P. Ferrazzi - Academia.edu (original) (raw)
Papers by P. Ferrazzi
American Heart Journal, 1974
Abstract We have described seven patients with aortic insufficiency and ventricular septal defect... more Abstract We have described seven patients with aortic insufficiency and ventricular septal defect (classified by Tatsuno and associates 6 as supracristal and infracristal). Four patients (Group I) had supracristal VSD and three (Goup II) had infracristal) VSD. All underwent VSD repair only, without operation on the aortic valve. In three patients from Group I the AI disappeared two to three years after VSD repair. From our present study and reports of others, it is suggested that, if the VSD is supracristal, appearance of AI is an indication for early surgical repair of the VSD prior to development of signs and symptoms of left ventricular failure, with the expectation that AI will disappear or be minimized.
European Journal of Heart Failure Supplements, 2008
Computers in Cardiology 1999. Vol.26 (Cat. No.99CH37004)
Cardiac transplantation is the treatment of reference for refractory cardiac failure but the limi... more Cardiac transplantation is the treatment of reference for refractory cardiac failure but the limited number of donors, the complication inherent to transplantation and the relative and absolute contra-indications has made it necessary to find alternative surgical solutions. For the surgical treatment of dilated cardiomyopathy two different procedures are used, together or separately: mitral valve repair and left ventricular volume reduction
Cardiologia (Rome, Italy), 1989
A cardiac transplant recipient developed systemic aspergillosis with abscesses from aspergillus f... more A cardiac transplant recipient developed systemic aspergillosis with abscesses from aspergillus fumigatus in the brain and the right kidney. Surgical resections were performed (lobectomy for the brain abscess, partial resection for the renal abscess followed, after extension of the infection, by right nephrectomy) combined with therapy with itraconazole, a new antimycotic agent. Recovery from the infection was obtained and at 18 months of follow-up the patient feels well without signs of recurrences of the infection.
American Journal of Kidney Diseases, 1994
We previously reported that heart transplant patients given cyclosporine for more than 2 years (s... more We previously reported that heart transplant patients given cyclosporine for more than 2 years (short-term evaluation) had severe renal lesions and markedly reduced glomerular filtration rate and renal plasma flow (Kidney Int 40:243-250, 1991). We report the analysis of renal function in the same patients after 3 additional years of follow-up (long-term evaluation) while they continued to take cyclosporine. Since the previous evaluation, the dose of cyclosporine was adjusted to maintain stable trough levels and antihypertensive therapy was unchanged. The mean time-averaged dose of cyclosporine during the follow-up was 4.5 +/- 2.1 mg/kg/d. The systolic blood pressure at long-term evaluation (146 +/- 16 mm Hg) was increased (P < 0.05) compared with that at short-term evaluation (140 +/- 13 mm Hg), whereas diastolic blood pressure (long-term 91 +/- 9 mm Hg v short-term 88 +/- 9 mm Hg) and mean blood pressure (long-term 110 +/- 12 mm Hg v short-term 108 +/- 11 mm Hg) did not change significantly. Serum creatinine concentrations at long-term (1.7 +/- 0.3 mg/dL) and at short-term (1.7 +/- 0.4 mg/dL) evaluations were similar. At long-term evaluation the renal plasma flow (300 +/- 64 mL/min/1.73 m2) was not decreased compared with that at short-term evaluation (325 +/- 94 mL/min/1.73 m2), while the glomerular filtration rate increased significantly (43 +/- 15 mL/min/1.73 m2 v 36 +/- 8 mL/min/1.73 m2, respectively; P < 0.05). None of the patients became proteinuric after short-term evaluation; in those patients who were already proteinuric, urinary protein excretion did not increase over time.(ABSTRACT TRUNCATED AT 250 WORDS)
The Physiology and Pathophysiology of Exercise Tolerance, 1996
Heart transplantation has become an accepted therapy for end-stage congestive heart failure not o... more Heart transplantation has become an accepted therapy for end-stage congestive heart failure not only in adults but also in children (P-HTR), particularly following improvements in the immunosuppressive regimens. However, little is known about the structural evolution of the allograft or its adaptive response to increased metabolic demand. Normal growth of the allograft is especially important in P-HTR, since the possibility to undergo cardiac development commensurate to the increase in body size is essential for the normal physical performance of these patients (10). In addition, adequate growth may hypothetically be associated with some form of cardiac reinnervation, which, as is well known, does not occur in adults. So far, however, experimental evidence of sinus node reinnervation is lacking even for P-HTR. In fact, a study by Hsu et al. (2) has shown that the heart rate (HR) response to graded exercise of P-HTR is similar to that of adult HTR (A-HTR).
