Davide Pacini | AICCON - Associazione Italiana per la Promozione della Cultura della Cooperazione e del Non Profit (original) (raw)
Papers by Davide Pacini
The Annals of thoracic surgery, Jan 27, 2015
Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidl... more Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidly progressive cardiac compromise that ultimately leads to refractory cardiogenic shock or cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in this circumstance, but few clinical series are available about early and long-term results. Data from a multicenter study group are reported which analyzed subjects affected by AFM and treated with VA-ECMO during a 5-year period. From hospital databases, 57 patients with diagnoses of AFM treated with VA-ECMO in the past 5 years were found and analyzed. Mean age was 37.6 ± 11.8 years; 37 patients were women. At VA-ECMO implantation, cardiogenic shock was present in 38 patients, cardiac arrest in 12, and severe hemodynamic instability in 7. A peripheral approach was used with 47 patients, whereas 10 patients had a central implantation or other access. Mean VA-ECMO support was 9.9 ...
Interactive CardioVascular and Thoracic Surgery, 2013
Interactive cardiovascular and thoracic surgery, 2008
A new bio-prosthetic valved conduit (Bio-Valsalva) has recently been introduced into surgical pra... more A new bio-prosthetic valved conduit (Bio-Valsalva) has recently been introduced into surgical practice in order to offer a valid option for elderly patients undergoing composite aortic root replacement. The conduit is made up of a stentless porcine valve (elan valve) pre-sewn inside a triple layer Valsalva prosthesis and it is entirely preserved in a glutaraldehyde solution. In our Department, 21 patients (16 males, mean age 67.8+/-5.5 years) underwent aortic root replacement using the Bio-Valsalva prosthesis. Composite root replacement was extended to the hemiarch in three cases while a complete arch replacement was performed in two patients. Type A aortic dissection was present in two cases while a bicuspid aortic valve was detected in eight patients. In-hospital mortality was 4.7% (1 patient). Re-thoracotomy for bleeding was performed in one case. The median in-hospital stay was 12 days. The median follow-up was six months and is 100% complete. There were no re-operations or stru...
The Heart Surgery Forum, 2004
Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery, 2011
Brain injury represents a primary concern during aortic arch surgery. Valid surgical techniques a... more Brain injury represents a primary concern during aortic arch surgery. Valid surgical techniques and reliable methods of brain protection are required to obtain a favorable outcome after such a complex surgery. Our aim was to review available methods of brain protection including deep hypothermia and circulatory arrest, retrograde cerebral perfusion and antegrade cerebral perfusion.
The Annals of Thoracic Surgery, 2006
http://ats.ctsnetjournals.org/cgi/content/full/81/2/758 located on the World Wide Web at:
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 26, 2016
The aim of this study was to compare 5-year rates of overall death, cardiac-related death, myocar... more The aim of this study was to compare 5-year rates of overall death, cardiac-related death, myocardial infarction, repeat revascularization, stroke and new occurrence of postoperative renal failure in a large cohort of patients with coronary disease, treated with on- or off-pump coronary artery bypass grafting (CABG). Two propensity score-matched cohorts, each of 560 patients, undergoing isolated surgical coronary revascularization at the regional public and private centres of Emilia-Romagna region (Italy) over the period 1 January 2003 - 31 December 2013, were used to compare long-term outcomes of on-pump CABG (6711 patients) and off-pump CABG (597 patients). The matched on-pump group received significantly more bypass grafts than the matched off-pump group (2.4 ± 1.1 vs 1.6 ± 0.9, P < 0.0001). The on-pump group reported statistically significant lower cardiac-related mortality. There was a trend towards higher overall mortality and the need for repeat revascularization procedure...
