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Medda M, Casilli F, Bande M, Glauber M, Tespili M, Cirri S, Donatelli F. Percutaneous treatment of abdominal aortic aneurysm and aortic valve stenosis with 'staged' EVAR and TAVR: a case series. J Cardiothorac Surg 2023; 18:231. [PMID: 37443033 DOI: 10.1186/s13019-023-02338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Symptomatic aortic valve stenosis (AS) and abdominal aortic aneurysm (AAA) are critical clinical conditions, increasingly more prevalent with aging of the population. Calcific aortic stenosis is the most common structural cardiac disease in the elderly population, and medical management of severe aortic stenosis of the elderly population is associated with poor outcomes as compared to surgical treatment. Transcatheter aortic valve replacement (TAVR) is a treatment of choice in inoperable, often elderly, patients with symptomatic severe AS and in intermediate-to-high surgical risk patients. It is not yet clarified the incidence of AAA and its impact on procedural and clinical outcomes among patients undergoing TAVR. It is known that after AS resolution with aortic valve replacement or TAVR there is an increase in blood pressure that increases the risk of dissection or abdominal aortic aneurysm rupture if AAA repair is delayed. The purpose of this report is to describe the anatomical details and technical and procedural considerations when proposing totally endovascular strategies dedicated to the treatment of patients with AS and AAA.
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Affiliation(s)
- Massimo Medda
- Clinical and Interventional Cardiology Unit, Cardio-Thoracic Center, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Gruppo San Donato, Via Cristina Belgioioso, 173, Milan, Italy
| | - Francesco Casilli
- Clinical and Interventional Cardiology Unit, Cardio-Thoracic Center, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Gruppo San Donato, Via Cristina Belgioioso, 173, Milan, Italy.
| | - Marta Bande
- Istituto Clinico Sant'Ambrogio, Milan, Italy
- Medical Affairs EMEA, Boston Scientific Corporation, Milan, Italy
| | - Mattia Glauber
- Department of Minimally Invasive Cardiac Surgery, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Gruppo San Donato, Milan, Italy
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Cardio-Thoracic Center, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Gruppo San Donato, Via Cristina Belgioioso, 173, Milan, Italy
| | - Silvia Cirri
- Department of Anesthesia and Intensive Care, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Gruppo San Donato, Milan, Italy
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2
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Aiolfi A, Sozzi A, Bonitta G, Lombardo F, Cavalli M, Cirri S, Campanelli G, Danelli P, Bona D. Linear- versus circular-stapled esophagogastric anastomosis during esophagectomy: systematic review and meta-analysis. Langenbecks Arch Surg 2022; 407:3297-3309. [PMID: 36242619 DOI: 10.1007/s00423-022-02706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Different techniques have been described for esophagogastric anastomosis. Over the past decades, surgeons have been improving anastomotic techniques with a gradual shift from hand-sewn to stapled anastomosis. Nowadays, circular-stapled (CS) and linear-stapled (LS) anastomosis are commonly used during esophagectomy. METHODS PubMed, MEDLINE, Scopus, and Web of Science were searched up to June 2022. The included studies evaluated short-term outcomes for LS vs. CS anastomosis in patients undergoing esophagectomy for cancer. Primary outcomes were anastomotic leak (AL) and stricture (AS). Risk ratio (RR) and standardized mean difference (SMD) were used as pooled effect size measures whereas 95% confidence intervals (95%CI) were used to assess relative inference. RESULTS Eighteen studies (2861 patients) were included. Overall, 1371 (47.9%) underwent CS while 1490 (52.1%) LS. Compared to CS, LS was associated with a significantly reduced RR for AL (RR = 0.70; 95% CI 0.54-0.91; p < 0.01) and AS (RR = 0.32; 95% CI 0.20-0.51; p < 0.0001). Stratified subgroup analysis according to the level of anastomosis (cervical and thoracic) still shows a tendency toward reduced risk for LS. No differences were found for pneumonia (RR 0.78; p = 0.12), reflux esophagitis (RR 0.74; p = 0.36), operative time (SMD -0.25; p = 0.16), hospital length of stay (SMD 0.13; p = 0.51), and 30-day mortality (RR 1.26; p = 0.42). CONCLUSIONS LS anastomosis seems associated with a tendency toward a reduced risk for AL and AS. Although surgeon's own training and experience might direct the choice of esophagogastric anastomosis, our meta-analysis encourages the use of LS anastomosis.
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Affiliation(s)
- Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy. .,Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy. .,Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy.
| | - Andrea Sozzi
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy.,Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.,Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy.,Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.,Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
| | - Francesca Lombardo
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy.,Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.,Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
| | - Marta Cavalli
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy.,Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.,Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
| | - Silvia Cirri
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy.,Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.,Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
| | - Giampiero Campanelli
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy.,Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.,Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
| | - Piergiorgio Danelli
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy.,Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.,Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy.,Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.,Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
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3
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Mve Mvondo C, Giamberti A, Ngowe Ngowe M, Mbuoh HA, Milocco I, Tsague Kengni HN, Cirri S, Frigiola A. Cardiac Surgery Development in Cameroon: Unexpected Challenges From a Socio-Political Crisis. Front Cardiovasc Med 2022; 9:778075. [PMID: 35310992 PMCID: PMC8931039 DOI: 10.3389/fcvm.2022.778075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022] Open
Abstract
Despite the alarming and growing burden of cardiovascular diseases in sub-Saharan Africa (SSA), there is still a huge lack of specialised institutions in the region with a mean of one cardio-surgical unit for 33 million inhabitants. Despite the numerous efforts from humanitarian organisations made in recent years, the setting up of cardio-surgical units in the region remains challenging with regards to long-term sustainability. Indeed, besides the lack of financial resources, the insufficient local expertise in addition to the inadequate health infrastructure, unpredictable threats from external factors such as recurrent conflicts and humanitarian crises are still major concerns in an environment characterised by endemic socio-political instability. In Cameroon, located in the North West Anglophone region at 500 km from the capital, the cardiac centre of Shisong (CCS) is currently the lone cardio-surgical institution of the country. Fruit of a joint initiative of two Italian Non-governmental organisations namely, Bambini Cardiopatici nel Mondo (ABCnM) and Cuore Fratello (CF), and a local religious partner, the Tertiary Sisters of Saint Francis (TSSF), the CCS was faced with in the middle of a socio-political crisis that led to the urgent need of revision of the cardio-surgical project. The current paper reviews the impact of the ongoing socio-political crisis on the CCS over the past 3 years, in terms of clinical activities, staff perspectives, and long-term sustainability.
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Affiliation(s)
- Charles Mve Mvondo
- Division of Cardiac Surgery, Shisong Cardiac Centre, St. Elizabeth Catholic General Hospital Shisong, Kumbo, Cameroon
- Department of Surgery, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- *Correspondence: Charles Mve Mvondo
| | - Alessandro Giamberti
- Division of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico San Donato Hospital, Milan, Italy
| | - Marcelin Ngowe Ngowe
- Department of Surgery, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Helen Anshoma Mbuoh
- Division of Cardiac Surgery, Shisong Cardiac Centre, St. Elizabeth Catholic General Hospital Shisong, Kumbo, Cameroon
| | - Italo Milocco
- Division of Cardiac Surgery, Shisong Cardiac Centre, St. Elizabeth Catholic General Hospital Shisong, Kumbo, Cameroon
| | | | - Silvia Cirri
- Department of Anesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Alessandro Frigiola
- Division of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico San Donato Hospital, Milan, Italy
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4
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Montisci A, Palmieri V, Liu JE, Vietri MT, Cirri S, Donatelli F, Napoli C. Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission. Front Cardiovasc Med 2021; 8:713694. [PMID: 34540917 PMCID: PMC8446380 DOI: 10.3389/fcvm.2021.713694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/27/2021] [Indexed: 12/28/2022] Open
Abstract
A steadying increase of cancer survivors has been observed as a consequence of more effective therapies. However, chemotherapy regimens are often associated with significant toxicity, and cardiac damage emerges as a prominent clinical issue. Many mechanisms sustain chemotherapy-induced cardiac toxicity: direct myocyte damage, arrhythmia induction, coronary vasospasm, and accelerated atherosclerosis. Anthracyclines are the most studied cardiotoxic drugs and represent a clinical model for cardiac damage induced by chemotherapy. In patients suffering from advanced heart failure (HF) because of chemotherapy-related cardiomyopathy, when refractory to optimal medical therapy, mechanical circulatory support or heart transplantation represents an effective treatment. Here, the main mechanisms of cardiac toxicity induced by cancer therapies are analyzed, with a focus on patients requiring intensive care unit (ICU) admission during the course of the disease because of acute cardiac toxicity, takotsubo syndrome, and acute-on-chronic HF in patients suffering from chemotherapy-induced cardiomyopathy. In a subset of patients, cardiac toxicity can be acute and life-threatening, leading to overt cardiogenic shock. The management of critically ill cancer patients poses a unique challenge and requires a multidisciplinary approach. Moreover, no etiologic therapy is available, and only supportive measures can be implemented.
