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Ramadan MS, Bertolino L, Boccia F, Hamieh M, Peluso AM, Gallo R, Patauner F, De Santo LS, Carozza A, Zampino R, Durante-Mangoni E. Features of infective endocarditis in a contemporary cohort of persons who inject drugs: a matched comparison analysis of long-term prognostic factors. Intern Emerg Med 2024; 19:455-464. [PMID: 38129537 DOI: 10.1007/s11739-023-03502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
The objective of the study was to assess the short- and long-term mortality of infective endocarditis (IE) among people who inject drugs (PWID). Using prospectively collected data on hospitalized patients (years 2000 through 2021) with IE, PWID were identified and included in this study. Survival analysis was performed to analyze short- and long-term mortality and study their risk factors among PWID and a matched group of non-intravenous drug users (N-IDU). In a study of 485 patients admitted for IE, 55 (11%) of them were PWID. These PWID patients were 1:1 age- and sex- matched to an N-IDU group (N = 55 per group). Both groups had similar baseline comorbid conditions, including congestive heart failure, type 2 diabetes, and neoplastic diseases. However, PWID were more likely to have HCV co-infection (62% vs 16%, respectively, p < 0.001) and advanced liver disease/cirrhosis (52% vs 7.9%, respectively, p < 0.001). IE in PWID more often affected the tricuspid valve (42% vs 22%, respectively, p = 0.024) and presented with more embolic events (66% vs 35%, respectively, p < 0.01). S. aureus was the primary cause of IE in PWID (44% vs 21%, respectively, p = 0.01). After adjusting for other variables, PWID (HR = 2.99, 95% CI [1.06, 8.43], p = 0.038) and valve bioprosthetic replacement (HR = 5.37, 95% CI [1.3, 22.1], p = 0.02) were independently associated with increased mortality risk, whereas IE caused by tricuspid valve infection was associated with reduced mortality risk (HR = 0.25, 95% CI [0.06, 0.97], p = 0.046). In this cohort, PWID had increased risk of long-term mortality after hospital discharge for IE, when compared to matched N-IDU with similar baseline characteristics. The reasons behind the significant increase in mortality warrant further investigation.
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Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
- Division of Infectious Diseases, Duke University Medical School, Durham, NC, USA
| | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Filomena Boccia
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2 80138, Naples, Italy
| | - Mahmoud Hamieh
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Anna Maria Peluso
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Raffaella Gallo
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Luca Salvatore De Santo
- Department of Translational Medical Sciences and Unit of Cardiac Surgery, University of Campania "Luigi Vanvitelli", A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy
| | - Antonio Carozza
- Department of Translational Medical Sciences and Unit of Cardiac Surgery, University of Campania "Luigi Vanvitelli", A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy
| | - Rosa Zampino
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2 80138, Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy.
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy.
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De Santo NG, Bisaccia C, De Santo LS. High Prevalence of Kidney Stone Disease of Gouty Origin in Roman Pontiffs Reigning in the Years 537-2005. EXP CLIN TRANSPLANT 2023; 21:91-94. [PMID: 37496353 DOI: 10.6002/ect.iahncongress.21] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Many Roman pontiffs are known to have had kidney stone disease. However, no specific report has explored the prevalence of the various stones in popes, which is the purpose of this study. MATERIALS AND METHODS We extensively studied the histories of all popes (n = 264) from Saint Peter to John Paul II (34-2005). RESULTS Among 206 popes reigning from 537 to 2005, 26 popes (12.6%) had uric acid stones. In the same period, 11 of 206 popes (5.3%) had nongouty stones (mainly calcium stones). In total, 37 of 208 (17.8%) popes complained of kidney stone disease. The ratio of calcium stone formers to other stone formers (including uric acid) was 0.42. CONCLUSIONS The data suggest a higher prevalence of uric acid stones, which is linked to higher consumption of meat and sodium chloride. However, the last pope with kidney stone disease died in 1914. Although renal stone disease disappeared from papal palaces, population studies now indicate an increase in uric acid levels in the general population. The data can be explained based on the "Theory of Epidemiological Transition," pointing to the importance of education in eradicating poor lifestyles.
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De Santo NG, Bisaccia C, De Santo LS. Acute Kidney Injury as a Leading Cause of Papal Deaths in the Years 1277 to 2005: A Review of 21 Cases. EXP CLIN TRANSPLANT 2023; 21:87-90. [PMID: 37496352 DOI: 10.6002/ect.iahncongress.20] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES This study was devised to investigate papal deaths due to acute kidney injury, a topic for which scarce data exist. MATERIALS AND METHODS We studied all popes between John XXI, who died in 1277 of crush syndrome, and John Paul II, who died of anuria and urinary sepsis in 2005. RESULTS Between pontification years from 1277 to 2005, 21 of 78 popes (26.9%) died of acute kidney injury. Sepsis was identified as the leading cause of acute kidney injury and death in 20 of 21 popes (95.2%). Mean ± SE age at death of the 21 popes was 69.4 ± 2.26 years. Six popes (28.6%) died of stroke. CONCLUSIONS Sepsis-associated acute kidney injury, a syndrome with a complex pathogenesis and poor prognosis, which is far from being fully understood, contributed to a high number of papal deaths.
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Bisaccia C, De Santo LS, De Santo NG. Malaria as a Papal Disease. EXP CLIN TRANSPLANT 2023; 21:28-32. [PMID: 37496339 DOI: 10.6002/ect.iahncongress.07] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES In this study, we aimed to investigate the effects of malaria on the lives of Roman pontiffs. MATERIALS AND METHODS The histories of all 264 popes from Saint Peter to John Paul II were extensively studied. RESULTS Malaria affected the lives of Roman pontiffs. Between 999 AD and 1644 AD, 21 of 99 popes were affected by malaria (21.4%). The first affected was Gregory V and the last was Urban VII, the 138th and the 235th pope, respectively. There were 15 deaths (15.2%). Six pontiffs (6.1%) were infected but survived. Many cardinals and their assistants, especially those coming from northern countries, contracted malaria during conclaves, and many died. CONCLUSIONS By about 450 BC, malaria had arrived in Rome. By the second century BC, malaria was endemic. It affected the lives of Roman people. To prevent infection, the popes adopted the custom of ancient affluent Romans who used to spend summer months in high plains far from Rome. The first to adopt the custom was Paul I in 767, who just moved his residence to Saint Paul, out of the walls. Sixtus V started the Congregation of Waters and Streets, which was routinely reinforced by his successors until 1860, when the Kingdom of Italy was born.
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Affiliation(s)
- Carmela Bisaccia
- From the Mazzini Institute University of Campania Luigi Vanvitelli, Naples, Italy
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Rubino AS, De Santo LS, Montella AP, Golini Petrarcone C, Palmieri L, Galbiati D, Galdieri N, De Feo M. Prognostic Implication of Preoperative Anemia in Redo Cardiac Surgery: A Single-Center Propensity-Matched Analysis. J Cardiovasc Dev Dis 2023; 10:160. [PMID: 37103039 PMCID: PMC10146465 DOI: 10.3390/jcdd10040160] [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: 03/15/2023] [Revised: 04/02/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
Preoperative anemia has been associated with increased morbidity and mortality after cardiac surgery, but little is known about its prognostic value in the setting of redo procedure. A retrospective, observational cohort study of prospectively collected data was undertaken on 409 consecutive patients referred for redo cardiac procedures between January 2011 and December 2020. The EuroSCORE II calculated an average mortality risk of 25.7 ± 15.4%. Selection bias was assessed with the propensity-adjustment method. The prevalence of preoperative anemia was 41%. In unmatched analysis, significant differences between the anemic and nonanemic groups emerged in the risk for postoperative stroke (0.6% vs. 4.4%, p = 0.023), postoperative renal dysfunction (29.7% vs. 15.6%, p = 0.001), a need for prolonged ventilation (18.1% vs. 7.2%, p = 0.002), and high-dosage inotropes (53.1% vs. 32.9%, p < 0.001) along with both length of ICU and hospital stay (8.2 ± 15.9 vs. 4.3 ± 5.4 days, p = 0.003 and 18.8 ± 17.4 vs. 14.9 ± 11.1, p = 0.012). After propensity matching (145 pairs), preoperative anemia was still significantly associated with postoperative renal dysfunction, stroke, and the need for high-dosage inotrope cardiac morbidity. Preoperative anemia is significantly associated with acute kidney injury, stroke, and the need for high-dosage inotropes in patients referred for redo procedures.
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Affiliation(s)
- Antonino Salvatore Rubino
- Cardio-Thoraco-Vascular Department, Division of Cardiac Surgery, Papardo Hospital, 98158 Messina, Italy
| | - Luca Salvatore De Santo
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80131 Neaples, Italy
| | - Antonio Pio Montella
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80131 Neaples, Italy
| | - Caterina Golini Petrarcone
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80131 Neaples, Italy
| | - Lucrezia Palmieri
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80131 Neaples, Italy
| | - Denise Galbiati
- Cardiovascular Department, Cardiac Surgery Unit of the IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Nicola Galdieri
- Cardiac Intensive Care Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131 Neaples, Italy
| | - Marisa De Feo
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80131 Neaples, Italy
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De Santo NG, Bisaccia C, De Santo LS. Correction: The Dropsy of Popes (1555-1978): A Bad Prognostic Sign Foreboding of Death. J Relig Health 2022; 61:4996. [PMID: 35689740 PMCID: PMC9569286 DOI: 10.1007/s10943-022-01599-1] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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De Santo NG, Bisaccia C, De Santo LS. The Dropsy of Popes (1555-1978): A Bad Prognostic Sign Foreboding of Death. J Relig Health 2022; 61:4978-4995. [PMID: 35596044 PMCID: PMC9569309 DOI: 10.1007/s10943-022-01578-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/24/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this study is to explore the historical background of edema as a prognostic sign in popes, a special category of medical subjects whose health status was closely monitored and chronicled because of their unique important status in the events of their times. Nine out of 51 popes, who reigned in the years 1555-1978, died edematous at a mean age of 75.5 years of age. The cause of edema was: heart failure for John Paul I, liver disease, obstructive nephropathy associated with anemia for Paul IV, who also suffered from deep vein thrombosis, and malnutrition for Innocent XIII. Chronic kidney disease due to renal stones of gouty origin caused edema in Clement VIII, Clement X, Clement XI, and Benedict XIV. Obstructive nephropathy due to renal stones of non-gouty origin caused edema in Clement XIII, whereas toxic nephropathy due to the use of mercurials caused edema in Clement XIV. Innocent XI, Benedict XIV, and Clement XIV were bled before death because of impending pulmonary edema. It is not surprising that chronic kidney disease was a significant cause of edema in popes with chronic kidney disease which is associated with impaired sodium excretion. The edema was likely aggravated by the excessive dietary salt intake of the period when the importance of sodium chloride restriction was still not discovered and effective diuretic agents were not available.
