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Lissandrin R, Sangani A, Pesare R, Minucci R, Pisani GP, Gazzoli F, Pelenghi S, Bruno R, Seminari E. Ultrasound for management of left ventricular assist device driveline infections: A single-center experience. Transpl Infect Dis 2024; 26:e14178. [PMID: 37870489 DOI: 10.1111/tid.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/24/2023]
Affiliation(s)
| | - Aurelia Sangani
- Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Treatment, University di Pavia, Pavia, Italy
| | - Rebecca Pesare
- Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Treatment, University di Pavia, Pavia, Italy
| | - Rita Minucci
- Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Treatment, University di Pavia, Pavia, Italy
| | - Giulia Pinuccia Pisani
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Cardiac Surgery Depertment, ASST Lecco, "A. Manzoni" Hospital, Lecco, Italy
| | - Fabrizio Gazzoli
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Pelenghi
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Medical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Elena Seminari
- Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Totaro P, Pelenghi S. Extracorporeal Membrane Oxygenation After Heart Transplantation: How to Improve This Relationship? Ann Thorac Surg 2023; 116:1353-1354. [PMID: 37414381 DOI: 10.1016/j.athoracsur.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/03/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Pasquale Totaro
- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Piazzale Golgi, 1, 20123 Pavia, Italy.
| | - Stefano Pelenghi
- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Piazzale Golgi, 1, 20123 Pavia, Italy
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Totaro P, Sciortino A, Amoroso F, Preda Z, Pelenghi S. [Ascending aortic disease: is general perception updated to current guidelines?]. G Ital Cardiol (Rome) 2023; 24:990-996. [PMID: 38009352 DOI: 10.1714/4139.41346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
BACKGROUND Thoracic aorta diseases represent a frequent cause of hospitalization and up to 15% of workload of a modern cardiac surgery centre. A dedicated thoracic aorta disease clinic was launched at our Division in January 2020. The clinic was open for new referrals as well as for preoperative and postoperative follow-up of patients. Here we report a summary of the activity of such dedicated clinic correlated to current international guidelines. METHODS Overall, 288 patients were seen at the clinic: 84 (29%) new referrals; 28 (10%) for preoperative follow-up and 176 (61%) for postoperative follow-up. New referrals included urgent referral (n = 57, 68%) and scheduled referral (n = 27, 32%). The majority of urgent new referrals were from general practitioners (n = 34, 60%). Postoperative follow-up also included a minority (n = 27, 15%) of urgent referrals. RESULTS Within new referrals, according to current guidelines, only 7% (n = 6) had surgical indication at time of referral (40% of urgent referral); 34% (n = 28) were in the so-called grey zone and required close follow-up (26% of urgent referrals); 59% (n = 50) had no significant aortic disease to require neither urgent specialist consultation nor close follow-up (85% of urgent referrals). Within postoperative follow-up, 7% (n = 12) required surgical reintervention (none with urgent referral). Furthermore, the majority of new referrals (especially within urgent referrals) showed only moderate aortic dilation. CONCLUSIONS Current perception of clinical severity of thoracic aorta diseases is still suboptimal. Most patients are indeed referred as urgent despite non-significant aortic dilation. In contrast, potentially dangerous situations are frequently underestimated. An accurate territorial policy of sensitization and updating focused on thoracic aorta diseases is therefore essential in order to reduce the risks of acute aortic syndromes in our country.
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Affiliation(s)
- Pasquale Totaro
- U.O.C. Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia
| | - Antonio Sciortino
- U.O.C. Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia
| | - Filippo Amoroso
- U.O.C. Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia
| | - Zaira Preda
- U.O.C. Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia
| | - Stefano Pelenghi
- U.O.C. Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia
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Lamastra R, Abbott DM, Degani A, Pellegrini C, Veronesi R, Pelenghi S, Dezza C, Gazzaniga G, Belliato M. Left atrium veno-arterial extra corporeal membrane oxygenation as temporary mechanical support for cardiogenic shock: A case report. World J Clin Cases 2023; 11:6531-6536. [PMID: 37900254 PMCID: PMC10600982 DOI: 10.12998/wjcc.v11.i27.6531] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Veno-arterial extra corporeal membrane oxygenation (VA-ECMO) support is commonly complicated with left ventricle (LV) distension in patients with cardiogenic shock. We resolved this problem by transeptally converting VA-ECMO to left atrium veno-arterial (LAVA)-ECMO that functioned as a temporary paracorporeal left ventricular assist device to resolve LV distension. In our case LAVA-ECMO was also functioning as a bridge-to-transplant device, a technique that has been scarcely reported in the literature. CASE SUMMARY A 65 year-old man suffered from acute myocardial injury that required percutaneous stents. Less than two weeks later, noncompliance to antiplatelet therapy led to stent thrombosis, cardiogenic shock, and cardiac arrest. Femoro-femoral VA-ECMO support was started, and the patient underwent a second coronary angiography with re-stenting and intra-aortic balloon pump placement. The VA-ECMO support was complicated by left ventricular distension which we resolved via LAVA-ECMO. Unfortunately, episodes of bleeding and sepsis complicated the clinical picture and the patient passed away 27 d after initiating VA-ECMO. CONCLUSION This clinical case demonstrates that LAVA-ECMO is a viable strategy to unload the LV without another invasive percutaneous or surgical procedure. We also demonstrate that LAVA-ECMO can also be weaned to a left ventricular assist device system. A benefit of this technique is that the procedure is potentially reversible, should the patient require VA-ECMO support again. A transeptal LV venting approach like LAVA-ECMO may be indicated over ImpellaTM in cases where less LV unloading is required and where a restrictive myocardium could cause LV suctioning. Left ventricular over-distention is a well-known complication of peripheral VA-ECMO in cardiogenic shock and LAVA ECMO through transeptal cannulation offers a novel and safe approach for treating LV overloading, without the need of an additional percutaneous access.
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Affiliation(s)
- Rossana Lamastra
- Department of Surgical, Pediatric and Diagnostic Sciences, University of Pavia, Pavia 27100, PV, Italy
| | - David Michael Abbott
- Department of Surgical, Pediatric and Diagnostic Sciences, University of Pavia, Pavia 27100, PV, Italy
| | - Antonella Degani
- Department of Cardiothoracic Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, PV, Italy
| | - Carlo Pellegrini
- Clinical, Surgical, Diagnostic and Pediatric Sciences Department, University of Pavia, Italy - Department of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo Foundation, Pavia 27100, PV, Italy
| | - Roberto Veronesi
- SC-AR2 Anestesia e Terapia Intensiva Cardiotoracica Fondazione IRCCS Policlinico San Matteo, Pavia 27100, PV, Italy
| | - Stefano Pelenghi
- Department of Cardiac Surgery 1, IRCCS University Hospital Foundation "San Matteo", Pavia 27100, Italy
| | - Chiara Dezza
- SC-AR2 Anestesia e Terapia Intensiva Cardiotoracica Fondazione IRCCS Policlinico San Matteo, Pavia 27100, PV, Italy
| | - Giulia Gazzaniga
- Department of Surgical, Pediatric and Diagnostic Sciences, University of Pavia, Pavia 27100, PV, Italy
| | - Mirko Belliato
- SC-AR2 Anestesia e Terapia Intensiva Cardiotoracica Fondazione IRCCS Policlinico San Matteo, Pavia 27100, PV, Italy
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Totaro P, Morganti S, Auricchio F, Pelenghi S. Aortic wall thickness in dilated ascending aorta: Comparison between tricuspid and bicuspid aortic valve. Arch Cardiovasc Dis 2023:S1875-2136(23)00167-5. [PMID: 37770332 DOI: 10.1016/j.acvd.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Bicuspid aortic valve (BAV) is frequently associated with dilatation of the thoracic aorta. Peculiar anatomical, histological and mechanical changes of the aortic wall in BAV aortopathy have been hypothesized to suggest an increased risk of acute aortic complications in patients with BAV. AIM In this study we tried to clarify any differences in the adaptability of the aortic wall to the mechanism of dilatation between patients with BAV and those with TAV. METHODS In total, 354 samples were taken from 71 patients undergoing elective aortic surgery and divided into two groups: BAV group (n=16; 101 samples); and TAV group (n=55; 253 samples). Aortic wall thickness was measured with a dedicated caliper. The relationship between aortic wall thickness and aortic dilatation and demographic variables was evaluated cumulatively and comparatively (BAV versus TAV). In patients with more than three samples available, intrapatient variability was also studied. Finally, potential risk factors for severely reduced aortic wall thickness were also assessed. RESULTS Analysis of preoperative characteristics revealed significant differences in patient age (54±16years for BAV and 66±11years for TAV; P=0.0011), with no differences in variables related to aortic dilatation (including phenotype). Cumulative aortic wall thickness was significantly thinner in the anterior than in the posterior wall. In the comparative analysis, aortic wall thickness was significantly thinner in patients with BAV in both the anterior and posterior regions. Furthermore, in patients with BAV, dilatation>51mm was a significant predictor of severely reduced aortic wall thickness. CONCLUSIONS In our experience, patients with BAV aortopathy reached the cut-off for the surgical indication at an early age. Careful monitoring in patients with BAV is mandatory when aortic dilatation has reached 51mm, as it is related to significant anatomical changes.
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Affiliation(s)
- Pasquale Totaro
- Division of Cardiac Surgery, IRCCS Foundation Hospital "San Matteo", Piazzale Golgi 1, 27100 Pavia, Italy.
| | - Simone Morganti
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, 27100 Pavia, Italy
| | - Stefano Pelenghi
- Division of Cardiac Surgery, IRCCS Foundation Hospital "San Matteo", Piazzale Golgi 1, 27100 Pavia, Italy
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Di Giacomo C, Cornara S, Aiello M, Lanzillo G, Somaschini A, Gazzoli F, Belliato M, Visconti LO, Pelenghi S, Ferlini M. Neutrophil-to-lymphocyte ratio in patients undergoing transfemoral transcatheter aortic valve replacement. J Cardiovasc Med (Hagerstown) 2023; 24:478-479. [PMID: 37285279 DOI: 10.2459/jcm.0000000000001478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | - Stefano Cornara
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona
| | - Marco Aiello
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | - Alberto Somaschini
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona
| | - Fabrizio Gazzoli
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Mirko Belliato
- AR2 Anestesia e Terapia Intensiva Cardiotoracica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Stefano Pelenghi
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona
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Ferlini M, Munafò AR, Lanzillo G, Aiello M, Gazzoli F, Mirizzi AM, Magrini G, Pelenghi S, Visconti LO. Early surgical aortic valve replacement in asymptomatic patients with severe aortic stenosis: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2022; 23:632-634. [PMID: 35905003 DOI: 10.2459/jcm.0000000000001338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo
| | | | - Giuseppe Lanzillo
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Marco Aiello
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo
| | - Fabrizio Gazzoli
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo
| | | | - Giulia Magrini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo
| | - Stefano Pelenghi
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo
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Totaro P, Sciortino A, Preda Z, Pelenghi S. P42 ASCENDING AORTIC DISEASE: IS CURRENT GENERAL PERCEPTION UPDATED TO CURRENT GUIDELINES ?? Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Backgroud
Thoracic aorta diseases represent a frequent cause of hospitalization and up to 15% of workload of a modern Cardiac Surgery centre. To allow for an accurate monitoring of such activity a dedicated thoracic aorta diseases clinic was launched in January 2019 at our Division. Clinic was open for all new referrals (both by general pratictioner and different specialities clinic) as well as for follow–up of operated on patients. Here we report our analysis of new referrals during past 30 months.
