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Matteucci A, Bonanni M, Massaro G, Chiricolo G, Stifano G, Forleo GB, Biondi-Zoccai G, Sangiorgi G. Treatment with gentamicin-impregnated collagen sponges in reducing infection of implantable cardiac devices: 10-year analysis with propensity score matching. Rev Port Cardiol 2023:S0870-2551(23)00220-2. [PMID: 37085085 DOI: 10.1016/j.repc.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/01/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The incidence of device infection has increased over time and is associated with increased mortality in patients with cardiac implantable electronic devices (CIEDs). Gentamicin-impregnated collagen sponges (GICSs) are useful in preventing surgical site infection (SSI) in cardiac surgery. Nevertheless, to date, there is no evidence concerning their use in CIED procedures. Our study aims to determine the effectiveness of treatment with GICSs in preventing CIED infection. METHODS A total of 2986 adult patients who received CIEDs between 2010 and 2020 were included. Before device implantation, all patients received routine periprocedural systemic antibiotic prophylaxis. The study endpoints were the CIED infection rate at one year and the effectiveness of the use of GICSs in reducing CIED infection. RESULTS Among 1524 pacemaker, 942 ICD and 520 CRT implantations, CIED infection occurred in 36 patients (1.2%). Early reintervention (OR 9 [95% CI 3.180-25.837], p<0.001), pocket hematoma (OR 11 [95% CI 4.195-28.961], p<0.001), diabetes (OR 2.9 [95% CI 1.465-5.799], p=0.002) and prolonged procedural time (OR 1.02 [95% CI 1.008-1.034], p=0.001) were independent risk factors for CIED infection. Treatment with GICSs reduced CIED infections significantly ([95% CI -0.031 to -0.001], p<0.001). CONCLUSIONS The use of GICSs may help in reducing infections associated with CIED implantation.
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Affiliation(s)
- Andrea Matteucci
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy; Division of Cardiology, San Filippo Neri Hospital, Via Martinotti, 20, Rome, Italy.
| | - Michela Bonanni
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy
| | - Gianluca Massaro
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy
| | - Gaetano Chiricolo
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Giuseppe Stifano
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy; Division of Cardiology, San Filippo Neri Hospital, Via Martinotti, 20, Rome, Italy; Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy; Arrhythmology, Luigi Sacco Hospital, Milan, Italy; Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | | | - Giuseppe Biondi-Zoccai
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
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Monaco C, Barone L, Cammalleri V, Stifano G, Magliano G, Geuna F, Romeo F, Sergi D. Local gentamicin-collagen sponge reduces cardiovascular implantable electronic device infections and pocket hematoma. Eur Rev Med Pharmacol Sci 2022; 26:5218-5224. [PMID: 35916820 DOI: 10.26355/eurrev_202207_29311] [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
OBJECTIVE Implantation or replacement of a cardiovascular implantable electronic device (CIED) may be associated with complications, such as pocket hematomas and infections. This study aims to determine whether a lyophilized gentamycin-containing collagen implant (GCCI) reduces major CIED infections and pocket hematomas after implant. SUBJECTS AND METHODS A retrospective study was conducted among patients who underwent implantation or replacement of CIED at the Tor Vergata Polyclinic (Rome, Italy) between June 2007 and November 2019. The primary combined endpoint was infection and hematoma occurrence through 12 months of follow-up post-procedure. The rate of single infectious complications, pocket hematomas or both were also assessed. RESULTS We compared 475 patients treated with the GCCI (GCCI group) with 714 patients who did not receive it (control group). Complications occurred in 127 patients (11%); a statistically significant reduction of infections and pocket hematomas in the GCCI group was reported when compared with control patients (1% vs. 17%; p<0.0001). A total of 20 (2%) infectious events were reported, 102 (8%) patients developed a pocket hematoma, and 5 (0.4%) had both. The rate of single complications was significantly lower in GCCI group: infection 0.2% vs. 2.6% (p=0.002), pocket hematoma 0.6% vs. 13.8% (p<0.001). The association between antiplatelet/anticoagulation therapy and hematoma development was not statistically significant. CONCLUSIONS The GCCI is a medical device that can be used in addition to local hemostasis and prophylactic doses of systemic antibiotics with the aim of reducing infective complications and pocket hematoma after permanent CIED implantation or replacement.
