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Bortolotti U, Livi U, Stellin G, Faggian G, Milano AD, Valfrè C, Mazzucco A. Vincenzo Gallucci: Memories of a Surgeon, Scientist, and Teacher. Ann Thorac Surg 2020; 111:370-375. [PMID: 33127401 DOI: 10.1016/j.athoracsur.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022]
Abstract
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. After 30 years, the memory of a great surgeon, scientist, and teacher is still alive, particularly in those who received his important heritage.
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Affiliation(s)
| | - Ugolino Livi
- Cardiothoracic Department, University of Udine, Udine, Italy
| | - Giovanni Stellin
- Pediatric Cardiac Surgery Unit, University of Padua, Padua, Italy
| | | | | | - Carlo Valfrè
- Division of Cardiac Surgery, Civic Hospital, Treviso, Treviso, Italy
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Moutakiallah Y, Maaroufi I, Aithoussa M, Bamous M, Abdou A, Atmani N, Hatim A, Amahzoune B, Bekkali YE, Boulahya A. [Subaortic diaphragm surgery]. Pan Afr Med J 2016; 23:265. [PMID: 27516830 PMCID: PMC4963174 DOI: 10.11604/pamj.2016.23.265.4212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 12/01/2014] [Indexed: 11/28/2022] Open
Abstract
Le diaphragme sous aortique se caractérise par une certaine latence clinique et une faible morbi-mortalité. La chirurgie reste le traitement de choix malgré un réel risque de récurrence à long terme. Nous rapportons 18 patients opérés entre Avril 1994 et Mars 2011 pour diaphragme sous aortique d’âge moyen de 18,1±9,7 ans avec 11 patients de sexe masculin. Le diaphragme était de nature fibreuse chez 13 patients et fibro-musculaire chez 5 patients. Tous les patients ont été opérés par résection de diaphragme associée à une myectomie, une plastie aortique, une fermeture de communication interventriculaire et une ligature de canal artériel perméable respectivement chez 3, 3, 2 et 2 patients. La Mortalité opératoire était nulle et sans aucun cas de trouble de conduction postopératoire. Le suivi a duré en moyenne 44,3±36,8 mois sans aucun décès tardif. Deux patients ont présenté une récidive de diaphragme qui a nécessité une réopération avec bonne évolution. La tendance actuelle dans la chirurgie du diaphragme se fait vers des interventions précoces et des résections plus extensives. Cependant, le risque de récidive impose une surveillance échographique systématique et rapprochée.
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Affiliation(s)
- Younes Moutakiallah
- Service de Chirurgie Cardiovasculaire, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Ilham Maaroufi
- Service de Chirurgie Cardiovasculaire, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Mahdi Aithoussa
- Service de Chirurgie Cardiovasculaire, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Mehdi Bamous
- Service de Chirurgie Cardiovasculaire, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Abdessamad Abdou
- Service de Chirurgie Cardiovasculaire, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Noureddine Atmani
- Service de Chirurgie Cardiovasculaire, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Abdedaïm Hatim
- Réanimation de Chirurgie Cardiovasculaire, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Brahim Amahzoune
- Service de Chirurgie Cardiovasculaire, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Youssef El Bekkali
- Service de Chirurgie Cardiovasculaire, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Abdelatif Boulahya
- Service de Chirurgie Cardiovasculaire, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
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Pickard SS, Geva A, Gauvreau K, del Nido PJ, Geva T. Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children. Heart 2015; 101:1547-53. [PMID: 26238147 DOI: 10.1136/heartjnl-2015-307460] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/18/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To characterise long-term outcomes after discrete subaortic stenosis (DSS) resection and to identify risk factors for reoperation and aortic regurgitation (AR) requiring repair or replacement. METHODS All patients who underwent DSS resection between 1984 and 2009 at our institution with at least 36 months' follow-up were included. Demographic, surgical and echocardiographic data were reviewed. Outcomes were reoperation for recurrent DSS, surgery for AR, death and morbidities, including heart transplant, endocarditis and complete heart block. RESULTS Median length of postoperative follow-up was 10.9 years (3-27.2 years). Reoperation occurred in 32 patients (21%) and plateaued 10 years after initial resection. Survival at 10 years and 20 years was 98.6% and 86.3%, respectively. Aortic valve (AoV) repair or replacement for predominant AR occurred in 31 patients (20%) during or after DSS resection. By multivariable analysis, prior aortic stenosis (AS) intervention (HR 22.4, p<0.001) was strongly associated with AoV repair or replacement. Risk factors for reoperation by multivariable analysis included younger age at resection (HR 1.24, p=0.003), preoperative gradient ≥60 mm Hg (HR 2.23, p=0.04), peeling of membrane off AoV or mitral valve (HR 2.52, p=0.01), distance of membrane to AoV <7.0 mm (HR 4.03, p=0.03) and AS (HR 2.58, p=0.01). CONCLUSIONS In this cohort, the incidence of reoperations after initial DSS resection plateaued after 10 years. Despite a significant rate of reoperation, overall survival was good. Concomitant congenital AS and its associated interventions significantly increased the risk of AR requiring surgical intervention.