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Rubino AS, De Santo LS, Pisano A, Mauro MD, Benussi S, Borghetti V, Castiglioni A, Chiariello L, Colli A, De Bellis A, De Filippo CM, De Paulis R, Di Benedetto G, Di Eusanio M, Faggian G, Fiorani B, Fratto PA, Giuffrida AG, Glauber M, Iannelli G, Iesu S, Livi U, Martinelli G, Massetti M, Mastroroberto P, Menicanti L, Minniti G, Miraldi F, Montesi G, Musumeci F, Nicolini F, Pace Napoleone C, Panisi P, Pappalardo A, Patanè F, Ragni T, Rinaldi M, Tribastone S, Triggiani M, Tritto FP, Zebele C, Parolari A, Gerosa G, De Feo M. Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey. Eur J Cardiothorac Surg 2021; 59:901-907. [PMID: 33657222 PMCID: PMC7989504 DOI: 10.1093/ejcts/ezaa436] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Antonino Salvatore Rubino
- Department of Translational Medicine, Cardiac Surgery Unit, University of Campania, Luigi Vanvitelli, AORN dei Colli, Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy
| | - Luca Salvatore De Santo
- Department of Translational Medicine, Cardiac Surgery Unit, University of Campania, Luigi Vanvitelli, AORN dei Colli, Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy
| | - Antonio Pisano
- Cardiac Anaesthesia and Intensive Care Unit, AORN Dei Colli, Monaldi Hospital, Naples, Italy
| | - Michele di Mauro
- Cardiology and Cardiac Surgery, API "Madonna del Ponte", Lanciano, Italy
| | | | | | | | | | - Andrea Colli
- Cardiac Surgery Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Antonio De Bellis
- Cardiac Surgery Unit, Casa di Cura San Michele, Maddaloni, Caserta, Italy
| | | | | | | | - Marco Di Eusanio
- Cardiac Surgery Department, Lancisi Cardiovascular Center-OORR-Polytechnic University of Marche-School of Medicine, Ancona, Italy
| | - Giuseppe Faggian
- Cardiac Surgery Unit, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Brenno Fiorani
- Cardiac Surgery Unit, AORNAS "San Giuseppe Moscati", Avellino, Italy
| | - Pasquale Antonio Fratto
- Cardiac Surgery Unit, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | | | - Mattia Glauber
- Cardiac Surgery Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Gabriele Iannelli
- Cardiac Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Severino Iesu
- Cardiac Surgery Unit, A.O. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Ugolino Livi
- Cardiac Surgery Unit, Azienza Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy
| | - Gianluca Martinelli
- Cardiac Surgery Unit, Clinica San Gaudenzio, Gruppo Policlinico di Monza, Novara, Italy
| | - Massimo Massetti
- Cardiac Surgery Unit, Policlinico "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | - Fabio Miraldi
- Cardiac Surgery Unit, Università La Sapienza, Rome, Italy
| | | | - Francesco Musumeci
- Cardiac Surgery Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | | | - Carlo Pace Napoleone
- Azienda Ospedaliera Città della Salute e della Scienza di Torino, Presidio Ospedale Infantile Regina Margherita, Torino, Italy
| | - Paolo Panisi
- Cardiac Surgery Unit, Humanitas Gavazzeni, Bergamo, Italy
| | | | - Francesco Patanè
- Cardiac Surgery Unit, Azienda Ospedaliera Papardo, Messina, Italy
| | | | - Mauro Rinaldi
- Cardiac Surgery Unit, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Presidio Molinette, Università di Torino, Torino, Italy
| | | | | | | | - Carlo Zebele
- Cardiac Surgery Unit, Casa di Cura Montevergine, Mercogliano (AV), Italy
| | - Alessandro Parolari
- Department of University Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, Milan, Italy
| | - Gino Gerosa
- Department of Cardiac Surgery, University of Padua, Padua, Italy
| | - Marisa De Feo
- Department of Translational Medicine, Cardiac Surgery Unit, University of Campania, Luigi Vanvitelli, AORN dei Colli, Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy
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De Santo NG, Bisaccia C, De Santo LS. MO1029RENAL STONE DISEASE IN 193 PONTIFFS: FROM VIGILUS TO PIUS VIII (537-1830)*. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab105.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
The history of popes is an untapped treasure for historian of medicine for many reasons including i. number, ii. richness of documents available on their lives, iii. gender homogeneity, iiii. Long lasting lives, v. their affluence, vi. number of archiaters and personal physicians and surgeon of high professional level, viii. lived for many years in the same environment (Rome). Taking into consideration the availability of documents from 1100 onward (10 centuries of European history), popes represent good models to study a. the diseases of popes, b. social medicine, c. history of European universities and beyond, d. the history of hospitals, e. the history of archiaters, and f. the diseases of power.
We are studying renal stone disease in popes from St Peter to John Paul II (34-2005). Preliminary results on gouty popes have been presented at ERA-EDTA Congress in Budapest and Milan pointing that out 20 gouty pontiffs 12 were stone formers or died because of its complications and 6 popes died because of non-gouty renal stones. The goal of this study is to provide an historical outline on renal stone disease in gouty and not gouty popes reigning in the years 537-1830 (from Vigilius―the 1st stone former pope―to Pius VIII, the last gouty pope).
Methods
We have studied history of popes on many books including those authored by von Ranke, von Pastor, de Novaes, Henrion, Paravicini Bagliani, Reardon, Rendina, Ceccarelli and Cosmacini. We have also studied the histories of archiaters of Platina and Marini.
Results
25 out 193 popes were found gouty. Their mean age at start of pontiff was 64.6 and 70.6 at death, that nearly correspond to the time-course decline of age-related uric acid excretion. Thirteen of these popes had histories, signs, symptoms, and /or postmortem examination compatible with a diagnosis of renal stone disease. Six of them died with uremia, 4 were hydropics, 6 died because of stroke. In addition we have also outlined the narratives of 14 non gouty popes who had renal stone disease. The last pope affected by renal stone disease was Pius VI (1775-1779) , the last gouty popes was Pius VIII (1829-1830).
Conclusion
We have excluded from gouty popes Alexander VII erroneously defined gouty by Giuseppe De Novaes in 1815 and also excluded John IX since his gout―hypothesized by Wendy J Reardon in 1971―is not supported by documents. There are a few available specific data on the topic. A fundamental contribution was published by Lorenzo Gualino in 1934. He reported on 19 gouty popes, 12 of whom with histories or signs, or symptoms, and/or postmortem examination confirming renal stone diseaase. He also reported on 8 non gouty popes suffering from or died of renal stone disease. The findings should be matched also with those of Giovanni Ceccarelli (2001) who reported on 11 gouty popes 6 presenting with signs of stones and five dying anuric and/or hydropic.
This paper includes on all popes with renal stone disease. Stroke and heart failure in gouty popes are a priority. In the last 2 centuries renal stone disease was no more a papal disease.
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De Santo LS, Rubino AS, Torella M, Galbiati D, Iannelli G, Iesu S, Tritto FP, Fiorani B, Chiariello L, De Bellis A, Di Benedetto G, Zebele C, De Feo M. Cardiac surgery practice during the COVID-19 outbreak: a regionwide survey. J Thorac Dis 2021; 13:125-132. [PMID: 33569192 PMCID: PMC7867799 DOI: 10.21037/jtd-20-2298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Health systems worldwide have been overburdened by the “COVID-19 surge”. Consequently, strategies to remodulate non-COVID medical and surgical care had to be developed. Knowledge of the impact of COVID surge on cardiac surgery practice is mainstem. Present study aims to evaluate the regional practice pattern during lockdown in Campania. Methods A multicenter regional observational 26-question survey was conducted, including all adult cardiac surgery units in Campania, Italy, to assess how surgical practice has changed during COVID-19 national lockdown. Results All centers adopted specific protocols for screening patients and personnel. A significant reduction in the number of dedicated intensive care unit (ICU) beds (–30.0%±38.1%, range: 0–100%) and cardiac operating rooms (–22.2%±26.4%, range: 0–50%) along with personnel relocation to other departments was disclosed (anesthesiologists –5.8%±11.1%, range: 0–33.3%; perfusionists –5.6%±16.7%, range: 0–50%; nurses –4.8%±13.2%, range: 0–40%; cardiologists –3.2%±9.5%, range: 0–28.6%). Cardiac surgeons were never reallocated to other services. Globally, we witnessed dramatically lower adult cardiac surgery case volumes (335 vs. 667 procedures, P<0.001), as institutions and surgeons followed guidelines to curtail non-urgent operations. Conclusions This regional survey demonstrates major changes in practice as a response to the COVID-19 pandemic. In this respect, this experience might lead to the development of permanent systems-based plans for future pandemic and may effectively help policy decision making when prioritizing healthcare resource reallocation during and after the pandemic.