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Affiliation(s)
- C Monaco
- Department of Cardiovascular Medicine, Tor Vergata University, Rome, Italy.
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Matteucci A, Bonacchi G, La Fazia VM, Stifano G, Sergi D. Matching Imaging and Remodulation Effects: Benefits of Cardiac Contractility Modulation Shown by Global Longitudinal Strain: A Case Report. Clin Pract 2022; 12:113-117. [PMID: 35200266 PMCID: PMC8870986 DOI: 10.3390/clinpract12010015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
Cardiac Contractility Modulation (CCM) has been proposed for inpatients affected by heart failure with reduced ejection fraction (HFrEF), with relapsing HF symptoms. We present a case of a patient treated with percutaneous coronary intervention (PCI) in the setting of acute coronary syndrome without persistent ST-segment elevation, with the best medical therapy for decompensated HF. The patient refused the implantable cardioverter-defibrillator (ICD), and to reduce the increasing number of hospitalizations for HF exacerbations, we proposed the use of the cardiac contractility modulation device. After the implant, the patient demonstrated a marked improvement in exercise effort and quality of life (QOL) with a six-minute walk test (SMWT), Minnesota Living with Heart Failure Questionnaire (MLWHFQ), and echocardiographic parameters. At 9 months after discharge, no hospital admissions for HF were recorded. We showed with the speckle tracking imaging how the improvement in global longitudinal strain (GLS) correlates with the remodeling effects on myocardial cells.
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Affiliation(s)
- Andrea Matteucci
- Division of Cardiology, San Filippo Neri Hospital, Via Martinotti, 20, 00135 Rome, Italy
- Division of Cardiology, University Hospital “Tor Vergata”, 00133 Rome, Italy; (G.B.); (V.M.L.F.); (G.S.); (D.S.)
- Correspondence:
| | - Giacomo Bonacchi
- Division of Cardiology, University Hospital “Tor Vergata”, 00133 Rome, Italy; (G.B.); (V.M.L.F.); (G.S.); (D.S.)
| | - Vincenzo M. La Fazia
- Division of Cardiology, University Hospital “Tor Vergata”, 00133 Rome, Italy; (G.B.); (V.M.L.F.); (G.S.); (D.S.)
| | - Giuseppe Stifano
- Division of Cardiology, University Hospital “Tor Vergata”, 00133 Rome, Italy; (G.B.); (V.M.L.F.); (G.S.); (D.S.)
| | - Domenico Sergi
- Division of Cardiology, University Hospital “Tor Vergata”, 00133 Rome, Italy; (G.B.); (V.M.L.F.); (G.S.); (D.S.)
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Massaro G, Stifano G, Ambrogi V, Anemona L, Mariano EG, Chiricolo G, Martuscelli E, Sangiorgi GM. A thymic hyperplasia-related reversible complete atrioventricular block: When compression is more important than compressor. J Electrocardiol 2021; 69:68-70. [PMID: 34600403 DOI: 10.1016/j.jelectrocard.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022]
Abstract
A 19-year-old patient presented for syncope with third-degree AV block (TDAVB) at ECG. A chest-CT showed a thymic mass that could be responsible for TDAVB due to extrinsic vagal nerve compression. Thymectomy led to complete AV block resolution. An extrinsic vagal compression mechanism should be considered among causes of complete atrioventricular block.
