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Sturla F, Caimi A, Romarowski RM, Nano G, Glauber M, Redaelli A, Votta E, Marrocco-Trischitta MM. Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant. J Endovasc Ther 2023; 30:756-768. [PMID: 35588222 PMCID: PMC10503258 DOI: 10.1177/15266028221095403] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Displacement forces (DFs) identify hostile landing zones for stent graft deployment in thoracic endovascular aortic repair (TEVAR). However, their use in TEVAR planning is hampered by the need for time-expensive computational fluid dynamics (CFD). We propose a novel fast-approximate computation of DFs merely exploiting aortic arch anatomy, as derived from the computed tomography (CT) and a measure of central aortic pressure. MATERIALS AND METHODS We tested the fast-approximate approach against CFD gold-standard in 34 subjects with the "bovine" aortic arch variant. For each dataset, a 3-dimensional (3D) model of the aortic arch lumen was reconstructed from computed tomography angiography and CFD then employed to compute DFs within the aortic proximal landing zones. To quantify fast-approximate DFs, the wall shear stress contribution to the DF was neglected and blood pressure space-distribution was averaged on the entire aortic wall to reliably approximate the patient-specific central blood pressure. Also, DF values were normalized on the corresponding proximal landing zone area to obtain the equivalent surface traction (EST). RESULTS Fast-approximate approach consistently reflected (r2=0.99, p<0.0001) the DF pattern obtained by CFD, with a -1.1% and 0.7° bias in DFs magnitude and orientation, respectively. The normalized EST progressively increased (p<0.0001) from zone 0 to zone 3 regardless of the type of arch, with proximal landing zone 3 showing significantly greater forces than zone 2 (p<0.0001). Upon DF normalization to the corresponding aortic surface, fast-approximate EST was decoupled in blood pressure and a dimensionless shape vector (S) reflecting aortic arch morphology. S showed a zone-specific pattern of orientation and proved a valid biomechanical blueprint of DF impact on the thoracic aortic wall. CONCLUSION Requiring only a few seconds and quantifying clinically relevant biomechanical parameters of proximal landing zones for arch TEVAR, our method suits the real preoperative decision-making process. It paves the way toward analyzing large population of patients and hence to define threshold values for a future patient-specific preoperative TEVAR planning.
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Affiliation(s)
- Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Alessandro Caimi
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Rodrigo M. Romarowski
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Unit, Istituto Clinico Sant’Ambrogio, Milano, Italy
| | - Alberto Redaelli
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Emiliano Votta
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Massimiliano M. Marrocco-Trischitta
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Monti CB, Righini P, Bonanno MC, Capra D, Mazzaccaro D, Giannetta M, Nicolino GM, Nano G, Sardanelli F, Marrocco-Trischitta MM, Secchi F. Psoas Cross-Sectional Measurements Using Manual CT Segmentation before and after Endovascular Aortic Repair (EVAR). J Clin Med 2022; 11:jcm11144023. [PMID: 35887786 PMCID: PMC9325160 DOI: 10.3390/jcm11144023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023] Open
Abstract
Sarcopenia has been associated with an increased incidence of adverse outcomes, including higher mortality, after endovascular aortic repair (EVAR). We aim to use computed tomography (CT) to quantify changes in total psoas muscles area (PMA) and psoas muscle density (PMD) after EVAR, and to evaluate the reproducibility of both measurements. PMA and PMD were assessed via manual segmentation of the psoas muscle on pre- and post-operative CT scans belonging to consecutive patients who underwent EVAR. Wilcoxon test was used to compare PMA and PMD before and after EVAR, and inter- and intra-reader agreements of both methods were evaluated through Bland−Altman analysis. A total of 50 patients, 42 of them males (84%), were included in the study. PMA changes from 1243 mm2 (1006−1445 mm2) to 1102 mm2 (IQR 937−1331 mm2), after EVAR (p < 0.001). PMD did not vary between pre-EVAR (33 HU, IQR 26.5−38.7 HU) and post-EVAR (32 HU, IQR 26−37 HU, p = 0.630). At inter-reader Bland−Altman analysis, PMA showed a bias of 64.0 mm2 and a coefficient of repeatability (CoR) of 359.2 mm2, whereas PMD showed a bias of −2.43 HU and a CoR of 6.19 HU. At intra-reader Bland−Altman analysis, PMA showed a bias of −81.1 mm2 and a CoR of 394.6 mm2, whereas PMD showed a bias of 1.41 HU and a CoR of 6.36 HU. In conclusion, PMA decreases after EVAR. A good intra and inter-reader reproducibility was observed for both PMA and PMD. We thus propose to use PMA during the follow-up of patients who underwent EVAR to monitor muscle depletion after surgery.
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Affiliation(s)
- Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (M.C.B.); (D.C.); (G.N.); (F.S.)
| | - Paolo Righini
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (P.R.); (D.M.); (M.G.)
| | - Maria Chiara Bonanno
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (M.C.B.); (D.C.); (G.N.); (F.S.)
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (M.C.B.); (D.C.); (G.N.); (F.S.)
| | - Daniela Mazzaccaro
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (P.R.); (D.M.); (M.G.)
| | - Matteo Giannetta
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (P.R.); (D.M.); (M.G.)
| | - Gabriele Maria Nicolino
- Radiology and Diagnostic Imaging Unit, Clinica San Carlo, Paderno Dugnano, 20100 Milan, Italy;
| | - Giovanni Nano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (M.C.B.); (D.C.); (G.N.); (F.S.)
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (P.R.); (D.M.); (M.G.)
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (M.C.B.); (D.C.); (G.N.); (F.S.)
- Unit of Radiology, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | | | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (M.C.B.); (D.C.); (G.N.); (F.S.)
- Unit of Radiology, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
- Correspondence:
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Cappelletti S, Caimi A, Caldiroli A, Baroni I, Votta E, Riboldi SA, Marrocco-Trischitta MM, Redaelli A, Sturla F. Non-invasive estimation of vascular compliance and distensibility in the arm vessels: a novel ultrasound-based protocol. Quant Imaging Med Surg 2022; 12:3515-3527. [DOI: 10.21037/qims-21-987] [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] [Received: 10/08/2021] [Accepted: 03/09/2022] [Indexed: 11/06/2022]
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Saitta S, Sturla F, Caimi A, Riva A, Palumbo MC, Nano G, Votta E, Corte AD, Glauber M, Chiappino D, Marrocco-Trischitta MM, Redaelli A. A Deep Learning-Based and Fully Automated Pipeline for Thoracic Aorta Geometric Analysis and Planning for Endovascular Repair from Computed Tomography. J Digit Imaging 2022; 35:226-239. [PMID: 35083618 PMCID: PMC8921448 DOI: 10.1007/s10278-021-00535-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Received: 03/03/2021] [Revised: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022] Open
Abstract
Feasibility assessment and planning of thoracic endovascular aortic repair (TEVAR) require computed tomography (CT)-based analysis of geometric aortic features to identify adequate landing zones (LZs) for endograft deployment. However, no consensus exists on how to take the necessary measurements from CT image data. We trained and applied a fully automated pipeline embedding a convolutional neural network (CNN), which feeds on 3D CT images to automatically segment the thoracic aorta, detects proximal landing zones (PLZs), and quantifies geometric features that are relevant for TEVAR planning. For 465 CT scans, the thoracic aorta and pulmonary arteries were manually segmented; 395 randomly selected scans with the corresponding ground truth segmentations were used to train a CNN with a 3D U-Net architecture. The remaining 70 scans were used for testing. The trained CNN was embedded within computational geometry processing pipeline which provides aortic metrics of interest for TEVAR planning. The resulting metrics included aortic arch centerline radius of curvature, proximal landing zones (PLZs) maximum diameters, angulation, and tortuosity. These parameters were statistically analyzed to compare standard arches vs. arches with a common origin of the innominate and left carotid artery (CILCA). The trained CNN yielded a mean Dice score of 0.95 and was able to generalize to 9 pathological cases of thoracic aortic aneurysm, providing accurate segmentations. CILCA arches were characterized by significantly greater angulation (p = 0.015) and tortuosity (p = 0.048) in PLZ 3 vs. standard arches. For both arch configurations, comparisons among PLZs revealed statistically significant differences in maximum zone diameters (p < 0.0001), angulation (p < 0.0001), and tortuosity (p < 0.0001). Our tool allows clinicians to obtain objective and repeatable PLZs mapping, and a range of automatically derived complex aortic metrics.
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Affiliation(s)
- Simone Saitta
- Department of Electronics Information and Bioengineering, Politecnico Di Milano, Milan, Italy
| | - Francesco Sturla
- Department of Electronics Information and Bioengineering, Politecnico Di Milano, Milan, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Caimi
- Department of Electronics Information and Bioengineering, Politecnico Di Milano, Milan, Italy
| | - Alessandra Riva
- Department of Electronics Information and Bioengineering, Politecnico Di Milano, Milan, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Maria Chiara Palumbo
- Department of Electronics Information and Bioengineering, Politecnico Di Milano, Milan, Italy
| | - Giovanni Nano
- Clinical Research Unit and Division of Vascular Surgery, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Emiliano Votta
- Department of Electronics Information and Bioengineering, Politecnico Di Milano, Milan, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Unit of Cardiac Surgery, V. Monaldi Hospital, Naples, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Dante Chiappino
- Department of Radiology, CNR (National Council of Research), Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Massa, Italy
| | - Massimiliano M Marrocco-Trischitta
- Clinical Research Unit and Division of Vascular Surgery, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.
| | - Alberto Redaelli
- Department of Electronics Information and Bioengineering, Politecnico Di Milano, Milan, Italy
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Henein MY, Mandoli GE, Pastore MC, Ghionzoli N, Hasson F, Nisar MK, Islam M, Bandera F, Marrocco-Trischitta MM, Baroni I, Malagoli A, Rossi L, Biagi A, Citro R, Ciccarelli M, Silverio A, Biagioni G, Moutiris JA, Vancheri F, Mazzola G, Geraci G, Thomas L, Altman M, Pernow J, Ahmed M, Santoro C, Esposito R, Casas G, Fernández-Galera R, Gonzalez M, Rodriguez Palomares J, Bytyçi I, Dini FL, Cameli P, Franchi F, Bajraktari G, Badano LP, Cameli M. Biomarkers Predict In-Hospital Major Adverse Cardiac Events in COVID-19 Patients: A Multicenter International Study. J Clin Med 2021; 10:jcm10245863. [PMID: 34945166 PMCID: PMC8703972 DOI: 10.3390/jcm10245863] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic carries a high burden of morbidity and mortality worldwide. We aimed to identify possible predictors of in-hospital major cardiovascular (CV) events in COVID-19. METHODS We retrospectively included patients hospitalized for COVID-19 from 10 centers. Clinical, biochemical, electrocardiographic, and imaging data at admission and medications were collected. Primary endpoint was a composite of in-hospital CV death, acute heart failure (AHF), acute myocarditis, arrhythmias, acute coronary syndromes (ACS), cardiocirculatory arrest, and pulmonary embolism (PE). RESULTS Of the 748 patients included, 141(19%) reached the set endpoint: 49 (7%) CV death, 15 (2%) acute myocarditis, 32 (4%) sustained-supraventricular or ventricular arrhythmias, 14 (2%) cardiocirculatory arrest, 8 (1%) ACS, 41 (5%) AHF, and 39 (5%) PE. Patients with CV events had higher age, body temperature, creatinine, high-sensitivity troponin, white blood cells, and platelet counts at admission and were more likely to have systemic hypertension, renal failure (creatinine ≥ 1.25 mg/dL), chronic obstructive pulmonary disease, atrial fibrillation, and cardiomyopathy. On univariate and multivariate analysis, troponin and renal failure were associated with the composite endpoint. Kaplan-Meier analysis showed a clear divergence of in-hospital composite event-free survival stratified according to median troponin value and the presence of renal failure (Log rank p < 0.001). CONCLUSIONS Our findings, derived from a multicenter data collection study, suggest the routine use of biomarkers, such as cardiac troponin and serum creatinine, for in-hospital prediction of CV events in patients with COVID-19.