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Affiliation(s)
- Luca Salvatore De Santo
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy
| | - Antonino Salvatore Rubino
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy
| | - Michele Torella
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy
| | - Denise Galbiati
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy
| | - Gabriele Iannelli
- Department of Advanced Biomedical Sciences, Cardiac Surgery Unit, University of Naples Federico II, Policlinico Federico II, Naples, Italy
| | - Severino Iesu
- Cardiac Surgery Unit, Azienda Ospedaliera San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Francesco Paolo Tritto
- Cardiac Surgery Unit, Azienda Ospedaliera Di Caserta - Sant'Anna e San Sebastiano, Caserta, Italy
| | - Brenno Fiorani
- Cardiac Surgery Unit, Azienda Ospedaliera San Giuseppe Moscati, Città Ospedaliera - Contrada Amoretta, Avellino, Italy
| | | | - Antonio De Bellis
- Cardiac Surgery Unit, Casa di Cura San Michele, Maddaloni, Caserta, Italy
| | | | - Carlo Zebele
- Cardiac Surgery Unit, Casa di Cura Montevergine, Mercogliano, Avellino, Italy
| | - Marisa De Feo
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy
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Bisacccia C, De Santo LS, De Santo NG. P1836GOUT A PAPAL DISEASE: A STUDY ON 20 PONTIFFS (540-1830 AD). Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa144.p1836] [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] Open
Abstract
Abstract
Background and Aims
Pope Gregory I (Magnus)―born c.540 AD, Pope 580-604 AD―in a letter to Bishop Venanzio ofLuni (later venerated as a saint) wrote “I have been confined to bed for the last eleven months, because of pain and malaise and suffer because of goutand my life has been turned into a penitence for my sins thus I am waiting death as a physician who will give me health”. He was the first Pope to suffer of gout and opens a list including in the years 20 pontiffs that includes Sisinnius, (b.650, pope 21 day in 708); Boniface VI (b. 806, Pope 15 days in 886), Honorius IV (b.1210, Pope 1285-1287); Boniface VIII (b. 1230, Pope 1294-1303); Clement VI (b.1281,Pope 1342-1352), Nicholas V (b.1387, Pope 1447-1455); Pius II( b. 1405, Pope 1458-1464); Sixtus IV (b. 1414, Pope 1471-1474); Pius III (b.1440, Pope 26 days in 1503); Pius IV (b. 1499, Pope 1559-1565); Julius II (b. 1443, Pope 1503-1516); Julius III (b.1481, Pope 1550-1555); Clement VIII (b. 1536, Pope 1592- 1605); Clement X (b.1581, Pope 1670-1676); Innocent XI (b.1681, Pope 1676-1689); Innocent XII (b.1649, Pope 1676-2692); Innocent XIII (b.1655, Pope 1721-1724); Benedict XIV (b. 1765, Pope 1740-1758), and Pius VIII (b.1761, Pope 1829-1830). Their mean age at death was 69.4 years, the youngest being Sisinnius (59 years), the oldest being Clement X (96 years).
Results
Some popes were strong eaters like Boniface VIII. He was chronically affected by gout and renal stone disease and by the fear for death, and the search for therapies capable to prolong life. Cosmacini says “podagroso e gottoso”… the Pope is affected by arthritis and renal disease due to overalimentation very rich (straricca) in meat”. He enrolled various archiaters among them Taddeo Alderotti (1223-1295), Pietro da Abano (1257-1315), Anselmo da Bergamo (artisphysicae professor), Simone of Genova (author of Clavissanationis), Accursino from Pistoia, Manzia from Fabriano, Gugliemo da Brescia, Angelo da Camerino and Campano da Novara (Magister Campanus), the naturalist he too affected by renal stone disease. Julius III too was a strong eater (he loved fatty foods seasoned with garlic) as was Pius IV, the hard worker who everyday used to take a nap after lunch and a long walk later in the day. By contrast Nicholas V (his Pontiff saw in 1453 the Fall of Costantinople and the end of the Hundred Years War) was a sober eater and drinker as were Pius II who made use of simple common foods, little wine and slept up to 5-6 hours. Probably Nicholas V died uremic since his pale natural color switched into yellowish-brown (itaque ex naturali et subcandido in croceumsubcinericiumque color suusconversusest). Pius III “was a sober eater and drinker and used to dine every two days. Some of the above popes were patrons of universities (Boniface VIII, Nicholas V, Pius II), some were patrons of arts and science (Nicholas V, Sixtus IV). Boniface VIII is remembered for the Bulla detestandeferitatis (against dismemberment and evisceration of cadavers), issued on September 27, 1299). For thatBulla, during the subsequent centuries he was wrongly accused even by Herman Boerhaave and Albrecht von Haller to have retarded the advancement of medicine by impeding anatomical dissections. By contrast Sixtus IV is remembered not only for modernizing Rome and embelling it, but for the 1482 Breve to the University of Tubingen allowing―for teaching purposes ―dissection of dead bodies of people sentenced to death.
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De Santo LS, Rubino AS, Torella M, De Feo M, Galgano V, Guarente N, Mango E, Savarese L, Iorio F, Zebele C. Topical rifampicin for prevention of deep sternal wound infections in patients undergoing coronary artery bypass grafting. Sci Rep 2020; 10:7400. [PMID: 32366992 PMCID: PMC7198576 DOI: 10.1038/s41598-020-64310-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/04/2020] [Indexed: 12/27/2022] Open
Abstract
Deep sternal wound infections (DSWI), although an infrequent complication, significantly impair postoperative outcomes after coronary artery bypass grafting (CABG) surgery. Among several preventive strategies, topical antibiotic therapy immediately before sternal closure has been strongly advocated. In this retrospective analysis, the incidence of DSWI in 517 patients undergoing isolated CABG and receiving rifampicin irrigation of mediastinum, sternum and suprasternal tissues was compared to an historical consecutive cohort of 448 patients. To account for the inherent selection bias, a 1:1 propensity matched analysis was performed. Patients receiving topical rifampicin experienced significantly less occurrence of postoperative DSWI (0.2% vs 2.5%, p = 0.0016 in the unmatched analysis; 0.3% vs 2.1%, p = 0.0391 in the matched analysis). Intensive care unit stay, hospital stay, and operative mortality were similar between groups. This study shows that topical rifampicin in combination with commonly prescribed preventative strategies significantly reduces the incidence of DSWI to less than 0.3% in unselected patients undergoing a full median sternotomy for CABG. Further studies, including a larger number of patients and with a randomization design, would establish the potential preventative role of topical rifampicin in reducing the occurrence of DSWI.
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Affiliation(s)
- Luca Salvatore De Santo
- University of Campania Luigi Vanvitelli, Department of Translational Medical Sciences, V Monaldi Hospital, Cardiac Surgery Unit, Naples, Italy
| | - Antonino Salvatore Rubino
- University of Campania Luigi Vanvitelli, Department of Translational Medical Sciences, V Monaldi Hospital, Cardiac Surgery Unit, Naples, Italy
| | - Michele Torella
- University of Campania Luigi Vanvitelli, Department of Translational Medical Sciences, V Monaldi Hospital, Cardiac Surgery Unit, Naples, Italy.
| | - Marisa De Feo
- University of Campania Luigi Vanvitelli, Department of Translational Medical Sciences, V Monaldi Hospital, Cardiac Surgery Unit, Naples, Italy
| | - Viviana Galgano
- University of Campania Luigi Vanvitelli, Department of Translational Medical Sciences, V Monaldi Hospital, Cardiac Surgery Unit, Naples, Italy
| | - Nicola Guarente
- Casa di Cura Montevergine, Intensive Care Unit, Mercogliano, Avellino, Italy
| | - Emilio Mango
- Clinica Montevergine, Cardiac Surgery Unit, Mercogliano, Avellino, Italy
| | - Leonardo Savarese
- Clinica Montevergine, Cardiac Surgery Unit, Mercogliano, Avellino, Italy
| | - Francesco Iorio
- Clinica Montevergine, Cardiac Surgery Unit, Mercogliano, Avellino, Italy
| | - Carlo Zebele
- Clinica Montevergine, Cardiac Surgery Unit, Mercogliano, Avellino, Italy
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Affiliation(s)
- Rosa Maria De Santo
- SiPGI, School of Specialization in Integrated Gestalt Psychotherapy, Torre Annunziata, Italy
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De Santo NG, Bisaccia C, De Santo LS. SP804CAUSES OF DEATH DUE TO DISEASES OF THE GENITO-URINARY SYSTEM AND OF THE HEART AMONG 264 POPES IN THE YEARS 65-2005 AD: FIRST APPROACH. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp804] [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: 11/14/2022] Open
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Karim HMR, Burns KEA, Ciobanu LD, El-Khatib M, Nicolini A, Vargas N, Hernández-Gilsoul T, Skoczyński S, Falcone VA, Arnal JM, Bach J, De Santo LS, Lucchini A, Steier J, Purro A, Petroianni A, Sassoon CS, Bambi S, Aguiar M, Soubani AO, Taniguchi C, Mollica C, Berlin DA, Piervincenzi E, Rao F, Luigi FS, Ferrari R, Garuti G, Laier-Groeneveld G, Fiorentino G, Ho KM, Alqahtani JS, Luján M, Moerer O, Resta O, Pierucci P, Papadakos P, Steiner S, Stieglitz S, Dikmen Y, Duan J, Bhakta P, Iglesias AU, Corcione N, Caldeira V, Karakurt Z, Valli G, Kondili E, Ruggieri MP, Raposo MS, Bottino F, Soler-González R, Gurjar M, Sandoval-Gutierrez JL, Jafari B, Arroyo-Cozar M, Noval AR, Corcione N, Barjaktarevic I, Sarc I, Mina B, Szkulmowski Z, Taniguchi C, Esquinas AM. Noninvasive ventilation: education and training. A narrative analysis and an international consensus document. Adv Respir Med 2019; 87:36-45. [PMID: 30830962 DOI: 10.5603/arm.a2019.0006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/22/2019] [Accepted: 02/05/2019] [Indexed: 11/25/2022]
Abstract
Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients' lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess the importance of NIV education and training. Literature search was conducted (MEDLINE: 1990 to June, 2018) to identify randomized controlled studies and systematic reviews with the results analyzed by a team of experts across the world through e-mail based communications. Clinical trials examining the impact of education and training in NIV as the primary objective was not found. A few studies with indirect evidence, a simulation-based training study, and narrative reviews were identified. Currently organized training in NIV is implemented only in a few developed countries. Due to a lack of high-grade experimental evidence, an international consensus on NIV education and training based on opinions from 64 experts across the twenty-one different countries of the world was formulated. Education and training have the potential to increase knowledge and skills of the clinical staff who deliver medical care using NIV. There is a genuine need to develop structured, organized NIV education and training programs, especially for the developing countries.
