Cesare Beghi | Insubria University (original) (raw)

Papers by Cesare Beghi

Research paper thumbnail of The Acute Effect of Intra-aortic Balloon Counterpulsation During Extracorporeal Life Support: An Experimental Study

Artificial Organs, 2007

Hemodynamically unstable patients supported by an extracorporeal life support (ECLS) circuit ofte... more Hemodynamically unstable patients supported by an extracorporeal life support (ECLS) circuit often receive additional support by intra-aortic balloon pump (IABP). However, it is not established whether support of the failing heart is improved by adjunctive IABP in both peripheral cannulation (PC) and central cannulation (CC) settings. Seven sheep were supported by an IABP and an ECLS system which were cannulated centrally as well as peripherally. In each cannulation configuration, hemodynamic and cardiac function indices were measured at baseline, ECLS, and ECLS plus IABP. The primary variables were mean coronary artery flow (Qcor), diastolic pressure time index (DPTI), left ventricular (LV) pressure-volume area (PVA), and tension time index (TTI). Additional IABP with ECLS support (CC/PC) decreased LV afterload (LV systolic peak pressure -4%, P < 0.05/-8%, P < 0.02), as well as TTI -2%/-10% and PVA -10%/-12% (P < 0.03).

Research paper thumbnail of Suction Due to Left Ventricular Assist: Implications for Device Control and Management

Artificial Organs, 2007

Left ventricular assist device (LVAD) overpumping is associated with hemolysis, thrombus release,... more Left ventricular assist device (LVAD) overpumping is associated with hemolysis, thrombus release, and tissue damage at the pump inlet. However, the impact of LVAD suction on pulmonary circulatory function remains unknown. We investigated LVAD suction as induced by pulmonary artery banding and overpumping in experimental animals and in a computer model. In six sheep, a rotary LVAD was implanted. Before inducing suction, partial support (40-60% of cardiac output) was established and characterized by measuring pressures and flows. In the animals, pulmonary artery occlusion (PAOC) elicited LVAD suction (left ventricular pressure was from -10 to -20 mm Hg) within 5-10 heartbeats. During suction, aortic pressure dropped to 50% and LVAD flow decreased significantly. After releasing the occlusion (20 s), the collapsed state persisted for another 20 s. A similar trend was obtained by simulating PAOC in the computer model. Additional simulations showed that pulmonary vascular resistance (PVR), volume status, and right ventricular (RV) contractility are exponentially related to the persistence of collapse after a suction event. Even modest increases in predisposing factors (elevated PVR, RV dysfunction, hypovolemia) caused sustained hemodynamic collapse lasting in excess of 15 min. Both in selected animals and the computer model, comparable suction-induced collapse was obtained by increasing LVAD speed by about 33%. Attempted compensation by simply decreasing speed was not effective, but temporarily shutting down the LVAD caused rapid reversal of collapse. In conclusion, rotary LVAD suction causes unfavorable conditions for effective unloading. The use of pump interventions appears a promising tool to detect suction and to avoid the associated hemodynamic depression.

Research paper thumbnail of Forewords

International Journal of Cardiology, 2004

Research paper thumbnail of Case report - Aortic and aneurysmal Saccular ascending aorta aneurysm: report of an unusual presentation

We describe an unusual presentation of a large saccular aneurysm of the ascending aorta, mimickin... more We describe an unusual presentation of a large saccular aneurysm of the ascending aorta, mimicking an acute coronary syndrome. The compression of the aneurysm on the left main coronary artery was probably the cause of these confusing symptoms. Our experience confirms the fundamental role of modern cardiac imaging techniques in the differential diagnosis of these unusual cases and in the

Research paper thumbnail of Mini-cardiopulmonary bypass system: results of a prospective randomized study

The Annals of thoracic surgery, 2006

We studied postoperative mortality and morbidity after coronary artery bypass graft surgery perfo... more We studied postoperative mortality and morbidity after coronary artery bypass graft surgery performed using the mini-extracorporeal circulation (MECC) system. From June 2001 to June 2002, we randomly enrolled 60 patients who underwent isolated elective coronary artery bypass graft surgery, and were operated on with the MECC system (30 patients: group A) or standard cardiopulmonary bypass (30 patients: group B). Serial blood samples were collected to evaluate the main preoperative, intraoperative, and postoperative clinical and biological variables; and to measure hemolysis, interleukin-6 cytokine, and plasma C-reactive protein release. A more stable hemoglobin level was detected in group A. The platelet count did not show a significant difference between the two groups. Interleukin-6 cytokine release showed higher values in group B, although no difference between groups was statistically significant. The time course of circulating plasma C-reactive protein concentration exhibited th...

