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Cattapan C, Guariento A, Bifulco O, Caraffa R, Bertelli F, Reffo E, Padalino M, Di Salvo G, Vida V. Three-Dimensional-Enabled Surgical Planning for the Correction of Right Partial Anomalous Pulmonary Venous Return. J Clin Med 2023; 12:jcm12020472. [PMID: 36675399 PMCID: PMC9863474 DOI: 10.3390/jcm12020472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Objectives: The surgical technique for right partial anomalous pulmonary venous return (PAPVR) depends on the location of the anomalous pulmonary veins (PVs). With this in mind, we sought to evaluate the impact of 3D heart segmentation and reconstruction on preoperative surgical planning. Methods: A retrospective study was conducted on all patients who underwent PAPVR repair at our institution between January 2018 and October 2021; three-dimensional segmentations and reconstructions of all the heart anatomies were performed. A score (the PAPVR score) was established and calculated using two anatomical parameters (the distance between the most cranial anomalous PV and the superior rim of the sinus venosus defect/the sum of the latter and the distance between the PV and the azygos vein) to predict the type of correction. Results: A total of 30 patients were included in the study. The PAPVR score was found to be a good predictor of the type of surgery performed. A value > 0.68 was significantly associated with a Warden procedure (p < 0.001) versus single/double patch repair. Conclusions: Three-dimensional heart segmentations and reconstructions improve the quality of surgical planning in the case of PAPVR and allow for the introduction of a score that may facilitate surgical decisions on the type of repair required.
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Affiliation(s)
- Claudia Cattapan
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Olimpia Bifulco
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Raphael Caraffa
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Francesco Bertelli
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Elena Reffo
- Pediatric Cardiology, Department of Pediatric and Maternal Medicine, University of Padua, 35128 Padua, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology, Department of Pediatric and Maternal Medicine, University of Padua, 35128 Padua, Italy
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-049-8212427
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Caraffa R, Bejko J, Carrozzini M, Bifulco O, Tarzia V, Lorenzoni G, Bottigliengo D, Gregori D, Castellani C, Bottio T, Angelini A, Gerosa G. A Device Strategy-Matched Comparison Analysis among Different Intermacs Profiles: A Single Center Experience. J Clin Med 2022; 11:jcm11164901. [PMID: 36013140 PMCID: PMC9410490 DOI: 10.3390/jcm11164901] [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] [Received: 08/01/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background: The present study evaluates outcomes of LVAD patients, taking into account the device strategy and the INTERMACS profile. Methods: We included 192 LVAD-patients implanted between January 2012 and May 2021. The primary and secondary end-points were survival and major adverse events between Profiles 1–3 vs. Profile 4, depending on implantation strategies (Bridge-to-transplant-BTT; Bridge-to-candidacy-BTC; Destination-Therapy-DT). Results: The overall survival was 67% (61–75) at 12 months and 61% (54–70) at 24 months. Profile 4 patients showed significantly higher survival (p = 0.018). Incidences of acute right-ventricular-failure (RVF) (p = 0.046), right-ventricular-assist-device (RVAD) implantation (p = 0.015), and continuous-venovenous-hemofiltration (CVVH) (p = 0.006) were higher in Profile 1–3 patients, as well as a longer intensive care unit stays (p = 0.050) and in-hospital-mortality (p = 0.012). Twelve-month and 24-month survival rates were higher in the BTT rather than in BTC (log-rank = 0.410; log-rank = 0.120) and in DT groups (log-rank = 0.046). In the BTT group, Profile 1–3 patients had a higher need for RVAD support (p = 0.042). Conclusions: LVAD implantation in elective patients was associated with better survival and lower complications incidence. LVAD implantation in BTC patients has to be considered before their conditions deteriorate. DT should be addressed to elective patients in order to guarantee acceptable results.
