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Ciprandi G, Crucianelli S, Zama M, Antonielli G, Armani R, Aureli S, Barra G, Beetham CJC, Bernardini G, Cancani F, Carai A, Cajozzo M, Carlesi L, Cialdella A, Ciaralli I, Ciliento G, Corsetti T, De Chirico B, Di Corato P, Dotta A, Filippelli S, Franci M, Frattaroli J, Grussu F, Lico S, Losani P, Giergji M, Magli S, Marino SF, Mongelli A, Nazzarri M, Pace M, Palmieri G, Pannacci I, Paparozzi F, Pomponi M, Portanova A, Preziosi A, Ragni A, Raponi M, Renzetti T, Rizzo M, Roberti M, Sasso E, Savarese I, Secci S, Selvaggio D, Serafini L, Spuntarelli G, Urbani U, Vanzi V, Permatunga R, Santamaria N. The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: A quality improvement study. Int Wound J 2022; 19:1887-1900. [PMID: 36250520 PMCID: PMC9615277 DOI: 10.1111/iwj.13967] [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: 07/05/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022] Open
Abstract
The prevention of hospital‐acquired pressure injuries (HAPIs) in children undergoing long‐duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long‐duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi‐modal, multi‐disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long‐duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long‐duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence‐based, multi‐modal, multidisciplinary HAPI prevention strategy.
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Affiliation(s)
- Guido Ciprandi
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Serena Crucianelli
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Mario Zama
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Giancarlo Antonielli
- Operative Unit of Odontostomatology, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Riccarda Armani
- PIO XII Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Stefano Aureli
- Cardiology ICU, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Gianmarco Barra
- PIO XII Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | | | - Giulio Bernardini
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Federica Cancani
- Emergency Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Andrea Carai
- Division of Neurology-Neurosurgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Marta Cajozzo
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Laura Carlesi
- S.Onofrio Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Alessandra Cialdella
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Italo Ciaralli
- Dpt of Pediatric Oncohematology and Transfusion Medicine, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Gaetano Ciliento
- Health Management, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Tiziana Corsetti
- Clinical Pharmacology Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Benedetta De Chirico
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Paolo Di Corato
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Sergio Filippelli
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Marina Franci
- Pediatric Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Jacopo Frattaroli
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Francesca Grussu
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Silvia Lico
- S.Onofrio Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Patrizia Losani
- Neonatal Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Marjola Giergji
- Dpt of Pediatric Oncohematology and Transfusion Medicine, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Simonetta Magli
- S.Onofrio Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Simone Faustino Marino
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Antonella Mongelli
- Clinical Pharmacology Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Martina Nazzarri
- Cardiology ICU, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Mauro Pace
- Pediatric Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Giancarlo Palmieri
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Ilaria Pannacci
- S.Onofrio Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Franca Paparozzi
- Dpt of Pediatric Oncohematology and Transfusion Medicine, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Manuel Pomponi
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Anna Portanova
- Neonatal Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Alessandra Preziosi
- Pediatric Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Angela Ragni
- Neonatal Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Massimiliano Raponi
- Health Management, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Tommaso Renzetti
- Division of Neurology-Neurosurgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Mirialda Rizzo
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Marco Roberti
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Eleonora Sasso
- Neonatal Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Immacolata Savarese
- Neonatal Intensive Care Unit, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Simone Secci
- PIO XII Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Daniele Selvaggio
- Division of Cardiology-Cardiothoracic Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Laura Serafini
- PIO XII Operating Room, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Giorgio Spuntarelli
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Urbano Urbani
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Valentina Vanzi
- Division of General and Specialized Pediatrics, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Roshani Permatunga
- Department of Nursing, University of Melbourne & Royal Melbourne Hospital, Melbourne, Australia
| | - Nick Santamaria
- Department of Nursing, University of Melbourne & Royal Melbourne Hospital, Melbourne, Australia
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Brancaccio G, Trezzi M, Secinaro A, Iacobelli R, Perri G, Filippelli S, Bordonaro V, Galletti L. Ascending aortic extension to increase aortopulmonary space after comprehensive stage II palliation. Interact Cardiovasc Thorac Surg 2021; 34:613-615. [PMID: 34888682 PMCID: PMC8972317 DOI: 10.1093/icvts/ivab345] [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: 08/08/2021] [Revised: 10/07/2021] [Accepted: 10/29/2021] [Indexed: 12/02/2022] Open
Abstract
Aortic reconstruction at the time of the comprehensive stage II (CSII) procedure can be complicated by compression within the aortopulmonary space resulting in airway or pulmonary artery narrowing. We describe our experience with 2 patients with hypoplastic left heart syndrome and pulmonary artery stenosis after the CSII procedure. Both patients underwent an aortic extension with a Hemashield interposition graft to open up the aortopulmonary space. The patients were discharged from the hospital. In all cases the aortopulmonary space was enlarged, and the pulmonary arteries and airway were free from compression. Aortic extension is an option to be considered in children with pulmonary artery compression who previously had a CSII procedure.
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Affiliation(s)
- Gianluca Brancaccio
- Department of Pediatric Cardiology and Cardiac Suegery, Ospedale Pediatrico bambino Gesù IRCCS, Rome, Italy
- Corresponding author. Department of Pediatric Cardiac Surgery and Cardiology, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio, 4, 00165 Rome, Italy. Tel: +39-06-68592465; e-mail: (G. Brancaccio)
| | - Matteo Trezzi
- Department of Pediatric Cardiology and Cardiac Suegery, Ospedale Pediatrico bambino Gesù IRCCS, Rome, Italy
| | - Aurelio Secinaro
- Department of Imaging, Cardio-Thoracic Imaging Unit, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Suegery, Ospedale Pediatrico bambino Gesù IRCCS, Rome, Italy
| | - Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Suegery, Ospedale Pediatrico bambino Gesù IRCCS, Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Suegery, Ospedale Pediatrico bambino Gesù IRCCS, Rome, Italy
| | - Veronica Bordonaro
- Department of Imaging, Cardio-Thoracic Imaging Unit, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Lorenzo Galletti
- Department of Pediatric Cardiology and Cardiac Suegery, Ospedale Pediatrico bambino Gesù IRCCS, Rome, Italy
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Giamberti A, Caldaroni F, Varrica A, Pace Napoleone C, Marianeschi SM, Uricchio N, Vanini V, Santoro F, Luciani GB, Stellin G, Gargiulo G, Murzi B, Filippelli S, Oppido G, Agati S, Galletti L, Frigiola A. Impact of COVID-19 Pandemic on the Italian Humanitarian Congenital Cardiac Surgery Activity: What No One Tells You. Front Cardiovasc Med 2021; 8:705029. [PMID: 34395564 PMCID: PMC8355370 DOI: 10.3389/fcvm.2021.705029] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/05/2021] [Indexed: 01/25/2023] Open
Abstract
More than 4 millions of children with congenital heart disease (CHD) are waiting for cardiac surgery around the world. Few of these patients are treated only thanks to the support of many non-governmental organizations (NGOs). Starting in December 2019, the so-called coronavirus disease 2019 (COVID-19) has rapidly become a worldwide pandemic and has dramatically impacted on all the international humanitarian activities for congenital heart disease. We analyzed data from all the Italian congenital cardiac surgery centers with the aim to quantify the impact of the pandemic on their charities. Fifteen Italian centers participated in the study and contributed to data collection. We analyzed and compared data regarding humanitarian activities carried out abroad and on site from two periods: year 2019 (pre-COVID-19) and year 2020 (COVID-19 pandemic). In 2019, 53 international missions were carried out by Italian congenital cardiac surgeons, resulting in the treatment of 471 CHD patients. In the same period 11 Italian cardiac centers operated on 251 foreign patients in Italy. In 2020, the pandemic led to a reduction of this activity by 96% for the surgery performed overseas and 86% for the interventions carried out in Italy. In conclusion our study shows the important quantitative impact of the pandemic on the Italian humanitarian cardiac surgical activity overseas and in Italy. This shocking result highlights the failure of the systems adopted so far to solve the problem of CHD in developing countries.