Research paper thumbnail of Saccular ascending aorta aneurysm: report of an unusual presentation

Interactive cardiovascular and thoracic surgery, 2008

We describe an unusual presentation of a large saccular aneurysm of the ascending aorta, mimickin... more We describe an unusual presentation of a large saccular aneurysm of the ascending aorta, mimicking an acute coronary syndrome. The compression of the aneurysm on the left main coronary artery was probably the cause of these confusing symptoms. Our experience confirms the fundamental role of modern cardiac imaging techniques in the differential diagnosis of these unusual cases and in the planning of the correct surgical procedure.

Research paper thumbnail of Cardiac valve reoperations: analysis of operative risk factors in 154 patients

The Journal of heart valve disease, 2002

The study aim was to evaluate the operative risks of reoperation on heart valve prostheses. Betwe... more The study aim was to evaluate the operative risks of reoperation on heart valve prostheses. Between January 1985 and December 2000, 154 patients (79 males, 75 females, mean age 61.2+/-9.5 years) underwent cardiac valve reoperation for which indications were prosthetic failure (n = 133; prosthetic mitro-aortic dysfunction occurred in 16 cases), native valve disease in patients with a previous prosthetic valve implantation (n = 12), and both situations concomitantly (n = 9). Total valve replacements numbered 161 (64 in the aortic position, 96 in the mitral position, and one in the tricuspid position). There were 18 valve repairs (eight in the mitral position, 10 in the aortic position). One patient underwent prosthesis thrombectomy (mechanical valve). Overall operative mortality was 8.4% (n = 13); emergency operation (p <0.002), advanced NYHA class (p <0.026), indication for reoperation (p <0.026), gender (p <0.016) and number of previous reoperations (p = 0.05) were indep...

Research paper thumbnail of Complications after radial artery harvesting for coronary artery bypass grafting: Our experience

Surgery, 2003

3386 cardiac surgery procedures were performed at our Department of Cardiac Surgery. Of these 338... more 3386 cardiac surgery procedures were performed at our Department of Cardiac Surgery. Of these 3386 interventions, 2415 (1824 men and 521 women) were CABG, and in 271 patients (238 men and 33 women) the RA was used to complete myocardial revascularization. We have reviewed these 271 patients undergoing CABG with an RA graft, with the aim to establish the rise of the neurologic symptoms after its harvesting. The main demographic and preoperative characteristics are documented in .

Research paper thumbnail of Italian multicentre study on type A acute aortic dissection: a 33-year follow-up†

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 26, 2015

Despite substantial progress in surgical techniques and perioperative management, the treatment a... more Despite substantial progress in surgical techniques and perioperative management, the treatment and long-term follow-up of type A acute aortic dissection (AAD) still remain a major challenge. The objective of this retrospective, multicentre study was to assess in a large series of patients the early and long-term results after surgery for type A AAD. We analysed the preoperative, intraoperative and postoperative conditions of 1.148 consecutive patients surgically treated in seven large referral centres from 1981 to 2013. We applied to each patient three different multi-parameter risk profiles (preadmission risk, admission risk and post-surgery risk) in order to compare risk factors and outcome. Long-term Kaplan-Meier survival was evaluated. The median age was 64 years and the male population was predominant (66%). Identified diagnosis of collagen disease was present in 9%, and Marfan syndrome in 5%. Bicuspid aortic valve was present in 69 patients (6%). Previous cardiac surgery was ...

