Ettore Vitali - Academia.edu (original) (raw)
Papers by Ettore Vitali
Sudden sensorineural hearing loss is a rare complication after cardiac surgery with extracorporea... more Sudden sensorineural hearing loss is a rare complication after cardiac surgery with extracorporeal circulation. We report a case of a 60-year-old man who experienced severe sensorineural hearing loss after Bentall procedure and recovery of normal hearing after 20 days of hyperbaric oxygen therapy.
Annals of Thoracic Surgery, 2002
Different types of mechanical ventricular assist devices are available for treating end stage con... more Different types of mechanical ventricular assist devices are available for treating end stage congestive heart failure. Despite technical improvements, however, various complications are still reported for patients during mechanical support. We report our experience with intraventricular thrombolysis as a treatment for possible thrombosis of a continuous flow device that had been implanted as a bridge to heart transplantation. This approach has been demonstrated to be both effective and safe.
Journal of Thoracic and Cardiovascular Surgery - J THORAC CARDIOVASC SURG, 2004
The International journal of artificial organs
ABSTRACT In the present study, twelve explanted mechanical heart valves (MHVs)with pyrolitic carb... more ABSTRACT In the present study, twelve explanted mechanical heart valves (MHVs)with pyrolitic carbon tilting disc and 14 bileaflet MHVs were analyzed to investigate the effects of material properties on valve performance and patients' general health conditions. Optical and scanning electron microscopy was used to investigate material imperfections, wear patterns or damages to housing and occluder components. All analyzed tilting disc valves exhibited wear effects, particularly due to abrasion and impact to both disc and housing. Wear of pyrolitic carbon disc and housing did not influence their in vivo performance. In the bileaflet MHVs, breakaway of the pyrolitic carbon coating sometimes caused malfunctioning and required surgical retrieval of the valve. In all cases, occurrence of clinical symptoms was more likely when wear effects were located in critical areas. The study supports a correlation between the properties of the MHVs material and patients' symptoms.
The Journal of heart valve disease
Björk-Shiley Delrin (BSD) tilting-disc mechanical valve occluders have demonstrated good performa... more Björk-Shiley Delrin (BSD) tilting-disc mechanical valve occluders have demonstrated good performance, with superior patient survival and low incidence of obstruction phenomena compared to caged-ball valves. Unfortunately, the use of Delrin as the occluder material was problematic, and in 1971 this led to its replacement with a pyrolitic carbon-coated occluder. The study aim was to report and to determine the mechanism of wear on BSD valve discs. To achieve this, three BSD valves which had been in place for between 312 and 355 months were explanted and analyzed. Optical microscopy and scanning electron microscopy were used to investigate material imperfections or damage to the housing and occluder components of the explanted valves. The valve discs showed more than one type of wear pattern. Notably, the wear pattern observed on the surface and edge of the disc did not affect correct in-vivo function of the valves, as indicated by their long implantation period. No cracks, fractures or perforations of the Delrin discs were observed, but clear imprints caused by the impact of the struts on the inlet and outlet disc surfaces were detected. The depth of the strut imprints was indicative of a hindered disc rotation. A reduction in the diameter of the Delrin disc (ca. 1.44 mm) was detected in valve #3. The results obtained for the three BSD valves were in agreement with data reported elsewhere, and showed good performance of this mechanical valve. Although the clinical follow up for these second-generation mechanical valves is extensive and supportive of their good clinical performance, they may in time fail due to wear of the polymer surface.
Giornale italiano di cardiologia (2006), 2007
Teleconsultation in echocardiography is complex owing to the heavy images and video files to be e... more Teleconsultation in echocardiography is complex owing to the heavy images and video files to be exchanged; moreover standards for data acquisition still need to be defined. The aim of this experience was to verify the feasibility to connect two laboratories for teleconsulting using a standard HDSL telephone cable. Hardware included one echocardiograph, one PC, video aquisition board and network board, USB webcam, Network router and an HDSL line for data communication. Software includes MS Windows XP and Netmeeting. The live interactivity between the labs was granted by a video streaming in MPEG4 format, directly delivered by the PC communication software. Standard DICOM was used for formal aspects. The platform has been verified during a demo at "National Congress of Cardiovascular Echography" in 2005. The experiment survey collected at the Teleconference gave a consistently good result. Twenty-one subjects filled in the questionnaire: 12 of them (57%) reported a difference between the video streaming and DICOM; whereas 7 of them (33%) did not point out it. Overall findings have been positive, even though 15 members (71%) reported feasibility with some difficulties; 18 members (86%) reported the possibility of really using this technology in the future. The total cost was 145000 euro. In our opinion, overall cost is more than acceptable especially considering how often to send data is more convenient than moving sick people or consultants.