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Affiliation(s)
- Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Association "Bambini cardiopatici nel Mondo" Non-Governmental Organization (NGO), Milan, Italy
| | - Federica Caldaroni
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Varrica
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | - Nicola Uricchio
- Cardiac Surgery, Aziende Socio Sanitarie Territoriali (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | | | - Francesco Santoro
- Missioni Cardio Chirurgiche Internazionali, Gaslini Pediatric Hospital, Genova, Italy
| | - Giovanni Battista Luciani
- Pediatric and Congenital Cardiac Surgery Unit, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Gaetano Gargiulo
- Pediatric and Grown-up Congenital Cardiac Surgery, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Bruno Murzi
- Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Guido Oppido
- Congenital Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Salvatore Agati
- Centro Cardiologico Pediatrico del Mediterraneo - Bambino Gesù, "San Vincenzo" Hospital, Taormina, Italy
| | - Lorenzo Galletti
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Association "Bambini cardiopatici nel Mondo" Non-Governmental Organization (NGO), Milan, Italy
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Perri G, Trezzi M, Formigari R, Adorisio R, Filippelli S, Brancaccio G, Galletti L, Amodeo A. Use of Transcarotid IMPELLA 2.5 Axial-Flow Pump Device for Left Ventricle Unloading During VA-ECMO Support in Pediatric Acute Heart Failure. World J Pediatr Congenit Heart Surg 2021; 12:542-546. [PMID: 34278855 DOI: 10.1177/21501351211017866] [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: 11/16/2022]
Abstract
An alternative strategy for left ventricular (LV) venting during short-term mechanical circulatory support is use of Impella axial-flow pump. We present our transcarotid Impella 2.5 implantation technique using a polytetrafluoroethylene graft, in two children with acute heart failure treated primarily with venoarterial ECMO. The venoarterial extracorporeal membrane oxygenator and Impella support were maintained for 5 and 17 days, respectively. Transcarotid Impella implantation might be an alternative and feasible option in pediatrics patients affected by severe LV failure, as a bridge to decision or bridge to candidacy. Potentially, the Impella 2.5 device provides less invasive support for children with heart failure.
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Affiliation(s)
- Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Surgery, 9342Bambino Gesù Children Hospital IRCS, Rome, Italy
| | - Matteo Trezzi
- Department of Pediatric Cardiology and Cardiac Surgery, 9342Bambino Gesù Children Hospital IRCS, Rome, Italy
| | - Roberto Formigari
- Department of Pediatric Cardiology and Cardiac Surgery, 9342Bambino Gesù Children Hospital IRCS, Rome, Italy
| | - Rachele Adorisio
- Department of Pediatric Cardiology and Cardiac Surgery, 9342Bambino Gesù Children Hospital IRCS, Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, 9342Bambino Gesù Children Hospital IRCS, Rome, Italy
| | - Gianluca Brancaccio
- Department of Pediatric Cardiology and Cardiac Surgery, 9342Bambino Gesù Children Hospital IRCS, Rome, Italy
| | - Lorenzo Galletti
- Department of Pediatric Cardiology and Cardiac Surgery, 9342Bambino Gesù Children Hospital IRCS, Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, 9342Bambino Gesù Children Hospital IRCS, Rome, Italy
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Adorisio R, Cantarutti N, D'Amario D, Grandinetti M, D'Amico A, Perri G, Filippelli S, Drago F, Amodeo A. Long-Term Outcome of LVAD in Duchenne Population with End Stage Cardiomyopathy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Adorisio R, Grandinetti M, Giorni C, Selvaggio D, Filippelli S, Trezzi M, Iacobelli R, Brancaccio G, Amodeo A. Preliminary Data on the Clinical Use of Infant Jarvik 2015 in Children with Dilated Cardiomyopathy; Recovery Will Be the New Therapeutic Goal? J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Brancaccio G, Perri G, Della Porta M, Iodice F, Trezzi M, Filippelli S, Amodeo A, D'Abramo M, Iorio FS, Galletti L. Use of carotid artery cannulation during redo sternotomy in congenital cardiac surgery: a single-centre experience. Interact Cardiovasc Thorac Surg 2021; 33:119-123. [PMID: 33704457 DOI: 10.1093/icvts/ivab060] [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] [Received: 09/18/2020] [Revised: 12/09/2020] [Accepted: 12/20/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Management of resternotomy is often a difficult challenge in patients with congenital diseases who have undergone multiple sternotomies. Our goal was to report our single-centre experience with carotid cannulation using a graft interposed during redo sternotomy in complex cardiac reintervention procedures. METHODS We performed a retrospective review of all patients who had undergone complex redo sternotomies between January 2019 and May 2020 utilizing a cervical cannulation technique with a Gore-Tex graft interposed on the carotid artery. We classified our population study on the basis of the primary diagnosis and the type of surgery. The primary outcomes of our analysis were the evaluation of the safety of the procedure in terms of survival and freedom from neurological events. RESULTS We analysed 22 patients who had undergone previous complex operations. The median age and weight at the time of reintervention were 130.35 (range 0.46-435) months and 31.5 (range 2.2-85) kg, respectively. Composite graft carotid cannulation provided adequate arterial flow in all patients with a median arterial flow of 3.5 l/min/m2 (range 0.6-6). One major cardiac injury occurred during sternotomy when emergency cardiopulmonary bypass (CPB) was initiated. Moreover, during their hospital stays, all patients had an uneventful recovery without neurological or vascular complications and no cervical wound infections. CONCLUSIONS Carotid cannulation using interposition of a side graft on the common carotid artery for arterial inflow is a reliable and safe method for initiation of CPB in complex redo surgeries in patients with congenital disease. Complications directly associated with this type of cannulation are uncommon and allow surgical re-entry with overall low risks.
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Affiliation(s)
- Gianluca Brancaccio
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Gianluigi Perri
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Della Porta
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Iodice
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Matteo Trezzi
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mizar D'Abramo
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Fiore S Iorio
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lorenzo Galletti
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
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Adorisio R, Cantarutti N, D'Amico A, Bertini E, Catteruccia M, Perri G, D'Amario D, Filippelli S, Drago F, Amodeo A. Long-Term Outcome of LVAD in Duchenne Population with End Stage Cardiomyopathy. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.857] [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: 10/24/2022] Open
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Vignaroli W, Curione D, Perri G, Secinaro A, Filippelli S, Iorio FS. Anomalous Origin of Left Common Carotid Artery From Left Pulmonary Artery in a 22q11.2 Deletion Syndrome Newborn With Right Aortic Arch and Aberrant Left Subclavian Artery. Circ Cardiovasc Imaging 2020; 13:e010087. [PMID: 32131618 DOI: 10.1161/circimaging.119.010087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Walter Vignaroli
- Department of Pediatric Cardiology and Cardiac Surgery (W.V., G.P., S.F, F.S.I.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Davide Curione
- Department of Imaging (D.C., A.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Surgery (W.V., G.P., S.F, F.S.I.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Aurelio Secinaro
- Department of Imaging (D.C., A.S.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery (W.V., G.P., S.F, F.S.I.), Bambino Gesù Children's Hospital, Rome, Italy
| | - Fiore Salvatore Iorio
- Department of Pediatric Cardiology and Cardiac Surgery (W.V., G.P., S.F, F.S.I.), Bambino Gesù Children's Hospital, Rome, Italy
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Di Molfetta A, Adachi I, Ferrari G, Gagliardi MG, Perri G, Iacobelli R, Qureshi AM, Di Pasquale L, Vera RZ, Guccione P, Di Molfetta M, Chiariello GA, Filippelli S, Amodeo A. Left ventricular unloading during extracorporeal membrane oxygenation – Impella versus atrial septal defect: A simulation study. Int J Artif Organs 2020; 43:663-670. [DOI: 10.1177/0391398820906840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Atrial septal defect and Impella have been proposed for left ventricular unloading in venoarterial extracorporeal membrane oxygenation patients. This work aims at evaluating the haemodynamic changes in venoarterial extracorporeal membrane oxygenation patients after Impella implantation or atrial septal defect realization by a simulation study. Methods: A lumped parameter model of the cardiovascular system was adapted to this study. Atrial septal defect was modelled as a resistance between the two atria. Venoarterial extracorporeal membrane oxygenation and Impella were modelled starting from their pressure-flow characteristics. The baseline condition of a patient undergoing venoarterial extracorporeal membrane oxygenation was reproduced starting from haemodynamic and echocardiographic data. The effects of different atrial septal defect size, Impella and venoarterial extracorporeal membrane oxygenation support were simulated. Results: Impella caused an increment of mean arterial pressure up to 67%, a decrement in mean pulmonary arterial pressure up to 8%, a decrement in left ventricular end systolic volume up to 11% with a reduction up to 97% of left ventricular cardiac output. Atrial septal defect reduces left atrial pressure (19%), increases right atrial pressure (22%), increases mean arterial pressure (18%), decreases left ventricular end systolic volume (11%), increases right ventricular volume (33%) and decreases left ventricular cardiac output (55%). Conclusion: Impella has a higher capability in left ventricular unloading during venoarterial extracorporeal membrane oxygenation in comparison to atrial septal defect with a lower right ventricular overload.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Cardiac Surgery, Policlinico Gemelli-Catholic University of Rome, Rome, Italy
| | - Iki Adachi
- Department of Cardiac Surgery and The Lillie Frank Abercrombie Section of Cardiology, Texas Heart Hospital, Texas Children’s Hospital, Houston, TX, USA
| | - Gianfranco Ferrari
- Nalecz Institute of Biocybernetics and Biomedical Engineering (IBBE) PAS, Warszawa, Poland
| | - Maria Giulia Gagliardi
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Gianluigi Perri
- Department of Cardiac Surgery, Policlinico Gemelli-Catholic University of Rome, Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Athar M Qureshi
- Department of Cardiac Surgery and The Lillie Frank Abercrombie Section of Cardiology, Texas Heart Hospital, Texas Children’s Hospital, Houston, TX, USA
| | - Luigi Di Pasquale
- Department of Cardiac Surgery and The Lillie Frank Abercrombie Section of Cardiology, Texas Heart Hospital, Texas Children’s Hospital, Houston, TX, USA
| | - Rodrigo Zea Vera
- Department of Cardiac Surgery and The Lillie Frank Abercrombie Section of Cardiology, Texas Heart Hospital, Texas Children’s Hospital, Houston, TX, USA
| | - Paolo Guccione
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Matteo Di Molfetta
- Department of Cardiac Surgery, Policlinico Gemelli-Catholic University of Rome, Rome, Italy
| | | | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
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Amodeo A, Filippelli S, Perri G, Iacobelli R, Adorisio R, Iodice F, Rizza A, Massicotte MP, Baldwin JT, Almond CS. First human implantation of a miniaturized axial flow ventricular assist device in a child with end-stage heart failure. J Heart Lung Transplant 2020; 39:83-87. [DOI: 10.1016/j.healun.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/09/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022] Open
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Adorisio R, D'Amario D, Cantarutti N, Cicenia M, D'Amico A, Baban A, Bertini E, Catteruccia M, Perri G, Filippelli S, Drago F, Amodeo A. P3446Left-ventricular assist device as a destination therapy in Duchenne cardiomyopathy: are we ready to change the natural history? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure is becoming the most prominent cause of death among patients with Duchenne Muscular Dystrophy (DMD) and end-stage cardiomyopathy (CMP). Implantation of left ventricular assist devices (LVAD) as destination therapy (DT) in this group of patients is still matter of debate. No current data are available on long-term follow- up of young patients.
