Objecti6e: To evaluate the mid-term results of complete arterial myocardial revascularization per... more Objecti6e: To evaluate the mid-term results of complete arterial myocardial revascularization performed with arterial conduits. Methods: From July 1987 to December 1994, 183 patients underwent a myocardial revascularization procedure with the use of at least two arterial grafts (IMAs, rGEA, IEA) at our institute. Their mean age was 569 8.7 years, the redo-operation rate was 16.9% (31:183), two-vessel disease was
This study was undertaken to compare the in vitro effects of 17beta-estradiol on human epicardial... more This study was undertaken to compare the in vitro effects of 17beta-estradiol on human epicardial coronary arteries, resistance coronary arteries and on arterial vessels usually employed as grafts in surgical myocardial revascularization. Coronary artery rings (descending coronary artery, right coronary artery, circumflex coronary artery, first septal branch) and arterial graft rings (internal thoracic artery, gastro-epiploic artery) obtained from human heart donors with heart not suitable to cardiac transplantation were connected to force transducer for isometric force recording. Precontracted specimens with and without endothelium were exposed to increasing concentration of 17beta-estradiol (3-30-300-3000 nmol/l) and to vehicle (0.1% v/v ethanol). We also evaluated the effects of 17beta-estradiol on vessels before and 20 minutes after exposure to L-monomethyl-arginine and indomethacin. 17beta-estradiol induced a significant relaxation in all precontracted vessels (mean maximum eff...
Progress in cardiovascular surgery, anesthesiology, post operative care, imaging, and a better kn... more Progress in cardiovascular surgery, anesthesiology, post operative care, imaging, and a better knowledge of medullar vascularization has resulted in an improved management of ischemic complications during acute aortic dissection. Scanners of new generation allow fast and precise analysis of the mechanisms involved in the visceral mal perfusion syndrome. Combined strategies using both surgical and endovascular interventional radiology constitute an offensive
The Journal of thoracic and cardiovascular surgery, 2004
Thoracic and thoracoabdominal aortic repair are still complicated by spinal cord ischemia and par... more Thoracic and thoracoabdominal aortic repair are still complicated by spinal cord ischemia and paraplegia. The aim of the present article is to present the results of an anatomical study conducted by means of both postmortem injection of the vertebral artery and perfusion of the abdominal aorta. The spinal cord blood supply was investigated in 51 Caucasian cadavers: in 40 cases a methylene blue solution was hand-injected into the vertebral artery, whereas in the remaining 11 cases the abdominal aorta was perfused with a methylene blue solution by means of a roller pump. The level and side of the arteria radicularis magna and the continuity of the anterior spinal artery were recorded. The anterior spinal artery was a continuous vessel without interruptions along the spinal cord in all 51 cases. The arteria radicularis magna level was variable, ranging from T9 to L5. The arteria radicularis magna arose from a lumbar artery in 36 cases (70.5%) and it was left-sided in 32 cases (62.7%). ...
Background. There is increasing interest in minimally invasive direct coronary artery bypass graf... more Background. There is increasing interest in minimally invasive direct coronary artery bypass grafting (MIDCABG); however, there is still little information about midterm results and postoperative quality of life.Methods. From March 1995 to March 1998, 64 patients underwent MIDCABG at our hospital. Their mean age was 60 ± 9.5 years; 22 (34.4%) had unstable angina. All patients were followed-up by both
Multimedia Manual of Cardio-Thoracic Surgery, 2006
The surgical treatment for thoracic and thoraco-abdominal aortic aneurysms still remains a challe... more The surgical treatment for thoracic and thoraco-abdominal aortic aneurysms still remains a challenge for the surgeon, as it can be complicated by paraplegia. Several techniques were developed in order to decrease the risk of paraplegia. We describe a surgical variation of the 'clamp and sew' technique, named 'Quick simple clamping' technique, that we adopted starting in 1995. In our experience, it has allowed us to eliminate paraplegia. This technique was developed on the basis of anatomical, patho-physiological and fluid-dynamic studies which demonstrated that the anterior spinal artery (ASA) is not interrupted, the arteria radicularis magna is not a terminal artery and the sacrifice of intercostal arteries does not lead to an increasing risk of spinal cord ischemia.