Transplantation Proceedings, 2001
Kidney International, 1991
We sought to clarify whether low-dose cyclosporine (5.0 +/- 2.2 mg/kg/day) given for more than tw... more We sought to clarify whether low-dose cyclosporine (5.0 +/- 2.2 mg/kg/day) given for more than two years to prevent cardiac graft rejection induced glomerular injury and to quantify the extent of the lesions. After renal hemodynamic studies, renal biopsy specimens were obtained from 10 patients on cyclosporine and analyzed by a novel morphometric technique consisting of a tridimensional reconstruction of the glomerular tuft. Autopsy kidney specimens from three patients with no clinical history of renal disease, and from four patients who died with dilatative cardiomyopathy served as controls. The glomerular filtration rate and renal plasma flow were significantly depressed below normal values in transplant recipients given cyclosporine, averaging 35 +/- 8 and 325 +/- 94 ml/min/1.73 m2, respectively. Conventional light microscopy of specimens from controls and from patients who died with dilatative cardiomyopathy did not reveal renal structural abnormalities. By contrast kidney specimens from cyclosporine-treated patients had obliterative arteriolopathy and ischemic-type changes, with thickening and wrinkling of glomerular capillary wall. Morphometrical analysis of 28 control glomeruli and 40 glomeruli from patients with dilatative cardiomyopathy showed glomerular capillary tuft volumes (VCT) ranging between 1.2 and 2.3 microns 3 x 10(-6), whereas of 102 glomeruli from cyclosporine-treated patients 42.1% had VCT lower than 1.2 microns 3 x 10(-6) and 24.4% VCT higher than 2.3 microns 3 x 10(-6).(ABSTRACT TRUNCATED AT 250 WORDS)
Clinical Cardiology, 1997
Backgruund: Coronary artery disease (CAD) of allografted hearts is the main cause of late mortali... more Backgruund: Coronary artery disease (CAD) of allografted hearts is the main cause of late mortality after cardiac transplant, but its etiology is still undetermined. klpothesis: This study was undertaken to evaluate the relevance of several risk factors, including cyclosporine (CsA) dose and blood CsA levels, to the incidence of CAD. Methods: In 163 heart transplants performed between November 1985 and August 1994 at our Institution, CAD was diagnosed by coronary angiography or at postmortem examination. Patients in whom postmortem examination or coronary angiography was not performed, as well as those < IS years of age and those who died within 1 month of surgery, were excluded from the study. The following risk factors were analyzed: recipient age, gender, pretransplant diagnosis, donor age, number of human leukocyte antigen (HLA)-AB mismatches, cytomegalovirus serology, mean serum cholesterol and triglyceride levels, the number of treated acute rejections, mean weighted CsA dose (CsA dosew) and weighted blood CsA levels (blood CsA level,). Results: Coronary artery disease was diagnosed in 32 patients (19.6%). A low mean CsA dosew was the only significant predictor for CAD at multivariate analysis (p<0.01); there was no correlation with blood CsA level,. In the patients receiving a CsA dosew > 4 mg/kg/day, the 8.9 year probability of their remaining CAD free was 69% [confidence interval (CI) 50-87%] in comparison with 31% (CIO-65%) inpatients receiving a CsA dosew < 4 mg/kg/day. Conclusion: In our experience, a low CsA maintenance dose is the main risk factor for CAD, irrespective of blood CsA levels.
Cardiovascular Drugs and Therapy, 1996
Summary Congestive heart failure is a lethal condition that affects an increasing number of patie... more Summary Congestive heart failure is a lethal condition that affects an increasing number of patients. In recent years a great amount of data have accumulated on the pathophysiology and medical and surgical therapy of this condition. In spite of the advances in its ...