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Affiliation(s)
- Habib Mohammad Reazaul Karim
- Department of Anesthesiology and Critical Care. All India Institute of Medical Sciences, Raipur, Great Eastern Road, Tatibandh, Raipur (CG)., 492099 Raipur, India
| | - Karen E A Burns
- Associate Professor, Clinician Scientist. Critical Care Medicine, Li Ka Shing Knowledge Insitute, St. Michael's Hospital,, 30 Bond Street, 4-045 Donnelly Wing. Toronto,, M5B 1W8 Ontario, Canada
| | - Laura D Ciobanu
- Assoc Professor, University of Medicine and Pharmacy, Romania, Romania
| | - Mohamad El-Khatib
- Department of Anesthesiology, American University of Beirut-Medical Center. School of Medicine,, Beirut-Lebanon, Lebanon
| | | | - Nicola Vargas
- Geriatric and Intensive Geriatric Cares,, Avelllino, Italy
| | - Thierry Hernández-Gilsoul
- Head of Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Critical Care, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas., Mexico
| | - Szymon Skoczyński
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia,, Katowice, Poland
| | - Vito Antonio Falcone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs - Section of Respiratory Disease, University of Bari Aldo Moro,, Bari, Italy
| | | | - John Bach
- Rutgers University New Jersey Medical School, New Jersey, United States
| | - Luca Salvatore De Santo
- Università della Campania Luigi Vanvitelli, Napoli and Cardiac Surgery Unit,, AORN dei Colli, Naples, Italy
| | - Alberto Lucchini
- General intensive care unit - San Gerardo Hospital, Milano-Bicocca University,, Milan, Italy
| | - Joerg Steier
- Professor of Respiratory and Sleep Medicine, King's College London, Faculty of Life Sciences and Medicine,, London, United Kingdom
| | - Andrea Purro
- Head of Intensive Care Unit, Humanitas Gradenigo Hospital., Turin, Italy
| | - Angelo Petroianni
- Respiratory Diseases Unit, Department of Cardiovascular and Respiratory Diseases, Policlinico Umberto I, Sapienza University of Rome,, Rome, Italy
| | - Catherine S Sassoon
- Professor of Medicine, Division of Pulmonary and Critical Care Medicine University of California, Irvine, CA,; VA Long Beach Healthcare System,, Long Beach, CA, United States
| | - Stefano Bambi
- Medical & Surgical Intensive Care Unit, Careggi University Hospital,, Florence, Italy
| | - Margarida Aguiar
- Pulmonologist, Pulmonary service, Hospital Beatriz Ângelo,, Loures, Portugal
| | - Ayman O Soubani
- Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine. Wayne State University School of Medicine, 3990 John R-3 Hudson, Detroit, MI, 48201, United States
| | - Corinne Taniguchi
- Physiotherapist Specialized in Intenvise Care and Pneumology- FMUSP/HCSão,, Paulo-SP, Brazil
| | | | - David A Berlin
- Department of Medicine, Weill Cornell Medicine New York, New York, United States
| | | | - Fabrizio Rao
- Respiratory Unit, Neuromuscular OmniCentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital,, Milan, Italy
| | | | - Rodolfo Ferrari
- Emergency Department, University Hospital Sant'Orsola, Malpighi,, Bologna, Italy
| | - Giancarlo Garuti
- Respiratory Unit, Santa Maria Bianca Hospital, Mirandola (MO),, ASL Modena, Modena, Italy
| | | | | | - Kwok M Ho
- Department of Intensive Care Medicine, Royal Perth Hospital; School of Population & Global Health, University of Western Australia; and School of Veterinary & Life Sciences, Murdoch University., Perth, Australia
| | - Jaber Saud Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences,, Dhahran, P.O. Box 33048, Dammam 31448, Saudi Arabia
| | - Manuel Luján
- Pneumology Service. Hospital of Sabadell, Universitat Autónoma de Barcelona., Sabadell, Spain
| | - Onnen Moerer
- Dept. of Anaesthesiology, Georg-August-University, University Medical Center Göttingen, Germany
| | - Onofrio Resta
- Cardiothoracic department, Respiratory and Sleep medicine Unit, Policlinic, Bari "Aldo Moro" University,, Italy
| | - Paola Pierucci
- Cardiothoracic department, Respiratory and Sleep medicine Unit, Policlinic, Bari "Aldo Moro" University,, Italy
| | - Peter Papadakos
- Department of Anesthesiology and Surgery. Director CCM. University of Rochester,, Rochester, New York, United States
| | - Stephan Steiner
- Departement of Cardiology, Pneumology and Intensive care, St Vincenz Hospital Limburg,, Limburg, Germany
| | - Sven Stieglitz
- Petrus Hospital Wuppertal, Academic Teaching Hospital of the University of Duesseldorf, Carnaper Str. 48, Clinic for Pneumology, Allergology, Sleep- and Intensive Care,, 42283 Wuppertal, Germany
| | - Yalim Dikmen
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Intensive Care,, Fatih, Istanbul, Turkey
| | - Jun Duan
- Department of Respiratory Medicine, First Affiliated Hospital of Chongqing Medical University,, Youyi Road 1, Yuzhong District, Chongqing, 400016, China
| | - Pradipta Bhakta
- Department of Anaesthesia and Intensive Care, University Hospital Limerick,, Dooradoyle, Limerick, Ireland
| | - Alejandro Ubeda Iglesias
- Intensive Care Unit, Hospital Punta de Europa, Algeciras Ctra, Getares,, s/n, 11207 Algeciras, Cádiz, Spain
| | - Nadia Corcione
- Departement of Anesthesia, Critical Care and Emergency. Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico., Milano, Italy
| | - Vânia Caldeira
- Pneumology Department, Hospital Santa Marta,, Lisboa, Portugal
| | - Zuhal Karakurt
- Assoc Prof, Pulmonary and Critical Care Department, Pulmonology and Intensivist, Dean in Hospital, University of Health Sciences,, Istanbul, Turkey
| | - Gabriele Valli
- Department of Emergency Medicine, San Giovanni Addolorata,, Rome, Italy
| | - Eumorfia Kondili
- Associate Professor of Intensive Care Medicine, Medical School , University of Crete Greece, ICU University Hospital of Heraklion,, Crete, Greece
| | - Maria Pia Ruggieri
- Direttore UOC PS-Breve Osservazione DEAI II livello AO San Giovanni Addolorata, Roma, Italy
| | - Margarida Simões Raposo
- Pulmonologist. Centro Hospitalar de Lisboa Ocidental Egas, Moniz Hospital,, Lisboa, Portugal
| | | | | | - Mohan Gurjar
- Department of Critical Care Medicine. Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS),, Rae Bareli Road, Lucknow (UP), 226014 Lucknow, India
| | | | - Behrouz Jafari
- Director, VALBHCS Sleep Program, Asst Professor of Medicine, Section of Pulmonary and Critical Care Medicine. University of California, Irvine. VA Long Beach Healthcare System 5901 East 7th Street (11/111P), Long Beach, CA, United States
| | | | - Ana Roca Noval
- Servicio de neumologia, Hospital Universitario La Princesa,, Madrid, Spain
| | - Nadia Corcione
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Irena Sarc
- Noninvasive ventilation department, University clinic for pulmonary and allergic diseases, Golnik, Slovenia
| | - Bushra Mina
- Department of Medicine, Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital, New York, NY USA
| | - Zbigniew Szkulmowski
- Departament of Anesthesia and ICU. University Hospital No 1 in Bydgoszcz. Collegium Medicum in Bydgoszcz. University Nicolaus Copernicus in Toruń. Bydgoszcz. Poland
| | | | - Antonio M Esquinas
- Intensive Care Unit. Hospital Morales Meseguer Murcia, Murcia, 30008, Spain.
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De Santo RM, De Santo LS. [Narrative Medicine can reduce opposition to organ removal for transplantation]. G Ital Nefrol 2019; 36:36-1-2019-11. [PMID: 30758156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In Italy in 2017 out of 2738 assessments of death, there was a 28.7% of oppositions of family members to the removal of organs post-mortem. This opposition is a serious limitation to the development of transplantation programs. There is a need to increase the number of transplants since transplantation grants the highest quality of life, a longer survival and at a lower cost for the society. We propose the use of Narrative Medicine (MN) to reduce this opposition. "Narrative Medicine - as Charon says - fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness". We have identified eight stories as having a particular echo: 1. That of Nicholas Green, the American child killed on the Salerno-Reggio Calabria highway and whose organs saved seven people. 2. The story of Ylenia, who learned solidarity from transplants. 3. That of Robin JA Eady, Dermatology Professor in London and the second person on dialysis from Scribner in Seattle. 4. The story of the organ donation of Liberato Venditti, a young man who loved life and climbs on a motorcycle. 5. That of the young football player Giuseppe Feola, remembered here by the Napoli player Gonzalo Higuaín. 6. The donation of the organs of Bruno Memoli, Professor of Nephrology in Naples. 7. The reflections of a heart surgeon. 8. The story written by Federico Finozzi about his own transplant. "The stories" - as Greenhalgh writes - "have an ethical dimension. The person who reads or hears such a story incurs a duty to act so. Stories are open and subversive".