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Affiliation(s)
- Michael Y. Henein
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (F.L.D.); (G.B.)
- St George London and Brunel Universities, London SW17 0QT, UK
- Correspondence: (M.Y.H.); (M.C.P.)
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (N.G.); (G.B.); (M.C.)
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (N.G.); (G.B.); (M.C.)
- Correspondence: (M.Y.H.); (M.C.P.)
| | - Nicolò Ghionzoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (N.G.); (G.B.); (M.C.)
| | - Fouhad Hasson
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton LU4 0DZ, UK; (F.H.); (M.K.N.); (M.I.)
| | - Muhammad K. Nisar
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton LU4 0DZ, UK; (F.H.); (M.K.N.); (M.I.)
| | - Mohammed Islam
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton LU4 0DZ, UK; (F.H.); (M.K.N.); (M.I.)
| | - Francesco Bandera
- Department for Biomedical Sciences for Health, University of Milano, 20133 Milan, Italy;
- Cardiology University Department, Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | | | - Irene Baroni
- Clinical Research Unit, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (M.M.M.-T.); (I.B.)
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Luca Rossi
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (L.R.); (A.B.)
| | - Andrea Biagi
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (L.R.); (A.B.)
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d’Aragona, 84125 Salerno, Italy;
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (M.C.); (A.S.)
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (M.C.); (A.S.)
| | - Giulia Biagioni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (N.G.); (G.B.); (M.C.)
| | | | - Federico Vancheri
- Department of Internal Medicine, S. Elia Hospital, 93100 Caltanissetta, Italy; (F.V.); (G.M.); (G.G.)
| | - Giovanni Mazzola
- Department of Internal Medicine, S. Elia Hospital, 93100 Caltanissetta, Italy; (F.V.); (G.M.); (G.G.)
| | - Giulio Geraci
- Department of Internal Medicine, S. Elia Hospital, 93100 Caltanissetta, Italy; (F.V.); (G.M.); (G.G.)
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital and Westmeead Clinical School, University of Sydney, Sydney, NSW 2145, Australia; (L.T.); (M.A.)
| | - Mikhail Altman
- Department of Cardiology, Westmead Hospital and Westmeead Clinical School, University of Sydney, Sydney, NSW 2145, Australia; (L.T.); (M.A.)
| | - John Pernow
- Department of Medicine, Division of Cardiology, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Mona Ahmed
- Department of Molecular Medicine and Surgery, Division of Cardiology, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Roberta Esposito
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy;
| | - Guillem Casas
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (G.C.); (R.F.-G.); (M.G.); (J.R.P.)
| | - Rubén Fernández-Galera
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (G.C.); (R.F.-G.); (M.G.); (J.R.P.)
| | - Maribel Gonzalez
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (G.C.); (R.F.-G.); (M.G.); (J.R.P.)
| | - Jose Rodriguez Palomares
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (G.C.); (R.F.-G.); (M.G.); (J.R.P.)
| | - Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (F.L.D.); (G.B.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo
| | - Frank Lloyd Dini
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (F.L.D.); (G.B.)
| | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medical Sciences, Siena University Hospital, 53100 Siena, Italy;
| | - Federico Franchi
- Department of Medical Biotechnologies, Anesthesia and Intensive Care, University of Siena, 53100 Siena, Italy;
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (F.L.D.); (G.B.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo
| | - Luigi Paolo Badano
- Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy;
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (N.G.); (G.B.); (M.C.)
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Sisinni A, Rossi L, Battista A, Poletti E, Battista F, Battista RA, Malagoli A, Biagi A, Zanni A, Sticozzi C, Comastri G, Marrocco-Trischitta MM, Monello A, Margonato A, Bandera F, Vergara P, Guazzi M, Godino C. Pre-admission acetylsalicylic acid therapy and impact on in-hospital outcome in COVID-19 patients: The ASA-CARE study. Int J Cardiol 2021; 344:240-245. [PMID: 34619262 PMCID: PMC8489263 DOI: 10.1016/j.ijcard.2021.09.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 01/12/2023]
Abstract
Background Patients with coronavirus disease 2019 (COVID-19) exhibit high thrombotic risk. The evidence on a potential independent prognostic role of antiplatelet treatment in those patients is limited. The aim of the study was to evaluate the prognostic impact of pre-admission low-dose acetylsalicylic acid (ASA) in a wide series of hospitalized patients with COVID-19. Methods This cohort study included 984 COVID-19 patients stratified according to ASA intake before hospitalization: ASA+ (n = 253) and ASA− (n = 731). Patients were included in ASA+ group if they received it daily in the 7 days before admission. 213 (83%) were on ASA 100 mg daily. Primary endpoint was a composite of in-hospital death and/or need for respiratory support upgrade, secondary endpoints were in-hospital death and need for respiratory support upgrade. Results Mean age was 72 [62; 81] with 69% of male patients. ASA+ patients were significantly older, with higher prevalence of comorbidities. No significant differences regarding the degree of respiratory dysfunction were observed. At 30-day Kaplan-Meier analysis, ASA+ patients had higher survival free from the primary endpoint and need for respiratory support upgrade, conversely in-hospital death did not significantly differ between groups. At multivariate analysis ASA intake was independently associated with a lower probability of reaching primary endpoint (HR 0.697, 95% C.I. 0.525–0.924; p = 0.012). Conclusions In COVID-19 patients undergoing hospitalization, pre-admission treatment with ASA is associated with better in-hospital outcome, mainly driven by less respiratory support upgrade.
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Affiliation(s)
- Antonio Sisinni
- Cardiology Unit, IRCCS Policlinico San Donato, Milan, Italy; Università degli studi di Milano, Milan, Italy
| | - Luca Rossi
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Antonio Battista
- Emergency Department, Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Enrico Poletti
- Cardiology Unit, IRCCS Policlinico San Donato, Milan, Italy; Università degli studi di Milano, Milan, Italy
| | | | | | - Alessandro Malagoli
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Andrea Biagi
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Alessia Zanni
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Concetta Sticozzi
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Greta Comastri
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Alberto Monello
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Alberto Margonato
- Università̀ Vita-Salute San Raffaele, Milano, Italy; Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandera
- Cardiology Unit, IRCCS Policlinico San Donato, Milan, Italy; Università degli studi di Milano, Milan, Italy
| | - Pasquale Vergara
- Arrhythmias and Cardiac Electrophysiology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Cosmo Godino
- Università̀ Vita-Salute San Raffaele, Milano, Italy; Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy.
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Perrone F, Piccirillo MC, Ascierto PA, Salvarani C, Parrella R, Marata AM, Popoli P, Ferraris L, Marrocco-Trischitta MM, Ripamonti D, Binda F, Bonfanti P, Squillace N, Castelli F, Muiesan ML, Lichtner M, Calzetti C, Salerno ND, Atripaldi L, Cascella M, Costantini M, Dolci G, Facciolongo NC, Fraganza F, Massari M, Montesarchio V, Mussini C, Negri EA, Botti G, Cardone C, Gargiulo P, Gravina A, Schettino C, Arenare L, Chiodini P, Gallo C. Correction to: Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial. J Transl Med 2021; 19:442. [PMID: 34674735 PMCID: PMC8529863 DOI: 10.1186/s12967-021-03094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy.
| | | | - Paolo Antonio Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Carlo Salvarani
- Rheumathology, Università degli Studi di Modena e Reggio Emilia and Azienda USL-IRCCS di Reggio Emilia, Modena, Italy
| | | | | | - Patrizia Popoli
- Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Roma, Italy
| | - Laurenzia Ferraris
- Infectious Diseases Unit, Hospital Health Direction, IRCCS - Policlinico San Donato, Milano, Milano, Italy
| | | | - Diego Ripamonti
- Infectious Diseases Unit - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Binda
- Infectious Diseases Unit - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Bonfanti
- Infectious Diseases Unit, ASST Monza and University Milano Bicocca, Milan, Italy
| | - Nicola Squillace
- Infectious Diseases Unit, ASST Monza and University Milano Bicocca, Milan, Italy
| | | | | | - Miriam Lichtner
- Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Carlo Calzetti
- Infectious Diseases and Hepatology Unit AOU, Parma, Italy
| | | | | | - Marco Cascella
- Anesthesia and Resuscitation Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | | | - Giovanni Dolci
- Rheumathology, Università degli Studi di Modena e Reggio Emilia and Azienda USL-IRCCS di Reggio Emilia, Modena, Italy
| | | | | | - Marco Massari
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | | | - Gerardo Botti
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Claudia Cardone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Piera Gargiulo
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Adriano Gravina
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Clorinda Schettino
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Laura Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Paolo Chiodini
- Department of Mental Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
| | - Ciro Gallo
- Department of Mental Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
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8
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Secchi F, Monti CB, Capra D, Vitale R, Mazzaccaro D, Conti M, Jin N, Giese D, Nano G, Sardanelli F, Marrocco-Trischitta MM. Carotid Phase-Contrast Magnetic Resonance before Treatment: 4D-Flow versus Standard 2D Imaging. Tomography 2021; 7:513-522. [PMID: 34698250 PMCID: PMC8544659 DOI: 10.3390/tomography7040044] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate the level of agreement between flow/velocity data obtained from 2D-phase-contrast (PC) and 4D-flow in patients scheduled for treatment of carotid artery stenosis. Image acquisition was performed using a 1.5 T scanner. We compared mean flow rates, vessel areas, and peak velocities obtained during the acquisition with both techniques in 20 consecutive patients, 15 males and 5 females aged 69 ± 5 years (mean ± standard deviation). There was a good correlation between both techniques for the CCA flow (r = 0.65, p < 0.001), whereas for the ICA flow and ECA flow the correlation was only moderate (r = 0.4, p = 0.011 and r = 0.45, p = 0.003, respectively). Correlations of peak velocities between methods were good for CCA (r = 0.56, p < 0.001) and moderate for ECA (r = 0.41, p = 0.008). There was no correlation for ICA (r = 0.04, p = 0.805). Cross-sectional area values between methods showed no significant correlations for CCA (r = 0.18, p = 0.269), ICA (r = 0.1, p = 0.543), and ECA (r = 0.05, p = 0.767). Conclusion: the 4D-flow imaging provided a good correlation of CCA and a moderate correlation of ICA flow rates against 2D-PC, underestimating peak velocities and overestimating cross-sectional areas in all carotid segments.
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Affiliation(s)
- Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (D.C.); (R.V.); (G.N.); (F.S.)
- Unit of Radiology, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
- Correspondence:
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (D.C.); (R.V.); (G.N.); (F.S.)
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (D.C.); (R.V.); (G.N.); (F.S.)
| | - Renato Vitale
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (D.C.); (R.V.); (G.N.); (F.S.)
| | - Daniela Mazzaccaro
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (D.M.); (M.M.M.-T.)
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, 27100 Pavia, Italy;
| | - Ning Jin
- Siemens Medical Solutions USA, Inc., Malvern, PA 19355, USA;
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare GmbH, 91052 Erlangen, Germany;
| | - Giovanni Nano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (D.C.); (R.V.); (G.N.); (F.S.)
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (D.M.); (M.M.M.-T.)
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (D.C.); (R.V.); (G.N.); (F.S.)
- Unit of Radiology, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Massimiliano M. Marrocco-Trischitta
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (D.M.); (M.M.M.-T.)
