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Torre T, Schlotterbeck H, Ferraro F, Klersy C, Surace G, Toto F, Pozzoli A, Ferrari E, Demertzis S. Continuous Glucose Monitoring System After Coronary Artery Bypass Graft Surgery: A Feasibility Study. Asian Cardiovasc Thorac Ann 2024:2184923241240035. [PMID: 38504616 DOI: 10.1177/02184923241240035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Blood glucose level variability has been associated with increased risk of complication in the postoperative setting of cardiovascular surgery. Although interesting for optimization of blood glucose management in this context, continuous blood glucose (CBG) devices can have a limited reliability in this context, in particular because of the use of paracetamol. The aim of this study was to evaluate the reliability of Dexcom G6®, a recently developed continuous glucose monitoring device. METHODS We performed a prospective, observational, non-randomized, single-centre study comparing Dexcom G6® CBG level monitoring with the standard methods routinely used in this context. The standard blood glucose values were paired to the time corresponding values measured with Dexcom G6®. Agreement between the two methods and potential correlation in case of paracetamol use were calculated. RESULTS From May 2020 to August 2021, 36 out of 206 patients operated for isolated coronary artery bypass grafting were enrolled; 673 paired blood glucose level were analyzed. Global agreement (ρc) was 0.85 (95% C.I.: 0.84-0.86), intensive care unit agreement was 0.78 (95%C.I.: 0.74-0.82) and ward agreement was 0.91 (95%C.I.: 0.89-0.93). In the diabetic population, it was 0.87 (95%C.I.: 0.85-0.90). When paracetamol was used, the difference was 0.02 mmol/l (95%C.I.: 0.29-0.33). CONCLUSIONS Dexcom G6® provides good blood glucose level accuracy in the postoperative context of cardiac surgery compared to the standard methods of measurements. The results are particularly reliable in the ward where the need for repeated capillary glucose measurements implies patient discomfort and time-consuming manipulations for the nursing staff.
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Affiliation(s)
- Tiziano Torre
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Hervé Schlotterbeck
- Anestesiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Francesco Ferraro
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Catherine Klersy
- Service of Clinical Epidemiology & Biometry, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Giuseppina Surace
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Francesca Toto
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Alberto Pozzoli
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Enrico Ferrari
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Stefanos Demertzis
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
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Notaristefano G, Ponziani FR, Ranalli M, Diterlizzi A, Policriti MA, Stella L, Del Zompo F, Fianchi F, Picca A, Petito V, Del Chierico F, Scanu M, Toto F, Putignani L, Marzetti E, Ferrarese D, Mele MC, Merola A, Tropea A, Gasbarrini A, Scambia G, Lanzone A, Apa R. Functional hypothalamic amenorrhea: gut microbiota composition and the effects of exogenous estrogen administration. Am J Physiol Endocrinol Metab 2024; 326:E166-E177. [PMID: 38019083 DOI: 10.1152/ajpendo.00281.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023]
Abstract
Functional hypothalamic amenorrhea (FHA) is characterized by estrogen deficiency that significantly impacts metabolic, bone, cardiovascular, mental, and reproductive health. Given the importance of environmental factors such as stress and body composition, and particularly considering the importance of estrogens in regulating the gut microbiota, some changes in the intestinal microenvironment are expected when all of these factors occur simultaneously. We aimed to assess whether the gut microbiota composition is altered in FHA and to determine the potential impact of hormonal replacement therapy (HRT) on the gut microbiota. This prospective observational study included 33 patients aged 18-34 yr with FHA and 10 age-matched healthy control women. Clinical, hormonal, and metabolic evaluations were performed at baseline for the FHA group only, whereas gut microbiota profile was assessed by 16S rRNA gene amplicon sequencing for both groups. All measurements were repeated in patients with FHA after receiving HRT for 6 mo. Gut microbiota alpha diversity at baseline was significantly different between patients with FHA and healthy controls (P < 0.01). At the phylum level, the relative abundance of Fusobacteria was higher in patients with FHA after HRT (P < 0.01), as was that of Ruminococcus and Eubacterium at the genus level (P < 0.05), which correlated with a decrease in circulating proinflammatory cytokines. FHA is a multidimensional disorder that is interconnected with dysbiosis through various mechanisms, particularly involving the gut-brain axis. HRT appears to induce a favorable shift in the gut microbiota in patients with FHA, which is also associated with a reduction in the systemic inflammatory status.NEW & NOTEWORTHY Our study marks the first comprehensive analysis of gut microbiota composition in FHA and the impact of HRT on it, along with biochemical, anthropometric, and psychometric aspects. Our results indicate distinct gut microbiota composition in patients with FHA compared with healthy individuals. Importantly, HRT prompts a transition toward a more beneficial gut microbiota profile and reduced inflammation. This study validates the concept of FHA as a multifaceted disorder interlinked with dysbiosis, particularly involving the gut-brain axis.
