Papers by Giovanni Mariscalco
Journal of Cardiothoracic Surgery, 2015
Clinical evidence in coronary surgery is usually derived from retrospective, single institutional... more Clinical evidence in coronary surgery is usually derived from retrospective, single institutional series. This may introduce significant biases in the analysis of critical issues in the treatment of these patients. In order to avoid such methodological limitations, we planned a European multicenter, prospective study on coronary artery bypass grafting, the E-CABG registry. The E-CABG registry is a multicenter study and its data are prospectively collected from 13 centers of cardiac surgery in university and community hospitals located in six European countries (England, Italy, Finland, France, Germany, Sweden). Data on major and minor immediate postoperative adverse events will be collected. Data on late all-cause mortality, stroke, myocardial infarction and repeat revascularization will be collected during a 10-year follow-up period. These investigators provided a score from 0 to 10 for any major postoperative adverse events and their rounded medians were used to stratify the severity of these complications in four grades. The sum of these scores for each complication/intervention occurring after coronary artery bypass grafting will be used as an additive score for further stratification of the prognostic importance of these events. The E-CABG registry is expected to provide valuable data for identification of risk factors and treatment strategies associated with suboptimal outcome. These information may improve the safety and durability of coronary artery bypass grafting. The proposed classification of postoperative complications may become a valuable research tool to stratify the impact of such complications on the outcome of these patients and evaluate the burden of resources needed for their treatment. NCT02319083.
Annals of Vascular Surgery, 2015
To report the use of thoracic endovascular aortic repair (TEVAR) in blunt thoracic aortic injurie... more To report the use of thoracic endovascular aortic repair (TEVAR) in blunt thoracic aortic injuries (BTAIs) presenting with complex anatomies of the aortic arch vessels.Two patients were admitted to our hospital for the management of BTAI. Anomalies were as follow: aberrant right subclavian artery (n = 1), and right-sided aortic arch with five vessels anatomy variant (n = 1). TEVAR was accomplished using parallel graft with periscope configuration in the patient with the aberrant right subclavian artery. At 12 months follow-up, computed tomography-angiographies confirmed the exclusion of the BTAI, the stability of the endograft, the resolution of the pseudoaneurysm and the patency of the parallel endograft. Aortic arch vessels variants and anomalies are not rare, and should be recognized and studied precisely to plan the most appropriate operative treatment. TEVAR proved to be effective even in complex anatomies.
Background: Postoperative atrial fibrillation is common after coronary surgery. The cellular cond... more Background: Postoperative atrial fibrillation is common after coronary surgery. The cellular condition of atrial myocytes might play a part in the postoperative devel- opment of atrial fibrillation. Our study aimed to investigate whether patients in whom postoperative atrial fibrillation develops show pre-existent alterations in histopathology of the right atrium and how such changes are expressed in relation to the use
Background—Atrial fibrillation (AF) after coronary artery bypass graft surgery is a difficult pro... more Background—Atrial fibrillation (AF) after coronary artery bypass graft surgery is a difficult problem and a continuing source of morbidity and mortality. However, the prognostic implications of postoperative AF are still in dispute. Our aim was to ascertain the impact of AF after coronary artery bypass graft on postoperative survival and to assess its prognostic role in cause-specific mortality. Methods and
Journal of the American Heart Association, 2014
Background--Atrial fibrillation (AF) remains the most common complication after cardiac surgery. ... more Background--Atrial fibrillation (AF) remains the most common complication after cardiac surgery. The present study aim was to derive an effective bedside tool to predict postoperative AF and its related complications.
The Journal of thoracic and cardiovascular surgery, 2014
The aim of the present study is to report a risk analysis for spinal cord injury in a recent coho... more The aim of the present study is to report a risk analysis for spinal cord injury in a recent cohort of patients with simultaneous and sequential treatment of multilevel aortic disease. We performed a multicenter study with a retrospective data analysis. Simultaneous treatment refers to descending thoracic and infrarenal aortic lesions treated during the same operation, and sequential treatment refers to separate operations. All descending replacements were managed with endovascular repair. Of 4320 patients, multilevel aortic disease was detected in 77 (1.8%). Simultaneous repair was performed in 32 patients (41.5%), and a sequential repair was performed in 45 patients (58.4%). Postoperative spinal cord injury developed in 6 patients (7.8%). At multivariable analysis, the distance of the distal aortic neck from the celiac trunk was the only independent predictor of postoperative spinal cord injury (odds ratio, 0.75; 95% confidence interval, 0.56-0.99; P=.046); open surgical repair of...