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
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9
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Mazzaccaro D, Giannetta M, Fancoli F, Milani V, Modafferi A, Malacrida G, Righini P, Marrocco-Trischitta MM, Nano G. COVID and venous thrombosis: systematic review of literature. J Cardiovasc Surg (Torino) 2021; 62:548-557. [PMID: 34520137 DOI: 10.23736/s0021-9509.21.12022-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION We aimed to review the prevalence, the risk factors and the outcomes of venous thrombosis (VT) in patients hospitalized for COronaVirus Disease 19 (COVID-19). METHODS Electronic bibliographic databases were searched using the words "COVID venous thrombosis". The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. RESULTS The search of the Literature retrieved 877 results. After assessment of full texts, 69 papers were included in the qualitative analysis and 23 of them in the quantitative evaluation. The analyzed studies included a total of 106838 patients hospitalized for COVID-19 from 01/2020 to 12/2020. The pooled reported prevalence rate of VT was in median 16.7% (IQR 5.8%-30%), being higher in ICU patients (60.8%-85.4%). VT events were reported in about 75% of cases in the popliteal and calf veins. Signs and symptoms were present in 6.1% of cases. At quantitative evaluation, older age, D-dimer and obesity increased the odds to experience a VT (OR 3.54, 95%CI 0.65-6.43, P=0.01; OR=956.86, 95%CI 225.67-1668.05, P=0.01; OR 1.42, 95%CI 1.01-1.99, P=0.03 respectively). Female sex seemed to be protective against the odds of VT (OR 0.77, 95%CI 0.63-0.93, P=0.007). CONCLUSIONS Among patients hospitalized for COVID-19, VT is a relatively common finding, with higher prevalence rates in ICU patients. VT occurs mostly in the distal regions of the lower limb and is asymptomatic in most cases. Older age, obesity and higher D-dimer values on admission increased the odds of VT, while female sex was protective against the odds of VT.
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Affiliation(s)
- Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy -
| | - Matteo Giannetta
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Fabiana Fancoli
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alfredo Modafferi
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Malacrida
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Righini
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Giovanni Nano
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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10
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Czerny M, Gottardi R, Puiu P, Bernecker OY, Citro R, Corte AD, di Marco L, Fink M, Gosslau Y, Haldenwang PL, Heijmen RH, Hugas-Mallorqui M, Iesu S, Jacobsen O, Jassar AS, Juraszek A, Kolowca M, Lepidi S, Marrocco-Trischitta MM, Matsuda H, Meisenbacher K, Micari A, Minatoya K, Park KH, Peterss S, Petrich M, Piffaretti G, Probst C, Reutersberg B, Rosati F, Schachner B, Schachner T, Sorokin VA, Szeberin Z, Szopinski P, Di Tommaso L, Trimarchi S, Verhoeven ELG, Vogt F, Voetsch A, Walter T, Weiss G, Yuan X, Benedetto F, De Bellis A, D'Oria M, Discher P, Zierer A, Rylski B, van den Berg JC, Wyss TR, Bossone E, Schmidli J, Nienaber C, Accarino G, Baldascino F, Böckler D, Corazzari C, D'Alessio I, de Beaufort H, De Troia C, Dumfarth J, Galbiati D, Gorgatti F, Hagl C, Hamiko M, Huber F, Hyhlik-Duerr A, Ianelli G, Iesu I, Jung JC, Kainz FM, Katsargyris A, Koter S, Kusmierczyk M, Kolsut P, Lengyel B, Lomazzi C, Muneretto C, Nava G, Nolte T, Pacini D, Pleban E, Rychla M, Sakamoto K, Shijo T, Yokawa K, Siepe M, Sirch J, Strauch J, Sule JA, Tobler EL, Walter C, Weigang E. Corrigendum to 'Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions'. Eur J Cardiothorac Surg 2021; 60:724-725. [PMID: 34378028 PMCID: PMC8385948 DOI: 10.1093/ejcts/ezab314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Martin Czerny
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Roman Gottardi
- Department of Cardiovascular and Thoracic Surgery, MediClin Heart Institute Lahr/Baden, Lahr, Germany.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Puiu
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Oliver Y Bernecker
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Rodolfo Citro
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | - Alessandro Della Corte
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Luca di Marco
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Martina Fink
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Yvonne Gosslau
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Maria Hugas-Mallorqui
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Severino Iesu
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | - Oyvind Jacobsen
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Oslo, Norway
| | - Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrzej Juraszek
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Maciej Kolowca
- Cardiac Surgery Department, University State Hospital No 2, University of Rzesznow, Rzesznow, Poland
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | | | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Michael Petrich
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Chris Probst
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Benedikt Reutersberg
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Bruno Schachner
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Schachner
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Vitaly A Sorokin
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Piotr Szopinski
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Santi Trimarchi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Eric L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Andreas Voetsch
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tim Walter
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | | | - Xun Yuan
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, London, UK
| | | | - Antonio De Bellis
- Cardiac Surgery Unit, Heart and Vessels Department, Casa di Cura San Michele, Maddaloni, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Philipp Discher
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Andreas Zierer
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Bartosz Rylski
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jos C van den Berg
- Centro Vasolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Vascular Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Nienaber
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, London, UK
| | | | - Giulio Accarino
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | | | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Claudio Corazzari
- Department of Cardiac Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching, Hospital, Varese, Italy
| | - Ilenia D'Alessio
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Hector de Beaufort
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Denise Galbiati
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Filippo Gorgatti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Marwan Hamiko
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Florian Huber
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Alexander Hyhlik-Duerr
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Gabriele Ianelli
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Ivana Iesu
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | - Joon-Chui Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Frieda-Maria Kainz
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Stephan Koter
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Piotr Kolsut
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Balazs Lengyel
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Chiara Lomazzi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Giovanni Nava
- Cardiovascular Department, IRCCS-Policlinico San Donato, Milan, Italy
| | - Thomas Nolte
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Eliza Pleban
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Miriam Rychla
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Kazuhisa Sakamoto
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Matthias Siepe
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Joachim Sirch
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Jai Ajitchandra Sule
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Eva-Luca Tobler
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Ernst Weigang
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
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11
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Marrocco-Trischitta MM, Sturla F. Blood flow helical pattern in type III arch configuration as a potential risk factor for type B aortic dissection. Eur J Cardiothorac Surg 2021; 61:132-139. [PMID: 34374753 DOI: 10.1093/ejcts/ezab307] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/28/2021] [Accepted: 05/13/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Abnormal helical flow (HF) in the aortic arch has been proposed as a causative factor for aortic dilatation and aortic dissections (ADs). Patients with type B AD present a high prevalence of type III arch configuration, which comprises recognized anatomic AD risk factors. Our aim was to assess whether the type III arch configures a consistent secondary HF pattern. METHODS We employed computational fluid dynamics to compare HF features associated with type I-III arches. The intra-aortic blood flow pattern was regionally assessed through the Modified Arch Landing Areas Nomenclature (MALAN) for planning endovascular aortic repair. Aortic flow pathlines were extracted from the systolic aortic velocity field and objectively characterized through intrinsic shape indices of absolute curvature |κ| and absolute torsion |τ|. Absolute local normalized helicity was computed and mapped on aortic flow pathlines. RESULTS The tendency of aortic flow pathlines to bend and rotate exacerbated in the isthmus of type III arch (MALAN 3/III), where the highest |κ| values (P < 0.0001) were paralleled by the lowest |τ| values (P = 0.010), demonstrating the persistence of a high rotational HF heavily insisting on 3/III. In 3/III area, local normalized helicity was higher than both 3/I and 3/II (P = 0.053). CONCLUSIONS Type III arch configuration is associated with a specific, consistent and abnormal secondary HF pattern, which may account for its high prevalence in patients with type B AD.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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12
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Czerny M, Gottardi R, Puiu P, Bernecker OY, Citro R, Della Corte A, di Marco L, Fink M, Gosslau Y, Haldenwang PL, Heijmen RH, Hugas-Mallorqui M, Iesu S, Jacobsen O, Jassar AS, Juraszek A, Kolowca M, Lepidi S, Marrocco-Trischitta MM, Matsuda H, Meisenbacher K, Micari A, Minatoya K, Park KH, Peterss S, Petrich M, Piffaretti G, Probst C, Reutersberg B, Rosati F, Schachner B, Schachner T, Sorokin VA, Szeberin Z, Szopinski P, Di Tommaso L, Trimarchi S, Verhoeven ELG, Vogt F, Voetsch A, Walter T, Weiss G, Yuan X, Benedetto F, De Bellis A, D Oria M, Discher P, Zierer A, Rylski B, van den Berg JC, Wyss TR, Bossone E, Schmidli J, Nienaber C, Accarino G, Baldascino F, Böckler D, Corazzari C, D Alessio I, de Beaufort H, De Troia C, Dumfarth J, Galbiati D, Gorgatti F, Hagl C, Hamiko M, Huber F, Hyhlik-Duerr A, Ianelli G, Iesu I, Jung JC, Kainz FM, Katsargyris A, Koter S, Kusmierczyk M, Kolsut P, Lengyel B, Lomazzi C, Muneretto C, Nava G, Nolte T, Pacini D, Pleban E, Rychla M, Sakamoto K, Shijo T, Yokawa K, Siepe M, Sirch J, Strauch J, Sule JA, Tobler EL, Walter C, Weigang E. Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions. Eur J Cardiothorac Surg 2021; 59:1096-1102. [PMID: 33394040 PMCID: PMC7799089 DOI: 10.1093/ejcts/ezaa452] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/30/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute and elective thoracic and abdominal aortic procedures. METHODS Forty departments shared their data on acute and elective thoracic and abdominal aortic procedures between January and May 2020 and January and May 2019 in Europe, Asia and the USA. Admission rates as well as delay from onset of symptoms to referral were compared. RESULTS No differences in the number of acute thoracic and abdominal aortic procedures were observed between 2020 and the reference period in 2019 [incidence rates ratio (IRR): 0.96, confidence interval (CI) 0.89-1.04; P = 0.39]. Also, no difference in the time interval from acute onset of symptoms to referral was recorded (<12 h 32% vs > 12 h 68% in 2020, < 12 h 34% vs > 12 h 66% in 2019 P = 0.29). Conversely, a decline of 35% in elective procedures was seen (IRR: 0.81, CI 0.76-0.87; P < 0.001) with substantial differences between countries and the most pronounced decline in Italy (-40%, P < 0.001). Interestingly, in Switzerland, an increase in the number of elective cases was observed (+35%, P = 0.02). CONCLUSIONS There was no change in the number of acute thoracic and abdominal aortic cases and procedures during the initial wave of the COVID-19 pandemic, whereas the case load of elective operations and procedures decreased significantly. Patients with acute aortic syndromes presented despite COVID-19 and were managed according to current guidelines. Further analysis is required to prove that deferral of elective cases had no impact on premature mortality.