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Affiliation(s)
- Giovanna Notaristefano
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Romana Ponziani
- Università Cattolica del Sacro Cuore, Rome, Italy
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome (Italy), Rome, Italy
| | - Monia Ranalli
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Alice Diterlizzi
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Martina Asia Policriti
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Leonardo Stella
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome (Italy), Rome, Italy
| | - Fabio Del Zompo
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome (Italy), Rome, Italy
| | - Francesca Fianchi
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome (Italy), Rome, Italy
| | - Anna Picca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Medicine and Surgery, LUM University, Casamassima, Italy
| | - Valentina Petito
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome (Italy), Rome, Italy
| | | | - Matteo Scanu
- Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | | | - Daniele Ferrarese
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Cristina Mele
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annamaria Merola
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anna Tropea
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore, Rome, Italy
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome (Italy), Rome, Italy
| | - Giovanni Scambia
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Lanzone
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosanna Apa
- Department of Women's and Children's Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Longo S, Del Chierico F, Scanu M, Toto F, Legramante JM, Rizza S, Putignani L, Federici M. An Investigation of Metabolic Risk Factors and Gut Microbiota in Unexplained Syncope. Biomedicines 2024; 12:264. [PMID: 38397866 PMCID: PMC10886590 DOI: 10.3390/biomedicines12020264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The pathogenesis of many syncopal episodes remains unexplained. Intestinal dysbiosis could be involved in the pathophysiological mechanisms of syncope due to its connection with the central nervous system via the microbiota-gut-brain axis. This pilot study aimed to explore the specific cardiometabolic risk factors and gut microbiota in unexplained syncope (US), compared to other types of syncope, to assess their similarity or verify their different origins. METHODS We studied 86 participants with syncope, who were divided into four groups: an orthostatic syncope group (OH, n = 24), a neuromediated syncope group (NMS, n = 26), a cardiological syncope group (CS, n = 9), and an unexplained syncope group (US, n = 27). We evaluated the anthropometric, clinical, and metabolic characteristics of the four groups; the α- and β-diversity; and the differences in the abundance of the microbial taxa. RESULTS The US group had a lower incidence of systolic hypertension at the first visit and a lower frequency of patients with nocturnal hypertension than the CS group. Compared to the OH and NMS groups, the US group had a higher incidence of carotid plaques and greater carotid intima-media thickness, respectively. The microbiota differed significantly between the US and CS groups, but not between the US group and the OH or NMS group. CONCLUSIONS We observed significant differences in the gut microbiota between CS and US. Future studies are necessary to evaluate the involvement of the gut microbiota in the complex pathogenesis of syncope and whether its analysis could support the interpretation of the pathophysiological mechasnisms underlying some episodes classifiable as US.
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Affiliation(s)
- Susanna Longo
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (S.L.); (J.M.L.); (S.R.)
| | - Federica Del Chierico
- Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.D.C.); (M.S.); (F.T.)
| | - Matteo Scanu
- Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.D.C.); (M.S.); (F.T.)
| | - Francesca Toto
- Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.D.C.); (M.S.); (F.T.)
| | - Jacopo M. Legramante
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (S.L.); (J.M.L.); (S.R.)
| | - Stefano Rizza
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (S.L.); (J.M.L.); (S.R.)
| | - Lorenza Putignani
- Unit of Microbiomics and Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (S.L.); (J.M.L.); (S.R.)
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Pozzoli A, Torre T, Toto F, Biroova S, Carletta D, Ferrari E, Demertzis S. Cardiac surgery simulation - part 2: Step-by-step Konno operation in a preclinical model. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37934088 DOI: 10.1510/mmcts.2022.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
This operation is performed on a preclinical model (porcine heart) that has been positioned and fixed inside a plastic mannequin, simulating the human anatomy. This set-up allows surgical operations to be performed at almost the same depth and orientation as in the operating theatre. The preclinical model allows the exact simulation of most of the key movements and steps of major adult and congenital operations. In this case, we replicate the Konno operation. This intervention addresses localized subaortic stenosis involving the left outflow tract or the narrowing of the left ventriculo-aortic junction.
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Affiliation(s)
| | | | - Francesca Toto
- Istituto Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Sara Biroova
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Dario Carletta
- Cardiocentro Ticino Institute, Lugano, 6900, Switzerland
| | - Enrico Ferrari
- The Heart Team Cardiocentro Ticino Foundation Via Tesserete 48 Lugano 6900 Switzerland
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Pozzoli A, Gabriella Surace G, Torre T, Bagnato P, Gallo M, Toto F, Ferrari E, Demertzis S. del Nido versus hematic cardioplegia in minimally invasive aortic valve surgery. Asian Cardiovasc Thorac Ann 2023; 31:795-801. [PMID: 37876227 DOI: 10.1177/02184923231209858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND The quality of a myocardial protection of a single-dose del Nido cardioplegia versus multiple dose blood-based cardioplegia on myocardial injury, outcomes and operative times in patients undergoing minimally invasive aortic valve replacement is basically unreported. METHODS AND RESULTS Preoperative and post-operative data, as well as technical details from isolated minimally invasive aortic valve replacements, performed using single-dose or multiple-dose cardioplegia were prospectively collected and retrospectively analysed. A total of 110 patients undergoing minimally invasive valve replacements at our institution composed two groups: 55 patients in the blood cardioplegia group (BloCa) and 55 in the del Nido group (DeNiCa). The two-matched groups were comparable in terms of preoperative variables. In the DeNiCa group, there was a statistically significant less need for cardiac defibrillation after aortic cross-clamp release (p < 0.001). Moreover, the BloCa group received intraoperatively more blood transfusions (p = 0.001) and more insulin administration for higher glucose levels (p < 0.001). The BloCa group showed higher intraoperative lactate levels (p = 0.01). Need for post-operative inotropic and vasoactive support, Creatine Kinase-MB levels after 6 and 12 h, onset of post-operative atrial fibrillation and length of stay were similar. No deaths occurred in neither groups. CONCLUSION Single-dose del Nido cardioplegia in the setting of minimally invasive aortic surgery seems to offer adequate myocardial protection, comparable to multiple dose hematic cardioplegia. It has been documented a lower peri-operative need of defibrillation after cross-clamp release, lactate- and glucose peak values, as well as less blood transfusions compared to blood cardioplegic strategy.