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Affiliation(s)
- Gianluca Massaro
- Division of Cardiology, "Tor Vergata" University Hospital, 00133 Rome, Italy.
| | - Giuseppe Stifano
- Division of Cardiology, "Tor Vergata" University Hospital, 00133 Rome, Italy
| | - Vincenzo Ambrogi
- Unit of Thoracic Surgery, "Tor Vergata" University of Rome, 00133 Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, "Tor Vergata" University of Rome, 00133 Rome, Italy
| | | | - Gaetano Chiricolo
- Division of Cardiology, "Tor Vergata" University Hospital, 00133 Rome, Italy; Department of Biomedicine and Prevention, "Tor Vergata" University of Rome, 00133 Rome, Italy
| | - Eugenio Martuscelli
- Division of Cardiology, "Tor Vergata" University Hospital, 00133 Rome, Italy; Department of Biomedicine and Prevention, "Tor Vergata" University of Rome, 00133 Rome, Italy
| | - Giuseppe Massimo Sangiorgi
- Division of Cardiology, "Tor Vergata" University Hospital, 00133 Rome, Italy; Department of Biomedicine and Prevention, "Tor Vergata" University of Rome, 00133 Rome, Italy
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Cammalleri V, Bonanni M, Bueti FM, Matteucci A, Cammalleri L, Stifano G, Muscoli S, Romeo F. Multidimensional Prognostic Index (MPI) in elderly patients with acute myocardial infarction. Aging Clin Exp Res 2021. [PMID: 33001403 DOI: 10.1007/s40520-020-01718-6/figures/2] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Management of elderly patients with acute myocardial infarction (AMI) is challenging due to lack of knowledge about the link between fragility, outcomes and interventional procedures. AIMS The aim of this study was to establish the prognostic role of the Multidimensional Prognostic Index (MPI) in elderly with AMI. METHODS A total of 241 patients ≥ 65 years old with AMI were continuously enrolled in this prospective study and divided into three groups according to the MPI score. The primary endpoint was 30-day mortality. Secondary endpoints were 6-month mortality and rate of adverse events. RESULTS In-hospital overall mortality rate was higher in MPI-3 (p = 0.009). Patients of MPI-3 had a significantly higher mortality rate regarding the primary endpoint with 30-day survival of 78.9%, compared to 97.4% and 97.2%, in MPI-1, MPI-2 (p < 0.001), respectively. The survival rate progressively decreased in the three MPI classes of risk with a 6-month survival of 96.5%, 96.3%, 73.7% in groups MPI-1, MPI-2, and MPI-3 (p < 0.001). Longer length of in-hospital stay was observed in MPI-3 group. In-hospital complications were more frequent in higher MPI score. DISCUSSION Our findings are in agreement with the results of other studies that evaluated the risk of in-hospital complications and mortality in older patients. In our "real-world" population of elderly hospitalized for AMI we observed poorer outcomes in patients belonged to higher MPI groups. CONCLUSIONS In the setting of AMI, MPI may be very useful in the daily clinical practice to manage older patients and predict the risk of in-hospital and follow-up complications.
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Affiliation(s)
- Valeria Cammalleri
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.