Materials and Metods
237 overall patients were seen at clinic. 68 patients (29%) were new referrals; 23 patients (10%) were preoperative follow up and 145 (61%) were postoperative follow up. New referrals were divided in urgent referral (42 pts 62%) and scheduled referral (26 patients 38%). Out of 168 follow up, 22 (12%) were requested as urgent follow up. Majority of urgent new referral were from general pratictioner (21 pts 50%).
Results
Only 5 patients (2 urgent referral) had surgical indication at time of clinic assessment, according current guidelines. 23 patients (6 urgent referral) were in the so–called grey zone and required close follow–up). 40 patients (34 urgent referral) had no significant aortic diseases to require neither urgent specialist consultation or close follow–up. Out of 181 postoperative follow up, 12 patients required surgical re–intervention none of these were referred with matter of urgency. Despite 56% of new referral did not have recent CT scan evaluation, majority of new referral clearly showed moderate aortic dilatation especially in urgent referral (Fig 1). When considering indexed–dilatation, proportion of patient with moderate dilation raised even more (Fig 2).
Conclusions
Current perception of clinical severity of thoracic aorta diseases is still sub–optimal. Majority of patients are indeed referred as a matter of urgency despite non–significant aortic ectasia. On other hands, potentially dangerous situation are underestimated by the general practitioner and/or medical specialist. An accurate territorial policy of sensitization and updating about these pathologies is therefore essential to try to reduce the risks of acute aortic syndromes in our country.
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Affiliation(s)
- P Totaro
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA
| | - A Sciortino
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA
| | - Z Preda
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA
| | - S Pelenghi
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA
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9
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Totaro P, Milanesi E, Belliato M, Pelenghi S. P48 RETROSPECTIVE POSTOPERATIVE NEAR INFRARED SPECTROSCOPY MONITORING ANALYSIS TO DETECT POTENTIAL CRITERIA TO IMPROVE POSTOPERATIVE PREDICTION OF UNFAVOURABLE OUTCOME FOLLOWING AORTIC SURGERY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
Near Infrared Spectroscopy (NIRS) monitoring has become a frequent practice during aortic surgery. The real impact of NIRS in predicting postoperative outcomes, however is still debated, as many cases of “false negative” with severe cerebral damage despite apparently normal NIRS monitoring during surgical procedure. We applied extended retrospective postoperative NIRS monitoring analysis in order to investigate potential criteria to enhance postoperative unfavorable outcome prediction. Materials and
Methods
Data of NIRS monitoring of 41 patients undergoing aortic surgery (19 acute dissection) were retrospectively analyzed. Partial circulatory arrest with selective bilateral (21 pts) or unilateral (20 pts) cerebral perfusion (CP) was used in all patients. Double channel (R and L) NIRS value was continuously recorded (every 30 sec) from anaesthetic induction to patient’s transfer to ICU. Postoperatively all data were downloaded in excel format and retrospectively analyzed. Baseline, maximum, and minimum value with percentage drop and R/L channel gap were all analyzed considering 5 different phases of surgery: before extracorporeal circulation (EC); in EC before circulatory arrest and selective cerebral perfusion (CA–SCP); in EC following CA–SCP, following EC. Overall time <25% (in each channel) or with a > 20% gap were also evaluated.
Results
Overall 661±125 values were recorded for each patient. Baseline value on the Left (61±7) was significantly lower then Right (66±12). Maximum drop did not differed in two channels (Fig 1a) but varied according surgical phases (Fig 1). R/L asymmetry also varied according surgical phases with a peak value during rewarming and not during CA–SCP despite unilateral SCP and complexity of procedure (Figure 2 and 3).
Conclusion
Extended postoperative analysis of NIRS recorded value shows different trend and behavior according surgical phase and cerebral perfusion strategy. Accurate extended NIRS analysis is therefore mandatory in order to improve knowledge of physiological cerebral perfusion during SCP and early identification of patients at high risk of postoperative cerebral complications.
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Affiliation(s)
- P Totaro
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA; ANESTESIA E RIANIMAZIONE 2, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA
| | - E Milanesi
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA; ANESTESIA E RIANIMAZIONE 2, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA
| | - M Belliato
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA; ANESTESIA E RIANIMAZIONE 2, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA
| | - S Pelenghi
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA; ANESTESIA E RIANIMAZIONE 2, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA
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10
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Totaro P, Scocozza F, Morganti S, Auricchio F, Pelenghi S. C16 PROPENSITY SCORE COMPARISON OF ELASTIN–BASED AND COLLAGEN–BASED MECHANICAL PROPERTIES OF AORTIC WALL IN BICUSPID VS TRICUSPID AORTIC VALVE PATIENTS UNDERGOING AORTIC SURGERY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objective
Several studies addressed characteristics of aortic wall in patients with bicuspid aortic valve (BAV) compared to those with tricuspid aortic valve (TAV). Different patients population and lack of randomization were the main limitations in many of such studies, focused furthermore, only on ultimate properties (at rupture). In this study we compared mechanical properties in BAV and TAV patients undergoing aortic surgery using propensity score analysis to obtain two homogeneous groups of patients. We also focused on both elastin–based and collagen–based mechanical properties.
Methods
Among 87 overall patients undergoing surgery of ascending aorta, 26 were selected, following propensity score analysis, and divided in 2 groups according the type of native aortic valve (13 BAV and 13 TAV). Mechanical tests were completed following circumferential and longitudinal force application. 137 cumulative tests were accepted (93 from anterior aortic wall). Aortic wall strain (marker of elasticity) and aortic wall stress (marker of strength) were measured either in the Elastin–based (initial) distension and in the Collagen–based ultimate distension (until rupture).
Results
Cumulative comparison of specimens thickness confirmed that anterior aortic wall is thinner in BAV patients. Aortic wall thickness, however was not correlated to any of mechanical tests in Elastin–based or Collagen–based distensions. Aortic wall elasticity and strength (applying either longitudinal and circumferential force) were not different in BAV compared to TAV patients. Initial and ultimate elasticity were significantly correlated either applying circumferential and longitudinal force. Direct correlation between initial and ultimate strength, on other hands, was showed only in BAV patients when a longitudinal force was applied.
Conclusions
We clearly showed that, in dilated aorta, anterior wall is thinner in case of BAV compared to TAV. Our study, furthermore, confirms that mechanical properties of aortic wall in BAV patients are no impaired, compared to an homogeneous group of TAV patients, neither in initial or ultimate tests. Elastin–based and collagen–based aortic wall mechanical properties (under circumferential force) are directly correlated regardless BAV presence. Lack of correlation between initial and ultimate strenght in TAV patients, under a longitudinal force, needs further evaluation as it could be related to an increased frailty of aortic wall in such conditions.
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Affiliation(s)
- P Totaro
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA; DIPARTIMENTO DI INGEGNERIA CIVILE E ARCHITETTURA, UNIVERSITÀ DEGLI STUDI, PAVIA; DIPARTIMENTO DI INGEGNERIA INDUSTRIALE E DELL‘INFORMAZIONE, UNIVERSITÀ DEGLI STUDI, PAVIA
| | - F Scocozza
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA; DIPARTIMENTO DI INGEGNERIA CIVILE E ARCHITETTURA, UNIVERSITÀ DEGLI STUDI, PAVIA; DIPARTIMENTO DI INGEGNERIA INDUSTRIALE E DELL‘INFORMAZIONE, UNIVERSITÀ DEGLI STUDI, PAVIA
| | - S Morganti
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA; DIPARTIMENTO DI INGEGNERIA CIVILE E ARCHITETTURA, UNIVERSITÀ DEGLI STUDI, PAVIA; DIPARTIMENTO DI INGEGNERIA INDUSTRIALE E DELL‘INFORMAZIONE, UNIVERSITÀ DEGLI STUDI, PAVIA
| | - F Auricchio
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA; DIPARTIMENTO DI INGEGNERIA CIVILE E ARCHITETTURA, UNIVERSITÀ DEGLI STUDI, PAVIA; DIPARTIMENTO DI INGEGNERIA INDUSTRIALE E DELL‘INFORMAZIONE, UNIVERSITÀ DEGLI STUDI, PAVIA
| | - S Pelenghi
- CARDIOCHIRURGIA, IRCCS FONDAZIONE POLICLINICO SAN MATTEO, PAVIA; DIPARTIMENTO DI INGEGNERIA CIVILE E ARCHITETTURA, UNIVERSITÀ DEGLI STUDI, PAVIA; DIPARTIMENTO DI INGEGNERIA INDUSTRIALE E DELL‘INFORMAZIONE, UNIVERSITÀ DEGLI STUDI, PAVIA
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11
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Colaneri M, Amarasinghe N, Rezzonico L, Pieri TC, Segalini E, Sambo M, Roda S, Meloni F, Gregorini M, Rampino T, Pelenghi S, Ricciardi A, Bruno R. Early remdesivir to prevent severe COVID-19 in recipients of solid organ transplant: a real-life study from Northern Italy. Int J Infect Dis 2022; 121:157-160. [PMID: 35533831 PMCID: PMC9076039 DOI: 10.1016/j.ijid.2022.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 04/08/2022] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 12/20/2022] Open
Abstract
Objectives The effectiveness of a 3-day course of remdesivir to prevent severe disease in patients with COVID-19 who received solid organ transplant (SOT) is unknown. We wanted to study the efficacy of this therapeutic option in patients with COVID-19 who received SOT in preventing both hospitalizations for outpatients and clinical worsening due to COVID-19 for those already hospitalized for other reasons. Methods This is a single-center, retrospective, observational study conducted in the Fondazione IRCSS Policlinico San Matteo of Pavia, Northern Italy. We extracted all the data of patients with COVID-19 receiving SOT who received and did not receive pre-emptive remdesivir between December 23, 2021, and February 26, 2022. We used a Cox proportional hazard model to assess whether receiving pre-emptive remdesivir was associated with lower rates of hospitalization. Results A total of 24 patients who received SOT were identified. Among these, seven patients (29, 1%) received pre-emptive remdesivir, whereas 17 (70, 9%) patients did not. Receiving remdesivir significantly reduced the hospitalization rate in outpatients who received SOT and the clinical worsening of the condition of already hospitalized patients who received SOT (hazard ratio 0.05; confidence interval [0.00–0.65], P-value = 0.01). Conclusion In our cohort of patients infected with SARS-CoV-2 who received SOT, pre-emptive remdesivir was effective in reducing the hospitalization rate due to COVID-19 and in preventing the clinical worsening of the condition of patients who received SOT who were hospitalized for reasons other than COVID-19.