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Affiliation(s)
- Alberto Pozzoli
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | | | - Tiziano Torre
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Pietro Bagnato
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Michele Gallo
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Francesca Toto
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Enrico Ferrari
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Stefanos Demertzis
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Toto F, Torre T, Pozzoli A, Biroova S, Ferrari E, Demertzis S. Cardiac surgery simulation: step-by-step Nicks procedure in a preclinical model. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37428537 DOI: 10.1510/mmcts.2023.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
We demonstrate the Nicks operation, one of the posterior aortic root enlargement procedures, on a preclinical model (porcine heart). The goal of this operation is to facilitate the implementation of a suitably sized aortic prosthetic valve. The procedure is performed by making a longitudinal incision through the non-coronary sinus without entering the fibrous body between the aortic valve and the anterior leaflet of the mitral valve and inserting a patch to enlarge the annulus.
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Affiliation(s)
| | | | | | - Sara Biroova
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Enrico Ferrari
- The Heart Team Cardiocentro Ticino Foundation Via Tesserete 48 Lugano 6900 Switzerland
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Toto F, Leo L, Klersy C, Torre T, Theologou T, Pozzoli A, Caporali E, Demertzis S, Ferrari E. Mid-Term Clinical Outcomes and Hemodynamic Performances of Trifecta and Perimount Bioprostheses following Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:jcdd10040139. [PMID: 37103018 PMCID: PMC10146805 DOI: 10.3390/jcdd10040139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/07/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Aims of the Study: We evaluated the clinical outcome and the hemodynamic and freedom from structural valve degeneration of two standard aortic bioprostheses. Methods: Clinical results, echocardiographic findings and follow-up data of patients operated for isolated or combined aortic valve replacement with the Perimount or the Trifecta bioprosthesis were prospectively collected, retrospectively analysed and compared. We weighted all the analyses by the inverse of the propensity of choosing either valves. Results: Between April 2015 and December 2019, 168 consecutive patients (all comers) underwent aortic valve replacement with Trifecta (n = 86) or Perimount (n = 82) bioprostheses. Mean age was 70.8 ± 8.6 and 68.8 ± 8.6 years for the Trifecta and Perimount groups, respectively (p = 0.120). Perimount patients presented a greater body mass index (27.6 ± 4.5 vs. 26.0 ± 4.2; p = 0.022), and 23% of them suffered from angina functional class 2–3 (23.2% vs. 5.8%; p = 0.002). Mean ejection fraction was 53.7 ± 11.9% (Trifecta) and 54.5 ± 10.4% (Perimount) (p = 0.994), with mean gradients of 40.4 ± 15.9 mmHg (Trifecta) and 42.3 ± 20.6 mmHg (Perimount) (p = 0.710). Mean EuroSCORE-II was 7 ± 11% and 6 ± 9% for the Trifecta and Perimount group, respectively (p = 0.553). Trifecta patients more often underwent isolated aortic valve replacement (45.3% vs. 26.8%; p = 0.016) and annulus enlargement (10.5% vs. 2.4%; p = 0.058). All-cause mortality at 30 days was 3.5% (Trifecta) and 8.5% (Perimount), (p = 0.203) while new pacemaker implantation (1.2% vs. 2.5%; p = 0.609) and stroke rate (1.2% vs. 2.5%; p = 0.609) were similar. Acute MACCE were observed in 5% (Trifecta) and 9% (Perimount) of patients with an unweighted OR of 2.22 (95%CI 0.64–7.66; p = 0.196) and a weighted OR of 1.10 (95%CI: 0.44–2.76, p = 0.836). Cumulative survival at 24 months was 98% (95%CI: 0.91–0.99) and 96% (95%CI: 0.85–0.99) for Trifecta and Perimount groups, respectively (log-rank test; p = 0.555). The 2-year freedom from MACCE was 94% (95%CI: 0.65–0.99) for Trifecta and 96% (95%CI: 0.86–0.99) for Perimount (log-rank test; p = 0.759, HR 1.46 (95%CI: 0.13–16.48)) in the unweighted analysis (not estimable in the weighted analysis). During the follow-up (median time: 384 vs. 593 days; p = 0.0001) there were no re-operations for structural valve degeneration. Mean valve gradient at discharge was lower for Trifecta across all valve sizes (7.9 ± 3.2 vs. 12.1 ± 4.7 mmHg; p < 0.001), but the difference did not persist during follow-up (8.2 ± 3.7 mmHg for Trifecta, 8.9 ± 3.6 mmHg for Perimount; p = 0.224); Conclusions: Postoperative outcome and mid-term follow-up were similar. An early better hemodynamic performance was detected for the Trifecta valve but did not persist over time. No difference in the reoperation rate for structural valve degeneration was found.