General & diagnostic pathology, 1997
We report a case of neoplasia of pulmonary vein in a 45-year-old woman who presented with increas... more We report a case of neoplasia of pulmonary vein in a 45-year-old woman who presented with increasing dyspnea. As a consequence, the neoplasia filled the entire left atrium and appeared to be attached to the left superior pulmonary vein on surgical excision. Histologically, it was composed of a proliferation of sarcomatous cells, with a high mitotic rate and diffuse immunohistochemical positivity for smooth muscle actin, consistent with a leiomyosarcoma. The microscopic, immunohistochemical, and ultrastructural findings are discussed.
Journal of Cardiovascular Medicine, 2011
Correspondence to Alessandro Malagoli, MD, Department of Cardiology, Policlinico Hospital, Modena... more Correspondence to Alessandro Malagoli, MD, Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Via del Pozzo 71, 41100 Modena, Italy Tel:+ 39 059 4222241; fax:+ 39 059 4224323; e-mail: ale. mala@ tiscali. it
Journal of Cardiovascular Medicine, 2010
A multidisciplinary approach to congenital heart diseases in adults is a primary element for mode... more A multidisciplinary approach to congenital heart diseases in adults is a primary element for modern medicine. The diagnosis of a sinus venosus atrial septal defect is a typical example of disease that requires the different skills of the cardiologist, cardiac surgeon and radiologist.
Giornale Italiano Di Cardiologia, Jun 1, 2011
Giornale Italiano Di Cardiologia, May 1, 2010
In recent decades, the outcome of patients after thoracic aortic surgery has improved considerabl... more In recent decades, the outcome of patients after thoracic aortic surgery has improved considerably. However, surgery of the thoracic aorta and, in particular, of the aortic arch is still associated with significant high mortality and morbidity caused by neurological complications resulting from temporary suspension of cerebral circulation. Cerebrovascular injuries in thoracic aortic surgery can be caused by inadequate cerebral protection, cerebral embolism and, in case of acute type A aortic dissection, cerebral malperfusion. The neurological outcome of these patients depends on the quality of central nervous system protection during the critical period of interruption of cerebral circulation. Various techniques have been proposed as a means of protecting the brain from ischemic injury, such as deep hypothermic circulatory arrest, retrograde cerebral perfusion, and antegrade selective cerebral perfusion. This review analyzes these three methods and the strategies of cerebral protection focusing on the advantages and disadvantages of each one.
Italian Heart Journal Official Journal of the Italian Federation of Cardiology, 2005
Surgical treatment of the thoracic aorta combined with endovascular stent grafting may be an inte... more Surgical treatment of the thoracic aorta combined with endovascular stent grafting may be an interesting approach to diseases of the thoracic aorta in high-risk patients. A patient with a chronic post-dissection aneurysm of the aortic arch and proximal descending aorta developed, after surgery, a perianastomotic leak of the distal suture of the graft. We successfully treated the leak by means of an endovascular stent graft procedure. These combined procedures may be useful to resolve surgical complications particularly in case of high operative risk.
Italian Heart Journal Official Journal of the Italian Federation of Cardiology, Apr 1, 2005
The aim of this study was to evaluate early results and to determine predictive risk factors asso... more The aim of this study was to evaluate early results and to determine predictive risk factors associated with an adverse outcome in elderly patients after acute type A aortic dissection repair using antegrade selective cerebral perfusion (ASCP). Adverse outcome was defined as the occurrence of death or permanent neurologic dysfunction. From October 1995 to March 2002, 178 patients (group A &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 75 years, n = 156, 87.6%; group B &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 75 years, n = 22, 12.4%) underwent surgery for acute type A aortic dissection using ASCP and moderate hypothermia. An ascending aorta/hemiarch replacement was performed in 128/178 (71.9%) patients (group A 71.2%, group B 77.3%, p = NS), an ascending aorta and arch replacement in 50/178 (28.1%) patients (group A 28.8%, group B 22.7%, p = NS). Associated procedures were performed in 55/178 (20.9%) patients (group A 31.4%, group B 27.3%, p = NS), the arch vessels were reimplanted using the separated graft technique in 32/50 (64.0%) patients (group A 62.2%, group B 80.0%, p = NS). The mean ASCP time was 59 +/- 27 min. The overall adverse outcome rate was 20.8% (group A 21.2%, group B 18.2%, p = NS). The transient neurologic dysfunction rate was 9.5% (group A 9.5%, group B 5.6%, p = NS). A logistic regression analysis revealed cardiopulmonary bypass time (p = 0.045, odds ratio 1.03/min) to be the only independent predictor of adverse outcome in group A. During type A aortic dissection repair the implementation of ASCP resulted in an acceptable hospital mortality and neurologic outcome. If ASCP is used, the risk of hospital mortality and postoperative morbidity is similar in patients younger and older than 75 years. Duration of cardiopulmonary bypass still remains an important risk factor for hospital mortality and neurologic outcome in elderly patients.