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Affiliation(s)
- Marta Colaneri
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Nicolò Amarasinghe
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Leonardo Rezzonico
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Teresa Chiara Pieri
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emilio Segalini
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Margherita Sambo
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Roda
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Meloni
- Division of Pneumology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marilena Gregorini
- Division of Nefrology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Teresa Rampino
- Division of Nefrology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Pelenghi
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Ricciardi
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Italy
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12
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Iacoviello M, Cipriani M, Valente S, Marini M, Ammirati E, Benvenuto M, Cassaniti LR, De Maria R, Gori M, Municinò A, Navazio A, Amodeo V, Aspromonte N, Barili F, Casolo G, Clemenza F, Di Eusanio M, Di Lenarda A, Di Tano G, Domenicucci S, Faggian G, Francese GM, Frongillo D, Gilardi R, Iacovoni A, Imazio M, Livi U, Maiello C, Milano A, Mondino M, Moreo AM, Mortara A, Murrone A, Palmieri V, Pelenghi S, Pini D, Pistono M, Porcu M, Potena L, Rinaldi M, Romanò M, Roncon L, Rossini R, Russo CF, Scotto di Uccio F, Urbinati S, Zecchin M, Caldarola P, Oliveti A, Frigerio M, Musumeci F, Gulizia MM, Oliva F, Gabrielli D, Colivicchi F. [ANMCO Position paper: Care pathway for advanced heart failure patients candidate for heart transplantation/ventricular assist device]. G Ital Cardiol (Rome) 2022; 23:340-378. [PMID: 35578958 DOI: 10.1714/3796.37817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Heart failure is a complex clinical syndrome with a severe prognosis, despite therapeutic progress. The management of the advanced stages of the syndrome is particularly complex in patients who are referred to palliative care as well as in those who are candidates for cardiac replacement therapy. For the latter group, a prompt recognition of the transition to the advanced stage as well as an early referral to the centers for cardiac replacement therapy are essential elements to ensure that patients follow the most appropriate diagnostic-therapeutic pathway. The aim of this document is to focus on the main diagnostic and therapeutic aspects related to the advanced stages of heart failure and, in particular, on the management of patients who are candidates for cardiac replacement therapy.
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Affiliation(s)
| | | | | | - Marco Marini
- S.O.D. Cardiologia-Emodinamica-UTIC, A.O.U. Ospedali Riuniti, Ancona
| | - Enrico Ammirati
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Manuela Benvenuto
- U.O.C. Cardiologia-UTIC-Emodinamica, Presidio Ospedaliero "G. Mazzini", Teramo
| | - Leonarda Rosaria Cassaniti
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Renata De Maria
- Istituto di Fisiologia Clinica CNR, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Mauro Gori
- U.O.C. Cardiologia 1, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Annamaria Municinò
- Dipartimento di Cardiologia, Ospedale Andrea Gallino, ASL3 Genovese, Genova
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Vincenzo Amodeo
- U.O.C. Cardiologia-UTIC, Ospedale Santa Maria degli Ungheresi, Polistena (RC)
| | - Nadia Aspromonte
- U.O.S. Scompenso Cardiaco, Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Fabio Barili
- S.C. Cardiochirurgia, Ospedale Santa Croce e Carle, Cuneo
| | - Giancarlo Casolo
- U.O.C. Cardiologia, Ospedale Versilia, Azienda USL Toscana Nord-Ovest, Lido di Camaiore (LU)
| | - Francesco Clemenza
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT) - IRCCS, Palermo
| | | | - Andrea Di Lenarda
- S.C. Cardiovascolare e Medicina dello Sport, Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Giuseppe Di Tano
- U.O. di Cardiologia-UTIC, Ospedale Civile Oglio Po, Casalmaggiore (CR)
| | | | - Giuseppe Faggian
- Divisione di Cardiochirurgia, Azienda Ospedaliera Universitaria Integrata Verona, Verona
| | - Giuseppina Maura Francese
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Doriana Frongillo
- U.O.C. Cardiologia, Ospedale San Sebastiano Martire, ASL Roma 6, Frascati (RM)
| | - Rossella Gilardi
- S.C. Cardiochirurgia, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Attilio Iacovoni
- U.O.C. Cardiologia 1, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Massimo Imazio
- Cardiologia, Dipartimento Cardiotoracico, Ospedale Santa Maria della Misericordia, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine
| | - Ugolino Livi
- Cardiochirurgia, Dipartimento Cardiotoracico, Ospedale Santa Maria della Misericordia, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine
| | - Ciro Maiello
- Dipartimento di Cardiochirurgia e dei Trapianti, A.O.R.N. Ospedale dei Colli - P.O. Monaldi, Napoli
| | - Aldo Milano
- Cardiochirurgia, A.O.U. Consorziale Policlinico di Bari, Bari
| | - Michele Mondino
- Anestesia e Rianimazione 3, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Antonella Maurizia Moreo
- Cardiologia 4-Diagnostica e Riabilitativa, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Andrea Mortara
- Dipartimento di Cardiologia Clinica, Policlinico di Monza, Monza
| | - Adriano Murrone
- S.C. Cardiologia-UTIC, Ospedali di Città di Castello e di Gubbio-Gualdo Tadino, AUSL Umbria 1, Perugia
| | - Vittorio Palmieri
- Dipartimento di Cardiochirurgia e dei Trapianti, A.O.R.N. Ospedale dei Colli - P.O. Monaldi, Napoli
| | - Stefano Pelenghi
- U.O.C. Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Daniela Pini
- U.O. Cardiologia Clinica, Istituto Clinico Humanitas, Rozzano (MI)
| | - Massimo Pistono
- Cardiologia, I.C.S. Maugeri - IRCCS Sede di Veruno, Gattico-Veruno (NO)
| | | | - Luciano Potena
- IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Mauro Rinaldi
- S.C. Cardiochirurgia, A.O.U. Città della Salute e della Scienza di Torino, Torino
| | - Massimo Romanò
- Comitato Ordinatore, Master Universitario di II Livello in Cure Palliative, Università degli Studi, Milano
| | - Loris Roncon
- U.O.C. Cardiologia, Ospedale Santa Maria della Misericordia, Rovigo
| | | | - Claudio Francesco Russo
- S.C. Cardiochirurgia, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | | | - Massimo Zecchin
- S.C. Cardiologia, Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Università di Trieste
| | | | | | - Maria Frigerio
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Francesco Musumeci
- U.O. Cardiochirurgia e Centro Trapianti di Cuore, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera Ospedale S. Camillo Forlanini, Roma
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Unità di Cure Intensive Cardiologiche, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
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Gazzoli F, Urtis M, Pagani F, Pelenghi S, Di Toro A. Aortic Valve Remodeling in CF-LVAD: Beyond the Arterial Wall. J Am Coll Cardiol 2022; 79:e221-e222. [PMID: 35331420 DOI: 10.1016/j.jacc.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/07/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
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Pocar M, Totaro P, Rinaldi M, Pelenghi S. Coronavirus disease 2019 and cardiac surgery: lessons learnt from a round-trip to hell. J Cardiovasc Med (Hagerstown) 2022; 23:84-86. [PMID: 34958312 DOI: 10.2459/jcm.0000000000001219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Marco Pocar
- Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza', University of Turin, Turin.,Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Pasquale Totaro
- Division of Cardiac Surgery, Policlinico San Matteo Scientific Institute, Pavia, Italy
| | - Mauro Rinaldi
- Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza', University of Turin, Turin
| | - Stefano Pelenghi
- Division of Cardiac Surgery, Policlinico San Matteo Scientific Institute, Pavia, Italy
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Munafò AR, Turco A, Benzoni G, Cattadori B, Pellegrini C, Pelenghi S, Ghio S, Ferrario M, Visconti LO, Ferlini M. 631 First vs. second generation drug-eluting STNET in heart transplant patients with cardiac allograft vasculopathy: a single centre experience. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Cardiac allograft vasculopathy (CAV) remains the ‘Achilles’ heel’ of successful long-term outcome after heart transplantation (HTx). Percutaneous coronary intervention (PCI) with bare-metal stents (BMS) and first (I) generation drug-eluting stents (DES) has been previously considered as a palliative treatment option in this setting, for the higher rate of restenosis and the lack of a survival benefit over medical therapy. Few data on the performance of second (II) generation DES in CAV are currently available. Our study aims to compare the efficacy and safety of PCI with I and II generation DES in patients with CAV.
Methods and results
All consecutive heart transplant patients who underwent urgent or elective PCI with I or II generation DES between 2003 and 2020 at Foundation IRCCS Polyclinic San Matteo (Pavia) were enrolled. The extent of revascularization for each patient was assessed calculating the post-procedural residual SYNTAX score. The primary endpoint was a composite of MACE [any myocardial infarction, cardiovascular death and target vessel revascularization (TVR)] at 3-year. The secondary endpoint was target lesion failure (TLF) at 3-year—composite of cardiovascular death, target vessel myocardial infarction (TV-MI) and target lesion revascularization (TLR). A total of 90 transplant patients (113 coronary lesions) were included: 28 patients (32 lesions) were treated with I generation DES and 62 patients (81 lesions) with II generation DES. No differences between the two study groups were identified in term of number of stents per patient implanted (overall 1.63 ± 0.87, P-value = 0.628), total stent length per patient [overall 26 (25th–75th : 18–44) mm, P-value = 0.486], pre-PCI [overall 8 (25th–75th: 5–15), P-value = 0.286], and post-PCI residual [overall 1.5 (25th–75th: 0–4), P-value = 0.187] SYNTAX score. In the whole study population, the primary and secondary endpoints occurred in 28 (33%) and 23 (27%) cases respectively, with a 3-year Kaplan–Meier estimate of freedom from MACE of 64%, and from TLF of 71%. No statistical differences between the two study arms were found (MACE log-rank test P-value = 0.269, TLF log-rank test P-value = 0.260). At multivariate Cox regression analysis, while treatment with II generation DES was confirmed to not predict the risk of MACE (HR: 0.70, CI: 0.32–1.5, P-value = 0.368), a borderline significant higher rate of events was found in patients with a post-PCI residual SYNTAX score >8 (HR: 2.37, CI: 0.98–5.73, P-value = 0.054). However, patients treated with II generation DES experienced a lower rate of TVR (3-year Kaplan-Meier estimate of freedom from TVR I generation DES 69% vs. II generation DES 85%, log-rank test P-value = 0.058, univariate Cox regression analysis HR: 0.4, CI: 0.13–1.07, P-value = 0.069).
Conclusions
In heart transplant patients with CAV, compared with I generation DES, PCI with II generation DES did not show to reduce the risk of MACE and TLF, guaranteeing however a lower rate of TVR. In this complex clinical scenario, incomplete revascularization (defined as a residual post-PCI SYNTAX score > 8) was associated with worse outcome at 3-year follow-up.
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Affiliation(s)
| | - Annalisa Turco
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giorgia Benzoni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Barbara Cattadori
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Pellegrini
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Pelenghi
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stafano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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16
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Tua L, Turco A, Acquaro M, Scelsi L, Greco A, Ghio S, Savastano S, Sanzo A, Vicentini A, Petracci B, Vullo E, Vicini Scajola L, Pelenghi S, Oltrona Visconti L, Rordorf R. Long-term follow-up of heart transplant patients treated with permanent pacemaker: a monocentric study. Europace 2021. [DOI: 10.1093/europace/euab116.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and purpose
Permanent pacemaker implantation (PPMi) is needed in about 5% of patients following heart transplant (HTx) primarily due to sinus node dysfunction (SND), which commonly occurs in an early phase, or to atrio-ventricular block (ABV), which is common later on. Currently, data on rate of ventricular pacing (VP) is lacking and little is known on long-term outcomes after PPMi.
Methods
This was a retrospective, monocentric study. Among 1123 patients treated with HTx, all with biatrial technique, from november 1985 to march 2019 at our institution, 61 (5.4%) patients needed PPMi. PM parameters, clinical and echocardiographic data were collected at 1 month and at 1-3-5-10 years follow-up. The primary aim was to analyse the percentage of right ventricular pacing in the overall population and in subgroups stratified by the timing of PPMi and by pacing indication. Secondary endpoints were to analyze long-term outcomes according to the percentage of ventricular pacing and to the type of implanted PM (single vs. dual chamber).