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Affiliation(s)
- Francesca Toto
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
- Correspondence: ; Tel.: +41-918055145; Fax: +41-918055148
| | - Laura Leo
- Department of Cardiology, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
| | - Catherine Klersy
- Service of Clinical Epidemiology & Biometry, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Tiziano Torre
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
| | - Thomas Theologou
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
| | - Alberto Pozzoli
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
| | - Elena Caporali
- Department of Cardiology, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
| | - Stefanos Demertzis
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
- Biomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
| | - Enrico Ferrari
- Cardiac Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland
- Biomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
- School of Medicine, University of Zurich, 8006 Zurich, Switzerland
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Toto F, Torre T, Pozzoli A, Zurfluh C, Ferrari E, Demertzis S. Cardiac surgery simulation: Step-by-step hemi-Yacoub operation in a preclinical model. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 36786667 DOI: 10.1510/mmcts.2022.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
We demonstrate a hemi-Yacoub operation on a preclinical model (porcine heart). It is an alternative remodelling technique for the management of dilatation of the ascending aorta with the involvement of the aortic root, particularly the noncoronary sinus or in case of an aortic dissection. The goal of this operation is to replace selectively the dilated/dissected portion (noncoronary sinus), thereby avoiding replacement of the entire aortic root.
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Affiliation(s)
- Francesca Toto
- Heart Surgery Unit - Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | | | | | - Chantal Zurfluh
- Heart Surgery Unit - Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Enrico Ferrari
- The Heart Team Cardiocentro Ticino Foundation Via Tesserete 48 Lugano 6900 Switzerland
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Torre TM, Toto F, Klersy C, Theologou T, Pozzoli A, Ferrari E, Demertzis S. Twenty-year experience with skeletonized bilateral internal thoracic arteries for surgical myocardial revascularization. A single center experience. J Card Surg 2022; 37:4928-4936. [PMID: 36378881 DOI: 10.1111/jocs.17176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY The mammary artery shows excellent long-term patency and encourages the use of skeletonized bilateral internal thoracic arteries (BITA) for coronary surgery. We analyzed the long-term outcome of patients operated for myocardial revascularization with BITA in a single center. MATERIALS AND METHODS Clinical data and surgical details of patients undergoing coronary surgery with BITA were prospectively collected and retrospectively analyzed. Selected variables were studied as risk factors for sternal wound complication and a subanalysis of clinical outcome for patients aged 70 years or greater was performed. A long-term follow-up of the study group is provided. RESULTS From January 2001 to November 2021, 750 patients underwent myocardial revascularization using BITA grafts (mean age: 61 ± 9.5 years; males: 91%) at our institute. Patients with triple-vessel disease were 81%, 15.3% of all procedures were performed off-pump and 3.6% were urgent cases. Hospital mortality was 0.5%. Sternal wound complication was observed in 67 patients (9.0%) with 7 deep sternal wound infections (0.9%). Female gender (odds ratios [OR]: 3.7, p < 0.01), BMI >30 (OR: 1.8, p = 0.04), smoking (OR: 1.8, p = 0.02), and chronic kidney failure (OR: 3.7, p = 0.05) were independent predictors for sternal complications. During a mean follow-up time of 8.7 ± 5.3 years, 34 patients (4.5%) underwent a repeated myocardial revascularization, and there were 89 all-cause deaths (11.9%) and the cumulative survival at 5, 10, 15, and 20 years was 97%, 89%, 76%, and 60% for the whole study group 92%, 74%, 47%, and 43% for the subgroup of elderly patients (mean age: 74 ± 3.5 years). CONCLUSIONS Use of skeletonized bilateral thoracic arteries shows low-rate of wound infection and good long-term outcome with low risk of repeated revascularizations, regardless of patients' age.
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Affiliation(s)
- Tiziano M Torre
- Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Francesca Toto
- Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Catherine Klersy
- Service of Clinical Epidemiology & Biometry, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Thomas Theologou
- Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Alberto Pozzoli
- Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Enrico Ferrari
- Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Stefanos Demertzis
- Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
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10
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Pozzoli A, Toto F, Torre T, Zurfluh C, Ferrari E, Demertzis S. Cardiac surgery simulation - part 1: Step-by-step David procedure in a preclinical model. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36373767 DOI: 10.1510/mmcts.2022.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We performed this operation on a preclinical model (porcine heart) that has been positioned and fixed inside a plastic mannequin that simulates the human anatomy. This simulation allows surgical operations to be performed at almost the same depth and orientation at which they would be performed on a patient in an operating room. The preclinical model allows the exact simulation of most of the key movements and steps of major coronary and valve surgery. In this case, we show the salient steps of the David I operation.