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Affiliation(s)
- Raphael Caraffa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Jonida Bejko
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Massimiliano Carrozzini
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Vincenzo Tarzia
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemilogy and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Daniele Bottigliengo
- Unit of Biostatistics, Epidemilogy and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemilogy and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Chiara Castellani
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Tomaso Bottio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-0498-212-410; Fax: +39-0498-212-409
| | - Annalisa Angelini
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
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D’Onofrio A, Caraffa R, Cibin G, Antonello M, Gerosa G. Total Endovascular Aortic Arch Repair: From Dream to Reality. Medicina (B Aires) 2022; 58:medicina58030372. [PMID: 35334549 PMCID: PMC8948628 DOI: 10.3390/medicina58030372] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
The gold-standard therapy for the treatment of aortic arch pathologies is conventional open surgery. Recently, total endovascular aortic arch replacement with branched stent-grafts has been introduced into clinical practice with the aim of reducing invasiveness especially in selected high-risk patients. The aim of this review is to describe the two most commonly used branched devices for endovascular arch stent-grafting: Nexus (Endospan, Herzlia, Israle) and RelayBranch (Terumo Aortic, Glasgow, United Kingdom). Nexus is a CE-certified off-the-shelf, single branch, double stent graft system. It consists of two different components: a main module for the aortic arch and the descending aorta with a side-branch for the brachiocephalic artery (BCA), and a curved module for the ascending aorta that lands into the sino-tubular junction and connects to the main module through a side-facing self-protecting sleeve. Nexus may be used in urgent-emergency cases and also in patients with only one suitable supra-aortic target vessel but, on the other hand, it makes cerebral blood flow dependent on one source vessel only. The RelayBranch Thoracic Stent-Graft System is a custom made, double branched endograft with a wide window on its superior portion to accommodate two inner tunnels for BCA and left common carotid artery connection; bilateral cervical accesses are generally used to advance guidewires for catheterization of the inner tunnels in a retrograde fashion. RelayBranch can be customized on every patient’s specific anatomy and provides a double blood source for the brain, but it cannot be used in urgent-emergency conditions. Therefore, in order to optimize outcomes, the choice of the most appropriate device should be made considering pros and cons of each system and patient’s anatomy by an experienced aortic team. In conclusion, total endovascular aortic arch exclusion is a promising reality in selected high-risk patients.
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Affiliation(s)
- Augusto D’Onofrio
- Division of Cardiac Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (R.C.); (G.C.); (G.G.)
- Correspondence: ; Tel.: +39-0498212410
| | - Raphael Caraffa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (R.C.); (G.C.); (G.G.)
| | - Giorgia Cibin
- Division of Cardiac Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (R.C.); (G.C.); (G.G.)
| | - Michele Antonello
- Division of Vascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy;
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (R.C.); (G.C.); (G.G.)
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Piperata A, Caraffa R, Bifulco O, Avesani M, Gerosa G, Bottio T. Heart transplantation in the new era of extended donor criteria. J Card Surg 2021; 36:4828-4829. [PMID: 34558118 DOI: 10.1111/jocs.16018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Antonio Piperata
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
| | - Raphael Caraffa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Olimpia Bifulco
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Martina Avesani
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, France
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
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D'Onofrio A, Cibin G, Antonello M, Caraffa R, Grego F, Gerosa G. Transapical Antegrade Ascending Aorta Stent-Grafting: Going Through the Front Door. Innovations (Phila) 2021; 16:523-528. [PMID: 34488465 DOI: 10.1177/15569845211042888] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Ascending aorta stent-grafting (AASG) is a new option that has shown initial promising results. In selected cases, when neither conventional surgery nor transfemoral retrograde approach are feasible, antegrade transapical (TA) access can be performed. The aim of this single-center retrospective study was to evaluate outcomes of patients undergoing AASG through a TA approach. METHODS We analyzed all patients undergoing AASG through a TA approach at our institution. Three different devices were used, including Relay Stent-Graft System (Terumo Aortic, UK), Gore Conformable Thoracic Aortic Graft (W. L. Gore & Associates, Inc., USA), and Valiant Thoracic Stent Graft (Medtronic, Ireland). All patients underwent clinical and computed tomographic angiogram (CTA) evaluation before hospital discharge. RESULTS From May 2010 to December 2019, 3 consecutive patients underwent AASG at our institution. Mean age was 69 years. Three different types of endografts were used in 1 patient each. All patients stayed in the intensive care unit for 24 hr and mean hospital stay was 12 days. We did not observe any major adverse event. One patient died of pneumonia 2 months after the procedure and the other 2 patients are alive and in good clinical conditions at a mean follow-up of 56 months. Predischarge CTA showed good anatomic results with no endoleaks in all cases. CONCLUSIONS This initial experience shows that AASG is feasible and provides encouraging clinical and anatomic results in selected high-risk patients.