Results
Among patients treated with PPMi (68.9% single-chamber), 62.2% were implanted for SND and 36% for AVB. Early PPMi (< 3 months after HTx), occurred in 34.4% of patients, mainly due to SND, while late PPMi (> 3 months after HTx) occurred in 65,6% with an equal distribution between SND and AVB. Median follow-up time from HTx was 140 months and 82 months from PPMi. Overall mean rate of VP was 21%. Rate of VP was higher in patients implanted early rather than late after HTx, both at 1 month (91% vs 2%, P = 0,002) and at 1 year after the procedure (43 vs 1, P = 0,037). Patients with AVB had a greater rate of VP compared to those implanted for SND, irrespective of timing of implantation and these findings were still present at 3 and 5 years follow-up (62 vs 1%, P = 0,011 at 3 years and 80 vs 6%, P = 0,002 at 5 years). VP declined progressively after PPM implantation. No differences were observed in terms of 10-years mortality between early vs late PPMi, dual vs single-chamber and mean VP > 21% vs ≤ 21%.
Conclusions
Patients treated with PPMi after HTx show on average low percentage of VP over long-term follow-up. AV block indication and early implantation are associated with a higher percentage of VP. The rate of VP, the timing of PPMi and the use of single vs dual chamber PM do not affect overall prognosis or left ventricular systolic function. Our data may justify implantation of a single-chamber PPM, which bears less complications and procedural time, in the majority of HTx patients needing PPMi.
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Affiliation(s)
- L Tua
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - A Turco
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - M Acquaro
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - L Scelsi
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - A Greco
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - S Ghio
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - S Savastano
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - A Sanzo
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - A Vicentini
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - B Petracci
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - E Vullo
- San Gerardo Hospital, Cardiology Department, Monza, Italy
| | - L Vicini Scajola
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - S Pelenghi
- Policlinic Foundation San Matteo IRCCS, Cardiothoracic Surgery, Pavia, Italy
| | - L Oltrona Visconti
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - R Rordorf
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
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Pelenghi S, Primiceri C, Belliato M, Ghio S, Scelsi L, Totaro P. Is it time for a paradigm shift: Should double-lung transplant be considered the treatment of choice for idiopathic pulmonary arterial hypertension and giant pulmonary aneurysm? J Card Surg 2021; 36:2996-2999. [PMID: 33993562 DOI: 10.1111/jocs.15655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/23/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 01/09/2023]
Abstract
Idiopathic pulmonary arterial hypertension is a rare condition, frequently complicated by pulmonary arteries' aneurysm. Aggressive medical therapy is often unsatisfactory and lung transplantation remains the only option. We report a unique case of severe idiopathic pulmonary arterial hypertension complicated by a giant pulmonary aneurism, massive pulmonary valve regurgitation, and right ventricle dysfunction. The patient was, as our first choice, listed for heart-lung transplantation and remained in emergency list for more than 7 months. Unfortunately, due to further clinical deterioration and the unavailability of a heart-lung bloc, plan B was mandatory. The patient underwent a combined procedure including: double lung transplant, pulmonary artery plasty, and sutureless pulmonary valve prosthesis with open deployment (first-in-man use in such scenario). Postoperative outcome was uneventful. Our thought is that double lung transplantation and conventional combined pulmonary artery/valve surgery should be considered as the first option avoiding excessive waiting times and potential further clinical deterioration.
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Affiliation(s)
- Stefano Pelenghi
- Division of Cardiac Surgery, IRCCS Fondazione Policlinico "San Matteo", Pavia, Italy
| | - Cristiano Primiceri
- Division of Thoracic Surgery, IRCCS Fondazione Policlinico "San Matteo", Pavia, Italy
| | - Mirko Belliato
- Department of Cardiopulmonary Anesthesia, IRCCS Fondazione Policlinico "San Matteo", Pavia, Italy
| | - Stefano Ghio
- Department of Cardiology, IRCCS Fondazione Policlinico "San Matteo", Pavia, Italy
| | - Laura Scelsi
- Department of Cardiology, IRCCS Fondazione Policlinico "San Matteo", Pavia, Italy
| | - Pasquale Totaro
- Division of Cardiac Surgery, IRCCS Fondazione Policlinico "San Matteo", Pavia, Italy
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Moschella MM, Turco A, Ferlini M, Ghio S, Pellegrini C, Cattadori B, Ferrario M, Pelenghi S, Visconti LO. [Early diagnosis and management of cardiac allograft vasculopathy: is it time for a standardized approach?]. G Ital Cardiol (Rome) 2021; 22:377-385. [PMID: 33960981 DOI: 10.1714/3592.35747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cardiac allograft vasculopathy (CAV) still represents the main cause of long-term graft loss after heart transplantation. Its silent clinical presentation makes an early identification difficult, with relevant implications for a standardized follow-up. Although technological advances have provided sophisticated non-invasive techniques for CAV assessment, intravascular ultrasound in conjunction with coronary angiography is still the gold standard to detect rapidly progressive CAV and to provide prognostic information during follow-up. Current guidelines recommend annual coronary angiography during the first 5 years and every 2 years thereafter. Although commonly performed, coronary angiography has multiple limitations, especially in young patients and in case of chronic kidney disease. This article aims to review the literature about the monitoring of CAV and to propose an ideal and individualized pathway for early diagnosis of CAV in transplanted patients, based on their cardiovascular risk.
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Affiliation(s)
- Martina M Moschella
- U.O.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia - Dipartimento di Medicina Molecolare, Università degli Studi, Pavia
| | - Annalisa Turco
- U.O.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Marco Ferlini
- U.O.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Stefano Ghio
- U.O.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Carlo Pellegrini
- U.O.C. Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Barbara Cattadori
- U.O.C. Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | - Stefano Pelenghi
- U.O.C. Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, Pavia
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19
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Loforte A, Di Mauro M, Pellegrini C, Monterosso C, Pelenghi S, Degani A, Rinaldi M, Cura Stura E, Sales G, Montrucchio G, Mangino D, Terrini A, Pacini D, Affronti A, Tarzia V, Bottio T, Pantaleo A, Donatelli F, Miceli A, Santini F, Salsano A, Colli A, Ravenni G, Montalto A, Musumeci F, Salvador L, Gerosa G, Parolari A, Picichè M. Extracorporeal Membrane Oxygenation for COVID-19 Respiratory Distress Syndrome: An Italian Society for Cardiac Surgery Report. ASAIO J 2021; 67:385-391. [PMID: 33470643 DOI: 10.1097/mat.0000000000001399] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
An increased need of extracorporeal membrane oxygenation (ECMO) support is going to become evident as treatment of SARS-CoV-2 respiratory distress syndrome. This is the first report of the Italian Society for Cardiac Surgery (SICCH) on preliminary experience with COVID-19 patients receiving ECMO support. Data from 12 Italian hospitals participating in SICCH were retrospectively analyzed. Between March 1 and September 15, 2020, a veno-venous (VV) ECMO system was installed in 67 patients (94%) and a veno-arterio-venous ECMO in four (6%). Five patients required VA ECMO after initial weaning from VV ECMO. Thirty (42.2%) patients were weaned from ECMO, while 39 (54.9%) died on ECMO, and six (8.5%) died after ECMO removal. Overall hospital survival was 36.6% (n = 26). Main causes of death were multiple organ failure (n = 14, 31.1%) and sepsis (n = 11, 24.4%). On multivariable analysis, predictors of death while on ECMO support were older age (p = 0.048), elevated pre-ECMO C-reactive protein level (p = 0.048), higher positive end-expiratory pressure on ventilator (p = 0.036) and lower lung compliance (p = 0.032). If the conservative treatment is not effective, ECMO support might be considered as life-saving rescue therapy for COVID-19 refractory respiratory failure. However warm caution and thoughtful approaches for timely detection and treatment should be taken for such a delicate patients population.
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Affiliation(s)
- Antonio Loforte
- From the Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | | | | | | | | | - Mauro Rinaldi
- Cardiothoracic Surgery Department, Città della Scienza, University of Turin, Turin, Italy
| | - Erik Cura Stura
- Cardiothoracic Surgery Department, Città della Scienza, University of Turin, Turin, Italy
| | - Gabriele Sales
- Cardiothoracic Surgery Department, Città della Scienza, University of Turin, Turin, Italy
| | - Giorgia Montrucchio
- Cardiothoracic Surgery Department, Città della Scienza, University of Turin, Turin, Italy
| | | | - Alberto Terrini
- Cardiac Surgery Department, Ospedale dell'Angelo, Mestre, Italy
| | - Davide Pacini
- From the Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Alessandro Affronti
- Cardiac Surgery Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Vincenzo Tarzia
- Cardiothoracic Department, University of Padua, Padua, Italy
| | - Tomaso Bottio
- Cardiothoracic Department, University of Padua, Padua, Italy
| | - Antonio Pantaleo
- Cardiac Surgery Department, Ca Foncello Hospital, Treviso, Italy
| | - Francesco Donatelli
- Cardiac Surgery Department, Sant'Ambrogio Hospital, University of Milan, Milan, Italy
| | - Antonio Miceli
- Cardiac Surgery Department, Sant'Ambrogio Hospital, University of Milan, Milan, Italy
| | - Francesco Santini
- Cardiac Surgery Department, San Martino Hospital, University of Genova, Genova, Italy
| | - Antonio Salsano
- Cardiac Surgery Department, San Martino Hospital, University of Genova, Genova, Italy
| | - Andrea Colli
- Cardiac Surgery Department, AOUP, University of Pisa, Pisa, Italy
| | - Giacomo Ravenni
- Cardiac Surgery Department, AOUP, University of Pisa, Pisa, Italy
| | - Andrea Montalto
- Cardiac Surgery Department, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Loris Salvador
- Cardiac Surgery Department, San Bortolo Hospital, Vicenza, Italy
| | - Gino Gerosa
- Cardiothoracic Department, University of Padua, Padua, Italy
| | - Alessandro Parolari
- UOC Cardiac Surgery and Translational Research, IRCCS San Donato and University of Milan, San Donato Milanese, Italy
| | - Marco Picichè
- Cardiac Surgery Department, San Bortolo Hospital, Vicenza, Italy
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20
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Bonalumi G, Giambuzzi I, Barbone A, Ranieri C, Cavallotti L, Trabattoni P, Naliato M, Polvani G, Torracca L, Pelenghi S, Ragni F, Russo CF, Guerra F, Trimarchi S, Civilini E, Romani F, Bellosta R, Losa S, Roberto M, Alamanni F. A call to action becomes practice: cardiac and vascular surgery during the COVID-19 pandemic based on the Lombardy emergency guidelines. Eur J Cardiothorac Surg 2020; 58:319-327. [PMID: 32584978 PMCID: PMC7337742 DOI: 10.1093/ejcts/ezaa204] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Giorgia Bonalumi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy.,DISCCO University of Milan, Milan, Italy
| | - Alessandro Barbone
- Department of Cardiovascular Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Camilla Ranieri
- Health Care Management, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Laura Cavallotti
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Piero Trabattoni
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Moreno Naliato
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy.,DISCCO University of Milan, Milan, Italy
| | - Lucia Torracca
- Department of Cardiovascular Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Stefano Pelenghi
- Division of Cardiovascular Surgery, Fondazione-IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | - Franco Ragni
- Vascular Surgery Unit, Fondazione-IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | | | - Francisco Guerra
- Cardiovascular Surgery, IRCCS Sesto San Giovanni Multimedica, Sesto San Giovanni, Milan, Italy
| | - Santi Trimarchi
- DISCCO University of Milan, Milan, Italy.,Vascular Surgery Department, IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Efrem Civilini
- Department of Cardiovascular Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Federico Romani
- Cardiovascular Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Raffaello Bellosta
- Vascular Surgery Unit, Cardiovascular Surgery Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Sergio Losa
- Cardiovascular Surgery, IRCCS Sesto San Giovanni Multimedica, Sesto San Giovanni, Milan, Italy
| | - Maurizio Roberto
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy.,DISCCO University of Milan, Milan, Italy
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21
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Antonacci F, Masiglat LJT, Borrelli E, Salati M, D'Armini AM, Pelenghi S, Totaro P. Acute massive pulmonary embolism during patient repositioning following excision of a thymic carcinoma in a patient affected by cryoglobulinemia. J Card Surg 2020; 35:2050-2052. [PMID: 32652608 DOI: 10.1111/jocs.14759] [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: 11/29/2022]
Abstract
Acute pulmonary embolism (APE) is a well-described complication following surgical procedures. The incidence of such a complication can be related to the presence of a peculiar patient's condition. Cryoglobulinemia, which consists in the presence of one or more immunoglobulins in the serum that precipitate at temperatures below 37°C and redissolve on warming, seems to increase the risk of thrombotic events. Treatment options of APE, according to clinical severity, include systemic thrombolysis, surgical embolectomy, and systemic anticoagulation. Thrombolysis is considered the first-line treatment, whereas surgery is reserved in case of extremely-compromised hemodynamic conditions related to massive central embolism, and in case of contraindication to thrombolysis. Here, we report a case of acute massive pulmonary embolism occurring at the end of a surgical procedure for a thymic carcinoma resection, in a patient with cryoglobulinemia, which required an emergent surgical pulmonary embolectomy.