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Affiliation(s)
- Alberto Pozzoli
- Heart Surgery Unit - Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Francesca Toto
- Heart Surgery Unit - Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Tiziano Torre
- Heart Surgery Unit - Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Chantal Zurfluh
- Heart Surgery Unit - Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Enrico Ferrari
- Heart Surgery Unit - Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Stefanos Demertzis
- Heart Surgery Unit - Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
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11
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Pozzoli A, Torre T, Toto F, Theologou T, Ferrari E, Demertzis S. Percutaneous Venous Cannulation for Minimally Invasive Cardiac Surgery: The Safest and Effective Technique Described Step-by-Step. Front Surg 2022; 9:828772. [PMID: 35392055 PMCID: PMC8980230 DOI: 10.3389/fsurg.2022.828772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
The current cardiac surgical landscape, with the expansion of minimally invasive operations, ECMO, and some interventional therapies, requires a thorough knowledge of peripheral cannulation techniques. In particular, venous cannulation may appear trivial and complication-free, but this does not reflect the reality. A venous cannulation which is not perfectly performed can lead to serious life-threatening complications in several steps. The technique we describe step by step is the current gold standard in terms of safety and efficacy: from the use of ultrasound for ultrasound-guided puncture to safe advancement of super stiff guidewires by means of a sentinel catheter, and concluding with smooth insertion of the venous cannula over the stiff guidewire up to the SVC. Moreover, a list of bailout maneuvers to solve complications is presented along with a report of institutional clinical experience since the adoption of this technique.
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Affiliation(s)
- Alberto Pozzoli
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
- *Correspondence: Alberto Pozzoli
| | - Tiziano Torre
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Francesca Toto
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Thomas Theologou
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Enrico Ferrari
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Stefanos Demertzis
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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12
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Alio JL, D'Oria F, Toto F, Balgos J, Palazon A, Versaci F, Del Barrio JLA. Retinal image quality with multifocal, EDoF, and accommodative intraocular lenses as studied by pyramidal aberrometry. Eye Vis (Lond) 2021; 8:37. [PMID: 34615549 PMCID: PMC8496005 DOI: 10.1186/s40662-021-00258-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 09/06/2021] [Indexed: 11/10/2022]
Abstract
Background To study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function (PSF) Strehl ratio using a pyramidal wavefront sensor (PWS)-based aberrometer. Methods This study included 194 eyes implanted with: (a) 19 AcrySof SA60AT (control group); (b) 19 Miniwell; (c) 24 LENTIS Mplus LS-313 MF30; d) 33 LENTIS Mplus LS-313 MF15; (e) 17 AkkoLens Lumina; (f) 31 AT LISA Tri 839MP; (g) 20 Precizon Presbyopic; (h) 20 AcrySof IQ PanOptix; (i) 11 Tecnis Eyhance. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root mean square (RMS), low-order aberration (LOA) and high-order aberration (HOA) RMS measured by PWS aberrometer. Results AT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0- and 4.0-mm pupil size (0.52 ± 0.14 and 0.31 ± 0.10; P < 0.05), followed by SA60AT (0.41 ± 0.11 and 0.28 ± 0.07) and PanOptix (0.4 ± 0.07 and 0.26 ± 0.04). AT LISA Tri was found to provide a significantly better retinal image quality than PanOptix at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.004). Mplus MF15 was found to be significantly better than Mplus MF30 at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.002). Total RMS, LOA RMS, HOA RMS, PSF Strehl ratio and PSFw2 varied significantly between the studied groups (P < 0.001). Conclusions Far distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens. AT LISA Tri, SA60AT and PanOptix showed the highest values of far distance retinal image quality, while the lowest PSFw2 Strehl ratios were displayed by Miniwell, Mplus MF30 and Precizon Presbyopic.
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Affiliation(s)
- Jorge L Alio
- Vissum Innovation, Alicante, Spain. .,Division of Ophthalmology, Universidad Miguel Hernández, Vissum Miranza, c/ Cabañal, 1, 03016, Alicante, Spain.
| | - Francesco D'Oria
- Vissum Innovation, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Vissum Miranza, c/ Cabañal, 1, 03016, Alicante, Spain.,Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | | | | | - Antonio Palazon
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Spain
| | - Francesco Versaci
- R&D Department, Costruzione Strumenti Oftalmici (CSO), Florence, Italy
| | - Jorge L Alio Del Barrio
- Vissum Innovation, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Vissum Miranza, c/ Cabañal, 1, 03016, Alicante, Spain
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13
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Alio JL, Arias A, D’Oria F, Toto F, Del Barrio JA, Duarte R, Artal P. Light scattering in intraocular lenses explanted 15 to 40 years after surgery. Biomed Opt Express 2021; 12:3485-3494. [PMID: 34221674 PMCID: PMC8221949 DOI: 10.1364/boe.423652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/28/2021] [Accepted: 05/13/2021] [Indexed: 06/13/2023]
Abstract
The optical quality of intraocular lenses (IOLs) of different materials that have been implanted from 16 to 44 years in human eyes was studied. The IOLs were explanted due to other causes than loss of transparency. The scattered light from the IOLs was assessed in two angular regimes by using dark field images (for wide angles) and the optical integration method (for narrower angles). No evident differences were found in the scattering intensities processed from the dark images. The explanted lenses presented slightly increased amounts of straylight between 1 and 5.1° when compared to a reference new unused lens.