Artificial Organs, 1994
In Italy, artificial heart development was promoted by virtue of a special program on technologic... more In Italy, artificial heart development was promoted by virtue of a special program on technological and industrial development in areas related to cardiology and cardiosurgery. A first prototype series of electromechanical total artificial hearts (TAHs) and ventricular assist devices (VADs), with ball-screw-based actuation technology, has been developed, and preliminary bench tests and short-term animal implant experiments were performed. The project started with analysis and develop
The Annals of Thoracic Surgery, 1986
European Journal of Cardio-Thoracic Surgery, 2012
OBJECTIVES: Heart transplantation (HTx) in patients with complex congenital heart disease (CHD) i... more OBJECTIVES: Heart transplantation (HTx) in patients with complex congenital heart disease (CHD) is a challenge because of structural anomalies and multiple previous procedures. We analysed our results in adult and paediatric patients to evaluate outcome and assess risk factors affecting mortality. METHODS: Between 1985 and 2011, among 839 patients who underwent HTx, 85 received transplantation for end-stage CHD. Patients were divided into four age subgroups: <1 year (8 patients, Group I), 1-10 years (20 patients, Group II), 11-18 years (24 patients, Group III) and >18 years (33 patients, Group IV) and into two time periods: 1985-2000 (47 patients) and 2001-2011 (38 patients). Anatomical diagnoses were single-ventricle defect in 37 patients (44%) and two-ventricle defect in 48 patients (56%). Seventy-three patients (86%) had undergone one or more cardiac surgical procedures prior to HTx (mean 2.4 ± 0.9). Twenty-two of them were suffering from Fontan failure. Mean pulmonary artery pressure was 25.2 ± 14.2 mmHg. Mean transpulmonary gradient was 9.4 ± 6.9 mmHg. RESULTS: Mean follow-up after HTx was 7.8 ± 6.8 years. Survival at 1 month was 37.7% in Group I, 85.8% in Group II, 96.8% in Group II and 98.4% in Group IV and was significantly worse in younger recipients. Overall 30-day mortality was 17.6%. Currently 56 patients (65.8%) are alive. Overall survival at 1, 5, 10 and 15 years is 83-, 73-, 67-and 58%, respectively. There were 14 late deaths. Univariate analysis found that risk factors for early and late death were those related to recipient illness, such as pre-transplant creatinine, intravenous inotropic drugs, intravenous diuretics, mechanical ventilation and presence of protein-losing enteropathy (PLE). Multivariate analysis for all events (early and late deaths) identified preoperative mechanical ventilation as an independent risk factor for mortality. Number of previous procedures did not influence survival. Previous Fontan procedure did not increase mortality. We documented the reversibility of PLE in survivors. CONCLUSIONS: We demonstrated that heart transplantation for patients with CHD can be performed with the expectation of excellent results. Previous procedures, including the Fontan operation, do not reduce survival. Mortality is related to preoperative patient condition. We advocate early referral of complex CHD patients for transplant assessment and for inclusion in waiting lists before the detrimental effects of end-stage failure manifest themselves.
Current Cardiology Reports, 2021
Purpose of Review Patients with hypertrophic cardiomyopathy (HCM) who have left ventricular outfl... more Purpose of Review Patients with hypertrophic cardiomyopathy (HCM) who have left ventricular outflow tract obstruction (LVOTO) often experience severe symptoms and functional limitation. Relief of LVOTO can be achieved by two invasive interventions, i.e., surgery myectomy and alcohol septal ablation (ASA), leading in experienced hands to a dramatic improvement in clinical status. Despite extensive research, however, the choice of the best option in individual patients remains challenging and poses numerous clinical dilemmas. Recent Findings Invasive strategies have been recently incorporated in recommendations for the diagnosis and treatment of HCM on both sides of the Atlantic. These guidelines are based on a bulk of well-designed but retrospective studies as well as on expert opinions. Evidence now exists that adequate evaluation and management of HCM requires a multidisciplinary team capable of choosing the best available options. Summary Management of LVOTO still varies largely b...
Journal of the American Society of Nephrology, 1995
In rodents, the intrathymic injection of donor cells or major histocompatibility complex peptides... more In rodents, the intrathymic injection of donor cells or major histocompatibility complex peptides induces indefinite survival of a subsequent allograft with little or no immunosuppression. Here, experiments have been performed in two patients with cardiac transplantation to establish (1) the safety and tolerability of the intrathymic injection of donor leukocytes at the time of transplant surgery and (2) whether conventional immunosuppression interfered with the process of the thymic recognition of alloantigens. It was shown that the intrathymic inoculation of donor cells is safe and can be done without undesired effects. However, the procedure, as performed, did not protect from acute graft rejection. There are data enough to attribute the failure of the thymus technique in these two patients to the concomitant use of immunosuppressants. The results of this study are relevant for future trials aimed at finding the appropriate experimental conditions for the use of the thymic approa...