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Affiliation(s)
- Andrea Montisci
- Division of Cardiothoracic Intensive Care, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Vittorio Palmieri
- Department of Cardiac Surgery and Transplantation, Ospedali dei Colli Monaldi-Cotugno-CTO, Naples, Italy
| | - Jennifer E Liu
- Department of Medicine/Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Maria T Vietri
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Silvia Cirri
- Department of Anesthesia and Intensive Care, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | | | - Claudio Napoli
- Clinical Department of Internal Medicine and Specialistics, University Department of Advanced Clinical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico - Synlab Diagnostica Nucleare (IRCCS SDN), Naples, Italy
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5
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Bona D, Lombardo F, Matsushima K, Cavalli M, Lastraioli C, Bonitta G, Cirri S, Danelli P, Aiolfi A. Three-field versus two-field lymphadenectomy for esophageal squamous cell carcinoma: A long-term survival meta-analysis. Surgery 2021; 171:940-947. [PMID: 34544603 DOI: 10.1016/j.surg.2021.08.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/01/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND In the setting of esophageal squamous cell carcinoma, controversy exists regarding the optimal extent of lymphadenectomy, while conclusive evidence regarding the advantages of 3-field versus 2-field lymphadenectomy remains controversial. The purpose of the present meta-analysis was to investigate the effect of 3-field lymphadenectomy versus 2-field lymphadenectomy on overall survival. METHODS Systematic review and meta-analyses were computed to compare 3-field lymphadenectomy versus 2-field lymphadenectomy in the setting of esophageal squamous cell carcinoma. Risk ratio, weighted mean difference, hazard ratio, and restricted mean survival time difference were used as pooled effect size measures. RESULTS Fourteen studies (3,431 patients) were included. Overall, 1,664 (48.8%) patients underwent 3-field lymphadenectomy, and 1,767 (51.5%) underwent 2-field lymphadenectomy. Three-field lymphadenectomy was associated with a significantly improved 5-year overall survival (hazard ratio: 0.80; 95% confidence interval 0.71-0.90; P < .001). The restricted mean survival time difference showed a statistically significant difference between 3-field lymphadenectomy versus 2-field lymphadenectomy up to 48 months (1.6 months; P = .04), however, no significant differences were found at 60-month follow-up (1.2 months; P = .14). No significant differences were found in term of postoperative mortality, anastomotic leak, pulmonary complications, chylothorax, and recurrent nerve palsy. CONCLUSION For resectable esophageal squamous cell carcinoma, 3-field lymphadenectomy seems associated with a slight trend toward improved 5-year overall survival; however, its clinical benefit remains limited.
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Affiliation(s)
- Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Italy
| | - Francesca Lombardo
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Italy
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA
| | - Marta Cavalli
- Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Caterina Lastraioli
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Italy
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Italy
| | - Silvia Cirri
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Italy
| | - Piergiorgio Danelli
- Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Italy.
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Montisci A, Donatelli F, Cirri S, Coscioni E, Maiello C, Napoli C. Veno-arterial Extracorporeal Membrane Oxygenation as Bridge to Heart Transplantation: The Way Forward. Transplant Direct 2021; 7:e720. [PMID: 34258387 PMCID: PMC8270578 DOI: 10.1097/txd.0000000000001172] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/19/2022] Open
Abstract
Advanced heart failure (HF) represents a public health priority due to the increase of affected patients and the meaningful mortality. Durable mechanical circulatory support (MCS) and heart transplantation (HTx) are unique therapies for end-stage HF (ESHF), with positive early and long-term outcomes. The patients who underwent HTx have a 1-y survival of 91% and a median survival of 12-13 y, whereas the median survival of ESHF is <12 mo. Short-term MCS with veno-arterial extracorporeal membrane oxygenation (VA ECMO) can be used as a bridge to transplantation strategy. Patients bridged with VA ECMO have significantly lower survival in comparison with non-MCS bridged and left ventricular assist device-bridged patients. VA ECMO represents an effective, and sometimes unique, system to obtain rapid hemodynamic stabilization, but possible negative effects on patients' outcomes after HTx must be considered. Here, we discuss the use of VA ECMO as bridge to transplantation.
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Affiliation(s)
- Andrea Montisci
- Department of Anesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, Milan, Italy
| | - Francesco Donatelli
- Department of Cardiac Surgery, Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Silvia Cirri
- Department of Anesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, Milan, Italy
| | - Enrico Coscioni
- Department of Cardiac Surgery, AOU San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Ciro Maiello
- Cardiac Transplantation Unit, Department of Cardiac Surgery and Transplantation, Ospedali dei Colli, Naples, Italy
| | - Claudio Napoli
- Clinical Department of Internal Medicine and Specialistic Units, Regional Referring Centre for Clinical Immunology of Organ Transplantation (LIT), University Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
- IRCCS-SDN, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
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7
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Donatelli F, Miceli A, Glauber M, Cirri S, Maiello C, Coscioni E, Napoli C. Adult cardiovascular surgery and the coronavirus disease 2019 (COVID-19) pandemic: the Italian experience. Interact Cardiovasc Thorac Surg 2020; 31:755-762. [PMID: 33099647 PMCID: PMC7665554 DOI: 10.1093/icvts/ivaa186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected all health care professionals. The outbreak required a thorough reorganization of the Italian regional local health care system to preserve resources such as ventilators, beds in intensive care units and surgical and anaesthesiological staff. Levels of priority were created, together with a rigorous triage procedure for patients with COVID-19, which led to postponement of all elective procedures. Urgent cases were discussed with the local heart team and percutaneous approaches were selected as the first treatment option to reduce hospital stay. COVID-19 and COVID-19-free pathways were created, including adequate preparation of the operating room, management of anaesthesiological procedures, transportation of patients and disinfection. It was determined that patients with chronic diseases were at increased risk of adverse outcomes. Systemic inflammation, cytokine storm and hypercoagulability associated with COVID-19 increased the risk of heart failure and cardiac death. In this regard, the early use of extracorporeal membrane oxygenation could be life-saving in patients with severe forms of acute respiratory distress syndrome or refractory heart failure. The goal of this paper was to report the Italian experience during the COVID-19 pandemic in the setting of cardiovascular surgery.
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Affiliation(s)
- Francesco Donatelli
- Chair of Cardiac Surgery, Department of Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan, Milan, Italy
| | - Antonio Miceli
- Chair of Cardiac Surgery, Department of Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan, Milan, Italy
| | - Mattia Glauber
- Chair of Cardiac Surgery, Department of Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan, Milan, Italy
| | - Silvia Cirri
- Department of Anaesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, Milan, Italy
| | - Ciro Maiello
- Cardiac Transplantation Unit, Department of Cardiac Surgery and Transplantation, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Enrico Coscioni
- Department of Cardiac Surgery, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Claudio Napoli
- Clinical Department of Internal Medicine and Specialists, Azienda Ospedaliera Universitaria, and University Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
- IRCCS-SDN, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy
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8
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Montisci A, Micheletto G, Sibilio S, Donatelli F, Tespili M, Banfi C, Casilli F, Cosseta D, Miceli A, Cirri S, Pappalardo F. Impella 5.0 supported oncological surgery as bridge to LVAD. ESC Heart Fail 2020; 8:167-170. [PMID: 33161652 PMCID: PMC7835545 DOI: 10.1002/ehf2.12758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 11/10/2022] Open
Abstract
We describe the case of a 58‐year‐old man presenting with myocardial infarction complicated by cardiogenic shock, treated with Impella CP which was escalated to an axillary 5.0 due to lack of cardiac recovery. Weaning from Impella 5.0 failed, and the patient was evaluated for heart transplantation (HTx) or left ventricular assist device (LVAD). HTx was excluded because of a rectal adenocarcinoma. The patient underwent colorectal surgery while on Impella. Perioperative course was uneventful. After 61 days of Impella, when the LVAD implantation was scheduled, the patient died due to K. pneumoniae infection.