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Affiliation(s)
- Filippo Antonacci
- Department of Cardio-Thoracic Surgery, Policlinico S. Orsola Malpighi University Hospital, Bologna, Italy
| | - Leslie J T Masiglat
- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Pavia, Italy
| | - Ermelinda Borrelli
- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Pavia, Italy
| | - Maurizio Salati
- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Pavia, Italy
| | - Andrea M D'Armini
- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Pavia, Italy.,Department of Surgical, Clinical, Diagnostic, Pediatric Sciences, University of Pavia School of Medicine, Pavia, Italy
| | - Stefano Pelenghi
- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Pavia, Italy
| | - Pasquale Totaro
- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Pavia, Italy
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22
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Cavagna L, Seminari E, Zanframundo G, Gregorini M, Di Matteo A, Rampino T, Montecucco C, Pelenghi S, Cattadori B, Pattonieri EF, Vitulo P, Bertani A, Sambataro G, Vancheri C, Biglia A, Bozzalla-Cassione E, Bonetto V, Monti MC, Ticozzelli E, Turco A, Oggionni T, Corsico A, Bertuccio F, Zuccaro V, Codullo V, Morosini M, Marena C, Gnecchi M, Pellegrini C, Meloni F. Calcineurin Inhibitor-Based Immunosuppression and COVID-19: Results from a Multidisciplinary Cohort of Patients in Northern Italy. Microorganisms 2020; 8:E977. [PMID: 32629788 PMCID: PMC7409165 DOI: 10.3390/microorganisms8070977] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 12/23/2022] Open
Abstract
The role of immunosuppression in SARS-CoV-2-related disease (COVID-19) is a matter of debate. We here describe the course and the outcome of COVID-19 in a cohort of patients undergoing treatment with calcineurin inhibitors. In this monocentric cohort study, data were collected from the COVID-19 outbreak in Italy up to April 28th 2020. Patients were followed at our hospital for solid organ transplantation or systemic rheumatic disorders (RMDs) and were on calcineurin inhibitor (CNI)-based therapy. Selected patients were referred from the North of Italy. The aim of our study was to evaluate the clinical course of COVID-19 in this setting. We evaluated 385 consecutive patients (220 males, 57%; median age 61 years, IQR 48-69); 331 (86%) received solid organ transplantation and 54 (14%) had a RMD. CNIs were the only immunosuppressant administered in 47 patients (12%). We identified 14 (4%) COVID-19 patients, all transplanted, mainly presenting with fever (86%) and diarrhea (71%). Twelve patients were hospitalized and two of them died, both with severe comorbidities. No patients developed acute respiratory distress syndrome or infectious complications. The surviving 10 patients are now fully recovered. The clinical course of COVID-19 patients on CNIs is generally mild, and the risk of superinfection seems low.
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Affiliation(s)
- Lorenzo Cavagna
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Elena Seminari
- Infectious Diseases Clinic, University of Pavia and IRCCS Policlinico S. Matteo Foundation, 27100 Pavia, Italy; (E.S.); (A.D.M.); (V.Z.)
| | - Giovanni Zanframundo
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Marilena Gregorini
- Nephrology, Dialysis and Transplantation Unit, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (M.G.); (T.R.); (E.F.P.)
| | - Angela Di Matteo
- Infectious Diseases Clinic, University of Pavia and IRCCS Policlinico S. Matteo Foundation, 27100 Pavia, Italy; (E.S.); (A.D.M.); (V.Z.)
| | - Teresa Rampino
- Nephrology, Dialysis and Transplantation Unit, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (M.G.); (T.R.); (E.F.P.)
| | - Carlomaurizio Montecucco
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Stefano Pelenghi
- Division of Cardiac Surgery, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (S.P.); (B.C.); (C.P.)
| | - Barbara Cattadori
- Division of Cardiac Surgery, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (S.P.); (B.C.); (C.P.)
| | - Eleonora Francesca Pattonieri
- Nephrology, Dialysis and Transplantation Unit, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (M.G.); (T.R.); (E.F.P.)
| | - Patrizio Vitulo
- Pulmonology Unit, IRCCS Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (ISMETT), 90100 Palermo, Italy;
| | - Alessandro Bertani
- Thoracic Surgery Unit, IRCCS Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (ISMETT), 90100 Palermo, Italy;
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy; (G.S.); (C.V.)
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy; (G.S.); (C.V.)
| | - Alessandro Biglia
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Emanuele Bozzalla-Cassione
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Valentina Bonetto
- Department of Biochemistry and Molecular Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Maria Cristina Monti
- Department of Public Health, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, 27100 Pavia, Italy;
| | - Elena Ticozzelli
- General Surgery Unit, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy;
| | - Annalisa Turco
- Cardiology Department, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy;
| | - Tiberio Oggionni
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
| | - Angelo Corsico
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
| | - Francesco Bertuccio
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
| | - Valentina Zuccaro
- Infectious Diseases Clinic, University of Pavia and IRCCS Policlinico S. Matteo Foundation, 27100 Pavia, Italy; (E.S.); (A.D.M.); (V.Z.)
| | - Veronica Codullo
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Monica Morosini
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
| | - Carlo Marena
- SC Direzione Medica di Presidio, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy;
| | - Massimiliano Gnecchi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Department of Medical Sciences and Infectious Disease, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy;
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, 27100 Pavia, Italy
| | - Carlo Pellegrini
- Division of Cardiac Surgery, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (S.P.); (B.C.); (C.P.)
| | - Federica Meloni
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
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23
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Tavazzi G, Pellegrini C, Maurelli M, Belliato M, Sciutti F, Bottazzi A, Sepe PA, Resasco T, Camporotondo R, Bruno R, Baldanti F, Paolucci S, Pelenghi S, Iotti GA, Mojoli F, Arbustini E. Myocardial localization of coronavirus in COVID-19 cardiogenic shock. Eur J Heart Fail 2020; 22:911-915. [PMID: 32275347 PMCID: PMC7262276 DOI: 10.1002/ejhf.1828] [Citation(s) in RCA: 726] [Impact Index Per Article: 181.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
We describe the first case of acute cardiac injury directly linked to myocardial localization of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in a 69‐year‐old patient with flu‐like symptoms rapidly degenerating into respiratory distress, hypotension, and cardiogenic shock. The patient was successfully treated with venous‐arterial extracorporeal membrane oxygenation (ECMO) and mechanical ventilation. Cardiac function fully recovered in 5 days and ECMO was removed. Endomyocardial biopsy demonstrated low‐grade myocardial inflammation and viral particles in the myocardium suggesting either a viraemic phase or, alternatively, infected macrophage migration from the lung.
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Affiliation(s)
- Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,ICU1 Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Carlo Pellegrini
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Cardiac Surgery, Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Marco Maurelli
- ICU2, Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Mirko Belliato
- ICU1 Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Fabio Sciutti
- ICU1 Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Andrea Bottazzi
- ICU1 Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | | | - Rita Camporotondo
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Department of Medical Sciences and Infectious Diseases, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Raffaele Bruno
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Infectious Diseases I, Department of Medical Sciences and Infectious Diseases, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Fausto Baldanti
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Molecular Virology Unit, Department of Diagnostic Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Stefania Paolucci
- Molecular Virology Unit, Department of Diagnostic Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Stefano Pelenghi
- Cardiac Surgery, Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Giorgio Antonio Iotti
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,ICU1 Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesco Mojoli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,ICU1 Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Department of Medical Sciences and Infectious Diseases, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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24
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Acquaro M, Scelsi L, Pellegrini C, Greco A, Klersy C, Guida S, Raineri C, Ghio S, Turco A, Cattadori B, D'Armini AM, Pelenghi S, Visconti LO. Long-Term Effects of the Replacement of Calcineurin Inhibitors With Everolimus and Mycophenolate in Patients With Calcineurin Inhibitor-Related Nephrotoxicity. Transplant Proc 2020; 52:836-842. [PMID: 32113691 DOI: 10.1016/j.transproceed.2020.01.030] [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] [Received: 12/21/2019] [Accepted: 01/10/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is little evidence on the long-term effects of calcineurin inhibitor (CNI) withdrawal and substitution with everolimus and mycophenolate mofetil in maintenance therapy of patients who have received heart transplants and have concurrent CNI nephrotoxicity. Aims of this study were to evaluate the progression of renal dysfunction after discontinuation of CNIs and to monitor for major adverse events after therapy change. METHODS Data from 41 patients who underwent heart transplant and have different degrees of renal dysfunction (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2), without evidence of proteinuria, and in whom CNI therapy was replaced by everolimus, were analyzed. At the time of CNI withdrawal, clinical parameters, echocardiographic data, blood tests of renal function, and monitoring of adverse events were recorded. The median follow-up period was 5 years ± 28 months. RESULTS In 52% of patients, there was a clear improvement in renal function (10.5 mL/min/1.73 m2 of extra eGFR on average). The former were characterized by less advanced age and a short time from the heart transplant. The echocardiographic parameters showed a significant reduction in septum thickness (11.58 ± 2 mm vs 10.29 ± 2 mm; P = .0001) and in left ventricle posterior wall thickness (10.74 ± 1 mm vs 9.74 ± 1 mm; P = .0004). The incidence of late acute rejection and cardiac allograft vasculopathy was similar in our population compared to literature data. CONCLUSIONS A therapeutic switch from CNIs to everolimus and mycophenolate mofetil can improve renal function in patients with CNI nephrotoxicity, especially in those with a shorter time period from transplantation, without exposing them to a higher incidence of late acute rejection and cardiac allograft vasculopathy.