European Heart Journal, 2020
Introduction Few centers worldwide have large experience with performing an extended septal myect... more Introduction Few centers worldwide have large experience with performing an extended septal myectomy in patients with obstructive hypertrophic cardiomyopathy (HCM). Therefore, many HCM patients eligible for surgical relief of left ventricular (LV) outflow gradient do not have access to treatment. In a previous study, cutting fibrotic anterior mitral leaflet secondary chordae, in association with only a shallow myectomy, proved highly effective in moving the mitral valve (MV) apparatus away from the LV outflow tract and relieving the outflow gradient in our HCM patients with mild hypertrophy (<19 mm), a surgical approach that simplifies the operation. Purpose To assess whether chordal cutting is equally effective in improving MV geometry and relieving LV outflow gradient and heart failure symptoms in HCM patients with more marked hypertrophy. Methods Surgical outcome and MV geometry and function were assessed in 226 consecutive HCM patients who underwent systematic cutting of fibr...
The International Journal of Artificial Organs, 1995
Two different anticoagulation protocols were used in 49 consecutive patients mechanically support... more Two different anticoagulation protocols were used in 49 consecutive patients mechanically supported either for bridge to transplantation (11) or for recovery of myocardial function after cardiac surgery (35). In 46 patients a Biomedicus centrifugal pump was used and in 3 patients a Pierce-Donachy ventricles. Mechanical support was provided to the left ventricle in 14 patients, to the right ventricle in 6 and to both ventricles in 12 patients; an extra-corporeal membrane oxygenator (ECMO) support was used in 17 patients. Thirty-seven males and 12 females, aged 0.2 to 58 years, were supported for an average time of 6.3 days (range 1-43). Anticoagulation was either based on a continuous infusion of heparin in the first 27 patients (group A) or on a multi-system therapy (“La Pitié” protocol) in the other 22 patients (group B). Overall survival rate was 47%. Patients in group A had a 30% (8/27) survival rate, whereas in group B a 68% (15/22) survival rate was observed (p=0.006). Transpla...
The Journal of Heart and Lung Transplantation, 2002
Between 50 and 59 years of age the risk for CAD amounts to 7.3% (10/137) but risk was independent... more Between 50 and 59 years of age the risk for CAD amounts to 7.3% (10/137) but risk was independent from sex (7.2% (6/83) and 7.4% (4/54) for male and female donors, respectively) (PϾ0.05). No donor heart older than 59 years (0/41) showed CAD in posttransplant angiography; however, 78.0% (32/41) underwent angiography as part of the pretransplant evaluation, whereas in the 40 to 49-year-old and 50 to 59-year-old donor group angiography was performed in only 1.9% (4/215) and 2.9% (4/137), respectively. Conclusions: As was to be expected, the prevalence of CAD in the donor pool is high. Donor screening without angiography overlooks CAD in about 5%. However, donor CAD is not only a risk factor for TVP but also seems to be a risk factor for PGF. Therefore angiography should be performed at least in male donors older than 40 years and female donors older than 50 years.
The Journal of heart valve disease, 2001
Limited data are available regarding the efficacy of mitral valve repair in patients affected by ... more Limited data are available regarding the efficacy of mitral valve repair in patients affected by active, acute infective endocarditis. In addition, the predictivity of transesophageal echocardiography (TEE) for guiding the surgical decision-making process in these patients has not yet been reported. The study aim was to evaluate the long-term results of mitral valve repair and role of TEE in active, acute infective endocarditis. The study population consisted of patients affected by infective endocarditis of the mitral valve who underwent surgery. TEE was performed intraoperatively to guide the best surgical approach. All patients were followed up (mean 73+/-8 months) after surgery. Twenty-eight patients underwent surgery for infective endocarditis; of these, 13 had mitral valve repair for active, acute infective endocarditis and formed the basis of the study. Sensitivity, specificity, positive predictive value, negative predictive value of TEE in detecting the mechanism of mitral r...