Research paper thumbnail of Red blood cell transfusion is a determinant of neurological complications after cardiac surgery

Interactive cardiovascular and thoracic surgery, 2015

The aim of this study was to evaluate the impact of red blood cell (RBC) transfusions on the occu... more The aim of this study was to evaluate the impact of red blood cell (RBC) transfusions on the occurrence of stroke and transient ischaemic attack (TIA) after cardiac surgery. Data on 14 956 patients undergoing coronary artery bypass grafting (CABG) and valve surgery (with or without concomitant CABG) were retrieved at three European University Hospitals. The prognostic impact of RBC transfusion on postoperative stroke and TIA was investigated by logistic regression and multilevel propensity score analysis. Postoperative stroke was observed in 147 (1.0%) patients and combined stroke/TIA in 238 (1.6%). Of the total population, 6439 (43%) patients received RBC transfusion with a median of 2 units (25th-75th percentile, 2-4 units). When adjusted for other significant risk factors, RBC transfusion was an independent predictor of stroke [odds ratio (OR) 1.14; 95% confidence interval (CI) 1.11-1.17 per unit] and stroke/TIA (OR 1.12; 95% CI 1.09-1.15 per unit). Increase in the amount of tran...

Research paper thumbnail of 757 Extra haemodynamic support provided by IABP in combination with ECLS

European Journal of Heart Failure Supplements

Research paper thumbnail of Outcome of emergency coronary artery bypass grafting

Journal of Cardiothoracic and Vascular Anesthesia, 2014

The aim of this study was to evaluate the immediate and late outcome of emergency coronary artery... more The aim of this study was to evaluate the immediate and late outcome of emergency coronary artery bypass grafting (CABG) in a multicenter setting. Multicenter, retrospective study. Four university hospitals. 596 patients were included in this study. Included patients underwent isolated, emergency CABG. Sixty patients (absolute rate: 10.1%, pooled rate: 8.7%) died during the in-hospital stay period. Increasing emergency CABG classes (p&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;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;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;0.0001), recent myocardial infarction (p = 0.019), left ventricular ejection fraction≤30% (p = 0.034), on-pump surgery (p = 0.012), and participating centers (p&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;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;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;0.0001) were independent predictors of in-hospital mortality. Survival rates at 1, 3, and 5 years were 86.4%, 81.6%, and 76.1%, respectively. Extracorporeal membrane oxygenation was used in 6 patients and 3 of them (50.0%) survived the immediate postoperative period. Patient populations of participating centers differed significantly in most of baseline characteristics. The preoperative use of intra-aortic balloon pump (8% to 51%) and off-pump surgery (2.8% to 56.3%) varied significantly between institutions. In-hospital mortality (2.8%, 5.9%, 7.7% and 19.8%, p&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;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;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;0.0001), as well as midterm survival, significantly differed between institutions (at 3 years, 90.6%, 89.8%, 81.2%, and 67.2%, p&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;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;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;0.0001). The outcome after emergency CABG is satisfactory despite a significant operative risk. However, the results of emergency CABG significantly differed between the participating institutions, likely due to differences in the referral pathways and perioperative treatment strategies. Evaluation of these factors is crucial for implementation of treatment in centers with suboptimal results.

Research paper thumbnail of MRI evaluation of myocardial viability

La radiologia medica, 2006

Cardiac magnetic resonance imaging (MRI) has become an accurate noninvasive imaging procedure for... more Cardiac magnetic resonance imaging (MRI) has become an accurate noninvasive imaging procedure for the study of postischaemic residual cardiac function, thanks to the evolution of MRI machines, postprocessing software and, above all, sequences. After infarction, and in chronic myocardial ischaemia, the degree of contractile dysfunction is one of the main determinants of longterm survival. The identification and quantification of viable dysfunctional myocardium and the possibility of improving its contractility after revascularisation improves patient prognosis and quality of life. In current clinical practice, myocardial viability is evaluated with stress echocardiography and nuclear methods. Thanks to its intrinsic characteristics and to the delayed-enhancement technique (DE-MRI), MRI has recently emerged as the only noninvasive modality able to provide a three-dimensional (3D) evaluation of cardiac viability with a multiparametric approach.

