays a key role in the neuroprotective effect of off-pump coronary revascularization, reducing the overall invasiveness. We have devised a new surgical plan using the proximal stump of the right internal thoracic artery as an intrathoracic, arterial source of flow for the saphenous vein, avoiding direct aorta manipulation. The saphenous vein can be as long as required, and its proximal anastomosis guarantees a better match of the two conduits and undergoes a lower peak pressure.

Bronchogenic cysts of the neck: a rare localization and review of the literature.

Personal experience in the diagnosis and management of two patients, one adult and one child, with pathologically proven bronchogenic cysts is described. Both patients presented with a solitary neck mass that proved to be bronchogenic cysts on histological examination. Aim of the review is to define the cytology, histopathological and clinical characteristics of bronchogenic cysts and discuss the features that distinguish them from other cervical cysts.

A new surgical ventricular restoration technique to reset residual myocardium's fiber orientation: the "KISS" procedure.

Background: The history of surgical reconstruction of the left ventricle after an anterior myocardial infarction shows an evolution of techniques which tend to a more and more physiologic restoration of ventricular shape and volume, with increasing attention to the orientation of myocardial fibers.

Methods: We set a new surgical procedure for endoventricular patch reconstruction technique with the aim to rebuild a physiologic shape and volume of the left ventricle caring about realignment of myocardial fibers orientation. Peculiarities of this reconstruction are the shape of the patch (reduction of minor axis compared with currently used oval-shaped patch) and the asymmetrical way of suturing it inside the ventricle.

Improvement of left ventricular function after modified surgical ventricular restoration: good, better, best.

Background: The techniques of surgical reconstruction of the left ventricle after an anterior myocardial infarction have evolved toward an increasingly physiologic restoration of ventricular shape and volume, with increasing attention being paid to the multilayered structure of myocardial fibers.

Methods: We describe the case of a patient who underwent operation with a new technique of endoventricular patch restoration surgery, which was aimed at rebuilding the physiologic shape and volume of the left ventricle, with special care taken to realign the orientation of myocardial fibers at the site of the surgical suture on the patch. The case was studied preoperatively and postoperatively via a complete echocardiographic assessment, included 2-dimensional speckle tracking imaging for the study of apical rotation and ventricular torsion.

Patch size, shape and orientation affect geometrical outcomes of surgical anterior ventricular restoration.

Objectives: To verify whether the use of a small, oval-shaped patch limits the trend toward re-dilatation compared to endoventricular circular patch plasty and leads to different geometrical and functional results in surgical anterior restoration.

Methods: Thirty-seven patients with ischemic cardiomyopathy after anterior myocardial infarction end-systolic volume index of > or =45 ml/m2, ejection fraction of < or =35%, and no combined mitral procedures, underwent surgical anterior ventricular restoration between January 2000 and April 2003: 18 patients (group 1) were operated on using the endoventricular circular patch plasty technique (mean patch area 9.6 cm2) and 19 patients (group 2) received a small, obliquely oriented, oval-shaped patch (mean patch area 6.

Endovascular treatment of a symptomatic carotid artery aneurysm with a stent graft.

Endovascular methods have become more widespread and offer an alternative to surgery, which is often difficult in case of a hostile neck resulting from radiotherapy. Carotid pseudoaneurysm after laryngectomy is a very uncommon complication. We report a case of symptomatic carotid artery pseudoaneurysm treated using a stent graft.

Rewind the heart: a novel technique to reset heart fibers' orientation in surgery for ischemic cardiomyopathy.

Ischemic cardiomyopathy is the most common cause of dilated cardiomyopathy and congestive heart failure. It affects approximately 1 out of 100 people, most often middle-aged to elderly men. Left ventricular restoration surgery is a challenging therapeutic approach to this pathology: it aims to rebuild a near-normal ventricular chamber in a heart damaged by a myocardial infarction, reducing its volume and improving the fraction of blood ejected by each systole.

Home therapy with LMWH in deep vein thrombosis: randomized study comparing single and double daily administrations.

The aim of this study was to assess the effectiveness of low-molecular-weight heparin (LMWH) treatment of deep vein thrombosis (DVT) in terms of the evolution of thrombosis, the incidence of adverse events, and compliance with heparin treatment using 2 types of LMWH available on the market administered in therapeutic doses throughout the period of treatment (Nadroparin) or at therapeutic doses only during the first month of treatment followed by a prophylactic phase at half dose (Parnaparin). A randomized prospective study was carried out on patients under observation with a recent diagnosis of DVT. The objectives of the study were to confirm the effectiveness of therapy with LMWH in terms of prevention of the risk of thromboembolism, of relapse of DVT, and of hemorrhagic complications, and to complete an evaluation of venous recanalization and residual valve competence in the 2 groups of patients.

Arterial versus plethysmographic dynamic indices to test responsiveness for testing fluid administration in hypotensive patients: a clinical trial.

In the present study, we compared indices of respiratory-induced variation obtained from direct arterial blood pressure measurement with analogous indices obtained from the plethysmogram measured by the pulse oximeter to assess the value of these indices for predicting the cardiac output increase in response to a fluid challenge. Thirty-two fluid challenges were performed in 22 hypotensive patients who were also monitored with a pulmonary artery catheter. Hemodynamic and plethysmographic data were collected before and after intravascular volume expansion.

A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle.

Background: Long-term morphofunctional outcome may vary widely in surgical anterior left ventricular wall restoration, suggesting variability in post-surgical remodeling similar to that observed following acute myocardial infarction. The aim of this pilot study was to demonstrate that surgical restoration obtained with a particular shape of endoventricular patch leads to steady morphofunctional ventricular improvement when geometry, volume and residual akinesia can be restored as normal as possible.

Methods: This study involved 12 consecutive patients with previous anterior myocardial infarction, dilated cardiomyopathy and no mitral procedures, who underwent left ventricular reconstruction and coronary revascularization between May 2002 and May 2003 using a small, narrow, oval patch aiming at a volume View Article and Find Full Text PDF

Factors affecting left ventricular remodeling after valve replacement for aortic stenosis. An overview.

Although a small percentage of patients with critical aortic stenosis do not develop left ventricle hypertrophy, increased ventricular mass is widely observed in conditions of increased afterload. There is growing epidemiological evidence that hypertrophy is associated with excess cardiac mortality and morbidity not only in patients with arterial hypertension, but also in those undergoing aortic valve replacement. Valve replacement surgery relieves the aortic obstruction and prolongs the life of many patients, but favorable or adverse left ventricular remodeling is affected by a large number of factors whose specific roles are still a subject of debate.