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Esquinas AM, De Santo LS. Noninvasive Ventilation after Surgical Myocardial Revascularization for Left-Ventricular Dysfunction: A Hypothesis-Generating Study. Respir Care 2018; 64:115-116. [PMID: 30578367 DOI: 10.4187/respcare.06510] [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: 11/05/2022]
Affiliation(s)
- Antonio M Esquinas
- Intensive Care and Noninvasive Ventilatory Unit Hospital General Universitario Morales Meseguer Murcia, Italy
| | - Luca Salvatore De Santo
- Cardiac Surgery Division Clinica Montevergine, GMV Health Care and Research Mercogliano, Italy
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De Santo LS. Commentary: Open surgery for descending thoracic aortic disease: "Pride and prejudice". J Thorac Cardiovasc Surg 2018; 157:2175-2176. [PMID: 30249341 DOI: 10.1016/j.jtcvs.2018.08.051] [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] [Received: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Luca Salvatore De Santo
- University of Foggia, Foggia, Italy; Casa di Cura Montevergine, Cardiac Surgery Unit, GVM Care and Research, Mercogliano, Avellino, Italy.
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De Santo LS, Moscariello C, Zebele C. Implications of obesity in cardiac surgery: pattern of referral, physiopathology, complications, prognosis. J Thorac Dis 2018; 10:4532-4539. [PMID: 30174906 DOI: 10.21037/jtd.2018.06.104] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A U-shaped relationship between body mass index (BMI) and outcomes emerged after cardiac surgery. This review analyses the physio pathologic basis of obesity related complications and evaluates prognostic implications. Both leaner and morbid obese should be considered pre-operatively rather than reactively and, when referred for elective surgery, should undergo a focused metabolic status management, and a thorough evaluation of health status. Adherence to sound surgical principles, and tailored patient blood management and perioperative care are mandatory.
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Affiliation(s)
- Luca Salvatore De Santo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care & Research, Mercogliano, AV, Italy
| | - Caesar Moscariello
- Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care & Research, Mercogliano, AV, Italy
| | - Carlo Zebele
- Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care & Research, Mercogliano, AV, Italy
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Affiliation(s)
- Luca Salvatore De Santo
- University of Foggia, Foggia, Italy and Cardiac Surgery Unit, Casa di Cura Montevergine, GVM Care and Research, Mercogliano, Italy.
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De Santo LS, Romano G, Mango E, Iorio F, Savarese L, Numis F, Zebele C. Age and blood transfusion: relationship and prognostic implications in cardiac surgery. J Thorac Dis 2017; 9:3719-3727. [PMID: 29268379 DOI: 10.21037/jtd.2017.08.126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Red blood cell (RBC) transfusion is a well-known predictor of acute kidney injury (AKI) and death after cardiac surgery. This study aimed to define the relationship between age and the need for RBC. Methods Study population included 1,765 consecutive patients undergoing on-pump procedures from 2013 to 2015. The relationship between RBC transfusion and both survival and AKI, and any interaction with age was estimated. A propensity score for the likelihood to receive RBC transfusion was calculated using multivariate logistic regression analysis to adjust for the effect of confounding factors. A logistic estimation curve was developed to investigate the interaction between this score and age. Results Patients receiving RBC transfusions had more comorbidities irrespective of age. Elderly patients underwent transfusion more often than younger patients with a 1.3-fold increase in the relative risk for transfusion. Age did not independently predict the need for RBC. AKI and mortality rates were significantly higher in transfused subsets irrespective of age. Conclusions Comorbidity profile and not age per se confers an increased risk of transfusion.
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Affiliation(s)
- Luca Salvatore De Santo
- Division of Cardiac Surgery, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care and Research, Mercogliano, Avellino, Italy
| | - Gianpaolo Romano
- Department of Cardiovascular Surgery and Transplants, V. Monaldi Hospital, Naples, Italy
| | - Emilio Mango
- Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care and Research, Mercogliano, Avellino, Italy
| | - Francesco Iorio
- Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care and Research, Mercogliano, Avellino, Italy
| | - Leonardo Savarese
- Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care and Research, Mercogliano, Avellino, Italy
| | - Flora Numis
- Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care and Research, Mercogliano, Avellino, Italy
| | - Carlo Zebele
- Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care and Research, Mercogliano, Avellino, Italy
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De Santo LS, Mango E, Savarese L, Zebele C. Off-pump versus on-pump coronary artery bypass grafting: 'there are no facts, only interpretations'. Eur J Cardiothorac Surg 2017; 51:1210. [PMID: 28007870 DOI: 10.1093/ejcts/ezw391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/07/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Luca Salvatore De Santo
- Chair of Cardiac Surgery, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy.,Cardiac Surgery Division, Casa di Cura Privata Montevergine, GVM Health and Research, Mercogliano, Avellino, Italy
| | - Emilio Mango
- Cardiac Surgery Division, Casa di Cura Privata Montevergine, GVM Health and Research, Mercogliano, Avellino, Italy
| | - Leonardo Savarese
- Cardiac Surgery Division, Casa di Cura Privata Montevergine, GVM Health and Research, Mercogliano, Avellino, Italy
| | - Carlo Zebele
- Cardiac Surgery Division, Casa di Cura Privata Montevergine, GVM Health and Research, Mercogliano, Avellino, Italy
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Esquinas AM, Zebele C, De Santo LS. Continuous Positive Airway Pressure in the Cardiac Surgery Setting: Always and Everywhere? First, Start With the Basics. J Cardiothorac Vasc Anesth 2017; 31:e46. [PMID: 28262448 DOI: 10.1053/j.jvca.2016.12.013] [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] [Received: 11/25/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Antonio M Esquinas
- Intensive Care and Non Invasive Ventilatory Unit, Hospital Morales Meseguer, Murcia, Spain
| | - Carlo Zebele
- Clinica Montevergine, Cardiac Surgery Unit, GVM Care & Research, Mercogliano, Italy
| | - Luca Salvatore De Santo
- Clinica Montevergine, Cardiac Surgery Unit, GVM Care & Research, Mercogliano, Italy; University of Foggia, Foggia, Italy
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De Santo LS. Hybrid aortic arch repair: Facts and hints beyond the statistical truth. J Thorac Cardiovasc Surg 2017; 154:107. [PMID: 28196709 DOI: 10.1016/j.jtcvs.2017.01.004] [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: 12/28/2016] [Accepted: 01/10/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Luca Salvatore De Santo
- University of Foggia, Foggia, Italy; Cardiac Surgery Unit, Casa di Cura Montevergine, GVM Care & Research, Mercogliano, Italy.
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Esquinas AM, Cravo J, De Santo LS. Adaptive support ventilation weaning protocols in cardiac surgical patients: Complex speculations with little practical impact. J Crit Care 2017; 37:250. [DOI: 10.1016/j.jcrc.2016.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
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Esquinas AM, De Santo LS. Impact of Sleep-Disordered Breathing on Postoperative Outcomes: Another Brick in the Wall. J Clin Sleep Med 2016; 12:1571. [PMID: 27707446 DOI: 10.5664/jcsm.6296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Antonio Maria Esquinas
- Intensive Care and Non Invasive Ventilatory Unit, Hospital Morales Meseguer. Murcia, Spain
| | - Luca Salvatore De Santo
- University of Foggia, Department of Clinical and Surgical Sciences, Chair of Cardiac Surgery, Foggia, Italy.,Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care & Research, Mercogliano, Avellino, Italy
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Esquinas AM, De Santo LS. The effects of adaptive servo-ventilation in the management of acute cardiogenic pulmonary edema: Definitely more than a blurb. J Cardiol 2016; 69:797-798. [PMID: 27575550 DOI: 10.1016/j.jjcc.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Antonio M Esquinas
- Intensive Care and Non Invasive Ventilatory Unit, Hospital Morales Meseguer, Murcia, Spain
| | - Luca Salvatore De Santo
- University of Foggia, Foggia, Italy; Cardiac Surgery Unit, Clinica Montevergine, Mercogliano, Avellino, Italy.
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De Santo NG, Bisaccia C, De Santo LS. The priority of Antonino D'Antona in describing rhabdomyolysis with acute kidney injury, following the Messina earthquake (December 28, 1908). Commentary. Ann Ist Super Sanita 2016; 52:1-3. [PMID: 27033609 DOI: 10.4415/ann_16_01_01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Following the Messina-Reggio Calabria earthquake (December 28, 1908) outstanding medical reports were published by Franz von Colmers (1875-1960), Antonino D'Antona (1842-1913), and Rocco Caminiti (1868-1940). The reports of D'Antona and Caminiti were heretofore neglected. Colmers, D'Antona and Caminiti described crush-syndrome. D'Antona who cured patients in shock also described two deaths due to uraemia. This gives him a priority in the description of crush syndrome with renal injury which has been traditionally attributed to Bywaters and Beall.