Minerva cardioangiologica
American Heart Journal, 1974
Abstract We have described seven patients with aortic insufficiency and ventricular septal defect... more Abstract We have described seven patients with aortic insufficiency and ventricular septal defect (classified by Tatsuno and associates 6 as supracristal and infracristal). Four patients (Group I) had supracristal VSD and three (Goup II) had infracristal) VSD. All underwent VSD repair only, without operation on the aortic valve. In three patients from Group I the AI disappeared two to three years after VSD repair. From our present study and reports of others, it is suggested that, if the VSD is supracristal, appearance of AI is an indication for early surgical repair of the VSD prior to development of signs and symptoms of left ventricular failure, with the expectation that AI will disappear or be minimized.
European Journal of Heart Failure Supplements, 2008
Computers in Cardiology 1999. Vol.26 (Cat. No.99CH37004)
Cardiac transplantation is the treatment of reference for refractory cardiac failure but the limi... more Cardiac transplantation is the treatment of reference for refractory cardiac failure but the limited number of donors, the complication inherent to transplantation and the relative and absolute contra-indications has made it necessary to find alternative surgical solutions. For the surgical treatment of dilated cardiomyopathy two different procedures are used, together or separately: mitral valve repair and left ventricular volume reduction
Cardiologia (Rome, Italy), 1989
A cardiac transplant recipient developed systemic aspergillosis with abscesses from aspergillus f... more A cardiac transplant recipient developed systemic aspergillosis with abscesses from aspergillus fumigatus in the brain and the right kidney. Surgical resections were performed (lobectomy for the brain abscess, partial resection for the renal abscess followed, after extension of the infection, by right nephrectomy) combined with therapy with itraconazole, a new antimycotic agent. Recovery from the infection was obtained and at 18 months of follow-up the patient feels well without signs of recurrences of the infection.
American Journal of Kidney Diseases, 1994
We previously reported that heart transplant patients given cyclosporine for more than 2 years (s... more We previously reported that heart transplant patients given cyclosporine for more than 2 years (short-term evaluation) had severe renal lesions and markedly reduced glomerular filtration rate and renal plasma flow (Kidney Int 40:243-250, 1991). We report the analysis of renal function in the same patients after 3 additional years of follow-up (long-term evaluation) while they continued to take cyclosporine. Since the previous evaluation, the dose of cyclosporine was adjusted to maintain stable trough levels and antihypertensive therapy was unchanged. The mean time-averaged dose of cyclosporine during the follow-up was 4.5 +/- 2.1 mg/kg/d. The systolic blood pressure at long-term evaluation (146 +/- 16 mm Hg) was increased (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) compared with that at short-term evaluation (140 +/- 13 mm Hg), whereas diastolic blood pressure (long-term 91 +/- 9 mm Hg v short-term 88 +/- 9 mm Hg) and mean blood pressure (long-term 110 +/- 12 mm Hg v short-term 108 +/- 11 mm Hg) did not change significantly. Serum creatinine concentrations at long-term (1.7 +/- 0.3 mg/dL) and at short-term (1.7 +/- 0.4 mg/dL) evaluations were similar. At long-term evaluation the renal plasma flow (300 +/- 64 mL/min/1.73 m2) was not decreased compared with that at short-term evaluation (325 +/- 94 mL/min/1.73 m2), while the glomerular filtration rate increased significantly (43 +/- 15 mL/min/1.73 m2 v 36 +/- 8 mL/min/1.73 m2, respectively; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). None of the patients became proteinuric after short-term evaluation; in those patients who were already proteinuric, urinary protein excretion did not increase over time.(ABSTRACT TRUNCATED AT 250 WORDS)
The Physiology and Pathophysiology of Exercise Tolerance, 1996
Heart transplantation has become an accepted therapy for end-stage congestive heart failure not o... more Heart transplantation has become an accepted therapy for end-stage congestive heart failure not only in adults but also in children (P-HTR), particularly following improvements in the immunosuppressive regimens. However, little is known about the structural evolution of the allograft or its adaptive response to increased metabolic demand. Normal growth of the allograft is especially important in P-HTR, since the possibility to undergo cardiac development commensurate to the increase in body size is essential for the normal physical performance of these patients (10). In addition, adequate growth may hypothetically be associated with some form of cardiac reinnervation, which, as is well known, does not occur in adults. So far, however, experimental evidence of sinus node reinnervation is lacking even for P-HTR. In fact, a study by Hsu et al. (2) has shown that the heart rate (HR) response to graded exercise of P-HTR is similar to that of adult HTR (A-HTR).