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Affiliation(s)
- Jorge L. Alio
- Vissum innovation, Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Augusto Arias
- Laboratorio de Óptica, Universidad de Murcia, Campus de Espinardo (Edificio 34), Murcia 30100, Spain
| | - Francesco D’Oria
- Vissum innovation, Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Francesca Toto
- Vissum innovation, Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Jorge Alio Del Barrio
- Vissum innovation, Alicante, Spain
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Raul Duarte
- Laboratorio de Óptica, Universidad de Murcia, Campus de Espinardo (Edificio 34), Murcia 30100, Spain
| | - Pablo Artal
- Laboratorio de Óptica, Universidad de Murcia, Campus de Espinardo (Edificio 34), Murcia 30100, Spain
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14
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Fierabracci A, Arena A, Toto F, Gallo N, Puel A, Migaud M, Kumar M, Chengappa KG, Gulati R, Negi VS, Betterle C. Autoimmune polyendocrine syndrome type 1 (APECED) in the Indian population: case report and review of a series of 45 patients. J Endocrinol Invest 2021; 44:661-677. [PMID: 32767280 DOI: 10.1007/s40618-020-01376-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Autoimmune polyendocrinopathy-candidiasis-ectodermal-dystrophy (APECED) or autoimmune polyglandular syndrome type 1 (APS-1) is a rare autosomal recessive genetic disease due to mutations in the AIRE (AutoImmune REgulator) gene. The clinical diagnosis is classically based on the presence of at least two of the three main components: chronic mucocutaneous candidiasis, hypoparathyroidism and primary adrenal insufficiency. Patients often suffer from other endocrine or non-endocrine autoimmune conditions throughout life. APECED etiopathogenesis is mediated by T lymphocytes. Autoantibodies against proteins of the affected organs are found in the serum of APECED patients as well as neutralizing antibodies against cytokines. We report here the clinical and genetic characteristics of 45 Indian APECED patients in comparison to Finnish, Sardinian, Turkish and North/South American cohorts from their published results. We also report a new case of APECED of Indian origin, a 2-year old child suffering from chronic mucocutaneous candidiasis since the age of 8 months, with confirmatory AIRE homozygous mutation c.274C > T (p.R92W). CONCLUSION With the inherent limitations of a retrospective study, analysis of Indian APECED patients suggested that compared to classic criteria, application of Ferre/Lionakis criteria validated in North/South American patients could help in earlier diagnosis in 3 of 8 (37.5%) patients for whom adequate information for evaluation was available.
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Affiliation(s)
- A Fierabracci
- Infectivology and Clinical Trials Research Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - A Arena
- Infectivology and Clinical Trials Research Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - F Toto
- Infectivology and Clinical Trials Research Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - N Gallo
- Laboratory Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - A Puel
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR 1163, Imagine Institute, University of Paris, Paris, France
| | - M Migaud
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR 1163, Imagine Institute, University of Paris, Paris, France
| | - M Kumar
- Department of Clinical Immunology, JIPMER, Pondicherry, India
| | - K G Chengappa
- Department of Clinical Immunology, JIPMER, Pondicherry, India
| | - R Gulati
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - V S Negi
- Department of Clinical Immunology, JIPMER, Pondicherry, India
| | - C Betterle
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
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15
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Torre T, Toto F, Klersy C, Theologou T, Casso G, Gallo M, Surace GG, Franciosi G, Demertzis S, Ferrari E. Early predictors of mortality in refractory cardiogenic shock following acute coronary syndrome treated with extracorporeal membrane oxygenator. J Artif Organs 2021; 24:327-335. [PMID: 33677800 DOI: 10.1007/s10047-021-01252-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
We aimed to analyze the outcome and identify predictors of hospital mortality in patients with refractory cardiac arrest (CA) complicating acute coronary syndromes (ACS) and requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment. Between Jan-2005 and Dec-2019, 51 patients underwent urgent VA-ECMO implantation for CA in ACS. Patients were divided in two groups: "in-hospital" cardiac arrest (IHCA) and "out-of-hospital" cardiac arrest (OHCA). Prospectively collected data were retrospectively analyzed and compared between groups. Predictors for hospital mortality were investigated. IHCA and OHCA patients were 32 (62.7%) and 19 (37.3%), respectively. The groups differed for: male gender (72% vs 95%; p = 0.070), lactate peak level (8.5 ± 4.3vs10.7 ± 2.9; p = 0.023), total elapsed time from CA to VA-ECMO implantation in both groups (p < 0.001) and elapsed time from CA (IHCA group) or hospital arrival (OHCA group) to VA-ECMO implantation (38 min vs 80 min; p = 0.001). At logistic regression analysis, concomitant lactate level greater than 8.0 mmol/L and elapsed time from CA to VA-ECMO ≥ 30 min were predictors of increased mortality (OR 3.9; 95% CI 1.19-12.79; p = 0.025) for the entire population. In-hospital mortality was 60.8% (31/51 patients): 68.4% in OHCA group and 56.2% in IHCA group. No risk factors related to 30-day mortality resulted significant at univariable analysis. When rapidly instituted, VA-ECMO improves survival in patients with refractory cardiac arrest allowing coronary syndrome treatment. The association of an elapsed time from CA to VA-ECMO implantation longer than 30 min and a preoperative lactate peak level over 8.0 mmol/L predict a poor outcome, independently from being IHCA or OHCA.