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Affiliation(s)
- Sarah S Pickard
- Departments of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA Departments of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Alon Geva
- Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts, USA Department of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Departments of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA Departments of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Pedro J del Nido
- Cardiovascular Surgery, Boston Children's Hospital, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Tal Geva
- Departments of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA Departments of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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van der Linde D, Roos-Hesselink JW, Rizopoulos D, Heuvelman HJ, Budts W, van Dijk APJ, Witsenburg M, Yap SC, Oxenius A, Silversides CK, Oechslin EN, Bogers AJJC, Takkenberg JJM. Surgical outcome of discrete subaortic stenosis in adults: a multicenter study. Circulation 2013; 127:1184-91, e1-4. [PMID: 23426105 DOI: 10.1161/circulationaha.112.000883] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Discrete subaortic stenosis is notable for its unpredictable hemodynamic progression in childhood and high reoperation rate; however, data about adulthood are scarce. METHODS AND RESULTS Adult patients who previously underwent surgery for discrete subaortic stenosis were included in this retrospective multicenter cohort study. Mixed-effects and joint models were used to assess the postoperative progression of discrete subaortic stenosis and aortic regurgitation, as well as reoperation. A total of 313 patients at 4 centers were included (age at baseline, 20.2 years [25th-75th percentile, 18.4-31.0 years]; 52% male). Median follow-up duration was 12.9 years (25th-75th percentile, 6.2-20.1 years), yielding 5617 patient-years. The peak instantaneous left ventricular outflow tract gradient decreased from 75.7±28.0 mm Hg preoperatively to 15.1±14.1 mm Hg postoperatively (P<0.001) and thereafter increased over time at a rate of 1.31±0.16 mm Hg/y (P=0.001). Mild aortic regurgitation was present in 68% but generally did not progress over time (P=0.76). A preoperative left ventricular outflow tract gradient ≥80 mm Hg was a predictor for progression to moderate aortic regurgitation postoperatively. Eighty patients required at least 1 reoperation (1.8% per patient-year). Predictors for reoperation included female sex (hazard ratio, 1.53; 95% confidence interval, 1.02-2.30) and left ventricular outflow tract gradient progression (hazard ratio, 1.45; 95% confidence interval, 1.31-1.62). Additional myectomy did not reduce the risk for reoperation (P=0.92) but significantly increased the risk of a complete heart block requiring pacemaker implantation (8.1% versus 1.7%; P=0.005). CONCLUSIONS Survival is excellent after surgery for discrete subaortic stenosis; however, reoperation for recurrent discrete subaortic stenosis is not uncommon. Over time, the left ventricular outflow tract gradient slowly increases and mild aortic regurgitation is common, although generally nonprogressive over time. Myectomy does not show additional advantages, and because it is associated with an increased risk of complete heart block, it should not be performed routinely.
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Affiliation(s)
- Denise van der Linde
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
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Abstract
Background—
Transluminal balloon tearing of the membrane in a thin discrete subaortic stenosis is an alternative to membrane surgical resection. However, the long-term outcome of patients with isolated thin discrete subaortic stenosis treated by transluminal balloon tearing remains unknown.
Methods and Results—
This 25-year study describes findings from 76 patients with isolated thin discrete subaortic stenosis who underwent percutaneous transluminal balloon tearing of the membrane and were followed up for a mean period of 16±6 years. The age at presentation had a wide range (2–67 years). The mean age at treatment was 19±16 years. Immediately after treatment, the subvalvular gradient decreased from 70±27 to 18±12 mm Hg (
P
<0.001). No significant postprocedural aortic regurgitation was observed. After a mean follow-up time of 16±6 years, 11 patients (15%) developed restenosis, 3 patients (4%) progressed to muscular obstructive disease, and 1 patient (1.3%) developed a new distant obstructive membrane. Twelve patients (16%) were redilated at a mean of 5±3 years after their first treatment, and 4 patients (5%) underwent surgery at a mean of 3±2 years after their first treatment. Fifty-eight patients (77%) remained alive and free of redilation or surgery at follow-up. Larger annulus diameter and thinner membranes were independent factors associated with better long-term results.
Conclusions—
Most patients (77%) with isolated thin discrete subaortic stenosis treated with transluminal balloon tearing of the membrane had sustained relief at subsequent follow-ups without restenosis, the need for surgery, progression to muscular obstructive disease, or an increase in the degree of aortic regurgitation.
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Rizzoli G, Tiso E, Mazzucco A, Daliento L, Rubino M, Tursi V, Fracasso A. Discrete subaortic stenosis. J Thorac Cardiovasc Surg 1993. [DOI: 10.1016/s0022-5223(19)33745-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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