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Affiliation(s)
- Mauro Acquaro
- Division of Cardiology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy.
| | - Carlo Pellegrini
- Division of Cardiac Surgery, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Alessandra Greco
- Division of Cardiology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Catherine Klersy
- Division of Cardiology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Stefania Guida
- Division of Cardiology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Claudia Raineri
- Division of Cardiology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Annalisa Turco
- Division of Cardiology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Barbara Cattadori
- Division of Cardiac Surgery, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | | | - Stefano Pelenghi
- Division of Cardiac Surgery, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
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25
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Totaro P, Marconi S, Morganti S, Corsico AG, Pelenghi S, Auricchio F. Multidisciplinary preoperative simulations to optimize surgical outcomes in a challenging case of the complete double aortic arch in the adult. J Card Surg 2020; 35:716-720. [PMID: 32027400 DOI: 10.1111/jocs.14448] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Challenging surgical cases are becoming more and more frequent, making the optimization of decision making process and an accurate preoperative planning mandatory in order to improve postoperative outcomes. AIMS Here we present an original multidisciplinary approach aimed at optimizing decision making in a peculiar case of double aortic arch (DAA) presenting in an adult patient. MATERIALS AND METHODS Following the diagnosis of DAA, based on conventional exams, a three steps engineering simulation was adopted including: a) three-dimensional (3D) rapid prototype simulation; b) computational fluid-dynamic analysis; c) 3D virtual simulation of surgical exposure. RESULTS Based on careful evaluation of such simulations we were able to identify optimal anatomical and functional surgical options, along with the optimal surgical approach. DISCUSSION In peculiar clinical case, a significant step forward to optimize preoperative surgical planning could be obtained applying current available engineering techniques. CONCLUSION We do believe that a multidisciplinary approach could become mandatory, in challenging cases, to optimize preoperative planning and outcomes.
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Affiliation(s)
- Pasquale Totaro
- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Pavia, Italy
| | - Stefania Marconi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Simone Morganti
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Angelo Guido Corsico
- Division of Respiratory Diseases, IRCCS Foundation Hospital San Matteo, University of Pavia, Pavia, Italy
| | - Stefano Pelenghi
- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Pavia, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
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Turco A, Totaro P, Pellegrini C, Guida S, Cattadori B, Di Matteo A, Seminari E, Camporotondo R, Riccardi M, Ghio S, Raineri C, Scelsi L, D'Armini AM, Oltrona Visconti L, Pelenghi S. P5416A single-center, thirty-year experience of heart transplantation: analysis of the evolution of patients profile and long term outcomes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Heart Transplantation is still the gold standard therapy for patients suffering from end-stage cardiomyopathy and has been successfully performed in our center since 1985. Over this 30 years period there has been a significant evolution in patients characteristics and in candidate selection (either as a donor and as recipient) as shown by the recent benchmark from International Society of Heart and Lung Transplantation (ISHLT). Here we analyze the evolution of patients profile in our population and we correlated such evolution to the clinical outcomes and to the overall data from ISHLT.
Materials and methods
Overall 1122 patients underwent heart transplantation at our center from November 19th1985 to date. To analyze the evolution patients profile and donor criteria, patient population was divided in 4 groups according era of transplantation following ISHLT model (Group A from 1985 to 1991; Group B from 1992 to 2003; Group C from 2004 to 2008 and Group D from 2009 to date). Patients characteristics at time of transplantation, donor criteria ad clinical outcomes were analyzed and compared within 4 groups. An overall comparison of our results to the data from ISHLT was also performed.
Results
Overall Kaplan-Meier survival curve correlates favourably with ISHLT data showing a 20 years survival approaching 40%. Patients age at transplantation changed significantly among 4 groups from a median of 49 years (95% CI 47 to 51) in Group A to 54 years (95% CI 50 to 57) in Group D (p<0.001). Likewise donor age also changed significantly from a median of 24 years (95% CI 22 to 28) in Group A to 43 years (95% CI 39 to 47) in group D (p<0.001). Time on waiting list also changed significantly from a median of 115 days (95% CI 94 to 137) in Group A to 293 (95% CI 200 to 401) in Group D (p<0.001). As a marker of evolution of accepted donor criteria also ischemic time changed from 125±52 minutes of Group A to 153±61 minutes of Group D (p<0.001). As showed in Fig 1, Kaplan-Meier survival curves demonstrated a worse 1-year survival in Group D compared to others 3 Group.
Figure 1
Conclusions
The significant changing characteristics of both recipients and donors, over 30 years of activity, had a significant impact in early (1 year) postoperative survival following heart transplantation. Although medium/long term outcomes are still satisfactory in patients surviving at least 1 year, these data clearly suggest a more accurate patients selection and the need of alternative treatment before patients conditions deteriorate while on waiting list for heart transplantation
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Affiliation(s)
- A Turco
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - P Totaro
- Policlinic Foundation San Matteo IRCCS, Cardiac Surgical Department, Pavia, Italy
| | - C Pellegrini
- Policlinic Foundation San Matteo IRCCS, Cardiac Surgery-Clinical,Surgical,Diagnostic and Paediatric Sciences Department University of Pavia, Pavia, Italy
| | - S Guida
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - B Cattadori
- Policlinic Foundation San Matteo IRCCS, Cardiac Surgical Department, Pavia, Italy
| | - A Di Matteo
- Policlinic Foundation San Matteo IRCCS, Department of Infectious disease, Pavia, Italy
| | - E Seminari
- Policlinic Foundation San Matteo IRCCS, Department of Infectious disease, Pavia, Italy
| | - R Camporotondo
- Policlinic Foundation San Matteo IRCCS, Cardiac Intensive Care Unit, Pavia, Italy
| | - M Riccardi
- Policlinic Foundation San Matteo IRCCS, Cardiopulmonary anhestesiological, Pavia, Italy
| | - S Ghio
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - C Raineri
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - L Scelsi
- Policlinic Foundation San Matteo IRCCS, Cardiology, Pavia, Italy
| | - A M D'Armini
- Policlinic Foundation San Matteo IRCCS, Cardiac Surgery-Cardiopulmonary Surgery and Pulmonary Hypertension Unit, University of Pavia, Pavia, Italy
| | | | - S Pelenghi
- Policlinic Foundation San Matteo IRCCS, Cardiac Surgical Department, Pavia, Italy
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Baldi E, Demarchi A, Mauri S, Di Giacomo C, Ferrario Ormezzano M, Ferlini M, Savastano S, Petracci B, Sanzo A, Aiello M, Gazzoli F, Pelenghi S, Oltrona Visconti L, De Ferrari GM, Rordorf R. 6118Mid- and long-term percentage of ventricular pacing in patients implanted with a pacemaker after a transcatheter aortic valve replacement procedure: potential clinical implications. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac conduction disturbances frequently occur following transcatheter aortic valve replacement (TAVR). As this procedure is getting more and more common, more research efforts should focus on post procedural rhythm disturbances and their evolution over time
Purpose
To evaluate the percentage of pacing in patients who underwent a TAVR procedure and developed a conduction disturbance requiring a transvenous pacemaker (PM) implantation
Methods
We considered all the patients who underwent a TAVR procedure between march 2009 and november 2018 in our centre. Patients implanted with a PM or an ICD before the TAVR procedure or 30 days after the TAVR were not considered eligible for our analysis, because likely not related to TAVR. The percentage of effective right ventricular pacing was assessed both at mid- and long-term follow-up
Results
265 patients underwent TAVR in the study period (45% males, 81±6 years). 20 patients already had a PM and were excluded. 39 of the 245 patients (16%) were implanted with a PM after TAVR, 26 of them were implanted within 30 days (median time TAVR-PM implant: 8±7 days). The rate of PM implant within 30 days after TAVR was 8% (20/246) for patients implanted with an Edward Sapien valve, 25% (4/16) for patients with an Evolute Pro valve and 66% (2/3) in patients with a Lotus Edge valve. The indication for PM implant was a permanent 3rd degree A-V block in 12 patients, a paroxysmal A-V block in 4, a bifascicular A-V block with an infra-hisian disease in 5, a II degree Mobitz II A-V block in 2, an atrial fibrillation with slow A-V conduction in 2 and a 2:1 A-V block with infra-hisian disease in 1. The first follow-up after the PM implantation was available in 24 patients (mean 78±87 days after PM implant) and the second in 15 patients (372±267 days after PM implant). The patients were divided into two groups based on the presence/absence of permanent 3rd degree AV block at the time of implantation. At the first follow-up the percentage of pacing was significantly higher in patients implanted with vs. without a permanent 3rd degree AV block (98.5% vs 11%, p<0.001). Notably, in none of the patients without a permanent 3rd AV block at baseline conduction disturbances progressed toward a permanent AV block during long-term follow-up. Accordingly, at the second follow-up patients without permanent 3rd AV block at baseline showed a significantly lower percentage of pacing (1% vs 100%; p<0.01)
Conclusion
Patients implanted with a PM after TAVR in the absence of a permanent 3rd AV block have a very low likelihood of progression to a permanent AV conduction disturbance and show a negligible percentage of pacing during follow-up. Our results may impact the choice of the correct timing of PM implantation after TAVR and the potential indication for a leadless PM.
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Affiliation(s)
- E Baldi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Demarchi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Mauri
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - C Di Giacomo
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | | | - M Ferlini
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - S Savastano
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - B Petracci
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Sanzo
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - M Aiello
- Foundation IRCCS Policlinic San Matteo, Department of Cardiothoracic Surgery, Pavia, Italy
| | - F Gazzoli
- Foundation IRCCS Policlinic San Matteo, Department of Cardiothoracic Surgery, Pavia, Italy
| | - S Pelenghi
- Foundation IRCCS Policlinic San Matteo, Department of Cardiothoracic Surgery, Pavia, Italy
| | - L Oltrona Visconti
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - G M De Ferrari
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - R Rordorf
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
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28
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Montalto C, Crimi G, Mandurino-Mirizzi A, Frassica R, Gazzoli F, Covi R, Moschella M, Ghio S, Magrini G, Raineri C, Pelenghi S, Ferrario M, De Ferrari GM, Oltrona-Visconti L. P1856Percutaneous mitral edge-to-edge valvuloplasty in end-stage heart failure as a bridge to heart transplant: a case series from a single tertiary referral center. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Improved outcomes after percutaneous edge-to-edge mitral valvuloplasthy with MitraClip implantation were recently observed in patients with heart failure (HF) and functional severe mitral regurgitation (MR). Nonetheless, its efficacy in end-stage heart failure (HF) are lacking.
Purpose
Our aim was to investigate feasibility, preliminary efficacy on hemodynamics and follow-up of MitraClip implantation in a cohort of patients with very advanced HF.
Methods
Patients were retrospectively included in the present analysis if already in HT list, unsuitable for HT despite optimal medical and device therapy, or if implantation was a “bridge-to-candidacy”.
Results
Baseline and procedural characteristics are listed in Table 1; MR etiology was predominantly functional (n=7). No major complications were observed in the peri-operative period. At 6-month follow-up, invasive hemodynamics was available for 8 patients. A significant increase in cardiac index was observed (Least Square Mean Difference, LSMD = +0.47 L/min/m2; p=0.03; Figure 1), in conjunction with a numerical reduction in pulmonary vascular resistance (LSMD = −1.02 WU; p=0.3), a trend towards lower mean pulmonary arterial pressure (LSMD = −6.5 mmHg; p=0.053) and lower ejection fraction (LSMD = −6.5%; p=0.053). At a median follow-up of 772 days (IQR 156–1,578), all three patients unsuitable for HT at baseline could be eligible to HT list and one of them received LVAD. Moreover, two patients were transplanted, four experienced unplanned rehospitalization for HF, and one died of non-cardiac cause.
Table 1. Baseline clinical evaluation (n=10) Age (y) 53.67±8.43 HF Etiology – post ischemic 4 (40) Male sex 6 (60) HF Etiology – no CAD 4 (40) Body Surface Area (m2) 1.76±0.22 HF Etiology – other 2 (20) Chronic Resynchronization Therapy 5 (50) Euroscore II 6.00±2.74 Baseline MR grade (+) 4 (40) STS mortality 1.71±2.65 Residual MR grade (+) 1.71±0.49 Clips implanted (number) 1.78±0.67 Data are expressed as mean ± SD or count (valid %). MR scored on a scale from 0+ to 4+. STS, Society of Thoracic Surgeons.