PurposeBone-marrow and peripheral blood-derived stem cells can be used as stimulators of myogenes... more PurposeBone-marrow and peripheral blood-derived stem cells can be used as stimulators of myogenesis and angiogenesis. We describe an original technique for collection and surgical intramyocardial injection of peripheral blood-derived stem cells.
Objective Aortic stenosis is the most common valvular heart disease in the Western world and the ... more Objective Aortic stenosis is the most common valvular heart disease in the Western world and the proportion of patientsunsuitable forconventional surgeryis increasing as a result of aging and comorbidities. We report our early experience with transcatheter aortic valve implantation in high-risk patients with severe symptomatic aortic stenosis. Methods Transcatheter Edwards-SAPIEN valve implantation was attempted in 22 patients (80W5 years) in
BackgroundOff-pump coronary artery bypass (OPCAB) challenges the conventional on-pump coronary ar... more BackgroundOff-pump coronary artery bypass (OPCAB) challenges the conventional on-pump coronary artery bypass grafting (CABG) as the standard of surgical therapy for coronary disease. The aim of this study is to assess the differences in clinical outcomes between CABG and OPCAB by meta-analysis of data published in randomized trials.
Following the experience of cardiac surgeons with homografts in the treatment of infective aortic... more Following the experience of cardiac surgeons with homografts in the treatment of infective aortic valve endocarditis, cardiovascular surgeons have investigated in situ revascularization by means of homografts in the management of vascular prosthetic graft infections. Preliminary results are encouraging, but their late fate in long-term follow-up and the influence of preservation techniques are still under investigation. This article reports the experience of the Italian Collaborative Vascular Homograft Group, with the use of fresh and cryopreserved arterial homografts for the treatment of prosthetic graft infections. Between March 1994 and December 1996, 44 patients with prosthetic graft infection were treated with homografts (13 preserved at 4 degrees C, 31 cryopreserved). The mean age of the patients was 65 years. Emergency surgical procedures were performed in eight patients (18%). Sepsis was diagnosed in 11 patients, aortoenteric fistula in 13, and false aneurysms in 10. Staphylococcus was the main cause of infection. The types of vascular reconstruction with homograft were: 32 aortobifemoral, 3 aortoaortic, 2 iliofemoral, 4 peripheral, and 3 axillobifemoral. Human lymphocyte antigen (HLA) and antibody (ABO) blood group system compatibility between donors and recipients was not respected. The mean duration of follow-up was 15 months (range 1-33). Clinical and duplex scanning evaluations were routinely performed. Computed tomography (CT) or magnetic resonance (MR) scanning or arteriography were performed on the basis of duplex scanning results. There were six deaths during the early postoperative period (30 days) with a mortality rate of 13.6%. During the follow-up there were five late deaths with a mortality rate of 11.4%. Eight patients had graft occlusion. Three cases were successfully treated with thrombectomy. Two cases were successfully treated with femoropopliteal bypass with autologous vein. In three cases leg amputation was necessary. The results of fresh and cryopreserved homograft were compared. No significative differences of early postoperative mortality, late mortality, homograft related mortality, and graft occlusion were observed. We have evaluated the actuarial survival of the patients and the actuarial patency of the homografts on the aortoiliac reconstructions. Twelve months after the surgery the actuarial survival of the patients was 73% and the actuarial patency of the homografts was 56%. In our preliminary experience, we have not observed any significant difference in terms of clinical outcome by using fresh rather than cryopreserved homografts. In the near future it will be our policy to employ only cryopreserved homografts. Moreover, we will extend vessel harvesting to nonheart-beating donors, thus maximizing retrieval. The aforementioned solutions will supply the best graft availability to obtain dimensional and ABO compatibility between donors and recipients.
