Objective This study analyzed total aortic arch reconstruction in a contemporary comparison of current open and endovascular repair. Methods Endovascular (group 1) and open arch procedures (group 2) ...performed during 2007 to 2013 were entered in a prospective database and retrospectively analyzed. Endovascular repair (proximal landing zones 0-1), with or without a hybrid adjunct, was selected for patients with a high comorbidity profile and fit anatomy. Operations involving coverage of left subclavian artery only (zone 2 proximal landing: n = 41) and open hemiarch replacement (n = 434) were excluded. Early and midterm mortality and major complications were assessed. Results Overall, 100 (78 men; mean age, 68 years) consecutive procedures were analyzed: 29 patients in group 2 and 71 in group 1. Seven group 1 patients were treated with branched or chimney stent graft, and 64 with partial or total debranching and straight stent graft. The 29 patients in group 2 were younger (mean age, 61.9 vs 70.3; P = .005), more frequently females (48.2% vs 11.3; P < .001) with less cardiac (6.9% vs 38.2%; P = .001), hypertensive (58.5% vs 88.4%; P = .002), and peripheral artery (0% vs 16.2%; P = .031) disease. At 30 days, there were six deaths in group 1 and four in group 2 (8.5% vs 13.8%; odds ratio, 1.7; 95% confidence interval, 0.45-6.66; P = .47), and four strokes in group 1 and one in group 2 (odds ratio, 0.59; 95% confidence interval, 0.06-5.59; P = 1). Spinal cord ischemia occurred in two group 1 patients and in no group 2 patients. Three retrograde dissections (1 fatal) were detected in group 1. During a mean follow-up of 26.2 months, two type I endoleaks and three reinterventions were recorded in group 1 (all for persistent endoleak), and one reintervention was performed in group 2. According to Kaplan Meier estimates, survival at 4 years was 79.8% in group 1 and 69.8% in group 2 ( P = .62), and freedom from late reintervention was 94.6% and 95.5%, respectively ( P = .82). Conclusions Despite the older age and a higher comorbidity profile in patients with challenging aortic arch disease suitable and selected for endovascular arch repair, no significant differences were detected in perioperative and 4-year outcomes compared with the younger patients undergoing open arch total repair. An endovascular approach might also be a valid alternative to open surgery in average-risk patients with aortic arch diseases requiring 0 to 1 landing zones, when morphologically feasible. However, larger concurrent comparison and longer follow-up are needed to confirm this hypothesis.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background Aortic dissection is an evolving process that may require one or several reoperations after its initial repair. We conducted a study to evaluate risk factors and define the incidence and ...locations of reoperations after surgical correction of acute type A aortic dissection (AAD). Methods Between 1998 and 2008, 250 consecutive patients (mean age 62.5 ± 12.4 years) underwent surgery for AAD at our institution. Replacement of the ascending aorta was done in 173 cases, composite graft replacement in 61 cases, separate aortic valve and ascending aorta replacement in 2 cases, and arch replacement required by distal repair in 14 cases. Mean follow-up time was 4.7 ± 5.6 years. Results Freedom from reoperation was 99%, 82%, and 79% at 1, 5, and 10 years, respectively. Twenty-five patients required 25 reoperations at a mean interval of 4.7 years after initial surgery for the correction of AAD. Reoperations included 21 procedures on the proximal aorta (ascending aorta, aortic root, or valve) and 4 procedures on the distal aorta (arch or descending aorta). Cox regression analysis identified the use of gelatin-resorcinol-formaldehyde (GRF) glue ( p = 0.0270), and nonreplacement of the aortic root at the time of initial AAD repair ( p = 0.0004), as a significant risk factor for proximal reoperation, and a patent false lumen ( p = 0.0107) as a significant risk factor for distal reoperation. Conclusions A patent false lumen, the use of GRF glue, and aortic root preservation at initial operation influence the risk for surgical correction in patients undergoing surgery for AAD. These patients need long-term follow-up.