Research paper thumbnail of Cardiac Troponin I (cTnI) concentration in an ovine model of myocardial ischemia

Research in Veterinary Science, 2008

Cardiac Troponin I (cTnI) is a polypeptide involved in myocardial contraction and has been shown ... more Cardiac Troponin I (cTnI) is a polypeptide involved in myocardial contraction and has been shown to be a highly sensitive biomarker of myocardial injury in humans. Chronic myocardial ischemia was induced in eight adult sheep by anterior coronary artery legation. Forty-five days after coronary artery legation, sheep underwent autologous myoblasts implantation to the infarct area to improve local tissue regeneration. Blood samples were taken at regular intervals before and after the induced coronary ischemia and myoblast implantation and serum levels of cTnI were assessed with chemiluminescent immunodosage using a commercially available anti-human cTnI monoclonal antibody. cTnI levels began to increase the day after coronary legation and after myoblast implantation and gradually recovered to physiological levels in the next 14 days. Furthermore, the commercial anti-human antibody was shown to completely cross react with the ovine polypeptide as well as with canine, swine and equine sera.

Research paper thumbnail of Recurrence of a right ventricular hemangioma

The Journal of Thoracic and Cardiovascular Surgery, 2003

Research paper thumbnail of Repair of coexistent infrarenal and thoracoabdominal aortic aneurysm: Combined endovascular and open surgical procedure with visceral vessel relocation

The Journal of Thoracic and Cardiovascular Surgery, 2002

Research paper thumbnail of Unruptured Giant Aneurysm of Sinus of Valsalva

Journal of the American Society of Echocardiography, 2007

An apparently healthy young adult was referred for echocardiography because of a cardiac 2/6 dias... more An apparently healthy young adult was referred for echocardiography because of a cardiac 2/6 diastolic murmur, heard during physical examination in the context of our competitive sports screening program.

Research paper thumbnail of A Heart-Shaped Heart

Journal of the American College of Cardiology, 2010

A n obese 61-year-old man without cardiac disease history presented with exertional dyspnea, but ... more A n obese 61-year-old man without cardiac disease history presented with exertional dyspnea, but denied anginal complaints. Transthoracic echocardiography could barely visualize the heart because of severely insufficient acoustic windows. After an intravenous bolus of ultrasonographic contrast media, contrast echocardiography revealed a surprising left ventricular morphology due to a massive lateral aneurysm (A, Online Video 1) (apical 4-chamber view). The additional cavity conferred onto the left ventricle a "heart shape," the way the heart is represented in children's iconography.

Research paper thumbnail of Influence of coronary artery bypass grafting on the outcome of aortic valve replacement in the presence of left ventricular dysfunction: the VERDI (Valve Replacement with Left Ventricular Dysfunction Italian) surgical study

Journal of the American College of Cardiology, 2002

Research paper thumbnail of The effect of timing of cardiac catheterization on acute kidney injury after cardiac surgery is influenced by the type of operation

International Journal of Cardiology, 2014

Acute kidney injury (AKI) is a vexing complication of cardiac surgery. Since exposure to contrast... more Acute kidney injury (AKI) is a vexing complication of cardiac surgery. Since exposure to contrast agents is a relevant contributing factor in the development of postoperative AKI, the optimal timing between cardiac catheterization and surgery is decisive. A total of 2504 consecutive nonemergent patients undergoing isolated coronary artery bypass grafting (CABG), valve surgery (with or without concomitant CABG), and proximal aortic procedures were enrolled. AKI was defined by consensus RIFLE (Risk, Injury, Failure, Loss of function, End-stage renal disease) criteria. The association of postoperative AKI and time between cardiac catheterization and operation was evaluated using multivariable logistic regression modeling and propensity-matched analysis. Postoperative AKI occurred in 230 (9%) patients. The median number of days from cardiac catheterization to operation was 5 (25th to 75th percentile: 2 to 10). The incidence of AKI was significantly higher in patients operated on ≤1 day after cardiac catheterization compared to those operated on &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;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;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;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;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;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;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;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;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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 day after (13% vs. 8%, p=0.004). The time interval between cardiac catheterization and surgery (tested both as a continuous and a categorical variable) was not an independent AKI predictor in the propensity-matched population or the pre-matched one. Contrast exposure≤1 day before surgery was independently associated with postoperative AKI in patients undergoing valve surgery with concomitant CABG only (post-matched: OR 3.68, 95%CI 1.30 to 10.39, p=0.014). Delaying cardiac surgery beyond 24h of exposure to contrast agents seems to be justified only in patients undergoing valve surgery with concomitant CABG.