| | - Michela Bonanni
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Francesca Maria Bueti
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Andrea Matteucci
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Lisa Cammalleri
- Department of OrthoGeriatrics, Rehabilitation and Stabilization, Galliera Hospital, Genova, Italy
| | - Giuseppe Stifano
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Francesco Romeo
- Department of Cardiovascular Disease, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
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Cammalleri V, Bonanni M, Bueti FM, Matteucci A, Cammalleri L, Stifano G, Muscoli S, Romeo F. Multidimensional Prognostic Index (MPI) in elderly patients with acute myocardial infarction. Aging Clin Exp Res 2021; 33:1875-1883. [PMID: 33001403 PMCID: PMC8249274 DOI: 10.1007/s40520-020-01718-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023]
Abstract
Background Management of elderly patients with acute myocardial infarction (AMI) is challenging due to lack of knowledge about the link between fragility, outcomes and interventional procedures. Aims The aim of this study was to establish the prognostic role of the Multidimensional Prognostic Index (MPI) in elderly with AMI. Methods A total of 241 patients ≥ 65 years old with AMI were continuously enrolled in this prospective study and divided into three groups according to the MPI score. The primary endpoint was 30-day mortality. Secondary endpoints were 6-month mortality and rate of adverse events. Results In-hospital overall mortality rate was higher in MPI-3 (p = 0.009). Patients of MPI-3 had a significantly higher mortality rate regarding the primary endpoint with 30-day survival of 78.9%, compared to 97.4% and 97.2%, in MPI-1, MPI-2 (p < 0.001), respectively. The survival rate progressively decreased in the three MPI classes of risk with a 6-month survival of 96.5%, 96.3%, 73.7% in groups MPI-1, MPI-2, and MPI-3 (p < 0.001). Longer length of in-hospital stay was observed in MPI-3 group. In-hospital complications were more frequent in higher MPI score. Discussion Our findings are in agreement with the results of other studies that evaluated the risk of in-hospital complications and mortality in older patients. In our “real-world” population of elderly hospitalized for AMI we observed poorer outcomes in patients belonged to higher MPI groups. Conclusions In the setting of AMI, MPI may be very useful in the daily clinical practice to manage older patients and predict the risk of in-hospital and follow-up complications.
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Cammalleri V, Marsili G, Stelitano M, Tavernese A, Mauceri A, Macrini M, Stifano G, Muscoli S, Mollace R, Di Luozzo M, Sergi D, De Vico P, Romeo F. Every minute counts: in-hospital changes of left ventricular regional and global function in patients with ST-segment elevation myocardial infarction. J Cardiovasc Med (Hagerstown) 2021; 22:363-370. [PMID: 33136804 DOI: 10.2459/jcm.0000000000001056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS The aim of our study was to assess the effects of an early percutaneous coronary intervention on changes of in-hospital left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) in patients with ST-segment elevation myocardial infarction. METHODS The study population consisted of 324 consecutive patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention, divided into two groups, according to the first medical contact (FMC)-to-reperfusion time, respectively, 90 min or less (n = 173) and more than 90 min (n = 151). Moreover, we performed a sub-analysis in the group of patients who showed at discharge an improvement in the LVEF of at least 10%. RESULTS In both groups at baseline, patients suffered from a moderately reduced LVEF (40.88 ± 8.38% in ≤90 min group vs. 40.70 ± 8.98% in >90 min group; P = 0.858). A WMSI of more than 1 was recorded uniformly: 1.71 ± 0.37 in patients with FMC-to-reperfusion 90 min or less and 1.72 ± 0.38 in patients more than 90 min (P = 0.810). At the time of discharge, a significant improvement in LVEF (43.82 ± 8.38%, P = 0.001) and WMSI (1.60 ± 0.41, P = 0.009) exclusively emerged in the 90 min or less group. Furthermore, we identified 105 patients who experienced an improvement in the LVEF of at least 10% compared with baseline values. In these patients FMC-to-reperfusion and total ischemic time resulted as significantly shorter, when compared with patients with LVEF improvement of less than 10%. CONCLUSION Our study confirms and reinforces the concept that reducing the duration of the time between FMC and reperfusion, as well as the total ischemic time influences a positive recovery of left ventricular global and regional function during in-hospital stay.