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Affiliation(s)
| | | | - Luca Salvatore De Santo
- Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Foggia, Foggia, Italy
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De Santo LS, Esquinas AM. How to delineate obstructive sleep apnea and continuous positive airway pressure link in postoperative atrial fibrillation conundrum? J Crit Care 2015; 31:276. [PMID: 26601755 DOI: 10.1016/j.jcrc.2015.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 09/20/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Luca Salvatore De Santo
- Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Division of Cardiac Surgery, Casa di Cura Montevergine, Mercogliano, Avellino, Italy.
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De Santo LS, Torella M, Romano G, Maiello C, Buonocore M, Bancone C, Della Corte A, Galdieri N, Nappi G, Amarelli C. Perioperative myocardial injury after adult heart transplant: determinants and prognostic value. PLoS One 2015; 10:e0120813. [PMID: 25942400 PMCID: PMC4420471 DOI: 10.1371/journal.pone.0120813] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 02/06/2015] [Indexed: 01/29/2023] Open
Abstract
Background and Aim of the Study Implications of Cardiac troponin (cTnI) release after cardiac transplantation are still unclear. This study disclosed risk factors and prognostic implication of cTnI early levels in a single centre cohort operated on between January 1999 and December 2010. Methods Data on 362 consecutive recipients (mean age: 47.8±13.7, 20.2% female, 18.2% diabetics, 22.1% with previous cardiac operations, 27.6% hospitalized, 84.9±29.4 ml/min preoperative glomerular filtration rate) were analyzed using multivariable logistic regression modeling. Target outcomes were determinants of troponin release, early graft failure (EGF), acute kidney injury (AKI) and operative death. Results Mean cTnI release measured 24 hours after transplant was 10.9±11.6 μg/L. Overall hospital mortality was 10.8%, EGF 10.5%, and AKI was 12.2%. cTnI release>10 μg/L proved an independent predictor of EGF (OR 2.2; 95% CI, 1.06–4.6) and AKI (OR 1.031; 95% CI, 1.001-1.064). EGF, in turn, proved a determinant of hospital mortality. Risk factors for cTnI>10 μg/L release were: status 2B (OR 0.35; 95% CI, 0.18-0.69, protective), duration of the ischemic period (OR 1.006; 95% CI, 1.001-1.011), previous cardiac operation (OR 2.9; 95% CI, 1.67-5.0), and left ventricular hypertrophy (OR 3.3; 95% CI, 1.9-5.6). Conclusions Myocardial enzyme leakage clearly emerged as an epiphenomenon of more complicated clinical course. The complex interplay between surgical procedure features, graft characteristics and recipient end-organ function highlights cTnI release as a risk marker of graft failure and acute kidney injury. The search for optimal myocardial preservation is still an issue.
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Affiliation(s)
- Luca Salvatore De Santo
- Chair of Cardiac Surgery, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy—Casa di Cura Montevergine (AV)
| | - Michele Torella
- Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
- * E-mail:
| | - Gianpaolo Romano
- Department of Cardiovascular Surgery and Transplants, V. Monaldi Hospital, Naples, Italy
| | - Ciro Maiello
- Department of Cardiovascular Surgery and Transplants, V. Monaldi Hospital, Naples, Italy
| | - Marianna Buonocore
- Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Ciro Bancone
- Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | | | - Nicola Galdieri
- Department of Cardiovascular Surgery and Transplants, V. Monaldi Hospital, Naples, Italy
| | - Gianantonio Nappi
- Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Cristiano Amarelli
- Department of Cardiovascular Surgery and Transplants, V. Monaldi Hospital, Naples, Italy
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Esquinas AM, De Santo LS. Implementing non-invasive positive pressure ventilation approach to respiratory failure after cardiac surgery: devil is in the detail. Chin Med J (Engl) 2014; 127:2550. [PMID: 24985600] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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De Santo LS, Amarelli C, Scardone M, Romano G. Reply to Petricevic et al. Eur J Cardiothorac Surg 2013; 44:776. [PMID: 23616483 DOI: 10.1093/ejcts/ezt223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Amarelli C, De Santo LS, Marra C, Maiello C, Bancone C, Della Corte A, Nappi G, Romano G. Early graft failure after heart transplant: risk factors and implications for improved donor-recipient matching. Interact Cardiovasc Thorac Surg 2012; 15:57-62. [PMID: 22493100 DOI: 10.1093/icvts/ivs113] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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
Early graft failure (EGF) is a dreaded complication after heart transplantation (HT). Despite several improvements, no effective therapy has been developed and the prognosis is poor. We evaluated the risk factors and clinical impact of EGF. In a consecutive series of 317 HTs performed at a single institution between January 1999 and December 2008, variables associated significantly with EGF were sought in bivariate and multivariable discriminant analyses. The deriving propensity score was used to stratify the study sample in to three groups (low, intermediate and high risk for EGF). Comparisons were performed between the higher-risk group and the remaining population in terms of preoperative features and outcomes. EGF occurred in 10.1% of the overall population (2.9, 3.8 and 23.6%, respectively, in the three groups). Overall, EGF-related mortality was 56.3% (100, 75 and 48%, respectively, in the three groups). Determinants of EGF in the highest-risk group were: redo procedure, valvular cardiomyopathy, status one at transplant, recipient male sex, donor-recipient (D/R) weight mismatch, high inotropic donor support, ischaemic time and first day troponin I release. In conclusion, several donor and recipient features predicted EGF. Since such characteristics are not readily modifiable but synergistically determine the occurrence of EGF, optimization of D/R matching is crucial to prevent it.
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Affiliation(s)
- Cristiano Amarelli
- Department of Cardiovascular Surgery and Transplants, Monaldi Hospital, Naples, Italy
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Amarelli C, Buonocore M, Romano G, Maiello C, De Santo LS. Nutritional issues in heart transplant candidates and recipients. Front Biosci (Elite Ed) 2012; 4:662-8. [PMID: 22201902 DOI: 10.2741/407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Heart transplant is the golden standard in the management of end-stage heart failure. Recent studies have pointed out the role of nutritional issues in patients evaluated for heart transplant listing. In particular, extremes in body habitus, cachexia and obesity, have been characterized and identified as independent prognostic factors and clinically relevant target for therapeutic interventions. Effects of such conditions exert a prognostic implication well beyond waiting time up to early post transplant setting. Changes in posttransplant clinical conditions and nutritional status have been recently described in their pattern of presentation and implications on weight gain, reversal of preoperative cachexia and early and late morbidity and mortality. New onset diabetes mellitus and metabolic syndrome have been disclosed as relevant clinical conditions in this setting. Implications for tailoring of immunosuppressive therapy and dietary prescription emerged as main stem of long term recipient management. All this issues have been reviewed focusing on the clinical relevance of this growing body of knowledge and emphasizing the role of a multidisciplinary approach for selection and management of heart transplant recipients.
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Affiliation(s)
- Cristiano Amarelli
- Department of Cardiovascular Surgery and Transplant, Vincenzo Monaldi Hospital, 5 Leonardo Bianchi Street, 80131, Naples, Italy
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Cotrufo M, Sibilio G, Marra C, Dialetto G, Giordano S, De Feo M, De Santo LS. Radical and harmless shave resection of atypical papillary fibroelastomas of the cardiac valves. Heart Surg Forum 2011; 14:E242-4. [PMID: 21859643 DOI: 10.1532/hsf98.20101156] [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: 11/20/2022]
Abstract
BACKGROUND Papillary fibroelastomas (PFEs) are rare cardiac tumors usually treated by shave resection. Up to 20% of the patients are actually denied such a conservative surgical approach because atypical morphology is thought to preclude radical and effective outcomes. METHODS/RESULTS Surgical tricks and tips of shave resection are elucidated, and a case series presentation of the morphology of atypical PFEs treated by shave resection is described. CONCLUSION In experienced hands surgical shave resection is the gold standard for the treatment of PFE even in atypical presentations.
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Affiliation(s)
- Maurizio Cotrufo
- Department of Cardiovascular Surgery, Pineta Grande Hospital, Castelvolturno, Caserta, Italy
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De Feo M, Dialetto G, D'Oria V, Pepino P, Giordano S, Cotrufo M, De Santo LS. Environmental Pollution as a Cause of Papillary Fibroelastoma: Hints for a New Etiological Hypothesis? Heart Surg Forum 2011; 14:E269-70. [DOI: 10.1532/hsf98.2011-1020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<p><b>Background:</b> Environmental pollution has adverse human health effects, mostly on the respiratory tract but also on the cardiovascular system. Papillary fibroelastomas are exceedingly rare primary cardiac tumors; their pathologic origin remains still elusive.</p><p><b>Case Report:</b> This is a brief report on 3 patients referred for surgical treatment of papillary fibroelastomas in the last 6 months. All patients were born, lived, and worked in a narrow region in Campania that is under active monitoring because of high rates of environmental pollution.</p><p><b>Conclusions:</b> Known mechanisms of cardiovascular damage generated by environmental pollution are cross linked with described papillary fibroelastomas' etiological cascade. Evidence is suggested for a common origin. These results provide intriguing but inconclusive insights into pathophysiological pathways that may link exposure to environmental pollution and development of papillary fibroelastomas.</p>
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De Santo LS, Romano G, Amarelli C, Maiello C, Baldascino F, Bancone C, Grimaldi F, Nappi G. Implications of acute kidney injury after heart transplantation: what a surgeon should know. Eur J Cardiothorac Surg 2011; 40:1355-61; discussion 1361. [PMID: 21514175 DOI: 10.1016/j.ejcts.2011.02.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 01/13/2011] [Accepted: 02/08/2011] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Data regarding risks and consequences of acute kidney injury (AKI) after cardiac transplantation are dismissingly few and unclear. This study defined the incidence, risk factors and prognostic implication of AKI in a single-center cohort operated on between January 1999 and December 2008. METHODS Data from 307 consecutive recipients (mean age: 47.42 ± 13.58, 20.5% female, 18.9% diabetics, 19.5% with previous cardiac operations, 26.4% hospitalized, 78.4 ± 33.7 ml min(-1) preoperative glomerular filtration rate (eGFR)) were analyzed using multivariable logistic regression modeling. AKI was defined according to RIFLE (Risk, Injury, and Failure; and Loss, and End-stage kidney disease) criteria. RESULTS RIFLE scores of I or F were detected in 14%, and continuous venovenous hemofiltration was needed in 6.1%. Risk factors for AKI were: previous cardiac operation (odds ratio (OR) 2.35; 95% confidence interval (CI), 1.11-4.9), blood transfusion (OR 1.08; 95% CI, 1.011-1.16), troponin I release >10 (OR 1.031; 95% CI, 1.001-1.064), length of ischemic time (OR 1.008; 95% CI, 1.011-1.16). Overall hospital mortality averaged 7.8% and overall 1-year mortality was 10.4%; both mortality rates increased with each RIFLE stratification (Normal 3.4%, RIFLE R = 7.1%; RIFLE I = 25.7%; and RIFLE F = 37.5% and Normal 5.6%, RIFLE R = 11.8%, RIFLE I = 25.7%, and RIFLE F = 37.5%, respectively). AKI proved independent predictors of both early and 1-year mortality. The burden of AKI significantly affected 1-year kidney function (Δ preoperative GFR-1-year GFR in AKI vs no AKI = -25.872 ± 22.54 vs -7.968 ± 34.18, p = 0.015). CONCLUSIONS AKI is a highly prevalent and prognostically important complication. Some of the risk factors for AKI identified may be modifiable.