Research paper thumbnail of The Acute Effect of Intra-aortic Balloon Counterpulsation During Extracorporeal Life Support: An Experimental Study

Artificial Organs, 2007

Hemodynamically unstable patients supported by an extracorporeal life support (ECLS) circuit ofte... more Hemodynamically unstable patients supported by an extracorporeal life support (ECLS) circuit often receive additional support by intra-aortic balloon pump (IABP). However, it is not established whether support of the failing heart is improved by adjunctive IABP in both peripheral cannulation (PC) and central cannulation (CC) settings. Seven sheep were supported by an IABP and an ECLS system which were cannulated centrally as well as peripherally. In each cannulation configuration, hemodynamic and cardiac function indices were measured at baseline, ECLS, and ECLS plus IABP. The primary variables were mean coronary artery flow (Qcor), diastolic pressure time index (DPTI), left ventricular (LV) pressure-volume area (PVA), and tension time index (TTI). Additional IABP with ECLS support (CC/PC) decreased LV afterload (LV systolic peak pressure -4%, P < 0.05/-8%, P < 0.02), as well as TTI -2%/-10% and PVA -10%/-12% (P < 0.03).

Research paper thumbnail of Suction Due to Left Ventricular Assist: Implications for Device Control and Management

Artificial Organs, 2007

Left ventricular assist device (LVAD) overpumping is associated with hemolysis, thrombus release,... more Left ventricular assist device (LVAD) overpumping is associated with hemolysis, thrombus release, and tissue damage at the pump inlet. However, the impact of LVAD suction on pulmonary circulatory function remains unknown. We investigated LVAD suction as induced by pulmonary artery banding and overpumping in experimental animals and in a computer model. In six sheep, a rotary LVAD was implanted. Before inducing suction, partial support (40-60% of cardiac output) was established and characterized by measuring pressures and flows. In the animals, pulmonary artery occlusion (PAOC) elicited LVAD suction (left ventricular pressure was from -10 to -20 mm Hg) within 5-10 heartbeats. During suction, aortic pressure dropped to 50% and LVAD flow decreased significantly. After releasing the occlusion (20 s), the collapsed state persisted for another 20 s. A similar trend was obtained by simulating PAOC in the computer model. Additional simulations showed that pulmonary vascular resistance (PVR), volume status, and right ventricular (RV) contractility are exponentially related to the persistence of collapse after a suction event. Even modest increases in predisposing factors (elevated PVR, RV dysfunction, hypovolemia) caused sustained hemodynamic collapse lasting in excess of 15 min. Both in selected animals and the computer model, comparable suction-induced collapse was obtained by increasing LVAD speed by about 33%. Attempted compensation by simply decreasing speed was not effective, but temporarily shutting down the LVAD caused rapid reversal of collapse. In conclusion, rotary LVAD suction causes unfavorable conditions for effective unloading. The use of pump interventions appears a promising tool to detect suction and to avoid the associated hemodynamic depression.

Research paper thumbnail of Forewords

International Journal of Cardiology, 2004

Research paper thumbnail of Case report - Aortic and aneurysmal Saccular ascending aorta aneurysm: report of an unusual presentation

We describe an unusual presentation of a large saccular aneurysm of the ascending aorta, mimickin... more We describe an unusual presentation of a large saccular aneurysm of the ascending aorta, mimicking an acute coronary syndrome. The compression of the aneurysm on the left main coronary artery was probably the cause of these confusing symptoms. Our experience confirms the fundamental role of modern cardiac imaging techniques in the differential diagnosis of these unusual cases and in the

Research paper thumbnail of Mini-cardiopulmonary bypass system: results of a prospective randomized study

The Annals of thoracic surgery, 2006

We studied postoperative mortality and morbidity after coronary artery bypass graft surgery perfo... more We studied postoperative mortality and morbidity after coronary artery bypass graft surgery performed using the mini-extracorporeal circulation (MECC) system. From June 2001 to June 2002, we randomly enrolled 60 patients who underwent isolated elective coronary artery bypass graft surgery, and were operated on with the MECC system (30 patients: group A) or standard cardiopulmonary bypass (30 patients: group B). Serial blood samples were collected to evaluate the main preoperative, intraoperative, and postoperative clinical and biological variables; and to measure hemolysis, interleukin-6 cytokine, and plasma C-reactive protein release. A more stable hemoglobin level was detected in group A. The platelet count did not show a significant difference between the two groups. Interleukin-6 cytokine release showed higher values in group B, although no difference between groups was statistically significant. The time course of circulating plasma C-reactive protein concentration exhibited th...