Purpose
The aim of this study was to evaluate the long-term outcome of LVAD in DMD end stage heart failure (HF) compared to a group treated optimal medical treatment (OMT) with inotropes
Methods
All patients affected by DMD patients presenting with end-stage HF receiving OMT or LVAD have been reviewed. All data about characteristics of HF at presentation including assessment of nutritional status and respiratory function, left ventricular ejection fraction, brain natriuretic peptide, serum sodium, in-hospital treatment and long term follow up have been collected. OMT group was constituted by 4 patients matching implantation VAD criteria but not eligible or refusing treatment. Survival was represented by Kaplan Meier analysis.
Results
A total of 12 DMD patients with end-stage CMP were considered for this analysis. 8 have been implanted with LVAD during the period from 2011 until mid-2017 and compared with 4 treated with OMT. Mean systolic pressure was 103 versus 91 mmHg in those not receiving LVAD (p=0.2), and left ventricular ejection fraction at the time of presentation was 16‰ for LVAD group and 22‰ for the second group (p=0.1). LVADs improved survival throughout follow-up for patients undergoing baseline inotropic infusions (P=0.0014); for the LVAD group versus the OMT group, 1-month survival was 100‰ and 67‰ respectively and 2-month survival was 100‰ versus 0‰. For LVAD group survival was 86‰ at one year, 71‰ at 2 years and 48‰ at 5 years from implantation. Analysis on short and long-term follow-up showed significant improvement of survival in DMD patients treated with LVAD (log rank<0.001), with a 5-year increase in life expectancy.
Conclusions
LVAD improved outcomes in patients with LVAD when compared to those without. Long-term follow-up was similar to DT LVAD adult population. Further studies are necessary to confirm these data.
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Affiliation(s)
- R Adorisio
- Bambino Gesù Children's Hospital and Research Institute, Department of Pediatric Cardiology and Cardiac Surgery, Rome, Italy
| | - D D'Amario
- Catholic University of the Sacred Heart, Rome, Italy
| | - N Cantarutti
- Bambino Gesù Children's Hospital and Research Institute, Department of Pediatric Cardiology and Cardiac Surgery, Rome, Italy
| | - M Cicenia
- Bambino Gesù Children's Hospital and Research Institute, Department of Pediatric Cardiology and Cardiac Surgery, Rome, Italy
| | - A D'Amico
- Bambino Gesù Children's Hospital and Research Institute, Department of Pediatric Cardiology and Cardiac Surgery, Rome, Italy
| | - A Baban
- Bambino Gesù Children's Hospital and Research Institute, Department of Pediatric Cardiology and Cardiac Surgery, Rome, Italy
| | - E Bertini
- Bambino Gesù Children's Hospital and Research Institute, Department of Pediatric Cardiology and Cardiac Surgery, Rome, Italy
| | - M Catteruccia
- Bambino Gesù Children's Hospital and Research Institute, Department of Pediatric Cardiology and Cardiac Surgery, Rome, Italy
| | - G Perri
- Bambino Gesù Children's Hospital and Research Institute, Department of Pediatric Cardiology and Cardiac Surgery, Rome, Italy
| | - S Filippelli
- Bambino Gesù Children's Hospital and Research Institute, Department of Pediatric Cardiology and Cardiac Surgery, Rome, Italy
| | - F Drago
- Bambino Gesù Children's Hospital and Research Institute, Department of Pediatric Cardiology and Cardiac Surgery, Rome, Italy
| | - A Amodeo
- Bambino Gesù Children's Hospital and Research Institute, Department of Pediatric Cardiology and Cardiac Surgery, Rome, Italy
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13
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Iacobelli R, Di Molfetta A, Cobianchi Bellisari F, Toscano A, Filippelli S, Di Chiara L, Pasquini L, Iorio FS, Amodeo A. Changes in left and right ventricular two-dimensional echocardiographic speckle-tracking indices in pediatric LVAD population: A retrospective clinical study. Int J Artif Organs 2019; 42:711-716. [PMID: 31238772 DOI: 10.1177/0391398819857446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Echocardiographic strain and strain-rate imaging is a promising tool for the evaluation of myocardial segmental function, for the early detection of myocardial dysfunction, and for the prediction of reverse remodeling. We aimed at studying the changes in left and right ventricular function in pulsatile left ventricular assist device pediatric patients by two-dimensional echocardiography and two-dimensional speckle-tracking echocardiography. Echocardiographic and clinical data of patients implanted with a pulsatile-flow left ventricular assist device from 2011 to 2018 were retrospectively reviewed before and after implantation at 1, 3, and 6 months. A total of 18 patients were enrolled. Median age and weight at implantation were 9 months (5-23 months) and 5.85 kg (4.85-8.75 kg), respectively; median left ventricular assist device support was 181 (114.5-289.5) days. 13 patients (73%) were transplanted and 5 patients (27%) died. At follow-up: left ventricular ejection fraction increase at 1 month (p = 0.001) and 3 months (p = 0.01), left ventricular global longitudinal strain improvement at 1 month (p = 0.0008) and 3 months (p = 0.02), and right ventricular free-wall longitudinal strain increase at 1 month (p = 0.01). At short term after left ventricular assist device implantation, both left ventricular and right ventricular mechanics improved. The temporary benefit seems to decrease over time. The worsening of left ventricular function has been followed by a worsening of right ventricular function probably due to the ventricular interdependence.