Transplantation Proceedings, 2001
Kidney International, 1991
We sought to clarify whether low-dose cyclosporine (5.0 +/- 2.2 mg/kg/day) given for more than tw... more We sought to clarify whether low-dose cyclosporine (5.0 +/- 2.2 mg/kg/day) given for more than two years to prevent cardiac graft rejection induced glomerular injury and to quantify the extent of the lesions. After renal hemodynamic studies, renal biopsy specimens were obtained from 10 patients on cyclosporine and analyzed by a novel morphometric technique consisting of a tridimensional reconstruction of the glomerular tuft. Autopsy kidney specimens from three patients with no clinical history of renal disease, and from four patients who died with dilatative cardiomyopathy served as controls. The glomerular filtration rate and renal plasma flow were significantly depressed below normal values in transplant recipients given cyclosporine, averaging 35 +/- 8 and 325 +/- 94 ml/min/1.73 m2, respectively. Conventional light microscopy of specimens from controls and from patients who died with dilatative cardiomyopathy did not reveal renal structural abnormalities. By contrast kidney specimens from cyclosporine-treated patients had obliterative arteriolopathy and ischemic-type changes, with thickening and wrinkling of glomerular capillary wall. Morphometrical analysis of 28 control glomeruli and 40 glomeruli from patients with dilatative cardiomyopathy showed glomerular capillary tuft volumes (VCT) ranging between 1.2 and 2.3 microns 3 x 10(-6), whereas of 102 glomeruli from cyclosporine-treated patients 42.1% had VCT lower than 1.2 microns 3 x 10(-6) and 24.4% VCT higher than 2.3 microns 3 x 10(-6).(ABSTRACT TRUNCATED AT 250 WORDS)
Clinical Cardiology, 1997
Backgruund: Coronary artery disease (CAD) of allografted hearts is the main cause of late mortali... more Backgruund: Coronary artery disease (CAD) of allografted hearts is the main cause of late mortality after cardiac transplant, but its etiology is still undetermined. klpothesis: This study was undertaken to evaluate the relevance of several risk factors, including cyclosporine (CsA) dose and blood CsA levels, to the incidence of CAD. Methods: In 163 heart transplants performed between November 1985 and August 1994 at our Institution, CAD was diagnosed by coronary angiography or at postmortem examination. Patients in whom postmortem examination or coronary angiography was not performed, as well as those < IS years of age and those who died within 1 month of surgery, were excluded from the study. The following risk factors were analyzed: recipient age, gender, pretransplant diagnosis, donor age, number of human leukocyte antigen (HLA)-AB mismatches, cytomegalovirus serology, mean serum cholesterol and triglyceride levels, the number of treated acute rejections, mean weighted CsA dose (CsA dosew) and weighted blood CsA levels (blood CsA level,). Results: Coronary artery disease was diagnosed in 32 patients (19.6%). A low mean CsA dosew was the only significant predictor for CAD at multivariate analysis (p<0.01); there was no correlation with blood CsA level,. In the patients receiving a CsA dosew > 4 mg/kg/day, the 8.9 year probability of their remaining CAD free was 69% [confidence interval (CI) 50-87%] in comparison with 31% (CIO-65%) inpatients receiving a CsA dosew < 4 mg/kg/day. Conclusion: In our experience, a low CsA maintenance dose is the main risk factor for CAD, irrespective of blood CsA levels.
Cardiovascular Drugs and Therapy, 1996
Summary Congestive heart failure is a lethal condition that affects an increasing number of patie... more Summary Congestive heart failure is a lethal condition that affects an increasing number of patients. In recent years a great amount of data have accumulated on the pathophysiology and medical and surgical therapy of this condition. In spite of the advances in its ...