ABSTRACT Introduction L'objectif de cette étude était de revoir notre expérience concerna... more ABSTRACT Introduction L'objectif de cette étude était de revoir notre expérience concernant les patients recevant un traitement endovasculaire électif pour anévrysme de l'aorte abdominale afin de détecter les facteurs prédictifs de mortalité précoce et tardive. Méthodes De Novembre 2000 à Juin 2008, 235 patients consécutifs (218 hommes ; âge moyen : 71,9 ± 8,0 ans, range : 48-95 ans) avaient un traitement endovasculaire pour anévrysme de l'aorte abdominale. Les comorbidités étaient classées suivant le système de score établi par la Society for Vascular Surgery et le risque préopératoire était évalué suivant la classification de l'American Society of Anesthesiologists (ASA). Un examen physique et une tomodensitométrie spiralée étaient planifiés 1, 4 et 12 mois après la procédure, puis tous les ans par la suite. Un écho-doppler et des radiographies étaient également réalisées. Résultats Le succès technique primaire était de 97% (228 cas sur 235). La mortalité hospitalière globale était de 2,1% (n = 5), plus spécifiquement de 1,2% et 2,8% chez les patients ayant un score ASA 2 et 3, respectivement, et de 7,7% chez les patients ayant un score ASA 4. L'analyse multivariée retrouvait que l'insuffisance rénale chronique (OR : 12,12, IC 95% : 1,83-80,17, p = 0,010) et l'utilisation d'endoprothèses à fixation suprarénale (OR : 9,61, IC 95% : 1,01-91,57, p = 0,049) étaient les seuls facteurs prédictifs indépendants de mortalité précoce. Le suivi était complet chez 230 patients qui quittaient l'hôpital, avec un suivi moyen de 26,3 ± 22,7 mois (maximum : 92 mois). L'analyse selon Kaplan–Meier révélait un taux de survie inférieur chez les patients les plus âgés (p < 0,001) ainsi que chez les ayant les anévrysmes les plus volumineux (p < 0,001). Un taux de survie inférieur était également retrouvé chez les femmes et les patients ayant les scores ASA les plus élevés (p = 0,007, et p = 0,003, respectivement). En analyse multivariée de Cox, le score ASA, l'âge, le diamètre de l'anévrysme, et le sexe féminin affectaient indépendamment la survie à long terme. Conclusion Sur la base de notre expérience, nous concluions que la défaillance rénale chronique et la configuration de l'endoprothèse utilisée étaient des facteurs prédictifs indépendants de mortalité précoce. Egalement, les patients les plus âgés, les femmes, les patients ayant les anévrysmes les plus volumineux et les scores ASA les plus élevés correspondaient aux moins bons taux de survie.
... Conclusions. The surgical repair of post-infarction VSD entails a high operative mortality; d... more ... Conclusions. The surgical repair of post-infarction VSD entails a high operative mortality; different techniques were employed with similar results. ... with double patch repairs. Associated procedures were one mitral and one tricuspid valve replacement. ...
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 26, 2015
Despite substantial progress in surgical techniques and perioperative management, the treatment a... more Despite substantial progress in surgical techniques and perioperative management, the treatment and long-term follow-up of type A acute aortic dissection (AAD) still remain a major challenge. The objective of this retrospective, multicentre study was to assess in a large series of patients the early and long-term results after surgery for type A AAD. We analysed the preoperative, intraoperative and postoperative conditions of 1.148 consecutive patients surgically treated in seven large referral centres from 1981 to 2013. We applied to each patient three different multi-parameter risk profiles (preadmission risk, admission risk and post-surgery risk) in order to compare risk factors and outcome. Long-term Kaplan-Meier survival was evaluated. The median age was 64 years and the male population was predominant (66%). Identified diagnosis of collagen disease was present in 9%, and Marfan syndrome in 5%. Bicuspid aortic valve was present in 69 patients (6%). Previous cardiac surgery was ...