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Affiliation(s)
- Roberta Iacobelli
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Arianna Di Molfetta
- Department of Cardiac Surgery, Policlinico Universitario A. Gemelli, Rome, Italy
| | | | - Alessandra Toscano
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Sergio Filippelli
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Luca Di Chiara
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Luciano Pasquini
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Fiore Salvatore Iorio
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Antonio Amodeo
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
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Adorisio R, Calvieri C, Cantarutti N, D'Amico A, Catteruccia M, Bertini E, Baban A, Filippelli S, Perri G, Amodeo A, Drago F. Heart rate reduction strategy using ivabradine in end-stage Duchenne cardiomyopathy. Int J Cardiol 2019; 280:99-103. [DOI: 10.1016/j.ijcard.2019.01.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 12/15/2022]
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15
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Di Molfetta A, Zielinski K, Ferrari G, Kozarski M, Okrzeja P, Iacobelli R, Filippelli S, Perri G, Darowski M, Massetti M, Jarvik R, Amodeo A. Is the New Infant Jarvik 2015 Suitable for Patients<8 kg? In Vitro Study Using a Hybrid Simulator. Artif Organs 2018; 43:E1-E8. [PMID: 30398290 DOI: 10.1111/aor.13302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Our aim was to study the feasibility of implanting the Infant Jarvik 2015 in patients weighing less than 8 kg. The Infant Jarvik 2015 left ventricular assist device (LVAD) was tested in a hybrid simulator of the cardiovascular system reproducing specific patients' hemodynamics for different patient weights (2-7 kg). For each weight, the sensitivity of the pump to different circulatory parameters (peripheral resistance, left ventricular elastance, right ventricular elastance, heart rate, and heart filling characteristics) has been tested repeating for each experiment a pump ramp (10 000-18 000 rpm). The increase in the pump speed causes a decrease (increase) in the left (right) atrial pressure, an increase (decrease) in the arterial systemic (pulmonary) pressure, an increase in the right ventricular pressure, a decrease (increase) in the left (right) ventricular volume, a decrease in the left ventricular cardiac output, an increase in the LVAD output and an increase in the right ventricular cardiac output (total cardiac output). Suction was observed for lower weight patients and for higher pump speed in the case of vasodilation, left ventricular recovery, bradycardia, right ventricular failure, and left ventricular hypertrophy. Backflow was observed in the case of left ventricular recovery at lower pump speed. In the hybrid simulator, the Infant Jarvik 2015 could be suitable for the implantation in patients lower than 8 kg because of the stability of the device respect to the cardio/circulatory changes (low frequency of suction and backflow) and because of the capability of the device to maintain adequate patient hemodynamics.
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Affiliation(s)
| | - Krzysztof Zielinski
- Nalecz Institute of Biocybernetics and Biomedical Engineering PAS, Warsaw, Poland
| | - Gianfranco Ferrari
- Nalecz Institute of Biocybernetics and Biomedical Engineering PAS, Warsaw, Poland
| | - Macej Kozarski
- Nalecz Institute of Biocybernetics and Biomedical Engineering PAS, Warsaw, Poland
| | - Piotr Okrzeja
- Nalecz Institute of Biocybernetics and Biomedical Engineering PAS, Warsaw, Poland
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Gianluigi Perri
- Department of Cardiac Surgery, Policlinico Gemelli Hospital, Rome, Italy
| | - Marek Darowski
- Nalecz Institute of Biocybernetics and Biomedical Engineering PAS, Warsaw, Poland
| | - Massimo Massetti
- Department of Cardiac Surgery, Policlinico Gemelli Hospital, Rome, Italy
| | | | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
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16
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Di Molfetta A, Iacobelli R, Filippelli S, Perri G, Massetti M, Amodeo A. RF63 PROSPECTIVE EVALUATION OF VENTRICULAR LOADING TREND IN PEDIATRIC PATIENTS WITH PULSATILE FLOW LVAD. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550027.72732.d7] [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: 11/05/2022]
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17
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Filippelli S, Perri G, Di Molfetta A, Iacobelli R, Toscano A, Adorisio R, Iodice F, Di Chiara L, Iorio F, Amodeo A. RF20 EVOLUTION OF SMALLEST INTRACORPOREAL CONTINUOUS FLOW LVAD. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550050.58377.16] [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: 11/05/2022]
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18
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Iacobelli R, Di Molfetta A, Toscano A, Drago F, Adorisio R, Perri G, Filippelli S, Di Chiara L, amodeo A, Iorio F, Amodeo A. RF96 WEANING IN CHILDREN WITH LEFT VENTRICULAR ASSIST DEVICE SUPPORT. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550051.58377.5f] [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: 11/05/2022]
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19
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Di Molfetta A, Zielinski K, Ferrari G, Iacobelli R, Perri G, Filippelli S, Darowski M, Massetti M, Amodeo A. OC07 CAN WE USE THE NEW INFANT JARVIK 2015 IN PATIENTS LESS THAN 8KG? A SIMULATION STUDY. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549893.33240.74] [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: 11/05/2022]
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20
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Perri G, Filippelli S, Di Molfetta A, Testa G, Iodice F, Adorisio R, Iacobelli R, Massetti M, Amodeo A. OC54 OUTCOME OF A CONTINOUS FLOW PUMP (JARVIK 2000) AS BRIDGE TO TRANSPLANTATION OR DESTINATION THERAPY IN PEDIATRIC PATIENTS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549871.57072.9e] [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: 11/05/2022]
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21
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Perri G, Filippelli S, Di Molfetta A, Iacobelli R, Di Pasquale L, Ferrari G, Adachi I, Vera RZ, Massetti M, Amode A. RF40 LEFT VENTRICULAR UNLOADING DURING ECMO. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550046.66001.4e] [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: 11/05/2022]
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22
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Marano M, Goffredo BM, Pisani M, Filippelli S, Cecchetti C, Drago F, Barbieri MA, Nunziata J, Genuini L, Di Nardo M. Pediatric extracorporeal cardiopulmonary resuscitation settled in an emergency department for a propafenone intentional intoxication. Am J Emerg Med 2018; 36:2132.e1-2132.e3. [PMID: 30082186 DOI: 10.1016/j.ajem.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 07/29/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022] Open
Abstract
The use of drugs in suicide attempts is becoming more and more frequent among adolescents. Intentional intoxication with propafenone is very rare and mainly reported in adults associated with other drugs. The therapeutic approach is symptomatic, since there is no specific antidote for propafenone. We present a pediatric case of intentional ingestion of 1.8 g of propafenone that caused refractory cardiogenic shock. The patient was successfully rescued with extracorporeal cardiopulmonary resuscitation in the emergency department of a secondary level peripheral hospital.
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Affiliation(s)
- Marco Marano
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Bianca M Goffredo
- Laboratory of Analytical Biochemistry, IRCCS, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Mara Pisani
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Children's Hospital Bambino Gesù, Rome, Italy
| | - Corrado Cecchetti
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Children's Hospital Bambino Gesù, Rome, Italy
| | - Maria A Barbieri
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Joseph Nunziata
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Leonardo Genuini
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Emergency Department, IRCCS, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy.