Research paper thumbnail of Saccular ascending aorta aneurysm: report of an unusual presentation

Interactive cardiovascular and thoracic surgery, 2008

We describe an unusual presentation of a large saccular aneurysm of the ascending aorta, mimickin... more We describe an unusual presentation of a large saccular aneurysm of the ascending aorta, mimicking an acute coronary syndrome. The compression of the aneurysm on the left main coronary artery was probably the cause of these confusing symptoms. Our experience confirms the fundamental role of modern cardiac imaging techniques in the differential diagnosis of these unusual cases and in the planning of the correct surgical procedure.

Research paper thumbnail of Cardiac valve reoperations: analysis of operative risk factors in 154 patients

The Journal of heart valve disease, 2002

The study aim was to evaluate the operative risks of reoperation on heart valve prostheses. Betwe... more The study aim was to evaluate the operative risks of reoperation on heart valve prostheses. Between January 1985 and December 2000, 154 patients (79 males, 75 females, mean age 61.2+/-9.5 years) underwent cardiac valve reoperation for which indications were prosthetic failure (n = 133; prosthetic mitro-aortic dysfunction occurred in 16 cases), native valve disease in patients with a previous prosthetic valve implantation (n = 12), and both situations concomitantly (n = 9). Total valve replacements numbered 161 (64 in the aortic position, 96 in the mitral position, and one in the tricuspid position). There were 18 valve repairs (eight in the mitral position, 10 in the aortic position). One patient underwent prosthesis thrombectomy (mechanical valve). Overall operative mortality was 8.4% (n = 13); emergency operation (p <0.002), advanced NYHA class (p <0.026), indication for reoperation (p <0.026), gender (p <0.016) and number of previous reoperations (p = 0.05) were indep...

Research paper thumbnail of Complications after radial artery harvesting for coronary artery bypass grafting: Our experience

Surgery, 2003

3386 cardiac surgery procedures were performed at our Department of Cardiac Surgery. Of these 338... more 3386 cardiac surgery procedures were performed at our Department of Cardiac Surgery. Of these 3386 interventions, 2415 (1824 men and 521 women) were CABG, and in 271 patients (238 men and 33 women) the RA was used to complete myocardial revascularization. We have reviewed these 271 patients undergoing CABG with an RA graft, with the aim to establish the rise of the neurologic symptoms after its harvesting. The main demographic and preoperative characteristics are documented in .

Research paper thumbnail of Italian multicentre study on type A acute aortic dissection: a 33-year follow-up†

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 26, 2015

Despite substantial progress in surgical techniques and perioperative management, the treatment a... more Despite substantial progress in surgical techniques and perioperative management, the treatment and long-term follow-up of type A acute aortic dissection (AAD) still remain a major challenge. The objective of this retrospective, multicentre study was to assess in a large series of patients the early and long-term results after surgery for type A AAD. We analysed the preoperative, intraoperative and postoperative conditions of 1.148 consecutive patients surgically treated in seven large referral centres from 1981 to 2013. We applied to each patient three different multi-parameter risk profiles (preadmission risk, admission risk and post-surgery risk) in order to compare risk factors and outcome. Long-term Kaplan-Meier survival was evaluated. The median age was 64 years and the male population was predominant (66%). Identified diagnosis of collagen disease was present in 9%, and Marfan syndrome in 5%. Bicuspid aortic valve was present in 69 patients (6%). Previous cardiac surgery was ...