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Affiliation(s)
- Martin Czerny
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Roman Gottardi
- Department of Cardiovascular and Thoracic Surgery, MediClin Heart Institute Lahr/Baden, Lahr, Germany.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Puiu
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Oliver Y Bernecker
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Rodolfo Citro
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | - Alessandro Della Corte
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Luca di Marco
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Martina Fink
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Yvonne Gosslau
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Maria Hugas-Mallorqui
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Severino Iesu
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | - Oyvind Jacobsen
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Oslo, Norway
| | - Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrzej Juraszek
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Maciej Kolowca
- Cardiac Surgery Department, University State Hospital No 2, University of Rzesznow, Rzesznow, Poland
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | | | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Michael Petrich
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Chris Probst
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Benedikt Reutersberg
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Bruno Schachner
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Schachner
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Vitali A Sorokin
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Piotr Szopinski
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Santi Trimarchi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Eric L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Andreas Voetsch
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tim Walter
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | | | - Xun Yuan
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | | | - Antonio De Bellis
- Cardiac Surgery Unit, Heart and Vessels Department, Casa di Cura San Michele, Maddaloni, Italy
| | - Mario D Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Philipp Discher
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Andreas Zierer
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Bartosz Rylski
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jos C van den Berg
- Centro Vasolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Vascular Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Nienaber
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | | | - Giulio Accarino
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | | | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Claudio Corazzari
- Department of Cardiac Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Ilenia D Alessio
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Hector de Beaufort
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Denise Galbiati
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Filippo Gorgatti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Marwan Hamiko
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Florian Huber
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Alexander Hyhlik-Duerr
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Gabriele Ianelli
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Ivana Iesu
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | - Joon-Chui Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Frieda-Maria Kainz
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Stephan Koter
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Piotr Kolsut
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Balazs Lengyel
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Chiara Lomazzi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Giovanni Nava
- Cardiovascular Department, IRCCS-Policlinico San Donato, Milan, Italy
| | - Thomas Nolte
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Eliza Pleban
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Miriam Rychla
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Kazuhisa Sakamoto
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Matthias Siepe
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Joachim Sirch
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Jai Ajitchandra Sule
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Eva-Luca Tobler
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Ernst Weigang
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
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Marrocco-Trischitta MM, Alaidroos M, Romarowski RM, Milani V, Ambrogi F, Secchi F, Glauber M, Nano G. Aortic arch variant with a common origin of the innominate and left carotid artery as a determinant of thoracic aortic disease: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 57:422-427. [PMID: 31620770 DOI: 10.1093/ejcts/ezz277] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/29/2019] [Accepted: 09/16/2019] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to investigate whether the 'bovine' arch [i.e. arch variant with a common origin of the innominate and left carotid artery (CILCA)] is associated with an increased risk of thoracic aortic disease (TAD). The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, EMBASE and Cochrane databases were searched to identify all case series reporting about CILCA arch and TAD between January 2008 and December 2018. A total of 485 studies were screened. The prevalence of CILCA arch was assessed, and data analysis was performed considering the difference in the risk of TAD for presence versus absence of CILCA arch. Eight studies enrolling 11 381 subjects were retrieved for quantitative analysis. The proportion of TAD among CILCA arch patients was higher [41.5% (28.1-56.4)] than the proportion among patients with standard arch configuration 34.0% (20.1-51.4). The odds ratio of developing TAD was 1.4 times higher in subjects with CILCA arch (95% confidence interval 1.068-1.839). The test for an overall effect indicated a significant association between CILCA arch and TAD (P < 0.015). The I2 was 78.1% with a value of P < 0.001 for heterogeneity. The Egger test did not show evidence of publication bias (P = 0.317). In conclusion, our meta-analysis supports the hypothesis of a correlation between the presence of CILCA arch and the onset of TAD. Our results warrant a specific and long-term surveillance for patients with this anatomical variant, and a thorough awareness of its potential clinical implications during image interpretation.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Clinical Research Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy.,Vascular Surgery Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy
| | - Moad Alaidroos
- Clinical Research Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy.,Vascular Surgery Unit, Policlinico San Marco, Zingonia, Italy
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS - Policlinico San Donato, Milan, Italy
| | - Valentina Milani
- Biostatistics Service, IRCCS - Policlinico San Donato, Milan, Italy
| | - Federico Ambrogi
- Biostatistics Service, IRCCS - Policlinico San Donato, Milan, Italy
| | - Francesco Secchi
- Division of Radiology, IRCCS - Policlinico San Donato, Milan, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Department, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy.,Department of "Scienze Biomediche per la Salute", University of Milan, Milan, Italy
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14
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Marrocco-Trischitta MM. Determinants of preoperative decision-making process for cirrhotic patients with infrarenal aortic aneurysm. J Vasc Surg 2021; 73:1839-1840. [PMID: 33894900 DOI: 10.1016/j.jvs.2020.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
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15
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Marrocco-Trischitta MM, Glauber M. Implications of different definitions for aortic arch classification provided by contemporary guidelines on thoracic aortic repair. Interact Cardiovasc Thorac Surg 2021; 32:950-952. [PMID: 33561198 DOI: 10.1093/icvts/ivab029] [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: 10/07/2020] [Revised: 01/04/2021] [Accepted: 01/17/2021] [Indexed: 12/13/2022] Open
Abstract
Contemporary guidelines on thoracic aortic repair provide inconsistent reporting standards for the definition of aortic arch classification in Types I, II and III. The different reported criteria cannot be used interchangeably, due to a very low level of concordance, and this finding has relevant implications for the comparisons between studies using different classifications, and between different datasets of multicentre trials, which are not consistently analyzed with the same criteria. Also, the reported definitions, which were originally proposed for predicting difficult carotid stenting and therefore were conceived for healthy aortic arches, can be influenced by the pathological derangements of the aortic wall, including aneurysms and dissections. In this respect, the Madhwal's classification, which is based on the diameter of the left common carotid artery, appears to be the more suitable one for aortic arch classification in patients with thoracic aortic disease because it provides relevant clinical information along with an adequate reproducibility.
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Affiliation(s)
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
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16
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Saitta S, Sturla F, Caimi A, Riva A, Palumbo MC, Votta E, Redaelli A, Marrocco-Trischitta MM. A deep learning-based and fully automated pipeline for thoracic aorta geometric analysis and TEVAR planning from computed tomography. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.251] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Publich Health - Ricerca Corrente
Introduction
Thoracic endovascular aortic repair (TEVAR) represents a well-established alternative to open repair in selected patients. Its preoperative feasibility assessment and planning requires a computational tomography (CT)-based analysis of the geometric aortic features to identify an adequate proximal and distal landing zone (LZ) for endograft deployment. Yet, controversies persist on the definition and methods of measurement of specific geometric features of the LZs, including angulation and tortuosity, which are associated with an increased risk of postoperative endograft failure. In this respect, the development of a preoperative image processing method that provides an automatic and highly reproducible 3D identification of critical geometric features and specific anatomical landmarks, thus reducing the time and uncertainties related to manual segmentation, remains a largely unmet clinical need.
In this study, we developed and applied a fully automated pipeline embedding a convolutional neural network (CNN), which feeds on 3D CT images to automatically segment the thoracic aorta, recognize the relevant anatomical landmarks and LZs, and quantifies the geometry of the aortic arch in each proximal LZ s (i.e. 0 to 3).
Methods
Ninety CT scans of healthy aortas were retrieved, being the study conceived as a proof of concept analysis. The thoracic aorta was manually segmented by five independent and expert operators. 72 scans with the corresponding ground truth segmentations were randomly selected and used to train the CNN, which was based on a 3D U-Net architecture. The other 18 scans were used to test the CNN-based segmentations. The fully automated pipeline was obtained by integrating the CNN, 3D geometry skeletonization, and processing of the aortic centerline and wall via computational geometry (Figure). The resulting metrics included aortic arch centerline radius of curvature, proximal landing zones (PLZs) maximum diameters, angulation and tortuosity calculated according to previously published work. These parameters were statistically analyzed to compare standard arches vs. arches with a common origin of the innominate and left carotid artery (CILCA), and the different landing zones in each arch type.
Results
The CNN segmentation yielded a mean Dice score of 0.94 with respect to manual ground truth segmentations. Standard arches were characterized by significantly larger radius of curvature (p = 0.002) and lower tortuosity in zone 3 (p = 0.004) vs. CILCA arches. For both standard and CILCA arches, comparisons among PLZs revealed statistically significant differences in maximum zone diameters (p < 0.0001), angulation (p < 0.0001) and tortuosity (p < 0.0001).
Conclusions
We developed a CNN-based automated pipeline for the automated, and reliable geometric quantification of standard and CILCA aortic arches. This tool has the potential to support TEVAR pre-procedural planning in a real clinical setting.
Abstract Figure. Automatic pipeline scheme
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Affiliation(s)
- S Saitta
- Milan Polytechnic, Department of Electronics Information and Bioengineering, Milan, Italy
| | - F Sturla
- IRCCS Policlinico San Donato, 3D and Computer Simulation Laboratory, San Donato Milanese, Italy
| | - A Caimi
- Milan Polytechnic, Department of Electronics Information and Bioengineering, Milan, Italy
| | - A Riva
- Milan Polytechnic, Department of Electronics Information and Bioengineering, Milan, Italy
| | - MC Palumbo
- Milan Polytechnic, Department of Electronics Information and Bioengineering, Milan, Italy
| | - E Votta
- Milan Polytechnic, Department of Electronics Information and Bioengineering, Milan, Italy
| | - A Redaelli
- Milan Polytechnic, Department of Electronics Information and Bioengineering, Milan, Italy
| | - MM Marrocco-Trischitta
- IRCCS Policlinico San Donato, Clinical Research Unit and Vascular Surgery Unit, San Donato Milanese, Italy
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Marrocco-Trischitta MM. Re "Leaving Behind Excess Aortic Neck in Open AAA Repair: To Be Avoided?". Eur J Vasc Endovasc Surg 2020; 61:523. [PMID: 33262087 DOI: 10.1016/j.ejvs.2020.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/09/2020] [Indexed: 10/22/2022]
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18
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Mazzaccaro D, Mazzeo G, Zuccon G, Modafferi A, Malacrida G, Righini PC, Marrocco-Trischitta MM, Nano G. Factors affecting the occurrence of proximal endoleak after endovascular abdominal aortic repair for abdominal aneurysms. J Int Med Res 2020; 48:300060520971515. [PMID: 33256478 PMCID: PMC7711229 DOI: 10.1177/0300060520971515] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This retrospective study was performed to assess the clinical and
radiological variables associated with proximal type IA endoleak (EL) in
patients treated with elective endovascular repair for abdominal aortic
aneurysms. Methods The chi-square test, t-test, and logistic regression analysis were performed
as appropriate. A P value of <0.05 was considered statistically
significant. Results The data of 79 patients were analyzed. No mortality occurred. During
follow-up (median, 28.5 months; interquartile range, 12.8–43.0 months), 10
patients developed type IA EL. In the logistic regression analysis,
undersizing of the endograft diameter by <10% significantly affected the
occurrence of type IA EL. When the diameter was used for measurements, less
oversizing was significantly associated with a higher risk of type IA EL.
When the area was used for measurements, oversizing of >20% significantly
affected the occurrence of type IA EL. Conclusion When sizing endografts, a discrepancy was noted between the measurements of
the diameter and area of the proximal neck. The area might represent a more
accurate measurement than the axial diameter to optimize the proximal
sealing and lower the risk of developing type IA EL.
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Affiliation(s)
- Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Girolomina Mazzeo
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianmarco Zuccon
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alfredo Modafferi
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Malacrida
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo C Righini
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Giovanni Nano
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, 9304University of Milan, Milan, Italy
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Perrone F, Piccirillo MC, Ascierto PA, Salvarani C, Parrella R, Marata AM, Popoli P, Ferraris L, Marrocco-Trischitta MM, Ripamonti D, Binda F, Bonfanti P, Squillace N, Castelli F, Muiesan ML, Lichtner M, Calzetti C, Salerno ND, Atripaldi L, Cascella M, Costantini M, Dolci G, Facciolongo NC, Fraganza F, Massari M, Montesarchio V, Mussini C, Negri EA, Botti G, Cardone C, Gargiulo P, Gravina A, Schettino C, Arenare L, Chiodini P, Gallo C. Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial. J Transl Med 2020; 18:405. [PMID: 33087150 PMCID: PMC7576974 DOI: 10.1186/s12967-020-02573-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients. METHODS A multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival. RESULTS In the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P = 0.52) and 22.4% (97.5% CI: 17.2-28.3, P < 0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline. CONCLUSIONS Tocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline. Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092).