Figure 1
Conclusions
Percutaneous edge-to-edge mitral valvuloplasty with MitraClip appears safe and effective in end-stage patients, impacts on clinical decision-making and therefore might be considered as a “bridge” towards a more definite strategy.
Acknowledgement/Funding
None
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Affiliation(s)
- C Montalto
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - G Crimi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - A Mandurino-Mirizzi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - R Frassica
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - F Gazzoli
- Policlinic Foundation San Matteo IRCCS, Division of Cardiac Surgery, Pavia, Italy
| | - R Covi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - M Moschella
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - S Ghio
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - G Magrini
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - C Raineri
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - S Pelenghi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiac Surgery, Pavia, Italy
| | - M Ferrario
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - G M De Ferrari
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit, Pavia, Italy
| | - L Oltrona-Visconti
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
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29
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Celentano A, Masiglat L, Pelenghi S, Totaro P. EP35 SHOULD MODEL FOR END STAGE LIVER DISEASES (MELD) AND MELD-BASED SCORES BE ROUTINELY APPLIED TO PREOPERATIVE ASSESMENT OF PATIENT UNDERGOING VALVULAR CARDIAC SURGERY? J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549950.09477.33] [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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30
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Sbaffi A, Cuko E, Pelenghi S, Totaro P. EP18 INCIDENCE AND CLINICAL IMPACT OF POSTOPERATIVE MITRAL PATIENT-PROSTHESIS MISSMATCH. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549948.01853.8f] [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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31
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Totaro P, Pelenghi S. Patient-prosthesis mismatch after mitral valve replacement: complex enigma with more than one solution. Eur J Cardiothorac Surg 2018; 54:609. [PMID: 29684117 DOI: 10.1093/ejcts/ezy163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/26/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Pasquale Totaro
- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Pavia, Italy
| | - Stefano Pelenghi
- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Pavia, Italy
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32
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Baroni M, Cattafi G, Arupi M, Paolucci M, Pelenghi S, Lunati M. Subcutaneous ICD implantation in a patient with hypertrophic cardiomyopathy after transvenous ICD failure: A case report. J Arrhythm 2018; 34:81-83. [PMID: 29721119 PMCID: PMC5828265 DOI: 10.1002/joa3.12011] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/15/2017] [Indexed: 11/12/2022] Open
Abstract
We describe the case of a patient with hypertrophic cardiomyopathy who experienced the failure of a transvenous implantable cardioverter defibrillator (T‐ICD) lead and the following inability of a second T‐ICD to convert a ventricular fibrillation. A subcutaneous ICD (S‐ICD) was finally implanted and was effective at defibrillation test.
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Affiliation(s)
- Matteo Baroni
- De Gasperis Cardio Center Niguarda Ca' Granda Hospital Milan Italy
| | - Giuseppe Cattafi
- De Gasperis Cardio Center Niguarda Ca' Granda Hospital Milan Italy
| | | | - Marco Paolucci
- De Gasperis Cardio Center Niguarda Ca' Granda Hospital Milan Italy
| | - Stefano Pelenghi
- De Gasperis Cardio Center Niguarda Ca' Granda Hospital Milan Italy
| | - Maurizio Lunati
- De Gasperis Cardio Center Niguarda Ca' Granda Hospital Milan Italy
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33
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Zanettini R, Gatto G, Mori I, Pozzoni MB, Pelenghi S, Martinelli L, Klugmann S. Cardiac rehabilitation and mid-term follow-up after transcatheter aortic valve implantation. J Geriatr Cardiol 2014; 11:279-85. [PMID: 25593575 PMCID: PMC4294143 DOI: 10.11909/j.issn.1671-5411.2014.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/16/2014] [Accepted: 10/28/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Evaluation of patient outcomes following transcatheter aortic valve implantation (TAVI) has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. METHODS Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. RESULTS On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days (range: 192-738 days), five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. CONCLUSIONS Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up.
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Affiliation(s)
- Renzo Zanettini
- Cardiac Rehabilitation Centre, Istituti Clinici di Perfezionamento Hospital, via Bignami 1, 20126 Milan, Italy
| | - Gemma Gatto
- Cardiac Rehabilitation Centre, Istituti Clinici di Perfezionamento Hospital, via Bignami 1, 20126 Milan, Italy
| | - Ileana Mori
- Cardiac Rehabilitation Centre, Istituti Clinici di Perfezionamento Hospital, via Bignami 1, 20126 Milan, Italy
| | - Maria Beatrice Pozzoni
- Cardiac Rehabilitation Centre, Istituti Clinici di Perfezionamento Hospital, via Bignami 1, 20126 Milan, Italy
| | - Stefano Pelenghi
- De Gasperis Cardiology and Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Luigi Martinelli
- De Gasperis Cardiology and Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Silvio Klugmann
- De Gasperis Cardiology and Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
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34
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Tasca G, Vismara R, Fiore GB, Mangini A, Romagnoni C, Pelenghi S, Antona C, Redaelli A, Gamba A. Fluid-dynamic results of in vitro comparison of four pericardial bioprostheses implanted in small porcine aortic roots. Eur J Cardiothorac Surg 2014; 47:e62-7. [DOI: 10.1093/ejcts/ezu446] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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35
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Botta L, Pelenghi S, Bruschi G, Martinelli L. Early giant pseudo-aneurysm originating from the right coronary ostium. Eur J Cardiothorac Surg 2013; 43:e102-3. [PMID: 23277435 DOI: 10.1093/ejcts/ezs649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Luca Botta
- Cardiac Surgery Unit, Cardiovascular Department, Niguarda Cà Granda Hospital, Milan, Italy.
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36
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Bruschi G, Colombo T, Botta L, Colombo P, Pelenghi S, Trunfio S, Cannata A, Merlanti B, Paino R, Klugmann S, Martinelli L. Off-pump coronary revascularization in chronic dialysis-dependent patients: early outcomes at a single institution. J Cardiovasc Med (Hagerstown) 2010; 11:481-7. [DOI: 10.2459/jcm.0b013e328335730a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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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37
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Affiliation(s)
- Andrew E Newcomb
- Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
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38
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Fundarò P, Tartara P, Villa E, Trunfio S, Campisi S, Pelenghi S, Tarelli G, Vitali E. [Surgical therapy of coronary artery disease in the Italian cardiac surgery centers]. G Ital Cardiol (Rome) 2006; 7:618-25. [PMID: 17128784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND We conducted a national survey on surgical therapy for coronary artery disease and its complications, with the aim to eventually identify differences in the processes of care adopted in the Italian cardiac surgery centers. METHODS Eighty-seven Italian cardiac surgery units received a questionnaire about their general activity profile and the following interest areas: (a) surgical myocardial revascularization techniques; (b) ischemic mitral regurgitation treatment; (c) left ventricular reconstruction procedures; (d) mechanical circulatory support and heart transplantation in ischemic cardiomyopathy. RESULTS Forty-one Centers (47.1%) returned a completely filled questionnaire. The analysis of the answers showed differences in the therapeutic approaches adopted in the various centers regarding: choice of surgical technique and grafts for myocardial revascularization; propensity to treat moderate ischemic mitral regurgitation in the setting of severe left ventricular dysfunction; propensity to treat extended myocardial scars; treatment options in ischemic cardiomyopathy with advanced heart failure. The specific center profile (volume of activity, availability of heart transplantation) seems to influence the choice among the different treatment options. CONCLUSIONS This study may contribute to show and analyze existing differences in clinical practice between different centers. Diagnostic and therapeutic approaches (processes of care) should be frequently monitored in order to promptly single out critical areas necessitating review or further researches, to standardize decision making criteria, and to improve care appropriateness.
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Affiliation(s)
- Pino Fundarò
- Divisione di Cardiochirurgia, Dipartimento Cardiologico A. De Gasperis, Ospedale Niguarda Ca'Granda, Milano.
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Catena E, Barosi A, Milazzo F, Paino R, Pelenghi S, Garatti A, Colombo T, Vitali E. Three-Dimensional Echocardiographic Assessment of a Patient Supported by Intravascular Blood Pump Impella Recover 100. Echocardiography 2005; 22:682-5. [PMID: 16174125 DOI: 10.1111/j.1540-8175.2005.40064.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Impella Recover 100 is an intravascular microaxial blood pump designed for short-term circulatory support in conditions of reduced left ventricular function. Two-dimensional echocardiography is a consolidated tool to study and monitor patients undergoing circulatory support. Three-dimensional (3D) echocardiography is emerging as a source of more accurate analysis in heart morphology and function. We described the use of 3D echocardiography in a patient who underwent Impella recover 100 support for postcardiotomy shock. 3D echocardiography allowed complete visualization of the pump and provided excellent intraoperative assessment of the complex spatial location into the left ventricle.
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Affiliation(s)
- Emanuele Catena
- Cardiothoracic Anesthesiology Division, Department of Cardio-Thoracic Surgery A. De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy.
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40
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Colombo T, Pelenghi S, Bruschi G, Tarelli G, Montorsi E, Merli M, Vitali E. [Comorbidity in surgical myocardial revascularization: risk factors or contraindications for surgery]. Ital Heart J Suppl 2004; 5:376-81. [PMID: 15182064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND The worsening evolution of patients undergoing surgical myocardial revascularization makes it difficult the stratification of the preoperative mortality risk, a correct evaluation of results and the comparison of results of different centers. The aim of the study was to evaluate the prognostic weight of comorbidity in surgical myocardial revascularization. METHODS We evaluated the characteristics of preoperative morbidity in 4999 patients who underwent surgical myocardial revascularization during four different periods (1979-1980, 1991-1992, 1994-1998, 1999-2002). We also evaluated the in-hospital results. RESULTS By comparing the four different periods, an increase in older age, female sex, comorbidity, three-vessel disease, and severe left ventricular dysfunction was observed. Surgical mortality decreased to 2.3%. Multivariate analysis of the 1999-2002 period showed that only renal insufficiency was a risk factor for in-hospital mortality. CONCLUSIONS Although the preoperative risk is higher, nowadays hospital mortality is reduced thanks to new cardiac-surgical techniques and approaches that increasing the capacity of controlling comorbidity in the pre-, intra- and postoperative course. For a correct decision-making process it is crucial to assess how much comorbidity may influence the long-term follow-up in these patients independently of surgical myocardial revascularization.
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Affiliation(s)
- Tiziano Colombo
- U. O. di Cardiochirurgia, Dipartimento Cardio-Toraco-Vascolare "A. De Gasperis", A.O. Niguarda Ca' Granda, Milano
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41
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Abstract
Congenital aneurysmal dilatation of the left atrial appendage is a rare but correctable lesion. It represents a diagnostic dilemma in patients with cardiomegaly and is commonly associated with supraventricular arrhythmias and life-threatening systemic embolization. We describe the diagnostic evaluation and surgical treatment during 1997 of a patient with congenital aneurysmal dilatation of the left atrial appendage. The patient was discharged previously from our hospital in 1967 with the diagnosis of congenital dilatation of the pulmonary artery.
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Affiliation(s)
- G Pomé
- A. De Gasperis Cardio-Thoracic Department, Cà Granda-Niguarda Hospital, Milan, Italy.