European Journal of Cardio-thoracic Surgery, 2001
Non-penetrating cardiac trauma resulting in mitral valve rupture is uncommon, requiring a high de... more Non-penetrating cardiac trauma resulting in mitral valve rupture is uncommon, requiring a high degree of suspicion for diagnosis. Sudden and severe mitral regurgitation, unless surgically corrected rapidly lead to congestive heart failure and death. We report a patient with traumatic rupture of the antero±lateral papillary muscle of the mitral valve and pericardial injury, after a lateral blunt chest trauma, who successfully underwent emergency mitral valve replacement. q
The American journal of cardiology, Jan 19, 2005
Chronic heart failure (HF) is a leading cause of death in developed countries. Over the last 2 de... more Chronic heart failure (HF) is a leading cause of death in developed countries. Over the last 2 decades, mechanical circulatory support (MCS) devices have steadily evolved in the clinical management of end-stage HF and have emerged as a standard of care for the treatment of acute and chronic HF refractory to conventional medical therapy. Possible indications for using MCS are acute cardiogenic shock, as a bridge to transplantation, as a bridge to recovery, and more recently, as destination therapy in dilated cardiomyopathy, of either ischemic or idiopathic etiology. We reviewed the different clinical scenarios in which we think there are currently indications to implant different kinds of MCS systems.
Proteomics, 2006
Eukaryotic cells plasma membranes are organized into microdomains of specialized function such as... more Eukaryotic cells plasma membranes are organized into microdomains of specialized function such as lipid rafts and caveolae, with a specific lipid composition highly enriched in cholesterol and glycosphingolipids. In addition to their role in regulating signal transduction, multiple functions have been proposed, such as anchorage of receptors, trafficking of cholesterol, and regulation of permeability. However, an extensive understanding of their protein composition in human heart, both in failing and non-failing conditions, is not yet available. Membrane microdomains were isolated from left ventricular tissue of both failing (n = 15) and non-failing (n = 15) human hearts. Protein composition and differential protein expression was explored by comparing series of 2-D maps and subsequent identification by LC-MS/MS analysis. Data indicated that heart membrane microdomains are enriched in chaperones, cytoskeletal-associated proteins, enzymes and protein involved in signal transduction pathway. In addition, differential protein expression profile revealed that 30 proteins were specifically up-or downregulated in human heart failure membrane microdomains. This study resulted in the identification of human heart membrane microdomain protein composition, which was not previously available. Moreover, it allowed the identification of multiple proteins whose expression is altered in heart failure, thus opening new perspectives to determine which role they may play in this disease.
Cardiovascular Surgery, 2003
Background: The management of patients with simultaneous coronary artery and carotid artery disea... more Background: The management of patients with simultaneous coronary artery and carotid artery disease is still controversial.Methods: A retrospective review of the records and follow-up data of 139 consecutive patients undergoing simultaneous coronary artery bypass graft and carotid endarterectomy from 1981 to 1999 was carried out.Results: Early mortality was 2.1%, perioperative myocardial infarction and stroke rates were 2.8 and 1.4%, respectively. Survival at 7 years was 74.7±5.1% and event-free survival at 7 years was 67.9±5.6%.Conclusions: The combined surgical approach has proved to be effective and safe allowing the treatment of both diseases in a single operative procedure.
European Journal of Cardio-thoracic Surgery, 1995
To identify the operating risks for mortality and morbidity in patients undergoing aortocoronary ... more To identify the operating risks for mortality and morbidity in patients undergoing aortocoronary bypass surgery, the data of 514 myocardial revascularisation procedures performed consecutively between January 1991 and December 1992 were analysed; 73.2% of the patients had associated diseases and 59.3% had suffered one or more previous myocardial infarctions. The mean ejection fraction of the population as a whole was 52.2 +/- 13. In 10.5% of the cases there was severe left ventricular (LV) function impairment with a mean ejection fraction (EF) of 30.2 +/- 4.4 (range 20-35). A major preoperative complication occurred in 8.2% of the entire population and 68.8% of the patients undergoing emergency surgery. Surgery was elective in 72.7% of the cases, urgent in 15.4% and emergency in 11.9%. Hospital mortality was 4.1% (CL 3.2-4.9). In the group of electively operated patients, mortality was 2.7% (CL 1.8-3.5), with no statistically significant difference (P = 0.943) from the mortality observed in the patients undergoing urgent surgery [2.5% (CL 0.8-4.1)]. The mortality in both groups was statistically different (P = 0.0001 and P = 0.008) from that of the patients undergoing emergency surgery [14.7% (CL 10.1-18.9)]. Perioperative acute myocardial infarction occurred in 5.4% of the patients (CL 4.4-6.4), in three cases resulting in death [10.7% (CL 4.8-15.8)]. Fourteen of the acute myocardial infarctions (AMI) occurred in the 42 patients undergoing emergency surgery for acute coronary occlusion (33.3%). A percentage of 18.7% of the 493 surviving patients suffered a postoperative complication.(ABSTRACT TRUNCATED AT 250 WORDS)
Artificial organs, 2012
An otherwise healthy 47-year-old man presented to the emergency department in cardiogenic shock a... more An otherwise healthy 47-year-old man presented to the emergency department in cardiogenic shock after suffering a massive myocardial infarction due to left main occlusion. He was initially supported by extracorporeal membrane oxygenation and subsequently was converted to paracorporeal support with a Levitronix left ventricular assist device. He experienced multiple postoperative complications including renal failure, respiratory failure, retroperitoneal hematoma requiring suspension of anticoagulation, and fungal bloodstream infection precluding transition to an implantable device. He was reconditioned and successfully underwent orthotopic heart transplant 183 days after presentation. A discussion of the relevant issues is included.