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De Santo LS, De Feo M, Della Corte A, Cerasuolo F, Santé P, Torella M, Nappi G. A Starr-Edwards mitral prosthesis after 44 years of good performance. Int J Artif Organs 2010; 33:405-407. [PMID: 20812436] [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: 05/29/2023]
Abstract
The Starr-Edwards caged-ball prosthesis has been widely used to replace cardiac valves. The Model 6120 mitral prosthesis was introduced on the market in 1965 to reduce the high incidence of ball variance and thromboembolism of the previous model. We report the case of a Starr-Edwards Model 6120 which had been in place for 44 years and was still well functioning with no apparent structural damage.
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Affiliation(s)
- Luca Salvatore De Santo
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Monaldi Hospital, Naples, Italy
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De Santo LS, De Feo M, Della Corte A, Cerasuolo F, Santè P, Torella M, Nappi G. A Starr-Edwards Mitral Prosthesis after 44 Years of Good Performance. Int J Artif Organs 2010. [DOI: 10.1177/039139881003300609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Starr-Edwards caged-ball prosthesis has been widely used to replace cardiac valves. The Model 6120 mitral prosthesis was introduced on the market in 1965 to reduce the high incidence of ball variance and thromboembolism of the previous model. We report the case of a Starr-Edwards Model 6120 which had been in place for 44 years and was still well functioning with no apparent structural damage.
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Affiliation(s)
- Luca Salvatore De Santo
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Monaldi Hospital, Naples - Italy
| | - Marisa De Feo
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Monaldi Hospital, Naples - Italy
| | - Alessandro Della Corte
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Monaldi Hospital, Naples - Italy
| | - Flavio Cerasuolo
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Monaldi Hospital, Naples - Italy
| | - Pasquale Santè
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Monaldi Hospital, Naples - Italy
| | - Michele Torella
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Monaldi Hospital, Naples - Italy
| | - Gianantonio Nappi
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Monaldi Hospital, Naples - Italy
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De Santo LS, Romano G, Galdieri N, Buonocore M, Bancone C, De Simone V, Della Corte A, Nappi G. RIFLE criteria for acute kidney injury in valvular surgery. J Heart Valve Dis 2010; 19:139-148. [PMID: 20329500] [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: 05/29/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The RIFLE classification, which defines three grades of increasing severity of acute kidney injury--risk (RIFLE R), injury (RIFLE I) and failure (RIFLE F), and two outcome classes (L, loss) and E (end-stage kidney disease)--represents a valuable method for evaluating acute renal failure. Risk factors for acute kidney injury (AKI) according to the RIFLE criteria and for operative mortality were identified in patients undergoing valvular procedures. METHODS A single-center prospective cohort study of 1424 patients who were not receiving renal replacement therapy preoperatively was conducted between January 2004 and December 2007. A total of 100 variables was collected from each patient. RESULTS The main features were: mean age 61.9 +/- 12.9 years (range: 15-88 years), 47% females, 6% endocarditis, 11% redo surgery, 8% urgent/emergent surgery, 30% combined procedures, 5% complex, and 16% associated coronary artery bypass grafting (CABG). The overall AKI prevalence was 10%, with RIFLE scores of I or F being detected in 8% and continuous veno-venous hemofiltration being required in 5%. Risk factors for AKI were age (OR 1.03; 95% CI 1.14-4.15), time of extracorporeal circulation (ECC) (OR 1.09; 95% CI 1.005-1.013), redo procedure (OR 2.35; 95% CI 1.42-3.8), chronic kidney disease (OR 3.2; 95% CI 1.6-6.1), and blood transfusion (OR 3.8; 95% CI 2.5-6.5). The transfusion of leukodepleted blood exerted a protective effect on AKI development (OR 0.6; 95% CI 0.4-0.9). The average overall hospital mortality was 4.8%. Risk factors for operative mortality included: ECC time (OR 1; 95% CI 1.002-1.014), age (OR 1.043; 95% CI 1.01-1.07), chronic kidney disease (OR 4.8; 95% CI 2.2-10.6), blood transfusion (OR 6.43; 95% CI 2.8-14.7), surgical priority (OR 6.5; 95% CI 2.8-14.7), RIFLE class I (OR 11.9; 95% CI 5.5-25.7), and RIFLE class F (OR 30; 95% CI 8.1-111.7). Mortality increased with each RIFLE stratification (Normal 1.7%, RIFLE R = 4.1%, RR = 2.5; RIFLE I = 27.6%, RR = 16.2; and RIFLE F = 43.8% RR = 25.8). CONCLUSION AKI is a highly prevalent and prognostically important complication, for which the majority of risk factors that have been identified are not modifiable. The transfusion of leukodepleted blood products was seen to exert a preventive effect.
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De Santo LS, Bisaccia C, De Santo RM. Water, from Gilgamesh Epic to Nobel Laureate Richard Feynman: a look into polywater and the memory of water. J Nephrol 2009; 22 Suppl 14:86-91. [PMID: 20013738] [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: 05/28/2023]
Abstract
Water is a complex source of imagination, dreams and rituals, where cultural differences ebb and flow, where a plethora of meanings and interpretations interlink and wash over one another. Water has an ambivalent character as stated in most of the ancient cosmogonies and in the Epic of Gilgamesh. Water's composition was discovered by the London scientist Henry Cavendish in about 1781. Although it is an apparently simple molecule (H2O), it has a highly complex and anomalous character. The anomalous properties of water are those where the behavior of liquid water is quite different from what is found with other liquids. As often stated, life depends indeed on these anomalous properties of water. Notably there are 12 phase, 22 density, 12 material, 11 thermodynamic and 9 physical anomalies. A powerful look into the water molecule was given by Nobel Prize recipient Richard P. Feynman as published in Six easy pieces. A look into the most recent quest for more knowledge about water leads us to the concept of pathological science. The cases of "polywater" and "the memory of water" are indeed paradigmatic episodes of fraudulent research published in journals with high impact factors. In conclusion, men came out of water engineered to handle water, and water greatly affects mythology and philosophy and is a strong presence in the arts and science.
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De Santo RM, Bisaccia C, Cirillo M, Pollastro RM, Raiola I, De Santo LS. The nature of water: Greek thought from Homer to Acusilaos. J Nephrol 2009; 22 Suppl 14:92-97. [PMID: 20013739] [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: 05/28/2023]
Abstract
Greek philosophy finds its roots in the myth of Homer's and Hesiod's poems and especially in Orphism which introduced the concept of a soul separated from the body with an independent principle, psiche (soul), to be rewarded or punished after death. Orphism was an important step in Greek culture. It introduced the divine into man, the soul which does not die with the body and reincarnates. From Orphism started the need of rituals capable of separating the spirit from the body. From Homer to Acusilaos, water was a very important element which connected humans and gods, long before Thales of Miletus defined it the arche.
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Bisaccia C, De Santo RM, Bilancio G, Anastasio P, Perna A, De Santo LS. The nature of water: excerpts from Pythagoras, Xenophanes, Heraclitus and Parmenides. J Nephrol 2009; 22 Suppl 14:103-107. [PMID: 20013741] [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: 05/28/2023]
Abstract
Water was a prominent substance with Pythagoras, Xenophanes, Heraclitus and Parmenides, who flourished in the years 530-490 bc. The basic Pythagorean elements were earth and fire, and between them there were 2 intermediate entities (water and air), which were instrumental and indispensable components of specific solids. All things are a blend of different elements. For Xenophanes, "All things that come into being and grow are earth and water," "We all originated from earth and water" and "And in certain caves water drips down."For Heraclitus water is an ambivalent substance: "One cannot bathe in the same river on two occasions." "The sea is the safest and the most polluted water, for fish it is healthy and gives life, for men it is unhealthy and causes death." "Fire experiences the death of earth, air experiences that of fire, water experiences the death of air and the earth that of water." Parmenides was a man who sought the truth through reasoning and was, according to Hegel, the founder of Western philosophy. He built a dualist theory of the cosmos based on heat and cold, fire and earth - the former as a cause, the latter as substrate. The former unified, the latter separated. According to Aristotle, Parmenides considered air and water as mixtures of earth and fire.
