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Vincenzo Gallucci: Memories of a Surgeon, Scientist, and Teacher

2020; Elsevier BV; Volume: 111; Issue: 1 Linguagem: Inglês

10.1016/j.athoracsur.2020.10.007

1552-6259

Uberto Bortolotti, Ugolino Livi, Giovanni Stellin, Giuseppe Faggian, Aldo Milano, Carlo Valfrè, Alessandro Mazzucco,

Cardiac Valve Diseases and Treatments

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. 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. On January 10, 1991, Vincenzo Gallucci, MD, head of the Cardiovascular Surgery Institute of the University of Padua Medical School in Italy, died in a car accident at age of 55 years. After 30 years, his memory is still alive and continuously refreshed by remembering the man and his many achievements in the field of cardiovascular surgery. This brief review recalls the professional life of one of the most authoritative Italian cardiac surgeons and his many interests in the field of cardiovascular diseases, underlining those in which he was particularly active and productive. Vincenzo Gallucci was born in Ferrara, Italy, on November 1, 1935, first of 4 children. His father was a family physician and his mother a pharmacologist (Figure 1). After attending the high school in Mantua, he received the MD degree from the University of Modena in 1959. He was initially interested in human pathology and moved to the Institute of General Pathology at Padua University, where he performed studies on the metabolism of myocytes. This experience provided an important scientific background and stimulated further research in the field of cardiac diseases. Early start of training with the Department of Surgery was instrumental in switching his activity from pure research to surgery, raising a specific interest in the treatment of cardiovascular pathologies. In the early 1960s, cardiac surgery in Italy was still at an early stage, and the chances to obtain an adequate preparation were substantially limited. With the aim of improving and refining his surgical training, in 1964 Vincenzo Gallucci moved to the United States with the position of research fellow in Thoracic and Cardiovascular Surgery at the Memorial Hospital of Charlotte, North Carolina, under the direction of Paul W. Sanger (Figure 2A). During this period, he worked, under the leadership of Francis Robicsek, with particular interest in experimental studies on total bypass of the right heart and evaluating the clinical application of cavopulmonary anastomosis.1Sanger P.W. Robicsek F. Taylor F.H. Gallucci V. Observations on partial and complete circulatory exclusion of the right heart.J Cardiovasc Surg. 1965; 6: 30-48PubMed Google Scholar Further research included transplantation of coronary arteries, heart transplantation (HT), and surgery of aortic aneurysms.2Robicsek F. Sanger P.W. Gallucci V. Transplantation of coronary arteries. An experimental study.Ann Thorac Surg. 1966; 2: 243-249Abstract Full Text PDF PubMed Scopus (1) Google Scholar, 3Robicsek F. Lesage A. Sanger P.W. Daugherty H.K. Gallucci V. Bagby E. Transplantation of "live" hearts.Am J Cardiol. 1967; 20: 803-811Abstract Full Text PDF PubMed Scopus (14) Google Scholar, 4Sanger P.W. Robicsek F. Daugherty H.K. Gallucci Operative mortality rate of aortic resections.Surgery. 1968; 64: 359-367PubMed Google Scholar The study on HT presented a "stabilized" form of heart-lung preparation that enabled experimental transplantation of a fully perfused, beating heart, without the assistance of extracorporeal circulation. This method maintained the donor heart viable and functioning in the extracorporeal phase as well as during transplantation.3Robicsek F. Lesage A. Sanger P.W. Daugherty H.K. Gallucci V. Bagby E. Transplantation of "live" hearts.Am J Cardiol. 1967; 20: 803-811Abstract Full Text PDF PubMed Scopus (14) Google Scholar A few months later, he became an intern, starting an intense surgical activity and reaching after 1 year the position of chief resident, showing a particular interest in major vascular surgery, namely in the treatment of aortic aneurysms.4Sanger P.W. Robicsek F. Daugherty H.K. Gallucci Operative mortality rate of aortic resections.Surgery. 1968; 64: 359-367PubMed Google Scholar In July 1967, he moved to Houston, Texas, with the position of resident in surgery at the Baylor University School of Medicine under the direction of Michael E. DeBakey, MD, whom he subsequently remembered not only as a great surgeon but also as an "extremely demanding person, with an extremely scrupulous dedication to the care of his patients" (Figure 2B). At Houston he became particularly involved with surgery of the thoracic and abdominal aorta. During this period, he also collaborated with Denton A. Cooley, MD, who at that time was also working under DeBakey's leadership. In 1969 Vincenzo Gallucci concluded his American experience and returned to Italy with the aim of reorganizing a program of cardiovascular surgery at the University of