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Rossini R, Masiero G, Fruttero C, Passamonti E, Calvaruso E, Cecconi M, Carlucci C, Barzaghi N, Locatelli A, Mojoli M, Parodi G, Talanas G, Pierini S, Angiolillo D, Musumeci G. P2815Antiplatelet therapy with cangrelor in patients undergoing surgery after coronary stent implantation: a real-world bridging protocol experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Perioperative management of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients deemed at high thrombotic risk undergoing non-deferrable surgery remains poorly defined. Cangrelor represents a potential treatment option as a “bridge” from discontinuation of oral P2Y12 receptor antagonists to surgical procedures, but data in this setting are still scant.
Purpose
We sought to describe a real-world experience of a bridging protocol using cangrelor for patients referred to relevant bleeding risk surgery requiring withdrawal of DAPT.
Methods
We collected data from 7 Italian centers on patients with previous PCI, still on DAPT, undergoing non-deferrable surgery which required discontinuation of one or both antiplatelet agents. A standardized bridging protocol using cangrelor infusion before and eventually after surgery was applied (Figure 1).
Results
Between December 2017 and January 2019, a total of 18 patients (mean age 70±10 years; male 85%) were enrolled. In the majority (89%) of patients, the index PCI was performed due to acute coronary syndrome (ACS) and 2±1.7 stents per patient were implanted. All patients required non-deferrable, intermediate-high bleeding risk surgery as pulmonary lobectomy, colectomy, endoscopic bladder surgery, paranasal sinus surgery, coronary artery by-pass surgery and valvular repair, hip replacement, endoscopy sphincterotomy. High thrombotic risk categories included PCI time <1 month, SCA time <3 months, stent failure occurrence, previous Absorb BVS implantation. Due to the surgical bleeding risk, discontinuation of P2Y12 inhibitor was required 5 days before surgery (ticagrelor, n=13; prasugrel=1; clopidogrel, n=5). All patients but 1 maintained aspirin through the perioperative phase. Cangrelor infusion was started at a bridging dose (0.75 mcg/kg/min) 3 days before planned surgery and was discontinued 6.9±1.5 hours before. After surgery, drainages were left in all patients but 3. In 56% of patients, cangrelor was resumed within 24 hours from surgery (mean time 9±7 hours) for a mean of 36±38 hours. Drainages were removed after discontinuation of cangrelor, in order to reduce bleeding complications. Within 2 hours from post-operative cangrelor discontinuation, a 300 mg clopidogrel loading dose was administered. No major ischemic adverse outcomes occurred during hospital stay and up to 30 days follow-up. The mean Hb drop was 2±1.8 g/dl, 7 patients received blood transfusions consistent with the type of surgeries and no life-threatening or fatal bleeding occurred.
Figure 1. Standardized bridging protocol.
Conclusions
Peri-operative bridge therapy with cangrelor is a feasible approach for stented patients at high thrombotic risk referred to non-deferrable surgery requiring DAPT discontinuation. Larger studies are warranted to support the safety of this strategy.