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23
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Brancaccio G, Filippelli S, Affinito V, Di Donato RM. Use of intermittent high negative pressure vacuum-assisted closure for pediatric poststernotomy mediastinitis. J Cardiovasc Med (Hagerstown) 2018; 18:694-695. [PMID: 21045715 DOI: 10.2459/jcm.0b013e32834037b8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Gianluca Brancaccio
- Department of Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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24
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Di Molfetta A, Iacobelli R, Ferrari G, Filippelli S, Perri G, Toscano A, Adorisio R, Guccione P, Amodeo A. A New 2D Echocardiographic Approach to Evaluate the Membrane and Valve Movement of the Berlin Heart EXCOR VAD Chamber in Pediatric VAD Patients. Artif Organs 2018; 42:451-456. [PMID: 29667250 DOI: 10.1111/aor.13122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/30/2017] [Accepted: 01/04/2018] [Indexed: 11/26/2022]
Abstract
The use of Berlin Heart EXCOR VAD (BH) is a validated therapy to bridge pediatric patients to heart transplant. Serial echocardiographic (ECHO) assessment of VAD patients is necessary to support patients' management. This work aims at developing an innovative strategy to evaluate the BH device functioning by ECHO and its interaction with the native heart in a pediatric population. ECHO evaluation of BH membrane movement, and inflow and outflow valves was performed in 2D, 2D-color Doppler, M-mode, and M-mode color Doppler to assess the functioning of the device by direct positioning of the ECHO probe on the BH cannulas and membranes. Forty Berlin Heart EXCOR VAD were analyzed in 18 patients. Seven BH were placed as RVAD and 33 as LVAD. Results evidenced that 14 (21) inflow (outflow) valves presented a mild regurgitation, while 5 inflow (3 outflow) valves presented a moderate regurgitation. In three cases, we observed severe valve regurgitation with back flow in the left ventricle/right atrium. In both cases, the BH chambers were substituted, but we observed that in one case the regurgitation was due to cannulas compression, while in the other case it was due to valve malfunctioning. The M-mode and the ECHO of the membranes and valves permitted to appreciate the beat phenomenon to assess if the native heart and the BH are working in opposite or in the same phase. The membrane ECHO permits evaluation of minimal changes in membrane movement to assure the completely empty-completely fully work modality. Systematic ECHO assessment of BH chamber might support the BH programming and the detection of anomalous VAD-heart interaction.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Gianfranco Ferrari
- Nalecz Institute of Technology- Department of Biocybernetics and Biomedical Engineer-Warsaw, Poland
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Alessandra Toscano
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Rachele Adorisio
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Paolo Guccione
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
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25
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Di Molfetta A, Iacobelli R, Filippelli S, Grutter G, Perri G, Iodice F, Pasquini L, Guccione P, Amodeo A. Evolution of Biventricular Loading Condition in Pediatric LVAD Patient: A Prospective and Observational Study. Artif Organs 2017; 42:386-393. [PMID: 29230826 DOI: 10.1111/aor.13050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this study was to describe the echocardiographic trend of left ventricular (LV) and right ventricular (RV) function after implantation of a pulsatile flow left ventricular assist device (LVAD) in children. From 2013 to 2016, we prospectively evaluated 13 consecutive pediatric Berlin Heart EXCOR LVAD patients. Clinical and echocardiographic data were collected at baseline, within 24 h after implantation and monthly until LVAD explant. Median age and weight at the implantation was 8 (4-23) months and 5 (4.6-8.3) kg at the time of implantation, respectively. All were affected by dilated cardiomyopathy. Average LVAD support time was 226.2 ± 121.2 days. Nine (70%) were transplanted, 4 (30%) died. LV end-systolic and end-diastolic volumes were reduced until the follow up of two months (P = 0.019 and P = 0.001). A progressive increase in RV dimensions was observed. After 4 months of follow up, RV fractional area change worsening was statistically related with the deterioration of LV unloading (P = 0.0036). Four patients needed prolonged inotropic support for RV failure. Pulsatile LVAD in pediatrics is followed by an early and mid-term LV unloading, as expressed by a decrease in LV volumes and diameters at echocardiogram. The effects of unloading do not remain stable at long term follow up. RV function improved in the acute phase, but a progressive dilatation of RV was noted over time. In some patients, RV failure might lead to the need of an increase of inotropic support at long term follow up.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Giorgia Grutter
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Francesca Iodice
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Luciano Pasquini
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Paolo Guccione
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
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26
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Di Molfetta A, Iacobelli R, Guccione P, Di Chiara L, Rocchi M, Cobianchi Belisari F, Campanale M, Gagliardi MG, Filippelli S, Ferrari G, Amodeo A. Evolution of Ventricular Energetics in the Different Stages of Palliation of Hypoplastic Left Heart Syndrome: A Retrospective Clinical Study. Pediatr Cardiol 2017; 38:1613-1619. [PMID: 28831530 DOI: 10.1007/s00246-017-1704-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/28/2017] [Indexed: 11/27/2022]
Abstract
Hyperplastic left heart syndrome (HLHS) patients are palliated by creating a Fontan-type circulation passing from different surgical stages. The aim of this work is to describe the evolution of ventricular energetics parameters in HLHS patients during the different stages of palliation including the hybrid, the Norwood, the bidirectional Glenn (BDG), and the Fontan procedures. We conducted a retrospective clinical study enrolling all HLHS patients surgically treated with hybrid procedure and/or Norwood and/or BDG and/or Fontan operation from 2011 to 2016 collecting echocardiographic and hemodynamic data. Measured data were used to calculate energetic variables such as ventricular elastances, external and internal work, ventriculo-arterial coupling and cardiac mechanical efficiency. From 2010 to 2016, a total of 29 HLHS patients undergoing cardiac catheterization after hybrid (n = 7) or Norwood (n = 6) or Glenn (n = 8) or Fontan (n = 8) procedure were retrospectively enrolled. Ventricular volumes were significantly higher in the Norwood circulation than in the hybrid circulation (p = 0.03) with a progressive decrement from the first stage to the Fontan completion. Ventricular elastances were lower in the Norwood circulation than in the hybrid circulation and progressively increased passing from the first stage to the Fontan completion. The arterial elastance and Rtot increased in the Fontan circulation. The ventricular work progressively increased. Finally, the ventricular efficiency improves passing from the first to the last stage of palliation. The use of ventricular energetic parameters could lead to a more complete evaluation of such complex patients to better understand their adaptation to different pathophysiological conditions.
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Affiliation(s)
- A Di Molfetta
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Piazza Sant'Onofrio, 4, 00165, Rome, RM, Italy.
| | - R Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Piazza Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - P Guccione
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Piazza Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - L Di Chiara
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Piazza Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - M Rocchi
- Faculty of Biomedical Engineer, Rome University Campus Bio-medico, Via Álvaro del Portillo, 21, Rome, RM, Italy
| | - F Cobianchi Belisari
- Department of Cardiology, Catholic University of Rome, Largo A. Gemelli, 1, 20123, Milan, MI, Italy
| | - M Campanale
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Piazza Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - M G Gagliardi
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Piazza Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - S Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Piazza Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - G Ferrari
- Nalecz Institute of Technology, IBBE-PAS, Warsaw, Poland
| | - A Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Piazza Sant'Onofrio, 4, 00165, Rome, RM, Italy
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Perri G, Filippelli S, Testa G, Iodice F, Adorisio R, Iacobelli R, Di Molfetta A, Massetti M, Amodeo A. Outcome of a Continous Flow Pump (Jarvik 2000) as Bridge to Transplantation or Destination Therapy in Pediatric Patients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.084] [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: 11/16/2022] Open
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Di Molfetta A, Iacobelli R, Grutter G, Filippelli S, Perri G, Iodice F, Pasquini L, Guccione P, Amodeo A. Prospective Evaluation of Ventricular Loading Trend in Pediatric Patients with Pulsatile Flow LVAD. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.743] [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: 11/24/2022] Open
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29
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Di Molfetta A, Iacobelli R, Adorisio R, Filippelli S, Perri G, Testa G, Guccione P, Amodeo A. Evolution of Mitral Regurgitation in Pulsatile Flow LVAD Patients Less Than 10kg. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.757] [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: 11/26/2022] Open
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Di Molfetta A, Ferrari G, Iacobelli R, Filippelli S, Fresiello L, Guccione P, Toscano A, Amodeo A. Application of a Lumped Parameter Model to Study the Feasibility of Simultaneous Implantation of a Continuous Flow Ventricular Assist Device (VAD) and a Pulsatile Flow VAD in BIVAD Patients. Artif Organs 2017; 41:242-252. [PMID: 28281287 DOI: 10.1111/aor.12911] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 11/18/2016] [Accepted: 12/07/2016] [Indexed: 11/30/2022]
Abstract
The aim of this work is to develop and test a lumped parameter model of the cardiovascular system to simulate the simultaneous use of pulsatile (P) and continuous flow (C) ventricular assist devices (VADs) on the same patient. Echocardiographic and hemodynamic data of five pediatric patients undergoing VAD implantation were retrospectively collected and used to simulate the patients' baseline condition with the numerical model. Once the baseline hemodynamic was reproduced for each patient, the following assistance modalities were simulated: (a) CVAD assisting the right ventricle and PVAD assisting the left ventricle (RCF + LPF), (b) CVAD assisting the left ventricle and PVAD assisting the right ventricle (LCF + RPF). The numerical model can well reproduce patients' baseline. The cardiac output increases in both assisted configurations (RCF + LPF: +17%, LCF + RPF: +21%, P = ns), left (right) ventricular volumes decrease more evidently in the configuration LCF + RPF (RCF + LPF), left (right) atrial pressure decreases in the LCF + RPF (RCF + LPF) modality. The pulmonary arterial pressure slightly decreases in the configuration LCF + RPF and it increases with RCF + LPF. Left and right ventricular external work increases in both configurations probably because of the total cardiac output increment. However, left and right artero-ventricular coupling improves especially in the LCF + RPF (-36% for the left ventricle and -21% for the right ventricle, P = ns). The pulsatility index decreases by 8.5% in the configuration LCF + RPF and increases by 6.4% with RCF + LPF (P = 0.0001). A numerical model could be useful to tailor on patients the choice of the VAD that could be implanted to improve the hemodynamic benefits. Moreover, a model could permit to simulate extreme physiological conditions and innovative configurations, as the implantation of both CVAD and PVAD on the same patient.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù
| | - Gianfranco Ferrari
- Cardiovascular Engineering, Institute of Clinical Physiology, Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù
| | - Libera Fresiello
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Paolo Guccione
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù
| | - Alessandra Toscano
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital, Bambino Gesù
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Di Molfetta A, Ferrari G, Iacobelli R, Filippelli S, Amodeo A. Concurrent use of continuous and pulsatile flow Ventricular Assist Device on a fontan patient: A simulation study. Artif Organs 2016; 41:32-39. [PMID: 28025826 DOI: 10.1111/aor.12859] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/07/2016] [Accepted: 08/18/2016] [Indexed: 01/15/2023]
Abstract
The aim of this work is to develop and test a lumped parameter model of the cardiovascular system to simulate the concurrent use of pulsatile (PVAD) and continuous flow (CVAD) ventricular assist device (VAD) on Fontan patients. Echocardiographic and hemodynamic data of five Fontan patients were retrospectively collected and used to simulate the patients' baseline hemodynamics. Then, for each patient, the following assistance modality was simulated for the cavopulmonary and the single ventricle (SV): (a) CVAD for cavopulmonary assistance (RCF) and PVAD assisting the SV (LCF) (RPF + LCF), (b) CVAD assisting SV and PVAD for cavopulmonary assistance (LPF + RCF). The numerical model can well reproduce patients' baseline. The cardiac output increases more importantly in the LCF + RPF configuration (35 vs. 8%). Ventricular volume decreases more evidently in the configuration LCF + RPF (28 vs. 6%), atrial pressure decreases in the LCF + RPF modality (10%), while it slightly increases in the RCF + LPF modality. The pulmonary arterial pressure slightly decreases (increases) in the configuration RCF + LPF (LCF + RPF). Ventricular external work increases in both configurations because of the total increment of the cardiac output. However, artero-ventricular coupling improves in both configurations: RCF + LPF-14%, LCF + RPF-41%. The pulsatility index decreases (increases) by 8% (13.8%) in the configuration LCF + RPF (RCF + LPF). A model could permit us to simulate extreme physiological conditions of the implantation of both CF and PF VAD on the Fontan patient and could permit to choose the proper VAD on the base of patients' condition. The configuration LCF + RPF seems to maximize the hemodynamic benefits.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù
| | | | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù
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Di Molfetta A, Gandolfo F, Filippelli S, Perri G, Di Chiara L, Iacobelli R, Adorisio R, Favia I, Rizza A, Testa G, Di Nardo M, Amodeo A. The Use of Berlin Heart EXCOR VAD in Children Less than 10 kg: A Single Center Experience. Front Physiol 2016; 7:614. [PMID: 27999550 PMCID: PMC5138210 DOI: 10.3389/fphys.2016.00614] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 08/28/2016] [Accepted: 11/24/2016] [Indexed: 12/23/2022] Open
Abstract
Objective: Despite the improvement in ventricular assist device (VAD) therapy in adults and in adolescents, in infant population only Berlin Heart EXCOR (BHE) is licensed as long term VAD to bridge children to Heart Transplantation (HTx). Particularly demanding in terms of morbidity and mortality are smallest patients namely the ones implanted in the first year of life or with a lower body surface area. This work aims at retrospective reviewing a single center experience in using BHE in children with a body weight under 10 kg. Methods: Data of all pediatric patients under 10 kg undergoing BHE implantation in our institution from March 2002 to March 2016 were retrospectively reviewed. Results: Of the 30 patients enrolled in the study, 53% were male, 87% were affected by a dilated cardiomyopathy with an average weight and age at the implantation of 6.75 ± 2.16 Kg and 11.57 ± 10.12 months, respectively. Three patients (10%) required a BIVAD implantation. After the implantation, 7 patients (23%) required re-intervention for bleeding and 9 patients (30%) experienced BHE cannulas infection. A total of 56 BHE pump were changed for thrombus formation (1.86 BHE pump for patient). The average duration of VAD support was 132.8 ± 94.4 days. Twenty patients (67%) were successfully transplanted and 10 patients (33%) died: 7 for major neurological complication and 3 for sepsis. Conclusion: Mechanical support in smaller children with end stage heart failure is an effective strategy for bridging patients to HTx. The need for BIVAD was relegated, in the last years, only to restrictive cardiomiopathy. Further efforts are required in small infants to improve anticoagulation strategy to reduce neurological events and BHE pump changes.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Fabrizio Gandolfo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Luca Di Chiara
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Rachele Adorisio
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Isabella Favia
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Alessandra Rizza
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Giuseppina Testa
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Matteo Di Nardo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù Rome, Italy
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33
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Di Molfetta A, Ferrari G, Iacobelli R, Fresiello L, Pilati M, Toscano A, Filippelli S, Morelli S, Amodeo A. Acute Biventricular Interaction in Pediatric Patients Implanted with Continuous Flow and Pulsatile Flow LVAD: A Simulation Study. ASAIO J 2016; 62:591-9. [DOI: 10.1097/mat.0000000000000396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Di Molfetta A, Filippelli S, Ferrari G, Secinaro A, Zielinski K, Amodeo A. Berlin Heart EXCOR Ventricular Assist Device: Multilayer Membrane Rupture in a Pediatric Patient. Ann Thorac Surg 2016; 102:e129-30. [PMID: 27449447 DOI: 10.1016/j.athoracsur.2016.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 12/29/2015] [Accepted: 01/06/2016] [Indexed: 11/17/2022]
Abstract
A 2-year-old child was implanted with an Berlin Heart EXCOR Ventricular Assist Device (Berlin Heart, Berlin, Germany) as a bridge to heart transplantation for idiopathic dilated cardiomyopathy. At postoperative day 296, a significant reduction of membrane movement was observed. The device was explanted and tested on a hydronumerical circulation simulator. Findings suggested that the integrity of the multilayered membrane had been compromised. This was confirmed by a computed tomography scan of the device. The computed tomography evidenced a detachment of the 3-layered membrane, with a thinner, convex layer on the side of the air chamber and an opposite convexity of the remaining membranes. These showed an additional air space within the layers.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy.
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Gianfranco Ferrari
- Cardiovascular Engineering Laboratory-Institute of Clinical Physiology, CNR, Rome, Italy
| | - Aurelio Secinaro
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Krystzof Zielinski
- Nałęcz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
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Gandolfo F, Brancaccio G, Donatiello S, Filippelli S, Perri G, Iannace E, D'Amario D, Testa G, D'Avenio G, Grigioni M, Amodeo A. Mechanically Assisted Total Cavopulmonary Connection With an Axial Flow Pump: Computational and In Vivo Study. Artif Organs 2015; 40:43-9. [DOI: 10.1111/aor.12641] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Fabrizio Gandolfo
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
| | - Gianluca Brancaccio
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
| | - Salvatore Donatiello
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
- Department of Technology and Health; Italian National Institute of Health; Rome Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
| | - Gianluigi Perri
- Department of Cardiology; Policlinico A. Gemelli; Rome Italy
| | - Enrico Iannace
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
| | | | - Giuseppina Testa
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
| | - Giuseppe D'Avenio
- Department of Technology and Health; Italian National Institute of Health; Rome Italy
| | - Mauro Grigioni
- Department of Technology and Health; Italian National Institute of Health; Rome Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiac Surgery; Bambino Gesù Children's Hospital IRCCS; Rome Italy
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36
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Di Molfetta A, Amodeo A, Fresiello L, Filippelli S, Pilati M, Iacobelli R, Adorisio R, Colella D, Ferrari G. The use of a numerical model to simulate the cavo-pulmonary assistance in Fontan circulation: a preliminary verification. J Artif Organs 2015; 19:105-13. [PMID: 26545595 DOI: 10.1007/s10047-015-0874-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/26/2015] [Accepted: 10/26/2015] [Indexed: 12/30/2022]
Abstract
The lack of an established experience on the use of VAD for the cavo-pulmonary assistance leads to the need of dedicated VADs development and animal experiments. A dedicated numerical model could support clinical and experimental strategies design and new VADs testing. The aim of this work is to perform a preliminary verification of a lumped parameter model of the cardiovascular system to simulate Fontan physiology and the effect of cavo-pulmonary assistance. Literature data of 4 pigs were used to simulate animals' baseline, and then the model was tested in simulating Fontan circulation and cavo-pulmonary-assisted condition comparing the simulation outcome (Sim) with measured literature data (Me). The results show that the numerical model can well reproduce experimental data in all three conditions (baseline, Fontan and assisted Fontan) [cardiac output (l/min): Me = 2.8 ± 1.7, Sim = 2.8 ± 1.8; ejection fraction (%): Me = 57 ± 17, Sim = 54 ± 17; arterial systemic pressure (mmHg): Me = 41.8 ± 18.6, Sim = 43.8 ± 18.1; pulmonary arterial pressure (mmHg): Me = 15.4 ± 8.9, Sim = 17.7 ± 9.9; caval pressure (mmHg): Me = 6.8 ± 4.1, Sim = 7 ± 4.6]. Systolic elastance, arterial systemic and arterial pulmonary resistances increase (10, 69, and 100 %) passing from the biventricular circulation to the Fontan physiology and then decrease (21, 39, and 50 %) once the VAD was implanted. The ventricular external work decreases (71 %) passing from the biventricular circulation to the Fontan physiology and it increases three times after the VAD implantation in parallel with the VAD power consumption. A numerical model could support clinicians in an innovative and challenging field as the use of VAD to assist the Fontan physiology and it could be helpful to personalize the VAD insertion on the base of ventricular systo-diastolic function, circulatory parameters and energetic variables.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy.