Padua. After new facilities were built, the activity of both vascular and cardiac surgery started to increase rapidly. He soon demonstrated how his previous training, coupled with a natural propensity, contributed to provide him with great surgical skills and a constant attitude to improvement and open-minded criticism. For such characteristics he was soon appreciated by the national and international cardiac surgery societies. Indeed, he was one of the very few Italian surgeons to become active member in the American Association for Thoracic Surgery and was a strong supporter of the European Association for Cardio-Thoracic Surgery since its foundation in 1986. Gallucci's team was soon confronted with all types of cardiovascular pathologies, acquiring confidence, under his guidance, with the treatment of all types of valvular, coronary, and congenital heart lesions. These, together with the diseases of the thoracic aorta, treated both electively and as emergencies, represented initially his major fields of interest. Vincenzo Gallucci is credited with the first implant of a glutaraldehyde-fixed, stented porcine Hancock bioprosthesis.5Gallucci V. Bortolotti U. Milano A. Valfrè C. Mazzucco A. Thiene G. Isolated mitral valve replacement with the Hancock bioprosthesis: a 13-year appraisal.Ann Thorac Surg. 1984; 38: 571-578Abstract Full Text PDF PubMed Scopus (67) Google Scholar,6Bortolotti U. Milano A.D. Valente M. Thiene G. The stented porcine bioprosthesis. A 50-year journey through hopes and realities.Ann Thorac Surg. 2019; 108: 304-308Abstract Full Text Full Text PDF Scopus (4) Google Scholar In the early 1970s, introduction into clinical practice of commercially manufactured tissue prosthetic valves represented a real breakthrough in valvular surgery. The possibility to avoid long-term anticoagulation in most cases was considered an important advantage for patients requiring valve replacement, eliminating or minimizing the risks of often severe anticoagulant-related complications, which, instead, were quite common in mechanical valve recipients.7Edmunds Jr., L.H. Thrombotic and bleeding complications of prosthetic heart valves.Ann Thorac Surg. 1987; 44: 430-445Abstract Full Text PDF PubMed Scopus (255) Google Scholar,8Celiento M. Filaferro L. Milano A.D. Anastasio G. Ferrari G. Bortolotti U. Single center experience with the Sorin Bicarbon prosthesis. A 17-year clinical follow-up.J Thorac Cardiovasc Surg. 2014; 148: 2039-2044Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar The early results reported with the Hancock I bioprosthesis by Vincenzo Gallucci at the American Heart Association Meeting in 1977 were extremely favorable, indicating a low incidence of prosthesis-related complications.9Cèvese P.G. Gallucci V. Morea M. Fasoli G. Dalla Volta S. Casarotto D. Heart valve replacement with the Hancock bioprosthesis. Analysis of long-term results.Circulation. 1977; 56: II-111-II-116Google Scholar This confirmed the initial enthusiasm, leading to an often indiscriminate use of porcine valves, particularly regardless the patient's age and underlying pathology. As a consequence, an increasing number of patients were referred for replacement of a failing bioprosthesis, allowing his institution to collect large samples of surgical explants. All bioprostheses retrieved at reoperation were extensively studied through a continuous collaboration with the Department of Cardiovascular Pathology, identifying as the major determinant of porcine valve failure the progressive valve tissue deterioration due to dystrophic calcification.10Milano A. Bortolotti U. Talenti E. et al.Calcific degeneration as the main cause of porcine bioprosthetic valve failure.Am J Cardiol. 1984; 53: 1066-1070Abstract Full Text PDF PubMed Scopus (179) Google Scholar,11Valente M. Bortolotti U. Thiene G. Ultrastructural substrates of dystrophic calcification in porcine bioprosthetic valve failure.Am J Pathol. 1985; 119: 12-21PubMed Google Scholar Similar studies were subsequently also performed on pericardial xenografts, proposed as an alternative to porcine heterografts, evidencing that such devices were plagued by a high rate of mechanical failures mostly due to technical problems during valve manufacture.12Gabbay S. Bortolotti U. Wasserman F. Factor S. Strom J. Frater R.W.M. Fatigue-induced failure of the Ionescu-Shiley pericardial xenograft in the mitral position. In vivo and in vitro correlation and a proposed classification.J Thorac Cardiovasc Surg. 1984; 87: 836-844Abstract Full Text PDF PubMed Google Scholar,13Bortolotti U. Milano A. Guerra F. et al.Failure of Hancock pericardial xenografts: is prophylactic bioprosthetic replacement justified?.Ann Thorac Surg. 1991; 51: 430-437Abstract Full Text PDF PubMed Scopus (27) Google Scholar The increasing clinical and pathologic experience in this field convinced Vincenzo Gallucci, with the patronage of the University of Padua, to organize the Second International Symposium on Cardiac Bioprostheses, which