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Affiliation(s)
- Andrea Montisci
- Department of Anesthesia and Intensive Care, Cardiothoracic Centre, Istituto Clinico Sant'Ambrogio, Milan, Italy.,Chair of Cardiac Surgery, Postgraduate in Cardiac Surgery, University of Milan, Milan, Italy
| | - Giancarlo Micheletto
- Department of General Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Serena Sibilio
- Chair of Cardiac Surgery, Postgraduate in Cardiac Surgery, University of Milan, Milan, Italy
| | - Francesco Donatelli
- Chair of Cardiac Surgery, Postgraduate in Cardiac Surgery, University of Milan, Milan, Italy.,Department of Cardiac Surgery, Cardiothoracic Centre, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Maurizio Tespili
- Department of Interventional Cardiology, Cardiothoracic Centre, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Carlo Banfi
- Chair of Cardiac Surgery, Postgraduate in Cardiac Surgery, University of Milan, Milan, Italy.,Department of Cardiac Surgery, Cardiothoracic Centre, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Francesco Casilli
- Department of Interventional Cardiology, Cardiothoracic Centre, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Daniele Cosseta
- Department of Anesthesia and Intensive Care, Cardiothoracic Centre, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Antonio Miceli
- Department of Minimally Invasive Cardiac Surgery, Cardiothoracic Centre, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Silvia Cirri
- Department of Anesthesia and Intensive Care, Cardiothoracic Centre, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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9
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Aiolfi A, Bruni B, Biraghi T, Montisci A, Miceli A, Baronio B, Khor D, Cirri S, Donatelli F, Clemente C, Bona D. Late histological findings in symptomatic COVID-19 patients: A case report. Medicine (Baltimore) 2020; 99:e21046. [PMID: 32664116 PMCID: PMC7360241 DOI: 10.1097/md.0000000000021046] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Although there have been several studies describing clinical and radiographic features about the novel coronavirus (COVID-19) infection, there is a lack of pathologic data conducted on biopsies or autopsies. PATIENT CONCERNS A 56-year-old and a 70-year-old men with fever, cough, and respiratory fatigue were admitted to the intensive care unit and intubated for respiratory distress. DIAGNOSIS The nasopharyngeal swab was positive for COVID-19 and the chest Computed Tomography (CT) scan showed the presence of peripheral and bilateral ground-glass opacities. INTERVENTIONS Both patients developed pneumothoraces after intubation and was managed with chest tube. Due to persistent air leak, thoracoscopies with blebs resection and pleurectomies were performed on 23rd and 16th days from symptoms onset. OUTCOMES The procedures were successful with no evidence of postoperative air-leak, with respiratory improvement. Pathological specimens were analyzed with evidence of diffuse alveolar septum disruption, interstitium thickness, and infiltration of inflammatory cells with diffuse endothelial dysfunction and hemorrhagic thrombosis. LESSONS Despite well-known pulmonary damages induced by the COVID-19, the late-phase histological changes include diffused peripheral vessels endothelial hyperplasia, in toto muscular wall thickening, and intravascular hemorrhagic thrombosis.
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Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant’Ambrogio, University of Milan
| | - Barbara Bruni
- Department of Pathology, I.R.C.C.S. Policlinico San Donato, Milano
| | - Tullio Biraghi
- Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant’Ambrogio, University of Milan
| | - Andrea Montisci
- Department of Anaesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan
| | - Antonio Miceli
- Department of Anaesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan
| | - Barbara Baronio
- Department of Anaesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan
| | - Desmond Khor
- Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant’Ambrogio, University of Milan
| | - Silvia Cirri
- Department of Anaesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, University of Milan
| | - Francesco Donatelli
- Chair of Cardiac Surgery, Department of Cardiothoracic Center, Istituto Clinico Sant’Ambrogio; University of Milan, Milano, Italy
| | - Claudio Clemente
- Department of Pathology, I.R.C.C.S. Policlinico San Donato, Milano
| | - Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant’Ambrogio, University of Milan
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Bona D, Micheletto G, Bonitta G, Panizzo V, Cavalli M, Rausa E, Cirri S, Aiolfi A. Does C-reactive Protein Have a Predictive Role in the Early Diagnosis of Postoperative Complications After Bariatric Surgery? Systematic Review and Bayesian Meta-analysis. Obes Surg 2020; 29:3448-3456. [PMID: 31240535 DOI: 10.1007/s11695-019-04013-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Postoperative leak and intra-abdominal infections are common after bariatric surgery with a significant impact on perioperative outcomes, hospital length of stay, and readmission rates. In the era of enhanced recovery programs, with patients being discharged from the hospital 24-36 h after surgery and potentially before developing any complications, an early indicator of postoperative complications may be decisive. The aim of this study was to evaluate the predictive role of the C-reactive protein (CRP) in the early diagnosis of complications in patients undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS PubMed, Embase, and Web of Science databases were consulted. A systematic review and a fully Bayesian meta-analysis were conducted. RESULTS Seven studies met the inclusion criteria for a total of 1401 patients. Overall, 57.7% underwent LSG while 42.3% underwent LRYGB. The pooled prevalence of postoperative complications was 9.8% (95% CI = 5-16%). The estimated pooled CRP cut-off value on postoperative day 1 (POD1) was 6.1 mg/dl with a significant diagnostic accuracy and a pooled area under the curve of 0.92 (95% credible interval (CrI) 0.73-0.98). The positive and negative likelihood ratios were 13.6 (95% CrI 8.40-15.9) and 0.16 (95% CrI 0.04-0.31), respectively. CONCLUSION A CRP value lower than the derived cut-off of 6.1 mg/dl on POD1, combined with reassuring clinical signs, could be useful to rule out early postoperative leak and complications after LSG and LRYGB. In the context of enhanced recovery after surgery protocols, the integration of a CRP-based diagnostic algorithm as an additional complementary instrument may be valuable to reduce cost and improve outcomes and patient care.
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Affiliation(s)
- Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy.
| | - Giancarlo Micheletto
- Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Valerio Panizzo
- Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Marta Cavalli
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Emanuele Rausa
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Silvia Cirri
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
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11
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Crimi E, Benincasa G, Cirri S, Mutesi R, Faenza M, Napoli C. Clinical epigenetics and multidrug-resistant bacterial infections: host remodelling in critical illness. Epigenetics 2020; 15:1021-1034. [PMID: 32290755 DOI: 10.1080/15592294.2020.1748918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The inappropriate use of antibiotics in man is driving to insurgence of pathogenic bacteria resistant to multiple drugs (MDR) representing a challenge in critical illness. The interaction of MDR bacteria with host cells can guide molecular perturbations of host transcriptional programmes involving epigenetic-sensitive mechanisms, mainly DNA methylation, histone modifications, and non-coding RNAs leading to pathogen survival. Clinical evidence of epigenetic manipulation from MDR bacteria mainly arises from Mycobacterium tuberculosis as well as Helicobacter pylori, Escherichia coli, Listeria monocytogenes, Pseudomonas aeruginosa, and Legionella pneumophila infection suggesting possible biomarkers of disease. For example, DNA hypermethylation of E-cadherin (CDH1), upstream transcription factor 1/2 (USF1/2), WW domain containing oxidoreductase (WWOX), and mutL homolog 1 (MLH1) genes in gastric mucosa is correlated with malignancy suggesting useful biomarkers of early disease state. Moreover, upregulated circulating miR-361-5p, miR-889, miR-576-3p may be useful biomarkers to discriminate tuberculosis patients. Moreover, Listeria monocytogenes can indirectly induce H3 hyperacetylation leading to inflammation in human endothelial cells whereas Pseudomonas aeruginosa excretes QS 2-AA to directly induce H3 deacetylation leading to bacterial persistence in human monocytes. Remarkably, epigenetic-sensitive drugs may aid to counteract MDR in clinical setting. Trichostatin A, a histone deacetyltransferase inhibitor (HDACi), leads to AMP β-defensin 2 (HBD2) gene up-regulation in human epithelial cells suggesting a useful 'epi-therapy' for Escherichia coli-induced intestinal diseases. We update on the most current clinical studies focusing on epigenetic changes involved in bacterial-host interactions and their putative role as biomarkers or drug targets to improve precision medicine and personalized therapy in critical illness and transplantation setting.
