Papers by Tommaso Generali
European Journal of Cardio-Thoracic Surgery, 2021
OBJECTIVE Our goal was to present 2 decades of our experience with the Ross procedure and its s... more OBJECTIVE Our goal was to present 2 decades of our experience with the Ross procedure and its sequential modifications, adopted since 2010, to improve the reoperation rate. METHODS We performed a single-centre, retrospective review of database information and medical notes about the implantation technique: the freestanding root. We compared era 1 (1997–2009) and era 2 (2010–2019). RESULTS Between 1997 and 2019, a total of 214 Ross procedures were performed (71% men, median age 24 years) [interquartile range (IQR) 15–38]. Of these, 87% had various forms of congenital-dysplastic aortic valves. The median cross-clamping and bypass times were 173 (IQR 148–202) and 202 (IQR 182–244) min. The median postoperative stay was 6 days (2–77). Thirty-day mortality was 0.5%. The median follow-up time was 8.2 years (IQR 3.9–13.2). Survival at 10 and 20 years was 97% and 95%; freedom from greater than moderate aortic regurgitation or aortic valve intervention was 91% and 80%; and 93% of the patie...
European Journal of Cardio-Thoracic Surgery
OBJECTIVES Contemporary modified Ross procedure continues to deliver excellent outcomes and remai... more OBJECTIVES Contemporary modified Ross procedure continues to deliver excellent outcomes and remains part of the treatment strategy for aortic valve disease in the young adult population. The aim of this study was to assess whether Ross procedure carried out as a second or subsequent intervention for aortic valve disease carries similar risk and long-term benefit, when compared to Ross procedure for first time aortic valve replacement. METHODS 158 patients aged 16 to 60 years from a single congenital cardiac centre between 1997 and 2020 were included. The sample was split into two subgroups, based on the history of previous aortic valve interventions prior to the Ross procedure. Primary outcomes were defined as survival and pulmonary autograft failure. Coarsened exact matching was used to balance for covariates. RESULTS 103 patients underwent primary Ross and 55 underwent secondary Ross with a mean follow-up of 7.8 years. 22 patients underwent 28 reoperations during follow-up. 49 wel...
The Journal of Heart and Lung Transplantation
The Journal of Thoracic and Cardiovascular Surgery
Current data suggest that cardiac bypass surgery is the single largest cause of iatrogenic stroke... more Current data suggest that cardiac bypass surgery is the single largest cause of iatrogenic stroke. Among the strategies to decrease or eliminate aortic manipulation, there is the use of off-pump coronary artery bypass grafting (CABG) through an aortic “no touch” technique, which reduces significantly the stroke rate. However, this off-pump aortic “no touch” technique is not always applicable, and, when saphenous vein and/or free arterial aortocoronary grafts are used, there is still risk of neurological injury due to tangential aortic clamp applied during the proximal anastomosis sewing. We aim to analyze the current incidence, etiology, and physiopathology of the neurological complications after coronary artery bypass surgery. We describe the methods and techniques that provide reduction in the occurrence of neurological complications. CABG with multiple clamp technique failed to find a better outcome in terms of neuropsychological deficit in the OPCABG group. By the way, patients ...
The Cardiothoracic Surgeon, 2021
A 34-year-old gentleman presented with Staphylococcus salivarius infective endocarditis 13 years ... more A 34-year-old gentleman presented with Staphylococcus salivarius infective endocarditis 13 years after aortic homograft and mitral valve repair for degenerative bicuspid aortic valve associated with rheumatic heart disease. The homograft had calcified, and the mitral repair had deteriorated with severe regurgitation. Multidisciplinary team decision to restore best quality of life was for re-do Ross procedure with bi-leaflet preserving mitral valve replacement with an inverted RESILIA aortic valve as the patient was fundamentally against lifelong anti-coagulation. The aortic homograft was excised, and coronary arteries dissected out followed by harvesting of the pulmonary autograft. The mitral valve was accessed via a trans-septal approach. On examination, there was a restricted and thickened posterior mitral valve leaflet. An inverted 27-mm INSPIRIS RESILIA aortic bio-prosthesis was placed with mitral cusps preserved. The pulmonary autograft was implanted in an intra-annular positio...