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy
| | | | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy
| | - Mara Pilati
- Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy
| | - Rachele Adorisio
- Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Via San Martino della Battaglia, 44, 00185, Rome, Italy
| | - Dionisio Colella
- Cardiac Surgery Intensive Care Unit, University of Tor Vergata, Rome, Italy
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Di Molfetta A, Amodeo A, Gagliardi MG, Trivella MG, Fresiello L, Filippelli S, Toscano A, Ferrari G. Hemodynamic Effects of Ventricular Assist Device Implantation on Norwood, Glenn, and Fontan Circulation: A Simulation Study. Artif Organs 2015; 40:34-42. [PMID: 26526959 DOI: 10.1111/aor.12591] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The growing population of failing single-ventricle (SV) patients might benefit from ventricular assist device (VAD) support as a bridge to heart transplantation. However, the documented experience is limited to isolated case reports. Considering the complex and different physiopathology of Norwood, Glenn, and Fontan patients and the lack of established experience, the aim of this work is to realize and test a lumped parameter model of the cardiovascular system able to simulate SV hemodynamics and VAD implantation effects to support clinical decision. Hemodynamic and echocardiographic data of 30 SV patients (10 Norwood, 10 Glenn, and 10 Fontan) were retrospectively collected and used to simulate patients' baseline. Then, the effects of VAD implantation were simulated. Simulation results suggest that the implantation of VAD: (i) increases the cardiac output and the mean arterial systemic pressure in all the three palliation conditions (Norwood 77.2 and 19.7%, Glenn 38.6 and 32.2%, and Fontan 17.2 and 14.2%); (ii) decreases the SV external work (Norwood 55%, Glenn 35.6%, and Fontan 41%); (iii) decreases the pressure pulsatility index (Norwood 65.2%, Glenn 81.3%, and Fontan 64.8%); (iv) increases the pulmonary arterial pressure in particular in the Norwood circulation (Norwood 39.7%, Glenn 12.1% and Fontan 3%); and (v) decreases the atrial pressure (Norwood 2%, Glenn 10.6%, and Fontan 8.6%). Finally, the VAD work is lower in the Norwood circulation (30.4 mL·mm Hg) in comparison with Fontan (40.3 mL·mm Hg) and to Glenn (64.5 mL·mm Hg) circulations. The use of VAD in SV physiology could be helpful to bridge patients to heart transplantations by increasing the CO and unloading the SV with a decrement of the atrial pressure and the SV external work. The regulation of the pulmonary flow is challenging because the Pap is increased by the presence of VAD. The hemodynamic changes are different in the different SV palliation step. The use of numerical models could be helpful to support patient and VAD selection to optimize the clinical outcome.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Maria G Gagliardi
- Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Maria G Trivella
- Cardiovascular Engineering Laboratory-Institute of Clinical Physiology, CNR, Rome, Italy
| | - Libera Fresiello
- Clinical Cardiac Surgery Department, Catholic University of Leuven, Leuven, Belgium
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Alessandra Toscano
- Department of Pediatric Cardiology and Cardiosurgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Gianfranco Ferrari
- Cardiovascular Engineering Laboratory-Institute of Clinical Physiology, CNR, Rome, Italy
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38
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Di Molfetta A, Ferrari G, Filippelli S, Fresiello L, Iacobelli R, Gagliardi MG, Amodeo A. Use of Ventricular Assist Device in Univentricular Physiology: The Role of Lumped Parameter Models. Artif Organs 2015; 40:444-53. [PMID: 26494529 DOI: 10.1111/aor.12583] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Failing single-ventricle (SV) patients might benefit from ventricular assist devices (VADs) as a bridge to heart transplantation. Considering the complex physiopathology of SV patients and the lack of established experience, the aim of this work was to realize and test a lumped parameter model of the cardiovascular system, able to simulate SV hemodynamics and VAD implantation effects. Data of 30 SV patients (10 Norwood, 10 Glenn, and 10 Fontan) were retrospectively collected and used to simulate patients' baseline. Then, the effects of VAD implantation were simulated. Additionally, both the effects of ventricular assistance and cavopulmonary assistance were simulated in different pathologic conditions on Fontan patients, including systolic dysfunction, diastolic dysfunction, and pulmonary vascular resistance increment. The model can reproduce patients' baseline well. Simulation results suggest that the implantation of VAD: (i) increases the cardiac output (CO) in all the three palliation conditions (Norwood 77.2%, Glenn 38.6%, and Fontan 17.2%); (ii) decreases the SV external work (SVEW) (Norwood 55%, Glenn 35.6%, and Fontan 41%); (iii) increases the mean pulmonary arterial pressure (Pap) (Norwood 39.7%, Glenn 12.1%, and Fontan 3%). In Fontan circulation, with systolic dysfunction, the left VAD (LVAD) increases CO (35%), while the right VAD (RVAD) determines a decrement of inferior vena cava pressure (Pvci) (39%) with 34% increment of CO. With diastolic dysfunction, the LVAD increases CO (42%) and the RVAD decreases the Pvci. With pulmonary vascular resistance increment, the RVAD allows the highest CO (50%) increment with the highest decrement of Pvci (53%). The single ventricular external work (SVEW) increases (decreases) increasing the VAD speed in cavopulmonary (ventricular) assistance. Numeric models could be helpful in this challenging and innovative field to support patients and VAD selection to optimize the clinical outcome and personalize the therapy.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | | | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Libera Fresiello
- Section of Rome, CNR, Institute of Clinical Physiology, Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Maria G Gagliardi
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Hospital Bambino Gesù, Rome, Italy
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Filippelli S, Perri G, Brancaccio G, Iodice FG, Albanese SB, Trimarchi E, Carotti A. Vacuum-Assisted Closure System in Newborns After Cardiac Surgery. J Card Surg 2014; 30:190-3. [DOI: 10.1111/jocs.12463] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Surgery; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Gianluca Brancaccio
- Department of Pediatric Cardiology and Cardiac Surgery; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Francesca G. Iodice
- Department of Pediatric Cardiology and Cardiac Surgery; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Sonia B. Albanese
- Department of Pediatric Cardiology and Cardiac Surgery; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Eugenio Trimarchi
- Pediatric Cardiac Surgery Unit; San Vincenzo Hospital; Taormina Italy
| | - Adriano Carotti
- Department of Pediatric Cardiology and Cardiac Surgery; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
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Gandolfo F, Brancaccio G, Iannace E, Filippelli S, Grigioni M, Donatiello S, D'Amario D, Amodeo A. 103 * MECHANICALLY ASSISTED TOTAL CAVOPULMONARY CONNECTION WITH AN AXIAL FLOW PUMP: IN VIVO AND COMPUTATIONAL STUDY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.103] [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: 11/12/2022] Open
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Filippelli S, Perri G, Kirk R, Hasan A, Griselli M. Surgical management of a neonate with congenitally corrected transposition of the great vessels, hypoplastic right aortic arch, and Ebstein anomaly. J Card Surg 2013; 28:764-6. [PMID: 23947600 DOI: 10.1111/jocs.12200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a neonate with a primary diagnosis of congenitally corrected transposition (ccTGA) of the great vessels, hypoplastic right aortic arch, and a severely regurgitant Ebstein tricuspid valve (TV). During the fetal period, she was listed for heart transplantation, and two weeks after birth due to a deterioration of her general condition, we performed a Norwood-Sano modified procedure. After 58 days a donor heart became available and the baby successfully received a orthotopic heart transplantation.