The Journal of Heart and Lung Transplantation, 2008
Purpose: Right ventricular (RV) failure after left ventricular assist device (LVAD) placement is ... more Purpose: Right ventricular (RV) failure after left ventricular assist device (LVAD) placement is a serious complication with a poor prognosis and is difficult to predict. In the era of LVAD use as destination therapy and alternatives such as the total artificial heart, predicting post-LVAD RV failure requiring mechanical support is extremely important. Methods and Materials: We reviewed patient characteristics, laboratory values, and hemodynamic data from 266 patients who underwent LVAD placement at the University of Pennsylvania from April 1995 to June 2007. Results: Of 266 LVAD patients, 99 required RV assist device (BiVAD) placement (37%). We compared 36 parameters between LVAD (nϭ167) and BiVAD patients (nϭ99) to determine preoperative risk factors for RV assist device (RVAD) need. By univariate analysis, 23 variables showed statistically significant differences between the two groups (P Յ 0.05). The strongest of these were female gender, low body surface area, echocardiographic evidence of severe preoperative RV dysfunction, previous cardiac surgery, preoperative mechanical ventilation, elevated creatinine, elevated INR, elevated central venous pressure, low systolic blood pressure (SBP), low pulmonary artery systolic and mean pressures, low cardiac index (CI), low mixed venous oxygen saturation, and low right ventricular stroke work index (RVSWI). By multivariate logistic regression, CI Ͻ 2.3 L/min⅐m 2 (odds ratio [OR] 5.7), RVSWI Յ 0.25 mmHg⅐mL/m 2 (OR 5.1), severe preoperative RV dysfunction (OR 5.0), preoperative creatinine Ն 1.9 mg/dL (OR 4.8), previous cardiac surgery (OR 4.5), and SBP Յ 96 mmHg (OR 2.9) were the best predictors of RVAD need. Conclusions: The most significant predictors for RVAD need were CI, RVSWI, severe preoperative RV dysfunction, creatinine, previous cardiac surgery, and SBP. Using these factors, we have constructed an algorithm which can predict which LVAD patients will require RVAD with greater than 80% sensitivity and specificity.
Circulation, 2011
Inflammation and pericarditis may be contributing factors for postoperative atrial fibrillation (... more Inflammation and pericarditis may be contributing factors for postoperative atrial fibrillation (POAF), and both are potentially affected by antiinflammatory drugs and colchicine, which has been shown to be safe and efficacious for the prevention of pericarditis and the postpericardiotomy syndrome (PPS). The aim of the Colchicine for the Prevention of the Post-Pericardiotomy Syndrome (COPPS) POAF substudy was to test the efficacy and safety of colchicine for the prevention of POAF after cardiac surgery. The COPPS POAF substudy included 336 patients (mean age, 65.7±12.3 years; 69% male) of the COPPS trial, a multicenter, double-blind, randomized trial. Substudy patients were in sinus rhythm before starting the intervention (placebo/colchicine 1.0 mg twice daily starting on postoperative day 3 followed by a maintenance dose of 0.5 mg twice daily for 1 month in patients ≥70 kg, halved doses for patients <70 kg or intolerant to the highest dose). The substudy primary end point was the incidence of POAF on intervention at 1 month. Despite well-balanced baseline characteristics, patients on colchicine had a reduced incidence of POAF (12.0% versus 22.0%, respectively; P=0.021; relative risk reduction, 45%; number needed to treat, 11) with a shorter in-hospital stay (9.4±3.7 versus 10.3±4.3 days; P=0.040) and rehabilitation stay (12.1±6.1 versus 13.9±6.5 days; P=0.009). Side effects were similar in the study groups. Colchicine seems safe and efficacious in the reduction of POAF with the potentiality of halving the complication and reducing the hospital stay.