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Guida B, Perrino NR, Laccetti R, Trio R, Nastasi A, Pesola D, Maiello C, Marra C, De Santo LS, Cotrufo M. Role of dietary intervention and nutritional follow-up in heart transplant recipients. Clin Transplant 2009; 23:101-7. [DOI: 10.1111/j.1399-0012.2008.00915.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vicchio M, Della Corte A, De Santo LS, De Feo M, Caianiello G, Scardone M, Cotrufo M. Prosthesis-Patient Mismatch in the Elderly: Survival, Ventricular Mass Regression, and Quality of Life. Ann Thorac Surg 2008; 86:1791-7. [DOI: 10.1016/j.athoracsur.2008.09.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Revised: 09/03/2008] [Accepted: 09/04/2008] [Indexed: 11/27/2022]
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Cotrufo M, De Santo LS, Della Corte A, Romano G, Amarelli C, De Feo M, Santarpino G, Scardone M, Nappi G. Acute hemodynamic and functional effects of surgical ventricular restoration and heart transplantation in patients with ischemic dilated cardiomyopathy. J Thorac Cardiovasc Surg 2008; 135:1054-60. [PMID: 18455584 DOI: 10.1016/j.jtcvs.2007.09.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 09/13/2007] [Accepted: 09/24/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Peak oxygen uptake (VO(2)) and ventilatory efficiency have prognostic implications in the population with congestive heart failure. This study evaluated quality-of-life functional capacity after the 2 treatment strategies of surgical ventricular restoration and transplantation for severe left ventricular dysfunction of ischemic cause. METHODS The 75-patient study population (between 2004 and 2006) with severe heart failure included 35 patients undergoing surgical ventricular restoration (mean age, 62.6 +/- 8.7 years), sometimes together with coronary artery bypass grafting or mitral surgery, and 40 cardiac transplant recipients (mean age, 55.6 +/- 7.7 years). Preoperative and 6-month postoperative function (peak VO(2), the anaerobic threshold, and the slope of minute ventilation/carbon dioxide uptake), cardiac catheterization parameters (left and right), and hospital and early outcomes were evaluated. RESULTS The 2 groups had comparable baseline functional impairment and experienced similar hospital stay and early outcomes. They also showed similar improvements in left ventricular volume indexes and hemodynamic parameters and sustained significant improvements of median VO(2), anaerobic threshold, and minute ventilation/carbon dioxide uptake values. CONCLUSIONS Both surgical strategies resulted in a significant and comparable improvement of functional capacity at the 6-month evaluation. These early studies must be repeated to determine the long-term benefits of surgical ventricular restoration because maximal VO(2) and ventilatory efficiency lose their prognostic survival role after transplantation.
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Affiliation(s)
- Maurizio Cotrufo
- Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
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Vicchio M, Della Corte A, De Santo LS, De Feo M, Caianiello G, Scardone M, Cotrufo M. Tissue Versus Mechanical Prostheses: Quality of Life in Octogenarians. Ann Thorac Surg 2008; 85:1290-5. [DOI: 10.1016/j.athoracsur.2007.12.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2007] [Revised: 12/11/2007] [Accepted: 12/12/2007] [Indexed: 10/22/2022]
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Vicchio M, De Santo LS, Della Corte A, De Feo M, Provenzano R, Miraglia M, Scardone M, Cotrufo M. Aortic valve replacement with 19-mm bileaflet prostheses in the elderly: left ventricular mass regression and quality of life. J Heart Valve Dis 2008; 17:216-221. [PMID: 18512494] [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: 05/26/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The study aim was to evaluate left ventricular mass (LVM) regression, survival and quality of life in elderly patients after aortic valve replacement (AVR) with small-sized bileaflet prostheses. METHODS Between September 1988 and September 2005, a total of 147 patients aged > 70 years underwent AVR with 19-mm bileaflet prostheses for aortic stenosis. In order to evaluate the impact of prosthesis-patient mismatch (PPM) on long-term outcome, survivors were allocated to two groups according to the effective orifice area index (EOAI): group A, with EOAI < 0.85 cm2/m2, and group B with EOAI > or = 0.85 cm2/m2. Hospital survivors were interviewed using the SF-36 questionnaire, and the scores compared with those of age- and gender-matched members of the general Italian population. RESULTS The mean patient age was 74.5 +/- 3.5 years, body surface area (BSA) 1.68 +/- 0.15 m2, and EOAI 0.73 +/- 0.2 cm2/m2. Hospital mortality was 8.8% (n = 13). Actuarial survival was 87.1 +/- 0.028% at one year, 81.3 +/- 0.035% at five years, and 77.2 +/- 0.044% at eight years. Eight-year survival was 74.0 +/- 0.062% in group A and 82.5 +/- 0.064% in group B (p = 0.29). Echocardiographic follow up showed a significant regression of LVM. Scores obtained in the SF-36 test were similar in the two groups, and significantly higher than those of the general Italian population matched for age and gender (p < 0.001 in all domains). CONCLUSION The implantation of 19-mm bileaflet mechanical prostheses in the elderly allowed LVM regression and a good perceived quality of life. PPM did not influence the long-term survival of these patients.
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Affiliation(s)
- Mariano Vicchio
- Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
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De Santo LS, Amarelli C, Romano G, Della Corte A, Maiello C, Giannolo B, Marra C, De Feo M, Scardone M, Cotrufo M. High-risk heart grafts: effective preservation with Celsior solution. Heart Vessels 2007; 21:89-94. [PMID: 16550309 DOI: 10.1007/s00380-005-0867-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Accepted: 08/23/2005] [Indexed: 10/24/2022]
Abstract
Celsior solution has already proved effective in heart graft preservation because it reduces myocardial edema, prevents free radical damage, and limits calcium overload. The aim of this study was to evaluate the effectiveness of Celsior solution as myocardial protection in high-risk transplantation. Hospital charts and follow-up data of 200 consecutive heart recipients (162 males, 38 females, mean age 47.4 +/- 12.6 years) were reviewed. Patients were divided into two groups: group A (73 patients) included recipients of high-risk grafts (at least two of the following: age >45; female sex; high preretrieval inotropic support, viz. dobutamine or dopamine >10 microg/kg per minute and/or infusion of norepinephrine regardless of its dosage; size mismatch >20%; ischemia time >180 min) and group B (127 patients) included recipients of standard grafts. Quality of preservation was assessed through enzyme release, echocardiographic evaluation, the need for inotropic support or pacemaker, and histology of biopsy samples. Hospital and 1-year mortality were also evaluated. Comparisons between the two groups were made through univariate analysis. Study groups proved homogeneous as to recipient age, pretransplant cardiomyopathy, status at transplantation, mean panel reactive antibodies, and redo cardiac surgery. Hospital mortality was 8% (11% vs 6.3%, P = 0.18) while 1-year mortality reached 12% (15.1% vs 10.2%, P = 0.6) without significant difference between groups. Graft performance as described by the need for inotropic support and/or pacemaker as well as echocardiography (left and right ventricular ejection fraction) proved comparable. There were no significant differences as to histology findings and patterns of enzyme release. Celsior provides optimal myocardial preservation in both standard and high-risk procedures. Such advances help to enhance donor pool expansion.
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Affiliation(s)
- Luca Salvatore De Santo
- Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, V. Monaldi Hospital, Naples, Italy.
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Agozzino L, Santè P, Ferraraccio F, Accardo M, De Feo M, De Santo LS, Nappi G, Agozzino M, Esposito S. Ascending aorta dilatation in aortic valve disease: morphological analysis of medial changes. Heart Vessels 2006; 21:213-20. [PMID: 16865296 DOI: 10.1007/s00380-005-0891-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Accepted: 12/02/2005] [Indexed: 11/29/2022]
Abstract
We investigated whether and how the severity of medial degeneration lesions varies along the circumference of the dilated intrapericardial aorta. Two groups of aortic wall specimens, respectively harvested in the convexity and concavity of ascending aorta in 72 patients undergoing surgery for dilatation of the intrapericardial aorta associated with aortic valve disease, were separately sent for pathology, morphometry, and ultrastructural examination. Cystic medial necrosis, fibrosis, and elastic fiber fragmentation were classified into three degrees of severity; their mean degree and morphometric findings in the convexity and in the concavity specimens were compared by paired t-test. Correlation between echocardiographic degree of aortic dilatation and severity of medial degeneration was assessed separately for each of the two groups of specimens. Morphologically, medial degeneration was found in all cases; a higher mean degree was found in the convexity group (2.39 +/- 0.58 vs 1.44 +/- 0.65 in the concavity group; P < 0.001). At morphometry normal smooth muscle cells in the convexity specimens were significantly reduced (P = 0.007); the length (P = 0.012) and number (P = 0.009) of elastic fibers reduced and increased, respectively. Moreover, in the convexity specimens a significantly smaller amount of smooth muscle cells and an increase of immunohistochemical labeling of apoptosis-associated proteins in the subintimal layer of the media was noticed. Correlation between aortic ratio and medial degeneration degree was significant in the convexity group (P < 0.001), but not in the concavity group (P = 0.249). Scanning electron microscopy analysis confirmed morphological results and allowed us to better distinguish the early pathological cavities from the microvessels, which were in the outer media in normal aorta and ubiquitous in aortitis or atherosclerosis. Electron transmission microscopy analysis showed changes in the extracellular matrix and smooth muscle cells, and these changes increased from the intima to the adventitial layer of the media. In dilated intrapericardial aorta, medial degeneration changes and expression of apoptosis-associated proteins are more marked in the ascending aorta convexity, likely due to hemodynamic stress asymmetry. Ultrastructural findings allow us to distinguish the early medial changes not yet evident on light microscopy.
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Affiliation(s)
- Lucio Agozzino
- Department of Public Health, Section of Pathology, Second University of Naples, Via L. Armanni 5, 80138 Naples, Italy.
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