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Affiliation(s)
- R Rossini
- Santa Croce E Carle Hospital, Cuneo, Italy
| | - G Masiero
- Santa Croce E Carle Hospital, Cuneo, Italy
| | - C Fruttero
- Santa Croce E Carle Hospital, Cuneo, Italy
| | | | | | - M Cecconi
- Hospital of Civitanova Marche, Civitanova Marche, Italy
| | - C Carlucci
- Hospital of Civitanova Marche, Civitanova Marche, Italy
| | - N Barzaghi
- Santa Croce E Carle Hospital, Cuneo, Italy
| | | | - M Mojoli
- Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - G Parodi
- University of Sassari, Sassari, Italy
| | - G Talanas
- University of Sassari, Sassari, Italy
| | - S Pierini
- P.O. BASSINI - ASST Nord Milano, Milano, Italy
| | - D Angiolillo
- College of Medicine-Jacksonville, Jacksonville, United States of America
| | - G Musumeci
- Santa Croce E Carle Hospital, Cuneo, Italy
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Carlucci C, Jones CS, Oliphant K, Yen S, Daigneault M, Carriero C, Robinson A, Petrof EO, Weese JS, Allen-Vercoe E. Effects of defined gut microbial ecosystem components on virulence determinants of Clostridioides difficile. Sci Rep 2019; 9:885. [PMID: 30696914 PMCID: PMC6351598 DOI: 10.1038/s41598-018-37547-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 11/28/2018] [Indexed: 12/19/2022] Open
Abstract
Many cases of Clostridioides difficile infection (CDI) are poorly responsive to standard antibiotic treatment strategies, and often patients suffer from recurrent infections characterized by severe diarrhea. Our group previously reported the successful cure of two patients with recurrent CDI using a standardized stool-derived microbial ecosystem therapeutic (MET-1). Using an in vitro model of the distal gut to support bacterial communities, we characterized the metabolite profiles of two defined microbial ecosystems derived from healthy donor stool (DEC58, and a subset community, MET-1), as well as an ecosystem representative of a dysbiotic state (ciprofloxacin-treated DEC58). The growth and virulence determinants of two C. difficile strains were then assessed in response to components derived from the ecosystems. CD186 (ribotype 027) and CD973 (ribotype 078) growth was decreased upon treatment with DEC58 metabolites compared to ciprofloxacin-treated DEC58 metabolites. Furthermore, CD186 TcdA and TcdB secretion was increased following treatment with ciprofloxacin-treated DEC58 spent medium compared to DEC58 spent medium alone. The net metabolic output of C. difficile was also modulated in response to spent media from defined microbial ecosystems, although several metabolite levels were divergent across the two strains examined. Further investigation of these antagonistic properties will guide the development of microbiota-based therapeutics for CDI.
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Affiliation(s)
- Christian Carlucci
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada.
| | - Carys S Jones
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
| | - Kaitlyn Oliphant
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
| | - Sandi Yen
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
| | - Michelle Daigneault
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
| | - Charley Carriero
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
| | - Avery Robinson
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
| | - Elaine O Petrof
- Division of Infectious Diseases/Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - J Scott Weese
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Emma Allen-Vercoe
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
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Scolletta S, Marianello D, Isgrò G, Dapoto A, Terranova V, Franchi F, Baryshnikova E, Carlucci C, Ranucci M. Microcirculatory changes in children undergoing cardiac surgery: a prospective observational study. Br J Anaesth 2018; 117:206-13. [PMID: 27440632 DOI: 10.1093/bja/aew187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The effects of cardiac surgery on the microcirculation of children are unknown. The aim of this study was to assess the microcirculatory changes in children undergoing surgery for correction of congenital heart disease. METHODS We used a videomicroscope (Sidestream Dark Field, SDF) in a convenience sample of 24 children <five yr old. Total vascular density (TVD, vessels mm(-2)), microvascular flow index (MFI, arbitrary units), proportion of perfused small vessels (PPV, percentage), and perfused vessel density (PVD) were obtained after induction of anaesthesia (T1), at the end of the surgical procedure (T2), after intensive care unit (ICU) admission (T3), and at six h (T4) and 12h (T5) after ICU admission. RESULTS Microcirculatory variables did not significantly change over time. Haemodynamic parameters and microcirculatory variables were not correlated. In a subanalysis conducted for cyanotic (n=7) and acyanotic (n=17) children, repeated measures ANOVA showed a significant interaction between time and the presence of cyanosis for PPV (P=0.03), TVD (P=0.03), and PVD (P=0.03). Weak inverse correlations were found between storage time of transfused red blood cell (RBCs) and MFI at T3 (r=-0.63, P=0.01) and T4 (r=-0.53, P=0.03). CONCLUSIONS Microcirculatory variables have a different time-related trend in cyanotic and acyanotic children undergoing cardiac surgery. The storage time of transfused RBCs seems to negatively impact the microcirculation. Further and larger studies are warranted to prove the potential implications of this study.