The Journal of heart valve disease, 2014
Standardized techniques of mitral valve repair (MVR) have recently witnessed the introduction of ... more Standardized techniques of mitral valve repair (MVR) have recently witnessed the introduction of a 'respect rather than resect' concept, the strategy of which involves the use of artificial chordae. MVR displays several advantages over mitral valve replacement in degenerative mitral regurgitation (MR), but the risk of reoperation for MVR failure must be taken into account. Different mechanisms could be advocated as the leading cause of MVR failure; procedure-related mechanisms are usually involved in early MVR failure, while valve-related mechanisms are common in late failure. Here, the case is reported of an early failure of MVR using artificial chordae that could be explained by an unusual procedure-related mechanism, namely anterior papillary muscle necrosis. MVR failure is a well-known complication after surgical repair of degenerative MR, but anterior papillary muscle partial necrosis might also be considered a possible mechanism of procedure-related MVR failure, especi...
World Journal for Pediatric and Congenital Heart Surgery
Background: Hypoplastic left heart syndrome (HLHS) with either intact atrial septum (IS) or highl... more Background: Hypoplastic left heart syndrome (HLHS) with either intact atrial septum (IS) or highly restrictive interatrial communication (HRIC) is associated with poor survival. Immediate postpartum access to cardiac therapy and timely left atrial decompression (LAD) are paramount to a successful outcome. We describe herein our evolving approach to LAD and report interstage and longer-term results. Methods: We retrospectively identified neonates with HLHS IS/HRIC requiring LAD between 2005 and 2019. All babies had prenatal/postnatal echocardiography. Our LAD strategy evolved over time from attempt at transcatheter balloon atrial septostomy (BAS) to surgical septectomy with inflow occlusion, to hybrid trans-atrial stent implantation. Results: Twelve neonates required LAD at a median time of 14 (0.5-31) hours after birth. Five patients underwent BAS that proved successful in 2 cases. Of the 3 unsuccessful cases, 2 required extra-corporeal membrane oxygenation (ECMO) support and died s...
The Annals of Thoracic Surgery
The Anatolian Journal of Cardiology
Catheterization and Cardiovascular Interventions
To analyze the results of extracorporeal life support (ECLS) for cardiogenic shock complicating a... more To analyze the results of extracorporeal life support (ECLS) for cardiogenic shock complicating acute myocardial infarction (AMI) in a single‐center experience.
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 25, 2016
Nowadays, transcatheter approaches are the treatment of choice for several congenital heart defec... more Nowadays, transcatheter approaches are the treatment of choice for several congenital heart defects. However, adverse events may occur during interventional procedures. Even if the complication rate has been reduced remarkably because of learning curve and technological improvements, catastrophic events are still possible. The aim of this study was to review cardiac catheter complications that required surgical treatment during or after a percutaneous procedure. We evaluated retrospectively a thirteen-year experience at our centre. We examined all transcatheter procedures involving device release or implantation needing surgical rescue. We performed 3,205 interventional catheterisation procedures with device release or implantation: ASD device closure (n=2,205), PDA device occlusion (n=355), VSD device closure (n=218), aortic coarctation or recoarctation stenting (n=199), pulmonary artery stenting (n=154) and pulmonary valve implantation (n=74). Complications that required surgical ...
Journal of Vascular Medicine & Surgery, 2015
While superficial temporal artery (STA) vasculitis is typically a disease of the elderly, spontan... more While superficial temporal artery (STA) vasculitis is typically a disease of the elderly, spontaneous STA aneurysm in children is anecdotic and usually caused by a subjacent vasculitis. Since 1948 around 40 cases have been listed in literature and just 6 of them under the age of 18. Three main forms have been classified: juvenile temporal arteritis, typical giant cells arteritis and temporal artery involvement secondary to systemic vasculitis. We report a rare case of STA aneurysm in an 8 year old patient already known for the surgical treatment of an aortic coarctation. The patient was asymptomatic, clinical exam was unremarkable and no traumatism, fever, arthralgias or recent infective episodes were reported. No residual coarctation at echocardiography. STA echo-colour Doppler suggested juvenile temporal arteritis, showing a dilation of 5.4 x 8.7 mm. Doppler scanning of the other districts was normal. At cerebral MRI a spindle-shaped dilation over the left STA was confirmed without other intracranial anomalies. Thoraco-abdominal angio-TC was normal to the entire aorta and at the visceral arteries level. Blood exams were unremarkable. A biopsy of the left STA was performed under general anesthesia: a true aneurysm of the artery (1.5×8 mm) was resected. At anatomopathologic examination neither epithelioid nor great cells were found but a lymphocytic infiltration was detected around the vasa vasorum. Isolated STA vasculitis in young individuals results in different findings, pathogenic triggers and clinical manifestations from affecting the elderly. Diagnosis is very important to direct the appropriate therapeutic strategy and must include histopathologic evaluation.