Research paper thumbnail of Red blood cell transfusion is a determinant of neurological complications after cardiac surgery

Interactive cardiovascular and thoracic surgery, 2015

The aim of this study was to evaluate the impact of red blood cell (RBC) transfusions on the occu... more The aim of this study was to evaluate the impact of red blood cell (RBC) transfusions on the occurrence of stroke and transient ischaemic attack (TIA) after cardiac surgery. Data on 14 956 patients undergoing coronary artery bypass grafting (CABG) and valve surgery (with or without concomitant CABG) were retrieved at three European University Hospitals. The prognostic impact of RBC transfusion on postoperative stroke and TIA was investigated by logistic regression and multilevel propensity score analysis. Postoperative stroke was observed in 147 (1.0%) patients and combined stroke/TIA in 238 (1.6%). Of the total population, 6439 (43%) patients received RBC transfusion with a median of 2 units (25th-75th percentile, 2-4 units). When adjusted for other significant risk factors, RBC transfusion was an independent predictor of stroke [odds ratio (OR) 1.14; 95% confidence interval (CI) 1.11-1.17 per unit] and stroke/TIA (OR 1.12; 95% CI 1.09-1.15 per unit). Increase in the amount of tran...

Research paper thumbnail of 757 Extra haemodynamic support provided by IABP in combination with ECLS

European Journal of Heart Failure Supplements

Research paper thumbnail of Outcome of emergency coronary artery bypass grafting

Journal of Cardiothoracic and Vascular Anesthesia, 2014

The aim of this study was to evaluate the immediate and late outcome of emergency coronary artery... more The aim of this study was to evaluate the immediate and late outcome of emergency coronary artery bypass grafting (CABG) in a multicenter setting. Multicenter, retrospective study. Four university hospitals. 596 patients were included in this study. Included patients underwent isolated, emergency CABG. Sixty patients (absolute rate: 10.1%, pooled rate: 8.7%) died during the in-hospital stay period. Increasing emergency CABG classes (p&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;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;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;0.0001), recent myocardial infarction (p = 0.019), left ventricular ejection fraction≤30% (p = 0.034), on-pump surgery (p = 0.012), and participating centers (p&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;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;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;0.0001) were independent predictors of in-hospital mortality. Survival rates at 1, 3, and 5 years were 86.4%, 81.6%, and 76.1%, respectively. Extracorporeal membrane oxygenation was used in 6 patients and 3 of them (50.0%) survived the immediate postoperative period. Patient populations of participating centers differed significantly in most of baseline characteristics. The preoperative use of intra-aortic balloon pump (8% to 51%) and off-pump surgery (2.8% to 56.3%) varied significantly between institutions. In-hospital mortality (2.8%, 5.9%, 7.7% and 19.8%, p&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;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;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;0.0001), as well as midterm survival, significantly differed between institutions (at 3 years, 90.6%, 89.8%, 81.2%, and 67.2%, p&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;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;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;0.0001). The outcome after emergency CABG is satisfactory despite a significant operative risk. However, the results of emergency CABG significantly differed between the participating institutions, likely due to differences in the referral pathways and perioperative treatment strategies. Evaluation of these factors is crucial for implementation of treatment in centers with suboptimal results.

Research paper thumbnail of MRI evaluation of myocardial viability

La radiologia medica, 2006

Cardiac magnetic resonance imaging (MRI) has become an accurate noninvasive imaging procedure for... more Cardiac magnetic resonance imaging (MRI) has become an accurate noninvasive imaging procedure for the study of postischaemic residual cardiac function, thanks to the evolution of MRI machines, postprocessing software and, above all, sequences. After infarction, and in chronic myocardial ischaemia, the degree of contractile dysfunction is one of the main determinants of longterm survival. The identification and quantification of viable dysfunctional myocardium and the possibility of improving its contractility after revascularisation improves patient prognosis and quality of life. In current clinical practice, myocardial viability is evaluated with stress echocardiography and nuclear methods. Thanks to its intrinsic characteristics and to the delayed-enhancement technique (DE-MRI), MRI has recently emerged as the only noninvasive modality able to provide a three-dimensional (3D) evaluation of cardiac viability with a multiparametric approach.