The Journal of heart and …, 2004
Background: Neurologic complication is an adverse event associated with mechanical circulatory su... more Background: Neurologic complication is an adverse event associated with mechanical circulatory support. To decrease the incidence of embolic cerebrovascular accidents (CVA) during support with the Novacor left ventricular assist system (LVAS), an expanded polytetrafluoroethylene (ePTFE) inflow conduit has been developed and introduced clinically.
European Journal of …, 2008
Background: Long-term implantable continuous axial-flow pumps are increasingly used in bridging h... more Background: Long-term implantable continuous axial-flow pumps are increasingly used in bridging heart failure patients to heart transplant. Compared to pulsatile left ventricular assist devices (LVADs), they offer smaller dimensions, less surgical trauma and less thromboembolisms. However concerns still remain about the long-term effects of continuous-flow on patients' outcome. The aim of this study was to review our mechanical bridge to transplant experience to compare pre-and post-transplant outcomes between pulsatile and continuous-flow LVAD recipients. Methods: Thirty-six patients with a continuous-flow device (Micromed DeBakey, Houston, TX or InCor Berlin Heart, Berlin, Germany -group A) were compared with 41 patients supported with a pulsatile device (Novacor W , WorldHeart, Oakland, CA -group B). Results: Mean age (48.6 AE 12.4 vs 47.2 AE 12.5) and LVAD duration (119.3 AE 115.4 vs 128.3 AE 198.3) were similar in the two groups. Group A recipients were smaller compared to group B (mean body surface area = 1.77 AE 0.18 vs 1.93 AE 0.16; p < 0.001). Idiopathic dilated cardiomyopathy was not significantly greater between the two groups (78% vs 58.3%; p = 0.085). Successful bridging to transplantation was similar in group A compared to group B (52.8% vs 63.4%; p = non significant). On-VAD mortality was similar between the two groups (A vs B = 33.3% vs 36.6%; p = non significant). Thirtyday mortality after HTx in group A was 10.5% compared to 7.7% in group B ( p = non significant). First year post-transplant incidence of treated rejections (36.8% vs 46%; p = non significant) as the mean number of rejection/patient (0.38 AE 0.5 vs 0.53 AE 0.83; p = non significant) were similar in group A compared to group B. Conclusions: In our experience, when compared to pulsatile LVAD, continuous-flow pumps are similarly effective in transplant rate and post-transplant outcome. #
Journal of the American …, 2004
Echocardiographic evaluation represents a basic tool for the treatment of patients undergoing ven... more Echocardiographic evaluation represents a basic tool for the treatment of patients undergoing ventricular assist device implant. Impella Recover 100 is a new left intraventricular assist device proposed for short-term mechanical circulatory support to be implanted without cardiopulmonary bypass. We report our experience with echocardiographic monitoring on a patient with ischemic cardiomyopathy who underwent Impella Recover 100 implant as a bridge to heart transplant. During the surgical procedure echocardiography had an essential role for anatomic evaluation of the heart and correct intraventricular positioning of the device. Moreover, during the whole period of assistance, echocardiography contributed to assessment of patient-device interaction and to check the device when malfunction was suggested. (J Am Soc Echocardiogr 2004;17: 470-3.)
ASAIO Journal, 2007
Th e in-hospital mortality for acute myocardial infarction (AMI) is currently around 7% . Death i... more Th e in-hospital mortality for acute myocardial infarction (AMI) is currently around 7% . Death is related predominantly to the development of cardiogenic shock, which aff ects 5% to 10% of all cases of AMI and has a mortality rate of 50% to 90% . Patients who develop cardiogenic shock frequently require critical care services, and AMI is one of the 10 leading causes for admission to adult critical care units . Over the past three decades, revascularization therapy has revolutionized care for these patients. Recent studies support prompt percutaneous coronary intervention (PCI) when there is electrocardiographic evidence of an AMI , and if PCI is not available within 90 minutes, fi brinolysis should be delivered within 30 minutes .
The Annals of Thoracic Surgery, 2002
Background. Bicuspid aortic valve (BAV) is a risk factor for aortic dissection and aneurysm. We s... more Background. Bicuspid aortic valve (BAV) is a risk factor for aortic dissection and aneurysm. We studied patients with BAV and tricuspid aortic valve (TAV) to evaluate long-term changes in the ascending aorta after aortic valve replacement (AVR).