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Matteucci A, Massaro G, Sergi D, Bonanni M, Stifano G, Matino M, Zerillo B, Rogliani P, Romeo F. Electrocardiographic modifications and cardiac involvement in COVID-19 patients: results from an Italian cohort. J Cardiovasc Med (Hagerstown) 2021; 22:190-196. [PMID: 33512975 DOI: 10.2459/jcm.0000000000001166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM The aim of this study was to detect predisposing CV risks factors and ECGs changes in COVID-19 patients. METHODS The study population included 60 noncritically ill patients with COVID-19 pneumonia admitted to our hospital between 16 March and 11 May 2020. Electrographic changes, evaluated from ECGs acquired at admission and at 7 days after starting COVID-19 therapy, were analysed. We also compared 45 patients without CV involvement with 15 patients with new onset of cardiac adverse events during hospitalization. RESULTS ECGs under treatment showed a lower heart rate (HR) (69.45 ± 8.06 vs 80.1 ± 25.1 beats/min, P = 0,001) and a longer QRS (102.46 ± 15.08 vs 96.75 ± 17.14, P = 0.000) and QT corrected (QTc) interval (452.15 ± 37.55 vs 419.9 ± 33.41, P = 0,000) duration than ECGs before therapy. Fifteen patients (25%) showed clinical CV involvement. Within this group, female sex, lower ejection fraction (EF), low serum haemoglobin, high Troponin I levels (TnI), low lymphocytes count, high serum IL-6 levels, or use of Tocilizumab (TCZ) were more represented. CONCLUSIONS Patients admitted for SARS-CoV2 infection and treated with anti-COVID-19 drug therapy develop ECG changes such as reduction in HR and increase in QRS duration and QTc interval. One in four patients developed CV events. Gender, EF, heamoglobin values, TnI, lymphocytes count, IL-6 and use of TCZ can be considered as predisposing factors for CV involvement.
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Affiliation(s)
- Andrea Matteucci
- Department of Experimental Medicine, University of Rome 'Tor Vergata'
| | | | - Domenico Sergi
- Division of Cardiology, University Hospital 'Tor Vergata'
| | - Michela Bonanni
- Department of Experimental Medicine, University of Rome 'Tor Vergata'
| | | | - Matteo Matino
- Department of Experimental Medicine, University of Rome 'Tor Vergata'
| | - Bartolomeo Zerillo
- Division of Respiratory Medicine, University Hospital 'Tor Vergata', Rome, Italy
| | - Paola Rogliani
- Department of Experimental Medicine, University of Rome 'Tor Vergata'.,Division of Respiratory Medicine, University Hospital 'Tor Vergata', Rome, Italy
| | - Francesco Romeo
- Department of Experimental Medicine, University of Rome 'Tor Vergata'.,Division of Cardiology, University Hospital 'Tor Vergata'
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Cammalleri V, Idone G, Cosma J, Marino MM, Mauceri A, Stifano G, Muscoli S, Boffi F, DE Persis F, DE Vico P, Versaci F, DI Luozzo M, Romeo F. Lambl's excrescence in transcatheter aortic valve implantation: prevalence and risk of embolic events. Minerva Cardiol Angiol 2020; 70:8-15. [PMID: 33258572 DOI: 10.23736/s2724-5683.20.05482-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The role of aortic valve Lambl's excrescence (LEs) in determining ischemic events has not been well clarified, but they can represent a potential embolic source during procedures with catheter/device manipulation through the aortic valve. Aim of our study was to assess the prevalence of LEs and the rate of embolism in patients with aortic valve stenosis scheduled for transcatheter aortic valve implantation (TAVI). METHODS Our population was divided into two groups, named LEs and no-LEs. In each group, the rate of cerebral embolic events was assessed, as well as other TAVI-related complications. RESULTS In our study population 28 patients (37%) had aortic strands and 48 (63%) did not have them. A cerebral protection device was used in four patients of LEs group (14% vs. 0, P=0.03). The mean procedural time was similar in the two groups: 50±19 and 55±26 minutes (P=0.38) in LEs and no-LEs groups, respectively. The device success was achieved in 96% of LEs and 88% of no-LEs patients (P=0.37). Two patients of no-LEs group died during the procedure. Major complications were observed in both groups without any significant differences. Only one case of stroke occurred in the population without LEs (0 LEs vs. 2% no-LEs, 0.78). No cases of peripheral embolism were observed. CONCLUSIONS In our population the observation of LEs is not uncommon. Despite the presumed high risk of embolism, we have not observed an increase in the rate of cerebral ischemic events or other TAVI related complications in patients with LEs.