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42
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Landoni C, Lucignani G, Paolini G, Zuccari M, Galli L, Di Credico G, Rossetti C, Pelenghi S, Gilardi MC, Fazio F, Grossi A. Assessment of CABG-related risk in patients with CAD and LVD. Contribution of PET with [18F]FDG to the assessment of myocardial viability. J Cardiovasc Surg (Torino) 1999; 40:363-72. [PMID: 10412921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Previous studies have demonstrated that hibernating myocardium can be assessed by [18F]fluorodeoxyglucose ([18F]FDG) and positron emission tomography (PET). This study evaluated the use of [18F]FDG-PET for CABG related risk assessment in patients with coronary artery disease (CAD) and left ventricle dysfunction (LVD). METHODS We retrospectively evaluated 241 to patients candidate CABG presenting with signs and symptoms of congestive heart failure (CHF) prevailing over ischemic signs. Of the 241 patients, 153 had undergone [18F]FDG-PET as well as conventional assessment: 110 out of 153 (group A) were operated because of PET evidence of hibernation. Of the 241 patients, 88 had not undergone [18F]FDG-PET: 86 out of 88 (group B) were operated on. The outcome of surgical patients was evaluated by considering all major perioperative complications including the use of mechanical and pharmacological support and in-hospital mortality. After hospital discharge, each patient was examined at 1, 4 and every 6 months thereafter. RESULTS Perioperative use of mechanical supports and inotropic drugs, was significantly lower for the PET selected group (A) than for the non PET selected group (B). Mortality within 30 days of surgery was 0.9% in group A and 19.8% in group B. The only predictors of perioperative outcome were the presence of hibernating tissue and the ejection fraction. CONCLUSIONS [18F]FDG-PET prior to CABG can be crucial for the assessment of perioperative risk in patients with CAD.
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Affiliation(s)
- C Landoni
- INB-CNR, Department of Nuclear Medicine, University of Milan, Italy
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43
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Donatelli F, Pelenghi S, Pocar M, Moneta A, Grossi A. Combined carotid and cardiac procedures: improved results and surgical approach. Cardiovasc Surg 1998; 6:506-10. [PMID: 9794272 DOI: 10.1016/s0967-2109(98)00032-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Severe cerebrovascular complications following cardiac surgical procedures remain a major concern, particularly in patients with significant carotid atherosclerotic involvement (14% of perioperative stroke). Operative mortality for carotid operations in patients with documented Coronary Artery Disease (CAD) may be as high as 20%. Seventy patients underwent combined operations (unilateral carotid stenosis > 70%, unilateral stenosis > 50% with ulcerated plaque or bilateral stenoses > 50%; and this also included patients with unilateral occlusion). Cardiac procedures were 69 coronary artery bypass grafts, four left ventricular aneurysmectomies, three aortic valve replacements and surgery on two mitral valves. Seven perioperative deaths occurred, which were all caused by cardiac events. There were no perioperative strokes. Carotid endarterectomy immediately before cardiopulmonary bypass is a safe and expeditious approach to coexisting significant cardiac and carotid disease. In our experience, technical details in monitoring and minimizing cerebral ischemia are possibly more crucial in these severe vasculopathic patients. Moreover, it is probably advantageous from an economic standpoint compared with other therapeutic treatments.
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Affiliation(s)
- F Donatelli
- Istituto di Malattie dell'apparato cardiovascolare e respiratorio, Universitá degli Studi di Milano, Ospedale Maggiore Policlinico, Milan, Italy
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44
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Pocar M, Moneta A, Pelenghi S, Donatelli F, Tresoldi F, Scomazzoni F, Grossi A. Mycotic aortic aneurysm presenting as multiple cerebral abscesses. Acta Neurochir (Wien) 1998; 140:289-90. [PMID: 9638268 DOI: 10.1007/s007010050098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 68-year-old male presented with multiple cerebral abscesses. Possible intrathoracic embolic sources were not detected by echocardiography and chest radiography and the main lesion was surgically excised. Following deterioration of the neurological status, computerized tomography performed 2 weeks later revealed a mycotic aneurysm of the ascending aorta, probably related to a previous cardiac operation. This is the first case in the literature of aortic infection presenting as multiple brain abscesses.
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MESH Headings
- Aged
- Aneurysm, Infected/complications
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/pathology
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/pathology
- Aortic Aneurysm, Thoracic/complications
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/pathology
- Brain Abscess/diagnostic imaging
- Brain Abscess/etiology
- Brain Abscess/pathology
- Diagnosis, Differential
- Fatal Outcome
- Humans
- Klebsiella Infections/diagnostic imaging
- Klebsiella Infections/etiology
- Klebsiella Infections/pathology
- Male
- Parietal Lobe/diagnostic imaging
- Parietal Lobe/pathology
- Staphylococcal Infections/diagnostic imaging
- Staphylococcal Infections/etiology
- Staphylococcal Infections/pathology
- Staphylococcus epidermidis
- Tomography, X-Ray Computed
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Affiliation(s)
- M Pocar
- Istituto di Malattie dell'Apparato Cardiovascolare e Respiratorio, Università degli Studi di Milano, Italy
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45
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Donatelli F, Pocar M, Triggiani M, Moneta A, Lazzarini I, D'Ancona G, Pelenghi S, Grossi A. Surgery of cavo-atrial renal carcinoma employing circulatory arrest: immediate and mid-term results. Cardiovasc Surg 1998; 6:166-70. [PMID: 9610830 DOI: 10.1016/s0967-2109(97)00135-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
From 1990 to 1995, 12 patients with cavo-atrial renal cell carcinoma underwent resection of the tumor. Circulatory arrest was employed in 11/12 cases. The neoplasm extended to the inferior vena cava in two patients and to the intrahepatic veins or right atrium in five cases. Two severely cardiac compromised patients died perioperatively. Of five patients who showed preoperative suspicion of isolated metastases, 3 patients died postoperatively because of relapsing disease after a mean period of 10.8 months. Five patients are alive and doing well after a mean follow-up of 14.8 months. In our experience myocardial dysfunction determined poor immediate survival. Mid-term survival was influenced by preoperative metastases and lymph-node involvement, but not by intracaval extension. Circulatory arrest appears to be a relatively safe technique to remove renal carcinoma with cavo-atrial extension and should be indicated whenever there are no metastases.
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Affiliation(s)
- F Donatelli
- Institute for Cardiovascular and Respiratory Diseases, University of Milan, Ospedale Maggiore Policlinico, Italy
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Abstract
In an adult with severe dysphagia, diagnosis of aneurysmal aberrant subclavian artery was suspected on computed tomogram; no vascular ring was visible on arteriogram. A diverticulum of the aortic isthmus was surgically resected. Histologic analysis ruled out acquired disease. In conclusion, dysphagia related to esophageal compression may be caused by an isolated congenital aortic diverticulum.
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Affiliation(s)
- F Donatelli
- Istituto di Malattie dell'apparato cardiovascolare e respiratorio, Università degli Studi di Milano, IRCCS H. San Raffaele, Italy
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47
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Donatelli F, Pocar M, Moneta A, Mariani MA, Pelenghi S, Triggiani M, Santoro F, Grossi A. Primary cardiac malignancy presenting as left atrial myxoma. Clinical and surgical considerations. MINERVA CHIR 1996; 51:585-8. [PMID: 8940803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Primary heart neoplasms occur in 0.002-0.3% of autopsies: 30% are myxomas and 20-30% are malignancies, almost always sarcomas. Cardiac metastases are 10 to 40 times more frequent than primary heart cancer. We describe a case of a left atrial sarcoma erroneously diagnosed as myxomas preoperatively. Standard surgical indication for resection of cardiac myxomas is based on echocardiography. Because of the severity of cardiac malignant lesions than can mimic atrial myxomas at echocardiography, through preoperative investigation should be accomplished, best by magnetic resonance imaging. In case of suspected malignancy, total body computed tomography should be performed to avoid unnecessary cardiac operations in case of disseminated cancer. To date the only good medium and long-term results in the therapeutic management of heart sarcomas have been achieved by transplantation: the probable explanation is that criteria of surgical radicality should be those followed for soft tissue tumors located elsewhere in the organism.
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Affiliation(s)
- F Donatelli
- Istituto di Malattie, Università degli Studi-Milano
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48
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Affiliation(s)
- F Donatelli
- Institute for Cardiovascular and Respiratory Diseases, University of Milan, IRCCS H.S. Raffaele, Italy
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49
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Mariani MA, Donatelli F, Pelenghi S, Triggiani M, Grossi A. [Myocardial revascularization in patients with impaired left ventricular function]. Cardiologia 1994; 39:159-67. [PMID: 8039194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
From March 1988 to May 1993, 1,125 patients with coronary artery disease (CAD) underwent coronary surgery at our Institute. In the same period 74 patients (mean age 59 +/- 7 years; range 36-73) with left ventricular dysfunction (LVD) were referred for surgical decision making. All patients underwent [99mTc]MIBI/SPET to assess perfusion at rest and [99mTc]MIBI first pass radionuclide angiography to assess the ejection fraction (EF). In 44/74 patients we performed [18F]FDG/PET in fasting conditions and pharmacologic wash-out, in order to identify viable myocardium. We divided patients with LVD into 3 groups: Group A (30 patients) operated on without preoperative [18F]FDG/PET, Group B (37 patients) operated on with FDG uptake in segments with wall motion abnormalities, and Group C (7 patients) with no FDG uptake, who were excluded from coronary surgery; there was no significant difference among the 3 groups with respect to age, sex, CAD, risk factors and EF (Group A: 29.1% +/- 6.6%, range 16-39%; Group B: 30.8 +/- 5.6%, range 20-40%; Group C: 26.5 +/- 6.8%, range 18-37%). The study of perfusion and EF was repeated 6 months postoperatively in Group A and B. Left ventricular end-dyastolic pressure at cardiac catheterization was 19.9 +/- 5.1 mmHg, 20.4 +/- 4.7 mmHg and 26.8 +/- 9.2 mmHg in Group A, B and C, respectively. Myocardial protection was achieved according to the Buckberg protocol.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M A Mariani
- Istituto per le Malattie dell'Apparato Cardiovascolare e Respiratorio, IRCCS H San Raffaele, Università degli Studi, Milano
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50
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Donatelli F, Mariani MA, Pocar M, Triggiani M, Pelenghi S, Grossi A. Successful treatment of coronary artery spasm following coronary artery bypass grafting. Cardiologia 1993; 38:601-5. [PMID: 8287390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case of coronary artery spasm developed 6 hours after myocardial revascularization inducing both hemodynamic and electrocardiographic changes, is reported. The spasm was documented by coronary angiography, and it was not reversed by intracoronary infusion of isosorbide dinitrate. Intravenous infusion of nifedipine (initial dose of 0.0104 mg/min to final dose of 0.0208 mg/min), along with infusion of glyceronitrate (1.0 micrograms/kg/min) was able to significantly improve hemodynamic impairment and to reverse electrocardiographic changes in 12 hours. Coronary angiography, repeated in postoperative day 3, after 48 hours of continuous nifedipine infusion, showed a resolution of coronary spasm. There was no evidence of myocardial infarction as resulted from total CPK and MB isoenzyme release. Nifedipine infusion was gradually reduced as oral administration of slow release nifedipine (40 mg twice daily) was started. The combined intravenous infusion of glyceronitrate and nifedipine seems to be able to control and overcome coronary artery spasm following coronary surgery.
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Affiliation(s)
- F Donatelli
- Istituto Malattie dell'Apparato Cardiovascolare e Respiratorio, Università degli Studi, IRCCS H San Raffaele, Milano
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