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Affiliation(s)
- Francesco Perrone
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Maria Carmela Piccirillo
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Paolo Antonio Ascierto
- grid.508451.d0000 0004 1760 8805Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Carlo Salvarani
- grid.7548.e0000000121697570Rheumathology, Università degli Studi di Modena e Reggio Emilia and Azienda USL-IRCCS di Reggio Emilia, Modena, Italy
| | | | | | - Patrizia Popoli
- grid.416651.10000 0000 9120 6856Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Roma, Italy
| | - Laurenzia Ferraris
- grid.419557.b0000 0004 1766 7370Infectious Diseases Unit, Hospital Health Direction, IRCCS - Policlinico San Donato, Milano Milano, Italy
| | | | - Diego Ripamonti
- grid.460094.f0000 0004 1757 8431Infectious Diseases Unit - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Binda
- grid.460094.f0000 0004 1757 8431Infectious Diseases Unit - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Bonfanti
- grid.7563.70000 0001 2174 1754Infectious Diseases Unit, ASST Monza and University Milano Bicocca, Milan, Italy
| | - Nicola Squillace
- grid.7563.70000 0001 2174 1754Infectious Diseases Unit, ASST Monza and University Milano Bicocca, Milan, Italy
| | - Francesco Castelli
- grid.7637.50000000417571846University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Maria Lorenza Muiesan
- grid.7637.50000000417571846University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Miriam Lichtner
- grid.7841.aSapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Carlo Calzetti
- Infectious Diseases and Hepatology Unit AOU, Parma, Italy
| | - Nicola Duccio Salerno
- grid.411475.20000 0004 1756 948XUOC Malattie Infettive e Tropicali, AOUI, Verona, Italy
| | | | - Marco Cascella
- grid.508451.d0000 0004 1760 8805Anesthesia and Resuscitation Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | | | - Giovanni Dolci
- grid.7548.e0000000121697570Rheumathology, Università degli Studi di Modena e Reggio Emilia and Azienda USL-IRCCS di Reggio Emilia, Modena, Italy
| | | | | | - Marco Massari
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Cristina Mussini
- grid.7548.e0000000121697570Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | - Gerardo Botti
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Claudia Cardone
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Piera Gargiulo
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Adriano Gravina
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Clorinda Schettino
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Laura Arenare
- grid.508451.d0000 0004 1760 8805Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Paolo Chiodini
- grid.9841.40000 0001 2200 8888Department of Mental Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
| | - Ciro Gallo
- grid.9841.40000 0001 2200 8888Department of Mental Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
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20
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Marrocco-Trischitta MM, Vitale R, Nava G, Baroni I, Boveri S, Nano G, Secchi F. Poor concordance between definitions of type III arch and implications for risk prediction and assessment for carotid artery stenting. J Vasc Surg 2020; 73:1277-1281. [PMID: 32987147 DOI: 10.1016/j.jvs.2020.08.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/29/2020] [Accepted: 08/18/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The type III arch configuration has been inconsistently reported as a stroke risk factor during carotid artery stenting. However, at least three different methods for the definition of type III arch can be identified in the literature, related to the level of the origin of the innominate artery (IA). According to Casserly's definition, a type III arch presents with an origin of the IA below the horizontal plane of the inner curvature. According to Madhwal's definition, a type III arch has a distance greater than twice the diameter of the left common carotid artery between the highest point of the arch and the origin of the IA. According to MacDonald's definition, a type III arch presents with a distance of ≥2 cm between the highest point of the arch and the origin of the IA. Our aim was to assess the level of concordance between these different methods. METHODS Anonymized thoracic computed tomography scans of 100 healthy patients were reviewed. Two of us independently stratified the selected cases as a type I to III arch, according to the three considered definitions. The interobserver level of concordance for each type III arch classification and level of concordance among the three definitions were assessed. RESULTS The 100 selected patients (64% male) were 76 ± 7 years old. For each definition, the interobserver repeatability was almost perfect for all three (Madhwal, κ = 0.81; 95% confidence interval [CI], 0.71-0.99; MacDonald, κ = 0.82; 95% CI, 0.72-0.92; Casserly, κ = 0.84; 95% CI, 0.74-0.93). The level of concordance among the different definitions was very low (Madhwal vs MacDonald, 85% [P = .002]; 33% for type III arch; Madhwal vs Casserly, 60% [P < .0001]; 12% for type III arch; MacDonald vs Casserly, 75% [P < .0001]; 12% for type III arch). CONCLUSIONS The three definitions of the type III arch have a very low level of concordance, which might account for the varying clinical relevance of this configuration. Our findings have relevant implications for risk prediction for carotid artery stenting based on the presence of a type III arch, for comparisons of the results from different studies, and for comparisons of different datasets from multicenter trials.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Clinical Research Unit, IRCCS-Policlinico San Donato, Milan, Italy; Vascular Surgery Unit, Cardiovascular Department, IRCCS-Policlinico San Donato, Milan, Italy.
| | - Renato Vitale
- Clinical Research Unit, IRCCS-Policlinico San Donato, Milan, Italy
| | - Giovanni Nava
- Vascular Surgery Unit, Cardiovascular Department, IRCCS-Policlinico San Donato, Milan, Italy
| | - Irene Baroni
- Clinical Research Unit, IRCCS-Policlinico San Donato, Milan, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS-Policlinico San Donato, Milan, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, Cardiovascular Department, IRCCS-Policlinico San Donato, Milan, Italy; Department of "Scienze Biomediche per la Salute", University of Milan, Milan, Italy
| | - Francesco Secchi
- Department of "Scienze Biomediche per la Salute", University of Milan, Milan, Italy; Division of Radiology, IRCCS-Policlinico San Donato, Milan, Italy
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21
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Bernardini A, Ciconte G, Negro G, Rondine R, Mecarocci V, Viva T, Santini F, de Innocentiis C, Giannelli L, Witkowska E, Locati ET, Castelvecchio S, Marrocco-Trischitta MM, Vicedomini G, Menicanti L, Pappone C. Assessing QT interval in COVID-19 patients:safety of hydroxychloroquine-azithromycin combination regimen. Int J Cardiol 2020; 324:242-248. [PMID: 32956782 PMCID: PMC7501148 DOI: 10.1016/j.ijcard.2020.09.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023]
Abstract
Background Hydroxychloroquine (HCQ) and azithromycin (AZT) have been proposed for COVID-19 treatment. Data available in the literature reported a potential increased risk of fatal arrhythmias under these therapies. The aim of this study was to assess the effects of these drugs on QT interval and outcome in a COVID-19 population. Method A total of 112 consecutive COVID-19 patients were included in this analysis and were divided in 3 groups according to the receiving therapeutic regimens: 19 (17%) patients in Group 1 (no treatment), 40 (36%) in Group 2 (HCQ only), 53 (47%) in Group 3 (HCQ/AZT). Results A prolonged QTc interval was found in 61% of patients treated with HCQ alone or in combination with AZT, but only 4 (4%) patients showed a QTc > 500 ms. HCQ/AZT combination determined a greater increase of QTc duration compared to the other two strategies (Group 3 452 ± 26.4 vs Group 2 436.3 ± 28.4 vs Group 1 424.4 ± 24.3 ms, respectively; p < 0.001). Multivariate analysis demonstrated that HCQ/AZT combination (OR 9.02, p = 0.001) and older age (OR 1.04, p = 0.031) were independent predictors of QTc prolongation. The risk increased with age (incremental utility analysis p = 0.02). Twenty patients (18%) died, and no cardiac arrest neither arrhythmic fatalities were documented. Conclusions The HCQ/AZT combination therapy causes a significantly increase of QT interval compared to HCQ alone. Older patients under such regimen are at higher risk of experiencing QT prolongation. The use of such drugs may be considered as safe relating to arrhythmic risk in the treatment of COVID-19 patients as no arrhythmic fatalities occurred. Only the use of HCQ in combination with AZT causes a significant increase of QT interval. Older patients are at higher risk of prolonged QT when treated with HCQ with/without AZT. The use of HCQ alone or in combination with AZT might be considered as safe relating to arrhythmic risk in the treatment of COVID-19 patients.
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Affiliation(s)
- Andrea Bernardini
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Gabriele Negro
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Roberto Rondine
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Valerio Mecarocci
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Tommaso Viva
- University Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Francesca Santini
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Carlo de Innocentiis
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Luigi Giannelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Ewa Witkowska
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | | | | | | | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Lorenzo Menicanti
- Cardiac Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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22
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Mazzaccaro D, Giacomazzi F, Giannetta M, Varriale A, Scaramuzzo R, Modafferi A, Malacrida G, Righini P, Marrocco-Trischitta MM, Nano G. Non-Overt Coagulopathy in Non-ICU Patients with Mild to Moderate COVID-19 Pneumonia. J Clin Med 2020; 9:jcm9061781. [PMID: 32521707 PMCID: PMC7355651 DOI: 10.3390/jcm9061781] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 01/14/2023] Open
Abstract
Introduction: Aim of the study is to assess the occurrence of early stage coagulopathy and disseminated intravascular coagulation (DIC) in patients with mild to moderate respiratory distress secondary to SARS-CoV-2 infection. Materials and methods: Data of patients hospitalized from 18 March 2020 to 20 April 2020 were retrospectively reviewed. Two scores for the screening of coagulopathy (SIC and non-overt DIC scores) were calculated. The occurrence of thrombotic complication, death, and worsening respiratory function requiring non-invasive ventilation (NIV) or admission to ICU were recorded, and these outcomes were correlated with the results of each score. Chi-square test, receiver-operating characteristic curve, and logistic regression analysis were used as appropriate. p Values < 0.05 were considered statistically significant. Results: Data of 32 patients were analyzed. Overt-DIC was diagnosed in two patients (6.2%), while 26 (81.2%) met the criteria for non-overt DIC. Non-overt DIC score values ≥4 significantly correlated with the need of NIV/ICU (p = 0.02) and with the occurrence of thrombotic complications (p = 0.04). A score ≥4 was the optimal cut-off value, performing better than SIC score (p = 0.0018). Values ≥4 in patients with thrombotic complications were predictive of death (p = 0.03). Conclusions: Overt DIC occurred in 6.2% of non-ICU patients hospitalized for a mild to moderate COVID-19 respiratory distress, while 81.2% fulfilled the criteria for non-overt DIC. The non-overt DIC score performed better than the SIC score in predicting the need of NIV/ICU and the occurrence of thrombotic complications, as well as in predicting mortality in patients with thrombotic complications, with a score ≥4 being detected as the optimal cut-off.
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Affiliation(s)
- Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20026 Milan, Italy; (M.G.); (A.V.); (A.M.); (G.M.); (P.R.); (M.M.M.-T.); (G.N.)
- Correspondence: or
| | - Francesca Giacomazzi
- Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, 20026 Milan, Italy;
| | - Matteo Giannetta
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20026 Milan, Italy; (M.G.); (A.V.); (A.M.); (G.M.); (P.R.); (M.M.M.-T.); (G.N.)
| | - Alberto Varriale
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20026 Milan, Italy; (M.G.); (A.V.); (A.M.); (G.M.); (P.R.); (M.M.M.-T.); (G.N.)
| | - Rosa Scaramuzzo
- Operative Unit of University General Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20026 Milan, Italy;
| | - Alfredo Modafferi
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20026 Milan, Italy; (M.G.); (A.V.); (A.M.); (G.M.); (P.R.); (M.M.M.-T.); (G.N.)
| | - Giovanni Malacrida
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20026 Milan, Italy; (M.G.); (A.V.); (A.M.); (G.M.); (P.R.); (M.M.M.-T.); (G.N.)
| | - Paolo Righini
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20026 Milan, Italy; (M.G.); (A.V.); (A.M.); (G.M.); (P.R.); (M.M.M.-T.); (G.N.)
| | - Massimiliano M. Marrocco-Trischitta
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20026 Milan, Italy; (M.G.); (A.V.); (A.M.); (G.M.); (P.R.); (M.M.M.-T.); (G.N.)
| | - Giovanni Nano
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20026 Milan, Italy; (M.G.); (A.V.); (A.M.); (G.M.); (P.R.); (M.M.M.-T.); (G.N.)