Sudden sensorineural hearing loss is a rare complication after cardiac surgery with extracorporea... more Sudden sensorineural hearing loss is a rare complication after cardiac surgery with extracorporeal circulation. We report a case of a 60-year-old man who experienced severe sensorineural hearing loss after Bentall procedure and recovery of normal hearing after 20 days of hyperbaric oxygen therapy.
Annals of Thoracic Surgery, 2002
Different types of mechanical ventricular assist devices are available for treating end stage con... more Different types of mechanical ventricular assist devices are available for treating end stage congestive heart failure. Despite technical improvements, however, various complications are still reported for patients during mechanical support. We report our experience with intraventricular thrombolysis as a treatment for possible thrombosis of a continuous flow device that had been implanted as a bridge to heart transplantation. This approach has been demonstrated to be both effective and safe.
Journal of Thoracic and Cardiovascular Surgery - J THORAC CARDIOVASC SURG, 2004
The International journal of artificial organs
ABSTRACT In the present study, twelve explanted mechanical heart valves (MHVs)with pyrolitic carb... more ABSTRACT In the present study, twelve explanted mechanical heart valves (MHVs)with pyrolitic carbon tilting disc and 14 bileaflet MHVs were analyzed to investigate the effects of material properties on valve performance and patients' general health conditions. Optical and scanning electron microscopy was used to investigate material imperfections, wear patterns or damages to housing and occluder components. All analyzed tilting disc valves exhibited wear effects, particularly due to abrasion and impact to both disc and housing. Wear of pyrolitic carbon disc and housing did not influence their in vivo performance. In the bileaflet MHVs, breakaway of the pyrolitic carbon coating sometimes caused malfunctioning and required surgical retrieval of the valve. In all cases, occurrence of clinical symptoms was more likely when wear effects were located in critical areas. The study supports a correlation between the properties of the MHVs material and patients' symptoms.
The Journal of heart valve disease
Björk-Shiley Delrin (BSD) tilting-disc mechanical valve occluders have demonstrated good performa... more Björk-Shiley Delrin (BSD) tilting-disc mechanical valve occluders have demonstrated good performance, with superior patient survival and low incidence of obstruction phenomena compared to caged-ball valves. Unfortunately, the use of Delrin as the occluder material was problematic, and in 1971 this led to its replacement with a pyrolitic carbon-coated occluder. The study aim was to report and to determine the mechanism of wear on BSD valve discs. To achieve this, three BSD valves which had been in place for between 312 and 355 months were explanted and analyzed. Optical microscopy and scanning electron microscopy were used to investigate material imperfections or damage to the housing and occluder components of the explanted valves. The valve discs showed more than one type of wear pattern. Notably, the wear pattern observed on the surface and edge of the disc did not affect correct in-vivo function of the valves, as indicated by their long implantation period. No cracks, fractures or perforations of the Delrin discs were observed, but clear imprints caused by the impact of the struts on the inlet and outlet disc surfaces were detected. The depth of the strut imprints was indicative of a hindered disc rotation. A reduction in the diameter of the Delrin disc (ca. 1.44 mm) was detected in valve #3. The results obtained for the three BSD valves were in agreement with data reported elsewhere, and showed good performance of this mechanical valve. Although the clinical follow up for these second-generation mechanical valves is extensive and supportive of their good clinical performance, they may in time fail due to wear of the polymer surface.
Giornale italiano di cardiologia (2006), 2007
Teleconsultation in echocardiography is complex owing to the heavy images and video files to be e... more Teleconsultation in echocardiography is complex owing to the heavy images and video files to be exchanged; moreover standards for data acquisition still need to be defined. The aim of this experience was to verify the feasibility to connect two laboratories for teleconsulting using a standard HDSL telephone cable. Hardware included one echocardiograph, one PC, video aquisition board and network board, USB webcam, Network router and an HDSL line for data communication. Software includes MS Windows XP and Netmeeting. The live interactivity between the labs was granted by a video streaming in MPEG4 format, directly delivered by the PC communication software. Standard DICOM was used for formal aspects. The platform has been verified during a demo at &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;National Congress of Cardiovascular Echography&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; in 2005. The experiment survey collected at the Teleconference gave a consistently good result. Twenty-one subjects filled in the questionnaire: 12 of them (57%) reported a difference between the video streaming and DICOM; whereas 7 of them (33%) did not point out it. Overall findings have been positive, even though 15 members (71%) reported feasibility with some difficulties; 18 members (86%) reported the possibility of really using this technology in the future. The total cost was 145000 euro. In our opinion, overall cost is more than acceptable especially considering how often to send data is more convenient than moving sick people or consultants.