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Affiliation(s)
- S Scolletta
- Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Via Bracci 1, Siena 53100, Italy
| | - D Marianello
- Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Via Bracci 1, Siena 53100, Italy
| | - G Isgrò
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - A Dapoto
- Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Via Bracci 1, Siena 53100, Italy
| | - V Terranova
- Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Via Bracci 1, Siena 53100, Italy
| | - F Franchi
- Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Via Bracci 1, Siena 53100, Italy
| | - E Baryshnikova
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - C Carlucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - M Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
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Martz SL, Guzman-Rodriguez M, He SM, Noordhof C, Hurlbut DJ, Gloor GB, Carlucci C, Weese S, Allen-Vercoe E, Sun J, Claud EC, Petrof EO. A human gut ecosystem protects against C. difficile disease by targeting TcdA. J Gastroenterol 2017; 52:452-465. [PMID: 27329502 PMCID: PMC5177537 DOI: 10.1007/s00535-016-1232-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND A defined Microbial Ecosystem Therapeutic (MET-1, or "RePOOPulate") derived from the feces of a healthy volunteer can cure recurrent C. difficile infection (rCDI) in humans. The mechanisms of action whereby healthy microbiota protect against rCDI remain unclear. Since C. difficile toxins are largely responsible for the disease pathology of CDI, we hypothesized that MET-1 exerts its protective effects by inhibiting the effects of these toxins on the host. METHODS A combination of in vivo (antibiotic-associated mouse model of C. difficile colitis, mouse ileal loop model) and in vitro models (FITC-phalloidin staining, F actin Western blots and apoptosis assay in Caco2 cells, transepithelial electrical resistance measurements in T84 cells) were employed. RESULTS MET-1 decreased both local and systemic inflammation in infection and decreased both the cytotoxicity and the amount of TcdA detected in stool, without an effect on C. difficile viability. MET-1 protected against TcdA-mediated damage in a murine ileal loop model. MET-1 protected the integrity of the cytoskeleton in cells treated with purified TcdA, as indicated by FITC-phalloidin staining, F:G actin assays and preservation of transepithelial electrical resistance. Finally, co-incubation of MET-1 with purified TcdA resulted in decreased detectable TcdA by Western blot analysis. CONCLUSIONS MET-1 intestinal microbiota confers protection against C. difficile and decreases C. difficile-mediated inflammation through its protective effects against C. difficile toxins, including enhancement of host barrier function and degradation of TcdA. The effect of MET-1 on C. difficile viability seems to offer little, if any, contribution to its protective effects on the host.
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Affiliation(s)
- Sarah Lynn Martz
- Division of Infectious Diseases/GI Diseases Research Unit Wing, Department of Medicine, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Mabel Guzman-Rodriguez
- Division of Infectious Diseases/GI Diseases Research Unit Wing, Department of Medicine, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Shu-Mei He
- Division of Infectious Diseases/GI Diseases Research Unit Wing, Department of Medicine, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Curtis Noordhof
- Division of Infectious Diseases/GI Diseases Research Unit Wing, Department of Medicine, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - David John Hurlbut
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, K7L 2V7, Canada
| | - Gregory Brian Gloor
- Department of Biochemistry, University of Western Ontario, London, ON, N6A 5C1, Canada
| | - Christian Carlucci
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Scott Weese
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Emma Allen-Vercoe
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Jun Sun
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Erika Chiong Claud
- Departments of Pediatrics and Medicine, University of Chicago, Chicago, IL, 60637, USA
| | - Elaine Olga Petrof
- Division of Infectious Diseases/GI Diseases Research Unit Wing, Department of Medicine, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
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Carlucci C, Petrof EO, Allen-Vercoe E. Fecal Microbiota-based Therapeutics for Recurrent Clostridium difficile Infection, Ulcerative Colitis and Obesity. EBioMedicine 2016; 13:37-45. [PMID: 27720396 PMCID: PMC5264253 DOI: 10.1016/j.ebiom.2016.09.029] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/21/2016] [Accepted: 09/29/2016] [Indexed: 02/07/2023] Open
Abstract
The human gut microbiome is a complex ecosystem of fundamental importance to human health. Our increased understanding of gut microbial composition and functional interactions in health and disease states has spurred research efforts examining the gut microbiome as a valuable target for therapeutic intervention. This review provides updated insight into the state of the gut microbiome in recurrent Clostridium difficile infection (CDI), ulcerative colitis (UC), and obesity while addressing the rationale for the modulation of the gut microbiome using fecal microbiota transplant (FMT)-based therapies. Current microbiome-based therapeutics in pre-clinical or clinical development are discussed. We end by putting this within the context of the current regulatory framework surrounding FMT and related therapies. There is an increased understanding of gut microbial composition and functional interactions in health and disease states. FMT is effective for rCDI and has led to the development of fecal microbiota-based therapeutics for other indications. For stool-substitute therapies to enter mainstream medicine, further mechanistic studies, RCTs and regulations are needed.