was held in Rome in 1982 (Figure 3A). This meeting gathered the most authoritative experts to discuss issues and present personal experiences related to the use of bioprosthetic valves. The symposium was then followed by the book of the proceedings, coedited with Lawrence H. Cohn and published by Yorke Medical Books, which also raised considerable interest.14Cohn L.H. Gallucci V. Proceedings of the Second International Symposium on Cardiac Bioprostheses, Rome, May 17-19, 1982. Yorke Medical Books, New York, NY1982Google Scholar Continuous follow-up of tissue valve recipients coupled with ultrastructural analysis of all explants greatly contributed to stimulate the industry to introduce several modifications in the manufacturing process, particularly adding various anticalcification treatments, allowing to be made available the currently generation of extremely reliable and effective bioprosthetic valves. 15Celiento M. Blasi S. De Martino A. et al.The Mosaic mitral valve bioprosthesis: a long-term clinical and hemodynamic follow-up.Texas Heart Inst J. 2016; 43: 13-19Crossref PubMed Scopus (9) Google Scholar,16Celiento M. Ravenni G. Tomei L. et al.Excellent durability of the Mosaic aortic bioprosthesis at extended follow-13up.J Heart Valve Dis. 2018; 27: 97-103PubMed Google Scholar Vincenzo Gallucci was one of the leaders in cardiac surgery in Italy, but he acquired great prestige after having performed the first Italian orthotopic HT on November 14, 1985. This had always been a recurrent dream, evident heritage of his American experience, and a project on which he did never gave up. This event was preceded by an intense training of the transplant team members in the most important American centers to acquire adequate confidence with the surgical technique and post-HT management protocols. At that time, HT was not yet allowed in Italy, and continuous efforts were done particularly to fight against bureaucracy. Nevertheless, once permission from the Ministry of Health was finally granted, the HT team in Padua was ready. The first recipient was a 39-year-old carpenter with a dilated cardiomyopathy, and the donor was an 18-year-old boy who died in a car accident. Surgery was uncomplicated, and when the new heart started to beat in the recipient' s chest, awareness to have witnessed a historical moment was evident. That unforgettable night of mid-November 1985, changed the outlook of cardiac surgery in Italy. Indeed, as a national newspaper wrote at that time the day after, "Italy woke up in the future." Three months later, Vincenzo Gallucci performed also the first combined heart-kidney transplant in Europe.17Faggian G. Bortolotti U. Stellin G. et al.Combined heart and kidney transplantation: a case report.J Heart Transpl. 1986; 5: 480-483PubMed Google Scholar The HT program in Padua grew rapidly, allowing him to enrich his international credibility and visibility in this field, also owing to the constant and friendly relationship with numerous foreign institutions, especially those considered recognized leaders in HT activity. This was confirmed when the International Society for Heart and Lung Transplantation assigned to the University of Padua the prestigious task to organize its 14th Annual Meeting, which was held in Venice on March 24-26, 1994 (Figure 3B). The first Italian patient to receive a new heart died on June 12, 1992, of HIV infection transmitted by a blood transfusion at the time of HT, when the test for HIV was not yet available18Calabrese F. Angelini A. Cecchetto A. Valente M. Livi U. Thiene G. HIV infection in the first heart transplantation in Italy: fatal outcome. Case Report.APMIS. 1998; 106: 470-474Crossref PubMed Scopus (21) Google Scholar; he survived 17 months after the man who gifted him a new life. With the increasing experience, attention was shifted to implement the HT program with the implant of the first paracorporeal pneumatic assist device in Italy in 1987, the first step to a large program of mechanical support to circulation. Subsequently, the possibility of starting in Padua also heart-lung transplantation was explored by organizing in 1988 an International Symposium with the active participation of renown international experts (Figure 3C), which also was followed by a book of proceedings collecting their contributions.19Gallucci V. Livi U. Faggian G. Mazzucco A. Lung & Heart-Lung Transplantation. Piccin Nuova Libreria, Padova, Italy1991Google Scholar Research on and treatment of congenital heart diseases has always been one of the major interests at the University of Padua. It was in the early 1950s that Carlo A. Carlon, a young surgeon in Padua and a pioneer of cardiac surgery in Italy, was the first to demonstrate experimentally the feasibility and effectiveness of the cavopulmonary anastomosis, giving a fundamental contribution to the rising treatment of cardiac malformations characterized by pulmonary hypoperfusion.20Bortolotti U. Stellin G. Mazzucco A. Carlo A. Carlon and the