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Affiliation(s)
- Valeria Cammalleri
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy -
| | - Gaetano Idone
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Joseph Cosma
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Maria M Marino
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Agnese Mauceri
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Giuseppe Stifano
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Federica Boffi
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | | | | | - Francesco Versaci
- Department of Cardiovascular Disease, S. Maria Goretti Hospital, Latina, Italy
| | - Marco DI Luozzo
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Francesco Romeo
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
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10
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Cammalleri V, Idone G, Cosma J, Marino MM, Mauceri A, Stifano G, Muscoli S, Boffi F, De Persis F, De Vico P, Versaci F, Di Luozzo M, Romeo F. Lambl's excrescence in transcatheter aortic valve implantation: prevalence and risk of embolic events. Minerva Cardioangiol 2020. [PMID: 33258572 DOI: 10.23736/s0026-4725.20.05482-1] [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: 11/08/2022]
Abstract
BACKGROUND The role of aortic valve Lambl's excrescence (LEs) in determining ischemic events has not been well clarified, but they can represent a potential embolic source during procedures with catheter/device manipulation through the aortic valve. Aim of our study was to assess the prevalence of LEs and the rate of embolism in patients with aortic valve stenosis scheduled for transcatheter aortic valve implantation (TAVI). METHODS Our population was divided into two groups, named LEs and no-LEs. In each group, the rate of cerebral embolic events was assessed, as well as other TAVI-related complications. RESULTS In our study population 28 patients (37%) had aortic strands and 48 (63%) did not have them. A cerebral protection device was used in 4 patients of LEs group (14% vs 0, p=0.03). The mean procedural time was similar in the two groups: 50±19 and 55±26 minutes (p=0.38) in LEs and no-LEs groups, respectively. The device success was achieved in 96% of LEs and 88% of no-LEs patients (p=0.37). Two patients of no-LEs group died during the procedure. Major complications were observed in both groups without any significant differences. Only one case of stroke occurred in the population without LEs (0 LEs vs 2% no-LEs, 0.78). No cases of peripheral embolism were observed. CONCLUSIONS In our population the observation of LEs is not uncommon. Despite the presumed high risk of embolism, we have not observed an increase in the rate of cerebral ischemic events or other TAVI related complications in patients with LEs.
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Affiliation(s)
- Valeria Cammalleri
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy -
| | - Gaetano Idone
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Joseph Cosma
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Maria M Marino
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Agnese Mauceri
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Giuseppe Stifano
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Federica Boffi
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | | | | | - Francesco Versaci
- Department of Cardiovascular Disease, S. Maria Goretti Hospital, Latina, Italy
| | - Marco Di Luozzo
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Francesco Romeo
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
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Monaco C, Barone L, Stifano G, Magliano G, Cammalleri V, Geuna F, Sergi D, Romeo F. A local gentamicin-collagen sponge reduces cardiovascular implantable electronic device infections and pocket hematoma. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0838] [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
Implantation or replacement of cardiovascular implantable electronic device (CIED) may be associated with complications such as pocket hematoma and infections.
Purpose
The aim of this study is to determine whether a lyophilized collagen impact impregnated with the aminoglycoside antibiotic gentamicin, applied according to the size of pocket into the surgical wound during implantation or replacement, reduces major CIED infections and pocket hematoma 12 months after the surgical intervention.
Methods
We conducted a retrospective study including 1189 patients (mean age 77.45±9.83 y.o.), who underwent implantation or replacement of CIED in our center between June 2007 and November 2018. We compared 475 patients treated with the local gentamicin-collage sponge (group I) with 714 patients who did not receive it (group II). The primary endpoints were the reduction of infectious complications and pocket hematoma through 12 months of follow-up post procedure.