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Affiliation(s)
| | - Giorgia Cibin
- 60242 Division of Cardiac Surgery, University of Padova, Italy
| | | | - Raphael Caraffa
- 60242 Division of Cardiac Surgery, University of Padova, Italy
| | - Franco Grego
- 9308 Division of Vascular Surgery, University of Padova, Italy
| | - Gino Gerosa
- 60242 Division of Cardiac Surgery, University of Padova, Italy
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Piperata A, Caraffa R, Bifulco O, Avesani M, Apostolo A, Gerosa G, Bottio T. Marginal donors and organ shortness: concomitant surgical procedures during heart transplantation: a literature review. J Cardiovasc Med (Hagerstown) 2021; 23:167-175. [PMID: 34420009 DOI: 10.2459/jcm.0000000000001233] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Heart transplantation represents the gold standard for end-stage heart failure. However, due to the increasing demand and the shortage of available organs, donor supply remains the main limitation. Marginal donor hearts in high-risk candidates who do not meet standard listing criteria are the only alternative when life expectancy is limited, but their use is still debated. Surgical correction of detected coronary lesions or valvular heart defects allows further enlargement of the number of available organs. In this article, we offer a literature review on this topic and report two marginal donor hearts with angiography evidence of coronary stenosis and preserved ventricular function, which underwent concomitant myocardial revascularization during heart implantation.
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Affiliation(s)
- Antonio Piperata
- Department of Cardiac, Thoracic, Vascular, and Public Health Sciences, University of Padua, Padova Cardiological Unit, Monzino Hospital, University of Milan, Milan, Italy
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Gerosa G, Nadali M, Longinotti L, Ponzoni M, Caraffa R, Fiocco A, Pradegan N, Besola L, D’Onofrio A, Bizzotto E, Bellu R, Gentian D, Colli A. Transapical off-pump echo-guided mitral valve repair with neochordae implantation mid-term outcomes. Ann Cardiothorac Surg 2021; 10:131-140. [PMID: 33575183 PMCID: PMC7867433 DOI: 10.21037/acs-2020-mv-86] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/22/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The NeoChord echo-guided transapical beating heart repair is a promising early-stage minimally invasive surgical procedure for degenerative mitral valve (MV) regurgitation (DMR) correction. The technique has been improved since its inception following procedure standardization, patient selection optimization, and learning curve stabilization. We hereby present the mid-term clinical results through three years of our large single center experience. METHODS All consecutive patients with severe symptomatic DMR due to prolapse or flail of one or both mitral leaflets that underwent the NeoChord procedure between November 2013 and June 2019 were included. Patients were categorized according to MV anatomy; Type A isolated central posterior leaflet prolapse and/or flail, Type B posterior multi-segment prolapse and/or flail, Type C anterior and/or bi-leaflet prolapse or flail, Type D paracommissural prolapse and/or flail and/or significant leaflet and/or annular calcifications. Patients underwent clinical and echocardiographic follow-up at one, three, six, twelve months and yearly thereafter. Clinical outcomes and the composite primary endpoint (patient success) were defined according to Mitral Valve Academic Research Consortium (MVARC) criteria. Mitral regurgitation (MR) severity was graded as absent, mild, moderate and severe according to American Society of Echocardiography (ASE) and European Society of Cardiology (ESC) guidelines. RESULTS Two hundred and three patients were included; median follow-up was 24 months [interquartile range (IQR), 9-36]. Median age was 64 years (IQR, 54-74 years), median Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) was 0.60% (IQR, 0.32-1.44%). There were 106 Type A patients (52.2%), 68 Type B (33.5%), 16 Type C (7.9%), and 13 Type D (6.4%). Kaplan-Meier estimate of survival was 99.0%±0.7% at one and two years and 94.0%±2.9% at three years. At one-year follow-up patient success was 91.2%±2.0% and 111 patients (74%) presented a residual MR mild or less (1+). At three-year follow-up patient success was 81.2%±3.8% and 32 patients (64%) had a residual MR mild or less (1+). Patient success was significantly different according to anatomical type (P=0.001). Echocardiographic analysis showed a significant acute left ventricle and left atrial reverse remodeling that was maintained up to three years. CONCLUSIONS The NeoChord echo-guided transapical beating heart repair procedure demonstrated good clinical outcomes and echocardiographic results up to three-year follow-up.