European Journal of Cardio-thoracic Surgery, 2001
Non-penetrating cardiac trauma resulting in mitral valve rupture is uncommon, requiring a high de... more Non-penetrating cardiac trauma resulting in mitral valve rupture is uncommon, requiring a high degree of suspicion for diagnosis. Sudden and severe mitral regurgitation, unless surgically corrected rapidly lead to congestive heart failure and death. We report a patient with traumatic rupture of the antero±lateral papillary muscle of the mitral valve and pericardial injury, after a lateral blunt chest trauma, who successfully underwent emergency mitral valve replacement. q
The American journal of cardiology, Jan 19, 2005
Chronic heart failure (HF) is a leading cause of death in developed countries. Over the last 2 de... more Chronic heart failure (HF) is a leading cause of death in developed countries. Over the last 2 decades, mechanical circulatory support (MCS) devices have steadily evolved in the clinical management of end-stage HF and have emerged as a standard of care for the treatment of acute and chronic HF refractory to conventional medical therapy. Possible indications for using MCS are acute cardiogenic shock, as a bridge to transplantation, as a bridge to recovery, and more recently, as destination therapy in dilated cardiomyopathy, of either ischemic or idiopathic etiology. We reviewed the different clinical scenarios in which we think there are currently indications to implant different kinds of MCS systems.
Proteomics, 2006
Eukaryotic cells plasma membranes are organized into microdomains of specialized function such as... more Eukaryotic cells plasma membranes are organized into microdomains of specialized function such as lipid rafts and caveolae, with a specific lipid composition highly enriched in cholesterol and glycosphingolipids. In addition to their role in regulating signal transduction, multiple functions have been proposed, such as anchorage of receptors, trafficking of cholesterol, and regulation of permeability. However, an extensive understanding of their protein composition in human heart, both in failing and non-failing conditions, is not yet available. Membrane microdomains were isolated from left ventricular tissue of both failing (n = 15) and non-failing (n = 15) human hearts. Protein composition and differential protein expression was explored by comparing series of 2-D maps and subsequent identification by LC-MS/MS analysis. Data indicated that heart membrane microdomains are enriched in chaperones, cytoskeletal-associated proteins, enzymes and protein involved in signal transduction pathway. In addition, differential protein expression profile revealed that 30 proteins were specifically up-or downregulated in human heart failure membrane microdomains. This study resulted in the identification of human heart membrane microdomain protein composition, which was not previously available. Moreover, it allowed the identification of multiple proteins whose expression is altered in heart failure, thus opening new perspectives to determine which role they may play in this disease.
Cardiovascular Surgery, 2003
Background: The management of patients with simultaneous coronary artery and carotid artery disea... more Background: The management of patients with simultaneous coronary artery and carotid artery disease is still controversial.Methods: A retrospective review of the records and follow-up data of 139 consecutive patients undergoing simultaneous coronary artery bypass graft and carotid endarterectomy from 1981 to 1999 was carried out.Results: Early mortality was 2.1%, perioperative myocardial infarction and stroke rates were 2.8 and 1.4%, respectively. Survival at 7 years was 74.7±5.1% and event-free survival at 7 years was 67.9±5.6%.Conclusions: The combined surgical approach has proved to be effective and safe allowing the treatment of both diseases in a single operative procedure.
European Journal of Cardio-thoracic Surgery, 1995
To identify the operating risks for mortality and morbidity in patients undergoing aortocoronary ... more To identify the operating risks for mortality and morbidity in patients undergoing aortocoronary bypass surgery, the data of 514 myocardial revascularisation procedures performed consecutively between January 1991 and December 1992 were analysed; 73.2% of the patients had associated diseases and 59.3% had suffered one or more previous myocardial infarctions. The mean ejection fraction of the population as a whole was 52.2 +/- 13. In 10.5% of the cases there was severe left ventricular (LV) function impairment with a mean ejection fraction (EF) of 30.2 +/- 4.4 (range 20-35). A major preoperative complication occurred in 8.2% of the entire population and 68.8% of the patients undergoing emergency surgery. Surgery was elective in 72.7% of the cases, urgent in 15.4% and emergency in 11.9%. Hospital mortality was 4.1% (CL 3.2-4.9). In the group of electively operated patients, mortality was 2.7% (CL 1.8-3.5), with no statistically significant difference (P = 0.943) from the mortality observed in the patients undergoing urgent surgery [2.5% (CL 0.8-4.1)]. The mortality in both groups was statistically different (P = 0.0001 and P = 0.008) from that of the patients undergoing emergency surgery [14.7% (CL 10.1-18.9)]. Perioperative acute myocardial infarction occurred in 5.4% of the patients (CL 4.4-6.4), in three cases resulting in death [10.7% (CL 4.8-15.8)]. Fourteen of the acute myocardial infarctions (AMI) occurred in the 42 patients undergoing emergency surgery for acute coronary occlusion (33.3%). A percentage of 18.7% of the 493 surviving patients suffered a postoperative complication.(ABSTRACT TRUNCATED AT 250 WORDS)
Artificial organs, 2012
An otherwise healthy 47-year-old man presented to the emergency department in cardiogenic shock a... more An otherwise healthy 47-year-old man presented to the emergency department in cardiogenic shock after suffering a massive myocardial infarction due to left main occlusion. He was initially supported by extracorporeal membrane oxygenation and subsequently was converted to paracorporeal support with a Levitronix left ventricular assist device. He experienced multiple postoperative complications including renal failure, respiratory failure, retroperitoneal hematoma requiring suspension of anticoagulation, and fungal bloodstream infection precluding transition to an implantable device. He was reconditioned and successfully underwent orthotopic heart transplant 183 days after presentation. A discussion of the relevant issues is included.