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Affiliation(s)
- Christian Carlucci
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada.
| | - Elaine O Petrof
- Division of Infectious Diseases/GI Diseases Research Unit Wing, Department of Medicine, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Emma Allen-Vercoe
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada.
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Bracci M, Mariotti L, Staffolani S, Strafella E, Carlucci C, Pasquini E, Tarchini P, Re M, Santarelli L. [Sinonasal carcinoma and exposure to wood and leather dust: analysis of 36 cases]. G Ital Med Lav Ergon 2012; 34:612-614. [PMID: 23405730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In order to define the best strategies of prevention and diagnosis of sinonasal cancer, the aim of our study was the investigation of the etiological and prognostic factors related to 36 cases. The enrolled cases were composed mostly of men working in the footwear industry, with a mean age of 63.7 years and mean exposure of 34.6 years. The period between the start of exposure and the appearance of the neoplasm was of 44.6 years, the time between the onset of symptoms and diagnosis was of 10.8 months. Our results suggest that a diagnosis within 6 months after the onset of symptoms is associated with a lower tumor stage, a better survival and to a lower rate of recurrence. Nasal obstruction (58.3%) and epistaxis (52.7%) are the main initial symptoms. In order to obtain an early diagnosis, in addition to periodic clinical controls, a proper information of workers is required.
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Affiliation(s)
- M Bracci
- Medicina del Lavoro, Dipartimento di Scienze Cliniche e Molecolari, Facoltà di Medicina e Chirurgia, Università Politecnica delle Marche, Ancona, Italy.
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Ranucci M, Carlucci C, Isgrò G, Baryshnikova E. A prospective pilot study of platelet function and its relationship with postoperative bleeding in pediatric cardiac surgery. Minerva Anestesiol 2012; 78:556-563. [PMID: 22310193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Postoperative bleeding is a major problem in pediatric cardiac surgery with cardiopulmonary bypass (CPB). It recognizes a multifactorial cause, inclusive of coagulation factors consumption, hyperfibrinolysis, incomplete heparin reversal, and platelet consumption. Limited information on platelet function is available. This pilot study investigates platelet function changes in pediatric cardiac operations and their relationship with postoperative bleeding. METHODS A cohort of 22 patients aged four years or less were prospectively analyzed. Besides the usual coagulation tests, they were studied for platelet function at four points in time: preoperative, arrival in the intensive care unit, first and second postoperative day. Platelet function was measured with multiple electrode aggregometry TRAP-test. RESULTS After the cardiac operation there was a non-significant decrease in platelet function, with 36% of the patients demonstrating increased aggregability. Platelet count demonstrated a significant (P=0.001) decrease related to the CPB duration. The International Normalized Ratio (INR) was significantly (P=0.001) increased after the operation. Postoperative bleeding was associated with the degree of thrombocytopenia (P=0.014), the increase in INR (P=0.001), and the prolongation of the activated partial thromboplastin time (P=0.002). CONCLUSION In this pilot study, platelet function in pediatric patients undergoing cardiac surgery demonstrates a variable pattern and no association with postoperative bleeding. Confounding factors like age and cyanosis should be addressed with larger patient populations.
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Affiliation(s)
- M Ranucci
- Department of Cardiothoracic-Vascular Anesthesia and Intensive Care, IRCCS Policlinico S. Donato, Milan, Italy.