Artificial Organs, 1994
In Italy, artificial heart development was promoted by virtue of a special program on technologic... more In Italy, artificial heart development was promoted by virtue of a special program on technological and industrial development in areas related to cardiology and cardiosurgery. A first prototype series of electromechanical total artificial hearts (TAHs) and ventricular assist devices (VADs), with ball-screw-based actuation technology, has been developed, and preliminary bench tests and short-term animal implant experiments were performed. The project started with analysis and develop
The Annals of Thoracic Surgery, 1986
European Journal of Cardio-Thoracic Surgery, 2012
OBJECTIVES: Heart transplantation (HTx) in patients with complex congenital heart disease (CHD) i... more OBJECTIVES: Heart transplantation (HTx) in patients with complex congenital heart disease (CHD) is a challenge because of structural anomalies and multiple previous procedures. We analysed our results in adult and paediatric patients to evaluate outcome and assess risk factors affecting mortality. METHODS: Between 1985 and 2011, among 839 patients who underwent HTx, 85 received transplantation for end-stage CHD. Patients were divided into four age subgroups: <1 year (8 patients, Group I), 1-10 years (20 patients, Group II), 11-18 years (24 patients, Group III) and >18 years (33 patients, Group IV) and into two time periods: 1985-2000 (47 patients) and 2001-2011 (38 patients). Anatomical diagnoses were single-ventricle defect in 37 patients (44%) and two-ventricle defect in 48 patients (56%). Seventy-three patients (86%) had undergone one or more cardiac surgical procedures prior to HTx (mean 2.4 ± 0.9). Twenty-two of them were suffering from Fontan failure. Mean pulmonary artery pressure was 25.2 ± 14.2 mmHg. Mean transpulmonary gradient was 9.4 ± 6.9 mmHg. RESULTS: Mean follow-up after HTx was 7.8 ± 6.8 years. Survival at 1 month was 37.7% in Group I, 85.8% in Group II, 96.8% in Group II and 98.4% in Group IV and was significantly worse in younger recipients. Overall 30-day mortality was 17.6%. Currently 56 patients (65.8%) are alive. Overall survival at 1, 5, 10 and 15 years is 83-, 73-, 67-and 58%, respectively. There were 14 late deaths. Univariate analysis found that risk factors for early and late death were those related to recipient illness, such as pre-transplant creatinine, intravenous inotropic drugs, intravenous diuretics, mechanical ventilation and presence of protein-losing enteropathy (PLE). Multivariate analysis for all events (early and late deaths) identified preoperative mechanical ventilation as an independent risk factor for mortality. Number of previous procedures did not influence survival. Previous Fontan procedure did not increase mortality. We documented the reversibility of PLE in survivors. CONCLUSIONS: We demonstrated that heart transplantation for patients with CHD can be performed with the expectation of excellent results. Previous procedures, including the Fontan operation, do not reduce survival. Mortality is related to preoperative patient condition. We advocate early referral of complex CHD patients for transplant assessment and for inclusion in waiting lists before the detrimental effects of end-stage failure manifest themselves.
Current Cardiology Reports, 2021
Purpose of Review Patients with hypertrophic cardiomyopathy (HCM) who have left ventricular outfl... more Purpose of Review Patients with hypertrophic cardiomyopathy (HCM) who have left ventricular outflow tract obstruction (LVOTO) often experience severe symptoms and functional limitation. Relief of LVOTO can be achieved by two invasive interventions, i.e., surgery myectomy and alcohol septal ablation (ASA), leading in experienced hands to a dramatic improvement in clinical status. Despite extensive research, however, the choice of the best option in individual patients remains challenging and poses numerous clinical dilemmas. Recent Findings Invasive strategies have been recently incorporated in recommendations for the diagnosis and treatment of HCM on both sides of the Atlantic. These guidelines are based on a bulk of well-designed but retrospective studies as well as on expert opinions. Evidence now exists that adequate evaluation and management of HCM requires a multidisciplinary team capable of choosing the best available options. Summary Management of LVOTO still varies largely b...
Journal of the American Society of Nephrology, 1995
In rodents, the intrathymic injection of donor cells or major histocompatibility complex peptides... more In rodents, the intrathymic injection of donor cells or major histocompatibility complex peptides induces indefinite survival of a subsequent allograft with little or no immunosuppression. Here, experiments have been performed in two patients with cardiac transplantation to establish (1) the safety and tolerability of the intrathymic injection of donor leukocytes at the time of transplant surgery and (2) whether conventional immunosuppression interfered with the process of the thymic recognition of alloantigens. It was shown that the intrathymic inoculation of donor cells is safe and can be done without undesired effects. However, the procedure, as performed, did not protect from acute graft rejection. There are data enough to attribute the failure of the thymus technique in these two patients to the concomitant use of immunosuppressants. The results of this study are relevant for future trials aimed at finding the appropriate experimental conditions for the use of the thymic approa...