Frontiers in Cardiovascular Medicine, 2016
Coronary artery bypass surgery (CABG) is still one of the most frequently performed surgical proc... more Coronary artery bypass surgery (CABG) is still one of the most frequently performed surgical procedures all over the world. The results of this procedure have been constantly improved over the years with low perioperative mortality rates, with relatively low complication rates. To further improve these outstanding results, the clinicians focused their attention at biomarkers as outcome predictors. Although biological testing for disease prediction has already been discussed many times, the role of biomarkers in outcome prediction after CABG is still controversial. In this article, we reviewed the current knowledge regarding the role of genetic and dynamic biomarkers and their possible association with the occurrence of adverse clinical outcomes after CABG. We also took into consideration that the molecular pathway activation and the possible imbalance may affect hard outcomes and graft patency. We analyzed biomarkers classified in two different categories depending on their possibility to change over time: genetic markers and dynamic markers. Moreover, we evaluated these markers by dividing them, into sub-categories, such as inflammation, hemostasis, renin-angiotensin, endothelial function, and other pathways. We showed that biomarkers might be associated with unfavorable outcomes after surgery, and in some cases improved outcome prediction. However, the identification of a specific panel of biomarkers or of some algorithms including biomarkers is still in an early developmental phase. Finally, larger studies are needed to analyze broad panel of biomarkers with the specific aim to evaluate the prediction of hard outcomes and graft patency.
Circulation, Nov 22, 2011
The Annals of thoracic surgery, Jan 21, 2015
Contemporary scores for estimating perioperative death have been proposed to also predict also lo... more Contemporary scores for estimating perioperative death have been proposed to also predict also long-term death. The aim of the study was to evaluate the performance of the updated European System for Cardiac Operative Risk Evaluation II, The Society of Thoracic Surgeons Predicted Risk of Mortality score, and the Age, Creatinine, Left Ventricular Ejection Fraction score for predicting long-term mortality in a contemporary cohort of isolated aortic valve replacement (AVR). We also sought to develop for each score a simple algorithm based on predicted perioperative risk to predict long-term survival. Complete data on 1,444 patients who underwent isolated AVR in a 7-year period were retrieved from three prospective institutional databases and linked with the Italian Tax Register Information System. Data were evaluated with performance analyses and time-to-event semiparametric regression. Survival was 83.0% ± 1.1% at 5 years and 67.8 ± 1.9% at 8 years. Discrimination and calibration of a...
The Journal of cardiovascular surgery
The Annals of thoracic surgery, Jan 27, 2015
Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidl... more Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidly progressive cardiac compromise that ultimately leads to refractory cardiogenic shock or cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in this circumstance, but few clinical series are available about early and long-term results. Data from a multicenter study group are reported which analyzed subjects affected by AFM and treated with VA-ECMO during a 5-year period. From hospital databases, 57 patients with diagnoses of AFM treated with VA-ECMO in the past 5 years were found and analyzed. Mean age was 37.6 ± 11.8 years; 37 patients were women. At VA-ECMO implantation, cardiogenic shock was present in 38 patients, cardiac arrest in 12, and severe hemodynamic instability in 7. A peripheral approach was used with 47 patients, whereas 10 patients had a central implantation or other access. Mean VA-ECMO support was 9.9 ...