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Affiliation(s)
- Ettore Crimi
- College of Medicine, University of Central Florida , Orlando, FL, USA.,Department of Anesthesiology and Critical Care Medicine, Ocala Health , Ocala, FL, USA
| | - Giuditta Benincasa
- Clinical Department of Internal Medicine and Specialistics, Department of Advanced Clinical and Surgical Sciences, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Silvia Cirri
- Division of Anesthesiology and Intensive Care, Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato , Milan, Italy
| | - Rebecca Mutesi
- College of Medicine, University of Central Florida , Orlando, FL, USA
| | - Mario Faenza
- Multidisciplinary Department of Medical and Dental Specialties, Plastic Surgery Unit, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Claudio Napoli
- Clinical Department of Internal Medicine and Specialistics, Department of Advanced Clinical and Surgical Sciences, University of Campania "Luigi Vanvitelli" , Naples, Italy.,IRCCS Foundation SDN , Naples, Italy
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Abstract
Epigenetic mechanisms including deoxyribonucleic acid (DNA) methylation, histone modifications (eg, histone acetylation), and microribonucleic acids (miRNAs) have gained much scientific interest in the last decade as regulators of genes expression and cellular function. Epigenetic control is involved in the modulation of inflammation and immunity, and its dysregulation can contribute to cell damage and organ dysfunction. There is growing evidence that epigenetic changes can contribute to the development of multiorgan dysfunction syndrome (MODS), a leading cause of mortality in the intensive care unit (ICU). DNA hypermethylation, histone deacetylation, and miRNA dysregulation can influence cytokine and immune cell expression and promote endothelial dysfunction, apoptosis, and end-organ injury, contributing to the development of MODS after a critical injury. Epigenetics processes, particularly miRNAs, are emerging as potential biomarkers of severity of disease, organ damage, and prognostic factors in critical illness. Targeting epigenetics modifications can represent a novel therapeutic approach in critical care. Inhibitors of histone deacetylases (HDCAIs) with anti-inflammatory and antiapoptotic activities represent the first class of drugs that reverse epigenetics modifications with human application. Further studies are required to acquire a complete knowledge of epigenetics processes, full understanding of their individual variability, to expand their use as accurate and reliable biomarkers and as safe target to prevent or attenuate MODS in critical disease.
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Affiliation(s)
- Ettore Crimi
- From the University of Central Florida, College of Medicine, Orlando, Florida.,Department of Anesthesiology and Critical Care Medicine, Ocala Health, Ocala, Florida
| | - Silvia Cirri
- Division of Anesthesiology and Intensive Care, Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Giuditta Benincasa
- Clinical Department of Internal Medicine and Specialistics, Department of Advanced Clinical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Claudio Napoli
- Clinical Department of Internal Medicine and Specialistics, Department of Advanced Clinical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Foundation SDN, Naples, Italy
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Meco M, Montisci A, Giustiniano E, Greco M, Pappalardo F, Mammana L, Panisi P, Roscitano C, Cirri S, Donatelli F, Albano G. Viscoelastic Blood Tests Use in Adult Cardiac Surgery: Meta-Analysis, Meta-Regression, and Trial Sequential Analysis. J Cardiothorac Vasc Anesth 2020; 34:119-127. [DOI: 10.1053/j.jvca.2019.06.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 12/29/2022]
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Meco M, Montisci A, Miceli A, Panisi P, Donatelli F, Cirri S, Ferrarini M, Lio A, Glauber M. Sutureless Perceval Aortic Valve Versus Conventional Stented Bioprostheses: Meta-Analysis of Postoperative and Midterm Results in Isolated Aortic Valve Replacement. J Am Heart Assoc 2018; 7:JAHA.117.006091. [PMID: 29453309 PMCID: PMC5850177 DOI: 10.1161/jaha.117.006091] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Aortic stenosis is the most common valvular disease and has a dismal prognosis without surgical treatment. The aim of this meta‐analysis was to quantitatively assess the comparative effectiveness of the Perceval (LivaNova) valve versus conventional aortic bioprostheses. Methods and Results A total of 6 comparative studies were identified, including 639 and 760 patients who underwent, respectively, aortic valve replacement with the Perceval sutureless valve (P group) and with a conventional bioprosthesis (C group). Aortic cross‐clamping and cardiopulmonary bypass duration were significantly lower in the P group. No difference in postoperative mortality was shown for the P and C groups (2.8% versus 2.7%, respectively; odds ratio [OR]: 0.99 [95% confidence interval (CI), 0.52–1.88]; P=0.98). Incidence of postoperative renal failure was lower in the P group compared with the C group (2.7% versus 5.5%; OR: 0.45 [95% CI, 0.25–0.80]; P=0.007). Incidence of stroke (2.3% versus 1.7%; OR: 1.34 [95% CI, 0.56–3.21]; P=0.51) and paravalvular leak (3.1% versus 1.6%; OR: 2.52 [95% CI, 0.60–1.06]; P=0.21) was similar, whereas P group patients received fewer blood transfusions than C group patients (1.16±1.2 versus 2.13±2.2; mean difference: 0.99 [95% CI, −1.22 to −0.75]; P=0.001). The incidence of pacemaker implantation was higher in the P than the C group (7.9% versus 3.1%; OR: 2.45 [95% CI, 1.44–4.17]; P=0.001), whereas hemodynamic Perceval performance was better (transvalvular gradient 23.42±1.73 versus 22.8±1.86; mean difference: 0.90 [95% CI, 0.62–1.18]; P=0.001), even during follow‐up (10.98±5.7 versus 13.06±6.2; mean difference: −2.08 [95% CI, −3.96 to −0.21]; P=0.030). We found no difference in 1‐year mortality. Conclusions The Perceval bioprosthesis improves the postoperative course compared with conventional bioprostheses and is an option for high‐risk patients.
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Affiliation(s)
- Massimo Meco
- Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Andrea Montisci
- Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Antonio Miceli
- Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Paolo Panisi
- Cardiac Centre, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Francesco Donatelli
- Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy.,Chair of Cardiac Surgery, University of Milan, Milan, Italy
| | - Silvia Cirri
- Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Matteo Ferrarini
- Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Antonio Lio
- Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Mattia Glauber
- Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
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15
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Giamberti A, Butera G, Mve Mvondo C, Cirri S, Varrica A, Moussaidi N, Isgrò G, Ambassa JC, Tantchou C, Giamberti G, Frigiola A. The Shisong Cardiac Center in Cameroon: An Example of a Long-Term Collaboration/Cooperation Toward Autonomy. Front Pediatr 2018; 6:188. [PMID: 30018948 PMCID: PMC6038727 DOI: 10.3389/fped.2018.00188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/06/2018] [Indexed: 01/23/2023] Open
Abstract
Congenital heart diseases (CHD) are present in nearly 1% of live births; according to WHO, there are 1. 5 million newborns affected by CHD per year and more than 4 million children waiting for cardiac surgery treatment worldwide. The majority of these children (~90%) could be treated, saved and subsequently have a good quality of life but unfortunately, in developing countries with a suboptimal care or no access to care, they are destined to die. Cameroon, one of the 40 poorest countries in the world, is a typical example of this dramatic scenario and this is why we started a collaboration project with a local religious partner (Tertiary Sisters of Saint Francis) in 2001 with the aim of establishing the first cardiac surgery center in this country. There are various well-known organizational models to start a cooperation project in pediatric cardiac surgery in a developing country. In our case, the project included a long-term collaboration with a stable local partner, a big financial investment and a long period of development (10 years or more). It is probably the most difficult model but it is the only one with the greatest guarantee of success in terms of sustainability and autonomy. The aim of this study is to analyze the constructive and problematic aspects of the 17-year collaboration in this project, and to assess possible solutions regarding its critical issues. Although much has been done during this 17-year we are aware that there is still a lot that needs to be done.