cavopulmonary anastomosis.Ann Thorac Surg. 1991; 52: 1204-1205Abstract Full Text PDF PubMed Scopus (2) Google Scholar,21Stellin G. A tribute to the pioneers of right heart bypass: an historical review.World J Ped Cong Heart Surg. 2020; 11: 198-203Crossref Google Scholar In the late 1960s, Vincenzo Gallucci returning from his American experience was strongly influenced by his work during such intense and productive years. When he first met Aldo Castaneda, who was developing a prestigious pediatric cardiac surgery program at the Boston Children's Hospital, he immediately understood that correction of many congenital heart defects in the neonatal period and early infancy, by avoiding palliations, had the potential for becoming soon the treatment of choice of most, even complex heart malformations.22Mazzucco A. Bortolotti U. Gallucci V. Del Torso S. Pellegrino P. Successful repair of symptomatic cor triatriatum dexter in infancy.J Thorac Cardiovasc Surg. 1983; 85: 140-143Abstract Full Text PDF PubMed Google Scholar,23Mazzucco A. Rizzoli G. Fracasso A. et al.Experience with operation for total anomalous pulmonary venous connection in infancy.J Thorac Cardiovasc Surg. 1983; 85: 686-690Abstract Full Text PDF PubMed Google Scholar After such indications, a similar program was also developed in Padua, which became one of the leading Italian centers for pediatric cardiac surgery, pioneering in Europe correction of many congenital heart defects in early infancy. This allowed Gallucci and his team to acquire worldwide recognition, so that the pediatric cardiac surgery program at Padua University is still today considered internationally among the most prestigious ones. A great contribution to this program was also given, through the collaboration with the local Cardiovascular Pathology Laboratory, by important studies on congenital heart defects, which provided detailed embryologic, anatomic, and pathologic observations, aiming to aid in the surgical treatment of very complex congenital intracardiac anomalies.24Thiene G. Bortolotti U. Gallucci V. Terribile V. Pellegrino P.A. Anatomical study of truncus arteriosus communis with embryological and surgical considerations.Br Heart J. 1976; 38: 1109-1123Crossref PubMed Scopus (46) Google Scholar,25Thiene G. Bortolotti U. Gallucci V. Valente M. Dalla Volta S. Pulmonary atresia with ventricular septal defect. Further anatomical observations.Br Heart J. 1977; 39: 1223-1233Crossref PubMed Scopus (35) Google Scholar Other important studies were produced on the results of surgical treatment in tricuspid atresia, double-outlet right ventricle, and tunnel subaortic stenosis and on the repair of mitral valve malformations in children.26Mazzucco A. Faggian G. Stellin G. et al.Surgical management of double-outlet right ventricle.J Thorac Cardiovasc Surg. 1985; 90: 29-34Abstract Full Text PDF PubMed Google Scholar, 27Stellin G. Mazzucco A. Bortolotti U. et al.Tricuspid atresia versus other complex lesions. Comparison of results with a modified Fontan procedure.J Thorac Cardiovasc Surg. 1988; 96: 204-211Abstract Full Text PDF PubMed Google Scholar, 28Stellin G. Mazzucco A. Bortolotti U. et al.Late results after resection of discrete and tunnel sub-aortic stenosis.Eur J Cardiothorac Surg. 1989; 3: 235-240Crossref Scopus (9) Google Scholar, 29Stellin G. Bortolotti U. Mazzucco A. et al.Repair of congenitally malformed mitral valve in children.J Thorac Cardiovasc Surg. 1988; 95: 480-485Abstract Full Text PDF PubMed Google Scholar After the first Italian HT, a pediatric HT program was allowed to perform, among the first in Europe, several successful transplants in young infants and neonates with end-stage congenital and acquired heart diseases.30Stellin G. Mazzucco A. Bortolotti U. et al.Late failure of double-inlet left ventricle septation: treatment by orthotopic heart transplantation.Ann Thorac Surg. 1989; 48: 577-578Abstract Full Text PDF PubMed Google Scholar,31Valente M. Cocco P. Thiene G. et al.Cardiac fibroma and heart transplantation.J Thorac Cardiovasc Surg. 1993; 106: 1208-1212Abstract Full Text PDF PubMed Google Scholar Vincenzo Gallucci spent most of his professional life at the University of Padua, consistently contributing to the growth of an important cardiovascular surgery program, maintaining the centennial academic role of this medical school, and even increasing its international reputation. The University of Padua, which is one of the oldest in the world, came into being in 1222 and will soon celebrate the 800th anniversary of foundation32Thiene G. Padua University: the role it has played in the history of medicine and cardiology and its position today.Eur Heart J. 2009; 30: 629-635Crossref Scopus (9) Google Scholar and played a fundamental role in the history of medicine, particularly in the study of circulation and cardiovascular diseases. Padua hosted many famous scientists, such as Galileo Galilei and Nicolaus Copernicus, who were among the most renowned lecturers and researchers.