The crucial role of water in the engine of life have encouraged many researchers in studying, both theoretically and experimentally, the possible "structure" of water. Many properties of water have ...been related to the interplay between two distinct and interconverting structural species, namely the low-density water (LDW) and the high-density water (HDW). Supported by the results obtained with other aqueous solutions, this paper deals with the possibility of using the ultra-weak delayed luminescence (DL) to investigate water structuring in a mixture with glycerol, characterized only by hydrogen bonds between the various molecules. Spectral and temporal characteristics of DL decays give information on the two components of the mixture, by evidencing the contribution of water at glycerol concentrations close to the values used in cryopreservation. DL results have shown a correlation with LDW clusters size as determined by other researchers on the basis of neutron diffraction experiments and computational modelling, as reported in Literature.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidly progressive cardiac compromise that ultimately leads to refractory cardiogenic shock or ...cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in this circumstance, but few clinical series are available about early and long-term results. Data from a multicenter study group are reported which analyzed subjects affected by AFM and treated with VA-ECMO during a 5-year period. Method From hospital databases, 57 patients with diagnoses of AFM treated with VA-ECMO in the past 5 years were found and analyzed. Mean age was 37.6 ± 11.8 years; 37 patients were women. At VA-ECMO implantation, cardiogenic shock was present in 38 patients, cardiac arrest in 12, and severe hemodynamic instability in 7. A peripheral approach was used with 47 patients, whereas 10 patients had a central implantation or other access. Results Mean VA-ECMO support was 9.9 ± 19 days (range, 2 to 24 days). Cardiac recovery with ECMO weaning was achieved in 43 patients (75.5%), major complications were observed in 40 patients (70.1%), and survival to hospital discharge occurred in 41 patients (71.9%). After hospital discharge (median follow-up, 15 months) there were 2 late deaths. The 5-year actual survival was 65.2% ± 7.9%, with recurrent self-recovering myocarditis observed in 2 patients (at 6 and 12 months from the first AFM event), and 1 heart transplantation. Conclusions Cardiopulmonary support with VA-ECMO provides an invaluable tool in the treatment of AFM, although major complications may characterize the hospital course. Long-term outcome appears favorable with rare episodes of recurrent myocarditis or cardiac-related events.
Ventricular septal defect (VSD) is a life-threatening complication of myocardial infarction. Surgical repair is generally performed through a left/right ventriculotomy. To avoid complications ...associated with ventriculotomy, a right transatrial approach has been proposed. We describe a modified transatrial approach through the left atrium for basal-inferior VSD. After left atriotomy, mitral valve is detached from the annulus to expose the defect, which is closed with a pericardial patch. Two patients were operated by this method. In both cases venoarterial extracorporeal membrane oxygenation with a ventricular vent was utilized to unload the left ventricle. Echocardiography revealed no residual shunt in both cases.
The evaluation of optical properties of biological samples is gaining increasing interests both in scientific and commercial fields concerning agriculture and food processing. The optical techniques ...can indeed be able to provide information on quality assessment in a fast and non-destructive way. This feature makes them suitable for automatic management of control processes. In this paper, we propose to use the Delayed Luminescence, a ultra-weak and photo-induced emission of optical photons, as a tool for a rapid evaluation of germination performance, the principal index reflecting seed quality. Two lots of ‘Mirella’ F1 watermelon dried seeds, of 96 seeds each, were considered. The seeds were analyzed in the conditions as provided by seed/breeding company. Characteristics of Delayed Luminescence emission from each single seed were correlated to the different germination levels as assessed by International Seed Testing Procedures. Parametric differences in the two lots were determined, based on the relaxation kinetics of some spectral components. A control test, with the aim to construct a calibration model, was conceived and successfully tested. Time decays of Delayed Luminescence spectral components at central wavelengths 450 nm, 550 nm and 650 nm, corresponding to spectrum region where natural biomarkers as NADH, flavins and lipopigments, protoporphyrin and ROS respectively emit, have been evaluated. The results show that such time decays are strictly connected to the biological state of the system under analysis and allow also proposing Delayed Luminescence measurement as a quick, cheap and non-destructive test for seed viability analysis.