The Annals of thoracic surgery, Jan 27, 2015
Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidl... more Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidly progressive cardiac compromise that ultimately leads to refractory cardiogenic shock or cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in this circumstance, but few clinical series are available about early and long-term results. Data from a multicenter study group are reported which analyzed subjects affected by AFM and treated with VA-ECMO during a 5-year period. From hospital databases, 57 patients with diagnoses of AFM treated with VA-ECMO in the past 5 years were found and analyzed. Mean age was 37.6 ± 11.8 years; 37 patients were women. At VA-ECMO implantation, cardiogenic shock was present in 38 patients, cardiac arrest in 12, and severe hemodynamic instability in 7. A peripheral approach was used with 47 patients, whereas 10 patients had a central implantation or other access. Mean VA-ECMO support was 9.9 ...
Interactive CardioVascular and Thoracic Surgery, 2013
Interactive cardiovascular and thoracic surgery, 2008
A new bio-prosthetic valved conduit (Bio-Valsalva) has recently been introduced into surgical pra... more A new bio-prosthetic valved conduit (Bio-Valsalva) has recently been introduced into surgical practice in order to offer a valid option for elderly patients undergoing composite aortic root replacement. The conduit is made up of a stentless porcine valve (elan valve) pre-sewn inside a triple layer Valsalva prosthesis and it is entirely preserved in a glutaraldehyde solution. In our Department, 21 patients (16 males, mean age 67.8+/-5.5 years) underwent aortic root replacement using the Bio-Valsalva prosthesis. Composite root replacement was extended to the hemiarch in three cases while a complete arch replacement was performed in two patients. Type A aortic dissection was present in two cases while a bicuspid aortic valve was detected in eight patients. In-hospital mortality was 4.7% (1 patient). Re-thoracotomy for bleeding was performed in one case. The median in-hospital stay was 12 days. The median follow-up was six months and is 100% complete. There were no re-operations or stru...
The Heart Surgery Forum, 2004
Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery, 2011
Brain injury represents a primary concern during aortic arch surgery. Valid surgical techniques a... more Brain injury represents a primary concern during aortic arch surgery. Valid surgical techniques and reliable methods of brain protection are required to obtain a favorable outcome after such a complex surgery. Our aim was to review available methods of brain protection including deep hypothermia and circulatory arrest, retrograde cerebral perfusion and antegrade cerebral perfusion.
The Annals of Thoracic Surgery, 2006
http://ats.ctsnetjournals.org/cgi/content/full/81/2/758 located on the World Wide Web at:
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 26, 2016
The aim of this study was to compare 5-year rates of overall death, cardiac-related death, myocar... more The aim of this study was to compare 5-year rates of overall death, cardiac-related death, myocardial infarction, repeat revascularization, stroke and new occurrence of postoperative renal failure in a large cohort of patients with coronary disease, treated with on- or off-pump coronary artery bypass grafting (CABG). Two propensity score-matched cohorts, each of 560 patients, undergoing isolated surgical coronary revascularization at the regional public and private centres of Emilia-Romagna region (Italy) over the period 1 January 2003 - 31 December 2013, were used to compare long-term outcomes of on-pump CABG (6711 patients) and off-pump CABG (597 patients). The matched on-pump group received significantly more bypass grafts than the matched off-pump group (2.4 ± 1.1 vs 1.6 ± 0.9, P < 0.0001). The on-pump group reported statistically significant lower cardiac-related mortality. There was a trend towards higher overall mortality and the need for repeat revascularization procedure...
General & diagnostic pathology, 1997
We report a case of neoplasia of pulmonary vein in a 45-year-old woman who presented with increas... more We report a case of neoplasia of pulmonary vein in a 45-year-old woman who presented with increasing dyspnea. As a consequence, the neoplasia filled the entire left atrium and appeared to be attached to the left superior pulmonary vein on surgical excision. Histologically, it was composed of a proliferation of sarcomatous cells, with a high mitotic rate and diffuse immunohistochemical positivity for smooth muscle actin, consistent with a leiomyosarcoma. The microscopic, immunohistochemical, and ultrastructural findings are discussed.