European Heart Journal, 2020
Introduction Few centers worldwide have large experience with performing an extended septal myect... more Introduction Few centers worldwide have large experience with performing an extended septal myectomy in patients with obstructive hypertrophic cardiomyopathy (HCM). Therefore, many HCM patients eligible for surgical relief of left ventricular (LV) outflow gradient do not have access to treatment. In a previous study, cutting fibrotic anterior mitral leaflet secondary chordae, in association with only a shallow myectomy, proved highly effective in moving the mitral valve (MV) apparatus away from the LV outflow tract and relieving the outflow gradient in our HCM patients with mild hypertrophy (<19 mm), a surgical approach that simplifies the operation. Purpose To assess whether chordal cutting is equally effective in improving MV geometry and relieving LV outflow gradient and heart failure symptoms in HCM patients with more marked hypertrophy. Methods Surgical outcome and MV geometry and function were assessed in 226 consecutive HCM patients who underwent systematic cutting of fibr...
The International Journal of Artificial Organs, 1995
Two different anticoagulation protocols were used in 49 consecutive patients mechanically support... more Two different anticoagulation protocols were used in 49 consecutive patients mechanically supported either for bridge to transplantation (11) or for recovery of myocardial function after cardiac surgery (35). In 46 patients a Biomedicus centrifugal pump was used and in 3 patients a Pierce-Donachy ventricles. Mechanical support was provided to the left ventricle in 14 patients, to the right ventricle in 6 and to both ventricles in 12 patients; an extra-corporeal membrane oxygenator (ECMO) support was used in 17 patients. Thirty-seven males and 12 females, aged 0.2 to 58 years, were supported for an average time of 6.3 days (range 1-43). Anticoagulation was either based on a continuous infusion of heparin in the first 27 patients (group A) or on a multi-system therapy (“La Pitié” protocol) in the other 22 patients (group B). Overall survival rate was 47%. Patients in group A had a 30% (8/27) survival rate, whereas in group B a 68% (15/22) survival rate was observed (p=0.006). Transpla...
The Journal of Heart and Lung Transplantation, 2002
Between 50 and 59 years of age the risk for CAD amounts to 7.3% (10/137) but risk was independent... more Between 50 and 59 years of age the risk for CAD amounts to 7.3% (10/137) but risk was independent from sex (7.2% (6/83) and 7.4% (4/54) for male and female donors, respectively) (PϾ0.05). No donor heart older than 59 years (0/41) showed CAD in posttransplant angiography; however, 78.0% (32/41) underwent angiography as part of the pretransplant evaluation, whereas in the 40 to 49-year-old and 50 to 59-year-old donor group angiography was performed in only 1.9% (4/215) and 2.9% (4/137), respectively. Conclusions: As was to be expected, the prevalence of CAD in the donor pool is high. Donor screening without angiography overlooks CAD in about 5%. However, donor CAD is not only a risk factor for TVP but also seems to be a risk factor for PGF. Therefore angiography should be performed at least in male donors older than 40 years and female donors older than 50 years.
The Journal of heart valve disease, 2001
Limited data are available regarding the efficacy of mitral valve repair in patients affected by ... more Limited data are available regarding the efficacy of mitral valve repair in patients affected by active, acute infective endocarditis. In addition, the predictivity of transesophageal echocardiography (TEE) for guiding the surgical decision-making process in these patients has not yet been reported. The study aim was to evaluate the long-term results of mitral valve repair and role of TEE in active, acute infective endocarditis. The study population consisted of patients affected by infective endocarditis of the mitral valve who underwent surgery. TEE was performed intraoperatively to guide the best surgical approach. All patients were followed up (mean 73+/-8 months) after surgery. Twenty-eight patients underwent surgery for infective endocarditis; of these, 13 had mitral valve repair for active, acute infective endocarditis and formed the basis of the study. Sensitivity, specificity, positive predictive value, negative predictive value of TEE in detecting the mechanism of mitral r...
Minerva cardioangiologica