Interactive cardiovascular and thoracic surgery, 2015
The aim of this study was to evaluate the impact of red blood cell (RBC) transfusions on the occu... more The aim of this study was to evaluate the impact of red blood cell (RBC) transfusions on the occurrence of stroke and transient ischaemic attack (TIA) after cardiac surgery. Data on 14 956 patients undergoing coronary artery bypass grafting (CABG) and valve surgery (with or without concomitant CABG) were retrieved at three European University Hospitals. The prognostic impact of RBC transfusion on postoperative stroke and TIA was investigated by logistic regression and multilevel propensity score analysis. Postoperative stroke was observed in 147 (1.0%) patients and combined stroke/TIA in 238 (1.6%). Of the total population, 6439 (43%) patients received RBC transfusion with a median of 2 units (25th-75th percentile, 2-4 units). When adjusted for other significant risk factors, RBC transfusion was an independent predictor of stroke [odds ratio (OR) 1.14; 95% confidence interval (CI) 1.11-1.17 per unit] and stroke/TIA (OR 1.12; 95% CI 1.09-1.15 per unit). Increase in the amount of tran...
Annals of Vascular Surgery, 2014
The purpose of this study was to compare midterm results of carotid-to-carotid bypass (CCB) after... more The purpose of this study was to compare midterm results of carotid-to-carotid bypass (CCB) after hybrid repair of aortic arch disease. Between October 2001 and April 2012, all patients undergoing hybrid aortic arch repair with CCB were enrolled. CCBs were positioned in the subcutaneous or in the retropharyngeal position. Hybrid aortic arch repair was performed in a single-stage intervention. We treated 19 (82.6%) men and 4 women; mean age was 74 ± 6 years (range, 58-83 years). Subcutaneous tunnelization was performed in 15 (65.5%) cases and the retropharyngeal route in 8 (34.5%). In-hospital mortality was 8.7% (n = 2); causes of death were major stroke (n = 1) and respiratory failure (n = 1). Cranial nerve injuries (transient or permanent), dysphagia, or local problems were not observed. Tracheostomy was never required. Early outcomes did not differ between the 2 types of bypass. Mean follow-up was 44 months (range, 1-118; median 24). Survival rate at 1, 3, and 5 years was 70% ± 9.6%, 55% ± 10.7%, and 50% ± 11.1%, respectively. At the time of the last follow-up control, all bypasses were patent: stenosis and thrombosis were not recorded. Bypass graft or endograft infection were not registered. Shrinkage of the aortic lesion was observed in 15 (71.4%) cases. CCBs are durable at midterm follow-up. No relevant superiority was identified between the 2 types of CCB; subcutaneous and retropharyngeal routes proved to be equally safe.
Journal of Cardiothoracic and Vascular Anesthesia, 2014
The aim of this study was to evaluate the immediate and late outcome of emergency coronary artery... more The aim of this study was to evaluate the immediate and late outcome of emergency coronary artery bypass grafting (CABG) in a multicenter setting. Multicenter, retrospective study. Four university hospitals. 596 patients were included in this study. Included patients underwent isolated, emergency CABG. Sixty patients (absolute rate: 10.1%, pooled rate: 8.7%) died during the in-hospital stay period. Increasing emergency CABG classes (p<0.0001), recent myocardial infarction (p = 0.019), left ventricular ejection fraction≤30% (p = 0.034), on-pump surgery (p = 0.012), and participating centers (p<0.0001) were independent predictors of in-hospital mortality. Survival rates at 1, 3, and 5 years were 86.4%, 81.6%, and 76.1%, respectively. Extracorporeal membrane oxygenation was used in 6 patients and 3 of them (50.0%) survived the immediate postoperative period. Patient populations of participating centers differed significantly in most of baseline characteristics. The preoperative use of intra-aortic balloon pump (8% to 51%) and off-pump surgery (2.8% to 56.3%) varied significantly between institutions. In-hospital mortality (2.8%, 5.9%, 7.7% and 19.8%, p<0.0001), as well as midterm survival, significantly differed between institutions (at 3 years, 90.6%, 89.8%, 81.2%, and 67.2%, p<0.0001). The outcome after emergency CABG is satisfactory despite a significant operative risk. However, the results of emergency CABG significantly differed between the participating institutions, likely due to differences in the referral pathways and perioperative treatment strategies. Evaluation of these factors is crucial for implementation of treatment in centers with suboptimal results.