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Affiliation(s)
- Gino Gerosa
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Matteo Nadali
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Lorenzo Longinotti
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Matteo Ponzoni
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Raphael Caraffa
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Fiocco
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Nicola Pradegan
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Laura Besola
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Augusto D’Onofrio
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Roberto Bellu
- Cardiology Unit, Policlinico di Abano, Abano Terme, Italy
| | - Denas Gentian
- Cardiology Unit, Policlinico di Abano, Abano Terme, Italy
| | - Andrea Colli
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Bottio T, Bagozzi L, Fiocco A, Nadali M, Caraffa R, Bifulco O, Ponzoni M, Lombardi CM, Metra M, Russo CF, Frigerio M, Masciocco G, Potena L, Loforte A, Pacini D, Faggian G, Onorati F, Sponga S, Livi U, Iacovoni A, Terzi A, Senni M, Rinaldi M, Boffini M, Marro M, Jorgji V, Carrozzini M, Gerosa G. COVID-19 in Heart Transplant Recipients: A Multicenter Analysis of the Northern Italian Outbreak. JACC Heart Fail 2021; 9:52-61. [PMID: 33309578 PMCID: PMC7604081 DOI: 10.1016/j.jchf.2020.10.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/04/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The aim of this study was to assess the clinical course and outcomes of all heart transplant recipients affected by coronavirus disease-2019 (COVID-19) who were followed at the leading heart transplant centers of Northern Italy. BACKGROUND The worldwide severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic has created unprecedented challenges for public health, demanding exceptional efforts for the successful management and treatment of affected patients. Heart transplant patients represent a unique cohort of chronically immunosuppressed subjects in which SARS-CoV-2 may stimulate an unpredictable clinical course of infection. METHODS Since February 2020, we enrolled all 47 cases (79% male) in a first cohort of patients, with a mean age of 61.8 ± 14.5 years, who tested positive for SARS-CoV-2, out of 2,676 heart transplant recipients alive before the onset of the COVID-19 pandemic at 7 heart transplant centers in Northern Italy. RESULTS To date, 38 patients required hospitalization while 9 remained self-home quarantined and 14 died. Compared to the general population, prevalence (18 vs. 7 cases per 1,000) and related case fatality rate (29.7% vs. 15.4%) in heart transplant recipients were doubled. Univariable analysis showed older age (p = 0.002), diabetes mellitus (p = 0.040), extracardiac arteriopathy (p = 0.040), previous PCI (p = 0.040), CAV score (p = 0.039), lower GFR (p = 0.004), and higher NYHA functional classes (p = 0.023) were all significantly associated with in-hospital mortality. During the follow-up two patients died and a third patient has prolonged viral-shedding alternating positive and negative swabs. Since July 1st, 2020, we had 6 new patients who tested positive for SARS-CoV-2, 5 patients asymptomatic were self-quarantined, while 1 is still hospitalized for pneumonia. A standard therapy was maintained for all, except for the hospitalized patient. CONCLUSIONS The prevalence and mortality of SARS-CoV-2 should spur clinicians to immediately refer heart transplant recipients suspected as having SARS-CoV2 infection to centers specializing in the care of this vulnerable population.