- Department of Biomedical Sciences for Health, University of Milan, 20124 Milan, Italy
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23
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Marrocco-Trischitta MM, Romarowski RM, Alaidroos M, Sturla F, Glauber M, Nano G. Computational Fluid Dynamics Modeling of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant. Ann Vasc Surg 2020; 69:413-417. [PMID: 32479874 DOI: 10.1016/j.avsg.2020.05.024] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/17/2020] [Accepted: 05/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND To assess the endograft displacement forces (DF), which quantify the forces exerted by the pulsatile blood flow on the vessel wall and transmitted on the terminal fixation site of the endograft after its deployment in proximal landing zones (PLZs) of the bovine aortic arch variant. METHODS Thirty healthy aortic computed tomographic angiographies of subjects with bovine arch configuration (10 per type of arch, I-III) were selected for the purpose of the study. A 3-dimensional model of the aortic arch lumen was reconstructed. Computational fluid dynamics modeling was then used to compute DF magnitude and orientation (i.e., x, y, and z axes) in PLZs of each case. DF values were normalized to the corresponding aortic wall area to estimate equivalent surface traction (EST). RESULTS DF were highest in zone 0, consistently with the greater surface area. DF in zone 3 were much greater than in zone 2 because of a 3-fold greater upward component (z axis) (P < 0.001), being therefore mainly oriented orthogonally to the aortic blood flow and to the vessel longitudinal axis in that zone. EST progressively increased from zone 0 toward more distal PLZs, with EST in zone 3 being much greater than that in zone 2 (P < 0.001). The same pattern was observed after stratification by type of arch. CONCLUSIONS The bovine arch is associated with a consistent fluid dynamic pattern, which identifies in zone 3 an unfavorable biomechanical environment for endograft deployment.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Cardiovascular Department, Clinical Research Unit, IRCCS - Policlinico San Donato, Milan, Italy; Cardiovascular Department, Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy.
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS - Policlinico San Donato, Milan, Italy
| | - Moad Alaidroos
- Cardiovascular Department, Clinical Research Unit, IRCCS - Policlinico San Donato, Milan, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS - Policlinico San Donato, Milan, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Giovanni Nano
- Cardiovascular Department, Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy; Department of Scienze Biomediche per la Salute, University of Milan, Milan, Italy
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24
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Marrocco-Trischitta MM, de Beaufort HW, Piffaretti G, Bonardelli S, Gargiulo M, Antonello M, van Herwaarden JA, Boveri S, Bellosta R, Trimarchi S, Castelli P, Gallitto E, Macchi E, Mazzeo G, Saviane G, Secchi F, Spampinato B, Xodo A. The Modified Arch Landing Areas Nomenclature predicts proximal endograft failure after thoracic endovascular aortic repair. Eur J Cardiothorac Surg 2020; 58:309-318. [DOI: 10.1093/ejcts/ezaa115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Our goal was to assess the value of the Modified Arch Landing Areas Nomenclature (MALAN) for thoracic endovascular aortic repair (TEVAR), in which each landing area (LA) is identified by a proximal landing zone and the type of arch (e.g. 0/I), as predictors of postoperative proximal endograft performance.
METHODS
A multicentre retrospective analysis was performed of patients treated with arch TEVAR (i.e. proximal landing zone 0–3) for various indications between 2007 and 2017. Patients were stratified by the MALAN classification into hostile LAs (i.e. 2/III and 3/III) and favourable LAs (i.e. 0/I–III, 1/I–III, 2/I–II and 3/I–II). Outcome criteria included composite proximal endograft failure (including type Ia endoleak, persistent false lumen perfusion at the level of the most proximal communication between the lumina in aortic dissections, endograft migration and retrograde dissection) and deaths from all causes. Competing risk analyses were performed.
RESULTS
A total of 359 patients (hostile LAs 133; favourable LAs 226) were identified. The median age was 71.0 (62.0–77.0); 78.3% were men. Proximal endograft failure occurred in 28/133 patients (21.1%) in the hostile LA group and in 12/226 (5.3%) in the favourable LA group. On multivariate analysis, hostile LAs were independently associated with proximal endograft failure (P < 0.0001). There was no other independent risk factor. Favourable LAs were associated with an increased mortality rate (P = 0.006), which could be attributed to the proximal LA subgroup (i.e. 0/I–III and 1/I–III) (P < 0.0001), in addition to age (P < 0.0001).
CONCLUSIONS
The MALAN classification identifies hostile proximal landing zones for TEVAR, namely 2/III and 3/III LAs, which are associated with dismal proximal endograft performance. The MALAN appears to be an intuitive and valuable tool to improve the preoperative decision-making process.
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Affiliation(s)
| | - Hector W de Beaufort
- Clinical Research Unit and Division of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Stefano Bonardelli
- Department of Vascular Surgery, A.O Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Mauro Gargiulo
- Vascular Surgery, DIMES, Policlinico Sant’Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Michele Antonello
- Vascular and Endovascular Surgery Division, Padua University, School of Medicine, Padua, Italy
| | | | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Raffaello Bellosta
- Vascular Surgery Unit, Cardiovascular Surgery Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Santi Trimarchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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25
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Marrocco-Trischitta MM, Baroni I, Vitale R, Nava G, Nano G, Secchi F. Type III Arch Configuration as a Risk Factor for Carotid Artery Stenting: A Systematic Review of Contemporary Guidelines on Management of Carotid Artery Stenosis. Ann Vasc Surg 2020; 68:505-509. [PMID: 32339684 DOI: 10.1016/j.avsg.2020.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Type III arch configuration is frequently reported as a stroke risk factor for carotid angioplasty and stenting (CAS). We reviewed contemporary guidelines on management of carotid artery stenosis to assess the clinical relevance attributed to this anatomic feature in current clinical practice. METHODS The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The PubMed, EMBASE, and Web of Science databases were searched to identify all guidelines on extracranial carotid disease published between January 2008 and March 2020. A total of 435 articles were screened. For multiple guidelines from the same writing group, only the most recent updated version was considered. Eighteen documents were identified for qualitative analysis. RESULTS Four guidelines specifically reported type III arch as a predictive factor of periprocedural complications after CAS. Two of them also provided a low level of evidence of their recommendation. None of the documents indicated the exact criteria for aortic arch classification. Three different methods to describe type III arch configuration were identified. CONCLUSIONS Type III arch configuration is inconsistently included among stroke risk factors for CAS in contemporary guidelines, and variably defined. Further studies on the level of concordance between the 3 existing definition criteria are warranted.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy; Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy.
| | - Irene Baroni
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Renato Vitale
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Giovanni Nava
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy; Department of "Scienze Biomediche per la Salute", University of Milan, Milan, Italy
| | - Francesco Secchi
- Department of "Scienze Biomediche per la Salute", University of Milan, Milan, Italy; Division of Radiology, IRCCS Policlinico San Donato, Milan, Italy
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Marrocco-Trischitta MM, Romarowski RM. Re: "Higher Prevalence of Bovine Aortic Arch Configuration in Patients Undergoing Blunt Isthmic Aortic Trauma Repair". Ann Vasc Surg 2020; 65:e291-e292. [PMID: 31923592 DOI: 10.1016/j.avsg.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS - Policlinico San Donato, San Donato Milanese, Italy
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Conti M, Romarowski RM, Vitale R, Secchi F, Nano G, Marrocco-Trischitta MM. Haemodynamic Crosstalk Between Carotid Arteries and Implications for Wall Shear Stress Measurements. EJVES Vasc Forum 2020. [DOI: 10.1016/j.ejvsvf.2020.07.022] [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: 10/23/2022] Open
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Marrocco-Trischitta MM, Romarowski RM. Clinical implications of biomechanical insights into thoracic endovascular aortic repair. Eur J Cardiothorac Surg 2020; 57:197. [PMID: 30815671 DOI: 10.1093/ejcts/ezz058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/07/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
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Marrocco-Trischitta MM, Alaidroos M, Romarowski RM, Secchi F, Righini P, Glauber M, Nano G. Geometric Pattern of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant. Eur J Vasc Endovasc Surg 2019; 59:808-816. [PMID: 31889656 DOI: 10.1016/j.ejvs.2019.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/20/2019] [Revised: 10/14/2019] [Accepted: 11/12/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim was to investigate whether the "bovine" aortic arch (i.e. arch variant with a common origin of the innominate and left carotid artery (CILCA)) is associated with a consistent geometric configuration of proximal landing zones for thoracic endovascular aortic repair (TEVAR). METHODS Anonymised thoracic computed tomography (CT) scans of healthy aortas were reviewed to retrieve 100 cases of CILCA. Suitable cases were stratified according to type 1 and 2 CILCA, and also based on type of arch (I, II, and III). Further processing allowed calculation of angulation and tortuosity of the proximal landing zones. Centre lumen line lengths of each proximal landing zone were measured in a view perpendicular to the centre line. All geometric features were compared with those measured in healthy patients with a standard arch configuration (n = 60). Two senior authors independently evaluated the CT scans, and intra- and interobserver repeatability were assessed. RESULTS The 100 selected patients (63% male) were 71.4 ± 7.7 years old. Type 1 CILCA (62/100) was more prevalent than type 2 CILCA (38/100), and the two groups were comparable in age (p = .11). Zone 3 presented a severe angulation (i.e. > 60°), which was greater than in Zone 2 (p < .001), and a consistently greater tortuosity than Zone 2 (p = .003). This pattern did not differ between type 1 and type 2 CILCA. A greater tortuosity was also observed in Zone 0, which was related to increased elongation of the ascending aorta (i.e. Zone 0), than the standard configuration. The CILCA had an overall greater elongation, and Zone 2 also was specifically longer. When stratifying by type of arch, reversely from Type III to Type I, the CILCA presented a gradual flattening of its transverse tract, which entailed a consistent progressive elongation (p = .03) and kinking of the ascending aorta, with a significant increase of Zone 0 angulation to even a severe degree (p = .001). Also, from Type III to Type I, Zone 2 presented a progressively shorter length (p = .004), which was associated with increased tortuosity (p < .05). Mean intra- and interobserver differences for angulation measurements were 1.4° ± 6.8° (p = .17) and 2.0° ± 10.1° (p = .19), respectively. CONCLUSION CILCA presents a consistent and peculiar geometric pattern compared with standard arch configuration, which provides relevant information for TEVAR planning, and may have prognostic implications.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Clinical Research Unit, IRCCS - Policlinico San Donato, Milan, Italy; Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy.