Objecti6e: To evaluate the mid-term results of complete arterial myocardial revascularization per... more Objecti6e: To evaluate the mid-term results of complete arterial myocardial revascularization performed with arterial conduits. Methods: From July 1987 to December 1994, 183 patients underwent a myocardial revascularization procedure with the use of at least two arterial grafts (IMAs, rGEA, IEA) at our institute. Their mean age was 569 8.7 years, the redo-operation rate was 16.9% (31:183), two-vessel disease was
This study was undertaken to compare the in vitro effects of 17beta-estradiol on human epicardial... more This study was undertaken to compare the in vitro effects of 17beta-estradiol on human epicardial coronary arteries, resistance coronary arteries and on arterial vessels usually employed as grafts in surgical myocardial revascularization. Coronary artery rings (descending coronary artery, right coronary artery, circumflex coronary artery, first septal branch) and arterial graft rings (internal thoracic artery, gastro-epiploic artery) obtained from human heart donors with heart not suitable to cardiac transplantation were connected to force transducer for isometric force recording. Precontracted specimens with and without endothelium were exposed to increasing concentration of 17beta-estradiol (3-30-300-3000 nmol/l) and to vehicle (0.1% v/v ethanol). We also evaluated the effects of 17beta-estradiol on vessels before and 20 minutes after exposure to L-monomethyl-arginine and indomethacin. 17beta-estradiol induced a significant relaxation in all precontracted vessels (mean maximum eff...
Progress in cardiovascular surgery, anesthesiology, post operative care, imaging, and a better kn... more Progress in cardiovascular surgery, anesthesiology, post operative care, imaging, and a better knowledge of medullar vascularization has resulted in an improved management of ischemic complications during acute aortic dissection. Scanners of new generation allow fast and precise analysis of the mechanisms involved in the visceral mal perfusion syndrome. Combined strategies using both surgical and endovascular interventional radiology constitute an offensive
The Journal of thoracic and cardiovascular surgery, 2004
Thoracic and thoracoabdominal aortic repair are still complicated by spinal cord ischemia and par... more Thoracic and thoracoabdominal aortic repair are still complicated by spinal cord ischemia and paraplegia. The aim of the present article is to present the results of an anatomical study conducted by means of both postmortem injection of the vertebral artery and perfusion of the abdominal aorta. The spinal cord blood supply was investigated in 51 Caucasian cadavers: in 40 cases a methylene blue solution was hand-injected into the vertebral artery, whereas in the remaining 11 cases the abdominal aorta was perfused with a methylene blue solution by means of a roller pump. The level and side of the arteria radicularis magna and the continuity of the anterior spinal artery were recorded. The anterior spinal artery was a continuous vessel without interruptions along the spinal cord in all 51 cases. The arteria radicularis magna level was variable, ranging from T9 to L5. The arteria radicularis magna arose from a lumbar artery in 36 cases (70.5%) and it was left-sided in 32 cases (62.7%). ...
Background. There is increasing interest in minimally invasive direct coronary artery bypass graf... more Background. There is increasing interest in minimally invasive direct coronary artery bypass grafting (MIDCABG); however, there is still little information about midterm results and postoperative quality of life.Methods. From March 1995 to March 1998, 64 patients underwent MIDCABG at our hospital. Their mean age was 60 ± 9.5 years; 22 (34.4%) had unstable angina. All patients were followed-up by both
Multimedia Manual of Cardio-Thoracic Surgery, 2006
The surgical treatment for thoracic and thoraco-abdominal aortic aneurysms still remains a challe... more The surgical treatment for thoracic and thoraco-abdominal aortic aneurysms still remains a challenge for the surgeon, as it can be complicated by paraplegia. Several techniques were developed in order to decrease the risk of paraplegia. We describe a surgical variation of the 'clamp and sew' technique, named 'Quick simple clamping' technique, that we adopted starting in 1995. In our experience, it has allowed us to eliminate paraplegia. This technique was developed on the basis of anatomical, patho-physiological and fluid-dynamic studies which demonstrated that the anterior spinal artery (ASA) is not interrupted, the arteria radicularis magna is not a terminal artery and the sacrifice of intercostal arteries does not lead to an increasing risk of spinal cord ischemia.