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Affiliation(s)
- Tomaso Bottio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy,Address for correspondence: Dr. Tomaso Bottio, Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy
| | - Lorenzo Bagozzi
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alessandro Fiocco
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Nadali
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Raphael Caraffa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Ponzoni
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carlo Maria Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Claudio Francesco Russo
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy
| | - Maria Frigerio
- Transplant Cardiology Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy
| | - Gabriella Masciocco
- Transplant Cardiology Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy
| | - Luciano Potena
- Cardiac, Thoracic, Vascular and Transplant Department, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Antonio Loforte
- Cardiac, Thoracic, Vascular and Transplant Department, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac, Thoracic, Vascular and Transplant Department, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Sandro Sponga
- Cardiac Surgery Department, University of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiac Surgery Department, University of Udine, Udine, Italy
| | - Attilio Iacovoni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Amedeo Terzi
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Massimo Boffini
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Matteo Marro
- Division of Cardiac Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Vjola Jorgji
- Hacohen Lab, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Massimiliano Carrozzini
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Caraffa R, Marcolongo R, Bottio T, Rizzo S, Bifulco O, Bagozzi L, D'Onofrio A, Caforio ALP, Jorgji V, Basso C, Gerosa G. Recurrent autoimmune myocarditis in a young woman during the coronavirus disease 2019 pandemic. ESC Heart Fail 2020; 8:756-760. [PMID: 33225579 PMCID: PMC7753829 DOI: 10.1002/ehf2.13028] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 11/25/2022] Open
Abstract
We report a unique case of a young woman with recurrent immune‐mediated (virus‐negative) lymphocytic fulminant myocarditis during the coronavirus disease 2019 pandemic. At the first endomyocardial biopsy (EMB)‐proven episode, she had concomitant pneumonia, and a temporary biventricular assist device implant was followed by complete and long‐lasting cardiac recovery. Five years later, she was re‐admitted for relapsing cardiogenic shock with a recent history of pneumonia. She was treated with extracorporeal life support with apical venting for left ventricular unloading, and full recovery was achieved. Despite negative seriate nasopharyngeal swabs and EMB during hospitalization, an antibody positivity for severe acute respiratory syndrome coronavirus 2 was discovered after 4 weeks from discharge. This is the first report of an EMB‐proven, immune‐mediated (virus‐negative) recurrence of fulminant myocarditis. We hypothesize that in patients with a predisposing immunogenetic background, autoimmune disease may be triggered or reactivated by major infections, for example, pneumonia, that may act as adjuvants leading to an immune‐mediated hyper‐response.
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Affiliation(s)
- Raphael Caraffa
- Cardiac Surgery, Department of Cardiological Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Renzo Marcolongo
- Haematology and Clinical Immunology Unit and Cardio-Immunology Outpatient Clinic, University of Padua, Padua, Italy.,Cardiology, Department of Cardiological Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Tomaso Bottio
- Cardiac Surgery, Department of Cardiological Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, Padua, 36100, Italy
| | - Olimpia Bifulco
- Cardiac Surgery, Department of Cardiological Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lorenzo Bagozzi
- Cardiac Surgery, Department of Cardiological Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Augusto D'Onofrio
- Cardiac Surgery, Department of Cardiological Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alida L P Caforio
- Haematology and Clinical Immunology Unit and Cardio-Immunology Outpatient Clinic, University of Padua, Padua, Italy
| | - Vjola Jorgji
- Hacohen Lab, Massachusetts General Hospital, Boston, MA, USA
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, Padua, 36100, Italy
| | - Gino Gerosa
- Cardiac Surgery, Department of Cardiological Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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10
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Caraffa R, Bagozzi L, Fiocco A, Bifulco O, Nadali M, Ponzoni M, Carrozzini M, Toscano G, Fraiese AP, Metra M, Lombardi CM, Serafini F, Ribola A, Jorgji V, Bottio T, Gerosa G. Coronavirus disease 2019 (COVID-19) in the heart transplant population: a single-centre experience. Eur J Cardiothorac Surg 2020; 58:899-906. [PMID: 33084868 PMCID: PMC7665480 DOI: 10.1093/ejcts/ezaa323] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES ![]()