Results
Complications occurred in 127 of 1189 patients (10.68%): 102 of 1189 patients (8.58%) developed pocket hematoma, 20 of 1189 patients (1.68%) infectious events and 5 of 1189 patients (0.42%) both. Specifically, the rate of complications was lower in group I: pocket hematoma 0.63% vs 13.86% (p<0.001), infections 0.21% vs 2.6% (p=0.02), both 0% vs 0.7% (p=0.17). The study also shows a statistically significant major incidence of infectious complications in subjects undergoing implantation or replacement of ICD, compared to subjects undergoing implantation or replacement of PPM (5.59% vs 1.5%; p<0.05%).
Regarding the type of intervention and the incidence of complications within the subgroups, was demonstrated a statistically significant reduction in the incidence of infections in de novo implant-group I subgroup compared to de novo implant-group II subgroup (0.5% vs 3.5%; p<0.05); a statistically significant reduction in the incidence of infectious complications was also observed in replacement-group I subgroup (0%) compared to replacement-group II subgroup (0% vs 1.4%; p<0.05). Similar results were demonstrated for the incidence of pocket hematoma, with a statistically significant reduction in de novo implant-group I subgroup compared to de novo implant-group II subgroup (0.5% vs 14.13%; p<0.05) and in replacement-group I subgroup compared to replacement-group II subgroup (1.4% vs 12.5%; p<0.05).
The association between therapy and development of hematoma was not statistically significant. The association between comorbidities and infectious complications in both groups was always statistically significant.
Conclusion
The local gentamicin-collagen sponge is a medical device which can be used in addition to local hemostasis and prophylactic doses of systemic antibiotics, with the aim of reducing infective complications and pocket hematoma after permanent CIED implantation or replacement.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Monaco
- Tor Vergata University Hospital Polyclinic, Rome, Italy
| | - L Barone
- Tor Vergata University Hospital Polyclinic, Rome, Italy
| | - G Stifano
- Tor Vergata University Hospital Polyclinic, Rome, Italy
| | - G Magliano
- Tor Vergata University Hospital Polyclinic, Rome, Italy
| | - V Cammalleri
- Tor Vergata University Hospital Polyclinic, Rome, Italy
| | - F Geuna
- Tor Vergata University Hospital Polyclinic, Rome, Italy
| | - D Sergi
- Tor Vergata University Hospital Polyclinic, Rome, Italy
| | - F Romeo
- Tor Vergata University Hospital Polyclinic, Rome, Italy
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12
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Cammalleri V, Muscoli S, Benedetto D, Stifano G, Macrini M, Di Landro A, Di Luozzo M, Marchei M, Mariano EG, Cota L, Sergi D, Bezzeccheri A, Bonanni M, Baluci M, De Vico P, Romeo F. Who Has Seen Patients With ST-Segment-Elevation Myocardial Infarction? First Results From Italian Real-World Coronavirus Disease 2019. J Am Heart Assoc 2020; 9:e017126. [PMID: 32901560 PMCID: PMC7792389 DOI: 10.1161/jaha.120.017126] [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] [Indexed: 12/15/2022]
Abstract
Background After the coronavirus disease 2019 outbreak, social isolation measures were introduced to contain infection. Although there is currently a slowing down of the infection, a reduction of hospitalizations, especially for myocardial infarction, was observed. The aim of our study is to evaluate the impact of the infectious disease on ST‐segment–elevation myocardial infarction (STEMI) care during the coronavirus disease 2019 pandemic, through the analysis of recent cases of patients who underwent percutaneous coronary intervention. Methods and Results Consecutive patients affected by STEMI from March 1 to 31, 2020, during social restrictions of Italian government, were collected and compared with patients with STEMI treated during March 2019. During March 2020, we observed a 63% reduction of patients with STEMI who were admitted to our catheterization laboratory, when compared with the same period of 2019 (13 versus 35 patients). Changes in all time components of STEMI care were notably observed, particularly for longer median time in symptom‐to‐first medical contact, spoke‐to‐hub, and the cumulative symptom‐to‐wire delay. Procedural data and in‐hospital outcomes were similar between the 2 groups, whereas the length of hospitalization was longer in patients of 2020. In this group, we also observed higher levels of cardiac biomarkers and a worse left ventricular ejection fraction at baseline and discharge. Conclusions The coronavirus disease 2019 outbreak induced a reduction of hospital access for STEMI with an increase in treatment delay, longer hospitalization, higher levels of cardiac biomarkers, and worse left ventricular function.