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8
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Rosti L, Vivaldo T, Butera G, Chessa M, Carlucci C, Giamberti A. Postoperative nutrition of neonates undergoing heart surgery. Pediatr Med Chir 2011; 33:236-240. [PMID: 22428432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Postoperative nutrition of newborns undergoing heart surgery (HS) is ill-defined. We compared the postoperative growth rates (grams/day) of neonates with congenital heart defects (CHDs) fed with their own mothers' milk (HU), a starting formula (SF; 67 kcal/100 mL), or a "preterm formula" (PF; 80 kcal/100 mL). PATIENTS AND METHODS We studied 122 newborns undergoing HS: 81 underwent corrective surgery (group A), and 41 palliative surgery (group B). RESULTS No statistically significant differences were found in the growth rate between group A and B. Moreover, in both groups, no differences in terms of growth rate between infants fed HU, SF, or PF were observed. This was also true when analyses were limited to infants undergoing HS either with or without cardiopulmonary bypass. CONCLUSIONS In neonates undergoing HS, human milk allowed a growth rate similar to that observed with starting formulas and "preterm formulas". This effect may depend on the particular features of human milk and its protective properties for the intestinal mucosa.
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Affiliation(s)
- L Rosti
- Department of Pediatric Cardiology and Heart Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
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9
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Ranucci M, Carlucci C, Isgrò G, Brozzi S, Boncilli A, Costa E, Frigiola A. Hypothermic cardiopulmonary bypass as a determinant of late thrombocytopenia following cardiac operations in pediatric patients. Acta Anaesthesiol Scand 2009; 53:1060-7. [PMID: 19496765 DOI: 10.1111/j.1399-6576.2009.02010.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Thrombocytopenia after cardiac operations is a common event in both adult and pediatric patients. Late thrombocytopenia (LTCP) is a less common event that is still without a well-recognized cause. This study explores the role of heparin-induced thrombocytopenia (HIT) and other factors (complexity of the operation, temperature management, and drug use) in determining LTCP. METHODS We conducted an observational study of 63 consecutive patients aged <36 months operated with or without cardiopulmonary bypass (CPB). LTCP was defined as a platelet count <100,000 cells/microl or <50% of the pre-operative count at any point in time between post-operative days 5 and 10. A diagnostic test for heparin-platelet factor 4 (PF4) antibodies was performed in patients with LTCP. Other pre- and post-operative factors were investigated for their association with LTCP. RESULTS LTCP occurred in 15 (24%) patients. No patient had positive heparin-PF4 antibodies. The lowest temperature on CPB was an independent predictor of LTCP, with a cut-off value at 29 degrees C (sensitivity 80%, specificity 70%). Other factors associated with LTCP were prolonged post-operative use of unfractionated heparin and milrinone. LTCP was associated with increased post-operative morbidity. CONCLUSION LTCP was related to a combination of factors (operation severity, degree of hypothermia during CPB, prolonged use of unfractionated heparin, and milrinone). The individual contribution of each factor seems difficult to establish. However, the degree of hypothermia during CPB and drug-associated effects were identified. HIT could be excluded in all cases.
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Affiliation(s)
- M Ranucci
- Department of Cardiothoracic-vascular Anesthesia and Intensive Care, IRCCS Policlinico S.Donato, Milan, Italy.
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10
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Carlucci C, Giamberti A, Pomè G, Chessa M, Butera G, Carminati M, Frigiola A. [Right ventricular restoration in adult patients after TOF surgery]. Pediatr Med Chir 2008; 30:9-15. [PMID: 18491673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE Pulmonary regurgitation may cause progressive right ventricular dilatation and dysfunction in adult patients previously repaired for tetralogy of Fallot. To assess the optimal surgical timing, the impact of the right ventricular restoration with a new surgical ventriculoplasty technique is evaluated following TFO repaired adult patients with severe pulmonary regurgitation and right ventricular dilatation. METHODS Sixteen patients with severe pulmonary valve regurgitation (PVR) and right ventricular dilatation with RVOT aneurysm underwent right ventricular remodelling since January 2002. Each underwent preoperative evaluation by Doppler echocardiography, magnetic resonance imaging (MRI), and right ventricular myocardial acceleration during isovolumic contraction (IVC). The surgical procedure included pulmonary valve implantation and RVOT restoration achieved by removal of the aneurysm tissue, coupled with a ventriculoplasty to reduce volume, accomplished by creating a satisfactory RVOT dimension by placing with 2-0 Gortex suture to allow acceptance of a 26 Hegar dilator to avoid restriction. Nine patients had associated surgical procedures. RESULTS All patients survived the operative procedure and underwent a 16-month follow-up interval. A reduction of cardio thoracic index and a clinical improvement occurred in each patient. Significant reduction of RVEDV and RVESV and increased right ventricular ejection fraction was observed. CONCLUSIONS This preliminary database implies that the right ventricular restoration is a simple and effective procedure, and introduces a structural component that should be added in repaired TFO patients with right ventricular dilatation and underlying aneurysm or akinesia of the right ventricular outflow tract.