Few anecdotal cases have been reported in the literature regarding heart transplant recipients and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report our experience with 6 patients hospitalized in Northern Italy during the outbreak. METHODS Of the 396 living heart transplant recipients from 1985 to 2020 included in the study, 6 patients developed the novel 2019 coronavirus disease. Risk factors, last follow-up characteristics, onset presentation, in-hospital course of disease and blood examinations data were collected for these patients. RESULTS All patients were symptomatic and had positive results from a nasopharyngeal swab test for SARS-CoV-2. Of the 6 patients, 5 were hospitalized and 1 remained self-quarantined at home. Two patients died and 3 were discharged home. Two patients were admittted to the intensive care unit . Immunosuppressive therapy was modified with a median reduction comprising doses that were 50% cyclosporine and 50% mycophenolate. All patients received a medium-dose of corticosteroids as a bolus medication in addition to their therapy. All hospitalized patients received hydroxychloroquine; 2 patients received ritonavir/lopinavir. Broad-spectrum antibiotics for prophylaxis were administered to all. One patient had an ischaemic stroke and died of sepsis. CONCLUSIONS In the absence of any strong evidence regarding the treatment of heart transplant recipients infected with SARS-CoV-2, we faced a new challenge in managing viral infection in an immunosuppressed population. Because immunomodulation interaction with the infection seems to be crucial for developing severe forms of the disease, we managed to reduce immunosuppressive therapy by adding medium doses of corticosteroids. Despite the limited number of affected patients, this report suggests that special considerations should be given to treating coronavirus disease in the heart transplant recipient population.
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Affiliation(s)
- Raphael Caraffa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lorenzo Bagozzi
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alessandro Fiocco
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Nadali
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Ponzoni
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Massimiliano Carrozzini
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Toscano
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Angela Pompea Fraiese
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Spedali Civili of Brescia, Brescia, Italy
| | - Carlo Maria Lombardi
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Spedali Civili of Brescia, Brescia, Italy
| | | | - Angela Ribola
- Department of Anesthesia, Ospedale di Cremona, Cremona, Italy
| | - Vjola Jorgji
- Hacohen Lab, Massachusetts General Hospital, Boston, MA, USA
| | - Tomaso Bottio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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11
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Fiocco A, Ponzoni M, Caraffa R, Carrozzini M, Bagozzi L, Nadali M, Bifulco O, Toscano G, Fraiese AP, Bottio T, Gerosa G. Heart transplantation management in northern Italy during COVID-19 pandemic: single-centre experience. ESC Heart Fail 2020; 7:2003-2006. [PMID: 32648348 PMCID: PMC7404909 DOI: 10.1002/ehf2.12874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/12/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alessandro Fiocco
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Matteo Ponzoni
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Raphael Caraffa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Massimiliano Carrozzini
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Lorenzo Bagozzi
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Matteo Nadali
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Giuseppe Toscano
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Angela Pompea Fraiese
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Tomaso Bottio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
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12
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D'Onofrio A, Cibin G, Caraffa R, Rubino M, Antonello M, Grego F, Gerosa G. A New and Unexpected Complication After Arch Stent Grafting for Residual Dissection. Ann Thorac Surg 2019; 109:e429-e430. [PMID: 31689408 DOI: 10.1016/j.athoracsur.2019.08.116] [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] [Received: 08/16/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
Abstract
This report describes a complication after stent grafting of the aortic arch for residual dissection after ascending aorta and aortic arch replacement for acute type A dissection. One year later, a pseudoaneurysm originating from the proximal suture line and therefore far from the stent graft landing zone developed and fistulized into the pulmonary artery. Possible causes were suture damage during stent deployment and change of system forces after stent placement leading to high tension on the suture line. Emergency surgery was performed. Aortic arch stent grafting is a new and promising technique, but its complications are still not completely known.
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Affiliation(s)
| | - Giorgia Cibin
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Raphael Caraffa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Maurizio Rubino
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | | | - Franco Grego
- Division of Vascular Surgery, University of Padova, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
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