Research paper thumbnail of Cardiac Troponin I (cTnI) concentration in an ovine model of myocardial ischemia

Research in Veterinary Science, 2008

Cardiac Troponin I (cTnI) is a polypeptide involved in myocardial contraction and has been shown ... more Cardiac Troponin I (cTnI) is a polypeptide involved in myocardial contraction and has been shown to be a highly sensitive biomarker of myocardial injury in humans. Chronic myocardial ischemia was induced in eight adult sheep by anterior coronary artery legation. Forty-five days after coronary artery legation, sheep underwent autologous myoblasts implantation to the infarct area to improve local tissue regeneration. Blood samples were taken at regular intervals before and after the induced coronary ischemia and myoblast implantation and serum levels of cTnI were assessed with chemiluminescent immunodosage using a commercially available anti-human cTnI monoclonal antibody. cTnI levels began to increase the day after coronary legation and after myoblast implantation and gradually recovered to physiological levels in the next 14 days. Furthermore, the commercial anti-human antibody was shown to completely cross react with the ovine polypeptide as well as with canine, swine and equine sera.

Research paper thumbnail of Recurrence of a right ventricular hemangioma

The Journal of Thoracic and Cardiovascular Surgery, 2003

Research paper thumbnail of Repair of coexistent infrarenal and thoracoabdominal aortic aneurysm: Combined endovascular and open surgical procedure with visceral vessel relocation

The Journal of Thoracic and Cardiovascular Surgery, 2002

Research paper thumbnail of Unruptured Giant Aneurysm of Sinus of Valsalva

Journal of the American Society of Echocardiography, 2007

An apparently healthy young adult was referred for echocardiography because of a cardiac 2/6 dias... more An apparently healthy young adult was referred for echocardiography because of a cardiac 2/6 diastolic murmur, heard during physical examination in the context of our competitive sports screening program.

Research paper thumbnail of A Heart-Shaped Heart

Journal of the American College of Cardiology, 2010

A n obese 61-year-old man without cardiac disease history presented with exertional dyspnea, but ... more A n obese 61-year-old man without cardiac disease history presented with exertional dyspnea, but denied anginal complaints. Transthoracic echocardiography could barely visualize the heart because of severely insufficient acoustic windows. After an intravenous bolus of ultrasonographic contrast media, contrast echocardiography revealed a surprising left ventricular morphology due to a massive lateral aneurysm (A, Online Video 1) (apical 4-chamber view). The additional cavity conferred onto the left ventricle a "heart shape," the way the heart is represented in children's iconography.

Research paper thumbnail of Influence of coronary artery bypass grafting on the outcome of aortic valve replacement in the presence of left ventricular dysfunction: the VERDI (Valve Replacement with Left Ventricular Dysfunction Italian) surgical study

Journal of the American College of Cardiology, 2002

Research paper thumbnail of The effect of timing of cardiac catheterization on acute kidney injury after cardiac surgery is influenced by the type of operation

International Journal of Cardiology, 2014

Acute kidney injury (AKI) is a vexing complication of cardiac surgery. Since exposure to contrast... more Acute kidney injury (AKI) is a vexing complication of cardiac surgery. Since exposure to contrast agents is a relevant contributing factor in the development of postoperative AKI, the optimal timing between cardiac catheterization and surgery is decisive. A total of 2504 consecutive nonemergent patients undergoing isolated coronary artery bypass grafting (CABG), valve surgery (with or without concomitant CABG), and proximal aortic procedures were enrolled. AKI was defined by consensus RIFLE (Risk, Injury, Failure, Loss of function, End-stage renal disease) criteria. The association of postoperative AKI and time between cardiac catheterization and operation was evaluated using multivariable logistic regression modeling and propensity-matched analysis. Postoperative AKI occurred in 230 (9%) patients. The median number of days from cardiac catheterization to operation was 5 (25th to 75th percentile: 2 to 10). The incidence of AKI was significantly higher in patients operated on ≤1 day after cardiac catheterization compared to those operated on &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;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;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;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;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;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;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;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;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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 day after (13% vs. 8%, p=0.004). The time interval between cardiac catheterization and surgery (tested both as a continuous and a categorical variable) was not an independent AKI predictor in the propensity-matched population or the pre-matched one. Contrast exposure≤1 day before surgery was independently associated with postoperative AKI in patients undergoing valve surgery with concomitant CABG only (post-matched: OR 3.68, 95%CI 1.30 to 10.39, p=0.014). Delaying cardiac surgery beyond 24h of exposure to contrast agents seems to be justified only in patients undergoing valve surgery with concomitant CABG.