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Affiliation(s)
- C Carlucci
- Ospedale Policlinico San Donato IRCCS, San Donato, Milanese
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11
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Carlucci C, Giamberti A, Chessa M, Negura D, Frigiola A, Carminati M. [Tetralogy of Fallot: evolution of medical-surgical management (part 2)]. Pediatr Med Chir 2007; 29:239-243. [PMID: 18402391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
This review is divided into two parts: the first of which traces the evolution of medical and palliative techniques; the following is a selective account of surgical concepts and procedures; the emphasis is on therapeutic developments during the last 50 years. The second part approaches the surgical corrections and tries to explain the reinterventional causes and the residual defects responsible of cardiac failure.
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Affiliation(s)
- C Carlucci
- Cardiologia-Cardiochirurgia Pediatrica, IRCCS Policlinico San Donato, San Donato, Milanese.
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12
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Carlucci C, Giamberti A, Chessa M, Negura D, Frigiola A, Carminati M. [Tetralogy of fallot: evolution of medical-surgical management (part 1)]. Pediatr Med Chir 2007; 29:183-8. [PMID: 17715600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Despite Tetralogy of Fallot is a well-known cardiac congenital disease, still an important cardiovascular surgery and intensive care challenge. The following is a selective account of medical and surgical concepts and procedures; the emphasis is on therapeutic developments during the last 50 years. This review is divided into two parts: the first of which traces the evolution of medical and palliative techniques; the second part approaches the surgical corrections and try to explain the reinterventional causes and the residual defects responsible of cardiac failure.
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Affiliation(s)
- C Carlucci
- Cardiologia-Cardiochirurgia Pediatrica, IRCCS Policlinico San Donato, San Donato, Milanese.
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Testa G, Vegetti W, Motta T, Alagna F, Bianchedi D, Carlucci C, Bianchi M, Parazzini F, Crosignani PG. Two-year treatment with oral contraceptives in hyperprolactinemic patients. Contraception 1998; 58:69-73. [PMID: 9773260 DOI: 10.1016/s0010-7824(98)00069-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The aim of this prospective study was the follow-up for 2 years in symptoms, serum prolactin (PRL) levels, and radiological aspects of a group of young patients using oral contraceptives (OC) with hyperprolactinemia. A total of 16 hyperprolactinemic women (eight with idiopathic hyperprolactinemia and eight with pituitary microadenoma) who started OC use were admitted in the study. After 2 years of OC use, the assessable patients showed a nonsignificant decrease in plasma PRL level (26.8 +/- 29.4 micrograms/mL, range 4.2-97.1 micrograms/mL vs 56.3 +/- 31.5 micrograms/mL, range 23.5-144 micrograms/mL). No patient experienced any radiological changes during OC treatment. In conclusion, although the number of observations is limited, the data suggest that after 2 years of follow-up, no harmful effect of OC use was observed in these patients.
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Affiliation(s)
- G Testa
- Clinica Ostetrica Ginecologica, Università di Pavia, Italy
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Testa G, Vegetti W, Motta T, Alagna F, Guermandi E, Carlucci C, Bramante T, Crosignani P. P-126. Long-term use of oral contraceptives in hyperprolactinaemic patients. Hum Reprod 1997. [DOI: 10.1093/humrep/12.suppl_2.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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