The Journal of heart valve disease, 2014
Standardized techniques of mitral valve repair (MVR) have recently witnessed the introduction of ... more Standardized techniques of mitral valve repair (MVR) have recently witnessed the introduction of a 'respect rather than resect' concept, the strategy of which involves the use of artificial chordae. MVR displays several advantages over mitral valve replacement in degenerative mitral regurgitation (MR), but the risk of reoperation for MVR failure must be taken into account. Different mechanisms could be advocated as the leading cause of MVR failure; procedure-related mechanisms are usually involved in early MVR failure, while valve-related mechanisms are common in late failure. Here, the case is reported of an early failure of MVR using artificial chordae that could be explained by an unusual procedure-related mechanism, namely anterior papillary muscle necrosis. MVR failure is a well-known complication after surgical repair of degenerative MR, but anterior papillary muscle partial necrosis might also be considered a possible mechanism of procedure-related MVR failure, especi...
Interactive cardiovascular and thoracic surgery, 2011
Pericardial cysts are intrathoracic lesions usually considered to be congenital and less frequent... more Pericardial cysts are intrathoracic lesions usually considered to be congenital and less frequently to be acquired. They are normally found incidentally upon chest radiography, computed tomography (CT)-scan or echocardiography. They are usually asymptomatic and have a benign behavior although sometimes they can cause clinical symptoms and diagnosis can be uncertain. We present, herein, the case of a 51-year-old male with a history of atrial arrhythmia resistant to transcatheter ablation therapies with an accidental finding of a pericardial cyst adherent to the lateral wall of the right atrium at the emerging superior vena cava. The patient was studied with transesophageal echocardiography, CT-scan and cardiovascular magnetic resonance with the evidence of dimensional increasing of the cyst at seriate controls. Considering this, in the absence of a definitive diagnosis and suspecting a link between the mass and the arrhythmia, the cyst was surgically removed through median sternotomy...
Razavi International Journal of Medicine, 2014
A 43-year-old man developed a mediastinal abscess after a redo aortic valve along with an ascendi... more A 43-year-old man developed a mediastinal abscess after a redo aortic valve along with an ascending aorta replacement and also a sub-aortic membrane resection. He was surgically revised: as there were no signs of involvement of the valve and vascular prosthesis, a pedunculated tract of the greater omentum was mobilized and positioned around the aortic prosthesis. During a 10-month follow-up, it has been revealed that the patient is doing well and has no recurrence of the infection. Use of the great omentum could be considered in the selected mediastinitis cases. Case Presentation: A 43-year-old man was referred to our institution for a severe aortic regurgitation and an ascending aorta enlargement associated with a relapsing sub-aortic membrane, which had been treated in his childhood. He underwent a redo ascending aorta replacement and an aortic valve replacement (mechanical prosthesis) along with a resection of the relapsing sub-valvular membrane. Some weeks after he was admitted to another hospital for fever, arthromyalgias and chest pain. After a few days, he developed an inflammatory jugular swelling and underwent a chest CT scan showing a bulky anterior mediastinal abscess in the direct continuity with the sternum. A further chest CT scan showed a mediastinal para-aortic capsulated mass, 135 × 85 × 90 mm in dimension, well delimited over the surrounding plans. At the top of the lesion, a further fluid collection was appreciated, extending through the sternum over the subcutaneous tissues, 30 × 20 mm in dimension. Re-sternotomy was performed and the mediastinal mass was opened and drained. After an extension of the median sternotomy through the epigastrium, a pedunculated tract of the greater omentum was mobilized and positioned around the vascular prosthesis to fill the empty space left by the abscess. Conclusions: The greater omentum is well known in cardiothoracic surgery for its valuable features such as plasticity, immune competence, good blood supply and neovascularization-potential. Dead space can be obliterated by omental flap because of its plasticity qualities. It contains a large number of immunologically active cells likely to be responsible for its anti-infective properties. We can affirm that use of the great omentum could be considered in selected post-operative mediastinitis cases after cardiac surgery.
Journal of Cardiac Surgery, 2012
Asian Cardiovascular and Thoracic Annals, 2012
Figure 1. (a) Initial sliding of the stent from the right subclavian vein into the superior vena ... more Figure 1. (a) Initial sliding of the stent from the right subclavian vein into the superior vena cava. (b) Presence of the stent in the right atrium. (c, d) Stent entrapment in the right atrium. LA = left atrium, LV = left ventricle, MV = mitral valve, ST = stent, RA = right atrium. RV = right ventricle, TV = tricuspid valve. Asian Cardiovascular & Thoracic Annals 20(5) 608–609 The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492311435685 aan.sagepub.com
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Papers by Tommaso Generali