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Affiliation(s)
- Alessandro Giamberti
- Department of Pediatric Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Association "Bambini Cardiopatici nel Mondo" ONG, Milan, Italy
| | - Gianfranco Butera
- Department of Pediatric Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Association "Bambini Cardiopatici nel Mondo" ONG, Milan, Italy
| | | | - Silvia Cirri
- Association "Bambini Cardiopatici nel Mondo" ONG, Milan, Italy
| | - Alessandro Varrica
- Department of Pediatric Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Nadia Moussaidi
- International Cooperation Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giuseppe Isgrò
- Department of Anesthesiology and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Giovanni Giamberti
- Purchase Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Frigiola
- Department of Pediatric Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Association "Bambini Cardiopatici nel Mondo" ONG, Milan, Italy
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16
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Meco M, Miceli A, Montisci A, Donatelli F, Cirri S, Ferrarini M, Lio A, Glauber M. Sutureless aortic valve replacement versus transcatheter aortic valve implantation: a meta-analysis of comparative matched studies using propensity score matching. Interact Cardiovasc Thorac Surg 2017; 26:202-209. [DOI: 10.1093/icvts/ivx294] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 07/30/2017] [Indexed: 11/13/2022] Open
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Frigiola A, Moussaidi N, Giamberti A, Pomé G, Isgrò G, Youssef T, Reali M, Varrica A, Nuri HA, Cirri S, Carminati M, Menicanti L, Ferrari R, Ranucci M. International cooperation in healthcare: model of IRCCS Policlinico San Donato and Bambini Cardiopatici nel Mondo Association for congenital heart diseases. Eur Heart J Suppl 2016; 18:E72-E78. [DOI: 10.1093/eurheartj/suw023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bedogni F, Latib A, De Marco F, Agnifili M, Oreglia J, Pizzocri S, Latini RA, Lanotte S, Petronio AS, De Carlo M, Ettori F, Fiorina C, Poli A, Cirri S, De Servi S, Ramondo A, Tarantini G, Marzocchi A, Fiorilli R, Klugmann S, Ussia GP, Tamburino C, Maisano F, Brambilla N, Colombo A, Testa L. Response to letter regarding article, "Clinical impact of persistent left bundle-branch block after transcatheter aortic valve implantation with CoreValve revalving system". Circulation 2013; 128:e444. [PMID: 24276881 DOI: 10.1161/circulationaha.113.005705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francesco Bedogni
- Department of Cardiology, Istituto Clinico S. Ambrogio, Milan, Italy
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Bedogni F, Latib A, De Marco F, Agnifili M, Oreglia J, Pizzocri S, Latini RA, Lanotte S, Petronio AS, De Carlo M, Ettori F, Fiorina C, Poli A, Cirri S, De Servi S, Ramondo A, Tarantini G, Marzocchi A, Fiorilli R, Klugmann S, Ussia GP, Tamburino C, Maisano F, Brambilla N, Colombo A, Testa L. Interplay between mitral regurgitation and transcatheter aortic valve replacement with the CoreValve Revalving System: a multicenter registry. Circulation 2013; 128:2145-53. [PMID: 24088530 DOI: 10.1161/circulationaha.113.001822] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known of the prognostic significance of mitral regurgitation (MR) on transcatheter aortic valve replacement (TAVR), the impact of TAVR on MR severity, and the variables associated with possible post-TAVR improvement in MR. We evaluated these issues in a multicenter registry of patients undergoing CoreValve Revalving System-TAVR. METHODS AND RESULTS Among 1007 consecutive patients, 670 (66.5%), 243 (24.1%), and 94 (9.3%) presented with no/mild, moderate, and severe MR, respectively. At 1 month after TAVR, patients with severe or moderate MR showed comparable mortality rates (odds ratio, 1.1; 95% confidence interval [95% CI], 0.7-1.55; P=0.2), but both were significantly higher compared with patients with mild/no MR (odds ratio, 2.2; 95% CI, 1.78-3.28; P<0.001; and odds ratio, 1.9; 95% CI, 1.1-3.3; P=0.02, respectively). One-year mortality was also similar between patients with severe and those with moderate MR (hazard ratio, 1.4; 95% CI, 0.94-2.4; P=0.06) and still significantly higher compared with patients with mild/no MR (hazard ratio, 1.7; 95% CI, 1.2-3.41; P<0.001; and hazard ratio, 1.4; 95% CI, 1.2-2.2; P=0.03, respectively). Severe pulmonary hypertension, atrial fibrillation, and MR more than mild, but not an improvement of ≥1 grade in MR severity, were independent predictors of mortality at 1 year. At 1 year, an improved MR was observed in 47% and 35% of patients with severe and moderate MR, respectively. The rate of low implantation was consistent across groups with improved, unchanged, or worsened MR. A functional type of MR and the absence of severe pulmonary hypertension and atrial fibrillation independently predicted the improvement in MR severity. CONCLUSIONS Baseline MR greater than mild is associated with higher mortality after CoreValve Revalving System-TAVR. A significant improvement in MR was more likely in patients with functional MR and without severe pulmonary hypertension or atrial fibrillation. The improvement in MR did not independently predict mortality.
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Affiliation(s)
- Francesco Bedogni
- Department of Cardiology, Istituto Clinico S. Ambrogio, Milan (F.B., M.A., S.P., R.A.L., S.L., S.C., N.B., L.T.); Interventional Cardiology Unit, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan (A.L., F.M., A.C.); Niguarda Ca Granda Hospital, Milan (F.D.M., J.O., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa (A.S.P., M.D.C.); Cardiothoracic Department, Spedali Civili, Brescia (F.E., C.F.); Azienda Ospedaliera Legnano, Legnano (A.P., S.D.S.); Ospedale di Bassano del Grappa, Vicenza (A.R.); Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Padova (G.T.); Institute of Cardiology, St. Orsola/Malpighi Hospital, Bologna University, Bologna (A.M.); Osp. San Camillo, Roma (R.F.); and Ferrarotto Hospital, Catania (G.P.U., C.T.), Italy
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Meco M, Cirri S. Can a meta-analysis that mixes apples with oranges be used to demonstrate that levosimendan reduces mortality after coronary revascularization? Crit Care 2011; 15:455; author reply 455. [PMID: 22188763 PMCID: PMC3388673 DOI: 10.1186/cc10484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Tchoumi JCT, Ambassa JC, Giamberti A, Cirri S, Frogiola A, Butera G. Late surgical treatment of tetralogy of Fallot. Cardiovasc J Afr 2011; 22:179-81. [PMID: 21881681 PMCID: PMC3721949 DOI: 10.5830/cvja-2010-057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 07/12/2010] [Indexed: 11/06/2022] Open
Abstract
Aim To study early post-operative results and follow up of patients over a year old, operated on for tetralogy of Fallot (ToF). Methods This retrospective analysis included 22 patients (14 male and eight female) with a mean age of 9.18 ± 6.5 years (range 13.5 months to 26 years), who underwent complete repair of ToF between April 2003 and June 2009. Data from patients’ records, pre-operative cardiac catheterisation studies, operative intervention, and pre-operative and postoperative two-dimensional echocardiographic studies were reviewed. All patients underwent complete repair including closure of ventricular septal defect (VSD). A trans-annular patch was used in 12 patients while an infundibular patch was used in 10 others. Patients were evaluated one, three, six and 12 months after surgery, and annually thereafter. The duration of follow up was from eight months to six years post surgery. Results Classical ToF was found in 10 patients. Twelve cases had associated anomalies: two patients with hypoplastic pulmonary artery branches, two with arterial duct malformations, and eight had proximal stenosis of the left branch of the pulmonary artery. NHYA class distribution was as follows: class I: two patients; class II: five subjects; class III: 10 patients; class IV: five subjects. The mean stay in hospital was 15 ± 7 days. Two patients (9%) died during the early post-surgical period. At a mean follow-up interval of 32 ± 9 months, all patients were asymptomatic and in NYHA class I. No late deaths occurred. In three patients, we registered isolated monomorphic ventricular extrasystoles. The right ventricle outflow tract (RVOT) pressure gradient was 29 ± 1.5 mmHg in the acute post-surgical period and it did not change significantly during follow up. The right ventricular function was defined as normal in 95% of the patients in the study and was mildly depressed in 5%. Conclusion Even if treated later in life, our study showed very good surgical results of patients with ToF.
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Affiliation(s)
- J C T Tchoumi
- St Elizabeth Catholic General Hospital, Cardiac Centre, Shisong, Cameroon.
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Meco M, Caratti A, Cirri S. A new and simple method for the correct localization of the intra-aortic balloon: the celiac artery Doppler ultrasound. Acta Anaesthesiol Scand 2011; 55:1284-5. [PMID: 22092136 DOI: 10.1111/j.1399-6576.2011.02521.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Meco M, Allaz MC, Cirri S. Effects of Fenoldopam Mesylate Infusion on Splanchnic Perfusion After Myocardial Revascularization on Cardiopulmonary Bypass: An Ultrasound Doppler Study. J Cardiothorac Vasc Anesth 2011; 25:642-6. [DOI: 10.1053/j.jvca.2010.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Indexed: 11/11/2022]
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Budzee A, Ghidoni I, Giamberti A, Cirri S, Tantchou Tchoumi JC, Ambassa JC, Butera G. The first coronary by-pass grafting surgery done in western and central Africa. Pan Afr Med J 2011; 8:46. [PMID: 22121454 PMCID: PMC3201609 DOI: 10.4314/pamj.v8i1.71163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 04/23/2011] [Indexed: 11/24/2022] Open
Abstract
Africa bears a significant proportion of the global burden of chronic diseases, along with poor countries of Asia and Latin America. The World Health Organisation projects that over the next ten years the Continent will experience the largest increase in death rates from cardiovascular disease, cancer, respiratory disease and diabetes. Probably for the first time in Western and Central Africa, the very first coronary artery bypass surgery grafting was performed in the Cardiac Centre of Shisong in Cameroon.