| | - Moad Alaidroos
- Clinical Research Unit, IRCCS - Policlinico San Donato, Milan, Italy; Vascular Surgery Unit, Policlinico San Marco, Zingonia, Italy
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS - Policlinico San Donato, Milan, Italy
| | - Francesco Secchi
- Division of Radiology, IRCCS - Policlinico San Donato, Milan, Italy; Department of "Scienze Biomediche per la Salute", University of Milan, Italy
| | - Paolo Righini
- Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy; Department of "Scienze Biomediche per la Salute", University of Milan, Italy
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Alaidroos M, Romarowski RM, Secchi F, Righini P, Nano G, Marrocco-Trischitta MM. A Systematic Review and Meta-analysis of the Bovine Aortic Arch Variant as a Determinant of Thoracic Aortic Disease. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.069] [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: 10/25/2022]
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Marrocco-Trischitta MM, Secchi F, Vitale R, Miloro R, de Beaufort HW, Piffaretti G, Castelli P, Trimarchi S. High Prevalence of Type III Arch Configuration in Patients with Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.739] [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: 10/25/2022]
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Marrocco-Trischitta MM, Rylski B, Schofer F, Secchi F, Piffaretti G, de Beaufort H, Belvroy V, Bismuth J, Czerny M, Trimarchi S. Corrigendum to 'Prevalence of type III arch configuration in patients with type B aortic dissection' [Eur J Cardiothoracic Surg 2019; doi:10.1093/ejcts/ezz137]. Eur J Cardiothorac Surg 2019; 56:1208. [PMID: 31131403 DOI: 10.1093/ejcts/ezz172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Division of Vascular Surgery II, IRCCS - Policlinico San Donato, San Donato Milanese, Italy.,Thoracic Aortic Research Center, IRCCS - Policlinico San Donato, San Donato Milanese, Italy
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Faculty of Medicine, Albert Ludwigs University, University Heart Center Freiburg, Freiburg, Germany
| | - Florian Schofer
- Department of Cardiovascular Surgery, Faculty of Medicine, Albert Ludwigs University, University Heart Center Freiburg, Freiburg, Germany
| | - Francesco Secchi
- Division of Radiology, IRCCS - Policlinico San Donato, San Donato Milanese, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Hector de Beaufort
- Thoracic Aortic Research Center, IRCCS - Policlinico San Donato, San Donato Milanese, Italy
| | - Viony Belvroy
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Jean Bismuth
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Martin Czerny
- Department of Cardiovascular Surgery, Faculty of Medicine, Albert Ludwigs University, University Heart Center Freiburg, Freiburg, Germany
| | - Santi Trimarchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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Sturla F, Romarowski R, Alaidroos M, Secchi F, Nano G, Marrocco-Trischitta MM. Blood Flow Helicity Pattern in Type III Arch Configuration as a Potential Risk Factor for Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.058] [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: 11/15/2022]
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Belvroy VM, van Herwaarden JA, de Beaufort HW, Marrocco-Trischitta MM, Bismuth J, Moll FL, Trimarchi S. Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection: A Quantitative Analysis. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.1168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Righini PC, Mazzaccaro D, Marrocco-Trischitta MM, Modafferi A, Malacrida G, Nano G. AAA 33. Reversed Bell-Bottom Technique for the Endovascular Treatment of Iliac Artery Aneurysms. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.089] [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: 10/25/2022]
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Marrocco-Trischitta MM, Romarowski RM, Sturla F, Alaidroos M, Secchi F, Righini P, Glauber M, Nano G. TAA 16. Biomechanical Pattern of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.108] [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: 10/25/2022]
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Marrocco-Trischitta MM, Spampinato B, Mazzeo G, Mazzaccaro D, Milani V, Alaidroos M, Ambrogi F, Nano G. Impact of the Bird-Beak Configuration on Postoperative Outcome After Thoracic Endovascular Aortic Repair: A Meta-analysis. J Endovasc Ther 2019; 26:771-778. [DOI: 10.1177/1526602819865906] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To investigate the association between the bird-beak configuration (BBC), a wedge-shaped gap between the undersurface of a thoracic endograft and the lesser curvature of the arch after thoracic endovascular aortic repair (TEVAR), and postoperative outcome after TEVAR. Methods: The study was performed according to the PRISMA guidelines. The PubMed, EMBASE, and Cochrane databases were searched to identify all case series reporting BBC after TEVAR between 2006 and April 2018. Data analysis was performed considering the difference in the risk of complications for presence vs absence of BBC. After screening 1633 articles, 21 studies were identified that matched the selection criteria; 12 of these reported detailed information to investigate the postoperative outcome using proportion meta-analysis with a random effects model. The pooled risk difference is reported with the 95% confidence interval (CI). Heterogeneity of the included studies was assessed with the I2 statistic (low 25%, medium 50%, high 75%). Results: Complications occurred within a range of 0 to 72 months in 14.7% (95% CI 7.4% to 27.3%) of patients with BBC and in 6.3% (95% CI 2.5% to 15.4%) of patients without BBC. A cumulative incidence could not be assessed. The summary risk difference was 11.1% (95% CI −0.1% to 22.3%, p=0.052). There was significant heterogeneity ( I2=85.6%). The Egger test did not show evidence of publication bias (p=0.975). When specifically considering type Ia endoleak and endograft migration, the risk difference between BBC and non-BBC patients was 8.2% (95% CI 0.3% to 16.1%, p=0.042; I2=69.0%). The specific risk difference for endograft collapse/infolding and thrombosis was 3.7% (95% CI −3.5% to 11.1%, p=0.308; I2=10.2%). Conclusion: At present the literature does not provide statistical evidence to establish an overall prognostic value of the BBC. Nevertheless, the BBC appears to be associated with a high risk of type Ia endoleak and endograft migration, which warrants specific and long-term surveillance. Clinically relevant values for BBC grading should be established to perhaps define indications for preemptive treatment based on the presence of BBC only.
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Affiliation(s)
- Massimiliano M. Marrocco-Trischitta
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Benedetta Spampinato
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
- Residency Program in Vascular Surgery, University of Milan, Italy
| | - Girolomina Mazzeo
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
- Residency Program in Vascular Surgery, University of Milan, Italy
| | - Daniela Mazzaccaro
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Valentina Milani
- Biostatistics Service, IRCCS Policlinico San Donato, Milan Italy
| | - Moad Alaidroos
- Vascular Surgery Unit, Policlinico San Marco, Zingonia, Italy
| | - Federico Ambrogi
- Biostatistics Service, IRCCS Policlinico San Donato, Milan Italy
- Laboratory of Medical Statistics, University of Milan, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
- Department of “Scienze Biomediche per la Salute,” University of Milan, Italy
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Marrocco-Trischitta MM, Rylski B, Schofer F, Secchi F, Piffaretti G, de Beaufort H, Belvroy V, Bismuth J, Czerny M, Trimarchi S. Prevalence of type III arch configuration in patients with type B aortic dissection. Eur J Cardiothorac Surg 2019; 56:1075-1080. [DOI: 10.1093/ejcts/ezz137] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
OBJECTIVES
Type III aortic arch configuration consistently presents anatomical and biomechanical characteristics which have been associated with an increased risk of type B aortic dissection (TBD). Our aim was to investigate the prevalence of type III arch in patients with TBD and type B intramural haematoma (IMH-B).
METHODS
A multicentre retrospective analysis was performed on patients with TBD and IMH-B observed between 2002 and 2017. The computed tomographic images were reviewed to identify the type of aortic arch. Exclusion criteria included previous arch surgery, presence of aortic dissection or aneurysm proximal to the left subclavian artery and bovine arches. An ad hoc systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to assess the prevalence of type III arch in non-TBD and non-aneurysmal patients.
RESULTS
Two hundred and sixty-one patients with TBD/IMH-B were found to be suitable for the study and were stratified according to aortic arch classification. The ad hoc literature search provided 10 relevant articles, from which a total of 7983 control cases were retrieved. TBD/IMH-B patients were significantly younger than controls [64.3, standard error: 0.74 (62.84–65.76) vs mean pooled age 70.5, standard error: 0.40 (69.71–71.28)]. Patients with TBD/IMH-B presented with a significantly higher prevalence of type III arch [41.0% (107/261) (35.2–47.1)] than controls [16% (1241/7983) (10–22)].
CONCLUSIONS
Our data indicate an association between type III arch configuration and the occurrence of TBD/IMH-B. These findings warrant further studies to disclose the potential role of type III arch configuration as an anatomical risk factor for TBD/IMH-B.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Division of Vascular Surgery II, IRCCS - Policlinico San Donato, San Donato Milanese, Italy
- Thoracic Aortic Research Center, IRCCS - Policlinico San Donato, San Donato Milanese, Italy
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Faculty of Medicine, Albert Ludwigs University, University Heart Center Freiburg, Freiburg, Germany
| | - Florian Schofer
- Department of Cardiovascular Surgery, Faculty of Medicine, Albert Ludwigs University, University Heart Center Freiburg, Freiburg, Germany
| | - Francesco Secchi
- Division of Radiology, IRCCS - Policlinico San Donato, San Donato Milanese, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Hector de Beaufort
- Thoracic Aortic Research Center, IRCCS - Policlinico San Donato, San Donato Milanese, Italy
| | - Viony Belvroy
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Jean Bismuth
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Martin Czerny
- Department of Cardiovascular Surgery, Faculty of Medicine, Albert Ludwigs University, University Heart Center Freiburg, Freiburg, Germany
| | - Santi Trimarchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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Spinelli D, Benedetto F, Donato R, Piffaretti G, Marrocco-Trischitta MM, Patel HJ, Eagle KA, Trimarchi S. Current evidence in predictors of aortic growth and events in acute type B aortic dissection. J Vasc Surg 2018; 68:1925-1935.e8. [PMID: 30115384 DOI: 10.1016/j.jvs.2018.05.232] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [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: 03/11/2018] [Accepted: 05/31/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Acute type B aortic dissection can have a stable course or evolve into aneurysm and subsequent adverse events. The aim of this systematic review was to analyze the morphologic predictors of an adverse course to establish their validity based on consistency of results. METHODS Fifty-one studies were included in this review, reporting on aortic size, false lumen (FL) size, primary entry tear (ET) size and location, status of FL thrombosis, number of ETs, branch vessels involvement, and FL longitudinal extent. RESULTS Some predictors showed good consistency, whereas others did not. Aortic size was the most investigated predictor. A larger diameter at presentation predicted worse outcomes, with few exceptions. Both FL size and size relative to true lumen size also predicted an adverse course, although a standardized measurement method was not used. Regarding primary ET size and location, evidence was sparse and somewhat conflicting. Although FL complete thrombosis was consistently associated with a more benign course, the role of partial thrombosis remained unclear and the concept of FL saccular formation might account for the inconsistency, but further evidence is needed. A higher number of re-entry tears was considered to be protective against false channel expansion, but results need to be confirmed. The predictive role of branch vessels involvement and FL longitudinal extent remain controversial. CONCLUSIONS Among several predictors of aortic growth and events in acute type B aortic dissection, controversial and even conflicting results have been described. Consistent evidence has been demonstrated only for two predictors: aortic size at presentation is associated with adverse events and total FL thrombosis has a protective role.
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Affiliation(s)
- Domenico Spinelli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy; Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Mich.
| | - Filippo Benedetto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy
| | - Rocco Donato
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | | | - Himanshu J Patel
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Mich
| | - Kim A Eagle
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Mich
| | - Santi Trimarchi
- Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Scienze Biomediche per la Salute, University of Milan, Milan, Italy
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Marrocco-Trischitta MM. Regarding "Baroreceptor Activation Therapy 2 Decades after Vascular Surgery on Both Carotid Arteries in a Patient with Resistant Hypertension: First Case Report in the Literature". Ann Vasc Surg 2018; 53:279-280. [PMID: 30081161 DOI: 10.1016/j.avsg.2018.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
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van Bakel TM, Romarowski RM, Morganti S, van Herwaarden JA, Moll FL, de Beaufort HW, Marrocco-Trischitta MM, Secchi F, Conti M, Auricchio F, Trimarchi S. Blood Flow after Endovascular Repair in the Aortic Arch: A Computational Analysis. Aorta (Stamford) 2018; 6:81-87. [PMID: 30795032 PMCID: PMC6386644 DOI: 10.1055/s-0039-1683771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/24/2017] [Accepted: 11/05/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND The benefits of thoracic endovascular aortic repair (TEVAR) have encouraged stent graft deployment more proximally in the aortic arch. This study quantifies the hemodynamic impact of TEVAR in proximal landing zone 2 on the thoracic aorta and the proximal supra-aortic branches. METHODS Patients treated with TEVAR in proximal landing zone 2 having available preoperative and 30-day postoperative computer tomography angiography and phase-contrast magnetic resonance imaging data were retrospectively selected. Blood flow was studied using patient-specific computational fluid dynamics simulations. RESULTS Four patients were included. Following TEVAR in proximal landing zone 2, the mean flow in the left common carotid artery (LCCA) increased almost threefold, from 0.21 (0.12-0.41) L/min to 0.61 (0.24-1.08) L/min (+294%). The surface area of the LCCA had not yet increased commensurately and therefore maximum flow velocity in the LCCA increased from 44.9 (27.0-89.3) cm/s to 72.6 (40.8-135.0) cm/s (+62%). One of the patients presented with Type Ib endoleak at 1-year follow-up. The displacement force in this patient measured 32.1 N and was directed dorsocranial, perpendicular to the distal sealing zone. There was a linear correlation between the surface area of the stent graft and the resulting displacement force (p = 0.04). CONCLUSION TEVAR in proximal landing zone 2 alters blood flow in the supra-aortic branches, resulting in increased flow with high flow velocities in the LCCA. High displacement forces were calculated and related to stent graft migration and Type I endoleak during 1-year follow-up.