•Delayed Luminescence decay from single seed correlates to its vigor.•High significant discrimination between seed lots of different germination performance.•The tool also works by using small size samples.•Non-destructive test for seed viability analysis.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
An uninterruptable wireless power supply is developed for a left ventricular assist device (LVAD), which is an implanted, electrically driven centrifugal pump used to treat advanced heart failure ...pathologies. The LVADs are currently powered through a cable driveline (DL) that exits the patient's body through the skin. Here, an innovative uninterruptable power supply is presented, based on a hybrid wireless/wired architecture: the electric power of 10 W is transferred by the near field wireless power transfer technology operating at 300 kHz, from outside the human body to an implanted subcutaneous receiver, and then by an internal cable to the LVAD. A significant improvement of the subcutaneous receiver is here proposed, based on the integration in the receiving coil of a battery pack providing the following benefits: no-break power supply for the LVAD; peak load management; enhanced system reliability; elimination of DL infection; enhancement of patient's quality of life. The proposed system is first designed and optimized, then a demonstrator is made and tested in a laboratory using the latest LVAD generation. The measured coil currents are used as sources for dosimetric analysis to assess the compliance of the system with the electromagnetic field safety and thermal regulations.
Background Prophylactic intraaortic balloon pump (IABP) support showed better outcomes in critical patients undergoing coronary revascularization compared with intraoperative or postoperative ...insertion. We conducted a prospective, randomized study to determine the optimal timing for preoperative IABP insertion in high-risk patients undergoing off-pump coronary artery revascularization. Methods The study enrolled 230 consecutive high-risk patients (having a logistic European System for Cardiac Operative Risk Evaluation score of ≥10) undergoing off-pump coronary artery revascularization. They were randomized for preoperative IABP starting at 2 hours (2T, n = 115) or 12 hours (12T, n = 115). Clinical, biochemical, and hemodynamic results, and the need for inotropic drug support, were markers of outcome and compared between groups. Results Hospital mortality in group 12T was reduced by 60%, but the difference between groups was not statistically significant (hazard ratio, 0.4; 95% confidence interval, 0.1 to 1.5; p = 0.1). Twelve hours of preoperative IABP therapy reduced postoperative low output syndrome (hazard ratio, 0.4; 95% confidence interval, 0.1 to 0.9; p = 0.03) and biomarker leakage upper normal limit (hazard ratio, 0.3; 95% confidence interval, 0.1 to 0.7; p = 0.001). Postoperative left ventricular function was similar between the groups. Group 2T patients required higher inotropic support for a longer average duration and prolonged postoperative intensive care unit and hospital length of stay. Conclusions Twelve hours preoperative IABP therapy improved treatment efficacy. Postoperative morbidity was reduced, but hospital mortality rate was not affected. The IABP-related complication rate was low and not related to the length of treatment.
Abstract Detection of high glycated hemoglobin (A1c) is associated with worse postoperative outcomes, including predisposition to develop systemic and local infectious events. Diabetes and infectious ...Outcomes in Cardiac Surgery (DOCS) study is a retrospective case–control study aimed to assess in DM and non-DM cardiac surgery patients if a new screening and management model, consisting of systematic A1c evaluation followed by a specialized DM consult, could reduce perioperative infections and 30-days mortality. Effective July 2021, all patients admitted to the cardiac surgery of IRCCS ISMETT were tested for A1c. According to the new protocol, glucose values of patients with A1c ≥ 6% or with known diabetes were monitored. The diabetes team was activated to manage therapy daily until discharge or provide indications for the diagnostic-therapeutic process. Propensity score was used to match 573 patients managed according to the new protocol (the Screen+ Group) to 573 patients admitted before July 2021 and subjected to the traditional management (Screen−). Perioperative prevalence of infections from any cause, including surgical wound infections (SWI), was significantly lower in the Screen+ as compared with the Screen− matched patients (66 11% vs. 103 18% p = 0.003). No significant difference was observed in 30-day mortality. A1c analysis identified undiagnosed DM in 12% of patients without known metabolic conditions. In a population of patients undergoing cardiac surgery, systematic A1c evaluation at admission followed by specialist DM management reduces perioperative infectious complications, including SWI. Furthermore, A1c screening for patients undergoing cardiac surgery unmasks unknown DM and enhances risk stratification.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
PDF