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Tantchou Tchoumi J, Ambassa J, Giamberti A, Cirri S, Frigiola A, Butera G. Management of congestive heart failure in St. Elizabeth Catholic General Hospital Shisong, cardiac centre. Int J Cardiol 2011; 147:318-9. [DOI: 10.1016/j.ijcard.2010.12.067] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 12/13/2010] [Indexed: 11/29/2022]
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Testa L, Meco M, Cirri S, Bedogni F. Pexelizumab and survival in cardiac surgery. HSR Proc Intensive Care Cardiovasc Anesth 2011; 3:23-4. [PMID: 23439772 PMCID: PMC3484601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A recent international consensus conference on the reduction in mortality in cardiac anesthesia and intensive care included pexelizumab, a recombinant monoclonal antibody to the component 5 of the complement system, among the ancillary (i.e. non-surgical) drugs/techniques/strategies that might influence survival rates in patients undergoing cardiac surgery. The consensus conferences state that "A subgroup analysis of a meta-analysis of randomized controlled trials suggested that pexelizumab might reduce mortality (longest follow up available, up to 6 months) in patients undergoing coronary artery bypass grafting. Pexelizumab was not included among the most important topics of the consensus conference as it was the only topic that did not receive a sufficient percentage of votes from the audience (32% at the first round and 35% at the second round). Pexelizumab is no longer on the market, however, the concept of reducing the generalized inflammatory process accompanying cardiopulmonary bypass deserves further investigation.
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Affiliation(s)
- L Testa
- Deptartment of Interventional Cardiology, Istituto Clinico S. Ambrogio, Milan, Italy
| | - M Meco
- Deptartment of Anesthesia and Intensive Care Unit, Istituto Clinico S. Ambrogio, Milan, Italy
| | - S Cirri
- Deptartment of Anesthesia and Intensive Care Unit, Istituto Clinico S. Ambrogio, Milan, Italy
| | - F Bedogni
- Deptartment of Anesthesia and Intensive Care Unit, Istituto Clinico S. Ambrogio, Milan, Italy
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Meco M, Cirri S. The effects of load on systolic mitral annulus movements by tissue Doppler imaging in cardiac surgery patients. J Cardiovasc Surg (Torino) 2010; 51:277-281. [PMID: 20354499] [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: 05/29/2023]
Abstract
AIM The main indexes of ventricular function used in clinical practice are strongly influenced by the ventricular load conditions. Tissue Doppler imaging (TDI) has been reported to be a powerful modality that enables assessment of ventricular wall motion with a high temporal and spatial resolution. The study of the systolic movements of the mitral annulus has been proposed as a valid index of myocardial contractility. The aim of this study was to verify if the systolic movements of the mitral annulus by TDI are load-dependent in patients undergoing coronary artery bypass grafting. We evaluated the effect of load changes on systolic (S(M)) and isovolumic (S(IVC)) velocity waves, and on isovolumic acceleration (S(IVA)). METHODS Twenty-three patients undergoing coronary artery bypass grafting were evaluate. Load was changed with a rapid infusion of 7 cc/kg of a gelatin solution. The sample volume of TDI was placed at the lateral side of the mitral annulus in the mid-esophageal 4-chamber view. RESULTS The increase preload resulted in a statistically significant increase of S(M) (8.7+/-1.04 cm/s vs. 9.99+/-0.88 cm/s P=0.01), and a statistically significant increase of S(IVC) (5.65+/-1.95 cm/s vs. 6.75+/-1.53 cm/s P=0.03). S(IVA) does not appear to be changed after the increase of preload (203.45+/-45.69 cm/s(2) vs. 211.41+/-71.28 p=0.81). CONCLUSION Only S(IVA) seems to be an independent index of cardiac functionality in cardiac surgery patients and appears to be an optimum index in the clinical evaluation of these patients.
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Affiliation(s)
- M Meco
- Thoracic Surgery and Anesthesia and Intensive Care Department, Sant'Ambrogio Clinical Institute, Milan, Italy.
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Meco M, Cirri S. Effects of Fenoldopam Mesylate on Central Hemodynamics and Renal Flow in Patients Undergoing Cardiac Surgery: Color Doppler Echocardiographic Evaluation. J Cardiothorac Vasc Anesth 2010; 24:58-62. [DOI: 10.1053/j.jvca.2009.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Indexed: 11/11/2022]
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Meco M, Cirri S. The Effect of Various Fenoldopam Doses on Renal Perfusion in Patients Undergoing Cardiac Surgery. Ann Thorac Surg 2010; 89:497-503. [DOI: 10.1016/j.athoracsur.2009.09.071] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/28/2009] [Accepted: 09/29/2009] [Indexed: 01/22/2023]
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Meco M, Cirri S. Comment on: “An assessment of the accuracy of renal blood flow estimation by doppler ultrasound” by Wan et al. Intensive Care Med 2009; 35:1492; author reply 1493. [DOI: 10.1007/s00134-009-1497-1] [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] [Accepted: 03/09/2009] [Indexed: 11/28/2022]
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Meco M, Cirri S, Gallazzi C, Magnani G, Cosseta D. Desflurane preconditioning in coronary artery bypass graft surgery: a double-blinded, randomised and placebo-controlled study. Eur J Cardiothorac Surg 2007; 32:319-25. [PMID: 17574858 DOI: 10.1016/j.ejcts.2007.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 05/01/2007] [Accepted: 05/07/2007] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Recent clinical and experimental data indicate that volatile anaesthetics may precondition myocardium against ischaemia and infarction. The present clinical trial was designed to verify the cardioprotective effects of desflurane in patients undergoing elective coronary artery bypass surgery. It was hypothesized that desflurane preconditioning would decrease postoperative release of troponin I and brain natriuretic peptide (NT-proBNP). Besides, we have hypothesized that desflurane preconditioning would preserve the myocardium from the dysfunction following cardioplegic arrest. METHODS Twenty-eight patients were randomly divided into two groups: Control group (14 patients) and Desflurane group (14 patients). In Desflurane group (DS) patients, preconditioning was elicited after the onset of cardiopulmonary bypass via a 5-min exposure to desflurane (2.5 minimum alveolar concentration), followed by a 10-min washout before aortic cross-clamping and cardioplegic arrest. The control group (C) patients underwent an equivalent period (15 min) of pre-arrest desflurane-free bypass. Haemodynamic measurements were obtained at six different times. The biochemistry markers of cellular damage and myocardial dysfunction (troponin I, NT-proBNP) were determined. Left ventricular (LV) function was assessed using tissue Doppler imaging (TDI) of mitral annulus. Two-factor repeated-measures analysis of variance was used to evaluate differences over time between groups for all parameters determined in plasma samples and for all TDI-derived variables. RESULTS After surgery, both the troponin I values (2.04+/-1.09 ng/ml vs 1.44+/-0.77 ng/ml, p<0.01 after 24h and 1.62+/-0.96 ng/ml vs 1.00+/-0.24 ng/ml, p<0.01 after 72 h respectively) and those of the NT-proBNP (2187+/-282.9 ng/l vs 885.4+/-117.35 ng/l, p<0.01 after 24h and 3097.9+/-226.2 vs 1393.6+/-312.07 ng/l, p<0.01 after 72 h respectively) were less in the desflurane-treated patients. The values of TDI of mitral annulus were constantly better in desflurane-treated patients. CONCLUSIONS We can conclude that the use of desflurane in these patients provides a pharmacological preconditioning so as to reduce myocardial necrosis and improve the cardiac performance in the postoperative period.
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Affiliation(s)
- Massimo Meco
- Cardiothoracic Surgery Unit and Intensive Care Department, Centro Malan Istituto Clinico Sant'Ambrogio, Milan, Italy.
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Meco M, Biraghi T, Panisi P, Casselman F, Cosseta D, Cirri S. Aortocoronary bypass grafting in high-risk patients over 75 years. Propensity score analysis of on versus off-pump, early and midterm results. J Cardiovasc Surg (Torino) 2007; 48:339-47. [PMID: 17505439] [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: 05/15/2023]
Abstract
AIM Bypass surgery in high risk patients over the age of 75 results in increased mortality and morbidity, which may be also related to the cardiopulmonary bypass system. METHODS Using the propensity score analysis, we have selected two homogeneous groups of high-risk elderly patients undergoing coronary surgery: 41 patients operated with cardiopulmonary bypass- coronary artery bypass graft (CPB-CABG), and 78 patients operated without cardiopulmonary bypass (off-pump coronary artery bypass graft, OPCABG). All preoperative and operative variables were similar and outcomes were compared. RESULTS Perioperative mortality was higher in the patient group operated with CPB (12.2%) as compared to patients operated without CPB (1.3%, P = 0.01). Perioperative complications were more frequent in the CPB-CABG group. Logistic regression analysis showed that avoiding CPB was an independent protective factor for mortality and morbidity. Midterm survival, freedom from angina, freedom from reintervention, and Canadian Cardiovascular Society (CSS) class were comparable between the 2 groups. CONCLUSION OPCABG is safe in the high risk elderly population and significantly reduces postoperative mortality and morbidity. There are no differences in midterm results between the 2 groups of patients in our study.