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Affiliation(s)
- Theodorus M. van Bakel
- Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rodrigo M. Romarowski
- Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Simone Morganti
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | | | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hector W. de Beaufort
- Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Francesco Secchi
- Department of Radiology, IRCCS—Policlinico San Donato, San Donato Milanese, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Santi Trimarchi
- Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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van Bakel TM, de Beaufort HW, Trimarchi S, Marrocco-Trischitta MM, Bismuth J, Moll FL, Patel HJ, van Herwaarden JA. Status of branched endovascular aortic arch repair. Ann Cardiothorac Surg 2018; 7:406-413. [PMID: 30155420 PMCID: PMC6094020 DOI: 10.21037/acs.2018.03.13] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 02/13/2018] [Accepted: 03/13/2018] [Indexed: 11/06/2022]
Abstract
Multiple medical device manufacturers are developing branched endografts for thoracic endovascular aortic repair (TEVAR), to provide a minimally invasive alternative for the treatment of aortic arch pathologies in patients who are deemed unfit for open or hybrid arch repair. Different branched endografts have been introduced, with varying number, size and orientation of the branches that redirect flow to the supra-aortic arteries. We present an overview of the currently investigated devices and review their outcomes. The results of branched TEVAR are promising, yet stroke remains the predominant periprocedural concern. For now, these procedures should be limited to select expert centers where the design and deployment procedure of branched endografts can be further developed to reduce the risk of stroke.
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Affiliation(s)
- Theodorus M. van Bakel
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Italy
- Department of Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Hector W. de Beaufort
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Italy
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Jean Bismuth
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Himanshu J. Patel
- Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
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Marrocco-Trischitta MM, de Beaufort HW, Secchi F, van Bakel TM, Ranucci M, van Herwaarden JA, Moll FL, Trimarchi S. A geometric reappraisal of proximal landing zones for thoracic endovascular aortic repair according to aortic arch types. J Vasc Surg 2017; 65:1584-1590. [DOI: 10.1016/j.jvs.2016.10.113] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/30/2016] [Indexed: 01/16/2023]
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Vianello E, Dozio E, Barassi A, Sammarco G, Tacchini L, Marrocco-Trischitta MM, Trimarchi S, Corsi Romanelli MM. A pilot observational study on magnesium and calcium imbalance in elderly patients with acute aortic dissection. Immun Ageing 2017; 14:1. [PMID: 28070203 PMCID: PMC5217585 DOI: 10.1186/s12979-016-0083-y] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/06/2016] [Indexed: 12/13/2022]
Abstract
Background Magnesium (Mg) and calcium (Ca) are the principal essential elements involved in endothelial cell homeostasis. Extracellular changes in the levels of either alter endothelial contraction and dilatation. Consequently Mg and Ca imbalance is associated with a high risk of endothelial dysfunction, the main process observed during acute aortic dissection (AAD); in this clinical condition, which mainly affects elderly men, smooth muscle cell alterations lead to intimal tears, creating a false new lumen in the media of the aorta. AAD patients have a high risk of mortality as a result of late diagnosis because often it is not distinguished from other cardiovascular diseases. We investigated Mg and Ca total circulating levels and the associated pro-inflammatory mediators in elderly AAD patients, to gain further information on the pathophysiology of this disorder, with a view to suggesting newer and earlier potential biomarkers of AAD. Results Total circulating Mg and Ca levels were both lower in AAD patients than controls (p < 0.0001). Using Ca as cut-off, 90% of AAD patients with low Ca (<8.4 mg/dL) came into the type A classification of AAD. Stratifying AAD according to this cut-off, Mg was lower in patients with lower total Ca. Compared to controls, both type A and B AAD patients had higher levels of all the pro-coagulant and pro-inflammatory mediators analyzed, including sP-sel, D-dimer, TNF-α, IL-6, and CRP (p < 0.05). Dividing types A and B using the Stanford classification, no significant differences were found (p > 0.05) The levels of both ICAM-1 and EN-1 were lower in AAD than in a control group (p < 0.0001 and p < 0.05 respectively). Conclusions These findings suggest that low Mg and Ca in AAD elderly patients may contribute to altering normal endothelial physiology and also concur in changing the normal concentrations of different mediators involved in vasodilatation and constriction, associated with AAD onset and severity.
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Affiliation(s)
- E Vianello
- Department of Biomedical Sciences for Health, Chair of Clinical Pathology, Università degli Studi di Milano, via Luigi Mangiagalli 31, 20133 Milan, Italy
| | - E Dozio
- Department of Biomedical Sciences for Health, Chair of Clinical Pathology, Università degli Studi di Milano, via Luigi Mangiagalli 31, 20133 Milan, Italy
| | - A Barassi
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - G Sammarco
- Laboratory Medicine Operative Unit-1, Clinical Pathology, I.R.C.C.S. Policlinico San Donato Milanese, Milan, Italy
| | - L Tacchini
- Department of Biomedical Sciences for Health, Chair of Clinical Pathology, Università degli Studi di Milano, via Luigi Mangiagalli 31, 20133 Milan, Italy
| | - M M Marrocco-Trischitta
- Thoracic Aortic Research Center, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - S Trimarchi
- Department of Biomedical Sciences for Health, Chair of Clinical Pathology, Università degli Studi di Milano, via Luigi Mangiagalli 31, 20133 Milan, Italy ; Thoracic Aortic Research Center, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - M M Corsi Romanelli
- Department of Biomedical Sciences for Health, Chair of Clinical Pathology, Università degli Studi di Milano, via Luigi Mangiagalli 31, 20133 Milan, Italy ; Laboratory Medicine Operative Unit-1, Clinical Pathology, I.R.C.C.S. Policlinico San Donato Milanese, Milan, Italy
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Marrocco-Trischitta MM. Regarding "Autonomic outcome is better after endarterectomy than after stenting in patients with asymptomatic carotid stenosis". J Vasc Surg 2016; 64:1550. [PMID: 27776710 DOI: 10.1016/j.jvs.2016.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/13/2016] [Indexed: 10/20/2022]
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Trimarchi S, Kamman A, Lomazzi C, Segreti S, Cova M, De Vincentiis C, Frigiola A, Menicanti L, Marrocco-Trischitta MM, Grassi V, Morganti S, Conti M, Auricchio F, Rampoldi V. Activities at Thoracic Aortic Research Center, IRCCS Policlinico San Donato. Eur Heart J Suppl 2016; 18:E57-E63. [PMID: 28533718 DOI: 10.1093/eurheartj/suw015] [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: 11/13/2022]
Abstract
The Thoracic Aortic Research Center (TARC) of the IRCCS Policlinico San Donato (PSD) aims to promote research on thoracic aortic diseases, to disclose the scientific knowledge and clinical experience and to develop new scientific paths within the Hospital and the aortic community, in collaboration with other national and international centres. Thoracic Aortic Research Center collaborates with many centres in both Europe (e.g. University of Utrecht, the Netherlands) and the USA (e.g. University of Michigan). This has led to multiple highly regarded publications in respected cardiovascular journals and has led to several PhD programmes resulting in doctorate degrees. Within Italy, in association with the Bioengineering School of the University of Pavia, TARC has founded the "BETA-lab" (Biomechanics for Endovascular Treatment of the Aorta laboratory), where MDs, Bioengineers, and PhD fellows conduct experimental studies using in vitro/ex vivo models of the physiologic aorta and aortic diseases. Furthermore, a database (iCardiocloud) where the medical imaging of cardiovascular patients from the PSD is structured, for in silico analysis utilizing computational fluid dynamics, and in vitro studies using also 3D printed aortic models. With the role of principal investigator or co-investigator, TARC at PSD has been participating in other several projects, including the International Registry of Acute Aortic Dissection, the International Aortic Arch Surgery Study Group, the European Registry of Endovascular Aortic Repair Complications, the ADSORB and ASSIST trials, and the GREAT registry. International collaborations have included also studies on predictors of aortic growth after dissection with the Yale University and University of Virginia, and on aortic biomarkers with the University of Tokyo.
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Affiliation(s)
- Santi Trimarchi
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Arnoud Kamman
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Chiara Lomazzi
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Sara Segreti
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Marta Cova
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Carlo De Vincentiis
- Section of Cardiac Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy
| | - Alessandro Frigiola
- Section of Cardiac Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy
| | - Lorenzo Menicanti
- Section of Cardiac Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy
| | - Massimiliano M Marrocco-Trischitta
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Viviana Grassi
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Simone Morganti
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | | | - Vincenzo Rampoldi
- Section of Vascular Surgery II°, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
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Vianello E, Dozio E, Rigolini R, Marrocco-Trischitta MM, Tacchini L, Trimarchi S, Corsi Romanelli MM. Acute phase of aortic dissection: a pilot study on CD40L, MPO, and MMP-1, -2, 9 and TIMP-1 circulating levels in elderly patients. Immun Ageing 2016; 13:9. [PMID: 27006681 PMCID: PMC4802618 DOI: 10.1186/s12979-016-0063-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 12/22/2015] [Accepted: 03/14/2016] [Indexed: 12/25/2022]
Abstract
Background Acute aortic dissection (AAD) is an event which may be rapidly fatal without early diagnosis and treatment. Aging is one of the main risk factors that could leading to AAD. To date, no specific biomarkers are available to increase the speed of diagnosis. CD40 ligand (CD40L), myeloperoxidase (MPO), matrix metalloproteinase (MMP)-1, -2, -9 and metallopeptidase tissue inhibitor 1 (TIMP-1) are biologically related molecules which integrate inflammation, tissue injury and remodeling, all events associated to AAD. Our is a pilot study to evaluate whether circulating levels of these molecules may be used as potential biomarkers in timely diagnosis of AAD. Results Within 24 h of symptom onset, circulating CD40L, MPO, MMP-1,-2,-9 and TIMP-1 were quantified by enzyme-linked immunosorbent assays in 22 patients (40–86 years of age) with AAD of ascending aorta (type A according to Stanford classification) and 11 patients with AAD of descending aorta (type B). 30 healthy individuals age matched were used as control group compared to controls, both type A and B AAD patients had higher CD40L (p < 0.001) and MPO (p < 0.01) levels. MMP-1 was higher in the overall AAD group (p < 0.01). After Stanford classification, type A group had increased level compared to both control and type B (p < 0.01 and p < 0.05, respectively). TIMP-1 was higher in both A and B groups compared to controls (p < 0.001). No differences were observed in MMP-2 and MMP-9 levels. Conclusions The simultaneous evaluation of CD40L, MPO and MMP-1 and TIMP-1, which may contribute to structural changes in aortic tissue in AAD patients, seems to be a novel promising diagnostic panel.
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Affiliation(s)
- E Vianello
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy
| | - E Dozio
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy
| | - R Rigolini
- Laboratory Medicine Operative Unit-1, Clinical Pathology, I.R.C.C.S. Policlinico, San Donato Milanese Milan, Italy
| | - M M Marrocco-Trischitta
- Thoracic Aortic Research Center, I.R.C.C.S. Policlinico San Donato, San Donato Milanese Milan, Italy
| | - L Tacchini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy
| | - S Trimarchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy ; Thoracic Aortic Research Center, I.R.C.C.S. Policlinico San Donato, San Donato Milanese Milan, Italy
| | - M M Corsi Romanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy ; Laboratory Medicine Operative Unit-1, Clinical Pathology, I.R.C.C.S. Policlinico, San Donato Milanese Milan, Italy
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Marrocco-Trischitta MM, Chiesa R. Regarding "The role of atropine in carotid stenting of recurrent stenosis after eversion endarterectomy". J Vasc Surg 2015; 61:1380-1. [PMID: 25925547 DOI: 10.1016/j.jvs.2015.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Roberto Chiesa
- Department of Vascular Surgery, Universitá Vita Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
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Marrocco-Trischitta MM, Cremona G, Lucini D, Natali-Sora MG, Cursi M, Cianflone D, Pagani M, Chiesa R. Peripheral baroreflex and chemoreflex function after eversion carotid endarterectomy. J Vasc Surg 2013; 58:136-44.e1. [DOI: 10.1016/j.jvs.2012.11.130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 08/20/2012] [Accepted: 11/25/2012] [Indexed: 12/19/2022]
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Marrocco-Trischitta MM, Chiesa R. Regarding "Preoperative prediction of mortality within 1 year after elective thoracic endovascular aortic aneurysm repair". J Vasc Surg 2013; 57:1176. [PMID: 23535047 DOI: 10.1016/j.jvs.2012.10.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 10/26/2012] [Accepted: 10/29/2012] [Indexed: 11/28/2022]
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