Journal of Vascular and Interventional Radiology, 2009
Archives of Medical Science, 2014
To compare early and long-term outcomes of endovascular abdominal aortic aneurysm repair (EVAR) v... more To compare early and long-term outcomes of endovascular abdominal aortic aneurysm repair (EVAR) versus open repair (OPEN). Prospective observational, per protocol, non-randomized, with retrospective analyses. Between 2000 and 2005, a total of 311 patients having EVAR or OPEN repair of infrarenal abdominal aortic aneurysms were identified and included in this prospective single-center observational study. A propensity score-based optimal-matching algorithm was employed, and 138 patients undergoing EVAR procedures were matched (1: 1) to OPEN repair. Open repair showed higher hospital mortality (17% vs. 6%, p = 0.004), respiratory failure (p < 0.026), transfusion requirement (p < 0.001), and intensive care unit admission (27% vs. 7%, p < 0.001), and longer hospitalization (p < 0.001). Median follow-up was 70 months (25(th) to 75(th) percentile, 24 to 101). Actuarial survival estimates at 1, 5 and 10 years were 93%, 74%, 49% for the OPEN group compared to 89%, 69%, 59% for the EVAR group (p = 0.465). A significant difference between groups was observed in younger patients (< 75 years) only (p < 0.044). Late complication and re-intervention rates were significantly higher in EVAR patients (p < 0.001 and p = 0.002, respectively). Freedom from late complications at 1, 5 and 10 years was 96%, 92%, 86%, and 84%, 70%, 64% for OPEN and EVAR procedures, respectively. Our experience confirms the excellent results of the EVAR procedures, offering excellent early and long-term results in terms of safety and reduction of mortality. Patients < 75 years seem to benefit from EVAR not only in the immediate postoperative period but even in a long-term perspective.
Annals of Vascular Surgery, 2011
Background: The purpose of this study was to review our personal experience with patients who und... more Background: The purpose of this study was to review our personal experience with patients who underwent elective endovascular repair of abdominal aortic aneurysms so as to detect the predictors of early and late mortality. Methods: Between November 2000 and June 2008, a total of 235 consecutive patients (218 men; mean age: 71.9 ± 8.0 years, range: 48-95 years) underwent endovascular repair of abdominal aortic aneurysms. Comorbidities were defined by using the Society for Vascular score grading system and the preoperative risk grade on the basis of the classification of the American Society of Anesthesiologists (ASA). Physical examination and spiral computed tomography were planned at 1, 4, and 12 months after the procedure, and on a yearly basis thereafter. Contrast-enhanced ultrasonography and plain X-rays were also performed. Results: Primary technical success rate was 97% (228 of 235 cases). The overall hospital mortality was 2.1% (n ¼ 5), ranging from 1.2% and 2.8% for patients with an ASA of score 2 and 3, respectively, to 7.7% for patients with an ASA score of 4. Multivariable analysis confirmed chronic renal failure (OR: 12.12, 95% CI: 1.83-80.17, p ¼ 0.010) and transrenal endograft (OR: 9.61, 95% CI: 1.01-91.57, p ¼ 0.049) as the only independent predictors of early mortality. Follow-up was completed for all 230 patients who were discharged, with a mean follow-up period of 26.3 ± 22.7 months (maximum: 92 months). KaplaneMeier analysis revealed a reduced survival rate for older patients ( p < 0.001) and patients with a larger aneurysm ( p < 0.001). A reduced survival rate was also demonstrated for women and patients with higher ASA scores ( p ¼ 0.007, and p ¼ 0.003, respectively). In multivariate Cox analysis, ASA score, age, diameter of the aneurysm, and being female independently affected long-term survival. Conclusion: On the basis of our experience, it was concluded that chronic renal failure and the endograft configuration were independent predictors of early mortality. Also, older patients, women, and patients with larger aneurysms and higher ASA scores had the poorest late survival rates.