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Affiliation(s)
- M Meco
- Cardiothoracic Surgery Department, Sant'Ambrogio Hospital, Milan, Italy.
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Bossone E, Di Benedetto G, Frigiola A, Carbone GL, Panza A, Cirri S, Ballotta A, Messina S, Rega S, Citro R, Trimarchi S, Fang J, Righini P, Distante A, Eagle KA, Mehta RH. Valve surgery in octogenarians: in-hospital and long-term outcomes. Can J Cardiol 2007; 23:223-7. [PMID: 17347695 PMCID: PMC2647872 DOI: 10.1016/s0828-282x(07)70749-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [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: 11/25/2022] Open
Abstract
BACKGROUND Global population aging and greater age-related incidence of ischemic, degenerative and calcific valve disease have led to an increasing number of very elderly patients being referred for valve surgery. However, their preoperative risk factors, and in-hospital and long-term outcomes have not been thoroughly investigated. METHODS Three hundred seven consecutive patients 80 years and older (60% female; mean age 83+/-2.4 years) attending three major Italian cardiac centres to undergo valve surgery were evaluated. Seventy-nine patients underwent mitral valve surgery (isolated n=30, combined n=49) and 228 underwent aortic valve surgery (isolated n=134, combined n=94). RESULTS The most frequent in-hospital complications were atrial arrhythmias, need for inotropic support for more than 48 h, renal insufficiency, congestive heart failure, respiratory failure, and stroke or transient ischemic attack. The in-hospital mortality rate was 9.7% (30 of 307). Multivariate logistic regression identified the following clinical variables as predictors of in-hospital death: New York Heart Association functional class IV, diabetes, hypertension, renal insufficiency at presentation, rheumatic etiology and left ventricular ejection fraction of less than 45%. Late mortality occurred in 45 of 277 patients (16.2%), but there was a substantial improvement in the New York Heart Association functional class of the 232 long-term survivors (from 3.0+/-0.7 to 1.7+/-0.6; P<0.0001). CONCLUSIONS Surgery seems to be an effective therapeutic option for selected symptomatic octogenarians with valve disease, associated with good long-term survival and an improved functional class. Operative mortality is related more to patients' preoperative clinical status and increased comorbidity than the type of surgery per se.
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Affiliation(s)
- Eduardo Bossone
- Institute of Clinical Physiology, National Research Council of Italy, Lecce Section.
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Rosti L, De Battisti F, Butera G, Cirri S, Chessa M, Delogu A, Drago M, Giamberti A, Pomè G, Carminati M, Frigiola A. Octreotide in the management of postoperative chylothorax. Pediatr Cardiol 2005; 26:440-3. [PMID: 16374694 DOI: 10.1007/s00246-004-0820-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Chylothorax (KT) may be a complication of thoracic surgery. Its management is not well established and may comprise dietary interventions and surgery. The effectiveness of somatostatin and its analogues has been reported, although their mechanism(s) of action is unclear. We report our experience with octreotide in a series of patients with postoperative chylothorax. Eight patients with KT were treated with a continuous intravenous infusion of octreotide (OCT) at a starting dose of 0.5 microg/kg/hr. They were compared with four additional patients with KT who were treated according to the conventional approach. After a mean of 3.3 +/- 1.9 days of treatment, fluid discharge diminished dramatically. In all patients, fluid losses stopped by postoperative day 10.5 +/- 2.9 and chest tubes could be removed after 12.8 +/- 4.1 days. Compared to a small group of historical controls, OCT reduced significantly the total fluid losses (141.1 +/- 89.3 vs 396.7 +/- 151.0 ml/kg; p = 0.003) and the postoperative length of stay (p = 0.05). No patients in the group treated with OCT required parenteral nutrition (compared to all four of the controls; p = 0.002) and/or thoracenteses (compared to two of four controls). In postoperative KT, OCT seems to be at least as effective as the conventional approach. Furthermore, OCT may reduce total fluid losses and postoperative length of stay. This may have a beneficial effect on the risk of complications and on hospital costs.
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Affiliation(s)
- L Rosti
- Department of Pediatric Cardiology and Heart Surgery, Istituto Policlinico San Donato, via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
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Abstract
Thousands of children live in developing countries with untreated but correctable congenital heart disease (CHD), and most of them will die simple because they live in poor countries that do not have suitable medical/surgical facilities. The aim of the Association of Children with Heart Disease in the World is to support the operatory and teaching activities of a group of voluntary doctors engaged in the management of children with CHD in developing countries. Since 1992, the association has obtained 160 grants for foreign doctors who have been trained in our hospitals; performed 75 missions abroad, with more than 2150 cases evaluated and 404 cardiac operations performed; obtained millions of dollars worth of donated medical equipment; and constructed two cardiac surgery departments in Syria and Cameroon. Many efforts have been made, but much more can be done as we attain more experience and develop better coordination and collaboration between the international groups engaged in this emerging social need.
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Affiliation(s)
- A Giamberti
- Association of Children with Heart Disease in the World, Milan, Italy.
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Meco M, Gramegna G, Yassini A, Bellisario A, Mazzaro E, Babbini M, Pediglieri A, Panisi P, Tarelli G, Frigiola A, Menicanti L, Cirri S. Mortality and morbidity from intra-aortic balloon pumps. Risk analysis. J Cardiovasc Surg (Torino) 2002; 43:17-23. [PMID: 11803322] [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: 02/23/2023]
Abstract
BACKGROUND The purpose of this study, was to assess the incidence of and predictors for mortality and morbidity in patients who required postoperative intra-aortic balloon pump (IABP) support. METHODS We have retrospectively estimated 116 patients and data were statistically analyzed, and significant variables were evaluated with multivariate analysis. RESULTS Mortality rate was 57.8% (67 patients). Nineteen patients (16.3%) had major vascular complications: 12 patients (10.3%) limb ischemia, 1 patient (0.9%) aortic dissection, 6 patients (5.2%) mesenteric infarction. Thirty patients (25.8%) had minor vascular complication: 23 patients (19.8%) bleeding from insertion site, 7 (6%) patients infection of insertion site. Limb ischemia was resolved by IABP removal (10 patients), thrombectomy (2 patients). No patient required limb amputation. Sixty patients (51.7%) had renal insufficiency, of which 40 patients needed dialysis. Fifteen patients (10.3%) had neurological complications, 13 patients (11.2%) thrombocytopenia and 5 patients (4.3%) sepsis. CONCLUSIONS The incidence of IABP insertion in our institution was 1.5%. Mortality rate is similar to mortality of other studies in which the IABP has been inserted in the postoperative period. We have found that timing of IABP insertion, thrombocytopenia, presence of peripheral vascular disease and the redo intervention are independent predictors of mortality. We also found that female sex, diabetes, history of cigarette smoking and preoperative use of antiplatelet drugs are independent predictors of limb ischemia. The following factors are instead independent predictors of renal insufficiency: postoperative ejection fraction lower than 40% and non use of dobutamine in the postoperative period.
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Affiliation(s)
- M Meco
- Division of Cardiac Surgery, Malan Center, S. Ambrogio Clinical Institute, Milan, Italy.
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Cirri S, Negri L, Babbini M, Latis G, Khlat B, Tarelli G, Panisi P, Mazzaro E, Bellisario A, Borghetti B, Bordignon F, Ferrara M, Pavan H, Meco M. Haemolysis due to active venous drainage during cardiopulmonary bypass: comparison of two different techniques. Perfusion 2001; 16:313-8. [PMID: 11486851 DOI: 10.1177/026765910101600408] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [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: 11/15/2022]
Abstract
To facilitate mini-access for cardiac surgery, two different methods of active venous drainage are used: vacuum assisted drainage and centrifugal pump aspiration on the venous line. The aim of this study was to compare the haemolysis produced using these two techniques. From June to December 1999, 50 consecutive patients were operated on using a ministernotomy. All of these patients had valvular surgery for either valve repair or valve replacement (9 MVRepair, 11 MVR, 29 AVR, 1 AVR + MVR). They were randomized into two groups: Group A, 25 patients who underwent surgery where vacuum assisted drainage was used, and Group B, 25 patients where kinetic asssisted venous drainage with centrifugal pump venous aspiration was used. Patient characteristics of both groups were similar for age, gender, body weight, body surface area, height, cardiopulmonary bypass (CPB) time, aortic crossclamp time, priming volume, cardioplegia volume, haemoglobin concentration, haematocrit, serum creatinine, bilirubin, lactate dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (sGOT), serum glutamic pyruvic transaminase (sGPT), aptoglobin, reticulocytes, and platelet count. We checked all these laboratory parameters preoperatively, at the end of CPB, and 2 and 24 h after operation. We also checked haemoglobinuria at these same time points. We assessed blood loss at 6, 12, and 24 h after the operation and calculated total postoperative bleeding. There was a tendency towards a greater increase in LDH, sGOT and sGPT in Group A more than in Group B, but these data did not reach statistical significance. Platelet count was always lower in Group A and aptoglobin increased in Group A more than in Group B. More patients in Group A had haemoglobinuria. These findings indicate that haemolysis is increased more in patients treated with vacuum assisted drainage, when compared to the rise in haemolysis in those treated with centrifugal pump venous drainage. Total bleeding is also greater in Group A.