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Affiliation(s)
- Tiziano Torre
- Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland.
| | - Francesca Toto
- Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland
| | - Catherine Klersy
- Service of Clinical Epidemiology and Biometry, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Thomas Theologou
- Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland
| | - Gabriele Casso
- Anesthesiology Department, Cardiocentro Ticino, Lugano, Switzerland
| | - Michele Gallo
- Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland
| | | | - Giorgio Franciosi
- Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland
| | - Stefanos Demertzis
- Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland
| | - Enrico Ferrari
- Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland
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16
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Abstract
Extended depth-of-focus (EDOF) is a new intraocular lens (IOL) technology in the treatment of presbyopia. In contrast to multifocal (MF) IOLs, EDOF lenses create a single elongated focal point, rather than several foci, to enhance depth of focus. In this way, EDOF IOLs aim to reduce photic phenomena, glare, and halos, which have been reported in MF IOLs. A potential disadvantage is a decrease of retinal image quality if the amount of the aberrations is excessively increased. Frequently, EDOF IOLs are combined with MF optical designs; for this reason, EDOF IOLs are commonly a subject of confusion with optical multifocality concepts. The aim of this article is to clarify what an EDOF IOL is and to discuss the recently reported outcomes with these IOLs. We propose naming lenses that have combined optical designs as "hybrid IOLs."
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Affiliation(s)
| | | | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
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17
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Colli A, Bizzotto E, Besola L, Gregori D, Toto F, Manzan E, Gerosa G. Risk stratification of severe aortic stenosis according to new guidelines: long term outcomes. J Thorac Dis 2018; 10:5833-5841. [PMID: 30505491 DOI: 10.21037/jtd.2018.09.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Current ESC and ACC/AHA guidelines for the management of valvular heart disease assign a class Ia indication for aortic valve replacement (AVR) only to patients with symptomatic severe aortic valve stenosis and asymptomatic patients with depressed left ventricular ejection fraction (LVEF <50%) or positive exercise test. We examined the long-term outcomes for patients undergoing AVR for aortic stenosis over a 11-year period at our institution compared to current international guidelines for AVR. Methods Patients who had undergone isolated AVR for severe aortic valve stenosis between January 2001 and December 2012 were selected. The population was divided into subgroups based on preoperative LVEF (< or ≥50%) and on presence/absence of symptoms (NYHA =I or ≥II, respectively). Results We identified 607 patients with a median follow-up (FU) time of 5.75 years (IQR 3.24-8.00 years). The presence of symptoms did not have a significant impact on cardiovascular mortality (P=0.201). Patients with LVEF <50% displayed a higher long-term cardiovascular mortality rate (P=0.015). Multivariate analysis showed that preserved LVEF was a protective factor for asymptomatic patients (P=0.021), while preoperative LVEF did not affect the mortality rate in symptomatic patients (HR 0.88; 95% CI, 0.54-1.44). Correspondingly, asymptomatic patients with reduced LVEF were found to be at a higher risk of long-term mortality compared to the other groups (P=0.011). The only other independent risk factor for death was age (HR 6.46; 95% CI, 2.22-18.76). Conclusions According to our data, current international class I indications for symptomatic patients ensure good long-term survival, while class I indications for asymptomatic patients with reduced LVEF are associated with poor long-term survival. Our results suggest that early surgery should also be considered also for asymptomatic patients with preserved LVEF, particularly in cases of very low operative risk.