The Journal of Heart and Lung Transplantation, 2008
Purpose: Right ventricular (RV) failure after left ventricular assist device (LVAD) placement is ... more Purpose: Right ventricular (RV) failure after left ventricular assist device (LVAD) placement is a serious complication with a poor prognosis and is difficult to predict. In the era of LVAD use as destination therapy and alternatives such as the total artificial heart, predicting post-LVAD RV failure requiring mechanical support is extremely important. Methods and Materials: We reviewed patient characteristics, laboratory values, and hemodynamic data from 266 patients who underwent LVAD placement at the University of Pennsylvania from April 1995 to June 2007. Results: Of 266 LVAD patients, 99 required RV assist device (BiVAD) placement (37%). We compared 36 parameters between LVAD (nϭ167) and BiVAD patients (nϭ99) to determine preoperative risk factors for RV assist device (RVAD) need. By univariate analysis, 23 variables showed statistically significant differences between the two groups (P Յ 0.05). The strongest of these were female gender, low body surface area, echocardiographic evidence of severe preoperative RV dysfunction, previous cardiac surgery, preoperative mechanical ventilation, elevated creatinine, elevated INR, elevated central venous pressure, low systolic blood pressure (SBP), low pulmonary artery systolic and mean pressures, low cardiac index (CI), low mixed venous oxygen saturation, and low right ventricular stroke work index (RVSWI). By multivariate logistic regression, CI Ͻ 2.3 L/min⅐m 2 (odds ratio [OR] 5.7), RVSWI Յ 0.25 mmHg⅐mL/m 2 (OR 5.1), severe preoperative RV dysfunction (OR 5.0), preoperative creatinine Ն 1.9 mg/dL (OR 4.8), previous cardiac surgery (OR 4.5), and SBP Յ 96 mmHg (OR 2.9) were the best predictors of RVAD need. Conclusions: The most significant predictors for RVAD need were CI, RVSWI, severe preoperative RV dysfunction, creatinine, previous cardiac surgery, and SBP. Using these factors, we have constructed an algorithm which can predict which LVAD patients will require RVAD with greater than 80% sensitivity and specificity.
Circulation, 2011
Inflammation and pericarditis may be contributing factors for postoperative atrial fibrillation (... more Inflammation and pericarditis may be contributing factors for postoperative atrial fibrillation (POAF), and both are potentially affected by antiinflammatory drugs and colchicine, which has been shown to be safe and efficacious for the prevention of pericarditis and the postpericardiotomy syndrome (PPS). The aim of the Colchicine for the Prevention of the Post-Pericardiotomy Syndrome (COPPS) POAF substudy was to test the efficacy and safety of colchicine for the prevention of POAF after cardiac surgery. The COPPS POAF substudy included 336 patients (mean age, 65.7±12.3 years; 69% male) of the COPPS trial, a multicenter, double-blind, randomized trial. Substudy patients were in sinus rhythm before starting the intervention (placebo/colchicine 1.0 mg twice daily starting on postoperative day 3 followed by a maintenance dose of 0.5 mg twice daily for 1 month in patients ≥70 kg, halved doses for patients &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;70 kg or intolerant to the highest dose). The substudy primary end point was the incidence of POAF on intervention at 1 month. Despite well-balanced baseline characteristics, patients on colchicine had a reduced incidence of POAF (12.0% versus 22.0%, respectively; P=0.021; relative risk reduction, 45%; number needed to treat, 11) with a shorter in-hospital stay (9.4±3.7 versus 10.3±4.3 days; P=0.040) and rehabilitation stay (12.1±6.1 versus 13.9±6.5 days; P=0.009). Side effects were similar in the study groups. Colchicine seems safe and efficacious in the reduction of POAF with the potentiality of halving the complication and reducing the hospital stay.