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Affiliation(s)
- S Cirri
- Anaesthesiology and Intensive Care Department, Instituto Clinico Sant'Ambrogio, Milan, Italy
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Ranucci M, Mazzucco A, Pessotto R, Grillone G, Casati V, Porreca L, Maugeri R, Meli M, Magagna P, Cirri S, Giomarelli P, Lorusso R, de Jong A. Heparin-coated circuits for high-risk patients: a multicenter, prospective, randomized trial. Ann Thorac Surg 1999; 67:994-1000. [PMID: 10320241 DOI: 10.1016/s0003-4975(99)00062-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Heparin-coated circuits (HCCs) in low-risk cardiac patients who have coronary revascularization have a limited impact on postoperative outcome. In this prospective, randomized investigation, we studied high-risk patients who had cardiac operations with or without HCCs. METHODS A total of 886 patients who had cardiac operations with cardiopulmonary bypass and at least one patient-related or procedure-related risk factor were enrolled in a multicenter study. They were randomly allocated to have cardiopulmonary bypass with Duraflo II HCCs (HCC group, n = 442) or conventional circuits (control group, n = 444). Postoperative outcome was investigated with respect to the occurrence of organ dysfunction. RESULTS HCCs are associated with a shorter intensive care unit and postoperative hospital stay and with a lower rate of patients having a severely impaired clinical outcome (stay in intensive care unit for more than 5 days or death) (relative risk 0.66, p = 0.045). Lung dysfunction rate was significantly lower for the patients in HCC group affected by chronic obstructive pulmonary disease or who had mitral procedure (relative risk, respectively, 0.31, p = 0.018 and 0.05, p = 0.02). Renal dysfunction rate was significantly (p = 0.05) lower for diabetics in the HCC group (relative risk 0.28). CONCLUSIONS When HCCs were used postoperative times decreased and they had a protective effect on lung and kidney function in high-risk patients.
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Affiliation(s)
- M Ranucci
- Cardiovascular Center E. Malan, San Donato Hospital, Milan
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Ranucci M, Cirri S, Conti D, Ditta A, Boncilli A, Frigiola A, Menicanti L. Beneficial effects of Duraflo II heparin-coated circuits on postperfusion lung dysfunction. Ann Thorac Surg 1996; 61:76-81. [PMID: 8561642 DOI: 10.1016/0003-4975(95)00820-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Heparin coating of the cardiopulmonary bypass circuit reduces the activation of the terminal part of the complement cascade. Conflicting data are reported concerning neutrophil activation and postoperative lung dysfunction. In this study, we compared three different types of oxygenator: a bubble oxygenator, a conventional hollow-fiber oxygenator, and a heparin-coated oxygenator and circuit. METHODS Sixty patients undergoing myocardial revascularization were randomly assigned to one of three oxygenator groups. All the patients were free from preoperative lung dysfunction. Lung function was studied with repeated measurements of respiratory index, intrapulmonary shunt, alveolar dead space, ventilation/perfusion ratio, and static thoracopulmonary compliance. RESULTS Immediately after cardiopulmonary bypass, the intrapulmonary shunt and respiratory index values in the bubble oxygenator and hollow-fiber oxygenator groups increased more than those in the heparin-coated oxygenator group. In the intensive care unit, the between-group difference in intrapulmonary shunt disappeared, but the within-group difference in respiratory index (from baseline) remained for the bubble oxygenator group. The other three variables did not significantly differ between groups. Intubation time and stay in the intensive care unit did not differ between groups. CONCLUSIONS Heparin-coated circuits exert a protective effect on pulmonary function. However, their use did not modify the postoperative clinical course of patients with normal lung function preoperatively.
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Affiliation(s)
- M Ranucci
- Department of Anesthesiology, University Hospital S. Donato, Milan, Italy
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Ranucci M, Corno A, Pavesi M, Cirri S, Menicanti L, Frigiola A, Celoria R, Ditta A, Boncilli A, Conti D. Renal effects of low dose aprotinin in pediatric cardiac surgery. Minerva Anestesiol 1994; 60:361-6. [PMID: 7528360] [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: 01/25/2023]
Abstract
Two groups of 15 children aged from 15 days to 6 years, undergoing surgery on cardiopulmonary by-pass for congenital heart disease have been retrospectively analyzed. Group A received a low-dose aprotinin treatment (30,000 KIU/kg in the priming solution); group C (control group) did not receive any aprotinin. Groups were homogeneous for pathology, cardiopulmonary by-pass time, aortic cross-clamping time, cyanotic/acyanotic patients ratio, temperature during cardiopulmonary bypass. A number of postoperative data were measured: activated clotting time was without any difference between aprotinin-treated and control patients; the same went for temperatures, urine output, intubation time, stay in Intensive Care Unit, coagulation tests, platelet counts, hematocrit, survival rate, and blood loss. Serum creatinine levels were significantly higher in group A than in group C both at the arrival in Intensive Care Unit (0.81 +/- 0.27 vs 0.66 +/- 0.12, p = 0.032) and in the first postoperative day (1.01 +/- 0.5 vs 0.72 +/- 0.19, p = 0.038). BUN was significantly higher in group A vs group C in the first postoperative day (43.6 +/- 21.1 vs 33.9 +/- 16.7, p = 0.043). We conclude that low-dose aprotinin did not reduce postoperative bleeding; we cannot exclude that higher dosages could be more effective, but the evidence of a moderate tubular function impairment suggests caution in using high-dose aprotinin in children.
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Affiliation(s)
- M Ranucci
- Department of Cardiovascular Anesthesia, Cardiovascular Center E. Malan, S. Donato Hospital, University of Milan
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Ranucci M, Pavesi M, Cirri S, Ceccopieri M, Ghanem G, Soro G, Casalinc S, Coot J. Complement activation during cardiopulmonary bypass: Evidence for a different response ifgduced by various priming solutions. J Cardiothorac Vasc Anesth 1994. [DOI: 10.1016/1053-0770(94)90433-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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42
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Ranucci M, Pavesi M, Cirri S, Ceccopieri M, Ghanem G, Casalino S, Rosina F, Mazza E, Conti D. Autologous fresh whole blood added to crystalloid priming improves the biocompatibility of the extracorporeal circulation (ECC) system. J Cardiothorac Vasc Anesth 1992. [DOI: 10.1016/1053-0770(92)90448-g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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43
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Ranucci M, Pavesi M, Ceccopieri M, Cirri S, Casalino S, Conti D. [Continuous pharmacologic infusion during extracorporeal circulation in heart surgery: comparison with the administration in fractionated doses]. Minerva Anestesiol 1990; 56:983-5. [PMID: 2274241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- M Ranucci
- Servizio di Anestesia e Rianimazione, Centro Cardiovascolare Edmondo Malan, Ospedale Clinicizzato S. Donato, Università degli Studi di Milano
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44
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Corli O, Cirri S, Prati R, Turio G. [Use of chlordemethyldiazepam in pediatric preanesthesia]. Minerva Anestesiol 1983; 49:445-8. [PMID: 6417573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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45
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Massei R, Parma A, Baratta P, Ceccopieri M, Cirri S. [Hypotensive drugs in vascular surgery]. Minerva Anestesiol 1983; 49:17-20. [PMID: 6403893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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46
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Bortone F, Martello L, Cirri S, Prati R, Ceccopieri M. [Respiratory complications in resuscitation after open-heart surgery]. Minerva Anestesiol 1981; 47:475-82. [PMID: 7312181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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47
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Catania S, Sansonetti G, Monguzzi G, Cappuccino M, Cirri S, Sarti L. [Surgical technic in the treatment of pectus excavatum]. MINERVA CHIR 1981; 36:381-8. [PMID: 7231744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
19 patients subjected to surgery for correction of p.e. have been followed up. The technique adopted is described. The results show the importance of early correction of the malformation and allow the indication to be extended to purely aesthetic needs.
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