Vascular and Endovascular Surgery, 2008
Detection of mobile thrombus of the thoracic aorta has become increasingly higher after any embol... more Detection of mobile thrombus of the thoracic aorta has become increasingly higher after any embolic event. Although the indication for treatment remains controversial, there is a growing interest about the ethiopathogenesis of this rare entity, and to define proper diagnostic and therapeutic approaches. The purpose of this article was to review the current management strategies and follow-up results of this rare pathology.
The Journal of thoracic and cardiovascular surgery, 2014
We evaluated the clinical significance and identified the predictors of the universal definition ... more We evaluated the clinical significance and identified the predictors of the universal definition of perioperative bleeding (UDPB) classes in patients undergoing isolated coronary artery bypass grafting (CABG). Data on antithrombotic medication, perioperative bleeding, blood transfusion, and adverse events were available for 2764 patients who had undergone isolated CABG. The Papworth risk score correlated significantly with the UDPB classes (rate of UDPB class 3-4 and Papworth risk score of 0, 12.1%; 1, 23.9%; 2, 37.5%; and 3, 45.0%; P<.0001). Ordinal regression showed that increased age, female sex, low body mass index, low estimated glomerular filtration rate, low hemoglobin, dialysis, urgent or emergency operation, critical status, on-pump surgery, potent antiplatelet drug pause of <5 days, and warfarin pause of <2 days were independent predictors of high UDPB classes. These risk factors also predicted UDPB classes 3-4 in logistic regression analysis. Increasing UDPB clas...
Journal of Cardiac Surgery, 2014
This multicenter study was undertaken to determine the immediate and long-term outcomes in patien... more This multicenter study was undertaken to determine the immediate and long-term outcomes in patients undergoing a primary surgical aortic valve replacement (AVR) who had a previous coronary artery bypass graft surgery with patent grafts. One hundred and thirteen consecutive patients (mean EuroSCORE II, 10.3 ± 7.7%, median 8.0%) who underwent first-time isolated AVR after coronary artery bypass grafting (CABG) were the subjects of this multicenter study. The procedure was performed through a full sternotomy in 95.7% of cases, a patent internal mammary artery graft was clamped in 76.6% of patients. The temperature of cardioplegia was ≤12 °C in 62.8% of patients and systemic temperature was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;32 °C in 23.9% of patients. Thirty-day mortality was 4.4%. Stroke was observed in 8.0% of patients, low cardiac output syndrome in 14.1%, prolonged tracheal intubation in 20.8%, and intensive care unit stay was longer than five days in 19.5% of patients. Among patients with a patent internal mammary graft (91 patients), clamping of this graft (5.7% vs. 0%, p = 0.57) was associated with a nonsignificant trend toward increased 30-day mortality. One-, three- and five-year survival rates were 91.5%, 90.4%, and 88.4%, respectively. Patients undergoing isolated AVR after prior CABG have a good immediate and late survival. A history of prior CABG should not be considered an absolute indication for transcatheter AVR.
Journal of cardiothoracic and vascular anesthesia, 2014
To evaluate the performance of the EuroSCORE II (ESII) and the Society of Thoracic Surgeons (STS)... more To evaluate the performance of the EuroSCORE II (ESII) and the Society of Thoracic Surgeons (STS) scores in surgical (SAVR) or transcatheter aortic valve replacement (TAVR). Systematic review of the literature and meta-analysis. University hospitals. Studies reporting data on the performance of ESII and STS scores in patients undergoing SAVR or TAVR. SAVR or TAVR. Ten studies validated these scores in 13,856 patients who underwent either TAVR or SAVR. Operative mortality was 5.9% (SAVR 3.1%; TAVR 9.6%). ESII-expected mortality was 5.1% (O/E ratio: 1.15, SAVR, O/E ratio 0.94; TAVR, O/E ratio 1.23) and STS-expected mortality was 6.3% (O/E ratio: 0.94, SAVR, O/E ratio 0.84; TAVR, O/E ratio 1.13). The area under the ROC curve for ESII was 0.70 and for STS was 0.70 (SAVR patients: 0.73 for ESII and 0.75 for STS; TAVR patients; 0.66 for ESII and 0.63 for STS). The difference between observed/expected mortality was not significant for ESII (Peto's OR 0.99, p = 0.88) and was significant...
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Papers by Giovanni Mariscalco