The Journal of heart and …, 2004
Background: Neurologic complication is an adverse event associated with mechanical circulatory su... more Background: Neurologic complication is an adverse event associated with mechanical circulatory support. To decrease the incidence of embolic cerebrovascular accidents (CVA) during support with the Novacor left ventricular assist system (LVAS), an expanded polytetrafluoroethylene (ePTFE) inflow conduit has been developed and introduced clinically.
European Journal of …, 2008
Background: Long-term implantable continuous axial-flow pumps are increasingly used in bridging h... more Background: Long-term implantable continuous axial-flow pumps are increasingly used in bridging heart failure patients to heart transplant. Compared to pulsatile left ventricular assist devices (LVADs), they offer smaller dimensions, less surgical trauma and less thromboembolisms. However concerns still remain about the long-term effects of continuous-flow on patients' outcome. The aim of this study was to review our mechanical bridge to transplant experience to compare pre-and post-transplant outcomes between pulsatile and continuous-flow LVAD recipients. Methods: Thirty-six patients with a continuous-flow device (Micromed DeBakey, Houston, TX or InCor Berlin Heart, Berlin, Germany -group A) were compared with 41 patients supported with a pulsatile device (Novacor W , WorldHeart, Oakland, CA -group B). Results: Mean age (48.6 AE 12.4 vs 47.2 AE 12.5) and LVAD duration (119.3 AE 115.4 vs 128.3 AE 198.3) were similar in the two groups. Group A recipients were smaller compared to group B (mean body surface area = 1.77 AE 0.18 vs 1.93 AE 0.16; p < 0.001). Idiopathic dilated cardiomyopathy was not significantly greater between the two groups (78% vs 58.3%; p = 0.085). Successful bridging to transplantation was similar in group A compared to group B (52.8% vs 63.4%; p = non significant). On-VAD mortality was similar between the two groups (A vs B = 33.3% vs 36.6%; p = non significant). Thirtyday mortality after HTx in group A was 10.5% compared to 7.7% in group B ( p = non significant). First year post-transplant incidence of treated rejections (36.8% vs 46%; p = non significant) as the mean number of rejection/patient (0.38 AE 0.5 vs 0.53 AE 0.83; p = non significant) were similar in group A compared to group B. Conclusions: In our experience, when compared to pulsatile LVAD, continuous-flow pumps are similarly effective in transplant rate and post-transplant outcome. #
Journal of the American …, 2004
Echocardiographic evaluation represents a basic tool for the treatment of patients undergoing ven... more Echocardiographic evaluation represents a basic tool for the treatment of patients undergoing ventricular assist device implant. Impella Recover 100 is a new left intraventricular assist device proposed for short-term mechanical circulatory support to be implanted without cardiopulmonary bypass. We report our experience with echocardiographic monitoring on a patient with ischemic cardiomyopathy who underwent Impella Recover 100 implant as a bridge to heart transplant. During the surgical procedure echocardiography had an essential role for anatomic evaluation of the heart and correct intraventricular positioning of the device. Moreover, during the whole period of assistance, echocardiography contributed to assessment of patient-device interaction and to check the device when malfunction was suggested. (J Am Soc Echocardiogr 2004;17: 470-3.)
ASAIO Journal, 2007
Th e in-hospital mortality for acute myocardial infarction (AMI) is currently around 7% . Death i... more Th e in-hospital mortality for acute myocardial infarction (AMI) is currently around 7% . Death is related predominantly to the development of cardiogenic shock, which aff ects 5% to 10% of all cases of AMI and has a mortality rate of 50% to 90% . Patients who develop cardiogenic shock frequently require critical care services, and AMI is one of the 10 leading causes for admission to adult critical care units . Over the past three decades, revascularization therapy has revolutionized care for these patients. Recent studies support prompt percutaneous coronary intervention (PCI) when there is electrocardiographic evidence of an AMI , and if PCI is not available within 90 minutes, fi brinolysis should be delivered within 30 minutes .
The Annals of Thoracic Surgery, 2002
Background. Bicuspid aortic valve (BAV) is a risk factor for aortic dissection and aneurysm. We s... more Background. Bicuspid aortic valve (BAV) is a risk factor for aortic dissection and aneurysm. We studied patients with BAV and tricuspid aortic valve (TAV) to evaluate long-term changes in the ascending aorta after aortic valve replacement (AVR).