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Affiliation(s)
| | - Saverio Muscoli
- Department of Cardiovascular Disease Tor Vergata University Rome Italy
| | - Daniela Benedetto
- Department of Cardiovascular Disease Tor Vergata University Rome Italy
| | - Giuseppe Stifano
- Department of Cardiovascular Disease Tor Vergata University Rome Italy
| | | | - Alessio Di Landro
- Department of Cardiovascular Disease Tor Vergata University Rome Italy
| | - Marco Di Luozzo
- Department of Cardiovascular Disease Tor Vergata University Rome Italy
| | - Massimo Marchei
- Department of Cardiovascular Disease Tor Vergata University Rome Italy
| | | | - Linda Cota
- Department of Cardiovascular Disease Tor Vergata University Rome Italy
| | - Domenico Sergi
- Department of Cardiovascular Disease Tor Vergata University Rome Italy
| | | | - Michela Bonanni
- Department of Cardiovascular Disease Tor Vergata University Rome Italy
| | - Martino Baluci
- Department of Cardiovascular Disease Tor Vergata University Rome Italy
| | | | - Francesco Romeo
- Department of Cardiovascular Disease Tor Vergata University Rome Italy
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13
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Benedicto HG, Bombonato PP, Macchiarelli G, Stifano G, Prado IM. Structural arrangement of the cardiac collagen fibers of healthy and diabetic dogs. Microsc Res Tech 2011; 74:1018-23. [DOI: 10.1002/jemt.20988] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 12/16/2010] [Indexed: 11/07/2022]
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14
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D'Angelo AM, Della Pepa D, Della Pepa GM, Fusco G, Garofalo D, Passaro A, Stifano G, Fusco B. [Impacted and ruptured Dormia's Basket in the biliary tract during ERCP: a rare surgical emergency]. MINERVA CHIR 2011; 66:73-74. [PMID: 21389927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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15
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Macchiarelli G, Nottola SA, Palmerini MG, Bianchi S, Maione M, Lorenzo C, Stifano G, Di Marco E, Correr S. Morphological expression of angiogenesis in the mammalian ovary as seen by SEM of corrosion casts. Ital J Anat Embryol 2010; 115:109-114. [PMID: 21072999] [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: 05/30/2023]
Abstract
In the mammalian ovary, follicular and corpus luteum cycle is associated with intensive microvascular remodelling. The complex angiogenic dynamics are finely tuned by numerous regulatory factors acting as activators (up-regulators) or inhibitors (down-regulators) of angiogenesis. Alterations of such a tight modulation are involved in several pathologies, including infertility, polycystic ovarian syndrome, ovarian hyperstimulation syndrome and ovarian cancer. We have demonstrated in several experimental models that ovarian function is critically and specifically dependent on angiogenesis for follicular development, ovulation, and corpus luteum growth. The aim of this review is to summarize the results we have obtained on the morphodynamic remodelling of ovarian microvascularization, in polyovulatory (rat, rabbit and pig) and monovulatory species (cow), using scanning electron microscopy of vascular corrosion casts. The knowledge of the morphological expression of the up- and down-regulation of angiogenesis occurring in mono and polyovulatory animals might provide useful information to preserve fertility and to increase of the effectiveness of reproductive management in species of domestic interest.
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Affiliation(s)
- Guido Macchiarelli
- Department of Health Sciences, University of L'Aquila, Via Vetoio, Coppito 2, 67100 L'Aquila.
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