PurposeBone-marrow and peripheral blood-derived stem cells can be used as stimulators of myogenes... more PurposeBone-marrow and peripheral blood-derived stem cells can be used as stimulators of myogenesis and angiogenesis. We describe an original technique for collection and surgical intramyocardial injection of peripheral blood-derived stem cells.
Objective Aortic stenosis is the most common valvular heart disease in the Western world and the ... more Objective Aortic stenosis is the most common valvular heart disease in the Western world and the proportion of patientsunsuitable forconventional surgeryis increasing as a result of aging and comorbidities. We report our early experience with transcatheter aortic valve implantation in high-risk patients with severe symptomatic aortic stenosis. Methods Transcatheter Edwards-SAPIEN valve implantation was attempted in 22 patients (80W5 years) in
BackgroundOff-pump coronary artery bypass (OPCAB) challenges the conventional on-pump coronary ar... more BackgroundOff-pump coronary artery bypass (OPCAB) challenges the conventional on-pump coronary artery bypass grafting (CABG) as the standard of surgical therapy for coronary disease. The aim of this study is to assess the differences in clinical outcomes between CABG and OPCAB by meta-analysis of data published in randomized trials.
Following the experience of cardiac surgeons with homografts in the treatment of infective aortic... more Following the experience of cardiac surgeons with homografts in the treatment of infective aortic valve endocarditis, cardiovascular surgeons have investigated in situ revascularization by means of homografts in the management of vascular prosthetic graft infections. Preliminary results are encouraging, but their late fate in long-term follow-up and the influence of preservation techniques are still under investigation. This article reports the experience of the Italian Collaborative Vascular Homograft Group, with the use of fresh and cryopreserved arterial homografts for the treatment of prosthetic graft infections. Between March 1994 and December 1996, 44 patients with prosthetic graft infection were treated with homografts (13 preserved at 4 degrees C, 31 cryopreserved). The mean age of the patients was 65 years. Emergency surgical procedures were performed in eight patients (18%). Sepsis was diagnosed in 11 patients, aortoenteric fistula in 13, and false aneurysms in 10. Staphylococcus was the main cause of infection. The types of vascular reconstruction with homograft were: 32 aortobifemoral, 3 aortoaortic, 2 iliofemoral, 4 peripheral, and 3 axillobifemoral. Human lymphocyte antigen (HLA) and antibody (ABO) blood group system compatibility between donors and recipients was not respected. The mean duration of follow-up was 15 months (range 1-33). Clinical and duplex scanning evaluations were routinely performed. Computed tomography (CT) or magnetic resonance (MR) scanning or arteriography were performed on the basis of duplex scanning results. There were six deaths during the early postoperative period (30 days) with a mortality rate of 13.6%. During the follow-up there were five late deaths with a mortality rate of 11.4%. Eight patients had graft occlusion. Three cases were successfully treated with thrombectomy. Two cases were successfully treated with femoropopliteal bypass with autologous vein. In three cases leg amputation was necessary. The results of fresh and cryopreserved homograft were compared. No significative differences of early postoperative mortality, late mortality, homograft related mortality, and graft occlusion were observed. We have evaluated the actuarial survival of the patients and the actuarial patency of the homografts on the aortoiliac reconstructions. Twelve months after the surgery the actuarial survival of the patients was 73% and the actuarial patency of the homografts was 56%. In our preliminary experience, we have not observed any significant difference in terms of clinical outcome by using fresh rather than cryopreserved homografts. In the near future it will be our policy to employ only cryopreserved homografts. Moreover, we will extend vessel harvesting to nonheart-beating donors, thus maximizing retrieval. The aforementioned solutions will supply the best graft availability to obtain dimensional and ABO compatibility between donors and recipients.
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Papers by Paolo Biglioli