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Affiliation(s)
- Sergio Filippelli
- Paediatric Cardiothoracic Surgery Department, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
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Filippelli S, Perri G, Kirk R, Griselli M, Hasan A. Successful Pediatric Orthotopic Heart Transplantation After Three Runs of Mechanical Circulatory Support. Ann Thorac Surg 2013; 95:2176-8. [DOI: 10.1016/j.athoracsur.2012.10.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 10/26/2012] [Accepted: 10/31/2012] [Indexed: 11/25/2022]
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Gandolfo F, Filippelli S, Cetrano E, Carotti A. Managing major vessel injuries with a Fogarty catheter during chest re-opening in children. Interact Cardiovasc Thorac Surg 2013; 17:216-7. [PMID: 23543404 DOI: 10.1093/icvts/ivt084] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Injury of structures, leading to a major bleeding during chest opening, is a severe and potentially life-threatening complication, especially in redo cardiac surgery, both in adults and children. In three paediatric redo operations performed via midline sternotomy, we managed this complication successfully and uneventfully by using an inflated Fogarty catheter to plug the blood leak from the injured vessel before repairing the lesion under direct vision in a bloodless surgical field. Herein we report in detail the technique used and a comment on our experience.
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Affiliation(s)
- Fabrizio Gandolfo
- Department of Paediatric Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Perri G, Filippelli S, Polito A, Di Carlo D, Albanese SB, Carotti A. Repair of incompetent truncal valves: early and mid-term results. Interact Cardiovasc Thorac Surg 2013; 16:808-13. [PMID: 23487600 DOI: 10.1093/icvts/ivt098] [Citation(s) in RCA: 9] [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] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To analyse the factors associated with in-hospital mortality and mid-term significant neoaortic valve regurgitation (AR) after truncal valve (TV) repair. METHODS Eleven children underwent TV repair at our institution from July 1999 to March 2012. All children presented significant preoperative TV regurgitation. Valve anatomy was quadricuspid in 7 (64%) patients and tricuspid in 4 (36%). The median age and weight at surgery were 29.6 (range 0.3-173.2) months and 12 (range 2.2-49) kg, respectively. Repair included bicuspidalization through the approximation of two leaflets associated with triangular resection of the opposite one (n = 2, 18%), or either bicuspidalization or tricuspidalization of the TV through excision of one leaflet and related sinus of Valsalva (n = 9, 82%). In 3 patients, repair was associated with coronary detachment before cusp removal, followed by coronary reimplantation. RESULTS In-hospital death occurred in 2 (18%) patients. Factors associated with hospital mortality were age <1 year (P = 0.05), weight <3 kg (P = 0.02) and longer cross-clamping time (P = 0.008). Follow-up was complete for all patients [median follow-up time: 52.2 (range 132.2-2.5) months]. Mid-term significant AR occurred in 4 patients (45%, moderate in 2 and severe in 2). One with severe AR underwent successful valve replacement 4 months postoperatively, leading to freedom from reintervention of 91%. Freedom from significant AR was 76.2 (33.2-93.5) and 60.9 (20.2-85.6) at 1 and 2 years, respectively. There was a trend towards longer freedom from mid-term significant AR for patients who underwent cusp removal compared with those who did not (P = 0.07). CONCLUSIONS TV repair in children can be performed safely with fairly good and durable results. Cusp removal might decrease the rate of severe AR on mid-term follow-up.
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Affiliation(s)
- Gianluigi Perri
- Unit of Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Botha P, Hasan A, Perri G, Filippelli S, Griselli M. Modified Technique for the Implantation of Berlin Heart Excor Ventricular Assist Device in Children. World J Pediatr Congenit Heart Surg 2012; 3:373-7. [DOI: 10.1177/2150135112437796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Phil Botha
- Department of Paediatric Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Trust, UK
| | - Asif Hasan
- Department of Paediatric Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Trust, UK
| | - Gianluigi Perri
- Department of Paediatric Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Trust, UK
| | - Sergio Filippelli
- Department of Paediatric Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Trust, UK
| | - Massimo Griselli
- Department of Paediatric Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Trust, UK
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Perri G, Filippelli S, Kirk R, Hasan A, Griselli M. Surgical repair of an unusual type of supra-cardiac total anomalous pulmonary venous connection to the superior vena cava. J Card Surg 2012; 27:384-6. [PMID: 22497294 DOI: 10.1111/j.1540-8191.2012.01438.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Anomalies of the pulmonary venous drainage vary widely in their anatomic spectrum and clinical presentation. We describe an unusual case of supra-cardiac total anomalous pulmonary venous connection (TAPVC), where the pulmonary veins drained directly in the posterior aspect of proximal right superior vena cava (SVC) through separate ostia. The veins were re-routed with a patch to the left atrium via the secundum atrial septal defect (ASD). The continuity between distal SVC and right atrium was re-established by re-implanting the SVC to the right atrial appendage (Warden Procedure).
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Affiliation(s)
- Gianluigi Perri
- Paediatric Cardiothoracic Surgery Department, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Trust, United Kingdom.
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Amodeo A, Brancaccio G, Michielon G, Filippelli S, Ricci Z, Morelli S, Gagliardi MG, Iacobelli R, Pongiglione G, Di Donato RM. Pneumatic Pulsatile Ventricular Assist Device as a Bridge to Heart Transplantation in Pediatric Patients. Artif Organs 2010; 34:1017-22. [DOI: 10.1111/j.1525-1594.2010.01144.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [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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Amodeo A, Grigioni M, Filippelli S, Gagliardi MG, Del Gaudio C, Morbiducci U, D'Avenio G, Brancaccio G, Di Donato RM. Improved management of systemic venous anomalies in a single ventricle: New rationale. J Thorac Cardiovasc Surg 2009; 138:1154-9. [DOI: 10.1016/j.jtcvs.2009.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Revised: 12/11/2008] [Accepted: 04/01/2009] [Indexed: 10/20/2022]
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Michielon G, Marino B, Oricchio G, Digilio MC, Iorio F, Filippelli S, Placidi S, Di Donato RM. Impact of DEL22q11, trisomy 21, and other genetic syndromes on surgical outcome of conotruncal heart defects. J Thorac Cardiovasc Surg 2009; 138:565-570.e2. [PMID: 19698836 DOI: 10.1016/j.jtcvs.2009.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [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: 09/09/2008] [Revised: 02/16/2009] [Accepted: 03/11/2009] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Genetic syndromes occur in more than 20% of patients with conotruncal heart defects. We investigated the impact of genetic syndromes on the surgical outcome of conotruncal anomalies in infancy. METHODS This retrospective study reviews the outcome of 787 patients (median age 6.3 months) who underwent primary (598) or staged (189) repair of a conotruncal defect between 1992 and 2007. RESULTS Proven genetic syndrome was diagnosed in 211 patients (26.8%), including del22q11 (91 patients), trisomy 21 (29 patients), VACTERL (18 patients), and other syndromes (73 patients). Primary repair was accomplished in 80.9% of nonsyndromic patients and 74.4% of syndromic patients (P = .18) Fifteen-year cumulative survival was 84.3% +/- 2.3% in nonsyndromic patients and 73.2% +/- 4.2% in syndromic patients (P < .001). Primary and staged repair allowed similar 15-year survival (81.4% +/- 4.5% vs 79.1% +/- 5.1%, P = .8). Freedom from noncardiac cause of death was significantly lower in syndromic patients (P = .0056). Fifteen-year Kaplan-Meier survival was 87.6% +/- 3.9% for del22q11, 95.8% +/- 4.1% for trisomy 21, 56.8% +/- 6.3% for VACTERL, and 62.3% +/- 12.7% for patients with other syndromes (P = .022). Total intensive care unit stay was 10.8 +/- 4.9 days in syndromic patients and 5.1 +/- 1.7 days in nonsyndromic patients (P < .001). Freedom from reintervention 15 years after repair was 79.6% +/- 4.9% in nonsyndromic patients and 62.4% +/- 7.4% in syndromic patients (P = .007). CONCLUSION Del22q11 and trisomy 21 do not represent risk factors for mortality after repair of conotruncal anomalies, whereas other syndromes adversely affect the surgical outcome for predominant noncardiac attrition. Higher morbidity and lower mid-term freedom from reintervention can be predicted in syndromic patients.
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Affiliation(s)
- Guido Michielon
- Dipartimento Medico-Chirurgico di Cardiochirurgia e Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
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Brancaccio G, Michielon G, Filippelli S, Perri G, Di Carlo D, Iorio FS, Oricchio G, Iacobelli R, Amodeo A, Di Donato RM. Transannular patching is a valid alternative for tetralogy of Fallot and complete atrioventricular septal defect repair. J Thorac Cardiovasc Surg 2009; 137:919-23. [DOI: 10.1016/j.jtcvs.2008.09.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 04/06/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
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