Journal of Cardiovascular Medicine, 2011
Correspondence to Alessandro Malagoli, MD, Department of Cardiology, Policlinico Hospital, Modena... more Correspondence to Alessandro Malagoli, MD, Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Via del Pozzo 71, 41100 Modena, Italy Tel:+ 39 059 4222241; fax:+ 39 059 4224323; e-mail: ale. mala@ tiscali. it
Journal of Cardiovascular Medicine, 2010
A multidisciplinary approach to congenital heart diseases in adults is a primary element for mode... more A multidisciplinary approach to congenital heart diseases in adults is a primary element for modern medicine. The diagnosis of a sinus venosus atrial septal defect is a typical example of disease that requires the different skills of the cardiologist, cardiac surgeon and radiologist.
Giornale Italiano Di Cardiologia, Jun 1, 2011
Giornale Italiano Di Cardiologia, May 1, 2010
In recent decades, the outcome of patients after thoracic aortic surgery has improved considerabl... more In recent decades, the outcome of patients after thoracic aortic surgery has improved considerably. However, surgery of the thoracic aorta and, in particular, of the aortic arch is still associated with significant high mortality and morbidity caused by neurological complications resulting from temporary suspension of cerebral circulation. Cerebrovascular injuries in thoracic aortic surgery can be caused by inadequate cerebral protection, cerebral embolism and, in case of acute type A aortic dissection, cerebral malperfusion. The neurological outcome of these patients depends on the quality of central nervous system protection during the critical period of interruption of cerebral circulation. Various techniques have been proposed as a means of protecting the brain from ischemic injury, such as deep hypothermic circulatory arrest, retrograde cerebral perfusion, and antegrade selective cerebral perfusion. This review analyzes these three methods and the strategies of cerebral protection focusing on the advantages and disadvantages of each one.
Italian Heart Journal Official Journal of the Italian Federation of Cardiology, 2005
Surgical treatment of the thoracic aorta combined with endovascular stent grafting may be an inte... more Surgical treatment of the thoracic aorta combined with endovascular stent grafting may be an interesting approach to diseases of the thoracic aorta in high-risk patients. A patient with a chronic post-dissection aneurysm of the aortic arch and proximal descending aorta developed, after surgery, a perianastomotic leak of the distal suture of the graft. We successfully treated the leak by means of an endovascular stent graft procedure. These combined procedures may be useful to resolve surgical complications particularly in case of high operative risk.
Italian Heart Journal Official Journal of the Italian Federation of Cardiology, Apr 1, 2005
The aim of this study was to evaluate early results and to determine predictive risk factors asso... more The aim of this study was to evaluate early results and to determine predictive risk factors associated with an adverse outcome in elderly patients after acute type A aortic dissection repair using antegrade selective cerebral perfusion (ASCP). Adverse outcome was defined as the occurrence of death or permanent neurologic dysfunction. From October 1995 to March 2002, 178 patients (group A &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 75 years, n = 156, 87.6%; group B &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 75 years, n = 22, 12.4%) underwent surgery for acute type A aortic dissection using ASCP and moderate hypothermia. An ascending aorta/hemiarch replacement was performed in 128/178 (71.9%) patients (group A 71.2%, group B 77.3%, p = NS), an ascending aorta and arch replacement in 50/178 (28.1%) patients (group A 28.8%, group B 22.7%, p = NS). Associated procedures were performed in 55/178 (20.9%) patients (group A 31.4%, group B 27.3%, p = NS), the arch vessels were reimplanted using the separated graft technique in 32/50 (64.0%) patients (group A 62.2%, group B 80.0%, p = NS). The mean ASCP time was 59 +/- 27 min. The overall adverse outcome rate was 20.8% (group A 21.2%, group B 18.2%, p = NS). The transient neurologic dysfunction rate was 9.5% (group A 9.5%, group B 5.6%, p = NS). A logistic regression analysis revealed cardiopulmonary bypass time (p = 0.045, odds ratio 1.03/min) to be the only independent predictor of adverse outcome in group A. During type A aortic dissection repair the implementation of ASCP resulted in an acceptable hospital mortality and neurologic outcome. If ASCP is used, the risk of hospital mortality and postoperative morbidity is similar in patients younger and older than 75 years. Duration of cardiopulmonary bypass still remains an important risk factor for hospital mortality and neurologic outcome in elderly patients.