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Affiliation(s)
- Andrea Colli
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Eleonora Bizzotto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Laura Besola
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Francesca Toto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Erica Manzan
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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18
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Carrozzini M, Bejko J, Comisso M, Toto F, Toscano G, Tarzia V, Gambino A, Cozzi E, Gregori D, Bottio T, Gerosa G. Impact of Continuous Flow Left Ventricular Assist Device on Graft Rejection and Donor-specific Antibodies Development After Heart Transplant. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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19
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Bejko J, Toto F, Gregori D, Gerosa G, Bottio T. Left ventricle assist devices and driveline’s infection incidence: a single-centre experience. J Artif Organs 2017; 21:52-60. [DOI: 10.1007/s10047-017-0997-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/18/2017] [Indexed: 11/30/2022]
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20
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Carrozzini M, Bottio T, Toto F, Comisso M, Cardillo M, Cozzi E, Tarzia V, Bejko J, Gerosa G. P3281Allosensitization with new generation left ventricular assist device. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Colli A, Carrozzini M, Francescato A, Galuppo M, Comisso M, Toto F, Gregori D, Gerosa G. Acute DeBakey Type I aortic dissection without intimal tear in the arch: is total arch replacement the right choice? Interact Cardiovasc Thorac Surg 2017; 26:84-90. [DOI: 10.1093/icvts/ivx229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/11/2017] [Indexed: 01/16/2023] Open
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22
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Carrozzini M, Bottio T, Tarzia V, Toto F, Comisso M, Manzan E, Cardillo M, Cozzi E, Bejko J, Gerosa G. Allosensitization in New Generation Left Ventricular Assist Device Recipients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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23
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Frezzotti P, Giorgio A, Toto F, De Leucio A, De Stefano N. Early changes of brain connectivity in primary open angle glaucoma. Hum Brain Mapp 2016; 37:4581-4596. [PMID: 27503699 DOI: 10.1002/hbm.23330] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 11/05/2022] Open
Abstract
Our aim was to assess in primary open angle glaucoma (POAG), a major cause of irreversible blindness worldwide, whether diffuse brain changes recently shown in advanced stage can be detected since the early stage. We used multimodal magnetic resonance imaging (MRI) in 57 patients with the three POAG stages and in 29 age-matched normal controls (NC). Voxelwise statistics was performed with nonparametric permutation testing. Compared with NC, disrupted anatomical connectivity (AC) was found in the whole POAG group along the visual pathway and in nonvisual white matter tracts (P < 0.001). Moreover, POAG patients showed decreased functional connectivity (FC) in the visual (P = 0.004) and working memory (P < 0.001) networks whereas an increase occurred in the default mode (P = 0.002) and subcortical (P < 0.001) networks. Altered AC and FC were already present in early POAG (n = 14) in both visual and nonvisual systems (P ≤ 0.01). Only severe POAG (n = 30) showed gray matter atrophy and this mapped on visual cortex (P < 0.001) and hippocampus (P < 0.001). Increasing POAG stage was associated with worsening AC in both visual and nonvisual pathway (P < 0.001), progressive atrophy in the hippocampus and frontal cortex (P < 0.003). Most of the structural and functional alterations within and outside the visual system showed correlation (P < 0.001 to 0.02) with computerized visual field and retinal nerve fiber layer thickness. In conclusion, the complex pathogenesis of POAG includes widespread damage of AC and altered FC within and beyond the visual system since the early disease stage. The association of brain MRI changes with measures of visual severity emphasizes the clinical relevance of our findings. Hum Brain Mapp 37:4581-4596, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Paolo Frezzotti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Francesca Toto
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Alessandro De Leucio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Toto F, Bejko J, Carrozzini M, Comisso M, Bortolussi G, Gallo M, Gregori D, Tarzia V, Gerosa G, Bottio T. The Impact of the Exit Site Left Ventricle Assist Device Power Supply on Infection Incidence: A Single Center Experience. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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25
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Colli A, Carrozzini M, Galuppo M, Comisso M, Toto F, Gregori D, Gerosa G. Analysis of early and long-term outcomes of acute type A aortic dissection according to the new international aortic arch surgery study group recommendations. Heart Vessels 2015; 31:1616-24. [PMID: 26577993 DOI: 10.1007/s00380-015-0770-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/30/2015] [Indexed: 01/16/2023]
Abstract
To evaluate predictors of early and long-term outcomes of surgical repair of acute Type A aortic dissection. Retrospective single-centre study evaluating patients surgically treated between 1998 and 2013. Clinical follow-up was performed. Complications were classified according to the International Aortic Arch Surgery Study Group recommendations. Statistical analysis included univariate and multivariate analysis of preoperative and operative data. One hundred eighty-five patients were evaluated. The follow-up was complete for 180 patients (97 %). Mean age was 63 years, 82 % had a DeBakey type I aortic dissection, 18 % a type II. Eleven patients (6 %) died intraoperatively, 119 of the remaining (68 %) had postoperative complications. Thirty-day mortality was 21 % (38 patients). Average ICU and hospital stay were 6 and 14 days, respectively. During a mean follow-up time of 6 ± 4 years we observed 44 deaths (31 %). Twenty patients (14 %) needed late thoracic aorta reoperation. Results from the multivariate analysis are as follows. Thirty-day mortality was associated with abdominal pain at presentation (p < 0.01). The incidence of postoperative complications was related to older age at intervention (p < 0.01) and longer cross-clamp time (p < 0.01). Mortality at follow-up was significantly increased by older age at intervention (p < 0.01), with a logarithmic growth after 60 years, female sex (p < 0.01), preoperative limb ischemia (p = 0.02) and DHCA (p < 0.01). The surgical results of type A aortic dissection are affected by age at intervention with a logarithmic increase of late mortality in patients older than 60 years.
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Affiliation(s)
- Andrea Colli
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
| | - Massimiliano Carrozzini
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Marco Galuppo
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Marina Comisso
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Francesca Toto
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Dario Gregori
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Colli A, Carrozzini M, Galuppo M, Gregori D, Comisso M, Toto F, Gerosa G. 295 * TWELVE-YEAR SURGICAL EXPERIENCE WITH TYPE A AORTIC DISSECTION: THE IMPACT OF AGE ON EARLY AND LONG-TERM OUTCOMES. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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