Frontiers in Cardiovascular Medicine, 2016
Coronary artery bypass surgery (CABG) is still one of the most frequently performed surgical proc... more Coronary artery bypass surgery (CABG) is still one of the most frequently performed surgical procedures all over the world. The results of this procedure have been constantly improved over the years with low perioperative mortality rates, with relatively low complication rates. To further improve these outstanding results, the clinicians focused their attention at biomarkers as outcome predictors. Although biological testing for disease prediction has already been discussed many times, the role of biomarkers in outcome prediction after CABG is still controversial. In this article, we reviewed the current knowledge regarding the role of genetic and dynamic biomarkers and their possible association with the occurrence of adverse clinical outcomes after CABG. We also took into consideration that the molecular pathway activation and the possible imbalance may affect hard outcomes and graft patency. We analyzed biomarkers classified in two different categories depending on their possibility to change over time: genetic markers and dynamic markers. Moreover, we evaluated these markers by dividing them, into sub-categories, such as inflammation, hemostasis, renin-angiotensin, endothelial function, and other pathways. We showed that biomarkers might be associated with unfavorable outcomes after surgery, and in some cases improved outcome prediction. However, the identification of a specific panel of biomarkers or of some algorithms including biomarkers is still in an early developmental phase. Finally, larger studies are needed to analyze broad panel of biomarkers with the specific aim to evaluate the prediction of hard outcomes and graft patency.
Circulation, Nov 22, 2011
The Annals of thoracic surgery, Jan 21, 2015
Contemporary scores for estimating perioperative death have been proposed to also predict also lo... more Contemporary scores for estimating perioperative death have been proposed to also predict also long-term death. The aim of the study was to evaluate the performance of the updated European System for Cardiac Operative Risk Evaluation II, The Society of Thoracic Surgeons Predicted Risk of Mortality score, and the Age, Creatinine, Left Ventricular Ejection Fraction score for predicting long-term mortality in a contemporary cohort of isolated aortic valve replacement (AVR). We also sought to develop for each score a simple algorithm based on predicted perioperative risk to predict long-term survival. Complete data on 1,444 patients who underwent isolated AVR in a 7-year period were retrieved from three prospective institutional databases and linked with the Italian Tax Register Information System. Data were evaluated with performance analyses and time-to-event semiparametric regression. Survival was 83.0% ± 1.1% at 5 years and 67.8 ± 1.9% at 8 years. Discrimination and calibration of a...
The Journal of cardiovascular surgery
The Annals of thoracic surgery, Jan 27, 2015
Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidl... more Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidly progressive cardiac compromise that ultimately leads to refractory cardiogenic shock or cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in this circumstance, but few clinical series are available about early and long-term results. Data from a multicenter study group are reported which analyzed subjects affected by AFM and treated with VA-ECMO during a 5-year period. From hospital databases, 57 patients with diagnoses of AFM treated with VA-ECMO in the past 5 years were found and analyzed. Mean age was 37.6 ± 11.8 years; 37 patients were women. At VA-ECMO implantation, cardiogenic shock was present in 38 patients, cardiac arrest in 12, and severe hemodynamic instability in 7. A peripheral approach was used with 47 patients, whereas 10 patients had a central implantation or other access. Mean VA-ECMO support was 9.9 ...